Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, Post-Essential Thrombocythemia Myelofibrosis, Polycythemia Vera, Essential Thrombocythemia
Conditions
Keywords
Primary Myelofibrosis, Post Polycythemia Vera Myelofibrosis, Post Essential Thrombocythemia Myelofibrosis, Polycythemia Vera, Essential Thrombocythemia, blood disorders
Brief summary
This open-label study is to determine the long-term safety and tolerability of momelotinib in previously enrolled study participants with primary myelofibrosis (PMF), post-polycythemia vera myelofibrosis (post-PV MF), post-essential thrombocythemia myelofibrosis (post-ET MF), polycythemia vera (PV), or essential thrombocythemia (ET), who have tolerated and achieved stable disease or better with momelotinib treatment while enrolled in a previous clinical trial.
Interventions
Momelotinib tablets administered orally once daily
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: * Currently enrolled in study CCL09101E, or YM387-II-02, or successfully completed 24 weeks of study GS-US-352-1672 * Able to comprehend and willing to sign informed consent form Key
Exclusion criteria
* Known hypersensitivity to momelotinib, its metabolites, or formulation excipients Note: Other protocol defined Inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Long Term Safety and Tolerability as Measured by the Incidence and Severity of Adverse Events and Clinical Laboratory Abnormalities | From the first dose of momelotinib in the parent study to 30 days following permanent discontinuation of momelotinib in Study GS-US-352-1154. | Long-term safety and tolerability profile of momelotinib based on safety data (adverse events and selected hematology and chemistry laboratory parameters) collected after the first dose of momelotinib in the parent study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Splenic Response | From baseline in the parent study until the last spleen assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib. | The interval from the first onset of splenic response (in the parent study or Study GS-US-352-1154) to the earliest date of loss of splenic response. Loss of response was defined as the reduction of splenomegaly by \< 50% among responders (with splenomegaly ≥ 10 cm below the LCM at baseline) that lasts ≥ 56 days, or the recurrence of \> 0 cm splenomegaly among responders (with splenomegaly \> 5 and \< 10 cm at baseline) that lasts ≥ 56 days. Duration of splenic response was measured by descriptive statistics. Data from responders who maintained their response was censored at the last assessment date. |
| Transfusion Independence Response Rate | From baseline in the parent study until the last assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib. | The number of transfusion dependent subjects at entry to a parent study who became transfusion-independent for ≥ 12 weeks at any time from the first dose of momelotinib in the parent study until the end of Study GS-US-352-1154. |
| Duration of Transfusion Independence Response | From baseline in the parent study until the last assessment date in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib. | The interval from the first onset date of transfusion independence (in the parent study or Study GS-US-352-1154) to the earliest date of loss of response for participants who are transfusion dependent at baseline in the parent study. Loss of TI response was defined as receiving an RBC transfusion after achieving a TI response. Duration of transfusion independence response was measured by descriptive statistics. Data from responders who maintained their response was censored at the last assessment date. |
| Anemia Response Rate | From baseline in the parent study until the last assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib. | The number of subjects achieving an anemia response, defined as: * Achieving transfusion independence for ≥ 12 weeks, for subjects who were transfusion-dependent at baseline in the parent study, or * Having ≥ 2 g/dL increase in Hgb from baseline for ≥ 12 weeks, for subjects with Hgb \< 10 g/dL at baseline in the parent study who were not transfusion-dependent (Cohort 1) or who were transfusion-independent (Cohort 2). |
| Splenic Response Rate | From baseline in the parent study until the last spleen assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib. | The number of subjects achieving a spleen response, defined as a reduction of 50% or more in palpable splenomegaly of a spleen that was at least 10 cm below the LCM at baseline, or a spleen that was palpable at \> 5 cm and \< 10 cm below the LCM at baseline becoming not palpable for at least 56 days, using baseline of the parent study as the reference. |
| Rate of RBC Transfusion | From the first dose of momelotinib in the parent study until the last dose of momelotinib in Study GS-US-352-1154. | The average number of RBC units per subject month during the parent study and/or Study GS-US-352-1154. |
