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Amgen has announced that the Phase 3 TRINOVA-1 trial evaluating Trebananib plus Paclitaxel versus placebo plus Paclitaxel in recurrent ovarian cancer met its primary endpoint of progression-free survival ( PFS ). A statistically significant difference was observed in progression-free survival with a 34% reduction in the risk of disease progression or death ( HR=0.66; p less than 0.001 ). The median progression-free survival was 7.2 months in the Trebananib arm versus 5.4 months in the control arm.

The primary analysis of overall survival, a key secondary endpoint, is expected to mature in 2014 in line with previous guidance. Although an early imbalance of deaths favoring the control arm was observed, there was an overall favorable overall survival trend for Trebananib in a pre-planned interim analysis.

In the Trebananib arm, the most frequently reported adverse events were localized edema, nausea and alopecia. The rate of discontinuation of investigational product due to adverse events was 20% in the Trebananib arm versus 7% in the control arm.

Approximately 22,240 new cases of ovarian cancer will be diagnosed in the United States in 2013. More than 70% of women with ovarian cancer will present with advanced disease at diagnosis and up to 80% of them will experience disease recurrence and eventually die from their disease.

TRINOVA-1 is a Phase 3 global, multicenter, randomized, double-blind, placebo-controlled study evaluating Trebananib in over 900 women with recurrent partially Platinum-sensitive or -resistant ( Platinum-free interval of 12 months or less ) epithelial ovarian, primary peritoneal or fallopian tube cancer. Patients were randomized 1:1 to receive either 15 mg/kg of intravenous Trebananib weekly plus 80 mg/m2 of intravenous Paclitaxel weekly ( three weeks on, one week off ) or weekly intravenous placebo plus 80 mg/m2 of intravenous Paclitaxel weekly ( three weeks on, one week off ).

Other ongoing Phase 3 studies of Trebananib include TRINOVA-2 and TRINOVA-3. TRINOVA-2 is evaluating whether Trebananib plus Pegylated liposomal Doxorubicin ( PLD ) is superior to placebo plus PLD as measured by progression-free survival in recurrent epithelial ovarian, primary peritoneal or fallopian tube cancer. TRINOVA-3 is evaluating Trebananib or placebo in combination with Paclitaxel and Carboplatin in the first-line treatment of epithelial ovarian, primary peritoneal or fallopian tube cancer.

Trebananib is an investigational peptibody designed to inhibit the angiopoietin axis. The angiopoietin axis is involved in angiogenesis, a process used by the body to grow new blood vessels, which is also involved in the pathogenesis of several diseases. Trebananib is designed to bind to both angiopoietin-1 and -2 ( Ang1 and Ang2 ), and inhibit their interaction with the Tie2 receptor. Ang1 and Ang2 each mediate separate actions upon binding with Tie2. Ang1 impacts vessel quality while Ang2 influences vessel quantity. The angiopoietins are also involved in lymphangiogenesis, the formation of new lymphatic vessels, which plays a key role in tumor metastasis.

Source: Amgen, 2013

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