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A Safety Trial of Fedratinib in Subjects With DIPSS, Intermediate or High-Risk Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, or Post-Essential Thrombocythemia Myelofibrosis and Previously Treated With Ruxolitinib With Concomitant Luspatercept for Subjects With Anemia (FREEDOM)

  • Clinicaltrials.gov identifier

    NCT03755518

  • Recruitment Status

    Recruiting

  • First Posted

    November 28, 2018

  • Last update posted

    August 23, 2021

Study Description

Brief summary:

This is Single-Arm, Open-Label Efficacy and Safety Trial of Fedratinib in Subjects with DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High- Risk Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (post-PV MF), or Post-Essential Thrombocythemia Myelofibrosis (post-ET MF) and Previously Treated with Ruxolitinib including a Sub-study with concomitant Luspatercept for subjects with anemia. The primary objective of the main study is to evaluate the percentage of subjects with at least a 35% reduction in spleen size and one of the secondary objectives is to evaluate the safety of fedratinib. The primary objective of the sub-study is to evaluate the safety and tolerability of Luspatercept when administered concomitantly with Fedratinib.

  • Condition or Disease:Primary Myelofibrosis
    Post-Polycythemia Vera
    Myelofibrosis
  • Intervention/Treatment: Drug: FEDRATINIB
    Drug: Luspatercept
  • Phase: Phase 3

Detailed Description

This is Single-Arm, Open-Label Efficacy and Safety Trial of Fedratinib in Subjects with DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High- Risk Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (post-PV MF), or Post-Essential Thrombocythemia Myelofibrosis (post-ET MF) and Previously Treated with Ruxolitinib including a Sub-study with concomitant Luspatercept for subjects with anemia. The spleen volume reduction at the end of Cycle 6 as the primary objective. The secondary objectives of the study are to further evaluate the safety and to assess and implement mitigation strategies for WE and for gastrointestinal (GI) adverse events. The study will be at multiple centers to provide access to a broad population and have assurance the results are likely to have general applicability. This is also conducted as an open-label study to collect efficacy and safety data with fedratinib use, no randomization or stratification will occur. The primary objective of the sub-study is to evaluate the safety and tolerability of Luspatercept when administered concomitantly with Fedratinib for the treatment of anemia in subjects with MF who are red blood cell (RBC) transfusion dependent (Group A) or non-transfusion dependent (Group B).

Study Design

  • Study Type: Interventional
  • Estimated Enrollment: 110 participants
  • Allocation: Randomized
  • Intervention Model: Single Group Assignment
  • Masking: None (Open Label) ()
  • Primary Purpose: Treatment
  • Official Title: A Phase 3b, Multicenter, Single-Arm, Open-Label Efficacy and Safety Study of Fedratinib in Subjects With DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High-Risk Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (Post-PV MF), or Post-Essential Thrombocythemia Myelofibrosis (Post-ET MF) and Previously Treated With Ruxolitinib Including a Sub-study With Concomitant Luspatercept for Subjects With Anemia
  • Actual Study Start Date: March 2019
  • Estimated Primary Completion Date: November 2021
  • Estimated Study Completion Date: May 2022

Arms and interventions

Arm Intervention/treatment
Experimental: Administration of Fedratinib 400mg/day
Self-administered Investigational Product (IP) (400 mg/day) on an outpatient basis, once daily preferably with food during an evening meal at the same time each day in consecutive 4-week (28-day) cycles.
Drug: FEDRATINIB
A potent and selective inhibitor of JAK2 kinase activity

Drug: Luspatercept
Luspatercept will be 1.33 mg/kg administered as a subcutaneous injection concomitantly with Fedratinib.
Experimental: Administration of Luspatercept 1.33 mg/kg
Administered as a subcutaneous injection concomitantly with Fedratinib at 3-week (21 day) cycles
Drug: Luspatercept
Luspatercept will be 1.33 mg/kg administered as a subcutaneous injection concomitantly with Fedratinib.

