FREEDOM2: An Efficacy and Safety Study of Fedratinib Compared to Best Available Therapy in Subjects With DIPSS-intermediate or High-risk Primary Myelofibrosis, Post-polycythemia Vera Myelofibrosis, or Post-essential Thrombocythemia Myelofibrosis and Previously Treated With Ruxolitinib

Sponsor
Celgene (Industry)
Overall Status
Recruiting
CT.gov ID
NCT03952039
Collaborator
Impact Biomedicines, Inc., a wholly owned subsidiary of Celgene Corporation (Industry)
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Study Details

Study Description

Brief Summary

A Phase 3, multicenter, open-label, randomized study to evaluate the efficacy and safety of fedratinib compared to best available therapy (BAT) in subjects with DIPSS (Dynamic International Prognostic Scoring System)-intermediate or high-risk primary myelofibrosis (PMF), post-polycythemia vera myelofibrosis (post-PV MF), or post-essential thrombocythemia myelofibrosis (post-ET MF) and previously treated with ruxolitinib. The primary objective of the study is to evaluate the percentage of subjects with at least 35% spleen volume reduction in the fedratinib and the BAT arms.

Condition or Disease Intervention/Treatment Phase
Phase 3

Detailed Description

This Phase 3, multicenter, randomized, two-arm, open-label study will include subjects with intermediate or high-risk (as per the DIPSS score) primary myelofibrosis (PMF), postpolycythemia vera myelofibrosis (post-PV MF), or post-essential thrombocythemia myelofibrosis (post-ET MF). This study will be conducted in compliance with International Council for Harmonisation (ICH) Good Clinical Practices (GCPs).

Study design includes:
  • A 28-day Screening Period

  • 2:1 Randomization to fedratinib or best available therapy (BAT)

  • Stratification at Randomization according to:

  • Spleen size by palpation: < 15 cm below left costal margin (LCM) versus ≥ 15 cm below LCM

  • Platelets ≥ 50 to < 100 x 109/L versus platelets ≥ 100 x 109/L

  • Refractory or relapsed to ruxolitinib treatment versus intolerant to ruxolitinib treatment

  • Study Treatment Period (time on study drug plus 30 days after last dose)

  • Subjects are allowed to crossover from BAT to the fedratinib arm after the Cycle 6 response assessment or before the Cycle 6 response assessment in the event of a confirmed progression of splenomegaly by MRI/CT scan

  • A Survival Follow-up Period for progression and survival

Study Design

Study Type:
Interventional
Anticipated Enrollment :
192 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase 3, Multicenter, Open-label, Randomized Study to Evaluate the Efficacy and Safety of Fedratinib Compared to Best Available Therapy (BAT) in Subjects With DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High-risk Primary Myelofibrosis (PMF), Post-polycythemia Vera Myelofibrosis (Post-PV MF), or Post-essential Thrombocythemia Myelofibrosis (Post-ET MF) and Previously Treated With Ruxolitinib
Actual Study Start Date :
Sep 9, 2019
Anticipated Primary Completion Date :
Dec 22, 2022
Anticipated Study Completion Date :
Jun 23, 2025

Arms and Interventions

Arm Intervention/Treatment
Experimental: Fedratinib 400mg/day

Will include up to 128 subjects receiving fedratinib 400 mg self-administered Investigational Product (IP) on an outpatient basis, once daily preferably together with food during an evening meal at the same time each day in consecutive 4-week (28-day) cycles.

Drug: FEDRATINIB
A potent and selective inhibitor of JAK2 kinase activity

Active Comparator: Best Available Therapy (BAT)

Best-available Investigator-selected therapy included a number of available compounds to treat MF and/or its symptoms and was chosen by the investigator for each subject. Therapy changed at different times during the treatment period. No investigational agents (e.g. not approved for the treatment of any indication) were allowed. BAT also included the choice of no treatment.

