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Theocharides A, Gisslinger H, De Stefano V, Accurso V, Iurlo A, Devos T, Egyed M, Lippert E, Delgado RG, Cantoni N, Dahm AEA, Sotiropoulos D, Houtsma E, Smyth A, Iqbal A, Di Matteo P, Zuurman M, Te Boekhorst PAW. Ruxolitinib in patients with polycythemia vera resistant and/or intolerant to hydroxyurea: European observational study. Eur J Haematol 2024; 112:379-391. [PMID: 37899734 DOI: 10.1111/ejh.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Hydroxyurea (HU) is a commonly used first-line treatment in patients with polycythemia vera (PV). However, approximately 15%-24% of PV patients report intolerance and resistance to HU. METHODS This phase IV, European, real-world, observational study assessed the efficacy and safety of ruxolitinib in PV patients who were resistant and/or intolerant to HU, with a 24-month follow-up. The primary objective was to describe the profile and disease burden of PV patients. RESULTS In the 350 enrolled patients, 70% were >60 years old. Most patients (59.4%) had received ≥1 phlebotomy in the 12 months prior to the first dose of ruxolitinib. Overall, 68.2% of patients achieved hematocrit control with 92.3% patients having hematocrit <45% and 35.4% achieved hematologic remission at month 24. 85.1% of patients had no phlebotomies during the study. Treatment-related adverse events were reported in 54.3% of patients and the most common event was anemia (22.6%). Of the 10 reported deaths, two were suspected to be study drug-related. CONCLUSION This study demonstrates that ruxolitinib treatment in PV maintains durable hematocrit control with a decrease in the number of phlebotomies in the majority of patients and was generally well tolerated.
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Affiliation(s)
- Alexandre Theocharides
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Heinz Gisslinger
- Department of Internal Medicine I, Hematology, Medical University of Vienna, Vienna, Austria
| | - Valerio De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico A Gemelli IRCCS, Roma, Italy
| | - Vincenzo Accurso
- U.O.C. Ematologia AZ.Osp.Univ. Policlinico Paolo Giaccone Palermo, Palermo, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Timothy Devos
- Department of Hematology, University Hospitals Leuven and Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Leuven, Belgium
| | - Miklos Egyed
- Hematológiai Osztály, Somogy Megyei Kaposi Mor Oktato Korhaz, Kaposvar, Hungary
| | - Eric Lippert
- Service Hématologie, CHU de Brest, Brest, France
| | | | - Nathan Cantoni
- Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Anders E A Dahm
- Avdeling for Blodsykdommer, Akershus Universitetssykehus, Lørenskog, Norway
| | - Damianos Sotiropoulos
- Heamatology Clinic, General Hospital of Thessaloniki G Papanikolaou, Thessaloniki, Greece
| | | | - Aoife Smyth
- Novartis Pharmaceuticals AG, Basel, Switzerland
- Novartis Pharmaceuticals UK Limited, London, UK
| | - Amir Iqbal
- Novartis Global Service Center, Dublin, Ireland
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Mesa R, Verstovsek S, Platzbecker U, Gupta V, Lavie D, Giraldo P, Recher C, Kiladjian JJ, Oh ST, Gerds AT, Devos T, Passamonti F, Vannucchi AM, Egyed M, Lech-Maranda E, Pluta A, Nilsson L, Shimoda K, McLornan D, Kawashima J, Klencke B, Huang M, Strouse B, Harrison C. Clinical outcomes of patients with myelofibrosis after immediate transition to momelotinib from ruxolitinib. Haematologica 2024; 109:676-681. [PMID: 37259556 PMCID: PMC10828756 DOI: 10.3324/haematol.2023.283106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Ruben Mesa
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston Salem, NC.
| | | | | | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, Ontario
| | - David Lavie
- Hadassah-Hebrew University Medical Center, Jerusalem
| | - Pilar Giraldo
- Miguel Servet University Hospital and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Zaragoza
| | - Christian Recher
- Institut Universitaire du Cancer de Toulouse, Université de Toulouse III, Toulouse
| | - Jean-Jacques Kiladjian
- Université Paris Cité, AP-HP, Ho_pital Saint-Louis, Centre d'Investigations Cliniques, INSERM, CIC1427, Paris
| | - Stephen T Oh
- Washington University School of Medicine, St. Louis, MO
| | - Aaron T Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Timothy Devos
- Department of Hematology, University Hospitals Leuven and Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Leuven, Belgium
| | | | | | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Ewa Lech-Maranda
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Andrzej Pluta
- Department of Hematological Oncology, Oncology Specialist Hospital, Brzozow, Poland
| | - Lars Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | | | | | | | - Mei Huang
- Sierra Oncology, Inc., San Mateo, CA
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Oh ST, Verstovsek S, Gupta V, Platzbecker U, Devos T, Kiladjian J, McLornan DP, Perkins A, Fox ML, McMullin MF, Mead AJ, Egyed M, Mayer J, Sacha T, Kawashima J, Huang M, Strouse B, Mesa R. Changes in bone marrow fibrosis during momelotinib or ruxolitinib therapy do not correlate with efficacy outcomes in patients with myelofibrosis. EJHaem 2024; 5:105-116. [PMID: 38406514 PMCID: PMC10887367 DOI: 10.1002/jha2.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 02/27/2024]
Abstract
Bone marrow fibrosis (BMF) is a pathological feature of myelofibrosis, with higher grades associated with poor prognosis. Limited data exist on the association between outcomes and BMF changes. We present BMF data from Janus kinase (JAK) inhibitor-naive patients from SIMPLIFY-1 (NCT01969838), a double-blind, randomized, phase 3 study of momelotinib vs ruxolitinib. Baseline and week 24 bone marrow biopsies were graded from 0 to 3 as per World Health Organization criteria. Other assessments included Total Symptom Score, spleen volume, transfusion independence status, and hemoglobin levels. Paired samples were available from 144 and 160 patients randomized to momelotinib and ruxolitinib. With momelotinib and ruxolitinib, transfusion independence was achieved by 87% and 44% of patients with BMF improvement of ≥1 grade and 76% and 56% of those with stable/worsening BMF; there was no association between BMF changes and transfusion independence for either arm (momelotinib, p = .350; ruxolitinib, p = .096). Regardless of BMF changes, hemoglobin levels also generally increased on momelotinib but decreased on ruxolitinib. In addition, no associations between BMF changes and spleen (momelotinib, p = .126; ruxolitinib, p = .407)/symptom (momelotinib, p = .617; ruxolitinib, p = .833) outcomes were noted, and no improvement in overall survival was observed with ≥1-grade BMF improvement (momelotinib, p = .395; ruxolitinib, p = .407). These data suggest that the anemia benefit of momelotinib is not linked to BMF changes, and question the use of BMF assessment as a surrogate marker for clinical benefit with JAK inhibitors.
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Affiliation(s)
- Stephen T. Oh
- Division of HematologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Srdan Verstovsek
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Vikas Gupta
- Department of Medicine, Princess Margaret Cancer CentreUniversity of TorontoTorontoCanada
| | - Uwe Platzbecker
- Clinic of Hematology, Cellular Therapy, and HemostaseologyUniversity of Leipzig Medical CenterLeipzigGermany
| | - Timothy Devos
- Microbiology, and Immunology, Laboratory of Molecular Immunology (Rega Institute)Department of Hematology, University Hospitals Leuven and Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU LeuvenLeuvenBelgium
| | - Jean‐Jacques Kiladjian
- Université Paris Cité, AP‐HP, Hôpital Saint‐Louis, Centre d’Investigations CliniquesParisFrance
| | - Donal P. McLornan
- Department of HaematologyGuy's and St Thomas’ NHS Foundation Trust and University College HospitalLondonUK
| | - Andrew Perkins
- Australian Centre for Blood DiseasesMonash UniversityMelbourneAustralia
| | - Maria Laura Fox
- Department of HaematologyVall d'Hebron University HospitalBarcelonaSpain
| | | | - Adam J. Mead
- MRC Molecular Haematology UnitMRC Weatherall Institute of Molecular MedicineNIHR Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Miklos Egyed
- Department of HematologySomogy County Kaposi Mór General HospitalKaposvárHungary
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and OncologyMasaryk University and University Hospital BrnoBrnoCzech Republic
| | - Tomasz Sacha
- Department of HematologyJagiellonian University HospitalKrakówPoland
| | - Jun Kawashima
- Sierra Oncology, a GSK companySan MateoCaliforniaUSA
| | - Mei Huang
- Sierra Oncology, a GSK companySan MateoCaliforniaUSA
| | - Bryan Strouse
- Sierra Oncology, a GSK companySan MateoCaliforniaUSA
| | - Ruben Mesa
- Atrium Health Wake Forest Baptist Comprehensive Cancer CenterWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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Kiladjian JJ, Vannucchi AM, Gerds AT, Gupta V, Verstovsek S, Egyed M, Platzbecker U, Mayer J, Grosicki S, Illés Á, Woźny T, Oh ST, McLornan D, Kirgner I, Yoon SS, Harrison CN, Klencke B, Huang M, Kawashima J, Mesa R. Momelotinib in Myelofibrosis Patients With Thrombocytopenia: Post Hoc Analysis From Three Randomized Phase 3 Trials. Hemasphere 2023; 7:e963. [PMID: 37908862 PMCID: PMC10615557 DOI: 10.1097/hs9.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/25/2023] [Indexed: 11/02/2023] Open
Abstract
The oral activin A receptor type I, Janus kinase 1 (JAK1), and JAK2 inhibitor momelotinib demonstrated symptom, spleen, and anemia benefits in intermediate- and high-risk myelofibrosis (MF). Post hoc analyses herein evaluated the efficacy and safety of momelotinib in patients with MF and thrombocytopenia (platelet counts <100 × 109/L) from randomized phase 3 studies: MOMENTUM (momelotinib versus danazol; JAK inhibitor experienced); SIMPLIFY-1 (momelotinib versus ruxolitinib; JAK inhibitor naïve); and SIMPLIFY-2 (momelotinib versus best available therapy; JAK inhibitor experienced); these studies were not statistically powered to assess differences in thrombocytopenic subgroups, and these analyses are descriptive. The treatment effect of momelotinib versus ruxolitinib on week 24 response rates (spleen volume reduction ≥35%/Total Symptom Score reduction ≥50%/transfusion independence) was numerically comparable or better in thrombocytopenic patients versus the overall JAK inhibitor naive population; rates were preserved with momelotinib in thrombocytopenic patients but attenuated with ruxolitinib (momelotinib: 27%/28%/67% overall versus 39%/35%/61% in thrombocytopenic group; ruxolitinib: 29%/42%/49% overall versus 0%/22%/39% in thrombocytopenic group, respectively). In contrast to ruxolitinib, momelotinib maintained high dose intensity throughout the treatment. In the JAK inhibitor experienced population, thrombocytopenic patients had the following: (1) numerically higher symptom and transfusion independence response rates with momelotinib than in control arms; and (2) preserved spleen, symptom, and transfusion independence response rates with momelotinib relative to the overall study populations. The safety profile of momelotinib in thrombocytopenic patients was also consistent with the overall study population. In summary, momelotinib represents a safe and effective treatment option for patients with MF and moderate-to-severe thrombocytopenia.
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Affiliation(s)
- Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hôpital Saint-Louis, Centre d’Investigations Cliniques, INSERM, Paris, France
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine, Center of Research and Innovation of Myeloproliferative Neoplasms (CRIMM), University of Florence, Careggi University Hospital, Florence, Italy
| | - Aaron T. Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Vikas Gupta
- Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Srdan Verstovsek
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Uwe Platzbecker
- Clinic of Hematology, Cellular Therapy, and Hemostaseology, University of Leipzig, Germany
| | - Jiří Mayer
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno, Czech Republic
- University Hospital Brno and Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Faculty of Health Sciences in Bytom, Silesian Medical University, Katowice, Poland
| | - Árpád Illés
- Department of Hematology, Faculty of Medicine, University of Debrecen, Hungary
| | - Tomasz Woźny
- Department of Hematology, Szpital MSWiA w Poznaniu, Poznan, Poland
| | - Stephen T. Oh
- Department of Medicine and Department of Pathology and Immunology, Division of Hematology, Washington University School of Medicine, St. Louis, MO, USA
| | - Donal McLornan
- Guy’s and St Thomas’ NHS Foundation Trust and University College London Hospitals, London, United Kingdom
| | - Ilya Kirgner
- The Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- Hematology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | | | - Mei Huang
- Sierra Oncology, a GSK company, San Mateo, CA, USA
| | | | - Ruben Mesa
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Gisslinger H, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, Dulicek P, Illes A, Pylypenko H, Sivcheva L, Mayer J, Yablokova V, Krejcy K, Empson V, Hasselbalch HC, Kralovics R, Kiladjian JJ. Event-free survival in patients with polycythemia vera treated with ropeginterferon alfa-2b versus best available treatment. Leukemia 2023; 37:2129-2132. [PMID: 37634011 PMCID: PMC10539163 DOI: 10.1038/s41375-023-02008-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University Vienna, Vienna, Austria.
| | | | | | - Dorota Krochmalczyk
- Teaching Unit of the Hematology Department, University Hospital in Krakow, Krakow, Poland
| | - Liana Gercheva-Kyuchukova
- Clinical Hematology Clinic, Multiprofile Hospital for Active Treatment "Sveta Marina", Varna, Bulgaria
| | - Miklos Egyed
- Department of Internal Medicine II, Kaposi Mor County Teaching Hospital, Kaposvar, Hungary
| | - Petr Dulicek
- Department of Clinical Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Arpad Illes
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Halyna Pylypenko
- Department of Hematology, Regional Treatment and Diagnostics Hematology Centre, Cherkasy Regional Oncology Centre, Cherkasy, Ukraine
| | - Lylia Sivcheva
- First Department of Internal Medicine, Multiprofile Hospital for Active Treatment - HristoBotev, Vratsa, Bulgaria
| | - Jiří Mayer
- Clinic of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vera Yablokova
- Department of Hematology, Yaroslavl Regional Clinical Hospital, Yaroslavl, Russia
| | | | | | - Hans C Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Robert Kralovics
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, CIC1427, Paris, France
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Gerds AT, Verstovsek S, Vannucchi AM, Al-Ali HK, Lavie D, Kuykendall AT, Grosicki S, Iurlo A, Goh YT, Lazaroiu MC, Egyed M, Fox ML, McLornan D, Perkins A, Yoon SS, Gupta V, Kiladjian JJ, Granacher N, Lee SE, Ocroteala L, Passamonti F, Harrison CN, Oh S, Klencke BJ, Yu J, Donahue R, Kawashima J, Mesa R. Momelotinib versus danazol in symptomatic patients with anaemia and myelofibrosis previously treated with a JAK inhibitor (MOMENTUM): an updated analysis of an international, double-blind, randomised phase 3 study. Lancet Haematol 2023; 10:e735-e746. [PMID: 37517413 DOI: 10.1016/s2352-3026(23)00174-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The MOMENTUM study met all key endpoints at week 24, demonstrating symptom, spleen, and anaemia benefits with momelotinib versus danazol in patients with myelofibrosis. In this updated analysis, we report duration of week 24 responses and new responses with momelotinib through week 48. METHODS MOMENTUM is an international, double-blind, randomised, phase 3 study done at 107 sites across 21 countries. Patients were 18 years or older with primary, post-polycythaemia vera, or post-essential thrombocythaemia myelofibrosis, previously treated with an approved Janus kinase (JAK) inhibitor for 90 days or more (≥28 days with haematological complications), and had an Eastern Cooperative Oncology Group performance status of 2 or less. Patients were randomly assigned (2:1) to either the momelotinib group (200 mg orally once per day) or danazol group (300 mg orally twice per day) through week 24 via non-deterministic biased coin minimisation and an interactive response system. Stratification factors were Total Symptom Score (TSS; <22 vs ≥22), spleen size (<12 cm vs ≥12 cm), transfusion burden (0 units vs 1-4 units vs ≥5 units), and study site. After week 24, all patients initially randomly assigned to either group who remained on the study received open-label momelotinib. The primary endpoint, which has already been reported, was Myelofibrosis Symptom Assessment Form TSS response rate at week 24. Predefined secondary endpoints were duration of week 24 TSS and transfusion independence responses, safety, and survival, which are summarised post hoc at the week 48 data cutoff (May 17, 2022). TSS, transfusion independence, and splenic responses at week 48 were defined post hoc and assessed in all evaluable patients who entered the open-label period and provided sufficient data. The timing of this updated analysis was defined post hoc after all patients had the opportunity to complete their week 48 assessments, as most patients entered an extended access study (NCT03441113) after week 48. This study is registered with ClinicalTrials.gov, number NCT04173494, and is now complete. FINDINGS Between April 24, 2020, and Dec 3, 2021, a total of 195 patients were randomised (130 [67%] in the momelotinib group and 65 [33%] in the danazol group). 93 (72%) of 130 patients in the momelotinib group and 41 (63%) of 65 in the danazol group entered the momelotinib open-label extension period. Median follow-up was 48·4 weeks (IQR 40·6-55·7). Among TSS-evaluable patients at week 48, 30 (45%) of 67 patients in the momelotinib group who continued treatment and 15 (50%) of 30 in the danazol group who crossed over were responders. TSS responders at any time during the open-label period by week 48 were 46 (61%) of 75 evaluable patients in the momelotinib group who continued and 19 (59%) of 32 in the danazol group who crossed over, including most week 24 responders plus new responders after week 24. No new safety signals emerged with long-term follow-up. The most common non-haematological treatment-emergent adverse events in momelotinib-treated patients over the entire study period as of the data cutoff were diarrhoea (45 [26%] of 171) and asthenia (28 [16%]); the most common grades 3-4 treatment-emergent adverse events were thrombocytopenia (33 [19%]) and anaemia (19 [11%]). Serious treatment-emergent adverse events were reported in 79 (46%) of 171 patients, and fatal treatment-emergent adverse events were reported in 30 (18%); two fatal treatment-emergent adverse events were considered possibly related to momelotinib (rotaviral enteritis and Staphylococcus pneumonia). INTERPRETATION Momelotinib was associated with durable symptom, spleen, and anaemia benefits, late responses after week 24, and favourable safety through week 48. These results highlight the potential benefits of treatment with momelotinib in patients with myelofibrosis, particularly those with anaemia. FUNDING Sierra Oncology, a GSK company.
