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Bristol Myers Squibb (NYSE: BMY) announced the U.S. FDA’s accelerated approval of KRAZATIĀ® (adagrasib) in combination with cetuximab for adult patients with previously treated KRAS G12C-mutated locally advanced or metastatic colorectal cancer (CRC).
The approval is based on positive results from the Phase 1/2 KRYSTAL-1 study, which showed an objective response rate (ORR) of 34% in patients with heavily pretreated CRC. The median duration of response (DOR) was 5.8 months. This combination therapy provides a new treatment option for CRC patients who have not responded well to prior therapies.
KRAZATI is the first KRAS G12C inhibitor approved beyond non-small cell lung cancer, marking a significant milestone for BMS and reinforcing the potential of KRAZATI across various tumor types.
However, it comes with warnings and precautions including gastrointestinal adverse reactions, QTc interval prolongation, hepatotoxicity, and interstitial lung disease. The most common adverse reactions include rash, nausea, diarrhea, fatigue, and musculoskeletal pain.
Positive
- FDA accelerated approval for KRAZATIĀ® in combination with cetuximab for KRAS G12C-mutated CRC.
- Objective response rate (ORR) of 34% in Phase 1/2 KRYSTAL-1 study.
- Median duration of response (DOR) was 5.8 months.
- First KRAS G12C inhibitor approved beyond non-small cell lung cancer.
- Provides new treatment options for patients with response to prior therapies.
Negative
- Serious adverse reactions occurred in 30% of patients.
- Common adverse reactions include rash, nausea, diarrhea, fatigue, and musculoskeletal pain.
- Warnings include gastrointestinal adverse reactions, QTc interval prolongation, hepatotoxicity, and interstitial lung disease.
The recent FDA approval of KRAZATI in combination with cetuximab for KRASG12C-mutated colorectal cancer (CRC) is significant. KRAS mutations have historically been difficult to target and this approval offers a new therapeutic option for patients whose cancer has progressed post-treatment with standard chemotherapies. One notable aspect is the objective response rate (ORR) of 34%, despite being in a heavily pretreated patient group. This is a substantial improvement over the 1-6% ORR seen with other late-line treatments. However, it also comes with significant side effects, including gastrointestinal issues and potential hepatotoxicity. The approval is contingent upon further verification through confirmatory trials, which could impact long-term outcomes. The accelerated approval mechanism underscores the urgency of making new treatments available while balancing safety and efficacy.
From a financial perspective, this approval is a noteworthy milestone for Bristol Myers Squibb (BMY). It highlights the company’s expanding oncology portfolio and innovation in targeting difficult cancer mutations. The initial market impact is tempered by the conditional nature of the approval, requiring additional confirmatory trials. This could create some uncertainties for long-term revenue projections. However, given the limited effective treatments for KRASG12C-mutated CRC, this approval positions BMY favorably, potentially driving short-term market interest and stock performance. Investors should monitor the outcomes of ongoing trials and further safety data to assess long-term viability.
KRAZATI’s mechanism as a KRASG12C inhibitor combined with cetuximab offers a targeted approach to a previously ‘undruggable’ mutation. This approval is based on the Phase 1/2 KRYSTAL-1 study, with a median duration of response (DOR) of 5.8 months. While promising, the relatively short DOR suggests that while the treatment can halt disease progression temporarily, it may not offer long-term benefits for all patients. The safety profile, particularly the high incidence of severe adverse reactions, will also necessitate careful patient management. The combination’s ability to enhance KRAS signaling inhibition due to adagrasibās long half-life and CNS penetration is a important factor in its efficacy.
