On 3 June 2008, orphan designation (EU/3/08/548) was granted by the European Commission to Interface International Consultancy Ltd, United Kingdom, for carfilzomib for the treatment of multiple myeloma.
The sponsorship was transferred as follows:
- to Nexus Oncology Ltd, United Kingdom, in October 2008;
- to Onyx Pharmaceuticals (UK) Ltd, United Kingdom, in November 2012 and
- to Amgen Europe BV, The Netherlands, in June 2014.
Update: Carfilzomib (Kyprolis) has been authorised in the EU since 19 November 2015. Kyprolis in combination with lenalidomide and dexamethasone is indicated for the treatment of adult patients with multiple myeloma who have received at least one prior therapy.
For a list of the administrative updates to this public summary of opinion please refer to the PDF document below.
- What is multiple myeloma?
Multiple myeloma is a cancer of a type of white blood cell called plasma cells. Plasma cells are found in the bone marrow, the spongy tissue inside the large bones in the body. In multiple myeloma, the division of plasma cells gets out of control, and results in abnormal, immature plasma cells multiplying and filling up the bone marrow. This interferes with production of the normal white blood cells, red blood cells and platelets (components that help the blood to clot), leading to complications such as anaemia (low red-blood-cell counts), bone pain and fractures, raised blood calcium levels and kidney disease. Multiple myeloma is a life-threatening disease.
- What is the estimated number of patients affected by the condition?
At the time of designation, multiple myeloma affected approximately 1.3 in 10,000 people in the European Union (EU). This was equivalent to a total of around 65,000 people*, and is below the threshold for orphan designation, which is 5 people in 10,000. This is based on the information provided by the sponsor and knowledge of the Committee for Orphan Medicinal Products (COMP).
*Disclaimer: For the purpose of the designation, the number of patients affected by the condition is estimated and assessed on the basis of data from the European Union (EU 27), Norway, Iceland and Liechtenstein. At the time of designation, this represented a population of 502,800,000 (Eurostat 2008).
- What treatments are available?
At the time of submission of the application for orphan-drug designation, several medicines were authorised for multiple myeloma in the European Union. The main treatment for multiple myeloma is chemotherapy (medicines to treat cancer) usually combined with steroids (a group of chemical substances, the so-called hormones, which have an effect on the activity of certain organs). Interferon alfa can also be used in combination with chemotherapy although the way it works in cancer treatment is not fully understood. Radiotherapy (using radiation to kill cancer cells) can be very useful to treat pain and weakened bones.
The sponsor has provided satisfactory documentation to justify the assumption that carfilzomib could be of benefit in the treatment of multiple myeloma because it may offer a new way of killing cancer cells and stopping tumour growth. This assumption will need to be confirmed at the time of a marketing authorisation, to maintain the orphan status of the medicine.
- How is this medicine expected to work?
Carfilzomib is a proteasome inhibitor. It blocks the proteasome, a system in cells that breaks down proteins when they are no longer needed. When the proteins in the cancer cells, such as the proteins that control the growth of the cells, are not broken down, the cells are affected and they eventually die. This is expected to reduce the number of multiple myeloma cells.
- What is the stage development of this medicine?
The effects of cafilzomib have been evaluated in experimental models. At the time of submission of the application for orphan designation, clinical trials in patients with multiple myeloma were ongoing.
At the time of submission, carfilzomib was not authorised anywhere in the world for the treatment of multiple myeloma, or designated as orphan medicinal product elsewhere for this condition.
In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 8 April 2008 recommending the granting of this designation.
- Opinions on orphan medicinal product designations are based on the following three criteria:
- the seriousness of the condition;
- the existence of alternative methods of diagnosis, prevention or treatment;
- either the rarity of the condition (affecting not more than 5 in 10,000 people in the Community) or insufficient returns on investment.
