Final report of Genasense Phase 3 trial in melanoma
Genasense, Genta's lead anticancer drug, is a novel targeted therapy that blocks the production of Bcl-2, a protein that appears to be a fundamental cause of resistance to cancer treatment. By knocking down Bcl-2 in cancer cells, Genasense may enhance the effectiveness of chemotherapy in patients with advanced melanoma. A summary of the data from the final analysis appears below.
The report is based on long-term data derived from the largest randomized controlled trial that has ever been conducted in patients with advanced melanoma. In this trial, which was conducted at 139 sites in 9 countries, 771 patients were randomly assigned to receive chemotherapy with dacarbazine (DTIC) alone or in combination with Genasense. The paper includes data from a prospectively defined analysis that evaluated 24-months of minimum follow-up on all patients. Unless otherwise noted, these results were based on an intent-to-treat analysis:
Overall response: Genasense/DTIC 13.5%; DTIC 7.5%; P 0.007
Complete response: Genasense/DTIC 2.8%; DTIC 0.8%; P 0.03
Durable response: Genasense/DTIC 7.3%; DTIC 3.6%; P 0.03
Progression-free survival, median: Genasense/DTIC 2.6 mos.; DTIC 1.6 mos.; P 0.0007
Overall survival, median: Genasense/DTIC 9.0 mos.; DTIC 7.8 mos.; P 0.077
Prior to randomization, patients were prospectively stratified according to certain risk factors, including elevated blood levels of an enzyme known as LDH - a factor that previous clinical studies have shown is strongly associated with poor outcome. The final analysis has shown that LDH was the sole stratification factor significantly associated with a treatment interaction. When this treatment effect was evaluated, the efficacy of Genasense was significantly superior for all major efficacy outcomes in patients who had normal LDH at baseline, a group that comprised approximately two-thirds of patients in the trial (N=508).
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