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Affiliation(s)
- Aaron T Gerds
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandro M Vannucchi
- Department of Hematology, University of Florence, Florence, Italy; Center of Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Florence, Italy
| | | | - David Lavie
- Department of Hematology and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Medical University of Silesia, Katowice, Poland
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Singapore
| | - Mihaela C Lazaroiu
- Department of Hematology, Policlinica de Diagnostic Rapid Brasov, Brasov, Romania
| | - Miklos Egyed
- Department of Hematology, Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Maria Laura Fox
- Department of Haematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Donal McLornan
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Perkins
- Department of Haematology, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Vikas Gupta
- Department of Medicine, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, CIC1427, Paris, France
| | - Nikki Granacher
- Department of Hematology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Sung-Eun Lee
- Department of Hematology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | | | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen Oh
- Division of Hematology, Washington University School of Medicine, St Louis, MO, USA
| | | | | | | | | | - Ruben Mesa
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Verstovsek S, Mesa R, Gupta V, Lavie D, Dubruille V, Cambier N, Platzbecker U, Hus M, Xicoy B, Oh ST, Kiladjian JJ, Vannucchi AM, Gerds A, Egyed M, Mayer J, Sacha T, Kawashima J, Morris M, Huang M, Harrison C. Momelotinib long-term safety and survival in myelofibrosis: integrated analysis of phase 3 randomized controlled trials. Blood Adv 2023; 7:3582-3591. [PMID: 37042865 PMCID: PMC10368854 DOI: 10.1182/bloodadvances.2022009311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 04/13/2023] Open
Abstract
Momelotinib is the first inhibitor of Janus kinase 1 (JAK1) and JAK2 shown to also inhibit activin A receptor type 1 (ACVR1), a key regulator of iron homeostasis, and has demonstrated improvements in splenomegaly, constitutional symptoms, and anemia in myelofibrosis (MF). This long-term analysis pooled data from 3 randomized phase 3 studies of momelotinib (MOMENTUM, SIMPLIFY-1, and SIMPLIFY-2), representing MF disease from early (JAK inhibitor-naive) to late (JAK inhibitor-experienced) stages. Patients in the control arms (danazol in MOMENTUM, ruxolitinib in SIMPLIFY-1, and best available therapy in SIMPLIFY-2) could cross over to receive momelotinib at the end of the 24-week randomized period, and all patients could continue momelotinib treatment after the completion of these studies via an extended access protocol (XAP). Across these studies, 725 patients with MF received momelotinib; 12% remained on therapy for ≥5 years, with a median treatment exposure of 11.3 months (range, 0.1-90.4 months). The most common nonhematologic treatment-emergent adverse event (AE) occurring in ≥20% of patients was diarrhea (any grade, 27% and grade ≥3, 3%). Any-grade thrombocytopenia, anemia, and neutropenia occurred in 25%, 23%, and 7% of patients, respectively. The most common reason for momelotinib discontinuation was thrombocytopenia (4% discontinuation rate). The incidence of AEs of clinical importance (eg, infections, malignant transformation, peripheral neuropathy, and hemorrhage) did not increase over time. This analysis of one of the largest randomized trial databases for a JAK inhibitor to date in MF demonstrated a consistent safety profile of momelotinib without long-term or cumulative toxicity. These trials were registered at www.clinicaltrials.gov as: MOMENTUM (#NCT04173494), SIMPLIFY-1 (#NCT01969838), SIMPLIFY-2 (#NCT02101268), and XAP (#NCT03441113).
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Affiliation(s)
| | - Ruben Mesa
- UT Health San Antonio Cancer Center, San Antonio, TX
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Lavie
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Viviane Dubruille
- Centre Hospitalier Universitaire de Nantes (CHU de Nantes), Nantes, France
| | - Nathalie Cambier
- Service d’hématologie, Centre hospitalier régional universitaire de Lille (CHRU Lille), Lille, France
| | - Uwe Platzbecker
- Clinic of Hematology, Cellular Therapy, and Hemostaseology, University of Leipzig, Leipzig, Germany
| | - Marek Hus
- Uniwersytet Medyczny w Lublinie, Lublin, Poland
| | - Blanca Xicoy
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Stephen T. Oh
- Division of Hematology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jean-Jacques Kiladjian
- Université de Paris, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, Paris, France
| | - Alessandro M. Vannucchi
- Center of Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Florence, Italy
| | | | | | - Jiří Mayer
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomasz Sacha
- Uniwersytet Jagielloński Collegium Medicum, Krakow, Poland
| | | | | | | | - Claire Harrison
- Guy's and St Thomas' National Health Services (NHS) Foundation Trust, London, United Kingdom
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Harrison C, Yacoub A, Scott B, Mead A, Gerds AT, Kiladjian JJ, Mesa R, Egyed M, Scheid C, Gutierrez VG, O'Sullivan J, Buckley S, Kanellopoulos K, Mascarenhas J. Long-term treatment with pacritinib on a compassionate use basis in patients with advanced myelofibrosis. Haematologica 2023; 108:1960-1964. [PMID: 36601980 PMCID: PMC10316250 DOI: 10.3324/haematol.2022.282089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
| | | | - Bart Scott
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Aaron T Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | | | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio, San Antonio
| | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvár
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9
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Verstovsek S, Gerds AT, Vannucchi AM, Al-Ali HK, Lavie D, Kuykendall AT, Grosicki S, Iurlo A, Goh YT, Lazaroiu MC, Egyed M, Fox ML, McLornan D, Perkins A, Yoon SS, Gupta V, Kiladjian JJ, Granacher N, Lee SE, Ocroteala L, Passamonti F, Harrison CN, Klencke BJ, Ro S, Donahue R, Kawashima J, Mesa R. Momelotinib versus danazol in symptomatic patients with anaemia and myelofibrosis (MOMENTUM): results from an international, double-blind, randomised, controlled, phase 3 study. Lancet 2023; 401:269-280. [PMID: 36709073 DOI: 10.1016/s0140-6736(22)02036-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Janus kinase (JAK) inhibitors approved for myelofibrosis provide spleen and symptom improvements but do not meaningfully improve anaemia. Momelotinib, a first-in-class inhibitor of activin A receptor type 1 as well as JAK1 and JAK2, has shown symptom, spleen, and anaemia benefits in myelofibrosis. We aimed to confirm the differentiated clinical benefits of momelotinib versus the active comparator danazol in JAK-inhibitor-exposed, symptomatic patients with anaemia and intermediate-risk or high-risk myelofibrosis. METHODS MOMENTUM is an international, double-blind, randomised, controlled, phase 3 study that enrolled patients at 107 sites across 21 countries worldwide. Eligible patients were 18 years or older with a confirmed diagnosis of primary myelofibrosis or post-polycythaemia vera or post-essential thrombocythaemia myelofibrosis. Patients were randomly assigned (2:1) to receive momelotinib (200 mg orally once per day) plus danazol placebo (ie, the momelotinib group) or danazol (300 mg orally twice per day) plus momelotinib placebo (ie, the danazol group), stratified by total symptom score (TSS; <22 vs ≥22), spleen size (<12 cm vs ≥12 cm), red blood cell or whole blood units transfused in the 8 weeks before randomisation (0 units vs 1-4 units vs ≥5 units), and study site. The primary endpoint was the Myelofibrosis Symptom Assessment Form (MFSAF) TSS response rate at week 24 (defined as ≥50% reduction in mean MFSAF TSS over the 28 days immediately before the end of week 24 compared with baseline). MOMENTUM is registered with ClinicalTrials.gov, number NCT04173494, and is active but not recruiting. FINDINGS 195 patients were randomly assigned to either the momelotinib group (130 [67%]) or danazol group (65 [33%]) and received study treatment in the 24-week randomised treatment period between April 24, 2020, and Dec 3, 2021. A significantly greater proportion of patients in the momelotinib group reported a 50% or more reduction in TSS than in the danazol group (32 [25%] of 130 vs six [9%] of 65; proportion difference 16% [95% CI 6-26], p=0·0095). The most frequent grade 3 or higher treatment-emergent adverse events with momelotinib and danazol were haematological abnormalities by laboratory values: anaemia (79 [61%] of 130 vs 49 [75%] of 65) and thrombocytopenia (36 [28%] vs 17 [26%]). The most frequent non-haematological grade 3 or higher treatment-emergent adverse events with momelotinib and danazol were acute kidney injury (four [3%] of 130 vs six [9%] of 65) and pneumonia (three [2%] vs six [9%]). INTERPRETATION Treatment with momelotinib, compared with danazol, resulted in clinically significant improvements in myelofibrosis-associated symptoms, anaemia measures, and spleen response, with favourable safety. These findings support the future use of momelotinib as an effective treatment in patients with myelofibrosis, especially in those with anaemia. FUNDING Sierra Oncology.
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Affiliation(s)
- Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Aaron T Gerds
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Alessandro M Vannucchi
- Department of Hematology, University of Florence, Florence, Italy; Center of Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Florence, Italy
| | | | - David Lavie
- Department of Hematology and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Medical University of Silesia, Katowice, Poland
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Singapore
| | - Mihaela C Lazaroiu
- Department of Hematology, Policlinica de Diagnostic Rapid Brasov, Brasov, Romania
| | - Miklos Egyed
- Department of Hematology, Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Maria Laura Fox
- Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Donal McLornan
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Perkins
- Department of Haematology, Alfred Hospital, Monash University, Melbourne, Australia
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Vikas Gupta
- Department of Medicine, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hoôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, CIC1427, Paris, France
| | - Nikki Granacher
- Department of Hematology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Sung-Eun Lee
- Department of Laboratory Medicine, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | | | | | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | - Ruben Mesa
- Mays Cancer Center, UT Health San Antonio MD Anderson, San Antonio, TX, USA
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10
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Gerds A, Verstovsek S, Vannucchi A, Al-Ali HK, Lavie D, Kuykendall A, Grosicki S, Iurlo A, Goh YT, Lazaroiu M, Egyed M, Fox ML, McLornan D, Perkins A, Yoon SS, Gupta V, Kiladjian JJ, Donahue R, Kawashima J, Mesa R. MPN-483 Thrombocytopenic Myelofibrosis (MF) Patients Previously Treated With a JAK Inhibitor in a Phase 3 Randomized Study of Momelotinib (MMB) versus Danazol (DAN) [MOMENTUM]. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S340. [PMID: 36164014 DOI: 10.1016/s2152-2650(22)01464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND MMB, an oral JAK1/2 and ACVR1/ALK2 inhibitor, was evaluated (vs DAN) in a pivotal phase 3 study of MF patients previously treated with a JAK inhibitor (JAKi). This subgroup analysis evaluated MOMENTUM patients with baseline platelet counts ≤150 × 109/L. METHODS Eligibility: Primary or post-ET/PV MF; DIPSS high risk, Int-2, or Int-1; total symptom score (TSS) ≥10; hemoglobin <10 g/dL; prior JAKi ≥90 days, or ≥28 days if RBC transfusions ≥4 units in 8 weeks or Grade 3/4 thrombocytopenia, anemia, or hematoma; palpable spleen ≥5 cm; platelets ≥25 × 109/L. JAKi taper/washout ≥21 days. Randomization 2:1 to MMB 200 mg or DAN 600 mg QD (+ placebo) for 24 weeks. PRIMARY ENDPOINT TSS response (≥50% reduction from baseline) rate at week 24. Secondary endpoints at week 24: transfusion independence (TI) rate, splenic response rate (SRR; ≥25% volume reduction from baseline), TSS change from baseline, SRR (≥35% reduction), and rate of zero transfusions since baseline. RESULTS Mean baseline TSS: 29 MMB, 26 DAN, hemoglobin: 8.1 MMB, 7.8 DAN g/dL, and platelets: 74 × 109/L MMB, 73 × 109/L DAN. Efficacy results are consistent with the ITT analysis set for MMB vs DAN, respectively: TSS response rate (29.6% vs 11.6%), TI rate (32.1% vs 18.6%), SRR ≥25% (39.5% vs 7.0%), TSS change (-10.7 vs -3.8), SRR ≥35% (22.2% vs 4.7%), and rate of zero transfusions (30.9% vs 11.6%). Most common grade ≥3 TEAEs were thrombocytopenia (MMB, 31%; DAN, 16%) and anemia (MMB, 7%; DAN, 14%); grade ≥3 bleeding events: 9% MMB, 5% DAN. TEAEs leading to study drug discontinuation: 15% MMB, 19% DAN. A trend toward improved overall survival up to week 24 was seen with MMB vs DAN [HR (95% CI)=0.490 (0.195, 1.235)]. Analyses of patients with baseline platelets <100 × 109/L (N=100) and baseline platelets <50 × 109/L (N=31) show similar efficacy, safety, and survival profiles for MMB vs DAN. CONCLUSIONS In symptomatic, anemic, and thrombocytopenic MF patients, MMB was superior to DAN for symptom responses, transfusion requirements, and spleen responses with comparable safety and favorable survival. MMB may address a critical unmet need in thrombocytopenic MF patients. NCT04173494.
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Affiliation(s)
- Aaron Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | | | - David Lavie
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Alessandra Iurlo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yeow Tee Goh
- Singapore General Hospital, Singapore, Singapore
| | | | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Maria Laura Fox
- Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Donal McLornan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Sung-Soo Yoon
- Seoul National University Hospital, Seoul, Korea, Republic of
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, CIC1427, Paris, France
| | | | | | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
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11
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Schuster M, Zijlstra J, Casasnovas RO, Vermaat JSP, Kalakonda N, Goy A, Choquet S, Neste EVD, Hill B, Thieblemont C, Cavallo F, De la Cruz F, Kuruvilla J, Hamad N, Jaeger U, Caimi P, Gurion R, Warzocha K, Bakhshi S, Sancho JM, Follows G, Egyed M, Offner F, Vassilakopoulos T, Samal P, Ku M, Ma X, Corona K, Chamoun K, Shah J, Shacham S, Kauffman MG, Canales M, Maerevoet M. Effect of Prior Therapy and Disease Refractoriness on the Efficacy and Safety of Oral Selinexor in Patients with Diffuse Large B-cell Lymphoma (DLBCL): A Post-hoc Analysis of the SADAL Study. Clin Lymphoma Myeloma Leuk 2022; 22:483-494. [PMID: 35078739 DOI: 10.1016/j.clml.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Despite a number of treatment options, patients with diffuse large B-cell lymphoma (DLBCL) whose disease has become refractory to treatment have a poor prognosis. Selinexor is a novel, oral drug that is approved to treat patients with relapsed/refractory DLBCL. In this post hoc analysis of the SADAL study, a multinational, open-label study, we evaluated subpopulations to determine if response to single agent selinexor is impacted by number of lines of prior treatment, autologous stem cell transplant (ASCT), response to first and most recent therapies, and time to progressive disease. PATIENTS Patients (n = 134) with DLBCL after 2-5 prior therapies were enrolled in SADAL and received 60mg selinexor twice weekly. RESULTS The median overall survival was 9.0 months and median progression free survival was 2.6 months. Patients who had the best overall response rate (ORR) and disease control rate were those who had prior ASCT (42.5% and 50.0%) or responded to last line of therapy (35.9% and 43.5%). Patients with primary refractory DLBCL also showed responses (ORR 21.8%). Adverse events between subgroups were similar to the overall study population, the most common being thrombocytopenia (29.1%), fatigue (7.5%), and nausea (6.0%). CONCLUSION Regardless of prior therapy and disease refractory status, selinexor treatment demonstrated results consistent with its novel mechanism of action and lack of cross-resistance. Thus, single agent oral selinexor can induce deep, durable, and tolerable responses in patients with DLBCL who have recurrent disease after several chemoimmunotherapy combination regimens.
