Citius Pharmaceuticals Receives FDA Approval for LYMPHIR™ (denileukin diftitox-cxdl) Immunotherapy for the Treatment of Adults with Relapsed or Refractory Cutaneous T-Cell Lymphoma
Citius Pharmaceuticals (NASDAQ: CTXR) has received FDA approval for LYMPHIR™ (denileukin diftitox-cxdl), a novel immunotherapy for treating relapsed or refractory cutaneous T-cell lymphoma (CTCL) in adults. LYMPHIR is the first systemic treatment for r/r CTCL targeting the IL-2 receptor on malignant T-cells and Tregs, and the first FDA-approved product for Citius Pharma.
Key highlights:
- Expected market launch within 5 months
- First novel targeted systemic therapy approved for r/r CTCL since 2018
- Phase 3 study showed 36% Objective Response Rate
- Reduction in skin disease in 84% of patients
- Estimated market size: $300-$400 million
Citius Pharmaceuticals (NASDAQ: CTXR) ha ricevuto l'approvazione della FDA per LYMPHIR™ (denileukin diftitox-cxdl), una nuova immunoterapia per il trattamento del linfoma cutaneo a cellule T (CTCL) recidivante o refrattario negli adulti. LYMPHIR è il primo trattamento sistemico per il CTCL r/r che mira al recettore IL-2 sulle cellule T maligne e sui Tregs, ed è il primo prodotto approvato dalla FDA per Citius Pharma.
Principali punti salienti:
- Lancio sul mercato previsto entro 5 mesi
- Prima terapia sistemica mirata e innovativa approvata per r/r CTCL dal 2018
- Lo studio di Fase 3 ha mostrato un tasso di risposta obiettiva del 36%
- Riduzione della malattia cutanea nell'84% dei pazienti
- Dimensione di mercato stimata: 300-400 milioni di dollari
Citius Pharmaceuticals (NASDAQ: CTXR) ha recibido la aprobación de la FDA para LYMPHIR™ (denileukin diftitox-cxdl), una nueva inmunoterapia para el tratamiento del linfoma cutáneo de células T (CTCL) en adultos, con recaídas o refractario. LYMPHIR es el primer tratamiento sistémico para el CTCL r/r que dirige el receptor IL-2 en las células T malignas y Tregs, y es el primer producto aprobado por la FDA para Citius Pharma.
Puntos destacados:
- Lanzamiento esperado en el mercado dentro de 5 meses
- Primera terapia sistémica dirigida e innovadora aprobada para el r/r CTCL desde 2018
- El estudio de Fase 3 mostró una tasa de respuesta objetiva del 36%
- Reducción de la enfermedad cutánea en el 84% de los pacientes
- Tamaño de mercado estimado: 300-400 millones de dólares
Citius Pharmaceuticals (NASDAQ: CTXR)는 성인에서 재발성 또는 난치성 피부 T-세포 림프종(CTCL) 치료를 위한 새로운 면역 요법인 LYMPHIR™ (denileukin diftitox-cxdl)의 FDA 승인을 받았습니다. LYMPHIR는 악성 T-세포와 Treg의 IL-2 수용체를 표적으로 하는 r/r CTCL을 위한 첫 번째 전신 치료제이며, Citius Pharma를 위한 최초의 FDA 승인 제품입니다.
주요 사항:
- 5개월 이내 시장 출시 예정
- 2018년 이후 r/r CTCL에 대한 첫 번째 새로운 표적 전신 요법 승인
- 3상 연구에서 36%의 객관적 반응률을 보임
- 84%의 환자에서 피부 질환 감소
- 추정 시장 규모: 3억-4억 달러
Citius Pharmaceuticals (NASDAQ: CTXR) a reçu l'approbation de la FDA pour LYMPHIR™ (denileukin diftitox-cxdl), une nouvelle immunothérapie pour le traitement du lymphome cutané à cellules T (CTCL) récidivant ou réfractaire chez les adultes. LYMPHIR est le premier traitement systémique pour le CTCL r/r ciblant le récepteur IL-2 sur les cellules T malignes et les Tregs, et c'est le premier produit approuvé par la FDA pour Citius Pharma.
