RALLY-MF: A Phase 1b/2 Open-Label Study to Evaluate the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Clinical Activity of DISC-0974 in Participants With Myelofibrosis or Myelodysplastic Syndrome and Anemia

Disc Medicine, Inc40 个研究点分布在 2 个国家目标入组 150 人开始时间: 2022年6月6日最近更新: 2026年9月15日

适应症

干预措施

试验速览

阶段: 1 期
状态: 招募中
发起方: Disc Medicine, Inc
入组人数: 150
试验地点: 40
主要终点: Incidence of treatment-emergent adverse events (Phase 1b only)

研究概览研究设计入排标准研究组 & 干预措施结局指标研究者研究点记录与标识符相似试验

研究概览

简要总结

This phase 1b/2a open-label study will evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and clinical activity of DISC-0974 as well as categorize the effects on hematologic response in participants with myelofibrosis or myelodysplastic syndrome and anemia.

研究设计

研究类型: Interventional
分配方式: Randomized
干预模型: Sequential
主要目的: Treatment
盲法: None

入排标准

年龄范围: 18 Years 至 —（Adult, Older Adult）
性别: All
接受健康志愿者: 否

入选标准

•for Participants with MF and Anemia:
•Participants are eligible for the study if all of the following criteria apply:
•Age 18 years or older at the time of signing the informed consent form (ICF).
•For Phase 1b: Dynamic International Prognostic Scoring System (DIPSS) score of 3 to 4 (intermediate 2 risk) or ≥5 (high-risk) primary MF, post PV MF, and/or post ET MF, as confirmed in the most recent local bone marrow biopsy report, according to World Health Organization (WHO) 2016 criteria.
•For Phase 2: In addition to the criteria above, DIPSS score of ≥2 (intermediate 1 risk) may also be included.
•Washout of at least 28 days prior to Screening of the following treatments:
•Immunomodulators (lenalidomide, thalidomide)
•Luspatercept/sotatercept
•Systemic corticosteroids are permitted for non-hematological conditions if stable or decreasing dose for ≥28 days prior to Screening and receiving an equivalent to ≤10 mg prednisone for the 28 days immediately prior to Screening.
•Screening can begin before the 28 day washout is completed, but the washout period must be completed prior to collection of Screening blood samples.
•For Phase 1b: Hgb <10 g/dL on ≥3 assessments over 84 days prior to Screening, without RBC transfusion, or Hgb <10 g/dL and receiving RBC transfusions periodically but not meeting criteria for TD participant as defined for the TD cohort. The baseline Hgb value for these participants is the lowest Hgb level during the 84 days prior to Screening, or RBC transfusion dependence, defined as an RBC transfusion frequency of ≥6 units PRBC over the 84 days immediately prior to Screening. There must not be any consecutive 42-day period without an RBC transfusion in the 84-day period, and the last transfusion must be within 28 days prior to Screening.
•For Phase 2:
•TD high transfusion burden cohort: RBC transfusion dependence, defined as an RBC transfusion requirement of 3 to 12 PRBC units over the 84 days immediately prior to Screening TD low transfusion burden cohort: RBC transfusion dependence, defined as an RBC transfusion requirement of 1 to 2 PRBC units over the 84 days immediately prior to Screening nTD Cohort: Non-transfusion dependence, baseline Hgb <10 g/dL as defined on ≥3 assessments over 84 days prior to Screening, without RBC transfusion
•Stable dosing of MF-directed therapy:
•Hydroxyurea, or, if taking any other treatment for MF, stable for at least 28 days prior to Screening.
•Interferon alpha stable dosing for at least 12 weeks prior to Screening.
•JAK inhibitors require 12 weeks of stable dosing prior to Screening. For the TD high, TD low, and nTD cohorts, JAK inhibitors allowed include momelotinib, pacritinib, fedratinib, and ruxolitinib.
•If the participant discontinues JAK inhibitor (including momelotinib/pacritinib/ruxolitinib/fedratinib) and/or hydroxyurea prior to Screening, a 60-day washout period is required.
•Eastern Cooperative Oncology Group (ECOG) performance score ≤
•Infusion of hematopoietic stem cell transplant not anticipated within 8 months after Screening.
•TSAT <75% (local lab acceptable) at or within 2 weeks of Screening.
•Liver iron concentration by MRI <7 mg/g dry weight within 3 months of eligibility confirmation by central review. Required for TD high participants only.
•Serum ferritin ≥50 µg/L at Screening.
•Platelet count ≥25,000/µL and <1,000,000/µL; neutrophils ≥1,000/µL; and total white blood cell (WBC) count <50,000/µL at Screening.
•Estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 by the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) formula.
•Aspartate aminotransferase (AST) and ALT <3.0x upper limit of normal (ULN) at Screening.
•Direct bilirubin <2x ULN at Screening. Higher levels are acceptable if these can be attributed by the Investigator to ineffective erythropoiesis or Gilbert's syndrome, with approval from Sponsor.
•If male with female sexual partner(s) of childbearing potential, agrees to use 1 of the following highly effective methods of contraception during the study and for at least 8 weeks after the last study drug dose:
•Stable hormonal contraceptive (≥3 months; female partner)
•Intrauterine device in place for at least 3 months (female partner)
•Surgically sterile hysterectomy, bilateral oophorectomy, or bilateral tubal ligation (female partner)
•Confirmed successful vasectomy
•If female, then EITHER postmenopausal (defined as 12 months of spontaneous amenorrhea, 6 months of spontaneous amenorrhea with serum follicle-stimulating hormone (FSH) levels >40 mIU/ml, or 6 weeks postsurgical bilateral oophorectomy with or without hysterectomy), surgically sterile, OR agreeable to use 1 of the following highly effective contraception methods (listed below) on Day 1 (or earlier) and for at least 8 weeks after the last dose of study drug:
•Stable hormonal contraceptive (≥3 months)
•Intrauterine device in place for at least 3 months
•Tubal ligation or single male partner with vasectomy
•Negative urine pregnancy test (females of childbearing potential) at Screening (Days 28 to 2).
•Able to understand the study aims, procedures, and requirements, and provide written informed consent.
•Able to comply with all study procedures.
•Inclusion Criteria for Exploratory Cohort of Participants with MDS and Anemia:
•Participants are eligible for the MDS exploratory cohort if all of the following criteria apply:
•Age 18 years or older at the time of signing the ICF.
•Molecular International Prognostic Scoring System (IPSS-M) classification of very low, low, or intermediate (ie, lower risk) MDS-ringed sideroblasts (RS) negative, MDS/MPN with ringed sideroblasts and thrombocytosis (RS-T), Chronic Myelomonocytic Leukemia (CMML), Atypical Chronic Myeloid Leukemia (aCML), or Myelodysplastic/Myeloproliferative Neoplasms, Unclassifiable (MDS/MPN-U) as confirmed in the most recent local bone marrow biopsy report according to WHO criteria.
•Washout of at least 28 days is required for prior anemia/neutropenia-directed therapies, including:
•EPO-stimulating agents
•Luspatercept
•Sotatercept (ACE-011)
•Granulocyte colony-stimulating factor (G CSF) OR granulocyte-macrophage CSF (GM CSF).
•Systemic corticosteroids (except for participants on a stable or decreasing dose for ≥28 days prior to randomization for non-hematological conditions and receiving an equivalent to ≤10 mg prednisone for the 28 days immediately prior to Screening) Screening can begin before the 28-day washout is completed, but the washout period must be completed prior to collection of Screening blood samples.
•Baseline Hgb of <10 g/dL on ≥3 assessments over 84 days prior to Screening, without RBC transfusion, or Hgb <10 g/dL and receiving RBC transfusions periodically during the 84 days prior to Screening
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排除标准