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Affiliation(s)
| | - Josée Zijlstra
- Amsterdam UMC, Vrije Universiteit, Cancer Center, Amsterdam, Netherlands
| | | | | | | | - Andre Goy
- Hackensack University Medical Center, Hackensack, NJ, United States
| | | | | | - Brian Hill
- Cleveland Clinic, Cleveland, OH, United States
| | - Catherine Thieblemont
- APHP, Saint-Louis Hospital, Hemato-oncology, Paris, France & Diderot University, Paris, France
| | | | | | | | - Nada Hamad
- St. Vincent's Hospital Sydney, Darlinghurst, Australia
| | | | - Paolo Caimi
- UH Seidman Cancer Center, Cleveland, OH, United States
| | | | | | - Sameer Bakhshi
- Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | | | | | | | | | | | - Priyanka Samal
- Institute of Medical Sciences & SUM Hospital, Odisha, India
| | - Matthew Ku
- St.Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Xiwen Ma
- Karyopharm Therapeutics, Newton, MA, United States
| | - Kelly Corona
- Karyopharm Therapeutics, Newton, MA, United States
| | | | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, United States
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Sharman JP, Egyed M, Jurczak W, Skarbnik AP, Kamdar MK, Munir T, Fogliatto L, Herishanu Y, Banerji V, Follows G, Walker P, Karlsson K, Ghia P, Janssens A, Ferrant E, Munugalavadla V, Yu T, Wang MH, Woyach JA. Acalabrutinib ± obinutuzumab versus obinutuzumab + chlorambucil in treatment-naïve chronic lymphocytic leukemia: Five-year follow-up of ELEVATE-TN. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7539 Background: For ELEVATE-TN (NCT02475681), we previously reported superior efficacy of acalabrutinib (A) ± obinutuzumab (O) vs O + chlorambucil (Clb) in patients (pts) with treatment-naive (TN) chronic lymphocytic leukemia (CLL) at 28.3 and 46.9 months (mo) median follow-up. Now, we report results from a 5-y update. Methods: Pts were randomized to A+O, A, or O+Clb. Pts who progressed on O+Clb could cross over to A monotherapy. Investigator-assessed (INV) progression-free survival (PFS), INV overall response rate (ORR), overall survival (OS), and safety were evaluated. Results: A total of 535 pts (A+O, n=179; A, n=179; O+Clb, n=177) had a median age of 70 y. At a median follow-up of 58.2 mo (range, 0.0–72.0; data cutoff Oct 1, 2021), median PFS was not reached (NR) (hazard ratio [HR]: 0.11) for A+O and A (HR: 0.21) vs 27.8 mo for O+Clb (both P<0.0001). Estimated 60-mo PFS rates were 84% (A+O), 72% (A), and 21% (O+Clb). Median OS was NR in any treatment arm, and significantly longer in the A+O vs O+Clb arms (HR: 0.55; P=0.0474); estimated 60-mo OS rates were 90% (A+O), 84% (A), and 82% (O+Clb). ORR was significantly higher with A+O (96%; 95% CI 92–98) and A (90%; 85–94) vs O+Clb (83%; 77–88; P<0.0001 [A+O], P=0.0499 [A]). Complete response (CR)/CR with incomplete hematologic recovery (CRi) rates were higher with A+O (29%/3%) vs O+Clb (13%/1%); 13%/1% had CR/CRi with A; CR increased since the interim analysis (previously 21% [A+O] and 7% [A]). Adverse events (AEs) and treatment exposure are shown in the Table. Treatment is ongoing in 65% (A+O) and 60% (A) of pts; the most common reasons for treatment discontinuation were AEs (17% [A+O], 16% [A], 14% [O+Clb]) and progressive disease (6%, 10%, 2%, respectively). Crossover from O+Clb to A occurred in 72 (41%) patients; 25% of these pts discontinued A (10% due to AEs and 11% due to progressive disease). Conclusions: After a 5-y follow-up, efficacy and safety of A+O and A monotherapy were maintained, with significantly longer OS in the A+O arm compared with O+Clb. Clinical trial information: NCT02475681. [Table: see text]
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Affiliation(s)
- Jeff Porter Sharman
- Willamette Valley Cancer Institute and US Oncology Research Center, Eugene, OR
| | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvar, Hungary
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | | | | | - Talha Munir
- Haematology, Haematological Malignancy Diagnostic Service (HMDS), St. James’s Institute of Oncology, Leeds, United Kingdom
| | | | | | - Versha Banerji
- Departments of Internal Medicine, Biochemistry & Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba and CancerCare Manitoba, Winnipeg, MB, Canada
| | - George Follows
- Department of Haematology, Addenbrooke’s Hospital NHS Trust, Cambridge, United Kingdom
| | - Patricia Walker
- Peninsula Health and Peninsula Private Hospital, Melbourne, VIC, Australia
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Emmanuelle Ferrant
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’Hématologie Clinique, Pierre-Bénite, France
| | | | - Ting Yu
- AstraZeneca, South San Francisco, CA
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Kotmayer L, László T, Kiss R, Hegyi LL, Mikala G, Farkas P, Balogh A, Masszi T, Demeter J, Weisinger J, Alizadeh H, Gergely L, Sulák A, Egyed M, Plander M, Pettendi P, Lévai D, Schneider T, Pauker Z, Masszi A, Szász R, Bödör C, Alpár D. P615: BCL2 RESISTANCE MUTATIONS IN A REAL-WORLD COHORT OF PATIENTS WITH VENETOCLAX-TREATED CHRONIC LYMPHOCYTIC LEUKAEMIA. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000845348.59055.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mesa RA, Gerds AT, Vannucchi A, Al-Ali HK, Lavie D, Kuykendall AT, Grosicki S, Iurlo A, Goh YT, Lazaroiu MC, Egyed M, Fox ML, McLornan DP, Perkins A, Yoon SS, Gupta V, Kiladjian JJ, Donahue R, Kawashima J, Verstovsek S. MOMENTUM: Phase 3 randomized study of momelotinib (MMB) versus danazol (DAN) in symptomatic and anemic myelofibrosis (MF) patients previously treated with a JAK inhibitor. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7002 Background: MMB, an oral JAK1/2 and ACVR1/ALK2 inhibitor, showed clinical activity on MF symptoms, RBC transfusion requirements (anemia), and spleen volume in the SIMPLIFY trials. This pivotal phase 3 study of MF patients (pts) previously treated with a JAK inhibitor (JAKi) tested MMB vs DAN on key symptom, anemia, and spleen volume endpoints at 24 weeks (wks). Methods: Eligibility: Primary or post-ET/PV MF; DIPSS high risk, Int-2, or Int-1; MF Symptom Assessment Form Total Symptom Score (MFSAF TSS) ≥10; Hgb <10 g/dL; prior JAKi for ≥90 days, or ≥28 days if RBC transfusions ≥4 units in 8 wks or Gr 3/4 thrombocytopenia, anemia, or hematoma; palpable spleen ≥5 cm. Stratification: TSS, palpable spleen, and RBC units transfused. JAKi taper and washout was ≥21 days. Randomization: 2:1 to MMB 200 mg QD plus DAN placebo or DAN 600 mg QD plus MMB placebo for 24 wks, after which pts could receive open-label MMB. Assessments: Pt reported symptoms using a daily eDiary and spleen volume by MRI or CT. The primary endpoint was TSS response (≥50% reduction from baseline [BL]) rate at wk 24. Secondary endpoints, assessed sequentially at wk 24, were RBC transfusion independence (TI) rate, splenic response rate (SRR; ≥25% reduction in volume from BL), change from BL in TSS, SRR (≥35% reduction from BL) and rate of zero transfusions since BL. Results: 94 of 130 (72%) MMB pts and 38 of 65 (58%) DAN pts completed the 24-wk randomized treatment (RT) phase. Median BL TSS were 28 (MMB) and 26 (DAN), Hgb were 8.1 (MMB) and 7.9 (DAN) g/dL, and platelets were 97 (MMB) and 94 (DAN) x109/L. BL TI was 13% (MMB) and 15% (DAN). Prior JAKi was ruxolitinib in 195 pts (100%) and fedratinib in 9 pts (5%). All primary and key secondary endpoints were met (Table). Most common Gr ≥3 TEAEs in the RT phase of the study were thrombocytopenia (MMB, 22%; DAN, 12%) and anemia (MMB, 8%; DAN, 11%). Gr ≥3 infections occurred in 15% of MMB and 17% of DAN pts. Peripheral neuropathy occurred in 5 (4%) of MMB (all Gr ≤2) and 1 (2%) of DAN (Gr ≤2) pts in the RT phase, and none discontinued study drug. Overall, TEAEs led to study drug discontinuation in 18% of MMB and 23% of DAN pts in RT phase. A trend toward improved OS up to wk 24 was seen with MMB vs DAN (HR=0.506, p=0.0719). Conclusions: In symptomatic and anemic MF pts, MMB was superior to DAN for symptom responses, transfusion requirements, and spleen responses with comparable safety and favorable survival. MMB may address a critical unmet need, particularly in MF pts with anemia. Clinical trial information: NCT04173494. [Table: see text]
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Affiliation(s)
| | - Aaron Thomas Gerds
- Cleveland Clinic Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland, OH
| | | | | | | | | | - Sebastian Grosicki
- Department of Hematology, Independent Public Healthcare Facility Municipal Hospitals, Katowice, Poland
| | - Alessandra Iurlo
- Hematology Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Yeow Tee Goh
- Singapore General Hospital, Singapore, Singapore
| | | | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvar, Hungary
| | - Maria Laura Fox
- Hematology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Andrew Perkins
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | | | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Gerds AT, Verstovsek S, Vannucchi A, Al-Ali HK, Lavie D, Kuykendall AT, Grosicki S, Iurlo A, Goh YT, Lazaroiu MC, Egyed M, Fox ML, McLornan DP, Perkins A, Yoon SS, Gupta V, Kiladjian JJ, Donahue R, Kawashima J, Mesa RA. Thrombocytopenic myelofibrosis (MF) patients previously treated with a JAK inhibitor in a phase 3 randomized study of momelotinib (MMB) versus danazol (DAN) [MOMENTUM]. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7061 Background: MMB, an oral JAK1/2 and ACVR1/ALK2 inhibitor, showed clinical activity on MF symptoms, RBC transfusion requirements (anemia), and spleen volume in the SIMPLIFY trials, including in MF patients (pts) with thrombocytopenia. MOMENTUM is a pivotal phase 3 study of symptomatic and anemic MF pts previously treated with a JAK inhibitor (JAKi) testing MMB vs DAN. This analysis evaluated MOMENTUM pts with baseline (BL) platelet counts (PLT) ≤150 x 109/L. Methods: Eligibility: Primary or post-ET/PV MF; DIPSS high risk, Int-2, or Int-1; MF Symptom Assessment Form Total Symptom Score (MFSAF TSS) ≥10; Hgb <10 g/dL; prior JAKi for ≥90 days, or ≥28 days if RBC transfusions ≥4 units in 8 weeks (wks) or Gr 3/4 thrombocytopenia, anemia, or hematoma; palpable spleen ≥5 cm; PLT ≥25 x 109/L. JAKi taper and washout was ≥21 days. Randomization: 2:1 to MMB 200 mg QD plus DAN placebo or DAN 600 mg QD plus MMB placebo for 24 wks. Primary endpoint: TSS response (≥50% reduction from BL) rate at wk 24. Key secondary endpoints, assessed sequentially at wk 24: RBC transfusion independence (TI) rate, splenic response rate (SRR; ≥25% reduction in volume from BL), change from BL in TSS, SRR (≥35% reduction from BL) and rate of zero transfusions since BL. Results: 60 (74%) of 81 MMB pts and 25 (58%) of 43 DAN pts with BL PLT ≤150 x 109/L completed the 24-week randomized treatment (RT) phase. Median BL TSS were 29 (MMB) and 24 (DAN), Hgb were 7.9 (MMB) and 8.0 (DAN) g/dL, and PLT were 67 x 109/L (MMB) and 64 x 109/L (DAN). Prior JAKi was ruxolitinib in 124 pts (100%) and fedratinib in 6 pts (5%). Efficacy results are in Table. These results are consistent with the overall ITT analysis set (N=195). Most common Gr ≥3 TEAEs in the RT phase were thrombocytopenia (MMB, 31%; DAN, 16%) and anemia (MMB, 7%; DAN, 14%); Gr ≥3 bleeding events occurred in 9% of MMB and 5% of DAN pts. TEAEs led to study drug discontinuation in 15% of MMB and 19% of DAN pts in RT phase. A trend toward improved OS up to wk 24 was seen with MMB vs DAN [HR (95% CI)=0.490 (0.195, 1.235)]. Additional analyses of pts with BL PLT <100 x 109/L (N=100) and BL PLT <50 x 109/L (N=31) show similar treatment effects of MMB vs DAN. Conclusions: In thrombocytopenic MF pts who were symptomatic and anemic, MMB was superior to DAN for symptom responses, transfusion requirements, and spleen responses and showed comparable safety and favorable survival. MMB may address a critical unmet need in thrombocytopenic MF pts. Clinical trial information: NCT04173494. [Table: see text]
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Affiliation(s)
- Aaron Thomas Gerds
- Cleveland Clinic Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland, OH
| | | | | | | | | | | | - Sebastian Grosicki
- Department of Hematology, Independent Public Healthcare Facility Municipal Hospitals, Katowice, Poland
| | - Alessandra Iurlo
- Hematology Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Yeow Tee Goh
- Singapore General Hospital, Singapore, Singapore
| | | | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvar, Hungary
| | - Maria Laura Fox
- Hematology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Andrew Perkins
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | | | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Kiladjian JJ, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, Dulicek P, Illes A, Pylypenko H, Sivcheva L, Mayer J, Yablokova V, Krejcy K, Empson V, Hasselbalch HC, Kralovics R, Gisslinger H. Long-term outcomes of polycythemia vera patients treated with ropeginterferon Alfa-2b. Leukemia 2022; 36:1408-1411. [PMID: 35210530 PMCID: PMC9061291 DOI: 10.1038/s41375-022-01528-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, CIC1427, Paris, France.
| | | | | | - Dorota Krochmalczyk
- Teaching Unit of the Hematology Department, University Hospital in Krakow, Krakow, Poland
| | - Liana Gercheva-Kyuchukova
- Clinical Hematology Clinic, Multiprofile Hospital for Active Treatment "Sveta Marina", Varna, Bulgaria
| | - Miklos Egyed
- Department of Internal Medicine II, Kaposi Mor County Teaching Hospital, Kaposvar, Hungary
| | - Petr Dulicek
- Department of Clinical Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Arpad Illes
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Halyna Pylypenko
- Department of Hematology, Regional Treatment and Diagnostics Hematology Centre, Cherkasy Regional Oncology Centre, Cherkasy, Ukraine
| | - Lylia Sivcheva
- First Department of Internal Medicine, Multiprofile Hospital for Active Treatment - HristoBotev, Vratsa, Bulgaria
| | - Jiří Mayer
- Clinic of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vera Yablokova
- Department of Hematology, Yaroslavl Regional Clinical Hospital, Yaroslavl, Russia
| | | | | | - Hans C Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, University of Copenhagen, Copenhagen, Denmark
| | - Robert Kralovics
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University Vienna, Vienna, Austria
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17
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Egyed M, Lueff S, Borbely J, Illes A. Acalabrutinib and its use in the treatment of chronic lymphocytic leukemia. Future Oncol 2022; 18:755-769. [PMID: 35139644 DOI: 10.2217/fon-2021-0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bruton's tyrosine kinase inhibitors have changed the treatment landscape for chronic lymphocytic leukemia (CLL), mantle cell lymphoma (MCL) and lymphoplasmacytic lymphoma dramatically. In 2019, acalabrutinib was approved by the US FDA for the treatment of treatment-naive and relapsed/refractory CLL and MCL. Acalabrutinib monotherapy was found to be effective and safe in CLL patients. In ASCEND and ELEVATE treatment-naive studies, acalabrutinib monotherapy and the combination with obinutuzumab demonstrated improved efficacy and an acceptable safety profile. The triple combination with venetoclax showed a high rate of molecular remission without an impaired safety profile. Adverse events, with an occurrence rate of >20%, were as follows: grade 1-2 myelosuppression, gastrointestinal toxicity, rash, constitutional symptoms; grade 3 or 4 toxicities were syncope, pneumonia, hypertension, atrial fibrillation, neutropenia and thrombocytopenia.
