Lilly's Retevmo® (selpercatinib) Phase 3 Results in RET Fusion-Positive Non-Small Cell Lung Cancer and RET-Mutant Medullary Thyroid Cancer Both Published in The New England Journal of Medicine and Presented in a Presidential Symposium at ESMO Congress 2023
- Retevmo more than doubled progression-free survival (PFS) compared to chemotherapy plus pembrolizumab in patients with RET fusion-positive non-small cell lung cancer (NSCLC)
- Retevmo provided a 72% improvement in PFS compared to cabozantinib or vandetanib in patients with RET-mutant medullary thyroid cancer (MTC)
- Retevmo demonstrated superior PFS with an HR of 0.482 and an increase of more than 13 months in median PFS in NSCLC patients
- Retevmo showed a significant improvement in treatment failure-free survival (TFFS) in patients with RET-mutant MTC
- Overall response rate (ORR) with Retevmo was 83.7% in NSCLC patients and 69.4% in MTC patients
- None.
- In the Phase 3 LIBRETTO-431 study, Retevmo more than doubled progression-free survival (PFS) compared to chemotherapy plus pembrolizumab in patients with advanced or metastatic rearranged during transfection (RET) fusion-positive non-small cell lung cancer (NSCLC)
- In the Phase 3 LIBRETTO-531 study, Retevmo provided a
"These results from LIBRETTO-431 and LIBRETTO-531 are striking and provide critical evidence supporting the importance of optimizing initial therapy for patients with RET-driven cancers," said David Hyman, M.D., chief medical officer, Lilly. "We are excited to be sharing these data with the clinical community in both NEJM and at ESMO. It is our hope that these data lead to further adoption of biomarker testing in the initial treatment journey for people with NSCLC and MTC and help make Retevmo a standard initial treatment option for all appropriate patients."
The labeling for Retevmo contains warnings and precautions for hepatotoxicity (evidence of liver dysfunction), interstitial lung disease (ILD)/pneumonitis, hypertension, QT interval prolongation, hemorrhagic events, hypersensitivity, tumor lysis syndrome, risk of impaired wound healing, hypothyroidism, and embryo-fetal toxicity.
RET Fusion-Positive NSCLC: Data from LIBRETTO-431
LIBRETTO-431 is a Phase 3, randomized, open-label trial that evaluated Retevmo in patients with advanced or metastatic, treatment-naïve RET fusion-positive NSCLC. In the study, patients were randomly assigned to receive Retevmo, or pemetrexed and the investigator's choice of platinum-based chemotherapy (cisplatin or carboplatin) with or without pembrolizumab — which is a current first-line standard of care treatment option. LIBRETTO-431 is the first randomized trial that compared the safety and effectiveness of a targeted therapy to a PD-1 inhibitor plus chemotherapy in a biomarker-selected NSCLC patient population. The primary endpoint was tested first in patients stratified by intent-to-treat (ITT) with pembrolizumab if assigned to the control arm (ITT-pembrolizumab), then tested in the ITT population if deemed positive.
"These data provide clear evidence that Retevmo offers highly meaningful clinical impact for patients diagnosed with RET fusion-positive NSCLC and it should be considered as the first treatment option for these patients," said Caicun Zhou, M.D., Ph.D., director and professor at the Cancer Institute of Tongji University School of Medicine and Shanghai Pulmonary Hospital, and LIBRETTO-431 primary investigator. "While there is often urgency to treat, these results further highlight the importance of incorporating routine biomarker testing into a patient's care plan to direct early clinical decision-making towards the most effective therapies."
A total of 256 patients received at least one dose of study treatment (Retevmo, 158; control arm, 98). Of the 261 patients in the ITT population, 159 were randomly assigned to Retevmo and 102 to the control arm. Of the 212 patients in the ITT-pembrolizumab population, 129 were randomly assigned to Retevmo and 83 to pembrolizumab with chemotherapy. Patients randomized to the control arm who had disease progression confirmed by blinded independent central review (BICR) were eligible for optional crossover to Retevmo.