•for Participants with MF and Anemia:
•Participants are excluded from the study if any of the following criteria apply:
•Medical History, Participants with MF and Anemia
•Hereditary hemochromatosis
•Hemoglobinopathy or intrinsic RBC defect associated with anemia
•Total splenectomy
•Hematopoietic cell transplant within the past 2 years, or graft vs host disease requiring immunosuppression
•Current anemia from iron deficiency, vitamin B12 or folate deficiency, infection, or bleeding
•Active immune-mediated hemolytic anemia
•Symptomatic bleeding, unrelated to surgery, in a critical area or organ and/or bleeding causing a decrease in Hgb of ≥2 g/dL or leading to transfusion of ≥2 units of RBCs in the 6 months prior to Screening
•Major surgery within 8 weeks prior to Screening or incomplete recovery from any previous surgery
•Malignancy within the past 3 years, other than primary MF, post ET, or post PV MF. The following history or concurrent conditions are allowed:
•basal or squamous cell carcinoma of the skin
•carcinoma in situ of the cervix or the breast
•histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis [TNM] clinical staging system) A history of completed treatment (medical or surgical) of stage 1-2 cancers may be permitted with prior Sponsor agreement
•Stroke, deep vein thrombosis, or pulmonary or arterial embolism within 3 months prior to Screening
•Known allergic reaction to any study drug excipient
•A history of anti-drug antibody formation
•Inadequately controlled heart disease (New York Heart Association Classification 3 or 4) and/or known to have left ventricular ejection fraction <35%
•Hepatitis B or C, or human immunodeficiency virus (HIV) with detectable viral load
•Uncontrolled fungal, bacterial, or viral infection (ongoing signs/symptoms related to the infection, without improvement despite appropriate treatment)
•Treatment History, Participants with MF and Anemia
•Iron chelation therapy in the 28 days prior to Screening
•Change in anticoagulant therapy regimen within 8 weeks prior to Screening
•Laboratory Exclusions, Participants with MF and Anemia
•Peripheral blood myeloblasts ≥10% of WBC differential at most recent evaluation prior to Screening
•Positive direct antiglobulin test in conjunction with a reactive RBC eluate at Screening
•Miscellaneous, Participants with MF and Anemia
•Pregnant or lactating
•Condition or concomitant medication that would confound the ability to interpret study data
•Other medical or psychiatric condition or laboratory finding not specifically noted above that, in the judgment of the Investigator or Sponsor, would put the participant at unacceptable risk or otherwise preclude the participant from participating in the study
•Participation in any other clinical protocol or investigational study that involves administration of experimental therapy and/or therapeutic devices within 30 days prior to Screening
•Exclusion Criteria for Exploratory Cohort of Participants with MDS and Anemia:
•Participants are excluded from the MDS exploratory cohort if any of the following criteria apply:
•Medical History, Participants with MDS and Anemia
•Secondary MDS, ie, MDS that is known to have arisen as the result of chemical injury or treatment with chemotherapy and/or radiation from other diseases
•Peripheral blasts ≥5%
•Current treatment with hypomethylating agent or other acute myeloid leukemia (AML)-like combination chemotherapy or planned use within 6 months after Screening
•Prior treatment with >3 anemia-directed therapies (unless otherwise approved by Sponsor) including:
•Luspatercept
•Sotatercept (ACE-011)
•EPO-stimulating agent
•Hereditary hemochromatosis
•Hemoglobinopathy or intrinsic RBC defect associated with anemia
•Total splenectomy
•Hematopoietic cell transplant within the past 10 years
•Current anemia from iron deficiency, vitamin B12 or folate deficiency, infection, or bleeding
•Active immune-mediated hemolytic anemia
•Symptomatic bleeding, unrelated to surgery, in a critical area or organ and/or bleeding causing a decrease in Hgb of ≥2 g/dL or leading to transfusion of ≥2 units of RBCs in the 6 months prior to Screening
•Major surgery within 8 weeks prior to Screening or incomplete recovery from any previous surgery
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研究组 & 干预措施

