SCIENCE MEDICINES HEALTH
EPAR summary for the public
This is a summary of the European public assessment report (EPAR) for Caprelsa. It explains how the Committee for Medicinal Products for Human Use (CHMP) assessed the medicine to reach its opinion in favour of granting a marketing authorisation and its recommendations on the conditions of use for Caprelsa.
Caprelsa is a medicine that contains the active substance vandetanib. It is available as tablets (100 mg and 300 mg).
Caprelsa is used to treat medullary thyroid cancer, a type of cancer affecting the thyroid gland that originates in the cells that produce the hormone calcitonin. It is used when the disease is aggressive and causes symptoms, and when the cancer cannot be removed by surgery and has progressed or spread to other parts of the body.
The medicine can only be obtained with a prescription.
Treatment should be started and supervised by a doctor who has experience in treating medullary thyroid cancer, using anticancer medicines and assessing electrocardiograms (ECG, a test that measures the electrical activity of the heart). Patients must be given a patient alert card containing important safety information and must be informed by their doctor about the risks of Caprelsa.
The recommended dose is 300 mg once a day, taken at around the same time each day. Patients who have difficulty swallowing tablets can mix the tablet in still water (no other liquids should be used).
An agency of the European Union
© European Medicines Agency, 2012. Reproduction is authorised provided the source is acknowledged.
The patient's QTc interval (a measure of the electrical activity of the heart) and certain blood values should be assessed in advance and monitored during treatment. The doctor should stop treatment if the QTc interval reaches 500 milliseconds or above or if the patient experiences severe side effects, until an improvement is seen, after which treatment may be re-started at a lower dose.
The benefits of Caprelsa may be smaller for patients who do not have a mutation in a gene called the 'rearranged during transfection' (RET) gene or if this is not known, and this should be taken into account when deciding whether to start treatment. For this purpose, it is recommended that the RET mutation status be tested before starting treatment with Caprelsa.
The active substance in Caprelsa, vandetanib, is a 'protein tyrosine kinase inhibitor'. This means that it blocks the activity of enzymes known as tyrosine kinases. These enzymes can be found in certain receptors (such as VEGF, EGF and RET receptors) on the surface of cancer cells, where they activate several processes including cell division and the growth of new blood vessels. By blocking the activity of VEGF receptors, the medicine reduces the blood supply to the cancer cells, slowing down the cancer's growth. By blocking the activity of EGF receptors, the cancer cells no longer receive the messages needed for growth and multiplication. Vandetanib also blocks the activity of RET receptors, which play a role in the growth of medullary thyroid cancer cells.
The effects of Caprelsa were first tested in experimental models before being studied in humans.
Caprelsa was compared with placebo (a dummy treatment) in a main study involving 331 patients with thyroid cancer that could not be removed by surgery or had spread to other parts of the body. The main measure of effectiveness was progression free survival (how long the patients lived without their disease getting worse).
Caprelsa was more effective than placebo at prolonging progression free survival. On average, patients taking Caprelsa lived for 30.5 months without their disease getting worse, compared with 19.3 months for patients taking placebo.
The most commonly reported side effects with Caprelsa are diarrhoea, rash, nausea (feeling sick), hypertension (high blood pressure) and head ache. For the full list of all side effects reported with Caprelsa, see the package leaflet.
Caprelsa must not be used in people who are hypersensitive (allergic) to vandetanib or any of the other ingredients. It must not be used in people with a heart problem called 'congenital long QTc syndrome' or who have a QTc interval over 480 milliseconds. It must not be used in women who are breast-feeding. Caprelsa must not be used in patients who are taking certain other medicines that can prolong the QTc interval. For the full list of restrictions, see the package leaflet.
The CHMP concluded that Caprelsa was shown to be effective in the treatment of medullary thyroid cancer although there were uncertainties about the size of the benefit in patients whose RET mutation
Caprelsa status is negative or unknown. The Committee noted the potential risk for QTc interval prolongation, and measures were introduced to minimise this risk. The CHMP concluded that the benefits of Caprelsa outweigh its risks in patients whose disease is both aggressive and causes symptoms, since they are in urgent need of treatment. Therefore, the Committee recommended that Caprelsa be granted marketing authorisation.
Caprelsa has been given 'conditional approval'. This means that there is more evidence to come about the medicine, in particular on the size of the benefit in patients without the RET mutation. Every year, the European Medicines Agency will review any new information that may become available and this summary will be updated as necessary.
The company that markets Caprelsa will carry out a study in patients with medullary thyroid cancer to compare the effects of Caprelsa in patients with and without the RET mutation.
The company that markets Caprelsa will ensure that doctors who are expected to prescribe Caprelsa receive educational material containing important safety information about Caprelsa, including measures to manage the risk of QTc prolongation and other potential side effects, and a patient alert card.
The European Commission granted a marketing authorisation valid throughout the European Union for Caprelsa on 17 February 2012.
The full EPAR for Caprelsa can be found on the Agency's website: ema.europa.eu/Find medicine/Human medicines/European Public Assessment Reports. For more information about treatment with Caprelsa, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.
This summary was last updated in 12-2011.