In the ITT-pembrolizumab population, the median PFS by BICR was 24.8 months (
Intracranial baseline assessments were available for evaluation by neuroradiologic BICR for 192 patients in the central nervous system (CNS)-pembrolizumab population (Retevmo, 120; control arm, 72). Time to CNS progression was longer with Retevmo than in the control arm (cause-specific HR: 0.28;
RET-Mutant MTC: Data from LIBRETTO-531
LIBRETTO-531 is a Phase 3, randomized, open-label trial that evaluated Retevmo versus physician's choice of MKIs cabozantinib or vandetanib, which are currently approved first-line options for patients with advanced or metastatic, kinase inhibitor-naïve RET-mutant MTC. It is the first randomized trial that compared the safety and effectiveness of a highly selective RET-kinase inhibitor versus MKIs in this population.
"The magnitude of benefit observed in patients treated with Retevmo makes clear that it should become the standard of care for the initial systemic treatment of patients with progressive advanced RET-mutant MTC," said Julien Hadoux, M.D., Ph.D., medical oncologist at the Gustave Roussy Cancer Center and LIBRETTO-531 investigator. "These data should prove to be practice-changing for clinicians caring for patients with MTC and lead to routine biomarker testing."
A total of 291 patients with progressive RET-mutant MTC and no prior history of MKI therapy for advanced or metastatic disease were randomized in the study. One hundred and ninety-three patients were randomized to the Retevmo arm and 98 to the control arm to receive investigator's choice of cabozantinib (73) or vandetanib (25). Patients randomized to the control arm who experienced disease progression confirmed by BICR were eligible to cross over to Retevmo.
At the interim analysis, the study had met the criteria for positive PFS. At a median follow-up of approximately 12 months, the BICR-assessed median PFS in the Retevmo arm was not reached and remained inestimable (
Treatment with Retevmo resulted in a significant improvement in treatment failure-free survival (TFFS) with an HR of 0.254 (
The safety profile observed for Retevmo in both studies was generally consistent with those identified across the previously reported Retevmo development program (LIBRETTO-001, LIBRETTO-121, LIBRETTO-321).
About RET-Driven Cancers
Genomic alterations in the RET kinase, which include fusions and activating point mutations, lead to overactive RET signaling and uncontrolled cell growth. RET fusions have been identified in approximately
MTC accounts for
About LIBRETTO-431
LIBRETTO-431 is a randomized Phase 3 clinical trial of patients with advanced or metastatic, treatment-naïve RET fusion-positive NSCLC. The trial enrolled 261 patients with advanced or metastatic RET fusion-positive NSCLC who had received no prior systemic therapy for metastatic disease. Enrolled trial participants were randomized 2:1 to receive either selpercatinib or platinum-based chemotherapy (carboplatin or cisplatin) and pemetrexed therapy with or without pembrolizumab as initial treatment of their advanced or metastatic RET fusion-positive NSCLC. RET fusions may be identified using local testing. This trial's primary endpoint is PFS, and secondary endpoints include OS, ORR, duration of response (DOR), and intracranial ORR. For patients randomized to the control arm, crossover was allowed at progression.
About LIBRETTO-531
LIBRETTO-531 is a randomized Phase 3 clinical trial of patients with progressive, advanced or metastatic, kinase inhibitor-naïve RET-mutant MTC. The trial enrolled 291 patients, and participants were randomized 2:1 to receive either selpercatinib or physician's choice of cabozantinib or vandetanib as initial treatment of their advanced or metastatic RET-mutant MTC. RET mutations may be identified using local testing. This trial's primary endpoint is PFS, and secondary endpoints include TFFS, ORR, DOR, and OS. For patients randomized to the control arm, crossover was allowed at progression.
About Retevmo® (selpercatinib, 40 mg & 80 mg capsules)
Retevmo (selpercatinib, formerly known as LOXO-292) (pronounced reh-TEHV-moh) is a highly selective and potent RET kinase inhibitor with central nervous system (CNS) activity. Retevmo may affect both tumor cells and healthy cells, which can result in side effects. RET-driver alterations are predominantly mutually exclusive from other oncogenic drivers. Retevmo is a
INDICATIONS FOR RETEVMO®
Retevmo® is a kinase inhibitor indicated for the treatment of:
- Adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with a rearranged during transfection (RET) gene fusion, as detected by an FDA-approved test.
