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STILL EARLY DAYS FOR LIQUID BIOPSY

MDDnowReutersSTILL EARLY DAYS FOR LIQUID BIOPSY

Multi-billion market opportunity draws variety of approaches from congested field of companies

http://www.medicaldevicedaily.com/servlet/com.accumedia.web.Dispatcher?next=bioWorldHeadlines_article&forceid=92613

By Amanda Pedersen

Tuesday, April 26, 2016

Analysts and market researchers often try to put a monetary value on an emerging sector but estimating the market potential of a new technology category is far from an exact science. The liquid biopsy market is a prime example of that challenge.

“There are a variety of numbers that have been thrown out by a variety of different sources and I think that’s really all to say it’s an embryonic area and people don’t really know where this is going to go,” Gene Walther, CEO of Vortex Biosciences Inc., told Medical Device Daily. “Some of the big firms, J.P. Morgan and Piper Jaffray have indicated that it’s a $22 billion to $32 billion market opportunity, but many of those are looking at the clinical applications and not really including or incorporating what the research potential is.”

Walther said the research applications in this space alone represents a market anywhere between $1 billion to $8 billion. Vortex, of Menlo Park, Calif., is among the many players that have seen the opportunity and potential of the fairly congested liquid biopsy field.

Suffice is to say the market for liquid-based cancer tests will eventually grow to become a multi-billion opportunity and there will be plenty of pie slices to go around. But what really makes this an interesting space is the variety of approaches liquid biopsy companies are taking with the technology and the array of purposes for which these various tests will be used.

This week, in a two-part series, Medical Device Daily is exploring both the potential clinical and business opportunities this young but fast-growing market has to offer.

Looking at the liquid biopsy space from the broadest viewpoint, it can be segregated by the type of liquid being collected: urine or blood. So far San Diego-based Trovagene Inc. appears to be the lone wolf in the urine-based liquid biopsy category while the majority of companies are duking it out for leadership on the blood-based side.

Zooming in on the blood-based sector, the market can be divided into at least four different categories based on the specific components of the blood the test is designed to capture — circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), nucleosomes and exosomal RNA — and some of those categories can be further split into subcategories, such as whether or not the test is used for clinical or research purposes and, if it is used in the clinic, is it being used to find cancer (detection) or to follow it (monitoring).

“A lot that work still needs to be done. I think the biology of cancer and really how we can maximize the use of liquid biopsies, whether it be the application of circulating tumor cells or circulating tumor DNA and how they can work and compliment each other still needs to be proven,” Walther said.

Finding the needle in a haystack

Vortex is trying to differentiate itself by not using any kind of labels such as magnetic beads or stains, but rather isolating intact CTCs to allow the end user to perform a variety of different types of analysis, such as next generation sequencing, growing the cells to be able to study them further or looking at the proteomics and the way the gene expressions are happening within the isolated tumor cells.

“By having these intact CTCs you’re able to do much more of a thorough and broad analysis on those cells,” Walther said. “Within that space what we think differentiates our technology and our approach is a higher purity.”

Vortex has developed a fully automated benchtop system called the Vtx-1 for collecting intact CTCs using microfluidic technology. Inside the Vtx-1 chip, unlabeled CTCs in whole blood are trapped in microsale vortices while smaller red and white blood cells pass through. After selectively trapping into the microfluidic chamber, CTCs can be flushed and collected into a variety of containers for downstream analysis.

This technique is easier said than done though. Walther explained that each blood sample contains billions of very small red cells and millions of slightly larger white cells and a much smaller number, roughly one to 500, of CTCs. It’s a lot like looking for a needle in a haystack, he said, and being able to isolate the CTCs from those red and white blood cells is a tremendous challenge. In the end, the Vtx-1 is expected to capture the CTCs in a sample of blood and only a minimal amount of white blood cells.