| Overall Survival | From baseline in the parent study until the date of last contact or last response assessment, up to 30 days following permanent discontinuation of momelotinib. | The interval from the first dose of momelotinib in the parent study until death from any cause. Overall survival was analyzed using the Kaplan-Meier method. Data from subjects who were lost to follow-up or remained alive until the end of the study were censored at the date of last contact or last response assessment. |
| Progression-Free Survival | From baseline in the parent study until the last response assessment, up to 30 days following permanent discontinuation of momelotinib. | The interval from the first dose of momelotinib in the parent study until the first documentation of definitive progressive disease as defined in 2006 IWG-MRT or death due to any cause. Subjects who were free of progression were censored at the last assessment date. |
| Leukemia-Free Survival | From baseline in the parent study until the date of the last assessment, up to 30 days following permanent discontinuation of momelotinib. | The interval from the first dose of momelotinib in the parent study until the first documented leukemic transformation or death from any cause. Leukemic transformation was documented in the adverse event electronic case report form. Leukemia-free survival was analyzed using the Kaplan-Meier method. Subjects who were free of leukemia transformation were censored at the last assessment date. |
| Duration of Anemia Response | From baseline in the parent study until the last assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib. | The interval from the first onset of anemia response (in the parent study or Study GS-US-352-1154) to the earliest date of loss of anemia response. Loss of anemia response was defined as having any RBC transfusion after achieving an anemia response. Duration of anemia response was measured by descriptive statistics. Data from responders who maintained their response was censored at the last assessment date. |
Countries
Australia, Canada, France, Germany, United States
Participant flow
Recruitment details
Benefiting subjects enrolled in 1 of 3 prior momelotinib (MMB) studies (parent studies) for the treatment of MF were included for continued dosing of MMB. Cohort 3 (PV/ET; n=13) was closed and subjects were discontinued due to limited efficacy of MMB in the treatment of PV/ET observed in the parent study. Cohort 3 was excluded from all analyses.
Participants by arm
| Arm | Count |
|---|---|
| Cohort 1 (CCL09101/ CCL09101E/ GS-US-352-1154) Subjects with PMF, post-PV MF or post-ET MF previously enrolled in parent study CCL09101/ CCL09101E. | 30 |
| Cohort 2 (YM387-II-02/GS-US-352-1154) Subjects with PMF, post-PV MF or post-ET MF previously enrolled in parent study YM387-II-02. | 22 |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) Subjects with PMF, post-PV MF or post-ET MF previously enrolled in parent study GS-US-352-1672. | 22 |
| Total | 74 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 2 | 1 | 2 |
| Overall Study | Death | 2 | 1 | 3 |
| Overall Study | Disease Progression | 3 | 6 | 4 |
| Overall Study | Lack of Efficacy | 3 | 2 | 2 |
| Overall Study | Non-Compliance with Study Drug | 0 | 1 | 0 |
| Overall Study | Physician Decision | 6 | 4 | 5 |
| Overall Study | Study Terminated by Sponsor | 0 | 0 | 6 |
| Overall Study | Withdrawal by Subject | 3 | 3 | 0 |
Baseline characteristics
| Characteristic | Cohort 2 (YM387-II-02/GS-US-352-1154) | Total | Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Cohort 1 (CCL09101/ CCL09101E/ GS-US-352-1154) |
|---|---|---|---|---|
| Age, Continuous | 64.0 years | 66.5 years | 68.0 years | 66.0 years |
| Race/Ethnicity, Customized Asian | 0 Participants | 2 Participants | 0 Participants | 2 Participants |
| Race/Ethnicity, Customized Black or African American | 2 Participants | 4 Participants | 2 Participants | 0 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 3 Participants | 2 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 20 Participants | 64 Participants | 18 Participants | 26 Participants |
| Sex: Female, Male Female | 10 Participants | 36 Participants | 9 Participants | 17 Participants |
| Sex: Female, Male Male | 12 Participants | 38 Participants | 13 Participants | 13 Participants |
| Transfusion Dependent (at baseline in parent study) Missing | 3 Participants | 3 Participants | 0 Participants | 0 Participants |
| Transfusion Dependent (at baseline in parent study) No | 12 Participants | 35 Participants | 0 Participants | 23 Participants |
| Transfusion Dependent (at baseline in parent study) Yes | 7 Participants | 36 Participants | 22 Participants | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 8 / 74 |
| other Total, other adverse events | 73 / 74 |
| serious Total, serious adverse events | 49 / 74 |
Outcome results
Long Term Safety and Tolerability as Measured by the Incidence and Severity of Adverse Events and Clinical Laboratory Abnormalities
Long-term safety and tolerability profile of momelotinib based on safety data (adverse events and selected hematology and chemistry laboratory parameters) collected after the first dose of momelotinib in the parent study.