Outcome Measures

  • Primary Outcome Measures: 1. Main study - Proportion of subjects who have a ≥ 35% SVR at end of Cycle 6 [ Time Frame: At the end of Cycle 6 (each cycle is 28 days) ]
    Spleen volume response rate (RR)
  • 2. Sub study - Adverse Events (AEs) [ Time Frame: From enrollment up until 42 days post last dose of luspatercept or 30 days post last dose of fedratinib ]
    To evaluate the safety and tolerability of luspatercept when administered concomitantly with fedratinib for the treatment of anemia in subjects with MPN-associated MF who are RBC transfusion dependent (Group A) or non-transfusion dependent (Group B).
  • Secondary Outcome Measures: 1. Main study - Adverse Event(s) [ Time Frame: Up to 12 months post last dose ]
    Number of participants with adverse event
  • 2. Main study - Proportion of subjects who have ≥ 50% reduction in spleen size by palpation [ Time Frame: At the end of Cycle 6 (each cycle is 28 days) ]
    Spleen response rate by palpation (RRP)
  • 3. Main study - Symptom response rate (SRR) [ Time Frame: At the end of Cycle 6 (each cycle is 28 days) ]
    Is defined as the proportion of subjects with ≥ 50% reduction from baseline to the end of Cycle 6 in total symptom score (TSS) measured by MFSAF version 4.0.
  • 4. Main study - To evaluate durability of spleen volume response (DR) [ Time Frame: From enrollment until treatment discontinuation (estimation of 12 months) ]
    Is defined as time from the first documented spleen response (ie, ≥ 35% reduction in spleen volume) to the first documented spleen volume reduction < 35%.
  • 5. Main study - To evaluate the durability of spleen response by palpation (DRP) [ Time Frame: From enrollment until treatment discontinuation (estimation of 12 months) ]
    Is defined as time from the first documented palpable spleen response, according to the IWG-MRT 2013 to the time of the first documented loss of response according to the IWG-MRT 2013.
  • 6. Main study - Durability of symptoms response (DSR) [ Time Frame: Up to 30 days post last dose ]
    Is defined as time from the first documented response in TSS (ie, reduction in TSS ≥ 50%) measured by MFSAF version 4.0 to the first documented TSS reduction < 50%.
  • 7. Main study - Gastrointestinal Adverse Events [ Time Frame: Up to 30 days post last dose ]
    Incidence of subjects with Grade 3 or higher Gastrointestinal events (nausea, diarrhea, or vomiting) according to CTCAE v5.0
  • 8. Main study - Wernicke encephalopathy (WE) [ Time Frame: Up to 30 days post last dose ]
    Occurrence of confirmed Wernicke encephalopathy events
  • 9. Main study - Wernicke encephalopathy (WE) thiamine monitoring [ Time Frame: Up to 30 days post last dose ]
    Monitoring and correction of thiamine levels as appropriate
  • 10. Sub study - Anemia response related to modified Hematological Improvement - Erythroid Response (HI-E) [ Time Frame: From SC1D1 through and including Sub-study Week 24 (Day 169) Also from SC1D1 through EOT ]
    it is defined as the proportion of subjects with hemoglobin increase by ≥ 1.5 g/dL OR reduction of units of RBC transfusion by an absolute number of at least 4 RBC transfusions over any consecutive 56-day (8 weeks) period compared with sub-study baseline.
  • 11. Sub study - Anemia Response related to Reduction in Transfusion Burden [ Time Frame: From SC1D1 through and including Sub-study Week 24 (Day 169) Also from SC1D1 through EOT ]
    it is defined as the proportion of RBC transfusion dependent subjects who reduce their transfusion burden by ≥ 50% and by ≥ 4 units/12 weeks over any consecutive 12-week period compared with sub-study baseline.
  • 12. Sub study - Anemia Response related to Mean Hemoglobin Increase [ Time Frame: From SC1D1 through and including Sub-study Week 24 (Day 169) Also from SC1D1 through EOT ]
    it is defined as the proportion of subjects achieving a mean ≥ 1.5 g/dL hemoglobin increase from baseline over any consecutive 84-day period without an RBC transfusion.
  • 13. Sub study - Anemia response related to RBC-transfusion independence [ Time Frame: From SC1D1 through and including Sub-study Week 24 (Day 169) Also from SC1D1 through EOT ]
    it is defined as the proportion of subjects who become RBC-transfusion free over any consecutive 84- day period. The response rate will be calculated using the number of responders divided by number of subjects in the sub-study Safety population.
  • 14. Sub study - Duration of anemia response [ Time Frame: Up to 12 months post last dose ]
    Maximum duration of anemia response in each of the endpoints and groups

