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3.1.2 Alkylating agents Alkylating agents represent a distinct category of anticancer drugs with a mechanism of action centered on the formation of an unstable alkyl group R-CH2+, which subsequently reacts with nucleophilic centers on proteins and nucleic acids

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While Alnylams Phase III APOLLO-B study hit both key primary and secondary endpoints, the FDA stated in the documents that the effects of patisiran compared to placebo on both endpoints were small, of questionable clinical meaningfulness, and may not be detectable by patients. Major discussion points during the adcomm meeting included whether these key endpoints were appropriate to ascertain clinical meaningfulness in the ATTR-CM population, and panelists expressed varying opinions on whether the magnitude of the benefit seen in trial data was clinically meaningful