Time frame: From the first dose of momelotinib in the parent study to 30 days following permanent discontinuation of momelotinib in Study GS-US-352-1154.
Population: It was pre-specified that safety outcomes would be analyzed and summarized by starting dose in Study GS-US-352-1154. Therefore data for this outcome measure are presented for the total subjects enrolled to Study GS-US-352-1154 and not by cohort.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Total | Long Term Safety and Tolerability as Measured by the Incidence and Severity of Adverse Events and Clinical Laboratory Abnormalities | Subjects with ≥ one AE (any grade) | 73 Participants |
| Total | Long Term Safety and Tolerability as Measured by the Incidence and Severity of Adverse Events and Clinical Laboratory Abnormalities | Subjects with ≥ one Grade 3 or higher AE | 62 Participants |
| Total | Long Term Safety and Tolerability as Measured by the Incidence and Severity of Adverse Events and Clinical Laboratory Abnormalities | Subjects with Grade 3 lab toxicity (highest grade) | 36 Participants |
| Total | Long Term Safety and Tolerability as Measured by the Incidence and Severity of Adverse Events and Clinical Laboratory Abnormalities | Subjects with Grade 4 lab toxicity (highest grade) | 16 Participants |
Anemia Response Rate
The number of subjects achieving an anemia response, defined as: * Achieving transfusion independence for ≥ 12 weeks, for subjects who were transfusion-dependent at baseline in the parent study, or * Having ≥ 2 g/dL increase in Hgb from baseline for ≥ 12 weeks, for subjects with Hgb \< 10 g/dL at baseline in the parent study who were not transfusion-dependent (Cohort 1) or who were transfusion-independent (Cohort 2).
Time frame: From baseline in the parent study until the last assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib.
Population: Subjects who were anemia response-evaluable at baseline in the parent studies and were enrolled in Study GS-US-352-1154 were evaluable for anemia response.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Total | Anemia Response Rate | 13 Participants |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Anemia Response Rate | 6 Participants |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Anemia Response Rate | 16 Participants |
| Total | Anemia Response Rate | 35 Participants |
Duration of Anemia Response
The interval from the first onset of anemia response (in the parent study or Study GS-US-352-1154) to the earliest date of loss of anemia response. Loss of anemia response was defined as having any RBC transfusion after achieving an anemia response. Duration of anemia response was measured by descriptive statistics. Data from responders who maintained their response was censored at the last assessment date.
Time frame: From baseline in the parent study until the last assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib.
Population: Duration of anemia response was assessed for anemia responders who were enrolled in Study GS-US-352-1154.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Total | Duration of Anemia Response | 995.0 days |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Duration of Anemia Response | 120.0 days |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Duration of Anemia Response | 281.5 days |
| Total | Duration of Anemia Response | 358.0 days |
Duration of Splenic Response
The interval from the first onset of splenic response (in the parent study or Study GS-US-352-1154) to the earliest date of loss of splenic response. Loss of response was defined as the reduction of splenomegaly by \< 50% among responders (with splenomegaly ≥ 10 cm below the LCM at baseline) that lasts ≥ 56 days, or the recurrence of \> 0 cm splenomegaly among responders (with splenomegaly \> 5 and \< 10 cm at baseline) that lasts ≥ 56 days. Duration of splenic response was measured by descriptive statistics. Data from responders who maintained their response was censored at the last assessment date.
Time frame: From baseline in the parent study until the last spleen assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib.
Population: Duration of splenic response was assessed for spleen responders who enrolled in Study GS-US-352-1154 only.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Total | Duration of Splenic Response | 1704.5 days |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Duration of Splenic Response | 736.0 days |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Duration of Splenic Response | 447.5 days |
| Total | Duration of Splenic Response | 990.0 days |
Duration of Transfusion Independence Response
The interval from the first onset date of transfusion independence (in the parent study or Study GS-US-352-1154) to the earliest date of loss of response for participants who are transfusion dependent at baseline in the parent study. Loss of TI response was defined as receiving an RBC transfusion after achieving a TI response. Duration of transfusion independence response was measured by descriptive statistics. Data from responders who maintained their response was censored at the last assessment date.
Time frame: From baseline in the parent study until the last assessment date in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib.
