A Study of Momelotinib Versus Danazol in Symptomatic and Anemic Myelofibrosis Patients (MOMENTUM)

• ClinicalTrials.gov Identifier: NCT04173494
• Recruitment Status: Active, not recruiting
• First Posted: November 22, 2019
• Last Update Posted: February 11, 2022
• Sponsor: Sierra Oncology, Inc.
• Information provided by (Responsible Party): Sierra Oncology, Inc.

Tracking Information

• First Submitted Date: November 20, 2019
• First Posted Date: November 22, 2019
• Last Update Posted Date: February 11, 2022
• Actual Study Start Date: February 7, 2020
• Actual Primary Completion Date: December 3, 2021 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: November 20, 2019)

Total Symptom Score (TSS) response rate at Week 24 measured using the Myelofibrosis Symptom Assessment Form v4.0 [ Time Frame: Week 24 landmark. ]

Difference in TSS response rate at Week 24. TSS response is defined as the proportion of subjects who achieve a ≥ 50% reduction in TSS over the 28 days immediately prior to the end of Week 24 compared to baseline

• Original Primary Outcome Measures: Same as current

Current Secondary Outcome Measures (submitted: November 20, 2019)

• Transfusion independence (TI) status at Week 24 [ Time Frame: Week 24 landmark. ]
  Proportion of subjects with TI status at the end of Week 24. TI is defined as not requiring RBC transfusion (except in the case of clinically overt bleeding) for ≥ 12 weeks immediately prior to the end of Week 24, with Hgb levels ≥ 8 g/dL.
• Splenic response rate (SRR) at Week 24 [ Time Frame: Week 24 ]
  Proportion of subjects who have splenic response (reduction in spleen volume of ≥ 35% from baseline) at the end of Week 24

• Original Secondary Outcome Measures: Same as current
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: A Study of Momelotinib Versus Danazol in Symptomatic and Anemic Myelofibrosis Patients (MOMENTUM)
• Official Title: A Randomized, Double-blind, Phase 3 Study to Evaluate the Activity of Momelotinib (MMB) Versus Danazol (DAN) in Symptomatic, Anemic Subjects With Primary Myelofibrosis (PMF), Post-polycythemia Vera (PV) Myelofibrosis, or Post-essential Thrombocythemia (ET) Myelofibrosis Who Were Previously Treated With JAK Inhibitor Therapy

Brief Summary

MOMENTUM is a randomized, double-blind, active control Phase 3 trial intended to confirm the differentiated clinical benefits of the investigational drug momelotinib (MMB) versus danazol (DAN) in symptomatic and anemic subjects who have previously received an approved Janus kinase inhibitor (JAKi) therapy for myelofibrosis (MF). The purpose of this clinical study is to compare the effectiveness and safety of MMB to DAN in treating and reducing: 1) disease related symptoms, 2) the need for blood transfusions and 3) splenomegaly, in adults with primary MF, post-polycythemia vera MF or post-essential thrombocythemia MF. The study is planned in countries including, but not limited to: Australia, Austria, Belgium, Bulgaria, Canada, Czech Republic, Denmark, France, Germany, Hungary, Israel, Italy, New Zealand, Poland, Romania, Singapore, South Korea, Spain, Sweden, Taiwan, UK, and US.

Subjects must be symptomatic with a MFSAF v4.0 Total Symptom Score of ≥ 10 at screening, and be anemic with Hgb < 10 g/dL. For subjects with ongoing JAKi therapy at screening, JAKi therapy must be tapered over a period of at least 1 week, followed by a 2-week non-treatment washout interval prior to randomization.

Subjects will be randomized 2:1 to orally self-administer blinded treatment: MMB plus placebo or DAN plus placebo. Subjects randomized to receive MMB who complete the randomized treatment period to the end of Week 24 may continue to receive MMB in the open-label extended treatment period to the end of Week 204 (a total period of treatment of approximately 4 years) if the subject tolerates and continues to benefit from MMB.

Subjects randomized to receive DAN may cross-over to MMB open-label treatment in the following circumstances:

• at the end of Week 24 if they complete the randomized treatment period; or
• at the end of Week 24 if they discontinue treatment with DAN but continue study assessments and do not receive prohibited medications including alternative active anti-MF therapy; or
• at any time during the randomized treatment period if they meet the protocol-defined criteria for radiographically-confirmed symptomatic splenic progression.

