- Trend towards improvement seen in primary PFS endpoint, does not
achieve significance
- A significant PFS improvement was achieved for patients with normal
LDH, a pre-specified exploratory analysis
- Mature survival data expected by end of 2009 or early 2010
Synta Pharmaceuticals Corp. (NASDAQ: SNTA), a biopharmaceutical company
focused on discovering, developing, and commercializing small molecule
drugs to treat severe medical conditions, today announced the
preliminary results of the Phase 3 SYMMETRYSM trial of
elesclomol in combination with paclitaxel in metastatic melanoma. The
results are the subject of an oral presentation by Steven O’Day, M.D.,
Chief of Research and Director of the Melanoma Program, The Angeles
Clinic and Research Institute, at the Annual Meeting of the American
Society of Clinical Oncology. The SYMMETRY trial and other trials for
elesclomol were suspended in February 2009 after a meeting of an
independent Data Monitoring Committee for the SYMMETRY trial observed an
imbalance in deaths in favor of the control (paclitaxel alone) arm.
“There is an enormous unmet need and lack of treatment options for
patients with metastatic melanoma. It is disappointing to all of us that
the primary endpoint of the SYMMETRY trial, progression free survival
(PFS), while showing a trend towards benefit, did not achieve
statistical significance in the full patient population, particularly
given the positive results from the prior, double-blind, randomized,
controlled Phase 2b trial,” said Dr. O’Day. “A statistically significant
PFS improvement was achieved, however, in the normal LDH population,
which constituted just over 2/3 of total evaluable patients in this
trial. The preliminary safety analysis shows that both the combination
and control arms were well tolerated with generally comparable adverse
event profiles. The imbalance in deaths observed between the two arms to
date cannot be explained by organ-specific toxicities attributable to
elesclomol. More mature survival data will be needed to understand the
safety profile more fully.”
SYMMETRY Primary Endpoint Preliminary Results
Database lock and final analysis for the primary endpoint of the trial,
PFS, are expected in Q3 2009. Preliminary results for PFS, in the full
intent-to-treat (ITT) population, consisting of the 621 patients who
were evaluable by April 2009 out of 651 total enrolled patients, were
presented today:
|
PFS, ITT population
|
Elesclomol + Paclitaxel (N=309)
|
Paclitaxel (N=312)
|
|
Events
|
170
|
192
|
|
Median (months; 95% C.I.)
|
3.4 (2.6 – 3.6)
|
1.9 (1.9 - 2.9)
|
|
Hazard ratio (95% C.I., p-value)
|
0.84 (0.64 – 1.04), p=0.111
|
These results show a trend towards improvement in PFS, which did not
achieve statistical significance (p=0.111; stratified log-rank test).
Patients in the SYMMETRY trial were stratified prospectively for level
of LDH (lactate dehydrogenase), a known prognostic factor in melanoma;
M-grade (degree of disease metastasis); and prior treatment history.
Results of pre-specified exploratory analyses with respect to these
variables showed a correlation between activity of elesclomol and level
of LDH:
|
PFS, ITT population, normal LDH
|
Elesclomol + Paclitaxel (N=209, 68%)
|
Paclitaxel (N=215,
69%)
|
|
Events
|
99
|
124
|
|
Median (months; 95% C.I.)
|
3.7 (3.5 – 5.4)
|
2.1 (1.9 – 3.5)
|
|
Hazard ratio (95% C.I., p-value)
|
0.72 (0.55 – 0.94), p=0.015
|
|
PFS, ITT population, elevated LDH
|
Elesclomol + Paclitaxel (N=100, 32%)
|
Paclitaxel (N=97,
31%)
|
|
Events
|
71
|
68
|
|
Median (months; 95% C.I.)
|
1.8 (1.7 – 2.0)
|
1.9 (1.8 - 2.5)
|
|
Hazard ratio (95% C.I., p-value)
|
1.11 (0.78 – 1.59), p=0.556
|
Medians are calculated using Kaplan-Meier methodology. Cox proportional
hazards modeling was used to generate hazard ratios. Normal LDH was
defined as less than 1x ULN (the upper limit of normal, 234 U/L);
elevated LDH was defined as greater than or equal to 1x ULN and less
than 2x ULN. Patients with LDH greater than 2x ULN were excluded from
the trial.