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Affiliation(s)
- Miklos Egyed
- Department of Hematology, Somogy County Moritz Kaposi General Hospital, Kaposvar, Hungary
| | - Sandor Lueff
- Department of Hematology, Somogy County Moritz Kaposi General Hospital, Kaposvar, Hungary
| | | | - Arpad Illes
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
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18
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Schjesvold FH, Dimopoulos MA, Delimpasi S, Robak P, Coriu D, Legiec W, Pour L, Špička I, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Lazzaro A, Maisnar V, Mikala G, Rosiñol L, Liberati AM, Symeonidis A, Moody V, Thuresson M, Byrne C, Harmenberg J, Bakker NA, Hájek R, Mateos MV, Richardson PG, Sonneveld P, Schjesvold F, Delimpasi S, Robak P, Coriu D, Nikolayeva A, Tomczak W, Pour L, Spicka I, Dimopoulos MA, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Maisnar V, Mikala G, Rosinol L, Konstantinova T, Lazzaro A, Liberati AM, Symeonidis A, Gatt M, Illes A, Abdulhaq H, Dungarwalla M, Grosicki S, Hajek R, Leleu X, Myasnikov A, Richardson PG, Avivi I, Deeren D, Gironella M, Hernandez-Garcia MT, Martinez Lopez J, Newinger-Porte M, Ribas P, Samoilova O, Voog E, Arnao-Herraiz M, Carrillo-Cruz E, Corradini P, Dodlapati J, Granell Gorrochategui M, Huang SY, Jenner M, Karlin L, Kim JS, Kopacz A, Medvedeva N, Min CK, Mina R, Palk K, Shin HJ, Sohn SK, Sonneveld P, Tache J, Anagnostopoulos A, Arguiñano JM, Cavo M, Filicko J, Garnes M, Halka J, Herzog-Tzarfati K, Ipatova N, Kim K, Krauth MT, Kryuchkova I, Lazaroiu MC, Luppi M, Proydakov A, Rambaldi A, Rudzianskiene M, Yeh SP, Alcalá-Peña MM, Alegre Amor A, Alizadeh H, Bendandi M, Brearton G, Brown R, Cavet J, Dally N, Egyed M, Hernández-Rivas JÁ, Kaare A, Karsenti JM, Kloczko J, Kreisle W, Lee JJ, Legiec W, Machherndl-Spandl S, Manda S, Mateos MV, Moiseev I, Moreb J, Nagy Z, Nair S, Oriol-Rocafiguera A, Osswald M, Otero-Rodriguez P, Peceliunas V, Plesner T, Rey P, Rossi G, Stevens D, Suriu C, Tarella C, Verlinden A, Zannetti A. Melflufen or pomalidomide plus dexamethasone for patients with multiple myeloma refractory to lenalidomide (OCEAN): a randomised, head-to-head, open-label, phase 3 study. The Lancet Haematology 2022; 9:e98-e110. [DOI: 10.1016/s2352-3026(21)00381-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
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19
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Sharman JP, Egyed M, Jurczak W, Skarbnik A, Pagel JM, Flinn IW, Kamdar M, Munir T, Walewska R, Corbett G, Fogliatto LM, Herishanu Y, Banerji V, Coutre S, Follows G, Walker P, Karlsson K, Ghia P, Janssens A, Cymbalista F, Woyach JA, Ferrant E, Wierda WG, Munugalavadla V, Yu T, Wang MH, Byrd JC. Efficacy and safety in a 4-year follow-up of the ELEVATE-TN study comparing acalabrutinib with or without obinutuzumab versus obinutuzumab plus chlorambucil in treatment-naïve chronic lymphocytic leukemia. Leukemia 2022; 36:1171-1175. [PMID: 34974526 PMCID: PMC8979808 DOI: 10.1038/s41375-021-01485-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Jeff P Sharman
- Willamette Valley Cancer Institute and Research Center, Eugene, OR, USA.
| | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Wojciech Jurczak
- Maria Skłodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | | | - John M Pagel
- Swedish Cancer Institute, Center for Blood Disorders and Stem Cell Transplantation, Seattle, WA, USA
| | - Ian W Flinn
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN, USA
| | - Manali Kamdar
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Talha Munir
- Haematology, Haematological Malignancy Diagnostic Service (HMDS), St. James's Institute of Oncology, Leeds, UK
| | | | | | | | | | - Versha Banerji
- Departments of Internal Medicine, Biochemistry & Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba and CancerCare Manitoba Research Institute, Winnipeg, MB, Canada
| | - Steven Coutre
- Stanford University School of Medicine, Stanford, CA, USA
| | - George Follows
- Department of Haematology, Addenbrooke's Hospital NHS Trust, Cambridge, UK
| | - Patricia Walker
- Peninsula Health and Peninsula Private Hospital, Frankston, Melbourne, VIC, Australia
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | | | | | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Emmanuelle Ferrant
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Hématologie Clinique, Pierre-Bénite, France
| | - William G Wierda
- Department of Leukemia, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ting Yu
- AstraZeneca, South San Francisco, CA, USA
| | | | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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20
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Casasnovas RO, Follows G, Zijlstra JM, Vermaat JSP, Kalakonda N, Choquet S, Neste EVD, Hill B, Thieblemont C, Cavallo F, la Cruz FD, Kuruvilla J, Hamad N, Jaeger U, Caimi PF, Gurion R, Warzocha K, Bakhshi S, Sancho JM, Schuster M, Egyed M, Offner F, Vassilakopoulos TP, Samal P, Ku M, Ma X, Chamoun K, Shah J, Canales M, Maerevoet M, Shacham S, Kauffman MG, Goy A. Comparison of the Effectiveness and Safety of the Oral Selective Inhibitor of Nuclear Export, Selinexor, in Diffuse Large B Cell Lymphoma Subtypes. Clin Lymphoma Myeloma Leuk 2021; 22:24-33. [PMID: 34493477 DOI: 10.1016/j.clml.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The SADAL study evaluated oral selinexor in patients with relapsed and/or refractory diffuse large B-cell lymphoma (DLBCL) after at least 2 prior lines of systemic therapy. In this post-hoc analysis, we analyzed the outcomes of the SADAL study by DLBCL subtype to determine the effects of DLBCL subtypes on efficacy and tolerability of selinexor. PATIENTS AND METHODS Data from 134 patients in SADAL were analyzed by DLBCL subtypes for overall response rate (ORR), overall survival (OS), duration of treatment response, progression-free survival, and adverse events rate. RESULTS ORR in the entire cohort was 29.1%, and similar in patients with germinal center (GCB) versus non-GCB DLBCL (31.7% vs. 24.2%, P = 0.45); transformed DLBCL showed a trend towards higher ORR than de novo DLBCL: 38.7% vs. 26.2% (P = 0.23). Despite similar prior treatment regimens and baseline characteristics, patients with DLBCL and normal C-MYC/BCL-2 protein expression levels had a significantly higher ORR (46.2% vs.14.8%, P = 0.012) and significantly longer OS (medians 13.7 vs. 5.1 months, hazard ratio 0.43 [95% CI, 0.23-0.77], P = 0.004) as compared with those whose DLBCL had C-MYC and BCL-2 overexpression. Among patients who had normal expression levels of either C-MYC or BCL-2 and baseline hemoglobin levels ≥ 10g/dL, ORR was 51.5% (n = 47), with median OS of 15.5 months and median PFS of 4.6 months. Similar rates of adverse events were noted in all subgroups. CONCLUSIONS Overall, single agent oral selinexor showed strong responses in patients with limited treatment alternatives regardless of germinal center B-cell type or disease origin.
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Affiliation(s)
| | | | - Josee M Zijlstra
- Amsterdam University Medical Center, Vrije Universiteit, Cancer Center, Amsterdam, The Netherlands
| | | | | | | | | | | | - Catherine Thieblemont
- AP-HP, Hopital Saint-Louis, Hémato-oncology, DMU DHI, Paris, France; Université de Paris, Paris, France
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology, University of Turin, Turin, Italy
| | | | | | - Nada Hamad
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | | | | | - Ronit Gurion
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Sameer Bakhshi
- Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | | | | | | | | | - Theodoros P Vassilakopoulos
- Department of Haematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Priyanka Samal
- Institute of Medical Sciences & SUM Hospital, Odisha, India
| | - Matthew Ku
- St.Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Xiwen Ma
- Karyopharm Therapeutics, Newton, MA
| | | | | | | | | | | | | | - Andre Goy
- Hackensack University Medical Center, Hackensack, NJ
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21
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Maerevoet M, Zijlstra JM, Follows G, Casasnovas RO, Vermaat JSP, Kalakonda N, Goy A, Choquet S, Van Den Neste E, Hill B, Thieblemont C, Cavallo F, De la Cruz F, Kuruvilla J, Hamad N, Jaeger U, Caimi P, Gurion R, Warzocha K, Bakhshi S, Sancho JM, Schuster M, Egyed M, Offner F, Vassilakopoulos TP, Samal P, Ku M, Ma X, Corona K, Chamoun K, Shah J, Shacham S, Kauffman MG, Canales M. Survival among patients with relapsed/refractory diffuse large B cell lymphoma treated with single-agent selinexor in the SADAL study. J Hematol Oncol 2021; 14:111. [PMID: 34271963 PMCID: PMC8283921 DOI: 10.1186/s13045-021-01122-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/01/2021] [Indexed: 01/22/2023] Open
Abstract
Patients with RR DLBCL who have received ≥ 2 lines of therapy have limited treatment options and an expected overall survival (OS) of < 6 months. The SADAL study evaluated single-agent oral selinexor in patients with RR DLBCL and demonstrated an overall response rate (ORR) of 29.1% with median duration of response (DOR) of 9.3 months. The analyses described here evaluated a number of subpopulations in order to understand how response correlates with survival outcomes in order to identify patients who could most optimally benefit from selinexor treatment. Median age was 67 years; 44.8% of patients were ≥ 70 years of age. The median OS was 9.0 months (95% CI 6.2, 13.7) at a median follow-up of 14.8 months. The median OS was not reached in patients with a CR or PR, while patients who did not respond have a median OS of 4.9 months (p < 0.0001). Patients < 70 years had an OS of 11.1 months compared with 7.8 months in patients ≥ 70 years. Among patients with or without prior ASCT, the median OS was 10.9 and 7.8 months, respectively. Among patients with disease refractory to the most recent DLBCL treatment regimen, the median OS was 7.0 months compared with 11.1 months for disease not refractory to the most recent treatment. In a patient population in which survival is expected to be < 6 months, treatment with single-agent oral selinexor was associated with a median survival of 9 months. Increased median OS observed in patients responding to selinexor was consistent across subgroups regardless of age, prior ASCT therapy, or refractory status. Randomized studies of selinexor in combination with a variety of other anti-DLBCL agents are planned. This trial was registered at ClinicalTrials.gov (NCT02227251) on August 28, 2014. https://clinicaltrials.gov/ct2/show/NCT02227251 .
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Affiliation(s)
- Marie Maerevoet
- Service Hématologie, Institut Jules Bordet, 1000, Brussels, Belgium.
| | - Josee M Zijlstra
- Amsterdam UMC, Vrije Universiteit, Cancer Center, Amsterdam, Netherlands
| | | | | | | | | | - Andre Goy
- Hackensack University Medical Center, Hackensack, USA
| | | | | | | | - Catherine Thieblemont
- APHP, Hemato-oncology, Saint-Louis Hospital, Paris, France.,Diderot University, Paris, France
| | | | | | | | - Nada Hamad
- St. Vincent's Hospital Sydney, Darlinghurst, Australia
| | | | | | - Ronit Gurion
- Rabin MC, Petah Tiqwa, Israel.,Tel Aviv University, Tel Aviv, Israel
| | | | - Sameer Bakhshi
- Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | | | | | | | | | | | - Priyanka Samal
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Matthew Ku
- St.Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Xiwen Ma
- Karyopharm Therapeutics, Newton, USA
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22
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Sharman JP, Egyed M, Jurczak W, Skarbnik A, Pagel JM, Kamdar MK, Munir T, Corbett G, Fogliatto LM, Herishanu Y, Banerji V, Coutre SE, Walker P, Karlsson K, Ghia P, Janssens A, Wierda WG, Patel P, Wang MH, Byrd JC. Acalabrutinib ± obinutuzumab versus obinutuzumab + chlorambucil in treatment-naïve chronic lymphocytic leukemia: Elevate-TN four-year follow up. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7509] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7509 Background: Early results from ELEVATE-TN (NCT02475681) at a median follow-up of 28.3 mo demonstrated superior efficacy of acalabrutinib (A) ± obinutuzumab (O) compared with O + chlorambucil (Clb) in patients (pts) with treatment-naïve (TN) chronic lymphocytic leukemia (CLL) (Sharman et al. Lancet 2020;395:1278-91). Results from a 4-year update are reported here. Methods: Pts received A±O or O+Clb. Crossover to A monotherapy was permitted in pts who progressed on O+Clb. Investigator-assessed (INV) progression-free survival (PFS), INV overall response rate (ORR), overall survival (OS), and safety were evaluated. Results: 535 pts (A+O, n=179; A, n=179; O+Clb, n=177) were randomized with a median age of 70 y; 63% had unmutated IGHV and 9% del(17p). At a median follow-up of 46.9 mo (range, 0.0–59.4; data cutoff: Sept 11, 2020), the median PFS was not reached (NR) for A+O and A pts vs 27.8 mo for O+Clb pts (both P<0.0001). In pts with unmutated IGHV, the median PFS was NR (A+O and A) vs 22.2 mo among O+Clb pts (both P<0.0001). In pts with del(17p), the median PFS was NR (A+O and A) vs 17.7 mo for O+Clb ( P<0.005). Estimated 48-mo PFS rates were 87% for A+O, 78% for A, and 25% for O+Clb. Median OS was NR in any treatment arm with a trend towards significance in the A+O group (A+O vs O+Clb, P=0.0604); estimated 48-mo OS rates were 93% (A+O), 88% (A), and 88% (O+Clb). ORR was significantly higher with A+O (96.1%; 95% CI 92.1–98.1) vs O+Clb (82.5%; 95% CI 76.2–87.4; P<0.0001); ORR with A was 89.9% (95% CI 84.7–93.5; P=0.035 vs O+Clb). Complete response/complete response with incomplete hematologic recovery (CR/CRi) rates were higher with A+O (26.8%/3.9%) vs O+Clb (12.4%/0.6%); 10.6%/0.6% had CR/CRi with A. Common adverse events (AEs) and AEs of interest are shown in the Table. Overall treatment discontinuation rates were 25.1% (A+O), 30.7% (A), and 22.6% (O+Clb); the most common reasons were AEs (12.8%, 12.3%, 14.7%, respectively) and progressive disease (4.5%, 7.8%, 1.7%). Most pts (77.4%) completed O+Clb treatment. Conclusions: With a median follow-up of 46.9 mo (̃4y), the efficacy and safety of A+O and A monotherapy was maintained, with an increase in CR since the interim analysis (from 21% to 27% [A+O] and from 7% to 11% [A]) and low rates of discontinuation.[Table: see text]
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Affiliation(s)
- Jeff Porter Sharman
- Willamette Valley Cancer Institute and US Oncology Research Center, Eugene, OR
| | - Miklos Egyed
- Somogy County Mór Kaposi General Hospital, Kaposvar, Hungary
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland
| | | | | | | | - Talha Munir
- St James's University Hospital, Leeds, United Kingdom
| | | | | | - Yair Herishanu
- Department of Hematology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Patricia Walker
- Peninsula Health and Peninsula Private Hospital, Melbourne, VIC, Australia
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - William G. Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - John C. Byrd
- The Ohio State University Comprehensive Cancer Center, Division of Hematology, Columbus, OH
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Korom VG, Lueff S, Liposits A, Kellner A, Pavlovics A, Egyed M. Is iron deficiency anemia always microcytic? Pol Arch Intern Med 2021; 131:199-201. [PMID: 33306294 DOI: 10.20452/pamw.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Viktoria Gyorine Korom
- Department of Hematology, Moritz Kaposi Somogy County General Hospital, Kaposvár, Hungary
| | - Sandor Lueff
- Department of Hematology, Moritz Kaposi Somogy County General Hospital, Kaposvár, Hungary
| | - Andrea Liposits
- Department of Hematology, Moritz Kaposi Somogy County General Hospital, Kaposvár, Hungary
| | - Adam Kellner
- Department of Hematology, Moritz Kaposi Somogy County General Hospital, Kaposvár, Hungary
| | - Anett Pavlovics
- Department of Hematology, Moritz Kaposi Somogy County General Hospital, Kaposvár, Hungary
| | - Miklos Egyed
- Department of Hematology, Moritz Kaposi Somogy County General Hospital, Kaposvár, Hungary.
