Improved transfusion independence rates for momelotinib versus ruxolitinib in anemic JAKi naïve myelofibrosis patients independent of baseline platelet or transfusion status.

Authors

null

Jean-Jacques Kiladjian

Hôpital Saint-Louis & Université de Paris, Paris, France

Jean-Jacques Kiladjian , Uwe Platzbecker , Jiří Mayer , Árpád Illés , Witold Prejzner , Tomasz Woźny , Nikolay Tzvetkov , Alessandro M. Vannucchi , Ilya Kirgner , Zsolt Nagy , Sebastian Grosicki , Åsa Derolf , Mihaela Cornelia Lazaroiu , Sung-Soo Yoon , Yeow Tee Goh , Nikolas von Bubnoff , Srdan Verstovsek , Barbara J. Klencke , Rafe Donahue , Ruben A. Mesa

Organizations

Hôpital Saint-Louis & Université de Paris, Paris, France, University Hospital Leipzig, Leipzig, Germany, Masaryk University Hospital, Brno, Czech Republic, University of Debrecen, Debrecen, Hungary, Department of Hematology and Transplantology Medical University of Gdansk, Gdansk, Poland, Department of Hematology Szpital MSWiA w Poznaniu, Poznan, Poland, UMHAT "Georgi Stranski" EAD, Department Clinic of Hematology, Sofia, Bulgaria, Center Research and Innovation of Myeloproliferative Neoplasms-CRIMM, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy, Division of Hematology Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel, First Department of Internal Medicine, Semmelweis University, Budapest, Hungary, Department of Hematology, Independent Public Healthcare Facility Municipal Hospitals, Katowice, Poland, Department of Medicine, Division of Hematology, Karolinska University Hospital Solna, Karolinska Institutet, Solna, Sweden, Policlinica de Diagnostic Rapid Brasov, Brasov, Romania, Seoul National University, Seoul, South Korea, Singapore General Hospital, Singapore, Singapore, Universitatsklinikum Schleswig Holstein, Campus Lübeck, Lübeck, Germany, The University of Texas MD Anderson Cancer Center, Houston, TX, Sierra Oncology, Inc., Vancouver, BC, Canada, UT Health San Antonio, San Antonio, TX

Research Funding

Pharmaceutical/Biotech Company
Sierra Oncology/Gilead Sciences

Background: Momelotinib (MMB) is a potent JAK1, JAK2 and ACVR1 inhibitor with clinical activity against the hallmark features of myelofibrosis (MF), namely anemia, constitutional symptoms and splenomegaly, across the continuum of JAKi naïve or previously JAKi treated intermediate/high risk MF patients as demonstrated in the previously conducted Phase 3 SIMPLIFY-1 & -2 clinical trials (S1, S2). S1 was conducted in JAKi-naïve patients with MF (n = 432) double-blind randomized 1:1 to MMB or ruxolitinib (RUX). MMB demonstrated a statistically non-inferior splenic response rate (SRR) to RUX at the W24 landmark analysis in S1 but did not meet significance for total symptom score (TSS) response. Low SRR and TSS response was observed for RUX in patients with low platelets, while MMB elicited consistent SRR and TSS response across the platelet subsets, comparable to the response in the ITT. Transfusion independence (TI) at W24 was higher for MMB vs RUX patients across all PLT strata. Methods: Progressive anemia is a common occurrence in MF with nearly all MF patients requiring transfusions as their disease advances. Given the prognostic importance of Hgb and transfusion status in MF patients including evidence that achieving or maintaining transfusion independence by Week 24 with momelotinib is associated with improved OS in S1 and S2, we expanded the previously reported retrospective platelet subset analysis to explore the W24 TI response rates for MMB and RUX randomized patients in S1 by baseline Hgb and PLT levels and transfusion status. Results: The data presented here suggest that the prognostically-important W24 TI rate was substantively higher in anemic patients receiving MMB versus RUX, irrespective of the degree of anemia. MMB is also more effective relative to RUX in achieving or maintaining TI in JAKi naïve patients irrespective of baseline PLT count or baseline transfusion status. Conclusions: Together with data suggesting that TI response at W24 with momelotinib is associated with a survival advantage, these data further support the potential TI benefits of inhibiting ACVR1 in addition to JAK1 and JAK2 with MMB in MF patients. Clinical trial information: NCT01969838, NCT02101268

Baseline Characteristic
MMB W24 TI response

ITT: 67% (143/215)
RUX W24 TI response

ITT: 49% (107/217)
Hgb < 8
29% (8/28)
18% (4/22)
Hgb < 10
47% (40/86)
27% (26/95)
Hgb < 12
62% (99/159)
37% (61/164)
Hgb < 14
67% (136/204)
45% (87/195)
Hgb ≥14
64% (7/11)
91% (20/22)
PLTs < 150
62% (29/47)
43% (24/56)
PLTs < 300
68% (93/136)
48% (62/128)
PLTs ≥300
63% (50/79)
51% (45/89)
Transfusion Independent
81% (119/147)
62% (94/152)
Transfusion Requiring
53% (8/15)
31% (4/13)
Transfusion Dependent
30% (16/53)
17% (9/52)

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Hematologic Malignancies—Leukemia, Myelodysplastic Syndromes, and Allotransplant

Track

Hematologic Malignancies

Sub Track

Myeloproliferative Neoplasms (MPN) and Mast Cell Disorders

Clinical Trial Registration Number

NCT01969838, NCT02101268

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e19039)

DOI

10.1200/JCO.2021.39.15_suppl.e19039

Abstract #

e19039

Abstract Disclosures