chronic myeloid leukaemia - European Medicines Agency - Rare disease designations - EU/3/10/762

On 4 August 2010, orphan designation (EU/3/10/762) was granted by the European Commission to Wyeth Europa Limited, United Kingdom, for bosutinib for the treatment of chronic myeloid leukaemia.

What is chronic myeloid leukaemia?
Chronic myeloid leukaemia (CML) is a cancer of the white blood cells (cells that fight against infections). In patients with CML, the bone marrow (the spongy tissue inside the large bones) produces large numbers of abnormal, immature white blood cells called ‘blasts’, so there are too many of them circulating in the blood. These blast cells are not fully developed and do not work properly. Over a period of time, they replace the normal white blood cells, red blood cells and platelets in the bone marrow.
CML is most common in adults and older people, but children may also be affected. The disease usually develops very slowly, which is why it is called ‘chronic’. However, when it progresses, CML is a severe and life-threatening disease that is associated with poor overall survival.

What is the estimated number of patients affected by the condition?
At the time of designation, CML affected approximately 1.6 in 10,000 people in the European Union (EU)*. This is equivalent to a total of around 81,000 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 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 27), Norway, Iceland and Liechtenstein. This represents a population of 506,500,000 (Eurostat 2010).

What treatments are available?
Treatment for CML is complex and depends on a number of factors including the extent of the disease, whether it has been treated before, and the patient’s age, symptoms and general state of health. At the time of designation, the main treatments for CML were chemotherapy (medicines to treat cancer) and bone marrow transplantation (a complex procedure where the bone marrow of the patient is destroyed and replaced with healthy bone marrow from a matched donor).
The sponsor has provided sufficient information to show that bosutinib might be of significant benefit for patients with CML because early studies indicate that it might improve the treatment of patients who do not respond to existing treatments. This assumption will need to be confirmed at the time of marketing authorisation, in order to maintain the orphan status.

How is this medicine expected to work?
Bosutinib is expected to work by blocking two types of enzymes called Src and Abl tyrosine kinases. These enzymes can be found in some receptors on the surface of leukaemia cells, including the receptors that are involved in stimulating the cells to divide uncontrollably. By blocking these enzymes, bosutinib is expected to control the spread of leukaemia cells.

What is the stage of development of this medicine?
The effects of bosutinib have been evaluated in experimental models.
At the time of submission of the application for orphan designation, clinical trials with bosutinib in patients with CML were ongoing.
At the time of submission, bosutinib was not authorised anywhere in the EU for CML. Orphan designation of bosutinib had been granted in the United States of America for this condition.
In accordance with Regulation (EC)No141/2000-of 16 December 1999, the COMP adopted a positive opinion on 6 May 2010 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.


EU/3/10/762: Public summary of opinion on orphan designation of Bosutinib for the treatment of chronic myeloid leukaemia
http://www.ema.europa.eu/docs/en_GB/document_library/Orphan_designation/2010/08/WC500095733.pdf

European Medicines Agency - Rare disease designations - EU/3/10/762