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Gerds AT, Savona MR, Scott BL, Talpaz M, Egyed M, Harrison CN, Yacoub A, Vannucchi A, Mead AJ, Kiladjian JJ, O'Sullivan J, García-Gutiérrez V, Bose P, Rampal RK, Miller CB, Palmer J, Oh ST, Buckley SA, Mould DR, Ito K, Tyavanagimatt S, Smith JA, Roman-Torres K, Devineni S, Craig AR, Mascarenhas JO. Determining the recommended dose of pacritinib: results from the PAC203 dose-finding trial in advanced myelofibrosis. Blood Adv 2020; 4:5825-5835. [PMID: 33232476 PMCID: PMC7686901 DOI: 10.1182/bloodadvances.2020003314] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/14/2020] [Indexed: 12/29/2022] Open
Abstract
PAC203 is a randomized dose-finding study of pacritinib, an oral JAK2/IRAK1 inhibitor, in patients with advanced myelofibrosis who are intolerant of or resistant to ruxolitinib. Patients were randomized 1:1:1 to pacritinib 100 mg once per day, 100 mg twice per day, or 200 mg twice per day. Enhanced eligibility criteria, monitoring, and dose modifications were implemented to mitigate risk of cardiac and hemorrhagic events. Efficacy was based on ≥35% spleen volume response (SVR) and ≥50% reduction in the 7-component total symptom score (TSS) through week 24. Of 161 patients, 73% were intolerant of and 76% had become resistant to ruxolitinib; 50% met criteria for both. Severe thrombocytopenia (platelet count <50 × 103/μL) was present in 44%. SVR rates were highest with 200 mg twice per day (100 mg once per day, 0%; 100 mg twice per day, 1.8%; 200 mg twice per day, 9.3%), particularly among patients with baseline platelet counts <50 × 103/μL (17%; 4 of 24). Although TSS response rate was similar across doses (100 mg once per day, 7.7%; 100 mg twice per day, 7.3%; 200 mg twice per day, 7.4%), median percent reduction in TSS suggested a dose-response relationship (-3%, -16%, and -27%, respectively). Pharmacokinetic and pharmacodynamic modeling based on all available data showed greatest SVR and TSS reduction at 200 mg twice per day compared with lower doses. Common adverse events were gastrointestinal events, thrombocytopenia, and anemia. There was no excess of grade ≥3 hemorrhagic or cardiac events at 200 mg twice per day. Pacritinib 200 mg twice per day demonstrated clinical activity and an acceptable safety profile and was selected as the recommended dose for a pivotal phase 3 study in patients with myelofibrosis and severe thrombocytopenia. This trial was registered at www.clinicaltrials.gov as #NCT03165734.
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Affiliation(s)
- Aaron T Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland OH
| | - Michael R Savona
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Bart L Scott
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Moshe Talpaz
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | | | - Claire N Harrison
- Haematology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Alessandro Vannucchi
- University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Adam J Mead
- National Institute for Health Research Oxford Biomedical Research Centre, Medical Research Center (MRC) Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Jennifer O'Sullivan
- National Institute for Health Research Oxford Biomedical Research Centre, Medical Research Center (MRC) Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | | | | | | | - Stephen T Oh
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Kaori Ito
- Projections Research Inc, Phoenixville, PA; and
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Gotic M, Egyed M, Gercheva L, Warzocha K, Kvasnicka HM, Achenbach H, Wu J. Cardiovascular Safety of Anagrelide Hydrochloride versus Hydroxyurea in Essential Thrombocythaemia. Cardiovasc Toxicol 2020; 21:236-247. [PMID: 33123978 PMCID: PMC7847982 DOI: 10.1007/s12012-020-09615-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Essential thrombocythaemia (ET) is a rare myeloproliferative neoplasm. This multicentre, Phase 3b, randomised, open-label, non-inferiority study investigated the cardiac safety, efficacy and tolerability of first-line treatment with anagrelide or hydroxyurea in high-risk ET patients for up to 3 years. Eligible patients aged ≥ 18 years with a diagnosis of high-risk ET confirmed by bone marrow biopsy within 6 months of randomisation received anagrelide (n = 75) or hydroxyurea (n = 74), administered twice daily. Treatment dose for either compound was titrated to the lowest dose needed to achieve a response. Planned primary outcome measures were change in left ventricular ejection fraction from baseline over time and platelet count at Month 6. Planned secondary outcome measures were platelet count change from baseline at Months 3 and 36; percentage of patients with complete or partial response; time to complete or partial response; number of patients with thrombohaemorrhagic events; and changes in white blood cell count or red blood cell count over time. Neither treatment altered cardiac function. There were no significant differences in adverse events between treatment groups, and no reports of malignant transformation. The incidence of disease-related thrombotic or haemorrhagic events was numerically higher in anagrelide-treated patients. Both treatments controlled platelet counts at 6 months, with the majority of patients experiencing complete or partial responses. In conclusion, these results suggest that long-term treatment with anagrelide is not associated with adverse effects on cardiac function. This is one of the few studies using left ventricular ejection fraction assessment and central biopsy reading to confirm the diagnosis of ET. Trial registration number: Clinicaltrials.gov NCT00202644
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Affiliation(s)
- Mirjana Gotic
- Clinic for Hematology Clinical Centre of Serbia Belgrade, Medical Faculty, University of Belgrade, Koste Todorovica 2, 11000, Belgrade, Serbia.
| | - Miklos Egyed
- Somogy Megyei Kaposi Mór Oktató Kórház, Kaposvár, 7400, Hungary
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St. Marina, 9010, Varna, Bulgaria
| | - Krzysztof Warzocha
- Institute of Hematology and Transfusion Medicine, Department of Haematology, 00-791, Warsaw, Poland
| | - Hans Michael Kvasnicka
- Institute of Pathology, University Clinic Wuppertal, University of Witten / Herdecke, Wuppertal, Germany
| | - Heinrich Achenbach
- Research & Development, Shire International GmbH (a Member of the Takeda Group of Companies), 6300, Zug, Switzerland
| | - Jingyang Wu
- Research & Development, Shire (a Member of the Takeda Group of Companies), Lexington, MA, 02421, USA
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26
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Kellner A, Dombi P, Illes A, Demeter J, Homor L, Ercsei I, Simon Z, Karadi E, Herczeg J, Gy Korom V, Gasztonyi Z, Szerafin L, Udvardy M, Egyed M. Anagrelide influences thrombotic risk, and prolongs progression-free and overall survival in essential thrombocythaemia vs hydroxyurea plus aspirin. Eur J Haematol 2020; 105:408-418. [PMID: 32557810 DOI: 10.1111/ejh.13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We report an extension study of patients with essential thrombocythaemia (ET) in the Hungarian Myeloproliferative Neoplasm (HUMYPRON) Registry, which demonstrated that over 6 years anagrelide significantly decreased the number of patients experiencing minor arterial and minor venous thrombotic events (TEs) vs hydroxyurea+aspirin. METHODS Data on patients with ET were collected through completion of a questionnaire developed according to 2008 WHO diagnostic criteria and with regard to Landolfi, Tefferi and IPSET criteria for thrombotic risk. Data were entered into the registry from 14 haematological centres. TEs, secondary malignancies, disease progression and survival were compared between patients with ET treated with anagrelide (n = 116) and with hydroxyurea+aspirin (n = 121). RESULTS Patients were followed for (median) 10 years. A between-group difference in the number of patients with TEs was observed (25.9% anagrelide vs 38.0% hydroxyurea+aspirin; P = .052). Minor arterial events were more frequently reported in the hydroxyurea+aspirin group (P < .001); there were marginally more reports of major arterial events in the anagrelide group (P = .049). TE prior to diagnosis was found to significantly influence TE incidence (P > .001). Progression-free survival (P = .004) and survival (P = .001) were significantly increased for the anagrelide group vs hydroxyurea+aspirin. CONCLUSIONS Anagrelide reduced TEs, and increased progression-free and overall survival vs hydroxyurea+aspirin over (median) 10 years.
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Affiliation(s)
- Adam Kellner
- Department of Haematology, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Peter Dombi
- Szent Borbala County Hospital, Tatabánya, Hungary
| | - Arpad Illes
- Department of Haematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Demeter
- First Department of Internal Medicine, Division of Haematology, Semmelweis University of Budapest, Budapest, Hungary
| | - Lajos Homor
- Faculty of Humanities and Social Sciences, Pazmany Peter Catholic University, Budapest, Hungary
| | - Ibolya Ercsei
- Department of Haematology, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Zsofia Simon
- Department of Haematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eva Karadi
- Department of Haematology, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Jozsef Herczeg
- Department of Haematology, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Viktoria Gy Korom
- Department of Haematology, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Zoltan Gasztonyi
- Karolina General Hospital Mosonmagyarovar, Mosonmagyarovar, Hungary
| | | | - Miklos Udvardy
- Department of Haematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklos Egyed
- Department of Haematology, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
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27
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Kalakonda N, Maerevoet M, Cavallo F, Follows G, Goy A, Vermaat JSP, Casasnovas O, Hamad N, Zijlstra JM, Bakhshi S, Bouabdallah R, Choquet S, Gurion R, Hill B, Jaeger U, Sancho JM, Schuster M, Thieblemont C, De la Cruz F, Egyed M, Mishra S, Offner F, Vassilakopoulos TP, Warzocha K, McCarthy D, Ma X, Corona K, Saint-Martin JR, Chang H, Landesman Y, Joshi A, Wang H, Shah J, Shacham S, Kauffman M, Van Den Neste E, Canales MA. Selinexor in patients with relapsed or refractory diffuse large B-cell lymphoma (SADAL): a single-arm, multinational, multicentre, open-label, phase 2 trial. Lancet Haematol 2020; 7:e511-e522. [PMID: 32589977 DOI: 10.1016/s2352-3026(20)30120-4] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) is an aggressive cancer with a median overall survival of less than 6 months. We aimed to assess the response to single-agent selinexor, an oral selective inhibitor of nuclear export, in patients with relapsed or refractory DLBCL who had no therapeutic options of potential clinical benefit. METHODS SADAL was a multicentre, multinational, open-label, phase 2b study done in 59 sites in 19 countries. Patients aged 18 years or older with pathologically confirmed diffuse large B-cell lymphoma, an Eastern Cooperative Oncology Group performance status of 2 or less, who had received two to five lines of previous therapies, and progressed after or were not candidates for autologous stem-cell transplantation were enrolled. Germinal centre B-cell or non-germinal centre B-cell tumour subtype and double or triple expressor status were determined by immunohistochemistry and double or triple hit status was determined by cytogenetics. Patients received 60 mg selinexor orally on days 1 and 3 weekly until disease progression or unacceptable toxicity. The study was initially designed to evaluate both 60 mg and 100 mg twice-weekly doses of selinexor; however, the 100 mg dose was discontinued in the protocol (version 7.0) on March 29, 2017, when an improved therapeutic window was observed at 60 mg. Primary outcome was overall response rate. The primary outcome and safety were assessed in all patients who received 60 mg selinexor under protocol version 6.0, or enrolled under protocol versions 7.0 or higher and received at least one dose of selinexor. This trial is registered at ClinicalTrials.gov, NCT02227251 (active but not enrolling). FINDINGS Between Oct 21, 2015, and Nov 2, 2019, 267 patients were randomly assigned, with 175 allocated to the 60 mg group and 92 to the discontinued 100 mg group. 48 patients assigned to the 60 mg group were excluded due to enrolment before version 6.0 of the protocol; the remaining 127 patients received selinexor 60 mg and were included in analyses of primary outcome and safety. The overall response rate was 28% (36/127; 95% CI 20·7-37·0); 15 (12%) achieved a complete response and 21 (17%) a partial response. The most common grade 3-4 adverse events were thrombocytopenia (n=58), neutropenia (n=31), anaemia (n=28), fatigue (n=14), hyponatraemia (n=10), and nausea (n=8). The most common serious adverse events were pyrexia (n=9), pneumonia (n=6), and sepsis (n=6). There were no deaths judged as related to treatment with selinexor. INTERPRETATION Single-drug oral selinexor induced durable responses and had a manageable adverse events profile in patients with relapsed or refractory DLBCL who received at least two lines of previous chemoimmunotherapy. Selinexor could be considered a new oral, non-cytotoxic treatment option in this setting. FUNDING Karyopharm Therapeutics Inc.
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Affiliation(s)
| | | | - Federica Cavallo
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | | | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Nada Hamad
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Josée M Zijlstra
- Amsterdam UMC, Vrije Universiteit, Cancer Center, Amsterdam, Netherlands
| | - Sameer Bakhshi
- Dr B R Ambedkar Institute Rotary Cancer Hospital AIIMS, New Delhi, India
| | | | | | - Ronit Gurion
- Rabin Medical Centre, Petah Tiqwa, Israel; Tel Aviv University, Petah Tiqwa, Israel
| | | | | | | | | | | | | | | | - Sourav Mishra
- Institute of Medical Sciences & SUM Hospital, Odisha, India
| | | | | | | | | | - Xiwen Ma
- Karyopharm Therapeutics Inc, Newton, MA, USA
| | | | | | - Hua Chang
- Karyopharm Therapeutics Inc, Newton, MA, USA
| | | | - Anita Joshi
- Karyopharm Therapeutics Inc, Newton, MA, USA
| | | | - Jatin Shah
- Karyopharm Therapeutics Inc, Newton, MA, USA
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28
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Sharman JP, Egyed M, Jurczak W, Skarbnik A, Pagel JM, Flinn IW, Kamdar M, Munir T, Walewska R, Corbett G, Fogliatto LM, Herishanu Y, Banerji V, Coutre S, Follows G, Walker P, Karlsson K, Ghia P, Janssens A, Cymbalista F, Woyach JA, Salles G, Wierda WG, Izumi R, Munugalavadla V, Patel P, Wang MH, Wong S, Byrd JC. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial. Lancet 2020; 395:1278-1291. [PMID: 32305093 PMCID: PMC8151619 DOI: 10.1016/s0140-6736(20)30262-2] [Citation(s) in RCA: 347] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acalabrutinib is a selective, covalent Bruton tyrosine-kinase inhibitor with activity in chronic lymphocytic leukaemia. We compare the efficacy of acalabrutinib with or without obinutuzumab against chlorambucil with obinutuzumab in patients with treatment-naive chronic lymphocytic leukaemia. METHODS ELEVATE TN is a global, phase 3, multicentre, open-label study in patients with treatment-naive chronic lymphocytic leukaemia done at 142 academic and community hospitals in 18 countries. Eligible patients had untreated chronic lymphocytic leukaemia and were aged 65 years or older, or older than 18 years and younger than 65 years with creatinine clearance of 30-69 mL/min (calculated by use of the Cockcroft-Gault equation) or Cumulative Illness Rating Scale for Geriatrics score greater than 6. Additional criteria included an Eastern Cooperative Oncology Group performance status score of 2 or less and adequate haematologic, hepatic, and renal function. Patients with significant cardiovascular disease were excluded, and concomitant treatment with warfarin or equivalent vitamin K antagonists was prohibited. Patients were randomly assigned (1:1:1) centrally via an interactive voice or web response system to receive acalabrutinib and obinutuzumab, acalabrutinib monotherapy, or obinutuzumab and oral chlorambucil. Treatments were administered in 28-day cycles. To reduce infusion-related reactions, acalabrutinib was administered for one cycle before obinutuzumab administration. Oral acalabrutinib was administered (100 mg) twice a day until progressive disease or unacceptable toxic effects occurred. In the acalabrutinib-obinutuzumab group, intravenous obinutuzumab was given on days 1 (100 mg), 2 (900 mg), 8 (1000 mg), and 15 (1000 mg) of cycle 2 and on day 1 (1000 mg) of cycles 3-7. In the obinutuzumab-chlorambucil group, intravenous obinutuzumab was given on days 1 (100 mg), 2 (900 mg), 8 (1000 mg), and 15 (1000 mg) of cycle 1 and on day 1 (1000 mg) of cycles 2-6. Oral chlorambucil was given (0·5 mg/kg) on days 1 and 15 of each cycle, for six cycles. The primary endpoint was progression-free survival between the two combination-therapy groups, assessed by independent review committee. Crossover to acalabrutinib was allowed in patients who progressed on obinutuzumab-chlorambucil. Safety was assessed in all patients who received at least one dose of treatment. Enrolment for this trial is complete, and the study is registered at ClinicalTrials.gov, NCT02475681. FINDINGS Between Sept 14, 2015, and Feb 8, 2017, we recruited 675 patients for assessment. 140 patients did not meet eligibility criteria, and 535 patients were randomly assigned to treatment. 179 patients were assigned to receive acalabrutinib-obinutuzumab, 179 patients were assigned to receive acalabrutinib monotherapy, and 177 patients were assigned to receive obinutuzumab-chlorambucil. At median follow-up of 28·3 months (IQR 25·6-33·1), median progression-free survival was longer with acalabrutinib-obinutuzumab and acalabrutinib monotherapy, compared with obinutuzumab-chlorambucil (median not reached with acalabrutinib and obinutuzumab vs 22·6 months with obinutuzumab, hazard ratio [HR] 0·1; 95% CI 0·06-0·17, p<0·0001; and not reached with acalabrutinib monotherapy vs 22·6 months with obinutuzumab, 0·20; 0·13-0·3, p<0·0001). Estimated progression-free survival at 24 months was 93% with acalabrutinib-obinutuzumab (95% CI 87-96%), 87% with acalabrutinib monotherapy (81-92%), and 47% with obinutuzumab-chlorambucil (39-55%). The most common grade 3 or higher adverse event across groups was neutropenia (53 [30%] of 178 patients in the acalabrutinib-obinutuzumab group, 17 [9%] of 179 patients in the acalabrutinib group, and 70 [41%] of 169 patients in the obinutuzumab-chlorambucil group). All-grade infusion reactions were less frequent with acalabrutinib-obinutuzumab (24 [13%] of 178 patients) than obinutuzumab-chlorambucil (67 [40%] of 169 patients). Grade 3 or higher infections occurred in 37 (21%) patients given acalabrutinib-obinutuzumab, 25 (14%) patients given acalabrutinib monotherapy, and 14 (8%) patients given obinutuzumab-chlorambucil. Deaths occurred in eight (4%) patients given acalabrutinib-obinutuzumab, 12 (7%) patients given acalabrutinib, and 15 (9%) patients given obinutuzumab-chlorambucil. INTERPRETATION Acalabrutinib with or without obinutuzumab significantly improved progression-free survival over obinutuzumab-chlorambucil chemoimmunotherapy, providing a chemotherapy-free treatment option with an acceptable side-effect profile that was consistent with previous studies. These data support the use of acalabrutinib in combination with obinutuzumab or alone as a new treatment option for patients with treatment-naive symptomatic chronic lymphocytic leukaemia. FUNDING Acerta Pharma, a member of the AstraZeneca Group, and R35 CA198183 (to JCB).
