Rozlytrek (entrectinib)

The following drug information is obtained from various newswires, published medical journal articles, and medical conference presentations.

Company:

Approval Status:

Approved August 2019

Specific Treatments:

ROS1-positive non-small cell lung cancer and NTRK Gene Fusion-Positive Solid Tumors

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General Information

Rozlytrek (entrectinib) is a kinase inhibitor.

Rozlytrek is specifically indicated for the following:

• the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors are ROS1-positive. 

• the treatment of adult and pediatric patients 12 years of age and older with solid tumors that:

· have a neurotrophic tyrosine receptor kinase (NTRK) gene fusion without a known acquired resistance mutation,

· are metastatic or where surgical resection is likely to result in severe morbidity, and 

· have either progressed following treatment or have no satisfactory alternative therapy. 

This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Rozlytrek is supplied as capsule for oral administration. Patients should be selected for treatment based on the presence of ROS1 rearrangement(s) or NTRK gene fusion.

Recommended Dosage for ROS1-Positive Non-Small Cell Lung Cancer:  600 mg orally once daily.

Recommended Dosage for NTRK Gene Fusion-Positive Solid Tumors: * Adults: 600 mg orally once daily. * Pediatric Patients 12 Years and Older: Recommended dosage is based on body surface area (BSA) as shown: • BSA greater than 1.50 m2: 600 mg once daily • BSA 1.11 to 1.50 m2: 500 mg once daily • BSA 0.91 to 1.10 m2: 400 mg once daily 

Clinical Results

FDA Approval

The FDA approval of Rozlytrek was based on the integrated analysis of the Phase II STARTRK-2, Phase I STARTRK-1 and Phase I ALKA-372-001 trials, and data from the Phase I/II STARTRK-NG study. In the integrated analysis, Rozlytrek was studied in several solid tumor types, including breast, cholangiocarcinoma, colorectal, gynecological, neuroendocrine, non-small cell lung, salivary gland, pancreatic, sarcoma and thyroid cancers. In ROS1-positive, metastatic NSCLC, Rozlytrek shrank tumors in 78% of people with the disease (overall response rate [ORR]; N=51) and the duration of response (DoR) ranged from 1.8 to 36.8+ months (N=40 out of 51). Rozlytrek also shrank tumors in more than half of people with NTRK gene fusion-positive, locally advanced or metastatic solid tumors (ORR=57%; N=54), and objective responses were observed across 10 tumor types (DoR ranged from 2.8 to 26.0+ months; N=31 out of 54). Objective responses to Rozlytrek were seen in people with central nervous system (CNS) metastases at baseline.

 

Side Effects

Adverse effects associated with the use of Rozlytrek may include, but are not limited to, the following:

fatigue

constipation

altered sense of taste (dysgeusia)

swelling (edema)

dizziness

diarrhea

nausea

nervous system disorders (dysesthesia)

shortness of breath (dyspnea)

muscle pain (myalgia)

cognitive impairment

increased weight

cough

vomiting

fever (pyrexia)

joint pain (arthralgia)

vision disorders

Mechanism of Action

Rozlytrek (entrectinib) is an inhibitor of the tropomyosin receptor tyrosine kinases (TRK) TRKA, TRKB, and TRKC (encoded by the neurotrophic tyrosine receptor kinase [NTRK] genes NTRK1, NTRK2, and NTRK3, respectively), proto-oncogene tyrosine-protein kinase ROS1 (ROS1), and anaplastic lymphoma kinase (ALK) with IC50 values of 0.1 to 2 nM. Entrectinib also inhibits JAK2 and TNK2 with IC50 values > 5 nM. The major active metabolite of entrectinib, M5, showed similar in vitro activity against TRK, ROS1, and ALK. Fusion proteins that include TRK, ROS1, or ALK kinase domains can drive tumorigenic potential through hyperactivation of downstream signaling pathways leading to unconstrained cell proliferation. Entrectinib demonstrated in vitro and in vivo inhibition of cancer cell lines derived from multiple tumor types harboring NTRK, ROS1, and ALK fusion genes.

Additional Information

For additional information regarding Rozlytrek or ROS1-positive non-small cell lung cancer and NTRK Gene Fusion-Positive Solid Tumors, please visit Genentech's Rozlytrek web page.