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He said the technology is able to clear the red blood cells fairly well but there are some residual white cells that will be left in with the CTCs. “When you compare it to other technologies, at least based on published reports, we believe that the purity of our technology is actually a high differentiation from the other technologies that are available,” he said. “The market is going to want to see some direct comparisons in the not-too-distant future to be able to actually differentiate the technologies.”

Walther said the company has generated a fair amount of interest from research labs and clinical labs but Vortex also has received notable attention from pharmaceutical companies because the ability to isolate CTCs and grow them presents an opportunity to test the effectiveness of various compounds they may have in development. That’s a distinct advantage over tests that use ctDNA, he said, because ctDNA shows fragments of DNA from cells that have been killed, in theory, by the treatments the patients are on.

“What it doesn’t capture is the residual cancer that may have become resistant to that drug or that may not respond to that drug,” Walther said. “It may be more effective in being able to determine cocktails of drugs. If you think about the approach that the pharma industry has taken fighting Aids, it’s a cocktail approach, it’s not a single drug.”

The company recently did a soft launch of the system to introduce it to researchers and plans to do a formal product launch early next year.

nucleosomes are the haystack

Volitionrx Limited, of Namur, Belgium, is trying to set itself apart in this crowded market by focusing on a cost-effective platform designed to work in multiple cancers and by looking at nucleosomes in circulation. The company received CE mark approval in April for two blood-based assays for the detection of colorectal cancer. The biomarker assays, Nuqv001 and Nuqt003 are designed to analyze fragments of nucleosomes circulating within the blood for the presence of cancer signatures. Volitionrx plans to launch a panel test for the detection of colorectal cancer for clinical use in Europe toward the end of the year.

“We’re not looking for the needle. The nucleosomes are the haystack,” CEO Cameron Reynolds told Medical Device Daily at J.P. Morgan’s health care conference in January.

Reynolds said his company’s test is so low cost that Volitionrx only spent about $18 million over five years to develop the assay because it is using a “very old platform” that is easy to roll out worldwide. He said if the company delivers what it intends to, which is a low-cost, accurate diagnostic screening blood test, it will “change everything.”

“People say blood tests are the answer and they really are,” Reynolds said. “But I think anyone in our business has to accept nothing has worked. Everyone’s very skeptical because the last big break through was 35 years ago with PSA for prostate cancer.”

For example, Reynolds said, thousands of papers have been published but not one has been launched and widely adopted as a screening test. Other companies are also looking at nucleosomes, he said, but he said those competitors are actually looking at the DNA wrapped around the nucleosomes.

Don’t dismiss RNA

Exosome Diagnostics Inc. is taking a very different approach in the liquid biopsy field with its test designed to isolate and analyze exosomal RNA from a blood sample. The plasma-based diagnostic is intended to enable real-time detection of EML4-ALK mutations in patients with non-small cell lung cancer (NSCLC). The company said its platform provides a more direct and sensitive method of detecting fusions such as EML4-ALK, compared to cell free DNA alone. EML4-ALK is a gene fusion found in a subset of patients with NSCLC and predicts response to ALK inhibitor therapies.

John Boyce, CEO of the Cambridge, Mass.-based company, told Medical Device Daily in February that DNA alone is not enough to solve the puzzle. Just like there will never be one drug that can cure cancer by itself, oncology doctors need more than one liquid biopsy tool to treat and monitor their patients, Boyce said. If they only measure the cell-free DNA to see if a particular drug is working, all they know is what is dying in the blood.

“And that’s good, you can see what’s dying, you can see that you’re killing off the [tumor cells] but you’re not able to see what’s on the rise,” Boyce said. “So it’s natural selection. As soon as you kill one of them off there’s a new bully on the block in the tumor.”

That’s something that can’t be identified with cell-free DNA, he said. “The only way you can do that is looking at the RNA and the only way that you can get the RNA from the blood is from exosomes because RNA doesn’t float around in the blood freely.”

In the end, Boyce said, oncologists need to see both what is dying and what is living in the blood.