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Affiliation(s)
- Jeff P Sharman
- Willamette Valley Cancer Institute/US Oncology, Eugene, OR, USA
| | - Miklos Egyed
- Department of Hematology, Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Institute of Oncology, Kraków, Poland
| | - Alan Skarbnik
- Department of Medicine, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA; Lymphoproliferative Disorders Program, Novant Health Cancer Institute, Charlotte NC, USA
| | - John M Pagel
- Swedish Cancer Institute, Center for Blood Disorders and Stem Cell Transplantation, Seattle, WA, USA
| | - Ian W Flinn
- Sarah Cannon Research Institute, Tennessee Oncology Nashville, Nashville, TN, USA
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO, USA
| | - Talha Munir
- Haematological Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds, UK
| | - Renata Walewska
- Molecular Pathology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Gillian Corbett
- Department of Medicine, Tauranga Hospital, Tauranga, New Zealand
| | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Versha Banerji
- Departments of Internal Medicine, Biochemistry & Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Steven Coutre
- Stanford University School of Medicine, Stanford, CA, USA
| | - George Follows
- Department of Haematology, Addenbrooke's Hospital NHS Trust, Cambridge, UK
| | - Patricia Walker
- Peninsula Health, and Peninsula Private Hospital, Frankston, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - Karin Karlsson
- Department of Haematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Ann Janssens
- Hematology Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center and Division of Hematology, Columbus, OH, USA
| | - Gilles Salles
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Hématologie Clinique, Pierre-Bénite, France
| | - William G Wierda
- Department of Leukemia, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Raquel Izumi
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | | | - Priti Patel
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | - Min Hui Wang
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | - Sofia Wong
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center and Division of Hematology, Columbus, OH, USA.
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29
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Newland AC, Sánchez‐González B, Rejtő L, Egyed M, Romanyuk N, Godar M, Verschueren K, Gandini D, Ulrichts P, Beauchamp J, Dreier T, Ward ES, Michel M, Liebman HA, Haard H, Leupin N, Kuter DJ. Phase 2 study of efgartigimod, a novel FcRn antagonist, in adult patients with primary immune thrombocytopenia. Am J Hematol 2020; 95:178-187. [PMID: 31821591 PMCID: PMC7004056 DOI: 10.1002/ajh.25680] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder, characterized by a low platelet count (<100 × 109/L) in the absence of other causes associated with thrombocytopenia. In most patients, IgG autoantibodies directed against platelet receptors can be detected. They accelerate platelet clearance and destruction, inhibit platelet production, and impair platelet function, resulting in increased risk of bleeding and impaired quality of life. Efgartigimod is a human IgG1 antibody Fc‐fragment, a natural ligand of the neonatal Fc receptor (FcRn), engineered for increased affinity to FcRn, while preserving its characteristic pH‐dependent binding. Efgartigimod blocks FcRn, preventing IgG recycling, and causing targeted IgG degradation. In this Phase 2 study, 38 patients were randomized 1:1:1 to receive four weekly intravenous infusions of either placebo (N = 12) or efgartigimod at a dose of 5 mg/kg (N = 13) or 10 mg/kg (N = 13). This short treatment cycle of efgartigimod in patients with ITP, predominantly refractory to previous lines of therapy, was shown to be well tolerated, and demonstrated a favorable safety profile consistent with Phase 1 data. Efgartigimod induced a rapid reduction of total IgG levels (up to 63.7% mean change from baseline), which was associated with clinically relevant increases in platelet counts (46% patients on efgartigimod vs 25% on placebo achieved a platelet count of ≥50 × 109/L on at least two occasions, and 38% vs 0% achieved ≥50 × 109/L for at least 10 cumulative days), and a reduced proportion of patients with bleeding. Taken together, these data warrant further evaluation of FcRn antagonism as a novel therapeutic approach in ITP.
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Affiliation(s)
- Adrian C. Newland
- Department of Haematology, Centre for HaematologyThe Royal London Hospital London UK
| | | | - László Rejtő
- Department of HematologyJósa András Teaching Hospital Nyíregyháza Hungary
| | - Miklos Egyed
- Department of HematologyKaposi Mor Teaching Hospital Kaposvar Hungary
| | | | - Marie Godar
- argenx BVBAIndustriepark‐Zwijnaarde 7 Zwijnaarde Belgium
| | | | | | - Peter Ulrichts
- argenx BVBAIndustriepark‐Zwijnaarde 7 Zwijnaarde Belgium
| | - Jon Beauchamp
- argenx BVBAIndustriepark‐Zwijnaarde 7 Zwijnaarde Belgium
| | - Torsten Dreier
- argenx BVBAIndustriepark‐Zwijnaarde 7 Zwijnaarde Belgium
| | - E. Sally Ward
- Department of Molecular and Cellular MedicineTexas A&M University Health Science Center College Station Texas
- Centre for Cancer ImmunologyUniversity of Southampton Southampton UK
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto‐Immunes de l'AdulteCentre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris, Université Paris Est Créteil Créteil France
| | - Howard A. Liebman
- Jane Anne Nohl Division of Hematology, Department of MedicineUniversity of Southern California Los Angeles California
| | - Hans Haard
- argenx BVBAIndustriepark‐Zwijnaarde 7 Zwijnaarde Belgium
| | - Nicolas Leupin
- argenx BVBAIndustriepark‐Zwijnaarde 7 Zwijnaarde Belgium
| | - David J. Kuter
- Department of HematologyMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
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Gisslinger H, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, Rossiev V, Dulicek P, Illes A, Pylypenko H, Sivcheva L, Mayer J, Yablokova V, Krejcy K, Grohmann-Izay B, Hasselbalch HC, Kralovics R, Kiladjian JJ. Ropeginterferon alfa-2b versus standard therapy for polycythaemia vera (PROUD-PV and CONTINUATION-PV): a randomised, non-inferiority, phase 3 trial and its extension study. Lancet Haematol 2020; 7:e196-e208. [PMID: 32014125 DOI: 10.1016/s2352-3026(19)30236-4] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The PROUD-PV and CONTINUATION-PV trials aimed to compare the novel monopegylated interferon ropeginterferon alfa-2b with hydroxyurea, the standard therapy for patients with polycythaemia vera, over 3 years of treatment. METHODS PROUD-PV and its extension study, CONTINUATION-PV, were phase 3, randomised, controlled, open-label, trials done in 48 clinics in Europe. Patients were eligible if 18 years or older with early stage polycythaemia vera (no history of cytoreductive treatment or less than 3 years of previous hydroxyurea treatment) diagnosed by WHO's 2008 criteria. Patients were randomly assigned 1:1 to ropeginterferon alfa-2b (subcutaneously every 2 weeks, starting at 100 μg) or hydroxyurea (orally starting at 500 mg/day). After 1 year, patients could opt to enter the extension part of the trial, CONTINUATION-PV. The primary endpoint in PROUD-PV was non-inferiority of ropeginterferon alfa-2b versus hydroxyurea regarding complete haematological response with normal spleen size (longitudinal diameter of ≤12 cm for women and ≤13 cm for men) at 12 months; in CONTINUATION-PV, the coprimary endpoints were complete haematological response with normalisation of spleen size and with improved disease burden (ie, splenomegaly, microvascular disturbances, pruritus, and headache). We present the final results of PROUD-PV and an interim analysis at 36 months of the CONTINUATION-PV study (per statistical analysis plan). Analyses for safety and efficacy were per-protocol. The trials were registered on EudraCT, 2012-005259-18 (PROUD-PV) and 2014-001357-17 (CONTINUATION-PV, which is ongoing). FINDINGS Patients were recruited from Sept 17, 2013 to March 13, 2015 with 306 enrolled. 257 patients were randomly assigned, 127 were treated in each group (three patients withdrew consent in the hydroxyurea group), and 171 rolled over to the CONTINUATION-PV trial. Median follow-up was 182·1 weeks (IQR 166·3-201·7) in the ropeginterferon alfa-2b and 164·5 weeks (144·4-169·3) in the standard therapy group. In PROUD-PV, 26 (21%) of 122 patients in the ropeginterferon alfa-2b group and 34 (28%) of 123 patients in the standard therapy group met the composite primary endpoint of complete haematological response with normal spleen size. In CONTINUATION-PV, complete haematological response with improved disease burden was met in 50 (53%) of 95 patients in the ropeginterferon alfa-2b group versus 28 (38%) of 74 patients in the hydroxyurea group, p=0·044 at 36 months. Complete haematological response without the spleen criterion in the ropeginterferon alfa-2b group versus standard therapy group were: 53 (43%) of 123 patients versus 57 (46%) of 125 patients, p=0·63 at 12 months (PROUD-PV), and 67 (71%) of 95 patients versus 38 (51%) of 74 patients, p=0·012 at 36 months (CONTINUATION-PV). The most frequently reported grade 3 and grade 4 treatment-related adverse events were increased γ-glutamyltransferase (seven [6%] of 127 patients) and increased alanine aminotransferase (four [3%] of 127 patients) in the ropeginterferon alfa-2b group, and leucopenia (six [5%] of 127 patients) and thrombocytopenia (five [4%] of 127 patients) in the standard therapy group. Treatment-related serious adverse events occurred in three (2%) of 127 patients in the ropeginterferon alfa-2b group and five (4%) of 127 patients in the hydroxyurea group. One treatment-related death was reported in the standard therapy group (acute leukaemia). INTERPRETATION In patients with early polycythaemia vera, who predominantly presented without splenomegaly, ropeginterferon alfa-2b was effective in inducing haematological responses; non-inferiority to hydroxyurea regarding haematological response and normal spleen size was not shown at 12 months. However, response to ropeginterferon alfa-2b continued to increase over time with improved responses compared with hydroxyurea at 36 months. Considering the high and durable haematological and molecular responses and its good tolerability, ropeginterferon alfa-2b offers a valuable and safe long-term treatment option with features distinct from hydroxyurea. FUNDING AOP Orphan Pharmaceuticals AG.
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Affiliation(s)
- Heinz Gisslinger
- Department of Internal Medicine I, Division of Haematology and Blood Coagulation, Medical University Vienna, Vienna, Austria.
| | | | - Pencho Georgiev
- University Multiprofile Hospital for Active Treatment "Sveti Georgi", Clinic of Haematology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Dorota Krochmalczyk
- Teaching Unit of the Haematology Department, University Hospital in Krakow, Krakow, Poland
| | - Liana Gercheva-Kyuchukova
- Multiprofile Hospital for Active Treatment "Sveta Marina", Clinical Haematology Clinic, Varna, Bulgaria
| | - Miklos Egyed
- Department of Internal Medicine II, Kaposi MorCounty Teaching Hospital, Kaposvar, Hungary
| | - Viktor Rossiev
- Samara Kalinin Regional Clinical Hospital, Samara, Russia
| | - Petr Dulicek
- Department of Clinical Haematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Arpad Illes
- Department of Haematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Halyna Pylypenko
- Department of Haematology, Regional Treatment and Diagnostics Haematology Centre, Cherkasy Regional Oncology Centre, Cherkasy, Ukraine
| | - Lylia Sivcheva
- Multiprofile Hospital for Active Treatment-HristoBotev, First Department of Internal Medicine, Vratsa, Bulgaria
| | - Jiri Mayer
- Clinic of Internal Medicine-Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vera Yablokova
- Yaroslavl Regional Clinical Hospital, Department of Haematology, Yaroslavl, Russia
| | - Kurt Krejcy
- AOP Orphan Pharmaceuticals AG, Vienna, Austria
| | | | - Hans C Hasselbalch
- Department of Haematology, Zealand University Hospital, Roskilde, University of Copenhagen, Denmark
| | - Robert Kralovics
- Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria; CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Jean-Jacques Kiladjian
- Université de Paris, CIC 1427, Inserm, F-75010, Paris, France; Centre d'Investigations Cliniques, AP-HP, Hopital Saint-Louis, F-75010, Paris, France
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Kalakonda N, Cavallo F, Follows G, Goy A, Vermaat J, Casasnovas O, Lavee O, Maerevoet M, Zijlstra J, Bakshi S, Bouabdallah R, Choquet S, Gurion R, Hill B, Jaeger U, Sancho J, Schuster M, Thieblemont C, De la Cruz F, Egyed M, Mishra S, Offner F, Vassilakopoulos T, Warzocha K, Oluyadi A, McCarthy D, Ma X, Corona K, Shah J, Van Den Neste E, Canales M. A PHASE 2B STUDY OF SELINEXOR IN PATIENTS WITH RELAPSED/REFRACTORY (R/R) DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL). Hematol Oncol 2019. [DOI: 10.1002/hon.31_2629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - F. Cavallo
- Molecular Biotechnology and Health Sciences; Aziena Ospedaliero - Universitaria Città della Salute e della Scienza di Torino; Turin Italy
| | - G. Follows
- Haematology; Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital; Cambridge United Kingdom
| | - A. Goy
- Oncology; Hackensack University Medical Center; Hackensack United States
| | - J. Vermaat
- Hematology; Leiden University Medical Center; Leiden Netherlands
| | | | - O. Lavee
- Hematology; St. Vincent's Hospital Sydney; Darlinghurst Australia
| | - M. Maerevoet
- Hematology; Service Hématologie, Institut Bordet; Bruxelles Belgium
| | - J. Zijlstra
- Hematology; Amsterdam UMC; Amsterdam Netherlands
| | - S. Bakshi
- Medical Oncology; Dr. B. R. A. Institute Rotary Cancer Hospital; New Delhi India
| | - R. Bouabdallah
- Oncology/Hematology; Institut Paoli-Calmettes; Marseille France
| | - S. Choquet
- Hematology; Hospital Pitie Salpetriere; Paris France
| | - R. Gurion
- Hematology; Rabin MC; Petah Tiqwa Israel
| | - B. Hill
- Hematology and Medical Oncology; Cleveland Clinic Main Campus; Cleveland United States
| | - U. Jaeger
- Medicine I; Medical University of Vienna; Vienna Austria
| | - J. Sancho
- Clinical Hematology; Hospital Germans Trias i Pujol; Barcelona Spain
| | - M. Schuster
- Medicine; Stony Brook University; Stony Brook United States
| | | | - F. De la Cruz
- Hematology; Hospital Universitario Virgen del Rocío; Sevilla Spain
| | - M. Egyed
- Hematology; Teaching Hospital Mór Kaposi; Kaposvár Hungary
| | - S. Mishra
- Medical Oncology; Institute of Medical Sciences & SUM Hospital; Bhubaneswar India
| | | | | | - K. Warzocha
- Hematology; Instytut Hematologii i Transfuzjologii; Warszawa Poland
| | - A. Oluyadi
- Clinical Development; Karyopharm Therapeutics Inc.; Newton United States
| | - D. McCarthy
- Clinical Operations; Karyopharm Therapeutics Inc.; Newton United States
| | - X. Ma
- Biostatistics; Karyopharm Therapeutics Inc.; Newton United States
| | - K. Corona
- Medical Affairs; Karyopharm Therapeutics Inc.; Newton United States
| | - J. Shah
- Clinical Development; Karyopharm Therapeutics Inc.; Newton United States
| | - E. Van Den Neste
- Hematology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - M. Canales
- Medicine; Hospital Universitario La Paz; Madrid Spain
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32
