11/02/2021
Sporadic basal cell carcinoma (BCC) is the most frequent malignant tumor in Caucasians (most common skin cancer worldwide). Generally, BCCs grow slowly and rarely metastasize or are fatal. Depending on tumour size, histological subtype (‘infiltrative’, ‘micronodular’ and ‘morphoeic’), tumor localization (mostly face) and perineural spread, some BCCs are considered high risk. Those, and neglected or inadequately treated BCCs, have a greater potential of progressing to locally advanced BCC (laBCC). laBCCs are at least 5.0 cm in maximum dimension, show deep tissue invasion, may metastasize and cause substantial morbidity or even mortality. Because laBCCs are histologically indistinguishable from common BCCs, they are classified according to the phenotypic characteristics as described above.
Most occur on the head and neck, where cosmetic and functional outcomes are critical. BCC can be locally destructive if not diagnosed early and treated appropriately.
On February 9, 2021, the Food and Drug Administration granted regular approval to cemiplimab-rwlc (Libtayo, Regeneron Pharmaceuticals, Inc.) for patients with locally advanced basal cell carcinoma (laBCC) previously treated with a hedgehog pathway inhibitor (HHI) or for whom a HHI is not appropriate and granted accelerated approval to cemiplimab-rwlc for patients with metastatic BCC (mBCC) previously treated with a HHI or for whom a HHI is not appropriate.
Cemiplimab-rwlc is a human programmed death receptor-1 (PD-1) blocking antibody. Cemiplimab-rwlc is a recombinant human IgG4 monoclonal antibody that binds to PD-1 and blocks its interaction with PD-L1 and PD-L2. Cemiplimab-rwlc is produced by recombinant DNA technology in Chinese hamster o***y (CHO) cell suspension culture. Cemiplimab-rwlc has an approximate molecular weight of 146 kDa. LIBTAYO (cemiplimab-rwlc) injection for intravenous use is a sterile, preservative-free, clear to slightly opalescent, colorless to pale yellow solution with a pH of 6. The solution may contain trace amounts of translucent to white particles. Each vial contains 350 mg of cemiplimab-rwlc. Each mL contains cemiplimab-rwlc 50 mg, L-histidine (0.74 mg), L-histidine monohydrochloride monohydrate (1.1 mg), sucrose (50 mg), L-proline (15 mg), Polysorbate 80 (2 mg), and Water for Injection, USP.
Efficacy was evaluated in Study an ongoing open-label, multi-center, non-randomized trial in patients with advanced BCC (laBCC or mBCC) who had progressed on HHI therapy, had not had an objective response after 9 months on HHI therapy, or were intolerant of prior HHI therapy. Eligibility required that laBCC patients were not candidates for curative surgery or curative RT, per multidisciplinary assessment. All patients received cemiplimab-rwlc 350 mg every 3 weeks for up to 93 weeks until disease progression, unacceptable toxicity, or completion of planned treatment.
The main efficacy outcome measures were confirmed objective response rate (ORR) and duration of response (DOR) as assessed by independent central review. For patients without externally visible target lesions (mBCC), confirmed ORR was assessed according to RECIST 1.1. A composite response assessment incorporating clinical response criteria using digital medical photography together with RECIST 1.1, was used for those with externally visible target lesions (laBCC and mBCC).
Among 84 patients with laBCC, the confirmed ORR was 29% (95% CI: 19, 40) with a median DOR not reached (range: 2.1 to 21.4+ months) and 79% of responders maintaining their response for at least 6 months. Among 28 patients with mBCC, the confirmed ORR was 21% (95% CI: 8, 41) with a median DOR not reached (range: 9 to 23.0+ months), and all responders maintaining their responses for at least 6 months.
Severe adverse reactions are immune-mediated adverse reactions (e.g. pneumonitis, hepatitis, colitis, adrenal insufficiency, hypo- and hyperthyroidism, diabetes mellitus and nephritis) and infusion reactions. The most common adverse reactions (incidence ≥ 20%) were fatigue, musculoskeletal pain, diarrhea, rash, and pruritis.
The recommended dosage of cemiplimab-rwlc is 350 mg as an intravenous infusion over 30 minutes every 3 weeks until disease progression or unacceptable toxicity.
View full prescribing information for Libtayo.
This review used the Assessment Aid, a voluntary submission from the applicant to facilitate the FDA’s assessment.
This application was granted priority review. A description of FDA expedited programs is in the Guidance for Industry: Expedited Programs for Serious Conditions-Drugs and Biologics.