Phase 1b: Dose Escalation

Experimental

In the Phase 1b (dose-escalation) portion of the study, DISC-0974 will be administered subcutaneously every 4 weeks.

干预措施: DISC-0974 (Drug)

Phase 2: Expansion

Experimental

In the Phase 2 (expansion) portion of the study, DISC-0974 will be administered subcutaneously every 4 weeks.

干预措施: DISC-0974 (Drug)

结局指标

主要结局

Incidence of treatment-emergent adverse events (Phase 1b only)

时间窗: up to 225 days

Incidence of clinically abnormal vital signs (Phase 1b only)

时间窗: up to 225 days

Incidence of clinically abnormal physical exam (Phase 1b only)

时间窗: up to 225 days

Incidence of clinically abnormal electrocardiograms (Phase 1b only)

时间窗: up to 225 days

Incidence of abnormal laboratory test results (Phase 1b only)

时间窗: up to 225 days

Transfusion-dependent (TD) high cohort: transfusion independence, defined as the absence of packed red blood cell (PRBC) transfusions over any rolling 12-week interval during the treatment period with a minimum hemoglobin (Hgb) of 7 g/dL (Phase 2 only)

时间窗: up to 225 days

TD low cohort: transfusion independence, defined as the absence of PRBC transfusions over any rolling 16 week interval during the treatment period with a minimum Hgb of 7 g/dL (Phase 2 only)

时间窗: up to 225 days

Non-transfusion-dependent (nTD) cohort: anemia response, defined as the composite of the absence of transfusions over any rolling 12 week period and a concomitant mean Hgb increase of ≥1.5 g/dL over baseline (Phase 2 only)

时间窗: up to 225 days

Safety and Tolerability of DISC-0974 (Phase 1b only)