- Adult and pediatric patients 12 years of age and older with advanced or metastatic medullary thyroid cancer (MTC) with a RET mutation, as detected by an FDA-approved test, who require systemic therapy.1
- Adult and pediatric patients 12 years of age and older with advanced or metastatic thyroid cancer with a RET gene fusion, as detected by an FDA-approved test, who require systemic therapy and who are radioactive iodine-refractory (if radioactive iodine is appropriate).1
- Adult patients with locally advanced or metastatic solid tumors with a RET gene fusion that have progressed on or following prior systemic treatment or who have no satisfactory alternative treatment options. 1
1 This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trial(s).
IMPORTANT SAFETY INFORMATION FOR RETEVMO® (selpercatinib)
Hepatotoxicity: Serious hepatic adverse reactions occurred in
Severe, life-threatening, and fatal interstitial lung disease (ILD)/pneumonitis can occur in patients treated with Retevmo. ILD/pneumonitis occurred in
Hypertension occurred in
Retevmo can cause concentration-dependent QT interval prolongation. An increase in QTcF interval to >500 ms was measured in
Serious, including fatal, hemorrhagic events can occur with Retevmo. Grade ≥3 hemorrhagic events occurred in
Hypersensitivity occurred in
Tumor lysis syndrome (TLS) occurred in
Impaired wound healing can occur in patients who receive drugs that inhibit the vascular endothelial growth factor (VEGF) signaling pathway. Therefore, Retevmo has the potential to adversely affect wound healing. Withhold Retevmo for at least 7 days prior to elective surgery. Do not administer for at least 2 weeks following major surgery and until adequate wound healing. The safety of resumption of Retevmo after resolution of wound healing complications has not been established.
Retevmo can cause hypothyroidism. Hypothyroidism occurred in
Based on data from animal reproduction studies and its mechanism of action, Retevmo can cause fetal harm when administered to a pregnant woman. Administration of selpercatinib to pregnant rats during organogenesis at maternal exposures that were approximately equal to those observed at the recommended human dose of 160 mg twice daily resulted in embryolethality and malformations. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential and males with female partners of reproductive potential to use effective contraception during treatment with Retevmo and for 1 week after the last dose. There are no data on the presence of selpercatinib or its metabolites in human milk or on their 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 Retevmo and for 1 week after the last dose.
Severe adverse reactions (Grade 3-4) occurring in ≥
Serious adverse reactions occurred in
Fatal adverse reactions occurred in
Common adverse reactions (all grades) occurring in ≥
Laboratory abnormalities (all grades ≥
Concomitant use of acid-reducing agents decreases selpercatinib plasma concentrations which may reduce Retevmo antitumor activity. Avoid concomitant use of proton-pump inhibitors (PPIs), histamine-2 (H2) receptor antagonists, and locally-acting antacids with Retevmo. If coadministration cannot be avoided, take Retevmo with food (with a PPI) or modify its administration time (with a H2 receptor antagonist or a locally-acting antacid).
Concomitant use of strong and moderate CYP3A inhibitors increases selpercatinib plasma concentrations which may increase the risk of Retevmo adverse reactions including QTc interval prolongation. Avoid concomitant use of strong and moderate CYP3A inhibitors with Retevmo. If concomitant use of a strong or moderate CYP3A inhibitor cannot be avoided, reduce the Retevmo dosage as recommended and monitor the QT interval with ECGs more frequently.
Concomitant use of strong and moderate CYP3A inducers decreases selpercatinib plasma concentrations which may reduce Retevmo anti-tumor activity. Avoid coadministration of Retevmo with strong and moderate CYP3A inducers.
Concomitant use of Retevmo with CYP2C8 and CYP3A substrates increases their plasma concentrations which may increase the risk of adverse reactions related to these substrates. Avoid coadministration of Retevmo with CYP2C8 and CYP3A substrates where minimal concentration changes may lead to increased adverse reactions. If coadministration cannot be avoided, follow recommendations for CYP2C8 and CYP3A substrates provided in their approved product labeling.
