A novel pill to treat bleeding from uterine fibroids aims for FDA approval

In continuation of my update on elagolix 

A new drug called elagolix cut blood loss by half over six months in the overwhelming majority of women who participated in two clinical trials published Wednesday in the New England Journal of Medicine.

Elagolix, being developed by AbbVie, was approved by the U.S. Food and Drug Administration in 2018 under the brand name Orilissa to reduce the pain of endometriosis—another common, debilitating female disorder.

The fibroid studies, conducted at 77 sites in the United States and Canada, were led by William D. Schlaff, the chair of obstetrics and gynecology at Thomas Jefferson University in Philadelphia. The results have been submitted to the FDA, which is expected to issue its decision in the first half of 2020.

Elagolix works by suppressing the gonadotropin hormone and the ovarian sex hormones, estrogen and progesterone. In effect, it throws women into a temporary menopause.

Because this suppression can cause bone loss, the researchers gave a subset of women low doses of sex hormones along with elagolix. Of those 395 women, about 70% cut their blood loss by half without suffering more bone thinning than women taking a placebo. The "add-back" hormones also reduced menopausal side effects such as hot flashes and night sweats, although these remained common.

"As a clinician working with patients like this for 40 years, I think this is a valuable clinical tool," Schlaff said of elagolix and add-back hormones. "It's oral, the effect is fast onset, and the side-effect profile is tolerable."

The brand name and pricing that would be used if the FDA approves this use of elagolix have not yet been established for the drug, an AbbVie spokesperson said. The list price for a four-week supply of Orilissa is $907.39.

An estimated 80% of women approaching menopause have fibroids—muscular growths in the uterine wall. Half of those women will develop symptoms, primarily heavy menstrual bleeding, which can lead to a blood iron deficiency. Charlotte Owens, medical director at AbbVie, noted that African American women have a higher risk for uterine fibroids and often develop more severe symptoms than Caucasian women.

After menopause, when the ovaries shut down, menstrual bleeding stops, but many women find the transitional bleeding so troublesome that they seek treatment.

Current options—including drugs that target hormones, procedures that destroy the uterine lining or surgical removal of the fibroids or entire uterus—all have drawbacks. A device called an electric morcellator, which minces fibroids and removes the tissue through tiny incisions, has been largely abandoned because in rare cases it can disseminate an undetected uterine cancer. Philadelphia cardiac surgeon Hooman Noorchashm and his late wife, anesthesiologist Amy Reed, campaigned for a ban on morcellators after her cancer was spread during a hysterectomy.

Existing gonadotropin hormone-suppressing drugs, including one approved in 1989 that Schlaff helped to test in patients, have to be given as injections and take up to two weeks to begin working.

Other companies besides AbbVie have been working to tap the potentially huge market of women with fibroid-related bleeding. A few years ago, Allergan seemed to be in the lead with ulipristal acetate, brand name Esmya, which was already approved in Europe. But after European regulators initiated an investigation into whether the drug led to liver damage in some patients, the FDA declined to approve it.

Myovant Sciences' relugolix, which reduced blood loss in nearly three-quarters of patients in the second of two late-stage clinical trials, is also seeking approval for the drug in combination with add-back hormone medications.

https://en.wikipedia.org/wiki/Elagolix

Existing drug, Ulipristal acetate- could reduce breast cancer risk in pre-menopausal women

In continuation of my update on Ulipristat

NYU Langone Health researchers found that a type of cell death caused by a buildup of highly reactive molecules suppresses lung tumor growth.

The process, called ferroptosis, evolved to let the body signal for self-destruction of cells that are overly stressed for various reasons. This includes cancer cells, but they in turn evolved to have mechanisms that counter ferroptosis so they can continue their uncontrolled growth despite the stress it creates.

Published in Nature, the new study showed that an experimental treatment blocked the action in cancer cells of a protein called ferroptosis suppressor protein 1 (FSP1) to reduce by up to 80% tumor growth in mice with lung adenocarcinoma (LUAD).

Lung cancer is the leading cause of cancer death worldwide, with LUAD the most common lung cancer among nonsmokers, making up about 40% of cases.

"This first test of a drug that blocks ferroptosis suppression highlights the importance of the process to cancer cell survival and paves the way for a new treatment strategy," said senior study author Thales Papagiannakopoulos, Ph.D., an associate professor in the Department of Pathology at the NYU Grossman School of Medicine.

Harmful reactions

Ferroptosis kills cells by building up levels of iron, which generates highly reactive molecules formed from oxygen, water, and hydrogen peroxide called reactive oxygen species (ROS).

Important for normal cell signaling, ROS also often cause oxidative stress, a disease mechanism in which ROS oxidize (add oxygen molecules to) delicate proteins and DNA to pull them apart. ROS damage fats making up the outer layers of cells to cause cell death and tissue damage.

For the new study, the research team genetically engineered mice to delete the FSP1 gene in lung cancer cells, which led to increased cancer cell death and significantly smaller tumors.

The team also found that a potent, relatively new drug type, an FSP1 inhibitor called icFSP1, improved overall survival of lung tumor-bearing mice, nearly to the extent seen in mice with lung tumors genetically engineered to lack the FSP1 gene.

Their work also showed that Fsp1 is likely a better target for future drugs than another ferroptosis suppressor, glutathione peroxidase 4 (GPX4), which has been studied longer.

FSP1 was shown in the new study to play a greater role in blocking ferroptosis in lung cancer cells specifically, and a smaller role than GPX4 in normal cell functions (likely fewer side effects). Unlike with GPX4, increased FSP1 levels were also found to track with poorer survival in human LUAD patients.

"Our future research will focus on optimizing FSP1 inhibitors and investigating the potential of harnessing ferroptosis as a treatment strategy for other solid tumors, such as pancreatic cancer," said lead study author Katherine Wu, an MD/Ph.D. student working in the Papagiannakopoulos lab.

"We aim to translate these findings from the lab into novel clinical therapies for cancer patients."

https://en.wikipedia.org/wiki/Ulipristal_acetate

Existing drug could reduce breast cancer risk in pre-menopausal women