Johnson & Johnson's erdafitinib has received marketing authorization from the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK for treating adults with unresectable or metastatic urothelial carcinoma (UC), the most common form of bladder cancer. This approval specifically targets patients with fibroblast growth factor receptor 3 (FGFR3) genetic alterations who have previously undergone at least one line of therapy involving a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor.
Addressing a Critical Need in Bladder Cancer Treatment
Bladder cancer affects approximately 10,500 individuals in the UK annually. Around 20% of those with advanced or metastatic bladder cancer exhibit FGFR3 alterations, which can promote cancer cell growth. Professor Alison Birtle, Consultant Oncologist, emphasized the importance of innovative precision therapies for patients with advanced bladder cancer and FGFR3 alterations, noting the limited treatment options previously available. She highlighted that erdafitinib's authorization, a targeted therapy improving overall and progression-free survival, is a welcome advancement. She also emphasized the necessity of integrating biomarker testing to detect genetic alterations like FGFR3 early in the treatment pathway.
Mechanism of Action and Clinical Trial Results
Erdafitinib is a once-daily, oral FGFR kinase inhibitor that functions by inhibiting the activity of FGFR3 alterations in cancer cells. The MHRA authorization is based on data from Cohort 1 of the Phase 3 THOR study, a randomized, open-label, multicenter trial. This study compared the efficacy and safety of erdafitinib (n=136) versus chemotherapy (n=130) in patients with advanced or metastatic UC with select FGFR alterations who had progressed on or after one or two prior treatments, including at least one PD-1 or PD-L1 inhibitor. The primary endpoint was overall survival (OS), with secondary endpoints including progression-free survival (PFS), objective response rate (ORR), and duration of response (DOR).
The THOR study was halted in June 2023 following a recommendation from the independent data safety monitoring committee after an interim analysis of efficacy and safety data. Patients randomized to chemotherapy (docetaxel or vinflunine) were offered erdafitinib as crossover therapy. Results demonstrated a median OS of over one year in patients receiving erdafitinib, a significant improvement compared to chemotherapy (12.1 months vs. 7.8 months; hazard ratio [HR], 0.64; 95 percent confidence interval [CI], 0.44 to 0.93; P=0.005). Erdafitinib also improved median PFS compared to chemotherapy (5.6 months vs. 2.7 months; HR 0.58; 95 percent CI, 0.41 to 0.82; P=0.0002) and showed a confirmed ORR of 35.3 percent (48/136 patients) versus 8.5 percent (11/130 patients).
Safety Profile
The most common adverse reactions associated with erdafitinib include hyperphosphatasemia (78.5 percent), diarrhea (55.5 percent), and stomatitis (52.8 percent). Adverse reactions leading to treatment discontinuation occurred in 19.4 percent of patients.
Industry Perspective
Dr. John Fleming, Country Medical Director at Johnson & Johnson Innovative Medicine UK, expressed delight that the MHRA recognized erdafitinib's value for eligible patients with metastatic urothelial cancer. He emphasized J&J's commitment to delivering innovative precision therapies and anticipates progressing with Health Technology Assessment (HTA) submissions to enable access to erdafitinib through the NHS as soon as possible.