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Röth A, Nagy Z, Peffault de Latour R, Ninomya H, Panse J, Yoon S, Egyed M, Ichikawa S, Ito Y, Seok Kim J, Schrezenmeier H, Sica S, Usuki K, Sostelly A, Higginson J, Dieckmann A, Anzures-Cabreras J, Shinomiya K, Klughammer B, Jahreis A, Bucher C, Nishimura J. PF348 LONG TERM FOLLOW-UP OF PNH PATIENTS TREATED WITH THE SMART ANTI-HC5 ANTIBODY (SKY59/RO7112689) IN THE OPEN LABEL EXTENSION (OLE) OF THE COMPOSER TRIAL. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000559604.06488.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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33
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Ravandi F, Ritchie EK, Sayar H, Lancet JE, Craig MD, Vey N, Strickland SA, Schiller GJ, Jabbour E, Pigneux A, Horst HA, Récher C, Klimek VM, Cortes JE, Carella AM, Egyed M, Krug U, Fox JA, Craig AR, Ward R, Smith JA, Acton G, Kantarjian HM, Stuart RK. Phase 3 results for vosaroxin/cytarabine in the subset of patients ≥60 years old with refractory/early relapsed acute myeloid leukemia. Haematologica 2018; 103:e514-e518. [PMID: 29794146 PMCID: PMC6278965 DOI: 10.3324/haematol.2018.191361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Farhad Ravandi
- University of Texas MD Anderson Cancer Center, Houston, TX, USA,Correspondence:
| | | | - Hamid Sayar
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | | | - Norbert Vey
- Institut Paoli-Calmettes and Aix-Marseille University, Marseille, France
| | | | - Gary J. Schiller
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Elias Jabbour
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnaud Pigneux
- Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux, France
| | | | - Christian Récher
- Institut Universitaire du Cancer de Toulouse Oncopole, Université de Toulouse III, Centre Hospitalier Universitaire de Toulouse, France
| | | | - Jorge E. Cortes
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Utz Krug
- Universitätsklinikum Münster, Germany
| | - Judith A. Fox
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA, USA
| | - Adam R. Craig
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA, USA
| | - Renee Ward
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA, USA
| | | | - Gary Acton
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA, USA
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Chanan-Khan AA, Zaritskey A, Egyed M, Vokurka S, Semochkin S, Schuh A, Kassis J, Simpson D, Zhang J, Purse B, Foà R. Lenalidomide maintenance therapy in previously treated chronic lymphocytic leukaemia (CONTINUUM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Haematol 2017; 4:e534-e543. [PMID: 28958469 DOI: 10.1016/s2352-3026(17)30168-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The efficacy and safety of lenalidomide as maintenance therapy after chemotherapy-based second-line therapy in patients with chronic lymphocytic leukaemia is unknown. Although kinase inhibitors can improve outcomes for some patients with relapsed and refractory disease, not all patients have access to these novel drugs. In this study, we aimed to assess the efficacy and safety of lenalidomide as maintenance therapy in patients with previously treated chronic lymphocytic leukaemia. METHODS This randomised, double-blind, placebo-controlled, phase 3 trial (CONTINUUM) was done at 111 hospitals, medical centres, and clinics in 21 countries. Patients were eligible if they had chronic lymphocytic leukaemia; were aged 18 years or older; had been treated with two lines of therapy (with at least a partial response after second-line therapy); had received a purine analogue, bendamustine, anti-CD20 antibody, chlorambucil, or alemtuzumab as first-line or second-line treatment; and had an Eastern Cooperative Oncology Group performance score of 0-2. Eligible patients were randomly assigned (1:1) by an interactive voice-response system to receive either oral lenalidomide (2·5 mg/day) or matching oral placebo capsules (2·5 mg/day) for 28-day cycles, until disease progression or unacceptable toxicity. Lenalidomide dose escalation (to 5 mg or 10 mg per day) was permitted if the drug was well tolerated. Patients, investigators, and those completing data analyses were masked to treatment allocation. Randomisation was stratified by age, response to second-line therapy, and prognostic factors. Co-primary endpoints were progression-free survival and overall survival; the primary endpoint was later changed to overall survival after the data cutoff for this analysis. Secondary endpoints were time from randomisation to second disease progression or death (PFS2),32 tumour response (improvement in response and duration of response), safety, and health-related quality of life (HRQoL). Efficacy analyses were done in the intention-to-treat population. Safety was analysed in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT00774345, and is closed to accrual, but follow-up is ongoing. FINDINGS Between Feb 16, 2009 and Sept 29, 2015, 314 patients with chronic lymphocytic leukaemia were enrolled and randomly assigned to receive either lenalidomide (n=160) or placebo (n=154). With a median follow-up of 31·5 months (IQR 18·9-50·8), there was no significant difference in overall survival between the lenalidomide and the placebo groups (median 70·4 months, 95% CI 57·5-not estimable [NE] vs NE, 95% CI 62·8-NE; hazard ratio [HR] 0·96, 95% CI 0·63-1·48; p=0·86). Progression-free survival was significantly longer in the lenalidomide group (median 33·9 months, 95% CI 25·5-52·5) than in the placebo group (9·2 months, 7·4-13·6; HR 0·40, 95% CI 0·29-0·55; p<0·0001). PFS2 was significantly longer in the lenalidomide group than in the placebo group (median 57·5 months [47·7-NE] vs 32·7 months [26·4-49·0]; HR 0·46, 95% CI 0·29-0·70; p<0·01). Improved responses from baseline were observed in ten (6%) of 160 lenalidomide-treated patients versus four (3%) of 154 placebo-treated patients (p=0·12). Median time to improved response was 12·2 weeks (IQR 7·2-22·5) in the lenalidomide group versus 76·3 weeks (20·2-182·6) in the placebo group. Duration of improved response was not estimable in either group (95% CI 22·9-NE in the lenalidomide group vs NE-NE for placebo). There were no clinically meaningful differences in HRQoL between lenalidomide-treated patients and placebo-treated patients, as measured by FACT-Leu and EQ-5D, during maintenance treatment. In the safety population, the most common grade 3 or 4 adverse events included neutropenia (94 [60%] of 157 patients in the lenalidomide group vs 35 [23%] of 154 patients in the placebo group), thrombocytopenia (26 [17%] vs ten [6%]), and diarrhoea (13 [8%] vs one [<1%]). There were five fatal adverse events (three [2%] patients in the lenalidomide group and two [1%] patients in the placebo group). INTERPRETATION Lenalidomide might delay time to subsequent therapy and does not adversely affect response to subsequent therapy. Chemoimmunotherapy followed by lenalidomide maintenance could be an effective treatment option for patients with chronic lymphocytic leukaemia who do not have access to kinase inhibitors. FUNDING Celgene Corporation.
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Affiliation(s)
| | - Andrey Zaritskey
- Institute of Hematology, Federal Almazov North-West Medical Research Centre, St Petersburg, Russia
| | - Miklos Egyed
- Department of Internal Medicine, Kaposi Mór Teaching Hospital, Kaspovár, Hungary
| | - Samuel Vokurka
- Department of Haemato-oncology, University Hospital Pilsen, Plzeň, Czech Republic
| | - Sergey Semochkin
- Division of Oncology and Hematology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Jeannine Kassis
- Department of Hematology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - David Simpson
- Department of Haematology, North Shore Hospital, Auckland, New Zealand
| | | | | | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
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35
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Mesa RA, Kiladjian JJ, Catalano JV, Devos T, Egyed M, Hellmann A, McLornan D, Shimoda K, Winton EF, Deng W, Dubowy RL, Maltzman JD, Cervantes F, Gotlib J. SIMPLIFY-1: A Phase III Randomized Trial of Momelotinib Versus Ruxolitinib in Janus Kinase Inhibitor-Naïve Patients With Myelofibrosis. J Clin Oncol 2017; 35:3844-3850. [PMID: 28930494 DOI: 10.1200/jco.2017.73.4418] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We evaluated the efficacy and safety of momelotinib, a potent and selective Janus kinase 1 and 2 inhibitor (JAKi), compared with ruxolitinib, in JAKi-naïve patients with myelofibrosis. Patients and Methods Patients (N = 432) with high risk or intermediate-2 risk or symptomatic intermediate-1 risk myelofibrosis were randomly assigned to receive 24 weeks of treatment with momelotinib 200 mg once daily or ruxolitinib 20 mg twice a day (or per label), after which all patients could receive open-label momelotinib. The primary end point was a ≥ 35% reduction in spleen volume at 24 weeks of therapy. Secondary end points were rates of symptom response and effects on RBC transfusion requirements. Results A ≥ 35% reduction in spleen volume at week 24 was achieved by a similar proportion of patients in both treatment arms: 26.5% of the momelotinib group and 29% of the ruxolitinib group (noninferior; P = .011). A ≥ 50% reduction in the total symptom score was observed in 28.4% and 42.2% of patients who received momelotinib and ruxolitinib, respectively, indicating that noninferiority was not met ( P = .98). Transfusion rate, transfusion independence, and transfusion dependence were improved with momelotinib (all with nominal P ≤ .019). The most common grade ≥ 3 hematologic abnormalities in either group were thrombocytopenia and anemia. Grade ≥ 3 infections occurred in 7% of patients who received momelotinib and 3% of patients who received ruxolitinib. Treatment-emergent peripheral neuropathy occurred in 10% of patients who received momelotinib (all grade ≤ 2) and 5% of patients who received ruxolitinib (all grade ≤ 3). Conclusion In JAKi-naïve patients with myelofibrosis, 24 weeks of momelotinib treatment was noninferior to ruxolitinib for spleen response but not for symptom response. Momelotinib treatment was associated with a reduced transfusion requirement.
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Affiliation(s)
- Ruben A Mesa
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Jean-Jacques Kiladjian
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - John V Catalano
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Timothy Devos
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Miklos Egyed
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Andrzei Hellmann
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Donal McLornan
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Kazuya Shimoda
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Elliott F Winton
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Wei Deng
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Ronald L Dubowy
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Julia D Maltzman
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Francisco Cervantes
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Jason Gotlib
- Ruben A. Mesa, Mayo Clinic Cancer Center, Scottsdale, AZ; Jean-Jacques Kiladjian, Saint-Louis Hospital (Assistance Publique-Hôpitaux de Paris) and Paris Diderot University, Paris, France; John V. Catalano, Frankston Hospital and Monash University, Melbourne, Victoria, Australia; Timothy Devos, University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium; Miklos Egyed, Kaposi Mor Teaching Hospital, Kaposvar, Hungary; Andrzei Hellmann, Medical University of Gdańsk, Gdańsk, Poland; Donal McLornan, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom; Kazuya Shimoda, University of Miyazaki, Miyazaki, Japan; Elliott F. Winton, Emory University School of Medicine, Atlanta, GA; Wei Deng, Ronald L. Dubowy, and Julia D. Maltzman, Gilead Sciences, Foster City; Jason Gotlib, Stanford Cancer Institute, Stanford, CA; and Francisco Cervantes, Hospital Clinic, Institut D'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
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Sehn L, Oestergaard M, Trněný M, Bosi A, Egyed M, Illes A, Nakamae H, Opat S, Topp M, Zaja F, Fingerle-Rowson G, Lei G, Nielsen T, Punnoose E, Rahman M, Ray J, Zhang L, Martelli M, Vitolo U. PROGNOSTIC IMPACT OF BCL2 AND MYC EXPRESSION AND TRANSLOCATION IN UNTREATED DLBCL: RESULTS FROM THE PHASE III GOYA STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- L.H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency and the University of British Columbia; Vancouver Canada
| | - M.Z. Oestergaard
- Oncology Biomarker Development; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - M. Trněný
- Charles University; General Hospital; Prague Czech Republic
| | - A. Bosi
- Department of Hematology; Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - M. Egyed
- Department of Hematology; Kaposi Mor Teaching Hospital; Kaposvár Hungary
| | - A. Illes
- Department of Hematology; University of Debrecen, Faculty of Medicine; Debrecen Hungary
| | - H. Nakamae
- Department of Hematology; Osaka City University Hospital; Osaka Japan
| | - S. Opat
- Department of Clinical Haematology; Monash Health and Monash University; Melbourne Australia
| | - M. Topp
- Department of Haematology, Medizinische Klinik und Poliklinik II; Universitätsklinikum Würzburg; Würzburg Germany
| | - F. Zaja
- Department of Hematology, ASUIUD S. M. Misericordia; Udine Italy
| | - G. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - G. Lei
- Department of Biostatistics, Roche Products Ltd; Welwyn Garden City UK
| | - T. Nielsen
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - E.A. Punnoose
- Oncology Biomarker Development; Genentech Inc.; South San Francisco USA
| | - M. Rahman
- Department of Biostatistics, Roche Products Ltd; Welwyn Garden City UK
| | - J. Ray
- Oncology Biomarker Development; Genentech Inc.; South San Francisco USA
| | - L. Zhang
- Department of Pathology; Ventana Medical Systems Inc.; Tucson USA
| | - M. Martelli
- Department of Cellular Biotechnologies and Haematology; Sapienza University; Rome Italy
| | - U. Vitolo
- Department of Hematology; Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino; Turin Italy
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Garcia-Manero G, Sekeres MA, Egyed M, Breccia M, Graux C, Cavenagh JD, Salman H, Illes A, Fenaux P, DeAngelo DJ, Stauder R, Yee K, Zhu N, Lee JH, Valcarcel D, MacWhannell A, Borbenyi Z, Gazi L, Acharyya S, Ide S, Marker M, Ottmann OG. A phase 1b/2b multicenter study of oral panobinostat plus azacitidine in adults with MDS, CMML or AML with ⩽30% blasts. Leukemia 2017; 31:2799-2806. [PMID: 28546581 PMCID: PMC5729337 DOI: 10.1038/leu.2017.159] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 12/15/2022]
Abstract
Treatment with azacitidine (AZA), a demethylating agent, prolonged overall survival (OS) vs conventional care in patients with higher-risk myelodysplastic syndromes (MDS). As median survival with monotherapy is <2 years, novel agents are needed to improve outcomes. This phase 1b/2b trial (n=113) was designed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of panobinostat (PAN)+AZA (phase 1b) and evaluate the early efficacy and safety of PAN+AZA vs AZA monotherapy (phase 2b) in patients with higher-risk MDS, chronic myelomonocytic leukemia or oligoblastic acute myeloid leukemia with <30% blasts. The MTD was not reached; the RP2D was PAN 30 mg plus AZA 75 mg/m2. More patients receiving PAN+AZA achieved a composite complete response ([CR)+morphologic CR with incomplete blood count+bone marrow CR (27.5% (95% CI, 14.6–43.9%)) vs AZA (14.3% (5.4–28.5%)). However, no significant difference was observed in the 1-year OS rate (PAN+AZA, 60% (50–80%); AZA, 70% (50–80%)) or time to progression (PAN+AZA, 70% (40–90%); AZA, 70% (40–80%)). More grade 3/4 adverse events (97.4 vs 81.0%) and on-treatment deaths (13.2 vs 4.8%) occurred with PAN+AZA. Further dose or schedule optimization may improve the risk/benefit profile of this regimen.