Points clés :
- Lancement sur le marché prévu dans 5 mois
- Première thérapie systémique ciblée et novatrice approuvée pour le CTCL r/r depuis 2018
- Une étude de phase 3 a montré un taux de réponse objectif de 36%
- Réduction de la maladie cutanée chez 84% des patients
- Taille du marché estimée : 300-400 millions de dollars
Citius Pharmaceuticals (NASDAQ: CTXR) hat die FDA-Zulassung für LYMPHIR™ (denileukin diftitox-cxdl) erhalten, eine neuartige Immuntherapie zur Behandlung von rezidivierenden oder refraktären kutanen T-Zell-Lymphomen (CTCL) bei Erwachsenen. LYMPHIR ist die erste systemische Behandlung für r/r CTCL, die den IL-2-Rezeptor auf malignen T-Zellen und Tregs anspricht und das erste von der FDA genehmigte Produkt von Citius Pharma.
Wichtige Highlights:
- Markteinführung innerhalb von 5 Monaten erwartet
- Erste neuartige zielgerichtete systemische Therapie, die seit 2018 für r/r CTCL genehmigt wurde
- Die Phase-3-Studie zeigte eine objektive Ansprechrate von 36%
- 84% der Patienten zeigten eine Reduktion der Hautkrankheit
- Geschätzte Marktgröße: 300-400 Millionen Dollar
- FDA approval of LYMPHIR for r/r CTCL treatment
- First FDA-approved product for Citius Pharmaceuticals
- Unique IL-2 receptor-targeted treatment with no cumulative toxicity
- 36.2% Objective Response Rate in Phase 3 study
- 84.4% of patients showed decrease in skin tumor burden
- Rapid median time to response of 1.41 months
- Estimated market size of $300-$400 million
- Boxed warning for Capillary Leak Syndrome (CLS) risk
- Postmarketing requirement to assess visual impairment risk
- Common adverse reactions include increased transaminases, decreased albumin, and nausea
Insights
The FDA approval of LYMPHIR for r/r CTCL is a significant breakthrough in the treatment landscape. As the first novel targeted systemic therapy approved since 2018, it offers a unique mechanism targeting the IL-2 receptor on malignant T-cells and Tregs. The 36% ORR and 84% reduction in skin disease are impressive outcomes for this difficult-to-treat population.
The rapid median time-to-response of 1.4 months is particularly noteworthy, as it can provide quick relief for patients suffering from debilitating skin lesions. The lack of cumulative toxicity also allows for potentially longer treatment duration. However, the boxed warning for Capillary Leak Syndrome (CLS) requires careful monitoring and may limit its use in certain patients.
Citius Pharmaceuticals' first FDA-approved product marks a pivotal moment for the company. With LYMPHIR targeting a market estimated at
Investors should note that as the only IL-2 receptor-targeted immunotherapy for CTCL, LYMPHIR could capture a substantial market share. However, the rare disease focus means a smaller patient pool, with only 2,500-3,000 new diagnoses annually. The company's ability to effectively commercialize and navigate potential safety concerns will be important for financial success. Watch for upcoming quarterly reports to gauge initial sales performance and market penetration.
LYMPHIR's approval could reshape the CTCL treatment landscape. Its unique mechanism and efficacy profile position it as a strong competitor in the r/r CTCL market. The rapid response time and pruritus improvement address key patient needs, potentially driving adoption.
However, market success will depend on several factors:
- Pricing strategy in the context of existing treatments
- Physician education and adoption rates
- Patient access and reimbursement landscape
- Management of safety concerns, particularly CLS
The postmarketing requirement to study visual impairment risk could impact long-term market positioning. Overall, LYMPHIR has the potential to expand the CTCL market, but its ultimate market share will depend on real-world performance and competitive dynamics.