“We were disappointed that the primary endpoint in the Phase 3 SYMMETRY
trial was not achieved,” said Eric Jacobson, M.D., Chief Medical Officer
of Synta Pharmaceuticals. “The observation, however, that the
combination of elesclomol plus paclitaxel improved PFS in a large
subpopulation of patients with this difficult to treat disease is
encouraging. The experience and insights that we have gained and will
continue to gain from the SYMMETRY trial will be very important as we
evaluate potential paths forward for this first-in-class program.”
“I want to thank the patients, their families, and all the healthcare
professionals around the world who worked so closely with us to conduct
this trial with such a high level of quality, efficiency, and attention
to detail,” said Safi R. Bahcall, Ph.D., Chief Executive Officer of
Synta. “While we wish results from this study would have rapidly led to
a new option for patients with metastatic melanoma, that is not the
case. We are encouraged by the signs of clinical activity, and are
strongly committed to more fully understanding the underlying science,
which could inform the selection of patients for future trials.”
Additional Preliminary Results
Adverse events of all NCI CTC Grades 1-4 occurring in >10% of patients
were, in the ELPAC vs PAC alone arm respectively, alopecia (40% vs 40%),
fatigue (39% vs 38%), nausea (31% vs 25%), diarrhea (25% vs 22%) and
constipation (18% vs 18%), cough (15% vs 13%), headache (14% vs 14%),
asthenia (13% vs 9%), rash (13% vs 11%), peripheral neuropathy (13% vs
12%), vomiting (12% vs 9%), and pyrexia (10% vs 7%).
Moderate to severe adverse events, those of NCI CTC Grade 3-4, were, in
the ELPAC vs PAC alone arm respectively, fatigue (3.6% vs <1%),
peripheral neuropathy (2% vs 1.3%), alopecia (1.6% vs 1.9%), vomiting
(1.3% vs 1.3%), diarrhea (1.3% vs 0%); nausea, headache and asthenia
(<1% vs <1%); and constipation, cough, rash and pyrexia (<1% vs 0%).
Overall Survival (OS) data are not yet mature; measures of significance
of the relative mortality risk between the two arms are still evolving.
No organ specific toxicities have been identified which would explain
the imbalance in deaths observed in the interim DMC analysis. Survival
data are expected to mature by end of 2009 or early 2010.
Although no patients are currently receiving study treatment, patients
are continuing to be followed for assessment of survival.
The complete oral presentation will be available at the ASCO website at www.asco.org.
SYMMETRY Trial Design
The SYMMETRY trial enrolled patients with stage IV metastatic melanoma
who had not received prior chemotherapy but who may have already been
treated with non-chemotherapeutic agents such as biologics. The blinded,
randomized, controlled study, conducted at approximately 160 centers in
15 countries. Patients were randomized (1:1) to elesclomol (213 mg/m2)
plus paclitaxel (80 mg/m2) or paclitaxel alone (80 mg/m2)
and receive three weekly treatments and one week without treatment per
each four week cycle. If tolerated, treatment continued until disease
progression. Patients were stratified according to LDH levels, M-grade
status and prior treatment history. Responses were assessed using
standard RECIST criteria at baseline and at a minimum every other cycle,
with radiology scans being assessed by independent, blinded, reviewers
at a central site. The primary endpoint of the study was
progression-free survival; overall survival and tumor response rate were
secondary endpoints. The trial enrolled a total of 651 patients and 621
patients were evaluable as of April 2009.
About Elesclomol
Elesclomol is a first in class oxidative stress inducer that triggers
apoptosis (programmed cell death) in cancer cells. Cancer cells operate
at high levels of reactive oxygen species, or oxidative stress.