Population: Duration of transfusion independence response was assessed for transfusion independence responders who were enrolled in Study GS-US-352-1154.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Total | Duration of Transfusion Independence Response | 357.0 days |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Duration of Transfusion Independence Response | 114.0 days |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Duration of Transfusion Independence Response | 281.5 days |
| Total | Duration of Transfusion Independence Response | 193.5 days |
Leukemia-Free Survival
The interval from the first dose of momelotinib in the parent study until the first documented leukemic transformation or death from any cause. Leukemic transformation was documented in the adverse event electronic case report form. Leukemia-free survival was analyzed using the Kaplan-Meier method. Subjects who were free of leukemia transformation were censored at the last assessment date.
Time frame: From baseline in the parent study until the date of the last assessment, up to 30 days following permanent discontinuation of momelotinib.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Total | Leukemia-Free Survival | NA months |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Leukemia-Free Survival | NA months |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Leukemia-Free Survival | NA months |
| Total | Leukemia-Free Survival | NA months |
Overall Survival
The interval from the first dose of momelotinib in the parent study until death from any cause. Overall survival was analyzed using the Kaplan-Meier method. Data from subjects who were lost to follow-up or remained alive until the end of the study were censored at the date of last contact or last response assessment.
Time frame: From baseline in the parent study until the date of last contact or last response assessment, up to 30 days following permanent discontinuation of momelotinib.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Total | Overall Survival | NA months |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Overall Survival | NA months |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Overall Survival | NA months |
| Total | Overall Survival | NA months |
Progression-Free Survival
The interval from the first dose of momelotinib in the parent study until the first documentation of definitive progressive disease as defined in 2006 IWG-MRT or death due to any cause. Subjects who were free of progression were censored at the last assessment date.
Time frame: From baseline in the parent study until the last response assessment, up to 30 days following permanent discontinuation of momelotinib.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Total | Progression-Free Survival | NA months |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Progression-Free Survival | NA months |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Progression-Free Survival | NA months |
| Total | Progression-Free Survival | NA months |
Rate of RBC Transfusion
The average number of RBC units per subject month during the parent study and/or Study GS-US-352-1154.
Time frame: From the first dose of momelotinib in the parent study until the last dose of momelotinib in Study GS-US-352-1154.
Population: It was pre-specified that safety outcomes would be analyzed and summarized by starting dose in Study GS-US-352-1154. Therefore data for this outcome measure are presented for the total subjects enrolled to Study GS-US-352-1154 and not by cohort.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Total | Rate of RBC Transfusion | RBC Transfusion Rate in Parent Studies | 0.08 RBC units per month |
| Total | Rate of RBC Transfusion | RBC Transfusion Rate in Study GS-US-352-1154 | 0.00 RBC units per month |
| Total | Rate of RBC Transfusion | RBC Transfusion Rate Since 1st Dose in ParentStudy | 0.06 RBC units per month |
Splenic Response Rate
The number of subjects achieving a spleen response, defined as a reduction of 50% or more in palpable splenomegaly of a spleen that was at least 10 cm below the LCM at baseline, or a spleen that was palpable at \> 5 cm and \< 10 cm below the LCM at baseline becoming not palpable for at least 56 days, using baseline of the parent study as the reference.
Time frame: From baseline in the parent study until the last spleen assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib.
Population: Subjects with splenomegaly \>5 cm at baseline in the parent studies who were enrolled in Study GS-US-352-1154 were evaluable for splenic response assessment.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Total | Splenic Response Rate | 20 Participants |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Splenic Response Rate | 19 Participants |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Splenic Response Rate | 6 Participants |
| Total | Splenic Response Rate | 45 Participants |
Transfusion Independence Response Rate
The number of transfusion dependent subjects at entry to a parent study who became transfusion-independent for ≥ 12 weeks at any time from the first dose of momelotinib in the parent study until the end of Study GS-US-352-1154.
Time frame: From baseline in the parent study until the last assessment in Study GS-US-352-1154, up to 30 days following permanent discontinuation of momelotinib.
Population: Subjects who were transfusion dependent at baseline in the parent studies and were enrolled in Study GS-US-352-1154 were evaluable for transfusion independence response.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Total | Transfusion Independence Response Rate | 7 Participants |
| Cohort 2 (YM387-II-02/GS-US-352-1154) | Transfusion Independence Response Rate | 5 Participants |
| Cohort 4 (GS-US-352-1672/GS-US-352-1154) | Transfusion Independence Response Rate | 16 Participants |
| Total | Transfusion Independence Response Rate | 28 Participants |