The US Food and Drug Administration (FDA) has approved Janssen Biotech Inc's Yondelis (trabectedin) for the treatment of patients with unresectable (unable to be removed with surgery) or metastatic liposarcoma (LPS) or leiomyosarcoma (LMS) who received a prior anthracycline-containing regimen.

The approval was based on recently published clinical efficacy and safety data from the phase 3, randomized, open-label, controlled study (ET743-SAR-3007), which evaluated Yondelis versus the chemotherapy agent dacarbazine, in patients with unresectable or metastatic LPS or LMS previously treated with an anthracycline and at least one additional chemotherapy regimen.

While approved for both LPS and LMS, Yondelis is the first treatment to be specifically approved for LPS in the US.

"Our academic teams are dedicated to finding new treatments with scientific merit and the promise to improve outcomes for patients with sarcomas. Today's announcement marks a meaningful event built upon years of research, offering new hope for people living with two of the most prevalent subtypes of this serious disease - liposarcoma and leiomyosarcoma - where there are limited available alternatives," said George D. Demetri, M.D., director of the Ludwig Center at Harvard and director of the Center for Sarcoma and Bone Oncology at the Dana-Farber Cancer Institute, and principal investigator of the phase 3 registration trial.

"In the clinical trial, Yondelis significantly increased progression free survival compared to dacarbazine; this is an important endpoint for these patients, in whom rapid worsening of the disease can lead to worse symptoms and life-threatening situations."

The pivotal phase 3 study enrolled over 500 patients and demonstrated an improvement in progression free survival (PFS) for patients treated with Yondelis. The median PFS among the YONDELIS treatment group was 4.2 months (n=345; 95 per cent confidence interval (CI): 3.0 - 4.8 months), while the median PFS in the dacarbazine treatment group was 1.5 months (n=173; 95 per cent CI: 1.5 - 2.6 months), representing a 45 per cent reduction in the risk of disease progression or death with Yondelis (HR=0.55; 95 per cent CI: 0.44 - 0.70; p<0.001). The final analysis of overall survival (OS) demonstrated a median OS of 13.7 months for the Yondelis arm and 13.1 months in dacarbazine arm, which was not significant (HR=0.93; 95 per cent CI: 0.75, 1.15; p=0.49).

LPS and LMS are subtypes of soft tissue sarcoma (STS) and represent more than 35 per cent of all STS cases. LMS is an aggressive type of STS where smooth muscle cells become cancerous. LMS typically occurs in the uterus, abdominal cavity or blood vessels but can also arise in any part of the body. LPS is comprised of several subtypes and develops in fat cells that become cancerous in any part of the body.

Since Yondelis was first approved in Europe in 2007, approximately 50,000 patients in close to 80 countries have benefited from this therapy across all indications. "The US approval for Yondelis exemplifies our commitment to improving the health of people living with cancer and addressing unmet needs," said Roland Knoblauch, M.D., Ph.D., clinical leader, Yondelis, Janssen Research & Development, LLC. "We are proud that our phase 3 study is the largest ever conducted in this patient population and we're delighted that patients in the US can now benefit from the treatment."

The safety profile of Yondelis in the phase 3 study was consistent with previous clinical studies. The most serious risks associated with Yondelis are neutropenic sepsis (severe infections due to decreased white blood cells), rhabdomyolysis (severe muscle problems), cardiomyopathy (heart muscle problems, including heart failure), hepatotoxicity (liver problems, including liver failure), anaphylaxis, and extravasation (leakage of Yondelis out of the vein during infusion) leading to tissue necrosis (tissue cell damage or death) and embryofetal toxicity. Among the 378 patients who received at least one dose of Yondelis in the randomized trial, the most common (=20 per cent) adverse reactions were nausea (75 per cent), fatigue (69 per cent), vomiting (46 per cent), constipation (37 per cent), decreased appetite (37 per cent), diarrhea (35 per cent), peripheral edema (28 per cent), dyspnea (25 per cent) and headache (25 per cent). The most common (=5per cent) Grade 3-4 laboratory abnormalities were neutropenia (43per cent), increased alanine transaminase (ALT) (31 per cent), thrombocytopenia (21 per cent), anemia (19 per cent), increased aspartate aminotransferase (AST) (17 per cent) and increased creatine phosphokinase (6.4 per cent).

The recommended dose of Yondelis is 1.5 mg/m2 administered as an intravenous infusion over 24 hours through a central venous line every 21 days (3 weeks) until disease progression or unacceptable toxicity in patients with normal bilirubin and AST or ALT, less than or equal to 2.5 times the upper limit of normal.