Drug: Best Available Therapy (BAT)
Best available therapy (BAT)

Outcome Measures

Primary Outcome Measures

  1. Proportion of subjects who have ≥ 35% SVR at end of cycle 6 [At the end of Cycle 1 (each cycle is 28 days)]

    Spleen volume response rate (RR)

Secondary Outcome Measures

  1. Proportion of subjects with ≥ 50% reduction in total symptom scores measured by MFSAF at end of cycle 6 [Up to end of Cycle 6 (each cycle is 28 days)]

    Symptom response rate (SRR)

  2. Proportion of subjects who have ≥ 25% reduction in spleen volume at the end of cycle 6 [At the end of Cycle 1 (each cycle is 28 days)]

    Spleen volume response rate (RR25)

  3. Adverse Events (AEs) [Up to 30 days post last dose]

    Number of participants with adverse event

  4. Proportion of subjects who have ≥ 50% reduction in spleen size by palpation at end of cycle 6 [Up to end of Cycle 6 (each cycle is 28 days)]

    Spleen response rate by palpation (RRP)

  5. Durability of Spleen Volume Response by MRI/CT (DR) [Up to end of Cycle 6 (each cycle is 28 days)]

    Is defined as time from the first documented spleen response (ie, ≥ 35% reduction in spleen volume) to the first documented spleen volume reduction < 35%.

  6. Duration of ≥ 50 % reduction in spleen size by palpation for subjects with a palpable spleen at least 5 cm below the left costal margin (LCM) at baseline [Up to approximately 30 months]

    From C1D1 until the 30- day follow-up after last dose visit

  7. Duration of ≥ 50% reduction in total symptom scores measured by MFSAF [From enrollment until 30 days post last dose]

    Durability of symptoms response (DSR)

  8. Time from randomization to death due to any reason or disease progression (modified IWG-MRT 2013 including ≥ 25% increase in spleen volume by MRI/CT) [Up to 24 months from enrollment to End of Survival Follow-up]

    Spleen and disease progression free survival (SDPFS)

  9. Gastrointestinal Adverse Events [Up to approximately 30 months]

    Incidence of subjects with Grade 3 or higher Gastrointestinal events (nausea, diarrhea, or vomiting) according to CTCAE v5.0

  10. Encephalopathy Events, including Wernicke's [Up to 30 days post last dose]

    Occurrence of confirmed encephalopathy events, including Wernicke's

  11. Health-Related Quality of Life (HRQoL) [Up to 30-day follow-up after last dose visit]

    To evaluate Health-Related Quality of Life (HRQoL) as measured by the European Organization for Research and Treatment of Cancer Quality of Life C30 (EORTC QLQ-C30)

  12. EQ-5D-5L [Up to 20-day follow-up after last dose visit]

    To evaluate Patient Reported Outcomes (PRO) as measured by the EQ-5D-5L questionnaire

  13. Overall Survival (OS) [From randomization to the End of Survival Follow-up (approximately 12 months)]

    Time from randomization to death due to any reason

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  1. Subject is at least 18 years of age at the time of signing the informed consent form (ICF)

  2. Subject has an Eastern Cooperative Oncology Group (ECOG) Performance Score (PS) of 0, 1 or 2

  3. Subject has diagnosis of primary myelofibrosis (PMF) according to the 2016 World Health Organization (WHO) criteria, or diagnosis of post-ET or post-PV myelofibrosis according to the IWG-MRT 2007 criteria, confirmed by the most recent local pathology report

  4. Subject has a DIPSS Risk score of Intermediate-2 or High

  5. Subject has a measurable splenomegaly during the screening period as demonstrated by spleen volume of ≥ 450 cm3 by MRI or CT-scan and by palpable spleen measuring ≥ 5 cm below the left costal margin

  6. Subject has a measurable total symptoms score (≥ 1) as measured by the Myelofibrosis Symptom Assessment Form (MFSAF)

  7. Subject has been previously exposed to ruxolitinib, and must meet at least one of the following criteria (a and/or b)

  8. Treatment with ruxolitinib for ≥ 3 months with inadequate efficacy response (refractory) defined as < 10% spleen volume reduction by MRI or < 30% decrease from baseline in spleen size by palpation or regrowth (relapsed) to these parameters following an initial response