Subjects randomized to receive DAN who are receiving clinical benefit at the end of Week 24 may choose to continue DAN therapy up to Week 48. The comparator treatment, DAN, is an approved medication in the US and in some other countries and is recommended by national guidelines as a treatment for anemia in MF.

• Detailed Description: MOMENTUM Contact Email: momentum_clintrials.gov@sierraoncology.com
• Study Type: Interventional
• Study Phase: Phase 3

Study Design

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description:

During the 24 week randomized treatment phase of the study, subjects, investigators and sponsor and relevant vendor personnel (with the exception of specified unblinded personnel, for example clinical supply) will remain blinded to the subject's treatment assignment and to aggregate data that may lead to inadvertent unblinding. Subjects who continue treatment with momelotinib or danazol after Week 24 in the extended treatment phase will receive unblinded treatment.

Primary Purpose: Treatment

Condition

• Primary Myelofibrosis
• Post-polycythemia Vera Myelofibrosis
• Post-essential Thrombocythemia Myelofibrosis

Intervention

• Drug: Momelotinib
  Momelotinib tablets will be self-administered orally once daily
  Other Name: MMB, GS-0387, CYT387
• Drug: Danazol
  Danazol capsules will be self-administered orally twice daily
  Other Name: Danocrine
• Drug: Placebo to match momelotinib
  Momelotinib placebo tablets will be self-administered orally once daily
• Drug: Placebo to match danazol
  Danazol placebo capsules will be self-administered orally twice daily

Study Arms

• Experimental: Momelotinib
  Participants will receive momelotinib plus placebo to match danazol
  Interventions:

  • Drug: Momelotinib
  • Drug: Placebo to match danazol
• Active Comparator: Danazol
  Participants will receive danazol plus placebo to match momelotinib
  Interventions:

  • Drug: Danazol
  • Drug: Placebo to match momelotinib

• Publications *: Not Provided

Recruitment Information

• Recruitment Status: Active, not recruiting
• Actual Enrollment (submitted: June 17, 2021): 195
• Original Estimated Enrollment (submitted: November 20, 2019): 180
• Estimated Study Completion Date: April 2028
• Actual Primary Completion Date: December 3, 2021 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

1. Age ≥ 18 years.
2. Confirmed diagnosis of PMF in accordance with the World Health Organization (WHO) 2016 criteria, or Post-PV/ET MF in accordance with the International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT criteria).
3. Symptomatic, defined as a TSS of ≥ 10 units assessed by a single MFSAF v4.0 assessment during Screening prior to Day BL1.
4. Anemic, defined as a Hgb < 10 g/dL in Screening/Baseline period.
5. Previously treated with an approved JAK inhibitor for PMF or Post-PV/ET MF for ≥ 90 days, or ≥ 28 days if JAK inhibitor therapy is complicated by RBC transfusion requirement of ≥ 4 units in 8 weeks, or Grade 3/4 AEs of thrombocytopenia, anemia, or hematoma.
6. Baseline splenomegaly, defined as having a palpable spleen at ≥ 5 cm, below the left costal margin, or with volume ≥ 450 cm³ on imaging (ultrasound, MRI or CT are acceptable), assessed during Screening at any point prior to Randomization.
7. High risk, intermediate-2, or intermediate-1 risk MF as defined by DIPSS, or DIPSS-plus.
8. No allogeneic stem cell transplant planned.

9. Acceptable laboratory assessments:

   • Absolute neutrophil count (ANC) ≥ 0.75 × 10⁹/L.
   • Platelet count (PLT) ≥ 25 × 10⁹/L (without requirement for platelet transfusion).
   • Peripheral blast count < 10%.
   • Alanine aminotransferase/ glutamic-oxaloacetic transaminase (AST/SGOT) and alanine aminotransferase/ serum glutamic-pyruvic transaminase (ALT/SGPT) ≤ 3 × ULN (≤ 5 × ULN if liver is involved by extramedullary hematopoiesis as judged by the investigator or if related to iron chelator therapy that was started within the prior 60 days).
   • Calculated creatinine clearance (CCr) ≥ 30 mL/min according to Cockcroft-Gault.
   • Direct bilirubin ≤ 2.0 × ULN.

Exclusion Criteria:

1. Use of the following treatments within the time periods noted:

   1. Prior momelotinib treatment at any time.
   2. Approved JAK inhibitor therapy (eg, fedratinib or ruxolitinib) within 1 week prior to the first day of Baseline.
   3. Active anti-MF therapy within 1 week prior to the first day of Baseline.
   4. Potent Cytochrome P450 3A4 (CYP3A4) inducers within 1 week prior to Randomization.
   5. Investigational agent (including investigational JAK inhibitors) within 4 weeks prior to Randomization.
   6. Erythropoiesis stimulating agent (ESA) within 4 weeks prior to Randomization.
   7. Danazol within 3 months prior to Randomization.
   8. Splenic irradiation within 3 months prior to Randomization.
   9. Current treatment with simvastatin, atorvastatin, lovastatin or rosuvastatin.
2. History of prostate cancer, with the exception of localized prostate cancer that has been treated surgically or by radiotherapy with curative intent and presumed cured.
3. Prostate specific antigen (PSA) > 4 ng/mL.
4. Unsuitable for spleen volume measurements due to prior splenectomy or unwilling or unable to undergo an MRI or CT scan for spleen volume measurement per protocol requirements.

5. Any of the following (criteria a - k):

   1. Uncontrolled intercurrent illness including, but not limited to: active uncontrolled infection (subjects receiving outpatient antibacterial and/or antiviral treatments for infection that is under control or as infection prophylaxis may be included in the trial).
   2. Significant active or chronic bleeding event ≥ Grade 2 per Common Terminology Criteria for Adverse Events (CTCAE) v5.0, within 4 weeks prior to Randomization.
   3. Unstable angina pectoris within 6 months prior to Randomization.
   4. Symptomatic congestive heart failure within 6 months prior to Randomization.
   5. Uncontrolled cardiac arrhythmia within 6 months prior to Randomization.
   6. QTcF interval > 500 msec, unless attributed to bundle branch block.
   7. Current progressive thrombosis despite treatment.
   8. History of porphyria.
   9. Child-Pugh score ≥ 10.
   10. Psychiatric illness, social situation, or any other condition that would limit compliance with trial requirements or may interfere with the interpretation of study results, as judged by investigator or sponsor.
   11. Inability or unwillingness to comply with the protocol restrictions on MF therapy and other medications prior to and during study treatment.
6. Subjects with a prior or concurrent malignancy, whose natural history or treatment has a significant potential to interfere with the safety or efficacy assessment of the investigational regimen.
7. Known clinically significant anemia due to iron, vitamin B12, or folate deficiencies, or autoimmune or hereditary hemolytic anemia, or gastrointestinal bleeding or thalassemia.
8. Known positive status for HIV.
9. Chronic active or acute viral hepatitis A, B, or C infection, or hepatitis B or C carrier (testing required for hepatitis B and C).
10. Unresolved non-hematologic toxicities from prior therapies that are > Grade 1 per CTCAE v5.0.
11. Presence of peripheral neuropathy ≥ Grade 2 per CTCAE v5.0.
12. Women who are already pregnant or lactating.

Additional inclusion/exclusion criteria may apply.

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 18 Years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Australia, Austria, Belgium, Bulgaria, Canada, Czechia, Denmark, France, Germany, Hungary, Israel, Italy, Korea, Republic of, New Zealand, Poland, Romania, Singapore, Spain, Sweden, Taiwan, United Kingdom, United States

Administrative Information

• NCT Number: NCT04173494
• Other Study ID Numbers: SRA-MMB-301
• Has Data Monitoring Committee: Not Provided

U.S. FDA-regulated Product

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

IPD Sharing Statement

• Plan to Share IPD: No

• Current Responsible Party: Sierra Oncology, Inc.
• Original Responsible Party: Same as current
• Current Study Sponsor: Sierra Oncology, Inc.
• Original Study Sponsor: Same as current
• Collaborators: Not Provided

Investigators

• Principal Investigator: Srdan Verstovsek, M.D., Ph.D.; Department of Leukemia, The University of Texas MD Anderson Cancer Center

• PRS Account: Sierra Oncology, Inc.
• Verification Date: January 2022