- Only systemic treatment for relapsed or refractory (r/r) CTCL to target the IL-2 receptor on malignant T-cells and Tregs
- LYMPHIR is expected to launch within the next five months
- LYMPHIR's approval marks the first novel targeted systemic therapy approved by the FDA r/r CTCL since 2018
- Approval based on Phase 3 Pivotal Study 302 results that demonstrated
36% ORR, reduction in skin disease in84% of patients, clinically significant pruritis improvement, and no cumulative toxicity
"LYMPHIR offers new hope for patients suffering from cutaneous T-cell lymphoma, a rare and chronic cancer characterized by debilitating skin lesions and severe itching. This approval is a significant milestone for CTCL patients. The introduction of LYMPHIR, with its potential to rapidly reduce skin disease and control symptomatic itching without cumulative toxicity, is expected to expand the CTCL treatment landscape and grow the overall market, currently estimated to be
"LYMPHIR, with an initial indication in the treatment of CTCL, is the first of our pipeline candidates to receive FDA approval. Citius is dedicated to working closely with healthcare providers to ensure that all r/r CTCL patients have timely access to this important new therapy. We are preparing to launch LYMPHIR in the U.S. market within the next five months," added Mazur.
"We are grateful to the clinicians, patients, and researchers who contributed to the development of LYMPHIR. We believe LYMPHIR's unique IL-2 receptor-targeted treatment, which kills tumor cells directly, and concurrently depletes host Tregs in order to boost the body's immune response, is an important differentiator and offers clinically meaningful benefits to a significant percentage of r/r patients. As the only IL-2 receptor-targeted immunotherapy for CTCL, LYMPHIR provides a novel and non-cross-resistant treatment option without cumulative toxicity for Stage I-III r/r patients for whom symptomatic skin involvement interferes with their daily quality of life. LYMPHIR's median time-to-response of only 1.4 months (min, max: 0.7, 5.6) offers many patients rapid skin relief," added Dr. Myron Czuczman, Chief Medical Officer of Citius Pharmaceuticals.
CTCL is a rare and often debilitating chronic non-Hodgkin lymphoma that primarily affects the skin. Approximately 2,500-3,000 patients are diagnosed each year with an estimated 40,000 living with the disease. Patients with r/r CTCL have limited treatment options. No universally defined single treatment is used to treat these patients with incurable cancer. Patients typically cycle through several skin-directed therapies before the cancer becomes resistant and/or progressive at which point systemic agents are needed to achieve effective disease control. Reducing and controlling skin plaques and itching without cumulative toxicity is a primary goal of CTCL treatment. Systemic medicines are prescribed until the disease progresses again or when dose-limiting toxicity occurs, after which HCPs prescribe a different systemic medicine. LYMPHIR provides another viable option in the treatment landscape with unique benefits to patients. It offers a novel mechanism of action designed to target and eradicate malignant T-cells while preserving healthy tissue. It is the only treatment option that targets the IL-2 receptors found in T-cell lymphomas and Tregs.
"As a treating oncologist, I have seen the profound negative effect on the quality of life in patients with r/r CTCL. Given the long-term nature of the disease, pruritus, ulceration of the tumors, and secondary pyogenic skin infection, it is vital to get this skin involvement under control. LYMPHIR is the first therapeutic option in many years to offer hope of reducing skin disease, bringing us one step closer to filling the need for CTCL patients, particularly those that are not able to complete or continue prior therapies," stated Dr. Francine Foss, Professor of Hematology and Director of the Multidisciplinary T-cell Lymphoma Program at Yale Cancer Center,
The approval of LYMPHIR is based on results from the Phase 3 Pivotal Study 302 (NCT01871727) of CTCL patients who had previously received at least one systemic treatment. Actual study patients received a median of 4 (min, max: 1, 18) prior anticancer therapies. The primary efficacy population includes 69 patients with stage I-III CTCL who were treated with denileukin diftitox-cxdl (9 μg /kg/day). The primary efficacy outcome measure was Objective Response Rate (ORR), as assessed by an Independent Review Committee (IRC). The ORR was
The median time to response was rapid at 1.41 months, with the majority of responders (~
LYMPHIR's safety profile is consistent with the known safety profile for denileukin diftitox. Across three studies of 119 CTCL patients receiving 9 μg dose of denileukin diftitox, the most common (≥
The
This approval includes a postmarketing requirement from the FDA to characterize the risk of visual impairment in CTCL patients treated with LYMPHIR. Citius is committed to the safety of patients and will continue to monitor all safety data as it emerges.
