A Study to Evaluate the Efficacy and Safety of Vismodegib in Combination With Ruxolitinib for the Treatment of Intermediate- or High-Risk Myelofibrosis (MF)
- Registration Number
- NCT02593760
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This multicenter, randomized, double-blind, placebo-controlled study will evaluate the efficacy and safety of vismodegib plus (+) ruxolitinib versus placebo + ruxolitinib in participants with intermediate- or high-risk MF. The study will be divided into 2 components. The Phase Ib portion of the study consists of participants receiving open-label vismodegib (150 milligrams \[mg\] orally \[PO\] once daily \[QD\]) + ruxolitinib (PO twice daily \[BID\]). A safety assessment will be performed after the first 10 participants have been treated for 6 weeks. An analysis for efficacy and safety is planned in the first 10 participants at Week 24. There will be a hold on participant screening and enrollment during this assessment. Another 10 participants may be enrolled, thereafter, to further assess efficacy and safety (at Week 24) before the initiation of the Phase III randomization portion of the study. Similarly, there will be another hold on participant screening and enrollment during this assessment. The participants enrolled in the Phase Ib portion of the study will continue to receive vismodegib (150 mg PO QD) + ruxolitinib (PO BID) for up to 48 weeks, if clinical benefit is observed after 24 weeks. The Phase III randomized, double-blind portion of the study will enroll approximately 84 participants. Participants will be randomly assigned in a 1:1 ratio (double blind) to receive either vismodegib (150 mg PO QD) + ruxolitinib (PO BID) or placebo (PO QD) + ruxolitinib (PO BID) for up to 48 weeks.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 10
- Pathologically confirmed diagnosis of primary MF, post-polycythemia vera MF, or post-essential thrombocythemia MF, according to the 2008 revised World Health Organization criteria
- Intermediate-1, intermediate-2, or high-risk according to the IWG-MRT Dynamic International Prognostic Scoring System
- Life expectancy >= 6 months
- Peripheral blood blast count of less than (<) 10%
- Palpable splenomegaly of greater than (>) 5 centimeters (cm) below the left costal margin
- Eastern Cooperative Oncology Group performance status of 0 to 2
- Adequate hepatic and renal function
- Prior treatment with a Hedgehog or Janus kinase pathway inhibitor
- Treatment with strong cytochrome P450 3A4 inhibitors/inducers within 28 days prior to Day 1
- Prior therapy for the treatment of intermediate- or high-risk MF including chemotherapy, interferon, thalidomide, busulfan, lenalidomide, anagrelide, or androgens within 28 days prior to Day 1
- Prior splenectomy or splenic irradiation
- Inadequate bone marrow reserve
- Participants with any history of platelet counts of < 50,000/mccL or ANC of < 500/mL, except during treatment for myeloproliferative neoplasm or treatment with cytotoxic therapy for any other reason
- Planned allogeneic bone marrow transplant during the study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo + Ruxolitinib Placebo Participants will receive placebo (PO QD) in combination with ruxolitinib (dose will depend on the participant's baseline platelet count) for up to 48 weeks. Placebo + Ruxolitinib Ruxolitinib Participants will receive placebo (PO QD) in combination with ruxolitinib (dose will depend on the participant's baseline platelet count) for up to 48 weeks. Vismodegib + Ruxolitinib Vismodegib Participants will receive vismodegib (150 mg PO QD) in combination with ruxolitinib (dose will depend on the participant's baseline platelet count) for up to 48 weeks. Vismodegib + Ruxolitinib Ruxolitinib Participants will receive vismodegib (150 mg PO QD) in combination with ruxolitinib (dose will depend on the participant's baseline platelet count) for up to 48 weeks.