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Affiliation(s)
- G Garcia-Manero
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M A Sekeres
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - M Egyed
- Kaposi Mor County Teaching Hospital, Kasposvár, Hungary
| | | | - C Graux
- Mont-Godinne University Hospital, Yvoir, Belgium
| | | | - H Salman
- Augusta University, Augusta, GA, USA
| | - A Illes
- University of Debrecen, Debrecen, Hungary
| | - P Fenaux
- Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | | | - R Stauder
- Innsbruck Medical University, Innsbruck, Austria
| | - K Yee
- Princess Margaret Cancer Centre, Toronto, Canada
| | - N Zhu
- University of Alberta Hospital, Edmonton, Canada
| | - J-H Lee
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | | | - A MacWhannell
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - L Gazi
- Novartis Pharma AG, Basel, Switzerland
| | - S Acharyya
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Ide
- Novartis Pharmaceuticals Corporation, Cambridge, MA, USA
| | - M Marker
- Novartis Pharma S.A.S., Rueil-Malmaison, France
| | - O G Ottmann
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
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Mesa RA, Kiladjian JJ, Catalano JV, Devos T, Egyed M, Hellman A, McLornan D, Shimoda K, Winton EF, Deng W, Dubowy RL, Maltzman JD, Cervantes F, Gotlib JR. Phase 3 trial of momelotinib (MMB) vs ruxolitinib (RUX) in JAK inhibitor (JAKi) naive patients with myelofibrosis (MF). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7000 Background: MMB, an oral JAKi, has been shown in early trials to reduce spleen volume, improve disease associated symptoms (Sx) and improve RBC transfusion (Tx) requirements in patients (pts) with MF. This study was designed to test non-inferiority of MMB vs RUX in splenic volume reduction and Sx amelioration, and superiority in Tx requirement, in JAKi naïve MF pts. Methods: Eligibility: MF, IPSS high risk, Int-2, or symptomatic Int-1; palpable spleen ≥5cm; platelets ≥ 50 K/μl, and no Gr ≥2 peripheral neuropathy (PN). Stratification by Tx dependency and platelets (<100, 100-200 and >200 K/μl). Pts were randomized 1:1 to 24 wks of MMB 200 mg qd + RUX placebo or RUX 20 mg bid (or modified per label) + MMB placebo, after which all pts could receive open label MMB. Assessments: spleen volume by MRI, and pt reported Sx using a daily eDiary of modified MPN-SAF Total Sx Score (TSS). Primary endpoint was splenic response rate (SRR; ≥35% reduction in volume from baseline) at 24 wks. Secondary endpoints, evaluated sequentially at 24 wks, were rates of TSS response (≥50% reduction from baseline), RBC Tx independence (TI), RBC Tx dependence (TD) and of RBC Tx . Results: 175 of 215 (81%) and 201 of 217 (93%) pts randomized to MMB and RUX, respectively, completed the 24 wk DB phase. Efficacy results are shown in Table. Most common Gr ≥3 AEs in the DB phase with MMB were thrombocytopenia (7%) and anemia (6%), and with RUX were anemia (23%), thrombocytopenia (5%) and neutropenia (5%). Gr ≥3 infections occurred in 7% of MMB and 3% of RUX pts. Treatment emergent PN occurred in 22 (10%) of MMB (all Gr ≤2) and 10 (5%) of RUX (9 Gr ≤2, 1 Gr 3) pts in DB phase, none discontinuing study drug for PN. Overall, AEs led to study drug D/C in 13% of MMB and 6% of RUX pts in DB phase. Conclusions: In pts with JAKi naive MF, 24 weeks of MMB is non-inferior to RUX for spleen response but not for symptom response. MMB treatment is associated with a reduced transfusion requirement. NCT01969838. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Donal McLornan
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Wei Deng
- Gilead Sciences, Inc., Foster City, CA
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Mesa RA, Vannucchi AM, Mead A, Egyed M, Szoke A, Suvorov A, Jakucs J, Perkins A, Prasad R, Mayer J, Demeter J, Ganly P, Singer JW, Zhou H, Dean JP, Te Boekhorst PA, Nangalia J, Kiladjian JJ, Harrison CN. Pacritinib versus best available therapy for the treatment of myelofibrosis irrespective of baseline cytopenias (PERSIST-1): an international, randomised, phase 3 trial. Lancet Haematol 2017; 4:e225-e236. [PMID: 28336242 PMCID: PMC8209752 DOI: 10.1016/s2352-3026(17)30027-3] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Available therapies for myelofibrosis can exacerbate cytopenias and are not indicated for patients with severe thrombocytopenia. Pacritinib, which inhibits both JAK2 and FLT3, induced spleen responses with limited myelosuppression in phase 1/2 trials. We aimed to assess the efficacy and safety of pacritinib versus best available therapy in patients with myelofibrosis irrespective of baseline cytopenias. METHODS This international, multicentre, randomised, phase 3 trial (PERSIST-1) was done at 67 sites in 12 countries. Patients with higher-risk myelofibrosis (with no exclusions for baseline anaemia or thrombocytopenia) were randomly assigned (2:1) to receive oral pacritinib 400 mg once daily or best available therapy (BAT) excluding JAK2 inhibitors until disease progression or unacceptable toxicity. Randomisation was stratified by risk category, platelet count, and region. Treatment assignments were known to investigators, site personnel, patients, clinical monitors, and pharmacovigilance personnel. The primary endpoint was spleen volume reduction (SVR) of 35% or more from baseline to week 24 in the intention-to-treat population as assessed by blinded, centrally reviewed MRI or CT. We did safety analyses in all randomised patients who received either treatment. Here we present the final data. This trial is registered with ClinicalTrials.gov, number NCT01773187. FINDINGS Between Jan 8, 2013, and Aug 1, 2014, 327 patients were randomly assigned to pacritinib (n=220) or BAT (n=107). Median follow-up was 23·2 months (IQR 14·8-28·7). At week 24, the primary endpoint of SVR of 35% or more was achieved by 42 (19%) patients in the pacritinib group versus five (5%) patients in the BAT group (p=0·0003). 90 patients in the BAT group crossed over to receive pacritinib at a median of 6·3 months (IQR 5·8-6·7). The most common grade 3-4 adverse events through week 24 were anaemia (n=37 [17%]), thrombocytopenia (n=26 [12%]), and diarrhoea (n=11 [5%]) in the pacritinib group, and anaemia (n=16 [15%]), thrombocytopenia (n=12 [11%]), dyspnoea (n=3 [3%]), and hypotension (n=3 [3%]) in the BAT group. The most common serious adverse events that occurred through week 24 were anaemia (10 [5%]), cardiac failure (5 [2%]), pyrexia (4 [2%]), and pneumonia (4 [2%]) with pacritinib, and anaemia (5 [5%]), sepsis (2 [2%]), and dyspnoea (2 [2%]) with BAT. Deaths due to adverse events were observed in 27 (12%) patients in the pacritinib group and 14 (13%) patients in the BAT group throughout the duration of the study. INTERPRETATION Pacritinib therapy was well tolerated and induced significant and sustained SVR and symptom reduction, even in patients with severe baseline cytopenias. Pacritinib could be a treatment option for patients with myelofibrosis, including those with baseline cytopenias for whom options are particularly limited. FUNDING CTI BioPharma Corp.
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Affiliation(s)
- Ruben A Mesa
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA.
| | - Alessandro M Vannucchi
- Center of Research and Innovation of Myeloproliferative Neoplasms, Department of Experimental and Clinical Medicine, AOU Careggi and University of Florence, Florence, Italy
| | - Adam Mead
- Clinical Haematology, NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Miklos Egyed
- Department of Hematology, Somogy County Kaposi Mor Hospital, Kaposvar, Hungary
| | - Anita Szoke
- Second Department of Internal Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | | | - Janos Jakucs
- Békés Megyei Pándy Kálmán Kórház, Gyula, Hungary
| | | | | | - Jiri Mayer
- Department of Internal Medicine, University Hospital Brno, Brno, Czech Republic
| | - Judit Demeter
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Ganly
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | | | | | | | | | | | - Jean-Jacques Kiladjian
- Centre d'Investigations Cliniques, APHP, Hôpital Saint-Louis, INSERM CIC 1427, Paris, France; Paris Diderot University, Paris, France
| | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Chanan-Khan A, Egyed M, Robak T, Martinelli de Oliveira FA, Echeveste MA, Dolan S, Desjardins P, Blonski JZ, Mei J, Golany N, Zhang J, Gribben JG. Randomized phase 3 study of lenalidomide versus chlorambucil as first-line therapy for older patients with chronic lymphocytic leukemia (the ORIGIN trial). Leukemia 2017; 31:1240-1243. [PMID: 28140392 PMCID: PMC5420789 DOI: 10.1038/leu.2017.47] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Chanan-Khan
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - M Egyed
- Department of Internal Medicine, Kaposi Mor Oktato Korhaz, Kaposvar, Hungary
| | - T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | - M A Echeveste
- Hematology Service, Hospital Universitario Donostia, San Sebastian, Spain
| | - S Dolan
- Division of Hematology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - P Desjardins
- Department of Hematology, Hospital Charles LeMoyne, Greenfield Park, Quebec, Canada
| | - J Z Blonski
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - J Mei
- Celgene Corporation, Summit, NJ, USA
| | - N Golany
- Celgene Corporation, Summit, NJ, USA
| | - J Zhang
- Celgene Corporation, Summit, NJ, USA
| | - J G Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, London, UK
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Rajnics P, Kellner VS, Kellner A, Karadi E, Kollar B, Egyed M. The Hematologic Toxicity of Methotrexate in Patients with Autoimmune Disorders. ACTA ACUST UNITED AC 2017. [DOI: 10.21767/2576-3903.100010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Passamonti F, Griesshammer M, Palandri F, Egyed M, Benevolo G, Devos T, Callum J, Vannucchi AM, Sivgin S, Bensasson C, Khan M, Mounedji N, Saydam G. Ruxolitinib for the treatment of inadequately controlled polycythaemia vera without splenomegaly (RESPONSE-2): a randomised, open-label, phase 3b study. Lancet Oncol 2017; 18:88-99. [DOI: 10.1016/s1470-2045(16)30558-7] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/28/2022]
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Dombi P, Illés Á, Demeter J, Homor L, Simon Z, Karadi E, Udvardy M, Egyed M. Anagrelide reduces thrombotic risk in essential thrombocythaemia vs. hydroxyurea plus aspirin. Eur J Haematol 2016; 98:106-111. [PMID: 27557754 DOI: 10.1111/ejh.12806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the reduction in thrombotic events (TE) in patients with essential thrombocythaemia (ET) treated with anagrelide versus hydroxyurea + aspirin (HU + ASA). METHODS A questionnaire was developed using 2008 WHO diagnostic criteria, and thrombotic risk factors were stratified according to Landolfi criteria. Through questionnaire completion, clinicians at Hungarian haematological centres entered data into the Hungarian MPN Registry on patients with myeloproliferative neoplasms. Based on ET registry data, TEs in anagrelide-treated patients (n = 139) were compared with HU + ASA-treated patients (n = 141). RESULTS Patients were followed up for (median) 6 yr. TEs were reported in significantly fewer anagrelide-treated patients versus HU + ASA (15.1% versus 49.6%; P < 0.001). Numbers of major arterial and major venous events were similar between the groups, although there were over fivefold more minor arterial and minor venous events in the HU + ASA group (P < 0.001). While median age at diagnosis was older and length of follow-up shorter in the HU + ASA group (P < 0.05), this did not influence TE incidence; medication and TE before diagnosis only influenced TE incidence. CONCLUSIONS Anagrelide significantly decreased the number of patients experiencing minor arterial and minor venous TEs versus HU + ASA over 6 yr. Risk of TE after diagnosis was significantly increased if the patient had TE before diagnosis.
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Affiliation(s)
- Péter Dombi
- Szent Borbala County Hospital, Tatabánya, Hungary
| | - Árpád Illés
- Department of Haematology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Judit Demeter
- First Department of Internal Medicine, Division of Haematology, Semmelweis University of Budapest, Budapest, Hungary
| | - Lajos Homor
- Faculty of Humanities and Social Sciences, Pazmany Peter Catholic University, Budapest, Hungary
| | - Zsofia Simon
- Department of Haematology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Eva Karadi
- Department of Haematology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Miklos Udvardy
- Department of Haematology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Miklos Egyed
- Department of Haematology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
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Rajnics P, Kellner Á, Karádi É, Moizs M, Bödör C, Király P, Marosvári D, Andrikovics H, Egyed M. Increased Lipocalin 2 level may have important role in thrombotic events in patients with polycythemia vera and essential thrombocythemia. Leuk Res 2016; 48:101-6. [DOI: 10.1016/j.leukres.2016.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/25/2016] [Accepted: 04/27/2016] [Indexed: 01/08/2023]
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Mesa RA, Egyed M, Szoke A, Suvorov A, Perkins A, Mayer J, Ganly P, Schouten HC, Tosi P, Farber CM, Zachee P, Scheid C, Dean JP, Granston T, Kiladjian JJ, Vannucchi AM, Nangalia J, Mead A, Harrison CN. Pacritinib (PAC) vs best available therapy (BAT) in myelofibrosis (MF): 60 week follow-up of the phase III PERSIST-1 trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Anita Szoke
- Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | | | | | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | - Peter Ganly
- Christchurch Hospital, Christchurch, New Zealand
| | | | | | | | | | | | | | | | | | | | - Jyoti Nangalia
- Cambridge Institute for Medical Research, Cambridge, United Kingdom
| | - Adam Mead
- Oxford University Hospitals, Oxford, United Kingdom
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Harrison CN, Egyed M, Szoke A, Suvorov A, Perkins A, Mayer J, Ganly P, Schouten HC, Tosi P, Farber CM, Zachee P, Scheid C, Dean JP, Zhou H, Kiladjian JJ, Vannucchi AM, Nangalia J, Mead A, Mesa RA. Outcomes in patients with myelofibrosis and RBC-transfusion dependence in the phase III PERSIST-1 study of pacritinib vs. best available therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Anita Szoke
- Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | | | | | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | - Peter Ganly
- Christchurch Hospital, Christchurch, New Zealand
| | | | | | | | | | | | | | | | | | | | - Jyoti Nangalia
- Cambridge Institute for Medical Research, Cambridge, United Kingdom
| | - Adam Mead
- Oxford University Hospitals, Oxford, United Kingdom
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Harrison CN, Egyed M, Szoke A, Suvorov A, Perkins A, Mayer J, Ganly P, Schouten HC, Tosi P, Farber CM, Zachee P, Scheid C, Dean JP, Zhou H, Kiladjian JJ, Vannucchi AM, Nangalia J, Mead A, Mesa RA. Pacritinib (PAC) vs best available therapy (BAT) in myelofibrosis (MF): Outcomes in patients (pts) with baseline (BL) thrombocytopenia. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Anita Szoke
- Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | | | | | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | - Peter Ganly
- Christchurch Hospital, Christchurch, New Zealand
| | | | | | | | | | | | | | | | | | | | - Jyoti Nangalia
- Cambridge Institute for Medical Research, Cambridge, United Kingdom
| | - Adam Mead
- Oxford University Hospitals, Oxford, United Kingdom
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Krahling T, Balassa K, Kiss KP, Bors A, Batai A, Halm G, Egyed M, Fekete S, Remenyi P, Masszi T, Tordai A, Andrikovics H. Co-occurrence of Myeloproliferative Neoplasms and Solid Tumors Is Attributed to a Synergism Between Cytoreductive Therapy and the Common TERT Polymorphism rs2736100. Cancer Epidemiol Biomarkers Prev 2015; 25:98-104. [DOI: 10.1158/1055-9965.epi-15-0805] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/16/2015] [Indexed: 11/16/2022] Open
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Mesa RA, Egyed M, Szoke A, Suvorov A, Perkins A, Mayer J, Ganly P, Jourdan E, Schouten HC, Tosi P, Farber CM, Zachee P, Scheid C, Dean JP, Cernohous P, Nangalia J, Kiladjian JJ, Vannucchi AM, Mead A, Harrison CN. Results of the PERSIST-1 phase III study of pacritinib (PAC) versus best available therapy (BAT) in primary myelofibrosis (PMF), post-polycythemia vera myelofibrosis (PPV-MF), or post-essential thrombocythemia-myelofibrosis (PET-MF). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.18_suppl.lba7006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7006 Background: PAC is a potent JAK2 inhibitor without significant JAK1 inhibition with minimal myelosuppression in early-phase studies in MF. Methods: The efficacy and safety of daily oral PAC was compared to BAT (2:1 randomization stratified for risk and platelet count). The 10 endpoint was the proportion of ITT patients (pts) achieving ≥ 35% spleen volume reduction (SVR) at week (wk) 24 by centrally reviewed MRI or CT. Secondary endpoints included the proportion achieving ≥ 50% reduction in total symptom score (TSS) at wk 24 using the MPN Symptom Assessment Form. Results: Patients:327 were enrolled (PAC:220, BAT:107), 62% with 10 MF. Median time from diagnosis was 1.12 years (PAC 0.99, BAT 1.60): 32% and 15% had a platelet counts < 100,000/µL or <50,000/ µL; 75% were JAK2V617F positive. Efficacy: The median duration of treatment was 16.2 months PAC and 5.9 months BAT. Sixty-two percent of BAT patients received active disease directed therapy. The SVR rates at week 24 were 19.1% for PAC vs. 4.7% for BAT (p=0.0003) in ITT and 25% vs. 5.9% (p=0.0001) in the evaluable population. 79% of BAT patients crossed over to PAC; 21% had achieved a >35% reduction in spleen volume at data cutoff. TSS composite V1 + V2 response rates were 24.5%for PAC vs. 6.5% for BAT (p<0.0001) by ITT, and were 40.9% vs. 9.9% in evaluable pts (p<0.0001). Efficacy with baseline cytopenias: In pts with <100,000 and <50,000 platelets/μ/L, the SVR rates were 16.7% for PAC vs. 0% for BAT (p=0.009), and 22.9% vs. 0% (p=0.045) by ITT and 23.5% vs. 0% (p=0.007) and 33.3% vs. 0% (p=0.037) in evaluable pts. In RBC transfusion dependent pts, 25.7% of PAC pts became RBC independent vs. 0% of BAT pts (p=0.043). Safety: The most common adverse events (AE) for PAC were diarrhea, nausea, and vomiting; (grade 3 were <5%, <1%, <1% respectively). Hematologic AEs were similar between PAC and BAT. Conclusions: This study demonstrated PAC was well tolerated and induced significant and sustained SVR and symptom control even in patients with severe thrombocytopenia. PAC therapy resulted in RBC transfusion independence in a significant proportion of pts. Clinical trial information: NCT01773187.
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Affiliation(s)
| | | | | | | | | | - Jiri Mayer
- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Peter Ganly
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Eric Jourdan
- Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | | | | | | | | | | | | | | | - Jyoti Nangalia
- Cambridge Institute for Medical Research, Cambridge, United Kingdom
| | | | | | - Adam Mead
- Oxford University Hospitals, Oxford, United Kingdom
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Mesa RA, Egyed M, Szoke A, Suvorov A, Perkins A, Mayer J, Ganly P, Jourdan E, Schouten HC, Tosi P, Farber CM, Zachee P, Scheid C, Dean JP, Cernohous P, Nangalia J, Kiladjian JJ, Vannucchi AM, Mead A, Harrison CN. Results of the PERSIST-1 phase III study of pacritinib (PAC) versus best available therapy (BAT) in primary myelofibrosis (PMF), post-polycythemia vera myelofibrosis (PPV-MF), or post-essential thrombocythemia-myelofibrosis (PET-MF). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.lba7006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Jiri Mayer
- Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Peter Ganly
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Eric Jourdan
- Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | | | | | | | | | | | | | | | - Jyoti Nangalia
- Cambridge Institute for Medical Research, Cambridge, United Kingdom
| | | | | | - Adam Mead
- Oxford University Hospitals, Oxford, United Kingdom
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