The FDA has granted approval to nilotinib tablets (Danziten; Azurity Pharmaceuticals) for the treatment of adults with newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in the chronic phase. This new formulation is the first and only nilotinib approved with no mealtime restrictions, according to Azurity Pharmaceuticals.
Nilotinib is also indicated for adult patients with chronic phase and accelerated phase CML who are resistant or intolerant to prior therapy, including imatinib. Tasigna, another formulation of nilotinib, has proven effective in treating adults with newly diagnosed Ph+ CML-CP and resistant or intolerant Ph+ CML-CP and CML-AP. However, Tasigna's bioavailability varies significantly and increases when taken with food. Critically, taking Tasigna with food can significantly prolong the QT interval on an electrocardiogram, necessitating strict fasting.
A poster presented by Radich et al. at the Society of Hematology Oncology (SOHO) 2024 Annual World Conference in September 2024 highlighted the efficacy of Danziten as a re-engineered formulation of nilotinib that does not require mealtime restrictions. The study indicated that this new formulation offers equivalent efficacy to Tasigna but with improved bioavailability, allowing for a lower dose and eliminating food-related restrictions. Clinical trials have shown that the reformulated nilotinib has consistent pharmacokinetics and no clinically significant differences in exposure, regardless of fasting state or meal type, while maintaining the same efficacy as previously indicated for nilotinib.
Clinical Impact and Expert Commentary
"Danziten offers a new nilotinib treatment option with the equivalent efficacy to Tasigna, but without the fasting requirements of Tasigna," said Richard Blackburn, CEO of Azurity Pharmaceuticals. "Unlike Tasigna, the boxed warning on the Danziten label has no requirement for patients to take their medication in a fasted state, liberating CML patients from mealtime restrictions."
Tyrosine kinase inhibitors (TKIs) have demonstrated increasing success in clinical trials for CML patients, who often face numerous challenges in managing their treatment and avoiding adverse outcomes. Advancements in TKIs for CML have led to overall survival rates approaching those of the general population. New options like Danziten can help reduce the burden of CML treatment.
Addressing Treatment Challenges in CML
"We need to deliver the lowest dose that can maintain efficacy without long term measurable adverse events," said Elias Jabbour, MD, from the Anderson Cancer Center in Houston, during a presentation at the SOHO meeting in September. Conference attendees noted that mutations in CML, such as Ph+ CML, can significantly affect patient response or resistance to treatment.
New treatments like Danziten can benefit patients with these mutations, particularly those with chronic disease. Furthermore, the elimination of fasting requirements may improve patient adherence to the newly formulated nilotinib.
