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Shanghai, China March 24 th 2001 Xeloda Future Developments Mr. John Collins
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Metastatic breast cancer –monotherapy (taxane + anthracycline failure) first approved April 1998 in the USA now approved in >50 countries –Xeloda/Taxotere combination USA supplementary New Drug Application filed March 2001 European filing April/May 2001 (with monotherapy) Xeloda Registration Update
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First-line, monotherapy of metastatic colorectal cancer (CRC) Xeloda is now approved in 30 countries for CRC Hong Kong, Canada, Australia, Switzerland, Russia and Latin Americas European Union Countries USA: –Xeloda received a letter of approvability from the US FDA on 20 September 2000 Xeloda Registration Update
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Enzymatic activation of Xeloda ® IntestineLiver Xeloda 5'-DFCR 5'-DFUR CyD 5'-DFCR 5'-DFUR 5-FU Tumour Xeloda Thymidine phosphorylase (TP) CyD CE 5'-DFCR = 5'-deoxy-5-fluorocytidine; 5'-DFUR = 5'-deoxy-5-fluorouridine; CyD = cytidine deaminase; CE = carboxylesterase
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Thymidine phosphorylase (TP) activity in human tissues TP activity (µg 5-FU/mg protein/hour) 0100200300400500 115 291 351 309 8 13 17 18 14 23 24 37 13 11 36 35 25 27 16 20 Colorectal Gastric Breast Cervix Uterus Ovarian Renal Bladder Thyroid Liver Liver (metastasis) (n =) Healthy tissue Tumour tissue * * * * * * * * * *p<0.05Miwa M et al. Eur J Cancer 1998;34:1274–81 *
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TP upregulation in tumour xenografts 05101520 (mg/kg) Control Paclitaxel100 Docetaxel15 Vincristine1.5 Vinblastine3 Vindesine5 Mitomycin C5 Doxorubicin7.5 Cisplatin10 Control Methotrexate50 Cyclophosphamide200 TP activity (unit/mg protein) Gemcitabine and vinorelbine also upregulate TP Ishitsuka H. Invest New Drugs 2000;18:343–54
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Xeloda Development Program Ph. II Taxane Failure NO15542 Ph. II Paclitaxel Failure Trial SO14697 Ph. II Breast Cancer, > 55 years: SO15179 Ph. II Anthracycline Failures SO14799 Ph. II CRC - SO14797 Ph. III CRC US - SO14695 Ph. III CRC EU - SO14796 Ph. I Paclitaxel Combo Ph. I Docetaxel Combo Ph. III BC Taxotere Combo Ph. 1 EU/US New Drug Application (NDA) 10/97 NDA 9/99 NDA 3/01
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Xeloda Colorectal Cancer Monotherapy: Summary Superior antitumor activity (26 % vs 17 %) Equivalent time to progression (median 4.6 vs 4.7m) Equivalent survival (median 12.9 vs 12.8 m) Significantly less stomatitis/mucositis, diarrhea, nausea, alopecia and neutropenia leading to significantly less neutropenic fever/sepsis Significantly fewer treatment-related hospitalizations More convenient than cumbersome IV therapy
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Adjuvant monotherapy X-ACT phase III trial –Xeloda vs intravenous bolus 5-FU/LV –1956 patients –Dukes C colon cancer –Primary study endpoint disease free survival Combination therapy –Xeloda / irinotecan phase II/III –Xeloda / oxaliplatin phase II –Xeloda / radiotherapy phase II/III Future Development for Xeloda in Colorectal Cancer
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Xeloda/ Irinotecan Combination Xeloda / irinotecan phase I/II –irinotecan 70 mg/m 2 weekly 6 weeks out of 7 with Xeloda 1000 mg/m 2 twice daily days 1-14 and 22-35 every 7 weeks Xeloda / irinotecan phase II –irinotecan 240 mg/m 2, day 1 (every three weeks) or 120 mg/m 2 days 1 and 8 every three weeks with Xeloda 1000 mg/m 2 twice daily days 1-14 with one week rest period –very promising anti-tumor activity –principal toxicities were diarrhea and neutropenia –trial is ongoing –ASCO 2001
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Xeloda/Oxaliplatin and Xeloda/Radiotherapy Xeloda / oxaliplatin phase II –oxaliplatin 130 mg/m 2 day 1 every three weeks + Xeloda 1000 mg/m 2 twice daily days 1-14 with one week rest period –96 patients –trial has completed recruitment Xeloda / radiotherapy –RT 50.5 grays, 6 weeks (1.8 Gy fractions) + Xeloda (continuous) recommended dose 825 mg/m 2 twice daily first to last day of radiotherapy –excellent tolerability at recommended dose level –tumor downstaging and induction of pCR
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Xeloda in Breast Cancer: summary Excellent response rates (20%) and median overall survival (>12 months) Patients with stable disease (43%) have similar survival to responders Palliative properties Favorable safety profile Patients prefer oral therapy Xeloda/ Taxotere first and only combination to show superior survival compared to a standard monotherapy in anthracycline failures
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Monotherapy –Xeloda vs vinorelbine post-taxanes –Xeloda intermitt vs Xeloda cont vs CMF first line –Xeloda vs ET combo vs ET sequ. first line Combination –EORTC phase III Xeloda + epirubicin (E) + cyclophosphamide (C) vs EC –phase II - 3 weekly docetaxel + Xeloda –phase II - weekly docetaxel + Xeloda Adjuvant –phase III doxorubicin + cyclophosphamide followed by docetaxel vs Xeloda / docetaxel Future Development for Xeloda in Breast Cancer
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Xeloda All Oral Combination Xeloda potential combinations with other oral agents –Colorectal Cancer oral irinotecan OSI 774 (tyrosine kinase inhibitor) Breast Cancer oral cyclophosphamide oral vinorelbine idarubicine oral taxanes
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. Target tumors include –pancreatic –stomach –esophageal –head and neck –renal cell –cervical –hepatic/biliary tract Future Developments for Xeloda - Other Indications
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Roche Oncology Portfolio TumorActivatedXelodaColorectal, Breast Cytotoxic Cancer Monoclonal antibodiesHerceptin Breast Cancer MabThera Lymphoma Novel Mechanism CCISolid tumors (phase I) OSI 774 InterferonsRoferon-A Melanoma, NHL, CML PegasysRCC, CML (phase I)
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Cell DifferentiationVesanoid APL Supportive Care Neupogen Neutropenia, PBSC NeoRecormon Platinum-induced anemia, myeloma, lymphoma, H/N Ostac Hypercalcemia, osteolysis Bondronat Hypercalcemia, breast Roche Oncology Portfolio
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Roche Oncology Portfolio - Vision Continue to research novel agents –specifically targeting cancer cells, –increasing efficacy and safety –focusing on outpatient therapy Patient stratification and selection through diagnostics research with your continued support and expertise for clinical development
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