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Advanced Accelerator Applications (AAA or Adacap) is a
France France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of overseas regions and territories in the Americas and the Atlantic, Pacific and Indian Oceans. Its metropolitan ar ...
-based pharmaceutical group, specialized in the field of
nuclear medicine Nuclear medicine or nucleology is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear imaging, in a sense, is "radiology done inside out" because it records radiation emit ...
.PrivateEquityWire, "Advanced Accelerator Applications completes fundraising", Feb 18th, 2014
/ref> The group operates in all three segments of nuclear medicine ( PET, SPECT and therapy) to diagnose and treat serious conditions in the fields of
oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's etymological origin is the Greek word ὄγκος (''ó ...
,
neurology Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
,
cardiology Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular he ...
, infectious and inflammatory diseases.Il Sole 24 Ore, "Dal Cern and Biopark canavese", March 12th, 2014
/ref> In late October 2017, ''
Reuters Reuters ( ) is a news agency owned by Thomson Reuters Corporation. It employs around 2,500 journalists and 600 photojournalists in about 200 locations worldwide. Reuters is one of the largest news agencies in the world. The agency was est ...
'' announced that
Novartis Novartis AG is a Swiss-American multinational pharmaceutical corporation based in Basel, Switzerland and Cambridge, Massachusetts, United States (global research).name="novartis.com">https://www.novartis.com/research-development/research-loc ...
would acquire the company for $3.9 billion, paying $41 per ordinary share and $82 per American depositary share representing a 47 percent premium. On January 22, 2018, Novartis AG announced the successful completion of the tender offer by its subsidiary, Novartis Groupe France S.A.


History

AAA was created in 2002 by Italian physicist Stefano Buono to exploit a patent from the European Organization for Nuclear Research ( CERN).AdnKronos," Research: from Rubbia to AAA, great success for an Italian physicist with European company"
March 19th, 2010.
AAA currently has a total of 31 sites in 12 countries, including: 19 production facilities in 8 countries (in Europe and the U.S.) that manufacture targeted radioligand therapies and precision imaging radioligands, and 6 sites with R&D activity. In October 2017, Novartis announced that it intended to acquire the company for US$3.9 billion.


Products

AAA has a portfolio of diagnostic and therapeutic applications and products in the fields of Molecular Imaging and Therapy. The group's portfolio of radiopharmaceuticals includes radioactive agents for
positron emission tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, ...
( PET) imaging as well as
single-photon emission computed tomography Single-photon emission computed tomography (SPECT, or less commonly, SPET) is a nuclear medicine tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera (that is, ...
( SPECT) diagnostic products.


Lutathera

The company's lead product is LUTATHERA, a Lutetium Lu 177 dotatate labeled somatostatin analogue peptide, a theragnostic cancer product being developed to treat certain gastro-entero pancreatic neuroendocrine tumors ( GEP-NETs). It selectively targets over-expressed somatostatin receptors while also giving off gamma emissions to allow physicians to visualize where in the body both the drug and the tumor are. It was approved by the FDA in January 2018 for GEP-NET.


Approval

Lutathera, also known as lutetium Lu 177 dotatate, is a target treatment drug for patients with GEP-NETs. Its approval for Advanced Accelerator Applications was announced on January 26, 2018, by the US Food and Drug Administration. Lutathera is most notable as the first FDA approved peptide receptor
radionuclide A radionuclide (radioactive nuclide, radioisotope or radioactive isotope) is a nuclide that has excess nuclear energy, making it unstable. This excess energy can be used in one of three ways: emitted from the nucleus as gamma radiation; transfer ...
therapy (PRRT) to combat GEP-NETs.


= GEP-NETs

= GEP-NETs are rare groups of cancer that continue to proliferate, regardless of initial therapy treatments. They are present in areas affected by pancreatic or
gastrointestinal cancer Gastrointestinal cancer refers to malignant conditions of the gastrointestinal tract (GI tract) and accessory organs of digestion, including the esophagus, stomach, biliary system, pancreas, small intestine, large intestine, rectum and anus. The ...
s; specifically, the
pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an en ...
, stomach, intestines, colon and rectum.


Use

Lutathera is used to combat pancreatic and gastrointestinal cancers that do not respond well to common chemotherapeutical treatments; namely for patients with somatostatin receptor-positive GEP-NETs. These receptors are commonly found on tumors located in the foregut, midgut, and hindgut.


Mechanism

Lutathera is a radioactive drug consisting of a tyrosine-containing somatostatin analog Tyr3-octreotate (TATE) attached to the chelating agent tetraazacyclododecanetetra-
acetic acid Acetic acid , systematically named ethanoic acid , is an acidic, colourless liquid and organic compound with the chemical formula (also written as , , or ). Vinegar is at least 4% acetic acid by volume, making acetic acid the main componen ...
(DOTA). Attached to the dotatate is the radioactive marker Lu-177, a radioisotope. The dotatate binds to the GEP-NET positive somatostatin receptor cells commonly present on neuroendocrine tumors. After binding to the receptor, Lutathera enters the cell and uses its radioactive property to damage DNA. This mechanism effectively triggers apoptosis of cancerous tumor cells. As a result, studies found that 16% of patients being treated with Lutathera experienced either complete or partial tumor shrinkage.


