EU/3/15/1590

On 14 December 2015, orphan designation (EU/3/15/1590) was granted by the European Commission to Merck KGaA, Germany, for recombinant human monoclonal IgG1 antibody against programmed death ligand-1 for the treatment of Merkel cell carcinoma.

What is Merkel cell carcinoma?

Merkel cell carcinoma (also known as cutaneous neuro-endocrine carcinoma) is a type of skin cancer that starts in ‘neuro-endocrine’ cells called Merkel cells. Neuro-endocrine cells release hormones into the blood when stimulated by the nervous system. Merkel cell carcinoma usually appears as a painless red-blue lump on the head and neck, but it can also be found on the arms and legs, and sometimes on the trunk.

Merkel cell carcinoma is a debilitating and life-threatening condition because it grows rapidly and spreads quickly to other parts of the body. Once this cancer has spread, it is associated with very poor long-term survival.

What is the estimated number of patients affected by the condition?

At the time of designation, Merkel cell carcinoma affected less than 0.4 in 10,000 people in the European Union (EU). This was equivalent to a total of fewer than 21,000 people*, and is below the ceiling for orphan designation, which is 5 people in 10,000. This isbased on the information provided by the sponsor and the knowledge of the Committee for Orphan Medicinal Products (COMP).

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* 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 28), Norway, Iceland and Liechtenstein. This represents a population of 512,900,000 (Eurostat 2015).

What treatments are available?

At the time of designation, no satisfactory methods were authorised in the EU to treat Merkel cell carcinoma. Patients were treated with chemotherapy (medicines to treat cancer), surgery and radiotherapy (treatment with radiation). However, in most patients whose disease had spread, the disease usually came back after treatment.

How is this medicine expected to work?

This medicine is a ‘monoclonal antibody’, a type of protein designed to recognise and attach to a protein called ‘programme death ligand-1’ (PD-L1). This protein is expressed in many cancer cells and it is thought to help to suppress the body’s defences (immune cells) thereby protecting cancer cells from being attacked by the immune cells.

By attaching to the PD-L1 protein, the medicine is expected to remove this suppressive effect, allowing the immune cells to recognise and kill the cancer cells. In addition, by attaching to the cancer cells it is thought that the antibody helps to kill them directly. This is expected to slow down the growth of the cancer.

What is the stage of development of this medicine?

The effects of the medicine have been evaluated in experimental models.

At the time of submission of the application for orphan designation, clinical trials with the medicine in patients with Merkel cell carcinoma were ongoing.

At the time of submission, the medicine was not authorised anywhere in the EU for Merkel cell carcinoma or designated as an 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 12 November 2015 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 EU) 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.

The Committee for Orphan Medicinal Products reviews the orphan designation of a product if it is approved for marketing authorisation.