E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, or Post-Essential Thrombocythemia Myelofibrosis |
|
E.1.1.1 | Medical condition in easily understood language |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10028537 |
E.1.2 | Term | Myelofibrosis |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare the efficacy of pacritinib with that of best available therapy (BAT) in patients with primary myelofibrosis (PMF), post-polycythemia vera myelofibrosis (PPV-MF), or post-essential thromocythemia myelofibrosis (PET-MF). The efficacy measure for this analysis is the proportion of patients achieving a ≥ 35% reduction in spleen volume from baseline to Week 24, as measured by magnetic resonance imaging (MRI) or computed tomography (CT) scan. |
|
E.2.2 | Secondary objectives of the trial |
The key secondary objective is the proportion of patients with ≥ 50% reduction in total symptom score from baseline to Week 24 on the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF TSS 2.0).
Other secondary objectives are to compare pacritinib with BAT with respect to:
- Proportion of patients with baseline platelet count < 100,000/μL achieving ≥ 35% reduction in spleen volume from baseline to Week 24 as measured by MRI or CT scan
- Proportion of patients with baseline platelet count < 100,000/μL achieving ≥ 50% reduction in TSS from baseline to Week 24
- Proportion of patients with baseline platelet count < 50,000/μL achieving ≥ 35% reduction in spleen volume from baseline to Week 24 as measured by MRI or CT scan
- Proportion of patients with baseline platelet count < 50,000/μL achieving ≥ 50% reduction in TSS from baseline to Week 24 |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1). Intermediate -1 or -2 or high-risk (Passamonti et al 2010) PMF, PPV-MF, or PET-MF (Tefferi and Vardiman 2008; Barosi et al 2008)
2). Palpable splenomegaly ≥ 5 cm below lower costal margin (LCM) in midclavicular line by physical examination
3). Total Symptom Score (TSS) ≥ 13 on the MPN-SAF TSS 2.0, not including the inactivity question
4). Eligible to receive a medically appropriate BAT therapy, taking into account all contraindications and precautions of available BAT therapy options
5). In the judgement of the investigator, patient is not a candidate for treatment with ruxolitinib due to medical reasons
6). Age ≥ 18 years old
7). Eastern Cooperative Oncology Group (ECOG) performance status 0-3
8). Peripheral blast count < 10%
9). Absolute neutrophil count > 500/μL
10). Patients who are platelet or red blood cell transfusion-dependent are eligible
11). Adequate liver and renal function, defined by liver transaminases (AST/SGOT and ALT/SGPT) ≤ 3 × ULN (AST/ALT ≤ 5 × ULN if transaminase elevation is related to MF), total bilirubin ≤ 1.5 x ULN (≤ 3 x ULN if due to Gilbert disease or low-grade hemolysis), and creatinine ≤ 2.5 mg/dL
12). At least 6 months from prior splenic irradiation
13). At least 12 months from prior 32P therapy
14). At least 1 week since prior treatment (most recent dose) with a potent CYP3A4 inhibitor
15). At least 4 weeks since any experimental treatment for PMF, PPV-MF, or PET-MF
16). At least 2 weeks since any treatment for PMF, PPV-MF, or PET-MF
17). If fertile, willing to use effective birth control methods during the study. Women of childbearing potential must use highly effective methods (defined as those resulting in a failure rate of <1% per year when used consistently and correctly) for the duration of study treatment and for 12 months after last dose of study drug. The contraceptive methods that are considered highly effective are intrauterine devices and hormonal contraceptives (contraceptive pills, implants, transdermal patches, hormonal vaginal devices, or injections with prolonged release). Males must use a condom for the duration of the study and for 90 days after the last dose of study treatment. When abstinence is used as a method of birth control, only true abstinence is acceptable, when this is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (calendar, ovulation, symptothermal, and post-ovulation methods) and withdrawal are not acceptable methods of contraception.
18). Willing to undergo and able to tolerate frequent MRI or CT assessments on study
19). Able to understand and willing to complete symptom assessments using a patient reported outcomes instrument
20). Able to understand and willing to sign the Informed Consent Form |
|
E.4 | Principal exclusion criteria |
1). Any gastrointestinal (GI) or metabolic condition that could interfere with absorption of oral medication
2). Life expectancy < 6 months
3). Prior treatment with a JAK2 inhibitor
4). Completed allogeneic stem cell transplantation (ASCT) or eligible for and willing to complete ASCT
5). History of splenectomy or planning to undergo splenectomy
6). Uncontrolled intercurrent illness, including but not limited to ongoing active infection or psychiatric illness or social situation that the treating physician judges would limit compliance with study requirements
7). Other malignancy within last 3 years other than curatively treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, organ-confined or treated nonmetastatic prostate cancer with negative prostate-specific antigen, in situ breast carcinoma after complete surgical resection, or superficial transitional cell bladder carcinoma
8). Inflammatory or chronic functional bowel disorder such as Crohn disease, inflammatory bowel disease, chronic diarrhea, or constipation
9). Clinically symptomatic and uncontrolled cardiovascular disease
10). History of any of the following, within 6 months prior to randomization: myocardial infarction, severe/unstable angina, or symptomatic congestive heart failure
11). New York Heart Association Class II, III, or IV congestive heart failure
12). Patients with National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (version 4) grade 2 cardiac arrhythmias may be considered for inclusion, with the approval of the medical monitor, if the arrhythmias are stable, asymptomatic and unlikely to affect patient safety. Patients will be excluded if they have ongoing cardiac dysrhythmias of CTCAE grade ≥3, corrected QT interval (QTc) prolongation > 450 ms or other factors that increase the risk for QT prolongation (eg, heart failure, hypokalemia [defined as serum potassium < 3.0 mEq/L that is persistant and refractory to correction], or family history of long QT interval syndrome)
13). Erythropoietic agent within 28 days prior to randomization
14). Thrombopoietic agent within 14 days prior to randomization
15). Known seropositivity for human immunodeficiency virus (HIV)
16). Known active hepatitis A, B, or C virus infection
17). Women who are pregnant or lactating |
|
E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint for measurement of efficacy is the proportion of patients achieving a ≥ 35% reduction in spleen volume from baseline to Week 24, as measured by magnetic resonance imaging (MRI) or computed tomography (CT) scan. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
MRI or CT assessments: Screening and Wk 24 (exploratory evaluation only at weeks 12, 36, 48 and every 12 weeks) |
|
E.5.2 | Secondary end point(s) |
The secondary efficacy endpoint is the proportion of patients with ≥ 50% reduction in total symptom score (TSS) from baseline to Week 24 as measured by the Myleloproliferative Neoplasm Symptom Assessment Form (MPN-SAF TSS 2.0). |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Patients will complete the MPN-SAF TSS 2.0 daily for 7 to 10 consecutive days prior to start of study treatment and then daily from Day 1 through Week 48, or until patient discontinues study treatment, whichever occurs first. |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
|
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | Yes |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Open study as Investigator and patients unblinded, but central data review and Sponsor is blinded. |
|
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
|
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 9 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 57 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Belgium |
Czech Republic |
France |
Germany |
Hungary |
Italy |
Netherlands |
New Zealand |
Russian Federation |
United Kingdom |
United States |
|
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The end of trial will be on completion of survival follow-up. This will continue until 3 years past Week 24 or 3 years past early termination of study treatment, whichever occurs first. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |