Open Label Ruxolitinib (INCB018424) in Patients With Myelofibrosis and Post Polycythemia Vera/Essential Thrombocythemia Myelofibrosis

• Number of Participants With Adverse Events (AEs) [ Time Frame: From Baseline to the interim clinical cut-off date (31 December 2009). The median time on study was 14.8 months, with a range of 26 days to 29.7 months. As of March 1, 2011 the total exposure to ruxolitinib was 269 patient-years. ] [ Designated as safety issue: Yes ]

  Treatment-Emergent AEs are events occurring after first drug administration or worsened from baseline.

  Treatment-Related AEs are those with a definite, probable, possible or missing causality.

  A serious AE is a medical occurrence that results in death, is life-threatening, requires inpatient hospitalization or prolongation of hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is a medical event requiring intervention to prevent 1 of the above.

  A severe or life-threatening AE is based on intensity, according to NCI-CTCAE v3.0.

• Percentage of Participants With Clinical Improvement (CI) Over Time [ Time Frame: Week 12, 24, 36, 48 and 60 ] [ Designated as safety issue: No ]

  Clinical improvement was defined according to the International Working Group Myelofibrosis Research and Treatment criteria, and required 1 of the following:

  1. A ≥ 2 g/dL increase in Hemoglobin level or becoming transfusion independent;
  2. Either a ≥ 50% reduction in palpable splenomegaly if spleen was ≥ 10 cm at Baseline or a spleen palpable at > 5 cm at Baseline becomes not palpable;
  3. A ≥ 100% increase in platelet count and an absolute platelet count of ≥ 50,000 x 10^9/L or
  4. A ≥ 100% increase in absolute neutrophil count (ANC) and an ANC of ≥ 0.5 x 10^9/L.

• Percentage of Participants Achieving ≥ 50% Reduction From Baseline in Spleen Palpation Length Over Time [ Time Frame: Baseline and Weeks 4, 8, 12, 24, 36, 48 and 60. ] [ Designated as safety issue: No ]
  For each visit, patients who had a missing value at the visit, dropped out of the study due to any reasons prior to the visit or had non-palpable spleen at baseline and then became palpable at the time of the visit were all considered as having not achieved the ≥ 50% reduction in spleen palpation length.
• Percentage of Participants With ≥ 35% Reduction From Baseline in Spleen Volume Over Time [ Time Frame: Baseline, Weeks 4, 12, 24 and 48. ] [ Designated as safety issue: No ]

  Spleen volume was assessed in a subgroup of 27 patients using magnetic resonance imaging (MRI) scans (or computed tomography (CT) scans in patients who were not candidates for MRI) of the abdomen in order to allow objective measurement of spleen volume using standard estimation techniques.

  For each visit, patients who had a missing value at the visit or dropped out of the study due to any reason prior to the visit were considered as not having achieved the ≥35% reduction in spleen volume.

• Change From Baseline in Myelofibrosis Total Symptom Score at Week 24 [ Time Frame: Baseline and Week 24 ] [ Designated as safety issue: No ]
  Symptoms of myelofibrosis were assessed using a modified Myelofibrosis Symptom Assessment Form (MFSAF). Abdominal discomfort, itching, muscle or bone pain, and night sweats are prominent and troubling symptoms in patients with MF. Therefore, the MFSAF-derived responses for these symptoms were analyzed as a total symptom score. Each symptom was assessed on a scale from 0 (absent), 1 (most favorable) to 10 (worst). The total symptom score is a sum of the individual scores and ranges from 0-40. A higher score indicates worse symptoms hence a negative change from baseline indicates improvement.
• Change From Baseline to Week 24 in Health-Related Quality of Life [ Time Frame: Baseline and Week 24 ] [ Designated as safety issue: No ]
  Health-related Quality of Life was assessed using the Global Health Status/Quality of Life Scale of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This scale ranges from 0 to 100, with higher scores indicating higher quality of life.
• Change From Baseline in Body Weight Over Time [ Time Frame: Baseline and Weeks 4, 8, 12, 24, 36, 48 and 60. ] [ Designated as safety issue: No ]
• Change From Baseline to Week 24 in Eastern Cooperative Oncology Group (ECOG) Performance Status [ Time Frame: Baseline and Week 24 ] [ Designated as safety issue: No ]

  The ECOG performance status measures patients' functional status on the following scale:

  • 0=Fully active, no restrictions;
  • 1=Restricted in physically strenuous activity but ambulatory, able to carry out light work;
  • 2=Ambulatory and capable of all selfcare, unable to carry out any work activities; Up and about > 50% of waking hours;
  • 3=Limited selfcare, confined to bed or chair more than 50% of waking hours;
  • 4=Completely disabled. Totally confined to bed or chair;
  • 5=Dead.

  Data reported indicate the number of participants with a change from Baseline score of -2, -1, 0 and 1.

To determine the safety, tolerability and effectiveness of ruxolitinib (INCB018424), administered orally to patients with Primary Myelofibrosis (PMF), Post Polycythemia Vera Myelofibrosis (PPV-MF) and Essential Thrombocythemia Myelofibrosis (PET-MF).

This is a multicenter, open-label, non-randomized, dose escalation study of ruxolitinib, a small molecule Janus kinase (JAK) inhibitor, administered orally to patients with PMF, PPEV-MF or PET-MF. The study is comprised of 3 parts:

Part 1: Dose escalation and determination of maximum tolerated dose (complete).

Part 2: Exploration of alternative dosing schedules (ongoing).

Part 3: Further evaluation of selected dose regimens, including additional response measures to explore effect of ruxolitinib on symptoms and other parameters including daily physical activity and long-term survival (ongoing).

• Myelofibrosis
• Polycythemia Vera
• Thrombocytosis

• Verstovsek S, Kantarjian HM, Estrov Z, Cortes JE, Thomas DA, Kadia T, Pierce S, Jabbour E, Borthakur G, Rumi E, Pungolino E, Morra E, Caramazza D, Cazzola M, Passamonti F. Long-term outcomes of 107 patients with myelofibrosis receiving JAK1/JAK2 inhibitor ruxolitinib: survival advantage in comparison to matched historical controls. Blood. 2012 Aug 9;120(6):1202-9. doi: 10.1182/blood-2012-02-414631. Epub 2012 Jun 20.
• Verstovsek S, Kantarjian H, Mesa RA, Pardanani AD, Cortes-Franco J, Thomas DA, Estrov Z, Fridman JS, Bradley EC, Erickson-Viitanen S, Vaddi K, Levy R, Tefferi A. Safety and efficacy of INCB018424, a JAK1 and JAK2 inhibitor, in myelofibrosis. N Engl J Med. 2010 Sep 16;363(12):1117-27.

Inclusion Criteria:

• Diagnosed with PMF or Post-PV/ET MF
• Patients with myelofibrosis requiring therapy
• Adequate bone marrow reserve

Exclusion Criteria:

• Received anti-cancer medications or investigational therapy in the past 14 days