- Primary Outcome Measures
Name Time Method Percentage of Participants who Achieve a Greater Than or Equal to (>=) 35% Reduction in Spleen Volume from Baseline at Week 24 Week 24 Determined by an Independent Review Committee (IRC) Using International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) Revised Response Criteria
Percentage of Participants with Complete Remission (CR) and Partial Remission (PR) at Week 24, as Determined by an IRC Using IWG-MRT Revised Response Criteria Week 24
- Secondary Outcome Measures
Name Time Method Percentage of Participants with Adverse Events (AEs) Baseline up to Month 48 Plasma Vismodegib Concentration at Steady State Predose (0 hour) on Weeks 6, 12, 24, 36, and 48 Unbound Vismodegib Concentration at Steady State Predose (0 hour) on Weeks 6, 12, 24, 36, and 48 Alpha 1-Acid Glycoprotein Concentration at Steady State Predose (0 hour) on Weeks 6, 12, 24, 36, and 48 Percentage of Participants who Achieve a >= 35% Reduction in Spleen Volume from Baseline, as Determined by an IRC Using IWG-MRT Revised Response Criteria at Week 48 Baseline, Week 48 Percentage of Participants who Achieve a >= 35% Reduction in Spleen Volume from Baseline, as Determined by an Investigator at Weeks 24 and 48 Baseline, Weeks 24 and 48 Percentage of Participants with CR and PR, as Determined by an IRC Using IWG-MRT Revised Response Criteria at Week 48 Week 48 Percentage of Participants with CR and PR, as Determined by an Investigator at Weeks 24 and 48 Weeks 24 and 48 Percentage of Participants with Overall Response Rate (CR, PR, and Clinical Improvement) at Weeks 24 and 48, as Determined by an IRC Using IWG-MRT Revised Response Criteria Weeks 24 and 48 Percentage of Participants with Overall Response Rate (CR, PR, and Clinical Improvement) at Weeks 24 and 48, as Determined by the Investigator Using IWG-MRT Revised Response Criteria Weeks 24 and 48 Percentage of Participants who Achieve Anemia Response at Weeks 24 and 48, as Determined by the Investigator Using IWG-MRT Revised Response Criteria Weeks 24 and 48 Percentage of Participants with Symptom Response (Participants who Achieve a >= 50% Reduction from Baseline in the Myeloproliferative Neoplasm Symptom Assessment Form [MPN-SAF] Total Symptom Score [TSS]) Baseline, Weeks 24 and 48 Duration of Response, as Determined by the Investigator and an IRC Using IWG-MRT Revised Response Criteria or Death from Any Cause During the Study Baseline up to 28 days after the last dose of study drug (52 weeks) Percentage of Participants with Improvement from Baseline in Bone Marrow Fibrosis at Weeks 24 and 48, as Determined by the Investigator Using the European Consensus Grading System Baseline, Weeks 24 and 48 Percentage of Participants with Improvement from Baseline in Bone Marrow Fibrosis at Weeks 24 and 48, as Determined by Independent Pathology Review Using the European Consensus Grading System Baseline, Weeks 24 and 48 Progression-Free Survival Baseline up to the end of the study (up to 1 year after completing 48 weeks of treatment by the last participant) Percentage of Participants who Achieve a >= 50% Reduction in Fatigue from Baseline to Weeks 24 and 48 as Measured by MPN-SAF TSS Baseline, Weeks 24 and 48 Percentage of Participants who Achieve a >= 50% Reduction in Other Symptom and Impact Item Scores from Baseline to Weeks 24 and 48, as Measured by the MPN-SAF Baseline, Weeks 24 and 48 Percentage of Participants who Achieve a Meaningful Improvement on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Scale Scores from Baseline to Weeks 24 and 48 Baseline, Weeks 24 and 48 Meaningful improvement is defined as a 10-point change.
Overall Survival Baseline up to the end of the study (up to 1 year after completing 48 weeks treatment by the last participant)
Trial Locations
- Locations (13)
Florida Cancer Specialists
🇺🇸West Palm Beach, Florida, United States
Oncology Hematology Care Inc
🇺🇸Cincinnati, Ohio, United States
Florida Cancer Specialists-Broadway, Fort Myers
🇺🇸Fort Myers, Florida, United States
A.O.U. Citta' Della Salute E Della Scienza-P.O. Molinette;S.C. Ematologia
🇮🇹Torino, Piemonte, Italy
Uniklinik RWTH Aachen; Med. Klinik IV; Klinik für Hämatologie, Onkologie, Hämostaseologie und Stammz
🇩🇪Aachen, Germany
Sarah Cannon Research Institute
🇺🇸Nashville, Tennessee, United States
Az. Osp. Di Careggi; Divisione Di Ematologia
🇮🇹Firenze, Toscana, Italy
Tom Baker Cancer Centre-Calgary; Clinical Research Unit
🇨🇦Calgary, Alberta, Canada
Florida Cancer Specialist, North Region
🇺🇸Saint Petersburg, Florida, United States
Queen Elizabeth II Health Sciences Centre; Oncology
🇨🇦Halifax, Nova Scotia, Canada
Campus Virchow-Klinikum Charité Centrum 14; Medizinische Klinik m.S. Hämatologie u. Onkologie
🇩🇪Berlin, Germany
Centre Hospitalier De L'Universite De Montreal, Hopital Notre-Dame
🇨🇦Montreal, Quebec, Canada
Uni of Texas - Md Anderson Cancer Center; Dept of Leukemia
🇺🇸Houston, Texas, United States