Studies

FDA approval of Lutathera was ultimately supported by two clinical studies. NETTER-1, a Phase 3 study, was a randomized
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...
which included patients with a severe form of somatostatin receptor-positive NETs. The study compared Lutathera treatment with a standard dose of octreotided LAR against a high-dose of octreotide LAR. Researchers measured tumor growth after the course of the treatment, also known as progression-free survival. The study concluded that patients who were treated with Lutathera lived substantially longer compared to those who only received the octreotide treatment. They experienced a 79% reduction in death and cancer progression. The Netherlands study gathered several patients with somatostatin receptor-positive tumors, including patients with GEP-NETs. The study found that 16% of patients with GEP-NETs, who were treated with Lutathera, experienced complete or partial tumor shrinkage. As a result, a pre-planned interim overall survival analysis found that Lutathera treatment lead to a 48% reduction in risk of death.


Common Grade 3-4 Adverse Reactions


Advances

Lutathera is a major technological advancement for the detection of tumors. Diagnostic imaging that relies on dotatates can now rely on Lutathera to locate somatostatin receptor-positive tumors by tagging them with its radioactive component. This tagging of tumors will allow them to become more visible during
positron emission tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, ...
(PET) scans. With LU-177 dotatates, more somatostatin receptor-positive GEP-NET patients can be identified for treatment of the disease.


Pipeline

AAA has a broad pipeline of products in development, including several theragnostic pairings for oncology indications. NETSPOT and SomaKit TOC are novel kits for radiolabeling somatostatin analogue peptides to help diagnose somatostatin receptor-positive NET lesions. Each kit has received orphan drug designation from both the EMA and the FDA.Devicespace.com, "Advanced Accelerator Applications Receives Orphan Drug Designation From FDA And European Medicines Agency For Gallium-68 DOTATATE For Use In Patients With Gastro-Entero-Pancreatic Neuroendocrine Tumors"
. 3 March 2014.
News Medical, "AAA gets orphan drug designation status for radiopharmaceutical, Gallium-68 DOTATATE"
4 March 2014.
99MTc-rhAnnexin V-128, a SPECT investigational candidate for the diagnosis and assessment of apoptotic and necrotic processes, which are present in a number of pathological conditions in oncology and cardiovascular disease, as well as in autoimmune disorders. 99MTc-rhAnnexin V-128 is currently in a Phase I/II trial for the diagnosis of rheumatoid arthritis and ankylosing spondylitis, as well as several Phase II studies in cardiovascular, cardio-oncology, and pulmonary indications. 177Lu-PSMA-617 and 68Ga-PSMA-617 are in development to treat, image, monitor and stage prostate cancer. PSMA-617 is a ligand of prostate-specific membrane antigen (PSMA) expressed on the majority of prostate tumor cells. 177Lu-PSMA-617 also known as lutetium (177Lu) vipivotide tetraxetan is being developed to treat prostate cancer by binding to PSMA-617. In June 2021 it was granted a
breakthrough therapy Breakthrough therapy is a United States Food and Drug Administration designation that expedites drug development that was created by Congress under Section 902 of the 9 July 2012 Food and Drug Administration Safety and Innovation Act. The FDA's " ...
designation. 68Ga-PSMA-617 is under development as a complementary diagnostic candidate. CTT1057 is an 18F-labeled investigational diagnostic candidate in development for PET imaging of prostate cancer. CTT1057 is a phosphoramidate-based peptide, which specifically binds to Prostate-Specific Membrane Antigen (PSMA), expressed on the majority of prostate tumor cells. 177LuNeoBOMB1 and 68GaNeoBOMB1 are new generation antagonist bombesin analogs in development to treat, image, monitor and stage gastrin-releasing peptide receptor (GRPR)-expressing malignancies, such as such as gastrointestinal stromal tumors (GIST), prostate cancer and breast cancer. 177LuNeoBOMB1 is a therapeutic candidate and 68GaNeoBOMB1 is its complementary diagnostic candidate.


Millburn site

In 2016, AAA opened a light manufacturing and distribution site in Millburn, NJ, a residential town in North Jersey.Danielle Desisto
"Millburn manufacturing site safely produces cancer-fighting drug"
When the site was first purchased, it caused substantial concerns among local residents."Concerns raised about proposed cancer drug factory in Millburn"
/ref> Per the requests of Millburn Residents, the Township Committee hired a nuclear/radiology expert to re-assess the appropriateness of opening a radioactive manufacturing site in the residential area.Cecilia Levine
"Nuclear meds expert hired"
''The Record''. 7 May 2015.
The expert concluded that the proposed operations at AAA are safe and pose no hazard to the citizens of Millburn.Jonathan Sym
"Advanced Accelerator Application Investigation Results: Risks Are "Close To Zero Without Being Zero" Says Expert". ''Tap Into Millburn/Short Hills''. 18 February 2016.
/ref>Harry Trumbore
"Expert says radiopharmaceutical factory proposed for Millburn is safe"
. 11 February 2016


References


External links

* {{Official website, www.adacap.com Pharmaceutical companies of France French companies established in 2002 Pharmaceutical companies established in 2002 Companies based in Auvergne-Rhône-Alpes