Published  April 26, 2016

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Growing evidence supports clinical potential of new cancer tests

MedicalDeviceDailyGrowing evidence supports clinical potential of new cancer tests

By Amanda Pedersen, Senior Staff Writer

With a market opportunity in the billions (as much as $20 billion by some estimates), diagnostic companies are rushing the liquid biopsy floodgates with new tests designed to make finding and monitoring cancer as easy as a blood draw or urine sample. This week, in a two-part series, Medical Device Daily will explore both the business opportunities and the clinical potential of this growing market. The true clinical impact of this technology remains to be seen and there are some early limitations of these tests that will need to be addressed, but some doctors say liquid biopsies could really transform cancer treatment. To validate the power of
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FDA approves Epigenomics’ Epi proColon test

BioCenturyFDA approves Epigenomics’ Epi proColon test

http://www.biocentury.com/dailynews/company/2016-04-13/fda-approves-epigenomics-epi-procolon-test

Published on Wednesday, April 13, 2016

Epigenomics AG (Xetra:ECX) said FDA approved a PMA for its Epi proColon blood-based colorectal cancer (CRC) screening test. Epigenomics and Polymedco Inc. (Cortlandt Manor, N.Y.) will jointly market Epi proColon in the U.S.

Epigenomics spokesperson Peter Vogt said the partners expect to launch the test in the next few weeks, but did not disclose the list price.

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In November, Epigenomics appealed FDA’s request for additional data demonstrating that Epi proColon would increase compliance in patients with a history of non-compliance to recommended CRC screening programs. The request came in a response letter for Epigenomics’ PMA, the second it had received for Epi proColon.

Epi proColon detects methylated DNA of the septin 9 (SEPT9) gene in blood plasma by real-time PCR.

Epigenomics gained EUR 1.31 (25%) to EUR 6.58 on Wednesday.

Exact Sciences Corp. (NASDAQ:EXAS), which markets CRC screening test Cologuard, rose $0.34 to $7.46 on Wednesday. Cologuard is a non-invasive stool DNA test that uses a multiplexed quantitative Invader assay for the simultaneous detection of methylated and unmethylated sequences in the promoter region of the vimentin (VIM) gene.

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Epigenomics scores FDA approval for colorectal cancer screening test

FierceMedicalDeviceshttp://www.fiercemedicaldevices.com/story/dx-digest-epigenomics-wins-fda-approval-colorectal-cancer-test-nanostring-a/2016-04-13

Welcome to Dx Digest, where FierceMedicalDevices highlights the highs and sometimes lows of the past week in the diagnostics industry. Epigenomics won FDA approval for its colorectal cancer screening tool. Testing heavyweight Siemens also got a regulatory nod for its Graves’ disease (GD) test. Last but certainly not least, NanoString Technologies and HalioDx teamed up to develop immuno-oncology gene expression tests. Read on for the details. And as always, feel free to contact us with any comments or questions. — Emily Wasserman (email | Twitter)

Epigenomics scores FDA approval for colorectal cancer screening test

German and U.S.-based molecular diagnostics firm Epigenomics got FDA approval for its blood-based colorectal cancer screening test.
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Epigenomics’ Epi proColon uses a blood sample to see whether or not patients are at risk for developing the disease. The test provides an alternative to other colorectal cancer screening methods including colonoscopy and stool-based fecal immunochemical tests.

The FDA based its approval on three major clinical studies, which showed that Epigenomics’ test was safe and effective in screening for colorectal cancer. But regulators are also asking the company to run a post-approval study to show Epi proColon’s long-term benefit.

The Berlin and Germantown, MD-based firm will market Epi proColon in the U.S. under a joint agreement with its partner Polymedco, who specializes in noninvasive colorectal screening technology.

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FDA Approves Epigenomics’ Blood-Based Colorectal Cancer Screening Test

genomewebFDA Approves Epigenomics’ Blood-Based Colorectal Cancer Screening Test

https://www.genomeweb.com/molecular-diagnostics/fda-approves-epigenomics-blood-based-colorectal-cancer-screening-test

Apr 13, 2016

a GenomeWeb staff reporter

NEW YORK (GenomeWeb) – Epigenomics announced today that the US Food and Drug Administration has approved the company’s blood-based colorectal cancer screening test Epi proColon.