Approval based on results from the Phase 1/2 KRYSTAL-1 study where KRAZATI in combination with cetuximab showed an objective response rate of 34% in pretreated patients with locally advanced or metastatic CRC harboring a KRASG12C mutation1
Second FDA approval for KRAZATI – reinforcing its potential across tumor types
PRINCETON, N.J.–(BUSINESS WIRE)– Bristol Myers SquibbĀ (NYSE: BMY) today announced that the U.S. Food and Drug Administration (FDA) has granted accelerated approval for KRAZATIĀ® (adagrasib) in combination with cetuximab as a targeted treatment option for adult patients with KRASG12C-mutated locally advanced or metastatic colorectal cancer (CRC), as determined by an FDA-approved test, who have received prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy. This indication is approved under accelerated approval based on objective response rate (ORR) and duration of response (DOR) results. Continued approval for this indication may be contingent upon verification and description of a clinical benefit in a confirmatory trial.Ā
āCRC with a KRASG12C mutation occurs in approximately 3-4% of CRC patients and has historically been challenging to treat,ā2 said Rona Yaeger, MD, Gastrointestinal Oncologist & Early Drug Development Specialist, Memorial Sloan Kettering Cancer Center. āThe FDA approval of KRAZATI combined with cetuximab now provides a new treatment option to these patients when their tumors do not respond well to prior therapies.ā
The approval is based on results from cohorts of the Phase 1/2 KRYSTAL-1 open-label study which evaluated KRAZATI (600 mg tablets administered orally twice daily) in combination with cetuximab in 94 patients with heavily pretreated CRC harboring a KRASG12C mutation. The study met its primary endpoint, with a confirmed ORR of 34% (n=94, 95% CI: 25-45) for KRAZATI with cetuximab, all of which were partial responses. The median DOR, one of the secondary endpoints, was 5.8 months (95% CI: 4.2-7.6).1 Current late-line standard of care options result in limited response rates (ORR 1-6%) after progression on chemotherapy Ā± VEGF/VEGFR inhibitors.3,4
KRAZATI is associated with the following Warnings & Precautions: Gastrointestinal adverse reactions including diarrhea, nausea, and vomiting, QTc interval prolongation, hepatotoxicity, and interstitial lung disease (ILD)/pneumonitis.1 Please see Important Safety Information below.
āTodayās approval of KRAZATI in CRC is the second in the U.S. for this therapy and the first for BMS’ recently expanded oncology portfolio. This is an important milestone for BMS and the patients we serve as we deliver on our commitment to provide innovative medicines for cancer,ā said Wendy Short Bartie, senior vice president, U.S. Oncology and Hematology at Bristol Myers Squibb. āWe are proud to make KRAZATI – the first KRASG12C inhibitor to be FDA approved beyond non-small cell lung cancer – available to CRC patients, and look forward to further evaluating KRAZATI through our ongoing development program.ā
In 2022, the FDA granted breakthrough therapy designation for KRAZATI in combination with cetuximab for patients with KRASG12C-mutated advanced CRC whose cancer has progressed following prior treatment with certain chemotherapy and an anti-VEGF therapy.
KRAZATI is an irreversible inhibitor of KRASG12C with a long half-life (23 hours), dose-dependent pharmacokinetics (PK), and central nervous system (CNS) penetration, which, in combination with cetuximab may enhance inhibition of KRAS-dependent signaling or overcome adaptive feedback.
The company partnered with QIAGEN to develop a tissue-based companion diagnostic (CDx) for KRAZATI that is now available.
KRAZATI is a registered trademark of Mirati Therapeutics, Inc., a Bristol Myers Squibb company.
About KRYSTAL-1
KRYSTAL-1 is an open-label, multicenter, multiple expansion cohort Phase 1/2 trial to determine the safety and efficacy of KRAZATI in patients with advanced colorectal cancer (CRC) that harbor a KRASG12C mutation. The primary endpoint for the Phase 2 cohort of the KRYSTAL-1 study was objective response rate (ORR). Secondary endpoints included duration of response (DOR).
The KRYSTAL-1 study was funded by Mirati Therapeutics, Inc., a Bristol Myers Squibb company.