Elesclomol is believed to act by increasing the level of oxidative
stress in cancer cells even further, beyond sustainable levels, inducing
apoptosis. This mechanism of action, called oxidative stress induction,
represents a novel way of selectively targeting and killing cancer cells.
In a double-blind, randomized, controlled Phase 2b clinical trial in 81
patients with stage IV metastatic melanoma, elesclomol in combination
with paclitaxel met the primary endpoint, doubling the median time
patients survived without their disease progressing, compared to
paclitaxel alone (p = 0.035). The most common adverse events in the
elesclomol plus paclitaxel group included fatigue, alopecia,
constipation, nausea, hypoaesthesia, arthralgia, insomnia, diarrhea, and
anemia.
In October 2007, Synta and GSK entered into a collaboration agreement
for elesclomol. Under the terms of the agreement, the companies will
jointly develop and commercialize elesclomol in the U.S. and GSK will
have exclusive responsibility for development and commercialization of
elesclomol outside the U.S.
About Oxidative Stress
Elesclomol increases the generation of reactive oxygen species (ROS)
such as oxygen radicals in cells. These ROS cause signaling leading to
an increase in pro-apoptotic factors, a decrease in anti-apoptotic
factors, and ultimately to the initiation of programmed cell death via
the mitochondrial apoptosis pathway. By elevating ROS and altering the
balance of apoptotic signaling factors, elesclomol sensitizes cancer
cells to conventional anti-cancer agents that cause cell death through
the mitochondrial apoptosis pathway.
Normal, non-cancer cells typically have very low levels of ROS and have
a high antioxidant capacity. In contrast, cancer cells generally have
much higher levels of ROS and exist in a state of oxidative stress,
leaving them vulnerable to any further increases in ROS.
About Metastatic Melanoma
Melanoma, the most deadly form of skin cancer, arises from melanocytes,
the pigment-producing cells of the skin. According to the American
Cancer Society, melanoma accounts for approximately five percent of all
skin cancers but causes about 75% of all skin cancer-related deaths. An
estimated 60,000 people will be diagnosed and nearly 8,200 people will
die from melanoma this year in the U.S. alone. If diagnosed and
surgically removed while localized in the outermost skin layer, melanoma
is potentially curable; however, for patients with metastatic disease
the prognosis is poor, with limited available treatments and an expected
survival of only six to nine months. The incidence of melanoma has
increased more rapidly than any other cancer during the past ten years.
About Synta Pharmaceuticals
Synta Pharmaceuticals Corp. is a biopharmaceutical company focused on
discovering, developing, and commercializing small molecule drugs to
extend and enhance the lives of patients with severe medical conditions,
including cancer and chronic inflammatory diseases. Synta has a unique
chemical compound library, an integrated discovery engine, and a diverse
pipeline of clinical- and preclinical-stage drug candidates with
distinct mechanisms of action and novel chemical structures. All Synta
drug candidates were invented by Synta scientists using our compound
library and discovery capabilities. For more information, please visit www.syntapharma.com.
Safe Harbor Statement
This media release may contain forward-looking statements about Synta
Pharmaceuticals Corp. Such forward-looking statements can be identified
by the use of forward-looking terminology such as "will", "would",
"should", "expects", "anticipates", "intends", "plans", "believes",
"may", "estimates", "predicts", "projects", or similar expressions
intended to identify forward-looking statements. Such statements,
including statements relating to the timing, developments and progress
of our clinical and preclinical programs, reflect our current views with
respect to future events and are based on assumptions and subject to
risks and uncertainties that could cause actual results to differ
materially from those expressed or implied by such forward-looking
statements, including those described in "Risk Factors" of our Form 10-K
for the year ended December 31, 2008 as filed with the Securities and
Exchange Commission. Synta undertakes no obligation to publicly update
forward-looking statements, whether because of new information, future
events or otherwise, except as required by law.
Synta Pharmaceuticals Corp.
Rob Kloppenburg, 781-541-7979
or
Synta
Pharmaceuticals Corp.
Aurora Krause, 781-541-7125