Capivasertib

The Emerald-3 showing draws a resemblance to AstraZeneca’s Emerald-1 readout in the same locoregional treatment setting among liver cancer patients eligible for TACE. Another green light appears increasingly within reach for AstraZeneca’s Emerald program after a combo regimen featuring the company’s immunotherapy duo, Imfinzi and Imjudo, showed benefit in certain liver cancer patients. Results from the phase 3 Emerald-3 trial showed that the combination, paired with transarterial chemoembolizaton (TACE) and Lenvima, significantly improved progression-free survival (PFS) versus TACE alone in patients with unresectable locoregional hepatocellular carcinoma. Lenvima is a multikinase inhibitor sold by Merck & Co. and Eisai.But whether AZ has struck gold with Emerald-3 remains to be seen. Overall survival (OS), a secondary endpoint that will be a key consideration for the FDA, was immature at the interim analysis, although AZ highlighted a trend toward improvement in its April 2 announcement. In two ways, the Emerald-3 showing draws a resemblance to AZ’s Emerald-1 readout in the same locoregional treatment setting among liver cancer patients eligible for TACE. Two years ago, the Emerald-1 trial hit its primary endpoint, showing that a cocktail of Imfinzi, Avastin and TACE reduced the risk of progression or death by 23% versus TACE alone. At that time, OS was also immature, and AZ’s oncology R&D chief, Susan Galbraith, Ph.D., flagged that patient survival data are crucial in this locoregional setting. Case in point: Despite a PFS win, Merck & Co. last year abandoned hopes for a similar liver cancer approval for its Keytruda-Lenvima-TACE regimen after it failed to improve OS compared with TACE alone.Emerald-1 still hasn’t reported its final OS data, and the study has not graduated to the regulatory submission batch in AZ’s most recent earnings report in February.  In addition, like Emerald-1, Emerald-3 has a second experimental arm. In this cohort, Imfinzi, Imjudo and TACE—without Lenvima—showed what AZ called “strong trends” toward improved PFS and OS, although these analyses were not formally tested. Previously, in Emerald-1, only the Avastin-containing triplet beat TACE, while Imfinzi-TACE failed to move the needle. AZ is discussing the latest Emerald-3 data with global regulatory authorities while waiting for final results from the trial’s key secondary endpoints, Galbraith said in an April 2 statement.As for Emerald-1, an AZ spokesperson said the company will share additional data in the future and will update its regulatory discussion plans as appropriate. Liver cancer helped AZ’s CTLA-4 agent Imjudo break into the market in 2022 as part of a combination with Imfinzi in unresectable hepatocellular carcinoma (HCC), the most common type of liver cancer. Patients who are eligible for embolization have an earlier stage of disease. In 2026, more than 200,000 patients belong to this category, according to data cited by AZ—however, most patients who receive the procedure experience progression or recurrence within six to ten months.The British pharma also has a third Emerald. Called Emerald-2, the phase 3 study is testing Imfinzi with Avastin in adjuvant liver cancer, with its data expected in the second half of 2026. As for the Imfinzi-Imjudo duo, AZ also expects readouts this year from its Nile trial in first-line metastatic bladder cancer and from its Volga study assessing a neoadjuvant regimen in cisplatin-ineligible muscle-invasive bladder cancer. Both will need to live up to the high expectations set by the combination of Merck & Co.’s Keytruda and Pfizer and Astellas’ antibody-drug conjugate Padcev.For AZ’s broader oncology portfolio, the company is bracing for an upcoming FDA advisory committee meeting that will dig into two separate applications for its oral SERD med camizestrant and the AKT inhibitor Truqap. The high-stakes first-line non-small cell lung cancer readout for Daiichi Sankyo-partnered Datroway from the Avanzar trial is also expected this year. 

