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Open Label Ruxolitinib (INCB018424) in Patients With Myelofibrosis and Post Polycythemia Vera/Essential Thrombocythemia Myelofibrosis

Primary Purpose

Myelofibrosis, Polycythemia Vera, Thrombocytosis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ruxolitinib
Sponsored by
Incyte Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelofibrosis

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosed with PMF or Post-PV/ET MF
  • Patients with myelofibrosis requiring therapy
  • Adequate bone marrow reserve

Exclusion Criteria:

  • Received anti-cancer medications or investigational therapy in the past 14 days

Sites / Locations

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ruxolitinib

Arm Description

All participants received oral ruxolitinib. Patients began treatment with either 10 mg twice a day (bid), 15 mg bid, 25 mg bid, 50 mg bid, 25 mg once a day (qd), 50 mg qd, 100 mg qd, or 200 mg qd, depending on the time period when they entered the study. The doses were titrated based on efficacy and safety to a maximum of 25 mg bid for patients who entered the study after sufficient dosing information had been obtained to define the maximum dose for patients in the study. Patients could continue receiving treatment indefinitely if receiving benefit at a dose that continues to maintain benefit but does not exceed a maximum dose of 25 mg BID.

Outcomes

Primary Outcome Measures

Number of Participants With Adverse Events (AEs)
Treatment-Emergent AEs are events occurring after first drug administration or worsened from baseline. Treatment-Related AEs are those with a definite, probable, possible or missing causality. A serious AE is a medical occurrence that results in death, is life-threatening, requires inpatient hospitalization or prolongation of hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is a medical event requiring intervention to prevent 1 of the above. A severe or life-threatening AE is based on intensity, according to National Cancer Institute-Common Toxicity Criteria for Adverse Effects (NCI-CTCAE) v3.0.
Percentage of Participants With Clinical Improvement (CI) Over Time
Clinical improvement was defined according to the International Working Group Myelofibrosis Research and Treatment criteria, and required 1 of the following: A ≥ 2 g/dL increase in Hemoglobin level or becoming transfusion independent; Either a ≥ 50% reduction in palpable splenomegaly if spleen was ≥ 10 cm at Baseline or a spleen palpable at > 5 cm at Baseline becomes not palpable; A ≥ 100% increase in platelet count and an absolute platelet count of ≥ 50,000 x 10^9/L or A ≥ 100% increase in absolute neutrophil count (ANC) and an ANC of ≥ 0.5 x 10^9/L.

Secondary Outcome Measures

Percentage of Participants Achieving ≥ 50% Reduction From Baseline in Spleen Palpation Length Over Time
For each visit, patients who had a missing value at the visit, dropped out of the study due to any reasons prior to the visit or had non-palpable spleen at baseline and then became palpable at the time of the visit were all considered as having not achieved the ≥ 50% reduction in spleen palpation length.
Percentage of Participants With ≥ 35% Reduction From Baseline in Spleen Volume Over Time
Spleen volume was assessed in a subgroup of 27 patients using magnetic resonance imaging (MRI) scans (or computed tomography (CT) scans in patients who were not candidates for MRI) of the abdomen in order to allow objective measurement of spleen volume using standard estimation techniques. For each visit, patients who had a missing value at the visit or dropped out of the study due to any reason prior to the visit were considered as not having achieved the ≥35% reduction in spleen volume.
Change From Baseline in Myelofibrosis Total Symptom Score at Week 24
Symptoms of myelofibrosis were assessed using a modified Myelofibrosis Symptom Assessment Form (MFSAF). Abdominal discomfort, itching, muscle or bone pain, and night sweats are prominent and troubling symptoms in patients with MF. Therefore, the MFSAF-derived responses for these symptoms were analyzed as a total symptom score. Each symptom was assessed on a scale from 0 (absent), 1 (most favorable) to 10 (worst). The total symptom score is a sum of the individual scores and ranges from 0-40. A higher score indicates worse symptoms hence a negative change from baseline indicates improvement.
Change From Baseline to Week 24 in Health-Related Quality of Life
Health-related Quality of Life was assessed using the Global Health Status/Quality of Life Scale of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This scale ranges from 0 to 100, with higher scores indicating higher quality of life.
Change From Baseline in Body Weight Over Time
Change From Baseline to Week 24 in Eastern Cooperative Oncology Group (ECOG) Performance Status
The ECOG performance status measures patients' functional status on the following scale: 0=Fully active, no restrictions; 1=Restricted in physically strenuous activity but ambulatory, able to carry out light work; 2=Ambulatory and capable of all selfcare, unable to carry out any work activities; Up and about > 50% of waking hours; 3=Limited selfcare, confined to bed or chair more than 50% of waking hours; 4=Completely disabled. Totally confined to bed or chair; 5=Dead. Data reported indicate the number of participants with a change from Baseline score of -2, -1, 0 and 1.