Select Safety Profile from KRYSTAL-1
The safety profile for KRAZATI plus cetuximab was evaluated in patients with KRASG12C-mutated, locally advanced or metastatic CRC, and is consistent with previous reports and known safety profile of each drug individually. Serious adverse reactions occurred in 30% of 94 patients who received KRAZATI in combination with cetuximab. The most common adverse reactions (ā„20%) were rash, nausea, diarrhea, vomiting, fatigue, musculoskeletal pain, hepatotoxicity, headache, dry skin, abdominal pain, decreased appetite, edema, anemia, dizziness, cough, constipation, and peripheral neuropathy.1
About Colorectal Cancer
Colorectal cancer (CRC) is cancer that develops in the colon or the rectum, which are part of the bodyās digestive, or gastrointestinal, system.5 CRC is the third most commonly diagnosed cancer in the world.6 In 2024, it is estimated that there will be approximately 106,590 new cases of the disease in the U.S.; it is the second leading cause of cancer-related deaths in the U.S. among men and women combined.7
KRAS is the most frequently mutated oncogene in human cancer and is one that drives oncogenesis in up to 50% of patients with CRC.2 The KRASG12C mutation occurs in approximately 3-4% of CRC cases.2
About KRAZATIĀ® (adagrasib)
KRAZATI (adagrasib) is a highly selective and potent oral small-molecule inhibitor of KRASG12C that is optimized to sustain target inhibition, an attribute that could be important to treat KRASG12C-mutated cancers, as the KRASG12C protein regenerates every 24-48 hours.8 KRASG12C mutations act as oncogenic drivers and occur in approximately 14% of non-small cell lung cancer (NSCLC; adenocarcinoma) and 3% of several other cancers.9,10
In 2022, KRAZATI was granted accelerated approval for treatment of adult patients with KRASG12C-mutated locally advanced or metastatic NSCLC, as determined by an FDA-approved test, who have received at least one prior systemic therapy. This indication is approved under accelerated approval based on objective response rate (ORR) and duration of response (DOR). Continued approval for this indication may be contingent upon verification and description of a clinical benefit in a confirmatory trial.
KRAZATI continues to be evaluated as a monotherapy and in combination with other anti-cancer therapies in patients with advanced KRASG12C-mutated solid tumors, including NSCLC and CRC.
Please see U.S. Full Prescribing Information for KRAZATI.
INDICATIONS
KRAZATI in combination with cetuximab is indicated for the treatment of adult patients with KRASG12C-mutated locally advanced or metastatic colorectal cancer (CRC), as determined by an FDA-approved test, who have received prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy.
KRAZATI, as a single agent, is indicated for the treatment of adult patients with KRASG12C-mutated locally advanced or metastatic non-small cell lung cancer (NSCLC), as determined by an FDA-approved test, who have received at least one prior systemic therapy.
These indications are approved under accelerated approval based on objective response rate (ORR) and duration of response (DOR). Continued approval for these indications may be contingent upon verification and description of a clinical benefit in confirmatory trials.
IMPORTANT SAFETY INFORMATION
IMPORTANT SAFETY INFORMATION
WARNINGS AND PRECAUTIONS
Gastrointestinal Adverse Reactions
- KRAZATI can cause severe gastrointestinal adverse reactions.
- Monitor and manage patients using supportive care, including antidiarrheals, antiemetics, or fluid replacement, as indicated. Withhold, reduce the dose, or permanently discontinue KRAZATI based on severity.
QTc Interval Prolongation
- KRAZATI can cause QTc interval prolongation, which can increase the risk for ventricular tachyarrhythmias (eg, torsades de pointes) or sudden death.
- Avoid concomitant use of KRAZATI with other products with a known potential to prolong the QTc interval. Avoid use of KRAZATI in patients with congenital long QT syndrome and in patients with concurrent QTc prolongation.
- Monitor ECGs and electrolytes, particularly potassium and magnesium, prior to starting KRAZATI, during concomitant use, and as clinically indicated in patients with congestive heart failure, bradyarrhythmias, electrolyte abnormalities, and in patients who are unable to avoid concomitant medications that are known to prolong the QT interval. Correct electrolyte abnormalities. Withhold, reduce the dose, or permanently discontinue KRAZATI, depending on severity.
Hepatotoxicity
- KRAZATI can cause hepatotoxicity, which may lead to drug-induced liver injury and hepatitis.
- Monitor liver laboratory tests (AST, ALT, alkaline phosphatase, and total bilirubin) prior to the start of KRAZATI, and monthly for 3 months or as clinically indicated, with more frequent testing in patients who develop transaminase elevations. Reduce the dose, withhold, or permanently discontinue KRAZATI based on severity.