About Study 302
The efficacy of LYMPHIR was evaluated in Study 302, an open-label, single-arm, multicenter trial in patients with r/r Stage I to IV CTCL. Eligible patients were required to have expression of CD25 on ≥
The efficacy population includes 69 patients with r/r Stage I to III CTCL. Of the 69 patients, the median age was 64 years (range: 28 to 87 years),
Efficacy was established based on ORR, according to ISCL/EORTC Global Response Score (GRS) per Independent Review Committee (Olsen 2011). Efficacy results are shown in the table below.
Table: Efficacy Results of Study 302 | |
Efficacy Endpoint | LYMPHIR 9 mcg/kg/day (N=69) |
ORR (GRS)%a ( | (25, 49) |
Complete Response | 9 % |
Partial Response | 27 % |
Duration of Responsec Range, months Duration ≥ 6 months, n (%) Duration ≥ 12 months, n (%) |
3.0+, 23.5+ 13 ( 5 ( |
a ORR, objective response rate per Olsen, et al (2011) Global Response Score (GRS), by |
b CI, confidence interval |
c The median ( |
Median time to response was 1.4 months (range: 0.7 to 5.6 months). |
Among responders, the median follow-up for duration of response was 6.5 months (range: 3.5+, |
About LYMPHIR™ (denileukin diftitox-cxdl)
LYMPHIR is a targeted immune therapy for r/r (R/R) CTCL indicated for use in Stage I-III disease after at least one prior systemic therapy. It is a recombinant fusion protein that combines the IL-2 receptor binding domain with diphtheria toxin fragments. The agent specifically binds to IL-2 receptors on the cell surface, causing diphtheria toxin fragments that have entered cells to inhibit protein synthesis. After uptake into the cell, the DT fragment is cleaved and the free DT fragments inhibit protein synthesis, resulting in cell death. Denileukin diftitox-cxdl demonstrated the ability to deplete immunosuppressive regulatory T lymphocytes (Tregs) and antitumor activity through a direct cytocidal action on IL-2R-expressing tumors.
In 2021, denileukin diftitox received regulatory approval in
About Cutaneous T-cell Lymphoma
Cutaneous T-cell lymphoma is a type of cutaneous non-Hodgkin lymphoma (NHL) that comes in a variety of forms and is the most common type of cutaneous lymphoma. In CTCL, T-cells, a type of lymphocyte that plays a role in the immune system, become cancerous and develop into skin lesions, leading to a decrease in the quality of life of patients with this disease due to severe pain and pruritus. Mycosis Fungoides (MF) and Sézary Syndrome (SS) comprise the majority of CTCL cases. Depending on the type of CTCL, the disease may progress slowly and can take anywhere from several years to upwards of ten to potentially reach tumor stage. However, once the disease reaches this stage, the cancer is highly malignant and can spread to the lymph nodes and internal organs, resulting in a poor prognosis. Given the duration of the disease, patients typically cycle through multiple agents to control disease progression. CTCL affects men twice as often as women and is typically first diagnosed in patients between the ages of 50 and 60 years of age. Other than allogeneic stem cell transplantation, for which only a small fraction of patients qualify, there is currently no curative therapy for advanced CTCL.
INDICATION
LYMPHIR is an IL2-receptor-directed cytotoxin indicated for the treatment of adult patients with r/r Stage I-III cutaneous T-cell lymphoma (CTCL) after at least one prior systemic therapy.
IMPORTANT SAFETY INFORMATION
BOXED WARNING: CAPILLARY LEAK SYNDROME
Capillary leak syndrome (CLS), including life-threatening or fatal reactions, can occur in patients receiving LYMPHIR. Monitor patients for signs and symptoms of CLS during treatment. Withhold LYMPHIR until CLS resolves, or permanently discontinue based on severity.