Pfizer (NYSE: PFE) reported Phase II results for atirmociclib in HR-positive, HER2-negative metastatic breast cancer, with the FOURLIGHT-1 trial meeting its primary endpoint by demonstrating a 40% reduction in the risk of disease progression or death compared to standard-of-care options. The data mark the first randomized Phase II readout for a selective CDK4 inhibitor in patients whose disease has progressed on prior CDK4/6 inhibitor therapy, a population with limited treatment options and no established targeted retreatment strategy. Trial specifics FOURLIGHT-1 is an open-label, randomized, multicenter Phase II study that enrolled 264 patients across 14 countries with HR-positive, HER2-negative advanced or metastatic breast cancer who had progressed after CDK4/6 inhibitor-based treatment. Patients were randomized to atirmociclib plus fulvestrant versus physician’s choice of fulvestrant alone or everolimus plus exemestane. The primary endpoint was investigator-assessed progression-free survival. Atirmociclib plus fulvestrant reduced the risk of progression or death by 40% versus control, with a hazard ratio of 0.60 (95% CI: 0.440–0.825; p=0.0007). The benefit was consistent across prespecified subgroups, including patients with visceral disease, those with prior CDK4/6 inhibitor treatment lasting less than or more than 12 months, and regardless of which CDK4/6 inhibitor was previously received. More than 90% of enrolled patients initiated atirmociclib within three months of their last CDK4/6 inhibitor treatment, indicating a population with recent disease progression rather than a prolonged treatment-free interval. Overall survival data were not mature, with approximately 20% of participants having had an event at the time of analysis. The safety profile was consistent with prior studies of atirmociclib. Discontinuation due to treatment-emergent adverse events occurred in 6.4% of patients on the atirmociclib arm, and no new safety signals were identified, according to the company. Detailed safety data were not disclosed and are expected at a future medical meeting. Development context Atirmociclib is an oral, selective inhibitor of cyclin-dependent kinase 4 (CDK4), a protein that drives the transition from G1 to S phase of the cell cycle. Unlike currently approved CDK4/6 inhibitors such as palbociclib, ribociclib, and abemaciclib, which inhibit both CDK4 and CDK6, atirmociclib targets CDK4 alone. The rationale for selective CDK4 inhibition centers on the hypothesis that sparing CDK6 may reduce hematologic toxicity, particularly neutropenia, which is the dose-limiting side effect of dual CDK4/6 inhibitors. Whether CDK4 selectivity translates into a clinically distinct efficacy or tolerability profile remains to be established in larger trials. The post-CDK4/6 inhibitor treatment landscape in HR-positive, HER2-negative metastatic breast cancer lacks a consensus targeted retreatment approach. Current options after progression on a CDK4/6 inhibitor include fulvestrant monotherapy, everolimus combined with exemestane, and more recently, agents such as elacestrant, an oral selective estrogen receptor degrader approved by the US FDA in 2023 for patients with ESR1-mutated tumors. The PI3K inhibitor alpelisib combined with fulvestrant is approved for PIK3CA-mutated disease. Capivasertib, an AKT inhibitor, received US FDA approval in 2023 in combination with fulvestrant for patients with PIK3CA/AKT1/PTEN-altered tumors. None of these therapies directly address the question of whether continued cell cycle inhibition through a next-generation mechanism can extend disease control after CDK4/6 inhibitor failure. Pfizer stated that a Phase III registrational study for atirmociclib in the first-line metastatic setting is ongoing, and results from a Phase II neoadjuvant study in early breast cancer will be presented at a future medical meeting. The company did not disclose a timeline for regulatory filing based on the FOURLIGHT-1 data or whether the Phase II results alone would support an accelerated approval pathway. The broader competitive context for next-generation CDK4 inhibitors includes programs from other companies, though atirmociclib is the first to report randomized Phase II data in the post-CDK4/6 inhibitor setting. Pfizer’s decision to advance atirmociclib into first-line and early-stage disease reflects a strategy to position the molecule as a potential replacement for, rather than a successor to, existing CDK4/6 inhibitors across treatment lines. Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website