India's drug regulatory committee has denied Pfizer Products India's request to bypass local clinical trials for its multiple myeloma therapy, creating a setback for the company's plans to introduce the treatment to the Indian market.
The Subject Expert Committee (SEC) under the Central Drug Standard Control Organisation (CDSCO) reviewed Pfizer's proposal during an oncology meeting held on April 3-4, 2024. After deliberation, the committee rejected the firm's request for a waiver of local clinical trials that would have allowed the import and marketing of elranatamab solution for injection.
Drug Profile and Mechanism of Action
Elranatamab is a bispecific antibody specifically designed to treat adults with relapsed or refractory multiple myeloma. The drug functions as a B-cell maturation antigen (BCMA)-directed CD3 T-cell engager, representing an innovative approach to treating this challenging hematological malignancy.
The molecular structure of elranatamab consists of a humanized immunoglobulin 2-alanine kappa antibody derived from two monoclonal antibodies: an anti-BCMA monoclonal antibody and an anti-CD3 monoclonal antibody. Each contributes one heavy chain and one light chain to the drug's structure, creating a molecule that can simultaneously bind to cancer cells and immune cells.
Regulatory Status and Indication
Pfizer had sought permission to import and market elranatamab solution for injection in two formulations: 44 mg/1.1 mL (40 mg/mL) and 76 mg/1.9 mL (40 mg/mL). The proposed indication was as monotherapy for adult patients with relapsed and refractory multiple myeloma who have received at least three prior therapies, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody, and who have demonstrated disease progression on the last therapy.
The SEC noted that elranatamab currently holds accelerated approval (conditional approval) from the U.S. Food and Drug Administration (FDA) for a similar indication. This approval was based on Phase II clinical trial data, with the trial still ongoing. In the United States, the drug is approved for patients who have received at least four prior lines of therapy.
Implications for Indian Patients
The rejection of the clinical trial waiver means that Pfizer will likely need to conduct local studies in Indian patients before gaining regulatory approval. This requirement ensures that the safety and efficacy of elranatamab are specifically evaluated in the Indian population, which may have different genetic backgrounds, comorbidities, and treatment responses compared to populations studied in global trials.
For Indian patients with relapsed and refractory multiple myeloma who have exhausted multiple lines of therapy, this decision delays access to a potentially beneficial treatment option. Multiple myeloma remains a challenging disease to treat, particularly in patients who have failed multiple prior therapies.
Next Steps for Pfizer
Following this regulatory setback, Pfizer will need to reassess its strategy for bringing elranatamab to the Indian market. Options may include conducting the required local clinical trials, appealing the SEC's decision, or providing additional data to support their waiver request.
The company has not yet publicly commented on its plans following the committee's decision or provided a timeline for potential local clinical trials.
