FDA Approval for Pralatrexate
Brand name: Folotyn™
- Approved for relapsed or refractory peripheral T-cell lymphoma (PTCL)
Full prescribing information is available, including clinical trial information, safety, dosing, drug-drug interactions and contraindications.
On September 24, 2009, the U.S. Food and Drug Administration (FDA) Office of Oncology Drug Products granted accelerated approval to pralatrexate injection (Folotyn™, made by Allos Therapeutics, Inc.) for the treatment of patients with relapsed or refractory peripheral T-cell lymphoma (PTCL). This approval was based on an overall objective response rate observed in a single-arm trial. As a condition of the accelerated approval, randomized, controlled trials are required post-approval to verify and describe the clinical benefit of pralatrexate in PTCL.
Trial PDX 008 was an open-label, multicenter, international trial that enrolled 115 patients with PTCL who had relapsed or had progressive disease following prior therapy. The median number of prior systemic therapies was 3 (range 1 to 12). Twenty-four percent of patients did not have an objective response to any previous therapies; 63 percent did not have an objective response to the most recent prior therapy.
One hundred and nine evaluable patients received pralatrexate at a starting dose of 30 mg/m2 administered as an intravenous push over 3-5 minutes once weekly for 6 weeks followed by a 1-week break (one cycle). In addition, each patient received vitamin B12 (1.0 mg intramuscular injection) every 8-10 weeks and a daily administration of folic acid (1.0 - 1.25 mg orally). Imaging scans to assess disease status were performed at week 7 (end of cycle 1) and subsequently at 14-week intervals. Patients who had tumor responses or stable disease continued to receive additional cycles until disease progression or unacceptable toxicity.
Responses were assessed by an independent central imaging review committee using the International Workshop Criteria (IWC) for malignant lymphoma.
The overall response rate (complete response plus complete response unconfirmed plus partial response) was 27 percent (95 percent confidence interval: 19 percent, 36 percent). The median response duration was 9.4 months (range: 1-503 days). Thirteen patients (12 percent of 109 evaluable patients) had response durations of at least 14 weeks; the median response duration of these patients has not yet been reached (range: 98 to 503 days). Six of these 13 patients achieved complete responses, one patient had a complete response unconfirmed, and the remaining six patients had partial responses.
Safety assessments were performed on the 111 patients who received at least one pralatrexate dose. Mucositis, thrombocytopenia, nausea, fatigue, anemia, constipation, pyrexia, edema, cough, epistaxis, vomiting, neutropenia, and diarrhea were the most common adverse reactions. Adverse reactions were the reason for dose reductions in 31 percent of patients, dose omission in 69 percent, and treatment withdrawal in 23 percent. Overall, 85 percent of scheduled doses were administered.
Serious adverse events were reported in 44 percent of patients. The most common serious adverse events (reported in at least three patients) were pyrexia, mucositis, febrile neutropenia, sepsis, and thrombocytopenia. Eight deaths were reported within 30 days of the last pralatrexate dose. Seven were attributed to progressive disease and one was due to cardiopulmonary arrest possibly related to pralatrexate.
This summary was provided by Richard Pazdur, M.D., director of the FDA's Division of Oncology Drug Products.
The FDA is the division of the U.S. Department of Health and Human Services charged with ensuring the safety and effectiveness of new drugs and other products. (See "Understanding the Approval Process for New Cancer Treatments.") The FDA's mission is to promote and protect the public health by helping safe and effective products to reach the market in a timely way, and monitoring products for continued safety after they are in use.