WARNINGS AND PRECAUTIONS
Capillary Leak Syndrome
LYMPHIR can cause capillary leak syndrome (CLS), including life-threatening or fatal reactions. CLS was defined in the clinical trials as the occurrence of at least 2 of the following symptoms at any time during LYMPHIR therapy: hypotension, edema, and serum albumin <3 g/dL. These symptoms were not required to occur simultaneously to be characterized as capillary leak syndrome.
As defined, CLS occurred in
Regularly assess patients for weight gain, new onset or worsening of edema, dyspnea, and hypotension (including orthostatic changes). Monitor serum albumin levels prior to the initiation of each cycle of therapy and more often as clinically indicated.
Withhold, reduce dose, or permanently discontinue based on severity. If LYMPHIR is withheld, resume LYMPHIR following resolution of CLS and when serum albumin is greater than or equal to 3 g/dL.
Visual Impairment
LYMPHIR can cause serious visual impairment, including changes in visual acuity and color vision. In the pooled population across 3 clinical trials, visual impairment occurred in
Perform baseline ophthalmic examination and monitor as clinically indicated. If patients experience symptoms of visual impairment, such as changes in visual acuity, changes in color vision, or blurred vision, refer for ophthalmologic evaluation.
Withhold LYMPHIR until visual impairment resolves or permanently discontinue based on severity.
Infusion-Related Reactions
LYMPHIR can cause serious infusion-related reactions. Infusion-related reactions were reported in
Premedicate patients for the first three cycles prior to starting a LYMPHIR infusion [see Dosage and Administration (2.3)]. Monitor patients frequently during infusion. For Grade 2 or higher infusion reactions, premedicate at least 30 minutes prior to each subsequent infusion with a systemic steroid for at least 3 cycles.
Interrupt or discontinue LYMPHIR based on severity [see Dosage and Administration (2.4)]. Institute appropriate medical management.
Hepatotoxicity
LYMPHIR can cause hepatotoxicity. In the pooled safety population, elevated ALT occurred in
Monitor liver enzymes and bilirubin at baseline and during treatment as clinically indicated. Withhold, reduce dose, or permanently discontinue LYMPHIR based on severity.
Embryo-Fetal Toxicity
Based on its mechanism of action, LYMPHIR can cause fetal harm when administered to a pregnant woman. Verify the pregnancy status of females of reproductive potential prior to the initiation of LYMPHIR. Advise pregnant women of the potential risk to the fetus. Advise females of reproductive potential to use effective contraception during treatment and for 7 days following the last dose of LYMPHIR.
ADVERSE REACTIONS
The most common adverse reactions (≥
USE IN SPECIFIC POPULATIONS
Pregnancy
Risk Summary
Based on its mechanism of action, LYMPHIR can cause fetal harm when administered to a pregnant woman. There are no available data on the use of LYMPHIR in pregnant women to evaluate for a drug-associated risk. No animal reproductive and developmental toxicity studies have been conducted with denileukin diftitox.
Denileukin diftitox-cxdl causes depletion of regulatory T lymphocytes (Treg), immune activation, and capillary leak syndrome, compromising pregnancy maintenance. Advise pregnant women of the potential risk to a fetus.
In the
Lactation
Risk Summary
No data are available regarding the presence of denileukin diftitox-cxdl in human milk, the effects on the breastfed child, or on milk production. Because of the potential for serious adverse reactions in breastfed children, advise women not to breastfeed during treatment with LYMPHIR and for 7 days after the last dose.
Females and Males of Reproductive Potential
Based on its mechanism of action, LYMPHIR can cause fetal harm when administered to a pregnant woman.
Pregnancy Testing
Verify the pregnancy status of females of reproductive potential prior to initiating LYMPHIR.
Contraception
Females
Advise females of reproductive potential to use effective contraception during treatment with LYMPHIR and for 7 days after the last dose.
Infertility
Males
Based on findings in rats, male fertility may be compromised by treatment with. The reversibility of the effect on fertility is unknown.
Pediatric Use
Safety and effectiveness of LYMPHIR in pediatric patients have not been established.
Geriatric Use
Of the 69 patients with Stage I-III r/r CTCL who received LYMPHIR, 34 patients (
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Citius Pharmaceuticals at 1-844-459-6744.