Interstitial Lung Disease/Pneumonitis
- KRAZATI can cause interstitial lung disease (ILD)/pneumonitis, which can be fatal.
- Monitor patients for new or worsening respiratory symptoms indicative of ILD/pneumonitis (eg, dyspnea, cough, fever) during treatment with KRAZATI. Withhold KRAZATI in patients with suspected ILD/pneumonitis and permanently discontinue KRAZATI if no other potential causes of ILD/pneumonitis are identified.
ADVERSE REACTIONS
- Serious adverse reactions occurred in 57% of 116 patients who received adagrasib in NSCLC patients. The most common adverse reactions in NSCLC patients (ā„20%) were diarrhea, nausea, fatigue, vomiting, musculoskeletal pain, hepatotoxicity, renal impairment, dyspnea, edema, decreased appetite, cough, pneumonia, dizziness, constipation, abdominal pain, and QTc interval prolongation.
- Serious adverse reactions occurred in 30% of 94 patients who received adagrasib in combination with cetuximab. The most common adverse reactions in CRC patients (ā„20%) were rash, nausea, diarrhea, vomiting, fatigue, musculoskeletal pain, hepatotoxicity, headache, dry skin, abdominal pain, decreased appetite, edema, anemia, dizziness, cough, constipation, and peripheral neuropathy.
DRUG INTERACTIONS
- Strong CYP3A4 Inducers: Avoid concomitant use.
- Strong CYP3A4 Inhibitors: Avoid concomitant use until adagrasib concentrations have reached steady state (after ~8 days).
- Sensitive CYP3A4 Substrates: Avoid concomitant use with sensitive CYP3A4 substrates.
- Sensitive CYP2C9 or CYP2D6 Substrates or P-gp Substrates: Avoid concomitant use with sensitive CYP2C9 or CYP2D6 substrates or P-gp substrates where minimal concentration changes may lead to serious adverse reactions.
- Drugs That Prolong QT Interval: Avoid concomitant use with KRAZATI.
Please see Drug Interactions Section of the Full Prescribing Information for additional information.
USE IN SPECIFIC POPULATIONS
Females and Males of Reproductive Potential
- Infertility: Based on findings from animal studies, KRAZATI may impair fertility in females and males of reproductive potential.
Lactation
- Advise not to breastfeed.
Please see U.S. Full Prescribing Information for KRAZATI.
Bristol Myers Squibb: Creating a Better Future for People with Cancer
Bristol Myers Squibb is inspired by a single vision ā transforming patientsā lives through science. The goal of the companyās cancer research is to deliver medicines that offer each patient a better, healthier life and to make cure a possibility. Building on a legacy across a broad range of cancers that have changed survival expectations for many, Bristol Myers Squibb researchers are exploring new frontiers in personalized medicine and, through innovative digital platforms, are turning data into insights that sharpen their focus. Deep understanding of causal human biology, cutting-edge capabilities and differentiated research platforms uniquely position the company to approach cancer from every angle.
Cancer can have a relentless grasp on many parts of a patientās life, and Bristol Myers Squibb is committed to taking actions to address all aspects of care, from diagnosis to survivorship. As a leader in cancer care, Bristol Myers Squibb is working to empower all people with cancer to have a better future.
About Bristol Myers Squibb
Bristol Myers Squibb is a global biopharmaceutical company whose mission is to discover, develop, and deliver innovative medicines that help patients prevail over serious diseases. For more information about Bristol Myers Squibb, please visit BMS.com or follow us on LinkedIn, X (formerly Twitter), YouTube, Facebook, and Instagram.