Eligibility Criteria

  • Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
  • Sexes Eligible for Study: All
  • Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria: Main Study Inclusion Criteria 1. Subject is at least 18 years of age at the time of signing the informed consent form (ICF) 2. Subject has an Eastern Cooperative Oncology Group (ECOG) Performance Score (PS) of 0, 1 or 2 3. Subject has diagnosis of primary myelofibrosis (PMF) according to the 2016 World Health Organization (WHO) criteria, or diagnosis of post-ET or post-PV myelofibrosis according to the IWG-MRT 2007 criteria, confirmed by the most recent local pathology report 4. Subject has a DIPSS Risk score of Intermediate or High 5. Subject has a measurable splenomegaly during the screening period as demonstrated by spleen volume of ≥ 450 cm3 by MRI or CT-scan assessment or by palpable spleen measuring ≥ 5 cm below the left costal margin. 6. Subject has been previously exposed to ruxolitinib, while diagnosed with MF (PMF, post-ET MF or post-PV MF), and must meet at least one of the following criteria (a or b) 1. Treatment with ruxolitinib for ≥ 3 months 2. Treatment with ruxolitinib for ≥ 28 days complicated by any of the following: - Development of a red blood cell transfusion requirement (at least 2 units/month for 2 months) or - Grade ≥ 3 AEs of thrombocytopenia, anemia, hematoma, and/or hemorrhage while on treatment with ruxolitinib 7. Subject must have treatment-related toxicities from prior therapy resolved to Grade 1 or pretreatment baseline before start of last therapy prior to fedratinib treatment. 8. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted 9. Subject is willing and able to adhere to the study visit schedule and other protocol requirements 10. Participants must agree to use effective contraception Sub-Study Inclusion Criteria 1. Subject must understand and voluntarily sign an optional sub-study ICF prior to any sub study-related assessments/procedures being conducted 2. Subject must have been taking fedratinib for at least 32 weeks (~ 8 cycles) 3. Subject must be on a stable dose of fedratinib for at least 16 weeks (~ 4 cycles) [no dose level changes] in the time immediately up to the projected date of enrollment (SC1D1) 4. Subject has anemia defined as either: 1. Group A - Transfusion dependent (TD) anemia - RBC-transfusion frequency: 4 to 12 RBC units/84 days immediately up to the SC1D1 date (Sub-study Cycle 1 Day 1), with no interval of > 6 weeks (42 days) without an RBC transfusion. - Subjects must have a Hgb value of < 11.5 g/dL on SC1D1 prior to luspatercept administration. 2. Group B - Non-transfusion dependent (NTD) anemia - RBC-transfusion frequency: < 4 RBC units/84 days immediately up to the SC1D1 date. OR - At least 3 Hgb levels of ≤ 9.5 g/dL recorded on ≥ 3 different days, including the day of dosing, in the 84-day period immediately up to Sub-study C1D1 date. There must be ≥ 14 days in between each Hgb measurement. No subjects with an interval ≥ 42 days between hemoglobin measurements will be enrolled. Baseline is defined as the 84-day rolling period (3 cycles at 28 days each) prior to Sub-study Cycle 1 Day 1. Any transfusions given either at a Hgb ≤ 7 or for a Hgb ≤ 9.5 g/dL with symptoms will be counted towards baseline transfusion needs. Transfusions given only for bleeding or infections will not be counted towards eligibility baseline transfusion requirements. 5. Subject has an Eastern Cooperative Oncology Group (ECOG) performance score of ≤ 2. Exclusion Criteria: Main Study Exclusion Criteria 1. Any of the following laboratory abnormalities: 1. Platelets < 50,000/μL 2. Absolute neutrophil count (ANC) < 1.0 x 109/L 3. White blood count (WBC) > 100 x 10^9/L 4. Myeloblasts > 5 % in peripheral blood 5. Estimated glomerular filtration rate < 30 mL/min/1.73 m^2 (as per the Modification of Diet in Renal Disease [MDRD] formula) 6. Serum amylase or lipase > 1.5 x ULN (upper limit of normal) 7. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3 x ULN 8. Total bilirubin > 1.5 x ULN, subject's total bilirubin between 1.5 - 3.0 x ULN are eligible if the direct bilirubin fraction is < 25% of the total bilirubin 2. Subject is pregnant or lactating female 3. Subject with previous splenectomy 4. Subject with previous or planned hematopoietic cell transplant 5. Subject with prior history of encephalopathy, including Wernicke's 6. Subject with signs or symptoms of encephalopathy including Wernicke's (eg, severe ataxia, ocular paralysis or cerebellar signs) 7. Subject with thiamine deficiency, defined as thiamine levels in whole blood below normal range according to institutional standard and not corrected prior to enrollment on the study 8. Subject with concomitant treatment with or use of pharmaceutical, herbal agents or food known to be strong or moderate inducers of Cytochrome P450 3A4 (CYP3A4), or dual CYP2C19 and CYP3A4 inhibitors 9. Subject on any chemotherapy, immunomodulatory drug therapy (eg, thalidomide, interferon-alpha), anagrelide, immunosuppressive therapy, systemic corticosteroids > 10 mg/day prednisone or