Epi proColon is a PCR-based test that detects methylated Septin9, a biomarker already incorporated into laboratory-based tests currently available in the US. It is now approved for use in average-risk patients who choose not to undergo screening by guideline-recommended methods such as colonoscopy and stool-based fecal immunochemical tests, and will be co-marketed by Epigenomics and strategic partner Polymedco.

The FDA approval comes after a series of setbacks for Epigenomics. Although Epi proColon received a positive recommendation from an FDA advisory panel in early 2014, the agency issued Epigenomics a “not approval letter” for the test a few months later.
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In its letter to Epigenomics, the FDA noted that the firm’s clinical studies of the Epi proColon were conducted in patients who had agreed to a routine screening colonoscopy, and asked for data demonstrating that the test would boost compliance to colorectal cancer screening in its intended population of patients who currently don’t undergo such screening.

Meanwhile, Exact Sciences’ stool-based colorectal screening test Cologuard got a nod from the advisory panel in 2014 and was approved by the FDA that August. The Centers for Medicare and Medicaid Services also issued a proposed national coverage determination for the test.

In July 2015, Epigenomics received some good news when China included the Epi proColon in its screening guidelines for colorectal cancer. However in late 2015, the FDA said it would require yet more data before making its own decision on the test. It was not until this January that the FDA told the company the additional information it had submitted was sufficient.

“We are excited by the FDA’s decision to approve Epi proColon as the first and only blood-based colorectal cancer screening test,” Epigenomics CEO and CFO Thomas Taapken said in a statement. “Given the significant benefits for patients, healthcare professionals, and payors, Epi proColon could help to meet the objective of 80 percent screening compliance of the eligible US population as pursued by US guideline bodies such as the American Cancer Society.”

Epigenomics said that it intends to conduct a post-approval study to demonstrate the long-term benefit of the test.

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Biologics Blossoming: CANbridge Looks To Taiwan, WuXi Partners Juno

PharmasiaNewsBiologics Blossoming: CANbridge Looks To Taiwan, WuXi Partners Juno

By Brian Yang

Apr. 11, 2016 7:05 AM GMT

https://www.pharmamedtechbi.com/Publications/Pharmasia-News/2016/4/11/Biologics-Blossoming-CANbridge-Looks-To-Taiwan-WuXi-Partners-Juno?result=1&total=22&searchquery=%253fq%253dCANbridge

Executive Summary

New policies including the allowance of contract manufacturing under a new marketing holder system are fast changing the nascent biologics sector in China, where the just 2% market penetration for such products is offering plenty of room for a new crop of startups including CANbridge to grow and thrive.

BEIJING – Many seemingly unconquerable barriers of the past are fast melting away, and biotech companies in China are wasting no time to seize new opportunities.

One such obstacle has been manufacturing site requirements. Previously in China, drug makers must have had their own production facilities to be able to conduct clinical trials for their new drugs, but now a pilot program is allowing contractor manufacturers to be used instead (“Authorization Holder Scheme To Shake Up China R&D, Production” — PharmAsia News, Nov. 6, 2015 4:18 AM GMT).

That is opening doors for smaller biotech startups like CANbridge Life Sciences Ltd. With fewer than 20 people and a virtual development model, the Beijing-based firm simply has to rely on contract manufacturing organizations (CMOs) for any chance of developing a new drug in China.

Now, the company has a concrete solution. It has signed up with WuXi Biologics, a subsidiary of WuXi AppTec Inc. to produce CAN-008 in China. The molecule, also known as APG001, was licensed by CANbridge in July 2015 from Germany’s Apogenix GMBH for mainland China, Hong Kong and Macau, and is at the clinical stage elsewhere for glioblastoma multiforme, a type of brain cancer.