  9. Treatment with ruxolitinib for ≥ 28 days complicated by any of the following (intolerant):

  • Development of a red blood cell transfusion requirement (at least 2 units/month for 2 months) or

  • Grade ≥ 3 AEs of thrombocytopenia, anemia, hematoma, and/or hemorrhage while on treatment with ruxolitinib

  1. Subject must have treatment-related toxicities from prior therapy resolved to Grade 1 or pretreatment baseline before start of last therapy prior to randomization

  2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted

  3. Subject is willing and able to adhere to the study visit schedule and other protocol requirements

  4. A female of childbearing potential (FCBP) must:

  5. Have 2 negative pregnancy tests as verified by the Investigator during screening prior to starting study treatment. She must agree to ongoing pregnancy testing during the course of the study, and after end of study treatment. This applies even if the subject practices true abstinence from heterosexual contact.

  6. Either commit to true abstinence from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree to use and be able to comply with highly effective contraception without interruption, -14 days prior to starting investigational product, during the study treatment (including dose interruptions), and for 30 days after discontinuation of study treatment.

Note: A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy, or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months).

  1. A male subject must:

Practice true abstinence (which must be reviewed on a monthly basis) or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions and for at least 30 days following investigational product discontinuation, or longer if required for each compound and/or by local regulations, even if he has undergone a successful vasectomy

Exclusion Criteria:
  1. Any of the following laboratory abnormalities:

  2. Platelets < 50 x 109/L

  3. Absolute neutrophil count (ANC) < 1.0 x 109/L

  4. White blood count (WBC) > 100 x 109/L

  5. Myeloblasts ≥ 5 % in peripheral blood

  6. Estimated glomerular filtration rate < 30 mL/min/1.73 m2 (as per the Modification of Diet in Renal Disease [MDRD] formula)

  7. Serum amylase or lipase > 1.5 x upper limit of normal (ULN)

  8. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3 x upper limit of normal (ULN)

  9. Total bilirubin > 1.5 x ULN, subject's total bilirubin between 1.5 - 3.0 x ULN are eligible if the direct bilirubin fraction is < 25% of the total bilirubin

  10. Subject is pregnant or lactating female

  11. Subject with previous splenectomy

  12. Subject with previous or planned hematopoietic cell transplant

  13. Subject with prior history of encephalopathy, including Wernicke's (WE)

  14. Subject with signs or symptoms of encephalopathy, including WE (eg, severe ataxia, ocular paralysis or cerebellar signs)

  15. Subject with thiamine deficiency, defined as thiamine levels in whole blood below normal range according to the central laboratory and not demonstrated to be corrected prior to randomization

  16. Subject with concomitant treatment with or use of pharmaceutical, herbal agents or food known to be strong or moderate inducers of Cytochrome P450 3A4 (CYP3A4), or dual CYP2C19 and CYP3A4 inhibitors

  17. Subject on any chemotherapy, immunomodulatory drug therapy (eg, thalidomide, interferon-alpha), anagrelide, immunosuppressive therapy, systemic corticosteroids > 10 mg/day prednisone or equivalent. Subjects who have had prior exposure to hydroxyurea (eg, Hydrea) in the past may be enrolled into the study as long as it has not been administered within 14 days prior to randomization

  18. Subject has received ruxolitinib within 14 days prior to randomization

  19. Subject with previous exposure to Janus kinase (JAK) inhibitor(s) other than ruxolitinib treatment

  20. Subject on treatment with aspirin with doses > 150 mg daily

  21. Subject with major surgery within 28 days prior to randomization

  22. Subject with diagnosis of chronic liver disease (eg, chronic alcoholic liver disease, autoimmune hepatitis, sclerosing cholangitis, primary biliary cirrhosis, hemochromatosis, non-alcoholic steatohepatitis)