equivalent. Subjects who have had prior exposure to hydroxyurea (eg, Hydrea) in the past may be enrolled into the study as long as it has not been administered within 14 days prior to the start of fedratinib treatment 10. Subject has received ruxolitinib within 14 days prior to the start of fedratinib 11. Subject on treatment with myeloid growth factor (eg, granulocyte-colony stimulating factor [G-CSF]) within 14 days prior to the start of fedratinib treatment 12. Subject with previous exposure to Janus kinase (JAK) inhibitor(s) for more than 1 cycle other than ruxolitinib treatment 13. Subject on treatment with aspirin with doses > 150 mg daily 14. Subject with major surgery within 28 days before starting fedratinib treatment 15. Subject with diagnosis of chronic liver disease (eg, chronic alcoholic liver disease, autoimmune hepatitis, sclerosing cholangitis, primary biliary cirrhosis, hemochromatosis, non-alcoholic steatohepatitis) 16. Subject with prior malignancy other than the disease under study unless the subject has not required treatment for the malignancy for at least 3 years prior to enrollment. However, subject with the following history/concurrent conditions provided successfully treated may enroll: non-invasive skin cancer, in situ cervical cancer, carcinoma in situ of the breast, incidental histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis [TNM] clinical staging system), or is free of disease and on hormonal treatment only 17. Subject with uncontrolled congestive heart failure (New York Heart Association Classification 3 or 4) 18. Subject with known human immunodeficiency virus (HIV), known active infectious Hepatitis B (HepB), and/or known active infectious Hepatitis C (HepC) 19. Subject with serious active infection 20. Subject with presence of any significant gastric or other disorder that would inhibit absorption of oral medication 21. Subject is unable to swallow capsule 22. Subject has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study 23. Subject has any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study 24. Subject has any condition that confounds the ability to interpret data from the study 25. Subject with participation in any study of an investigational agent (drug, biologic, device) within 30 days prior to start of fedratinib treatment 26. Subject with life expectancy of less than 6 months. Sub- Study Exclusion Criteria 1. Subject with anemia from causes other than MPN-associated MF or JAK2 inhibitor therapy (eg, iron deficiency, vitamin B12 and/or folate deficiencies, autoimmune or hemolytic anemia, infection, or any type of known clinically significant bleeding or sequestration). 2. Subject with any of the following laboratory abnormalities at SC1D1: 1. Neutrophils < 1 x 10^9/L 2. White blood count (WBC) > 100 x 10^9/L 3. Platelets < 50 x 10^9/L or > 1000 x 10^9/L 4. Peripheral blood myeloblasts > 5%. 5. Estimated glomerular filtration rate < 40 mL/min/1.73 m^2 (via the 4-variable modification of diet in renal disease [MDRD] formula) 6. Aspartate aminotransferase (AST) or alanine transaminase (ALT) > 3.0 x upper limit of normal (ULN) 7. Direct bilirubin ≥ 2 x ULN (higher levels are acceptable if these can be attributed to active red blood cell precursor destruction within the bone marrow (ie, ineffective erythropoiesis)) 3. Subject with diastolic blood pressure ≥ 90 mmHg or systolic blood pressure ≥ 140 mmHg before SC1D1 despite appropriate treatment. 4. Subject with prior malignancy other than the disease under study unless the subject has not required treatment for the malignancy for at least 3 years prior to enrollment. However, subject with the following history/concurrent conditions is allowed: 1. Basal or squamous cell carcinoma of the skin 2. Carcinoma in situ of the cervix 3. Carcinoma in situ of the breast 4. Incidental histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis [TNM] clinical staging system) 5. Subject with stroke, deep venous thrombosis, pulmonary or arterial embolism within 6 months immediately up to SC1D1. 6. Subject with major surgery within 2 months up to the enrollment date. Subject must have completely recovered from any previous surgery immediately up to the enrollment date. 7. Subject with inadequately controlled heart disease and/or have a known left ventricular ejection fraction < 35%. 8. Subject with uncontrolled systemic fungal, bacterial, or viral infection (defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics, antiviral therapy, and/or other treatment). 9. Subject with prior therapy of luspatercept or sotatercept. 10. Subject with history of severe allergic or anaphylactic reactions or hypersensitivity to recombinant proteins or excipients in the investigational products (see luspatercept IB). 11. Subject with a major bleeding event (defined as symptomatic bleeding in a critical area or organ and/or bleeding causing a decrease in Hgb of ≥ 2 g/dL or leading to transfusion of ≥ 2 units of packed red cells) in the last 6 months prior to enrollment. 12. Subject use of erythropoietin-stimulating agents (ESA) ≤ 56 days prior to SC1D1.