Full Information

First Posted
July 30, 2007
Last Updated
February 13, 2018
Sponsor
Incyte Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT00509899
Brief Title
Open Label Ruxolitinib (INCB018424) in Patients With Myelofibrosis and Post Polycythemia Vera/Essential Thrombocythemia Myelofibrosis
Official Title
A Phase 1/2, Open-Label Study of the JAK2 Inhibitor INCB018424 Administered Orally to Patients With Primary Myelofibrosis (PMF) and Post Polycythemia Vera/Essential Thrombocythemia Myelofibrosis (Post-PV/ET)
Study Type
Interventional

2. Study Status

Record Verification Date
February 2018
Overall Recruitment Status
Completed
Study Start Date
June 2007 (undefined)
Primary Completion Date
December 2007 (Actual)
Study Completion Date
February 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Incyte Corporation

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
To determine the safety, tolerability and effectiveness of ruxolitinib (INCB018424), administered orally to patients with Primary Myelofibrosis (PMF), Post Polycythemia Vera Myelofibrosis (PPV-MF) and Essential Thrombocythemia Myelofibrosis (PET-MF).
Detailed Description
This is a multicenter, open-label, non-randomized, dose escalation study of ruxolitinib, a small molecule Janus kinase (JAK) inhibitor, administered orally to patients with PMF, PPEV-MF or PET-MF. The study is comprised of 3 parts: Part 1: Dose escalation and determination of maximum tolerated dose (complete). Part 2: Exploration of alternative dosing schedules (complete). Part 3: Further evaluation of selected dose regimens, including additional response measures to explore effect of ruxolitinib on symptoms and other parameters including daily physical activity and long-term survival (ongoing).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelofibrosis, Polycythemia Vera, Thrombocytosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
154 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ruxolitinib
Arm Type
Experimental
Arm Description
All participants received oral ruxolitinib. Patients began treatment with either 10 mg twice a day (bid), 15 mg bid, 25 mg bid, 50 mg bid, 25 mg once a day (qd), 50 mg qd, 100 mg qd, or 200 mg qd, depending on the time period when they entered the study. The doses were titrated based on efficacy and safety to a maximum of 25 mg bid for patients who entered the study after sufficient dosing information had been obtained to define the maximum dose for patients in the study. Patients could continue receiving treatment indefinitely if receiving benefit at a dose that continues to maintain benefit but does not exceed a maximum dose of 25 mg BID.
Intervention Type
Drug
Intervention Name(s)
Ruxolitinib
Other Intervention Name(s)
INCB018424, Jakafi(TM)
Intervention Description
5 and 25 mg tablets with a daily dosing range from 10 to 200 mg qd or bid.
Primary Outcome Measure Information:
Title
Number of Participants With Adverse Events (AEs)
Description
Treatment-Emergent AEs are events occurring after first drug administration or worsened from baseline. Treatment-Related AEs are those with a definite, probable, possible or missing causality. A serious AE is a medical occurrence that results in death, is life-threatening, requires inpatient hospitalization or prolongation of hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is a medical event requiring intervention to prevent 1 of the above. A severe or life-threatening AE is based on intensity, according to National Cancer Institute-Common Toxicity Criteria for Adverse Effects (NCI-CTCAE) v3.0.
Time Frame
From Baseline to the interim clinical cut-off date (31 December 2009). The median time on study was 14.8 months, with a range of 26 days to 29.7 months. As of March 1, 2011 the total exposure to ruxolitinib was 269 patient-years.
Title
Percentage of Participants With Clinical Improvement (CI) Over Time
Description
Clinical improvement was defined according to the International Working Group Myelofibrosis Research and Treatment criteria, and required 1 of the following: A ≥ 2 g/dL increase in Hemoglobin level or becoming transfusion independent; Either a ≥ 50% reduction in palpable splenomegaly if spleen was ≥ 10 cm at Baseline or a spleen palpable at > 5 cm at Baseline becomes not palpable; A ≥ 100% increase in platelet count and an absolute platelet count of ≥ 50,000 x 10^9/L or A ≥ 100% increase in absolute neutrophil count (ANC) and an ANC of ≥ 0.5 x 10^9/L.
Time Frame
Week 12, 24, 36, 48 and 60
Secondary Outcome Measure Information:
Title
Percentage of Participants Achieving ≥ 50% Reduction From Baseline in Spleen Palpation Length Over Time
Description
For each visit, patients who had a missing value at the visit, dropped out of the study due to any reasons prior to the visit or had non-palpable spleen at baseline and then became palpable at the time of the visit were all considered as having not achieved the ≥ 50% reduction in spleen palpation length.