Please read Important Safety Information and full Prescribing Information, including Boxed WARNING, for LYMPHIR™ which will be available in the next few days
About Citius Pharmaceuticals, Inc.
Citius Pharmaceuticals, Inc. is a biopharmaceutical company dedicated to the development and commercialization of first-in-class critical care products. In August 2024, the FDA approved LYMPHIR, a targeted immunotherapy for an initial indication in the treatment of cutaneous T-cell lymphoma. Citius Pharma's late-stage pipeline also includes Mino-Lok®, an antibiotic lock solution to salvage catheters in patients with catheter-related bloodstream infections, and CITI-002 (Halo-Lido), a topical formulation for the relief of hemorrhoids. A Pivotal Phase 3 Trial for Mino-Lok and a Phase 2b trial for Halo-Lido were completed in 2023. Mino-Lok met primary and secondary endpoints of its Phase 3 Trial. Citius is actively engaged with the FDA to outline next steps for both programs. For more information, please visit www.citiuspharma.com.
Forward-Looking Statements
This press release may contain "forward-looking statements" within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. Such statements are made based on our expectations and beliefs concerning future events impacting Citius. You can identify these statements by the fact that they use words such as "will," "anticipate," "estimate," "expect," "plan," "should," and "may" and other words and terms of similar meaning or use of future dates. Forward-looking statements are based on management's current expectations and are subject to risks and uncertainties that could negatively affect our business, operating results, financial condition and stock price. Factors that could cause actual results to differ materially from those currently anticipated are: our ability to commercialize LYMPHIR and any of our other product candidates that may be approved by the FDA; the estimated markets for our product candidates and the acceptance thereof by any market; the ability of our product candidates to impact the quality of life of our target patient populations; the planned transaction between TenX Keane Acquisition and Citius Pharma to form Citius Oncology, Inc. may not be completed for failure to meet closing conditions or other reasons; our need for substantial additional funds; risks relating to the results of research and development activities, including those from our existing and any new pipeline assets; our dependence on third-party suppliers; our ability to procure cGMP commercial-scale supply; our ability to obtain, perform under and maintain financing and strategic agreements and relationships; uncertainties relating to preclinical and clinical testing; the early stage of products under development; market and other conditions; risks related to our growth strategy; patent and intellectual property matters; our ability to identify, acquire, close and integrate product candidates and companies successfully and on a timely basis; government regulation; competition; as well as other risks described in our SEC filings. These risks have been and may be further impacted by Covid-19 and could be impacted by any future public health risks. Accordingly, these forward-looking statements do not constitute guarantees of future performance, and you are cautioned not to place undue reliance on these forward-looking statements. Risks regarding our business are described in detail in our Securities and Exchange Commission ("SEC") filings which are available on the SEC's website at www.sec.gov, including in our Annual Report on Form 10-K for the year ended September 30, 2023, filed with the SEC on December 29, 2023, and updated by our subsequent filings with the Securities and Exchange Commission. These forward-looking statements speak only as of the date hereof, and we expressly disclaim any obligation or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein to reflect any change in our expectations or any changes in events, conditions or circumstances on which any such statement is based, except as required by law.
Investor Relations for Citius Pharmaceuticals:
Investor Contact:
Ilanit Allen
ir@citiuspharma.com
908-967-6677 x113
Media Contact:
STiR-communications
Greg Salsburg
Greg@STiR-communications.com
View original content to download multimedia:https://www.prnewswire.com/news-releases/citius-pharmaceuticals-receives-fda-approval-for-lymphir-denileukin-diftitox-cxdl-immunotherapy-for-the-treatment-of-adults-with-relapsed-or-refractory-cutaneous-t-cell-lymphoma-302217630.html
SOURCE Citius Pharmaceuticals, Inc.
FAQ
What is LYMPHIR and what has the FDA approved it for?
When is Citius Pharmaceuticals (CTXR) planning to launch LYMPHIR?
What were the key results from LYMPHIR's Phase 3 study?
What is the estimated market size for CTCL treatments that LYMPHIR is entering?