The partnership with WuXi will allow CANbridge to submit a planned IND for clinical trials to the China FDA. Wasting no time, the company has meanwhile completed an IND application (the venture’s first) to initiate a Phase I/II trial in Taiwan (which is now included in its licensed territories) to help expedite the regulatory process in the mainland, disclosed James Xue, CANbridge’s CEO.

“Due to a ‘four plus four’ agreement between the mainland and Taiwan, in which clinical trial study data from four selected facilities from each side are accepted by the [respective] regulatory agencies, we hope the data obtained from the Taiwan study will be used towards starting Phase II trials in the mainland, bypassing a Phase I study [in China],” explained Xue in a phone interview. Data from the Taiwan study are expected next year, he added.

Such a development approach is a direct result of a cross-strait clinical study collaboration agreement, a pathway that several Taiwanese biotechs including Taiwan Liposome Co. Ltd. are hoping to use to get their novel drugs approved in a far larger market (“Taiwan Liposome Eyes Phase II Liver-Cancer Drug Trials At Home, China” — PharmAsia News, Aug. 11, 2014 10:33 PM GMT).

CANbridge has also recently in-licensed global rights ex-US, Canada and Mexico to AVEO Oncology‘s clinical stage ErbB3 (HER3) inhibitor for esophageal squamous cell cancer (ESCC) (“CANbridge Looks Beyond Asia With AVEO’s Oncology Drug” — PharmAsia News, Mar. 24, 2016 7:59 AM GMT).

Clinical Benefits Matter

Unlike its biotech peers, which are focusing on cancer types that are prevalent in China such as lung, liver and gastric cancer, Xue’s firm is fixing its eyes on brain tumors and esophageal squamous cell carcinoma. The executive said that although patient numbers matter, identified patients and clinical benefits carry more weight.
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Glioblastoma multiforme is the most prevalent and aggressive form of brain cancer, and the current standard first-line treatment is Temodar (temozolomide injection), a chemotherapy agent developed by Merck & Co. Inc. and first marketed in 1999.

The average survival in the malignancy is roughly seven months, resulting in a large unmet medical need, Xue said.

A CD95-Fc fusion protein in the TNF family, APG101 is currently under Phase II study for glioblastoma and is the first targeted therapy for the indication in late-stage development, with Apogenix planning to start a Phase III program in Europe.

Although the drug is being studied as a second-line therapy in Europe, the 55-patient Taiwan study (set to start in August) will test it in the first-line setting in combination with temozolomide, during and after radiation therapy. The data generated are also expected to complement the Apogenix data obtained in Europe, Xue said.

“A clear pathway and potential benefits to patients” provided CANbridge with the main reasons to license the asset for greater China. Additionally, Xue said the company is also looking to expand to other cancer indications once it obtains proof-of-concept data. APG101 is already being developed for myelodysplastic syndromes, where CANbridge has an option to acquire selected rights.

Similarly, there is a lack of effective treatments for ESCC, which affects people in certain regions of China.

MAH Impact

China’s rollout of the marketing authorization holder (MAH) pilot scheme is enabling smaller biotechs like CANbridge to file for their own regulatory approvals for the first time. “MAH is opening the door,” Xue pointed out, adding that WuXi is one of the few CMOs with international standards.

Another factor is that WuXi has experience filing new drug approvals with the China FDA. Even as the goal is to develop the Apogenix asset into an international first-in-class drug, Xue said manufacturing such a product will even be a new challenge for WuXi.

In another move under the MAH scheme, German’s Boehringer Ingelheim GMBH has also set up a CMO subsidiary in China and has partnered with BeiGene (Beijing) Co. Ltd. to manufacture BeiGene’s anti-PD-1 monoclonal antibody BGB-A317 (“Beigene/Boehringer Biomanufacturing Bond Tests China MAH System” — PharmAsia News, Mar. 10, 2016 6:28 AM GMT).