Retevmo is a P-glycoprotein (P-gp) inhibitor. Concomitant use of Retevmo with P-gp substrates increases their plasma concentrations, which may increase the risk of adverse reactions related to these substrates. Avoid coadministration of Retevmo with P-gp substrates where minimal concentration changes may lead to increased adverse reactions. If coadministration cannot be avoided, follow recommendations for P-gp substrates provided in their approved product labeling.
The safety and effectiveness of Retevmo have not been established in pediatric patients less than 12 years of age. The safety and effectiveness of Retevmo have been established in pediatric patients aged 12 years and older for medullary thyroid cancer (MTC) who require systemic therapy and for advanced RET fusion-positive thyroid cancer who require systemic therapy and are radioactive iodine-refractory (if radioactive iodine is appropriate). Use of Retevmo for these indications is supported by evidence from adequate and well-controlled studies in adults with additional pharmacokinetic and safety data in pediatric patients aged 12 years and older. Monitor open growth plates in adolescent patients. Consider interrupting or discontinuing Retevmo if abnormalities occur.
No dosage modification is recommended for patients with mild to severe renal impairment (estimated Glomerular Filtration Rate [eGFR] ≥15 to 89 mL/min, estimated by Modification of Diet in Renal Disease [MDRD] equation). A recommended dosage has not been established for patients with end-stage renal disease.
Reduce the dose when administering Retevmo to patients with severe hepatic impairment (total bilirubin greater than 3 to 10 times upper limit of normal [ULN] and any AST). No dosage modification is recommended for patients with mild or moderate hepatic impairment. Monitor for Retevmo-related adverse reactions in patients with hepatic impairment.
Please see full Prescribing Information for Retevmo.
SE HCP ISI All_21SEP22
About Lilly
Lilly unites caring with discovery to create medicines that make life better for people around the world. We've been pioneering life-changing discoveries for nearly 150 years, and today our medicines help more than 51 million people across the globe. Harnessing the power of biotechnology, chemistry and genetic medicine, our scientists are urgently advancing new discoveries to solve some of the world's most significant health challenges, redefining diabetes care, treating obesity and curtailing its most devastating long-term effects, advancing the fight against Alzheimer's disease, providing solutions to some of the most debilitating immune system disorders, and transforming the most difficult-to-treat cancers into manageable diseases. With each step toward a healthier world, we're motivated by one thing: making life better for millions more people. That includes delivering innovative clinical trials that reflect the diversity of our world and working to ensure our medicines are accessible and affordable. To learn more, visit Lilly.com and Lilly.com/news or follow us on Facebook, Instagram, Twitter and LinkedIn. P-LLY
Retevmo® is a registered trademark owned by or licensed to Eli Lilly and Company, its subsidiaries, or affiliates.
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Lilly Cautionary Statement Regarding Forward-Looking Statements
This press release contains forward-looking statements (as that term is defined in the Private Securities Litigation Reform Act of 1995) about Retevmo® (selpercatinib) as a potential treatment for people with locally advanced and metastatic RET fusion-positive NSCLC and RET-mutant MTC and reflects Lilly's current beliefs and expectations. However, as with any pharmaceutical product, there are substantial risks and uncertainties in the process of drug research, development and commercialization. Among other things, there is no guarantee that planned or ongoing studies will be completed as planned, that future study results will be consistent with study results to date, or that Retevmo will receive additional regulatory approvals, or that they will be commercially successful. For further discussion of these and other risks and uncertainties that could cause actual results to differ from Lilly's expectations, see Lilly's Form 10-K and Form 10-Q filings with the United States Securities and Exchange Commission. Except as required by law, Lilly undertakes no duty to update forward-looking statements to reflect events after the date of this release.
Refer to: | Kyle Owens; owens_kyle@lilly.com; (332) 259-3932 – media |
Joe Fletcher; jfletcher@lilly.com; (317) 296-2884 – investors |
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FAQ
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