Contacts and Locations

Contacts

Contact: Daniel Aversa, MS 908.499.9666 daversa@celgene.com

Locations

United States, Colorado
University of Colorado Cancer Center
Aurora

United States, Florida
Baptist Health - Miami Cardiac & Vascular Institute
Miami

United States, Georgia
Augusta University - Georgia Cancer Center
Augusta

United States, Illinois
Rush University Medical Center - University Cardiovascular Surgeons
Chicago

United States, Illinois
The University of Chicago Medical Center - Duchossois Center for Advanced Medicine
Chicago

United States, Illinois
Advocate Medical Group
Park Ridge

United States, Kansas
University of Kansas Medical Center
Kansas City

United States, Maryland
St. Agnes - Medical Center
Baltimore

United States, Maryland
Center for Cancer and Blood Disorders, P.C.
Bethesda

United States, Maryland
Maryland Oncology Hematology PA
Columbia

United States, Michigan
University of Michigan Comprehensive Cancer Center
Ann Arbor

United States, Missouri
Washington Univ School of Medicine
Saint Louis

United States, New Jersey
Newark Beth Israel Medical Center
Newark

United States, New York
Brookdale University Hospital and Medical Center
Brooklyn

United States, New York
Icahn School of Medicine at Mount Sinai
New York

United States, New York
Columbia University Medical Center
New York

United States, New York
SUNY Upstate Medical University
Syracuse

United States, North Carolina
North Carolina Women's Hospital
Chapel Hill

United States, North Carolina
Duke University Medical Center
Durham

United States, Ohio
UC Health Barrett Cancer Center
Cincinnati

United States, Pennsylvania
Western Pennsylvania Cancer Institute
Pittsburgh

United States, South Dakota
Avera Cancer Institute
Sioux Falls

United States, Texas
UT Southwestern Medical Center Simmons Comprehensive Cancer Center
Dallas

United States, Texas
Texas Oncology- Fort Worth Cancer Center
Fort Worth

United States, Texas
The University of Texas MD Anderson Cancer Center
Houston

United States, Texas
UT Health - San Antonio
San Antonio

United States, Washington
Fred Hutchinson Cancer Research Center
Seattle

United States, Wisconsin
University of Wisconsin Medical School
Madison

Canada, British Columbia
Providence Hematology
Vancouver

Canada, Ontario
London Health Sciences Centre
London

Canada, Ontario
Ottawa Hospital
Ottawa

Canada, Ontario
Princess Margaret Hospital University Health Network
Toronto

Canada, Quebec
Hopital Maisonneuve-Rosemont
Montreal

Canada, Quebec
Jewish General Hospital
Montreal

Canada, Quebec
CIUSSS de l'Estrie - CHUS
Sherbrooke

Sponsors and Collaborators

Celgene

Impact Biomedicines, Inc., a wholly owned subsidiary of Celgene Corporation

Investigators

Study Director: Shelo Rose, MD Celgene

More Information

  • Responsible Party: Celgene
  • ClinicalTrials.gov Identifier: NCT03755518 History of Changes
  • Other Study ID Numbers: FEDR-MF-001, U1111-1223-2862, 2018-002237-38
  • First Posted: November 28, 2018 Key Record Dates
  • Last Update Posted: August 23, 2021
  • Last Verified: August 2021
  • Studies a U.S. FDA-regulated Drug Product: Yes
  • Studies a U.S. FDA-regulated Device Product: No
  • Keywords provided by Celgene: Myelofibrosis (MF)
    Primary Myelofibrosis (PMF)
    Post-Polycythemia vera (Post-PV)
    Post-essential thrombocythemia (Post-ET)
    Myeloproliferative neoplasms (MPN)
  • Additional relevant MeSH terms: Polycythemia Vera
    Primary Myelofibrosis
    Polycythemia
    Thrombocytosis
    Thrombocythemia, Essential