EU/3/19/2199: Orphan designation for the treatment of glioma

Glioma is a brain tumour that affects glial cells (cells that surround and support nerve cells). It mainly affects adults aged over 45 years, but it can occur at any age. Patients with glioma can have severe symptoms. The nature of their symptoms depends on where the tumour develops in the brain.

Symptoms can include headaches, nausea (feeling sick), loss of appetite, vomiting, muscle weakness in one part of the body and changes in personality, mood, mental capacity and concentration. About one-fifth of patients with glioma have seizures (fits) for months or years before the disease is diagnosed.

Glioma is a long-term debilitating and life-threatening disease because of the severe damage to the brain, and it is associated with poor long-term survival.

At the time of designation, glioma affected approximately 2.6 in 10,000 people in the European Union (EU). This was equivalent to a total of around 135,000 people¹, and is below the ceiling for orphan designation, which is 5 people in 10,000. This is based on the information provided by the sponsor and the knowledge of the Committee for Orphan Medicinal Products (COMP).

¹Disclaimer: 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 518,400,000 (Eurostat 2019).

At the time of designation, several medicines were authorised for the treatment of glioma in the EU. Treatments for glioma included surgery, radiotherapy (treatment with radiation), and chemotherapy (medicines to treat cancer). Patients also received treatments for the symptoms of glioma, including corticosteroids to reduce pressure within the skull and medicines to prevent seizures.

The sponsor has provided sufficient information to show that the medicine (in combination with another medicine called ‘adenoviral vector serotype 5 encoding the human interleukin-12 p70 transgene under the control of activator ligand veledimex’) might be of significant benefit for patients with glioma because early studies showed that patients lived longer compared to those who received the usual treatment for glioma in previous studies. This assumption will need to be confirmed at the time of marketing authorisation, in order to maintain the orphan status.

Veledimex, which the patient takes by mouth, switches on a gene in another medicine injected into the tumour called ‘adenoviral vector serotype 5 encoding the human interleukin-12 p70 transgene under the control of activator ligand veledimex’. Once switched on, the gene produces interleukin-12 (IL-12), a protein that activates the immune system (the body’s defences). Producing IL-12 in the tumour is expected to cause the immune system to fight the cancer, thereby leading to improvement of symptoms.

The effects of veledimex have been evaluated in experimental models.

At the time of submission of the application for orphan designation, clinical trials with veledimex in patients with glioma were ongoing.

At the time of submission, veledimex was not authorised anywhere in the EU for the treatment of glioma. Orphan designation of veledimex had been granted in the United States for malignant glioma.

In accordance with Regulation (EC) No 141/2000, the COMP adopted a positive opinion on 18 July 2019, recommending the granting of this designation.

• 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.