Cautionary Statement Regarding Forward-Looking Statements
This press release contains āforward-looking statementsā within the meaning of the Private Securities Litigation Reform Act of 1995 regarding, among other things, the research, development and commercialization of pharmaceutical products. All statements that are not statements of historical facts are, or may be deemed to be, forward-looking statements. Such forward-looking statements are based on current expectations and projections about our future financial results, goals, plans and objectives and involve inherent risks, assumptions and uncertainties, including internal or external factors that could delay, divert or change any of them in the next several years, that are difficult to predict, may be beyond our control and could cause our future financial results, goals, plans and objectives to differ materially from those expressed in, or implied by, the statements. These risks, assumptions, uncertainties and other factors include, among others, whether KRAZATI (adagrasib) in combination with cetuximab for the additional indication described in this release will be commercially successful, that any marketing approvals, if granted, may have significant limitations on their use, and that continued approval of KRAZATI in combination with cetuximab for such additional indication described in this release may be contingent upon verification and description of clinical benefit in confirmatory trials. No forward-looking statement can be guaranteed. Forward-looking statements in this press release should be evaluated together with the many risks and uncertainties that affect Bristol Myers Squibbās business and market, particularly those identified in the cautionary statement and risk factors discussion in Bristol Myers Squibbās Annual Report on Form 10-K for the year ended December 31, 2023, as updated by our subsequent Quarterly Reports on Form 10-Q, Current Reports on Form 8-K and other filings with the Securities and Exchange Commission. The forward-looking statements included in this document are made only as of the date of this document and except as otherwise required by applicable law, Bristol Myers Squibb undertakes no obligation to publicly update or revise any forward-looking statement, whether as a result of new information, future events, changed circumstances or otherwise.
1 KRAZATI. Prescribing Information. Princeton, NJ. Mirati Therapeutics, Inc., a Bristol Myers Squibb company; 2024.
2 Yaeger, R., Weiss, et al. Adagrasib with or without cetuximab in colorectal cancer with mutated KRAS G12C. New England Journal of Medicine. 2023;388(1), 44ā54. https://doi.org/10.1056/nejmoa2212419
3 Prager, G., et al. TrifluridineāTipiracil and Bevacizumab in Refractory Metastatic Colorectal Cancer. New England Journal of Medicine. 2023 May 4;388(18). https://www.nejm.org/doi/full/10.1056/NEJMoa2214963
4 Grothey, A., et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. https://pubmed.ncbi.nlm.nih.gov/23177514/
5 What is colorectal cancer? American Cancer Society. (n.d.) https://www.cancer.org/cancer/colon-rectal-cancer/about/what-is-colorectal-cancer.html
6 Globocan 2020, World https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf
7 Colorectal cancer statistics: How common is colorectal cancer? American Cancer Society. (n.d.). https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html
8 Hallin J, Engstrom LD, Hargis L, et al. The KRAS Inhibitor MRTX849 Provides Insight toward Therapeutic Susceptibility of KRAS-Mutant Cancers in Mouse Models and Patients. Cancer Discov. 2020;10(1):54-71
9 Campbell et al, Nature Genetics 2016 āDistinct patterns of somatic genome alterations in lung adenocarcinomas
10 Nassar, A., et al. Distribution of KRASG12C Somatic Mutations across Race, Sex, and Cancer Type. New England Journal of Medicine, 384:185-187. https://doi.org/10.1056/nejmc2030638
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FAQ
What recent FDA approval did Bristol Myers Squibb (BMY) receive?
Bristol Myers Squibb received FDA accelerated approval for KRAZATIĀ® (adagrasib) in combination with cetuximab for KRAS G12C-mutated colorectal cancer (CRC).
What is the objective response rate for KRAZATIĀ® with cetuximab in the KRYSTAL-1 study?
The objective response rate (ORR) for KRAZATIĀ® with cetuximab in the KRYSTAL-1 study was 34%.
For which patients is KRAZATIĀ® approved?
KRAZATIĀ® is approved for adult patients with KRAS G12C-mutated locally advanced or metastatic colorectal cancer (CRC) who have received prior treatment.
What are common adverse reactions for KRAZATIĀ® in combination with cetuximab?
Common adverse reactions include rash, nausea, diarrhea, fatigue, and musculoskeletal pain.
What significant milestone does the approval of KRAZATIĀ® represent for Bristol Myers Squibb (BMY)?
The approval marks the first FDA approval of a KRAS G12C inhibitor beyond non-small cell lung cancer, indicating its potential across multiple tumor types.
