What is it?

Atriance is a solution for infusion. It contains the active substance nelarabine.

Table of Contents
What is it used for?
How is it used?
How does it work?
How has it been studied?
What benefits has it shown during the studies?
What is the risk associated?
Why has it been approved?

What is it used for?

Atriance is used to treat patients with T-cell acute lymphoblastic leukaemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LBL). These are types of cancer where T-lymphoblasts (a type of immature white blood cell) multiply too quickly. In T-ALL the abnormal cells are mainly in the blood and bone marrow, and in T-LBL they are mainly in the lymphatic system (lymph nodes or thymus gland). Atriance is used when patients have failed to respond to, or have stopped responding to at least two types of chemotherapy.
Because the number of patients with these diseases is low, the diseases are considered ?rare?, and Atriance was designated an ?orphan medicine? (a medicine used in rare diseases) on 16 June 2005. The medicine can only be obtained with a prescription.

How is it used?

Atriance is given by intravenous infusion (a drip into a vein) under the supervision of a doctor who has experience in the use of these types of medicine. The dose and frequency of infusion depend on the patient?s age and body surface area. In adults and adolescents aged over 16 years, the recommended starting dose is 1,500 mg per square metre, given over two hours on days 1, 3 and 5, repeated every 21 days. Younger patients receive a lower dose (650 mg per square metre) given over one hour on five consecutive days, repeated every 21 days. This schedule can also be used in patients aged 16 to 21 years. Treatment should be stopped if the patient develops serious side effects affecting the brain or nervous system.
Patients receiving Atriance should be monitored regularly for changes in blood counts and should receive adequate hydration if they are at risk of tumour lysis syndrome (a complication due to the breakdown of cancer cells). Patients who have problems with their kidneys should be closely monitored for side effects during Atriance treatment. Atriance should be used with caution in patients with liver problems.

How does it work?

The active substance in Atriance, nelabarine, is a cytotoxic, a medicine that kills cells that are dividing, such as cancer cells. It belongs to the group of anti-cancer medicines called ?antimetabolites?.

Nelarabine is converted within cells to an analogue of guanine, one of the fundamental chemicals that make up DNA. In the body, this active analogue takes the place of guanine and interferes with the enzymes involved in making new DNA, DNA polymerases. This stops the production of DNA and thus slows down the growth and multiplication of tumour cells. As the active guanine analogue accumulates in T-cells and lasts longer in these cells, Atriance slows down the growth and multiplication of the cells involved in T-ALL and T-LBL.

How has it been studied?

The effects of Atriance were first tested in experimental models before being studied in humans. Atriance has been studied in two main studies of patients with T-ALL and T-LBL who had stopped responding to one or more previous anticancer treatments. The first study involved a total of 70 children and young adults aged below 21 years, and the second involved a total of 40 adults and adolescents aged over 16 years. Around half of the patients had failed two or more previous treatments. In both studies, the patients were treated with Atriance, but its effects were not compared with those of any other medicine. The main measure of effectiveness was the proportion of patients who responded to treatment, defined as no evidence of disease and recovery of blood cell counts, within a month of starting Atriance treatment.

What benefits has it shown during the studies?

Atriance was shown to be effective in a proportion of the patients in both studies. In the first study, among the 39 children and young adults who had failed two or more previous treatments, five (13%) had a complete response to treatment after a month, with no evidence of disease and normal blood counts. In the second study, among the 28 adults and adolescents who had failed two or more previous treatments, five (18%) had a complete response to treatment. In both studies, more patients had a partial response to Atriance treatment, with blood counts returning towards normal levels.

What is the risk associated?

The most common side effects with Atriance in adults (seen in more than 1 patient in 10) are infection, febrile neutropenia (low white blood cell counts with fever), neutropenia (low white blood cell counts), thrombocytopenia (low platelet counts), anaemia (low red blood cell counts), somnolence (sleepiness), peripheral neuropathy (damage to the nerves in the extremities), hypoesthesia (a reduced sense of touch), paresthesia (abnormal sensations), dizziness, headache, dyspnoea (breathlessness), cough, diarrhoea, vomiting, constipation, nausea (feeling sick), myalgia (muscle pain), oedema (swelling), pyrexia (fever), pain, fatigue (tiredness) and asthenia (weakness). Most of these side effects were also seen very commonly in children. For the full list of all side effects reported with Atriance, see the Package Leaflet.
Severe side effects affecting the brain and nervous system have been reported in patients taking Atriance, including somnolence, convulsions, and peripheral neuropathy causing numbness, unusual sensations, weakness and even paralysis. Patients should be monitored closely for these side effects and treatment stopped if necessary.
Atriance should not be used in people who may be hypersensitive (allergic) to nelarabine or any of the other ingredients.

Why has it been approved?

The Committee for Medicinal Products for Human Use (CHMP) noted that, due to the small number of patients with these diseases, the information to support the approval of Atriance is limited, but it agreed that the medicine could allow some patients to go on to receive a bone marrow transplant, increasing their chances of survival. Therefore, the Committee decided that Atriance?s benefits are greater than its risks for the treatment of patients with T-ALL and T-LBL whose disease has not responded to or has relapsed following treatment with at least two chemotherapy regimens. The Committee recommended that Atriance be given marketing authorisation.
Atriance has been authorised under ?Exceptional Circumstances?. This means that because the diseases are rare, it has not been possible to obtain complete information about Atriance. Every year, the European Medicines Agency (EMEA) will review any new information that may become available and this summary will be updated as necessary.

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