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Device/Product name
Lorviqua
Active Ingredient
Lorlatinib
Date of decision
Published
Submission type
New chemical entity
ATC codes
L01XE44
Decision
Approved for provisional registration
What was the decision based on
The decision was based on quality (chemistry and manufacturing), nonclinical (pharmacology and toxicology), clinical (pharmacology, safety and efficacy) and risk management plan information submitted by the sponsor. The benefit-risk profile of Lorviqua was considered favourable for the therapeutic use approved.
What steps were involved in the decision process

Registration timeline

The following table summarises the key steps and dates for this application.

Description Date
Submission dossier accepted and first round evaluation commenced 30 November 2018
First round evaluation completed 3 May 2019
Sponsor provides responses on questions raised in first round evaluation 28 June 2019
Second round evaluation completed 24 October 2019
Delegate's overall benefit-risk assessment 12 September 2019
Sponsor's pre-Advisory Committee response Not applicable
Advisory Committee meeting Not applicable
Registration decision (Outcome) 11 November 2019
Completion of administrative activities and registration on ARTG 19 November 2019
Number of working days from submission dossier acceptance to registration decision* 197

*Statutory timeframe for standard applications is 255 working days

Date of entry onto ARTG
Original publication date
Black triangle scheme
Yes. This product will remain in the scheme for the entire period of provisional registration.
Dose forms
Tablet, film coated
Strength
25 mg and 100 mg
Other ingredients

Tablet core contains: Microcrystalline cellulose, Calcium hydrogen phosphate, Sodium starch glycollate, Magnesium stearate.

Film coating contains: Hypromellose (E464), Lactose monohydrate, Macrogol 3350, Triacetin, Titanium dioxide (E171), Iron oxide black (E172), Iron oxide red (E172).

1.58 mg of lactose per 25 mg strength film coated tablet, 4.20 mg of lactose per 100 mg strength film coated tablet.

Containers
Blister pack and bottle (for both strengths)
Pack sizes
Blister pack: 25 mg: 9 blister strips of 10 tablets (90 tablets) per carton or 12 blister strips of 10 tablets (120 tablets) per carton. 100 mg: 3 blister strips (30 tablets) per carton.Each bottle contains 30 tablets.
Routes of administration
Oral
Dosage

The recommended dose of Lorviqua is 100 mg taken orally once daily. Continue treatment for as long as the patient is deriving clinical benefit from therapy.

For further information refer to the Product Information.

Pregnancy category
DDrugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.The use of any medicine during pregnancy requires careful consideration of both risks and benefits by the treating health professional. This must not be used as the sole basis of decision making in the use of medicines during pregnancy. The TGA does not provide advice on the use of medicines in pregnancy for specific cases. More information is available from obstetric drug information services in your State or Territory.
What was approved

Lorviqua (lorlatinib) was provisionally approved for the following therapeutic use:

Lorviqua has provisional approval in Australia for the treatment of patients with anaplastic lymphoma kinase (ALK) positive advanced non small cell lung cancer (NSCLC) whose disease has progressed on:

  • Crizotinib and at least one other ALK inhibitor; or
  • Alectinib as the first ALK inhibitor therapy; or
  • Ceritinib as the first ALK inhibitor therapy.

The decision to approve this indication has been made on the basis of tumour response rate and duration of response in a single arm study. Continued approval of this indication depends on verification and description of benefit in a confirmatory trial.

The provisional registration period for the above medicine is two years starting on the day specified in the ARTG certificate of registration.

What is this medicine and how does it work
Lorlatinib is an adenosine triphosphate (ATP)-competitive, brain-penetrant, small molecule inhibitor of anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1) tyrosine kinases that addresses mechanisms of resistance following previous treatment with ALK inhibitor therapy.In nonclinical studies, lorlatinib inhibited catalytic activities of non-mutated ALK and a broad range of clinically relevant ALK mutant kinases in recombinant enzyme and cell-based assays. The ALK mutations analyzed included those conferring resistance to other ALK inhibitors, including alectinib, brigatinib, ceritinib, and crizotinib.Lorlatinib demonstrated anti-tumour activity at nanomolar free plasma concentrations in mice bearing tumor xenografts that express echinoderm microtubule-associated protein-like 4 (EML4) fusions with ALK variant 1 (v1), including ALK mutations L1196M, G1269A, G1202R, and I1171T. Two of these ALK mutants, G1202R and I1171T, are known to confer resistance to first and second generation ALK inhibitors. Lorlatinib is also capable of penetrating the blood-brain barrier and achieved efficacious brain exposure in mice and rat. In mice bearing orthotopic EML4-ALK or EML4-ALKL1196M brain tumour implants, lorlatinib caused tumour shrinkage and prolonged survival. The overall anti-tumour efficacy of lorlatinib was dose-dependent and strongly correlated with inhibition of ALK phosphorylation.
What post-market commitments will the sponsor undertake
  • Lorviqua (lorlatinib) is to be included in the Black Triangle Scheme. The Product Information (PI) and Consumer Medicines Information (CMI) for Lorviqua must include the black triangle symbol and mandatory accompanying text for the products entire period of provisional registration.
  • Confirmatory trial data (as identified in the sponsor's plan to submit comprehensive clinical data on the safety and efficacy of the medicine before the end of the 6 years that would start on the day that registration would commence) must be provided. Specifically the sponsor must conduct studies as described in the clinical study plan submitted with version 0.1 (date 11 April 2018) of the Australia-Specific Annex. The following study report(s) should be submitted to TGA:
    • B7461006; A Phase III, randomised, open label study of lorlatinib (PF-06463922) monotherapy versus crizotinib monotherapy in the first-line treatment of patients with advanced ALK-positive non-small cell lung cancer; by Q4 2021.
  • The Lorviqua European Union-Risk Management Plan (EU-RMP) (version 1.0, dated 26 February 2019, data lock point 2 February 2018), with Australian Specific Annex (version 0.2, dated 26 August 2019), included with submission PM-2018-04291-1-4, to be revised to the satisfaction of the TGA, will be implemented in Australia.

    An obligatory component of risk management plans is routine pharmacovigilance. Routine pharmacovigilance includes the submission of periodic safety update reports (PSURs).

    Reports are to be provided in line with the current published list of EU reference dates and frequency of submission of PSURs until the period covered by such reports is not less than three years from the date of this approval letter.

    The reports are to at least meet the requirements for PSURs as described in the European Medicines Agency's Guideline on Good Pharmacovigilance Practices (GVP) Module VII periodic safety update report (Rev 1), Part VII.B Structures and processes. Note that submission of a PSUR does not constitute an application to vary the registration.

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