  23. Subject with prior malignancy other than the disease under study unless the subject has not required treatment for the malignancy for at least 3 years prior to randomization. However, subject with the following history/concurrent conditions provided successfully treated may enroll: non-invasive skin cancer, in situ cervical cancer, carcinoma in situ of the breast, incidental histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis [TNM] clinical staging system), or is free of disease and on hormonal treatment only

  24. Subject with uncontrolled congestive heart failure (New York Heart Association Classification 3 or 4)

  25. Subject with known human immunodeficiency virus (HIV), known active infectious Hepatitis B (HepB), and/or known active infectious Hepatitis C (HepC)

  26. Subject with serious active infection

  27. Subject with presence of any significant gastric or other disorder that would inhibit absorption of oral medication

  28. Subject is unable to swallow capsule

  29. Subject with any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study

  30. Subject has any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study

  31. Subject has any condition that confounds the ability to interpret data from the study

  32. Subject with participation in any study of an investigational agent (drug, biologic, device) within 30 days prior to randomization

  33. Subject with a life expectancy of less than 6 months

Contacts and Locations

Locations

Site City State Country Postal Code
1 Saint Vincent's Hospital Darlinghurst New South Wales Australia 2010
2 Local Institution - 101 Adelaide South Australia Australia 5000
3 Royal Adelaide Hospital Adelaide South Australia Australia 5000
4 Peninsula Private Hospital Frankston Victoria Australia 3199
5 Eastern Health Clinical School Box Hill Australia 3128
6 Alfred Hospital Melbourne Australia 3004
7 Medical University of Graz Graz Austria A-8036
8 Medical University Innsbruck Innsbruck Austria 6020
9 Elisabethinen Hospital Linz Linz Austria 4020
10 Salzburger Landkliniken St. Johanns-Spital Salzburg Austria 5020
11 Medical University of Vienna Vienna Austria 1090
12 Klinikum Wels-Grieskirchen GmbH Wels Austria 4600
13 Hanusch Krankenhaus Wien Austria 1140
14 AZ Sint-Jan AV Brugge Brugge Belgium 8000
15 Cliniques Universitaires Saint-Luc Bruxelles Belgium 1200
16 Centre Hospitalier de Jolimont-Lobbes La Louvière-(Haine St-Paul) Belgium 7100
17 UZ Leuven Leuven Belgium 3000
18 Centre Hospitalier Universitaire de Liege - Sart Tilman Liege Belgium 4000
19 Cliniques Universitaires UCL de Mont-Godine Yvoir Belgium 5530
20 Peking University People's Hospital Beijing China 100044
21 Fujian Medical University Union Hospital Fuzhou China 350001
22 Guangdong General Hospital Guangzhou, Guangdong China 510080
23 Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University Nanjing China 210029
24 Chinese Academy of Medical Sciences & Peking Union Medical College Tianjin China 300041
25 Local Institution - 553 Tianjin China 300041
26 Henan Cancer Hospital Zhengzhou China
27 Fakultni Nemocnice Brno Brno Czechia 625 00
28 Fakultni Nemocnice Ostrava Ostrava-Poruba Czechia 708 52
29 Vseobecna Fakultni Nemocnice v Praze Prague 2 Czechia 128 08
30 CHU d'Angers Angers France 49033
31 CHRU de Brest - Hopital Morvan Brest France 29200
32 Centre Hospitalier de Lens Lens Cedex France 62307
33 CHRU Claude Huriez Lille France 59037