Time Frame
Baseline and Weeks 4, 8, 12, 24, 36, 48 and 60
Title
Percentage of Participants With ≥ 35% Reduction From Baseline in Spleen Volume Over Time
Description
Spleen volume was assessed in a subgroup of 27 patients using magnetic resonance imaging (MRI) scans (or computed tomography (CT) scans in patients who were not candidates for MRI) of the abdomen in order to allow objective measurement of spleen volume using standard estimation techniques. For each visit, patients who had a missing value at the visit or dropped out of the study due to any reason prior to the visit were considered as not having achieved the ≥35% reduction in spleen volume.
Time Frame
Baseline, Weeks 4, 12, 24 and 48
Title
Change From Baseline in Myelofibrosis Total Symptom Score at Week 24
Description
Symptoms of myelofibrosis were assessed using a modified Myelofibrosis Symptom Assessment Form (MFSAF). Abdominal discomfort, itching, muscle or bone pain, and night sweats are prominent and troubling symptoms in patients with MF. Therefore, the MFSAF-derived responses for these symptoms were analyzed as a total symptom score. Each symptom was assessed on a scale from 0 (absent), 1 (most favorable) to 10 (worst). The total symptom score is a sum of the individual scores and ranges from 0-40. A higher score indicates worse symptoms hence a negative change from baseline indicates improvement.
Time Frame
Baseline and Week 24
Title
Change From Baseline to Week 24 in Health-Related Quality of Life
Description
Health-related Quality of Life was assessed using the Global Health Status/Quality of Life Scale of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This scale ranges from 0 to 100, with higher scores indicating higher quality of life.
Time Frame
Baseline and Week 24
Title
Change From Baseline in Body Weight Over Time
Time Frame
Baseline and Weeks 4, 8, 12, 24, 36, 48 and 60.
Title
Change From Baseline to Week 24 in Eastern Cooperative Oncology Group (ECOG) Performance Status
Description
The ECOG performance status measures patients' functional status on the following scale: 0=Fully active, no restrictions; 1=Restricted in physically strenuous activity but ambulatory, able to carry out light work; 2=Ambulatory and capable of all selfcare, unable to carry out any work activities; Up and about > 50% of waking hours; 3=Limited selfcare, confined to bed or chair more than 50% of waking hours; 4=Completely disabled. Totally confined to bed or chair; 5=Dead. Data reported indicate the number of participants with a change from Baseline score of -2, -1, 0 and 1.
Time Frame
Baseline and Week 24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed with PMF or Post-PV/ET MF Patients with myelofibrosis requiring therapy Adequate bone marrow reserve Exclusion Criteria: Received anti-cancer medications or investigational therapy in the past 14 days
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Srdan Verstovsek, MD, PhD
Organizational Affiliation
M.D. Anderson Cancer Center, Houston, TX
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ayalew Tefferi, MD
Organizational Affiliation
Mayo Clinic, Rochester, MN
Official's Role
Principal Investigator
Facility Information:
City
Rochester
State/Province
Minnesota
Country
United States
City
Houston
State/Province
Texas
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20843246
Citation
Verstovsek S, Kantarjian H, Mesa RA, Pardanani AD, Cortes-Franco J, Thomas DA, Estrov Z, Fridman JS, Bradley EC, Erickson-Viitanen S, Vaddi K, Levy R, Tefferi A. Safety and efficacy of INCB018424, a JAK1 and JAK2 inhibitor, in myelofibrosis. N Engl J Med. 2010 Sep 16;363(12):1117-27. doi: 10.1056/NEJMoa1002028.
Results Reference
result
PubMed Identifier
22718840
Citation
Verstovsek S, Kantarjian HM, Estrov Z, Cortes JE, Thomas DA, Kadia T, Pierce S, Jabbour E, Borthakur G, Rumi E, Pungolino E, Morra E, Caramazza D, Cazzola M, Passamonti F. Long-term outcomes of 107 patients with myelofibrosis receiving JAK1/JAK2 inhibitor ruxolitinib: survival advantage in comparison to matched historical controls. Blood. 2012 Aug 9;120(6):1202-9. doi: 10.1182/blood-2012-02-414631. Epub 2012 Jun 20.
Results Reference
result
PubMed Identifier
29544547
Citation
Kvasnicka HM, Thiele J, Bueso-Ramos CE, Sun W, Cortes J, Kantarjian HM, Verstovsek S. Long-term effects of ruxolitinib versus best available therapy on bone marrow fibrosis in patients with myelofibrosis. J Hematol Oncol. 2018 Mar 15;11(1):42. doi: 10.1186/s13045-018-0585-5.
Results Reference
derived

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Open Label Ruxolitinib (INCB018424) in Patients With Myelofibrosis and Post Polycythemia Vera/Essential Thrombocythemia Myelofibrosis

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