Designated orphan medicinal products are products that are still under investigation and are considered for orphan designation on the basis of potential activity. An orphan designation is not a marketing authorisation. As a consequence, demonstration of quality, safety and efficacy is necessary before a product can be granted a marketing authorisation.
|Name||Language||First published||Last updated|
|EU/3/08/548: Public summary of positive opinion for orphan designation of carfilzomib for the treatment of multiple myeloma||(English only)||17/09/2009||11/07/2014|
|Disease/condition||Treatment of multiple myeloma|
|Date of decision||03/06/2008|
|Orphan decision number||EU/3/08/548|
Review of designation
During its meeting of 6 to 8 October 2015, the Committee for Orphan Medicinal Products (COMP) reviewed the designation EU/3/08/548 for Kyprolis (carfilzomib) as an orphan medicinal product for the treatment of multiple myeloma. The COMP assessed whether, at the time of marketing authorisation, the medicinal product still met the criteria for orphan designation. The Committee looked at the seriousness and prevalence of the condition, and the existence of other methods of treatment. As other methods of treatment are authorised in the European Union (EU), the COMP also considered whether the medicine is of significant benefit to patients with multiple meyloma. The COMP recommended that the orphan designation of the medicine be maintained*.
*The maintenance of the orphan designation at time of marketing authorisation would, except in specific situations, give an orphan medicinal product 10 years of market exclusivity in the EU. This means that in the 10 years after its authorisation similar products with a comparable therapeutic indication cannot be placed on the market.
- Life-threatening or long-term debilitating nature of the condition
The Committee for Medicinal Products for Human Use (CHMP) recommended the authorisation of Kyprolis for:
treatment, in combination with lenalidomide and dexamethasone, of adult patients with multiple myeloma who have received at least one prior therapy.
This falls within the scope of the product’s designated orphan indication, which is: ‘treatment of multiple myeloma’.
The COMP concluded that there had been no change in the seriousness of the condition since the orphan designation in 2008. Multiple myeloma remains a debilitating and life-threatening condition because it disrupts the normal functioning of the bone marrow, leads to bone destruction and causes kidney failure.
- Prevalence of the condition
The sponsor provided updated information on the prevalence of multiple myeloma based on data from the GLOBOCAN 2012 database.
On the basis of the information provided by the sponsor and the knowledge of the COMP, the COMP concluded that the prevalence of multiple myeloma remains below the ceiling for orphan designation, which is 5 people in 10,000. At the time of the review of the orphan designation, the prevalence was estimated to be approximately 3.3 people in 10,000. This is equivalent to a total of around 169,000 people in the EU.
- Existence of other methods of treatment
At the time of the review of the orphan designation, bortezomib, doxorubicin and lenalidomide were authorised in the EU for the treatment of multiple myeloma in patients who had received a previous treatment (‘second-line therapy’), as is the case for Kyprolis.
- Significant benefit of Kyprolis
The COMP concluded that the claim of a significant benefit of Kyprolis in multiple myeloma is justified because data show that, in patients who received at least one prior therapy, Kyprolis is more effective at improving the progression-free survival (how long the patients lived without their disease getting worse) than bortezomib, doxorubicin or lenalidomide. This is based on a study directly comparing Kyprolis with bortezomib, and on indirect comparisons versus doxorubicin or lenalidomide.
Therefore, although other methods for the treatment of this condition have been authorised in the EU, the COMP concluded that Kyprolis is of significant benefit to patients affected by multiple myeloma.
Based on the data submitted and the scientific discussion within the COMP, the COMP considered that Kyprolis still meets the criteria for designation as an orphan medicinal product and that it should remain in the Community Register of Orphan Medicinal Products.
|Name||Language||First published||Last updated|
|Recommendation for maintenance of orphan designation at the time of marketing authorisation: Kyprolis (carfilzomib) for the treatment of multiple myeloma||(English only)||02/12/2015|
Sponsor’s contact details
Amgen Europe B.V.
4817 ZK Breda
Tel. +31 7657 32000
Fax +31 7657 32002
For contact details of patients’ organisations whose activities are targeted at rare diseases, see:
- Orphanet, a database containing information on rare diseases, which includes a directory of patients’ organisations registered in Europe;
- European Organisation for Rare Diseases (EURORDIS), a non-governmental alliance of patient organisations and individuals active in the field of rare diseases.