EU/3/13/1200: Orphan designation for the treatment of papillary thyroid cancer

Papillary thyroid cancer is a type of cancer affecting the thyroid, a small gland at the base of the neck that produces thyroid hormones. The thyroid is composed of two main cell types: follicular cells, which produce hormones that help regulate growth and metabolism (the process of breaking down substances in the body), and parafollicular cells, which produce a hormone called calcitonin that helps to regulate calcium levels in the blood. Papillary thyroid cancer originates in the follicular cells and it can spread to other parts of the body, usually via the lymphatic system.

Signs of papillary thyroid cancer are difficult to detect in the early stages of the disease and are usually limited to local swelling of the thyroid gland. Patients are often diagnosed when the disease has spread locally giving symptoms such as shortness of breath, difficulties in swallowing or changes in the voice.

Papillary thyroid cancer is a long-term debilitating disease which is life-threatening if it does not respond to treatment and if the cancer spreads to other parts of the body.

At the time of designation, papillary thyroid cancer affected between 1 and 3 in 10,000 people in the European Union (EU). This was equivalent to a total of between 51,000 and 154,000 people*, 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).

*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 512,200,000 (Eurostat 2013).

At the time of designation, the main treatment for papillary thyroid cancer in the EU was surgery to remove the thyroid. Therapy using radioactive iodine (131I) to destroy thyroid cells was also used.

Hormonal therapy was used as an additional treatment for preventing recurrence of the disease. In addition, the anticancer medicine doxorubicin was authorised for the treatment of papillary thyroid cancer in some EU Member States.
The sponsor has provided sufficient information to show that sorafenib tosylate might be of significant benefit for patients with papillary thyroid cancer because clinical studies indicate that it might improve the outcome of patients whose cancer does not respond to therapy with radioactive iodine. This assumption will need to be confirmed at the time of marketing authorisation, in order to maintain the orphan status.

Sorafenib tosylate is a cancer medicine already authorised as Nexavar for the treatment of liver and kidney cancer. The medicine is a 'protein kinase inhibitor'. This means that it blocks some specific enzymes known as protein kinases. These enzymes can be found in some receptors on the surface of cancer cells, where they are involved in the growth and spread of cancer cells, and in the blood vessels that supply the tumours, where they are involved in the development of new blood vessels. By blocking these enzymes, the medicine is expected to reduce the growth of cancer cells in patients with papillary thyroid cancer and cut off the blood supply that keeps cancer cells growing.

The effects of sorafenib tosylate have been evaluated in experimental models.

At the time of submission of the application for orphan designation, clinical trials with sorafenib tosylate in patients with papillary thyroid cancer were ongoing.

At the time of submission, sorafenib tosylate was authorised in the EU for the treatment of hepatocellular carcinoma (a type of liver cancer) and advanced renal-cell carcinoma (a type of kidney cancer).

At the time of submission, sorafenib tosylate was not authorised anywhere in the EU for papillary thyroid cancer. Orphan designation of sorafenib tosylate had been granted in the United States, Australia and Switzerland for some types of thyroid cancer, including papillary thyroid cancer.

In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 9 October 2013 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.