Syndax Pharmaceuticals has received FDA approval for Revuforj (revumenib), a first-in-class menin inhibitor, for the treatment of adult and pediatric patients (1 year and older) with relapsed or refractory acute leukemia harboring a KMT2A rearrangement. This approval marks a significant advancement in treating this aggressive form of leukemia, which often presents with poor prognoses and high rates of drug resistance.
Mechanism of Action and Clinical Efficacy
Revuforj is designed to inhibit the menin protein, which plays a crucial role in driving cancer growth in patients with KMT2A-rearranged leukemia, which accounts for approximately 10% of acute leukemias. The drug works by blocking the interaction of menin with KMT2A fusion proteins, thereby disrupting key oncogenic pathways.
The FDA approval was based on data from a Phase 1/2 open-label, single-arm study involving 104 participants. The results, published in the Journal of Clinical Oncology, demonstrated that Revuforj induced a complete remission (CR) or complete remission with partial hematologic recovery (CRh) in 21.2% of patients. The median duration of response was 6.4 months. Notably, 23% of patients (24 out of 104) underwent stem cell transplants following Revuforj treatment, which can restore the patient's ability to produce healthy blood cells.
According to Dr. Ghayas Issa, associate professor of leukemia at The University of Texas MD Anderson Cancer Center, "The significant clinical benefit and robust efficacy seen with Revuforj represents a substantial improvement over what has been historically observed in these patients with previously available therapies and has the potential to be an important new treatment option for patients."
Safety and Warnings
The Revuforj label includes a black box warning for differentiation syndrome, a potentially fatal complication characterized by an excessive immune response from leukemia cells. Symptoms of differentiation syndrome require immediate intervention, including corticosteroid therapy and close monitoring of the patient's circulatory and cardiac function.
Pricing and Availability
Syndax has priced Revuforj at $39,500 per month, or $474,000 annually before rebates or discounts. The drug will be available in 110 mg and 160 mg tablets through specialty distributors and pharmacies later this month. A lower 25 mg dose, intended for patients weighing less than 40 kg, will be available in early 2025 via an expanded access program until the tablet form is commercially available.
Competitive Landscape and Future Development
While Revuforj is the first FDA-approved menin inhibitor, other companies are developing similar therapies. Kura Oncology's ziftomenib is in Phase 2 testing, and Biomea Fusion's icovamenib is in early clinical development. Syndax is also exploring Revuforj's potential in earlier lines of treatment for KMT2A-rearranged leukemia and in leukemias driven by mNPM1 mutations. Positive Phase 2 data in mNPM1-mutated acute myeloid leukemia were recently reported, with plans to seek FDA approval for this indication in the first half of 2025.
Syndax recently gained FDA approval for Niktimvo, an antibody drug for graft-versus-host disease, developed in collaboration with Incyte.
