Alexion, AstraZeneca Rare Disease, and Merck have announced positive topline results from the Phase 3 KOMET trial, evaluating KOSELUGO® (selumetinib) in adults with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas (PN). The trial demonstrated a statistically significant and clinically meaningful improvement in objective response rate (ORR) compared to placebo, marking a potential advancement in the treatment of this rare genetic condition.
KOMET Trial Details
The KOMET trial (NCT04924608) is a global, randomized, double-blind, placebo-controlled, multi-center Phase 3 trial. It enrolled 145 adults with NF1 across 13 countries. Participants were randomized 1:1 to receive either KOSELUGO or placebo for twelve 28-day cycles. The primary endpoint was confirmed ORR by cycle 16, defined as the percentage of patients with a confirmed complete response (disappearance of PNs) or partial response (at least 20% reduction in tumor volume) as determined by independent central review (ICR) per response evaluation in neurofibromatosis and schwannomatosis (REiNS) criteria.
Clinical Significance
Neurofibromatosis type 1 affects an estimated 1.7 million people worldwide, with approximately 70% being adults. Tumors develop on the nerve sheaths in 30-50% of patients, leading to debilitating symptoms. Currently, there are no approved treatments for adults with NF1, leaving many to experience disfigurement, dysfunction, persistent pain, or the need for multiple surgeries.
Professor Ignacio Blanco Guillermo, M.D., Ph.D., principal investigator of the KOMET trial, stated, “With limited options to manage NF1 plexiform neurofibromas in adults, many patients experience functional impairment and symptoms, which can substantially impact their lives. These clinically meaningful data show KOSELUGO has the potential to make a positive impact in patient care by reducing the size of plexiform neurofibromas.”
Safety Profile
The safety profile of KOSELUGO in the KOMET trial was consistent with previous clinical trials in children and adolescents, with no new safety signals identified. Common adverse reactions (≥40%) in pediatric patients include vomiting, rash, abdominal pain, diarrhea, nausea, dry skin, musculoskeletal pain, fatigue, pyrexia, acneiform rash, stomatitis, headache, paronychia, and pruritus.
Future Steps
Alexion and Merck plan to share these data with regulatory authorities and present them at a forthcoming medical meeting. KOSELUGO is currently approved for pediatric patients 2 years of age and older with NF1 who have symptomatic, inoperable PNs. The KOMET trial results could potentially expand the drug's use to adult patients, addressing a significant unmet need in this population.
