A phase 2 trial published in The New England Journal of Medicine indicates that ponsegromab (PF-06946860), a GDF-15 inhibitor, has shown efficacy in alleviating cancer cachexia symptoms. The study demonstrated that ponsegromab led to increased weight gain and activity levels, while reducing cachexia symptoms in cancer patients with elevated GDF-15.
The randomized, double-blind trial (NCT05546476) involved 187 patients with cancer cachexia and a serum GDF-15 level of 1500 pg per mL or higher. Participants were randomly assigned (1:1:1:1) to receive either 100 mg, 200 mg, or 400 mg of ponsegromab or placebo, administered subcutaneously every 4 weeks for 3 doses. The patient population included 40% with non–small cell lung cancer, 32% with pancreatic cancer, and 29% with colorectal cancer.
Weight Gain and Appetite Improvement
The trial's primary endpoint, change in body weight from baseline at 12 weeks, was met with significant improvements across all ponsegromab dose levels compared to placebo. Specifically, the between-group differences for the 100 mg, 200 mg, and 400 mg groups, respectively, versus placebo were 1.22 kg (95% CI, 0.37-2.25; P <.05), 1.92 kg (95% CI, 0.92-2.97; P <.05), and 2.81 kg (95% CI, 1.55-4.08; P <.05). Furthermore, a higher percentage of patients in the 200-mg ponsegromab group (39%) reported no appetite loss at baseline compared to the 400-mg (28%), 100-mg (26%), and placebo (21%) groups.
Functional Assessment and Symptom Scale Improvements
Key secondary endpoints, including changes from baseline in the Functional Assessment of Anorexia Cachexia Treatment–Anorexia Cachexia Subscale (FAACT-ACS) and the FAACT 5-Item Anorexia Symptom Scale (FAACT-5IASS), also showed improvements. Patients in the 100-mg and 400-mg groups experienced increases in FAACT-ACS scores from baseline over placebo, with increases of 4.12 (95% CI, 0.86-7.34) and 4.50 (95% CI, 1.29-7.77), respectively. Similar improvements were observed in the 100-mg and 400-mg groups for the FAACT-5IASS, with increases of 2.20 (95% CI, 0.36-3.99) and 2.39 (95% CI, 0.61-4.15), respectively.
Expert Commentary
"Ponsegromab-mediated inhibition of GDF-15 resulted in a reduction in cachexia symptoms and increases in body weight, appetite, overall activity, and skeletal muscle mass as compared with placebo in patients with cancer cachexia and an elevated circulating GDF-15 level," stated John D. Groarke, MBBCh, MSc, MPH, executive director of Cardiometabolic Clinical Research and Development at Pfizer, and study coinvestigators in the publication. "These findings support the hypothesis that GDF-15 is a primary driver of cachexia and establish this cytokine as a potential therapeutic target for further evaluation in clinical trials."
Safety Profile
The safety profile of ponsegromab was deemed manageable, with any-grade adverse events (AEs) occurring in 70% of the ponsegromab groups compared to 80% in the placebo arm. Serious AEs occurred in 32% and 24% of each respective group, with dose discontinuations occurring in 11% and 13%, respectively. Grade 3 AEs related to treatment with placebo or ponsegromab occurred in 0 patients receiving placebo and 3 patients assigned to ponsegromab.