34 CHU Nice Hopital de L'Archet 2 Nice Cedex 3 France 06200
35 Centre Hospitalier Universitaire de Nimes - Hopital Universitaire Caremeau Nimes Cedex 9 France 30029
36 Hopital Saint Louis Paris France 75010
37 CHRU - Hopital du Haut Leveque Pessac France 33604
38 Centre Hospitalier Lyon Sud - Hospices Civils de Lyon Groupement Hospitalier Sud Pierre-Benite France 69495
39 CHU La Miletrie Poitiers Cedex France 86021
40 CHU Strasbourg - Hopital Civil Strasbourg France 67091
41 Institut Universitaire du Cancer de Toulouse - Oncopole Toulouse Cedex 9 France 31059
42 Unviversitatsklinikum Aachen Aachen Germany 52074
43 Klinikum der Johann Wolfgang Goethe Universitat Frankfurt am Main Germany 60590
44 Universitaetsklinikum Halle Saale Halle Germany 06120
45 Universitaetsklinikum Jena Jena Germany 07747
46 Universitaetsklinikum Magdeburg A oeR Magdeburg Germany 39120
47 University of Heidelberg - Universitatsklinikum Mannheim Mannheim Germany 68167
48 Johannes Wiesling Klinikum Minden Minden Germany 32429
49 Universitaetsklinikum Ulm Ulm Germany 89081
50 Semmelweis Egyetem Budapest Hungary 1088
51 Petz Aladar Megyei Oktato Korhaz Gyor Hungary 9023
52 Local Institution - 602 Kaposvar Hungary 7400
53 Somogy Megyei Kaposi Mor Oktato Korhaz Kaposvar Hungary 7400
54 SzSzB Megyei Korhazak es Egyetemi Oktatokorhaz Nyiregyhaza Hungary 4400
55 Local Institution - 603 Szeged Hungary 6720
56 Szegedi Tudomanyegyetem - Szent-Gyorgyi Albert Klinikai Kozpont Szeged Hungary 6720
57 Cork University Hospital Cork Ireland
58 Mater Misericordiae University Hospital Dublin Ireland Dublin 7
59 St. James' Hospital Dublin Ireland Dublin 8
60 A.O.U. di Bologna Policlinico S.Orsola-Malpighi Bologna Italy 40138
61 ASST Spedali Civili P.O. di Brescia Brescia Italy 25123
62 Azienda Ospedaliero - Universitaria Policlinico - Vittorio Emanuele - Ospedale Gaspare Rodolico Catania Italy 95123
63 Azienda Ospedaliero-Universitaria Careggi Firenze Italy 50134
64 IRCSS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena Milano Italy 20122
65 Ospedale Cardarelli Naples Italy 80131
66 Fondazione IRCCS Policlinico San Matteo Pavia Italy 27100
67 Policlinico Umberto I - Universita La Sapienza Roma Italy 00168
68 Universita Cattololica del Sacro Cuore Roma Italy 00168
69 Azienda Ospedaliera S. Andrea - Università La Sapienza Roma Italy 00189
70 Local Institution - 359 Roma Italy 00189
71 Azienda Ospedaliera Citta della Salute e della Scienza di Torino Torino Italy 10126
72 Local Institution - 355 Torino Italy 10126
73 Azienda Ospedaliero-Universitaria Santa Maria della Misericordia die Udine Udine Italy 33100
74 Universita degli Studi dell'Insubria - Ospedale di Circolo e Fondazione Macchi - Varese Varese Italy 21100
75 Azienda Ospedaliera Universitaria Integrata di Verona Verona Italy 37134
76 Seoul National University Bundang Hospital Seongnam-si Korea, Republic of 13620
77 Samsung Medical Center Seoul Korea, Republic of 06351
78 Seoul St Marys Hospital College of Medicine The Catholic University of Korea Seoul Korea, Republic of 137-701
79 Soon Chun Hyang University Hospital Seoul Seoul Korea, Republic of 140-887
80 Seoul National University Hospital Seoul Korea, Republic of 3080
81 Asan Medical Center Seoul Korea, Republic of 5505
82 Local Institution - 902 Seoul Korea, Republic of 5505
83 UMC Maastricht Maastricht Netherlands 6229 HX
84 Radboud University Medical Center Nijmegen Netherlands 6525 GA