WuXi Links With Juno

Meanwhile, WuXi – China’s largest contract research organization – has been busy signing other deals, including wit Juno Therapeutics Inc. to set up a 50/50 joint venture, JW Biotechnology (Shanghai) Co. Ltd, to develop immune-oncology products in China.

The JV will leverage Juno’s technology in chimeric antigen receptor (CAR) and T-cell receptor drugs and WuXi’s R&D and manufacturing capabilities, and plans to in-license the rights in China to Juno products in exchange for undisclosed upfront, milestone and royalty payments.

The new joint venture is being led by WuXi’s co-founding CEO James Li, formerly a partner with Kleiner Perkins and GM for Amgen Inc. in China, while WuXi chairman Ge Li serves as chairman. Other board directors include Juno CEO Hans Bishop, Juno CFO Steve Harr and WuXi CFO Edward Hu.

Juno is one of the portfolio firms that had previously received investment from WuXi Healthcare Ventures (“WuXi AppTec Aiming To Relist Biologics Unit In Hong Kong IPO” — PharmAsia News, Mar. 4, 2016 1:21 AM GMT).

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UPDATED: China’s CANbridge files Taiwan IND for PhI/II anti-TNF candidate

FiercePharmaAsiahttp://www.fiercepharmaasia.com/story/chinas-canbridge-files-taiwan-ind-phiii-anti-tnf-candidate/2016-04-07

Topics:

Clinical trials | Partnering

UPDATED: China’s CANbridge files Taiwan IND for PhI/II anti-TNF candidate

Adds comments from Xue

April 7, 2016 | By EJ Lane

Share

Beijing-based CANbridge Life Sciences has sent the Taiwan FDA an Investigational New Drug (IND) application for candidate CAN-008 aimed at brain cancer immunotherapy that was in-licensed for China rights from Germany’s Apogenix.

 CEOJamesXue

CANbridge Chairman and CEO James Xue

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The Taiwan trials will see CAN-008 administered with temozolomide (Temodar) along with radiation therapy for 55 patients in the open-label, dose-escalation Phase I on safety, tolerability pharmacokinetics and preliminary efficacy, according to a press release.

The WuXi Biologics unit of Shanghai-based WuXi AppTec will manufacture the candidate in China, aiming to use the speedier IND process in Taiwan as a possible springboard into Mainland China, though the pathway relies on China FDA granting a fast-track review.

“We are delighted to join forces with WuXi, which will manufacture CAN-008 for the Chinese market, where we plan to begin the pre-clinical work immediately, preparatory to an IND submission,” James Xue, CANbridge Chairman and CEO, said in a statement. CANbridge will rely on WuXi for CD-95 fusion protein.

In a phone interview with FiercePharmaAsia, Xue said that patient enrollment should be finished by the end of the year and results for the Phase I leg out by the second quarter of 2017. He said the trial was being conducted under a 4 + 4 arrangement between Taiwan and China that recognizes clinical trial data from 4 hospitals in each country.

In that regard, CANbridge hopes to take successful Phase I data to the China FDA for an IND application and if the data is exceptional – aim for a straight shot into Phase II without having to repeat the Phase I in China.

With a bit more than $15 million raised up to Series A, Xue expects Series B cash this year at around twice that amount to carry on work through 2018, adding that he sees the biotech space in China moving to a “self-select” mode in funding in the coming years as excellent talent and candidates are in place now.

The multi-center, double-blind, randomized, placebo-controlled Phase II leg of the trial eyes efficacy and safety with a start date seen in August of this year.

Apogenix’s own efforts in a Phase II trial in Europe saw increased median survival to 16.1 months from 6.5 months and meeting efficacy endpoints and no serious adverse effects.

In March, CANbridge inked a deal worth a potential $134 million deal with Nasdaq-listed Aveo Oncology ($AVEO) for a clinical-stage ErbB3 (HER3) antibody candidate AV203.

CANbridge received $10 million in venture capital financing in October of last year, led by Qiming Venture Partners and TF Capital, the venture arm of Chinese CRO Tigermed, which built on angel investor funding of the same amount received in 2014.