85 Szpital Kliniczny im. H.Swiecickiego Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu Poznan Poland 60-569
86 Instytut Hematologii i Transfuzjologii w Warszawie Warszawa Poland 02-776
87 Akademicki Szpital Kliniczny im. Jana Mikulicza-Radeckiego Wroclaw Poland 50-556
88 FSBI Hematology Research Center Ministry of Healthcare of the Russian Federation Moscow Russian Federation 125167
89 Moscow State Healthcare Institution City clinical hospital n.a. S.P.Botkin Moscow Russian Federation 125284
90 City Clinical Hospital 40 Moscow Russian Federation 129301
91 Novosibirsk State Medical University (NSMU) Novosibirsk Russian Federation 630066
92 Russian Research Institute of Hematology and Transfusiology of the Federal Biomedical Agency Saint Petersburg Russian Federation 191024
93 Pavlov First Saint Petersburg State Medical University Saint-Petersburg Russian Federation 197022
94 Federal Centre of Heart, Blood and Endocrinology of Rosmed technlologies V.A. Almazov St Petersburg Russian Federation 197341
95 State Budgetary Healthcare Organization Vladikavkaz Russian Federation 362002
96 Complejo Hospitalario Universitario A Coruna A Coruna Spain 15006
97 Hospital General Universitario de Alicante Alicante Spain 03010
98 Hospital Universitari Germans Trias i Pujol Badalona (Barcelona) Spain 8916
99 Hospital Universitario Cruces Barakaldo Spain 48903
100 Hospital Clinic de Barcelona Barcelona Spain 08036
101 Instituto Catalan de Oncologia de Girona Gerona Spain 17007
102 Hospital Universitario de Gran Canaria Dr. Negrin Las Palmas de Gran Canaria Spain 35012
103 Hospital Ramon y Cajal Madrid Spain 28034
104 Hospital Universitario 12 de Octubre Madrid Spain 28041
105 Hospital Universitario Virgen de la Victoria Malaga Spain 29010
106 Local Institution - 457 Malaga Spain 29010
107 Hospital General Universitario Morales Meseguer Murcia Spain 30008
108 Universitario de Salamanca - Hospital Clinico Salamanca Spain 37007
109 Hospital Universitario de Tenerife Santa Cruz de Tenerife Spain 38320
110 Hospital Clinico Universitario de Santiago Santiago de Compostela Spain 15706
111 Hospital Clinico Universitario de Valencia Valencia Spain 46010
112 University Hospitals Birmingham NHS Foundation Trust - Queen Elizabeth Hospital Birmingham United Kingdom B15 2TH
113 United Lincolnshire Hospitals NHS Trust Boston United Kingdom PE21 9QS
114 Guy's and St Thomas' NHS Foundation Trust - Guy's Hospital London United Kingdom SE1 9RT
115 Imperial College Hammersmith Hospital London United Kingdom W12 0HS
116 The Christie NHS Foundation Trust Manchester United Kingdom M20 4BX
117 Nottingham City Hospital Nottingham United Kingdom NG5 1PB
118 The Churchill Hospital Oxford United Kingdom 0X3 7LE

Sponsors and Collaborators

  • Celgene
  • Impact Biomedicines, Inc., a wholly owned subsidiary of Celgene Corporation

Investigators

  • Study Director: Bristol-Myers Squibb, Bristol-Myers Squibb

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Celgene
ClinicalTrials.gov Identifier:
NCT03952039
Other Study ID Numbers:
  • FEDR-MF-002
  • U1111-1223-2962
  • 2018-003411-21
First Posted:
May 16, 2019
Last Update Posted:
Aug 1, 2022
Last Verified:
Jul 1, 2022
Individual Participant Data (IPD) Sharing Statement:
Yes
Plan to Share IPD:
Yes
Studies a U.S. FDA-regulated Drug Product:
Yes
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by Celgene
Additional relevant MeSH terms:

Study Results

No Results Posted as of Aug 1, 2022