Imetelstat Sodium in Treating Patients With Primary or Secondary Myelofibrosis

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ClinicalTrials.gov Identifier: NCT01731951

Recruitment Status : Completed

First Posted : November 22, 2012

Last Update Posted : May 24, 2019

Sponsor:

Information provided by (Responsible Party):

Geron Corporation

Study Description

Brief Summary:

This pilot clinical trial studies how well imetelstat sodium works in treating patients with primary or secondary myelofibrosis and other myeloid malignancies. Imetelstat sodium may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth

Condition or disease	Intervention/treatment	Phase
Primary Myelofibrosis Secondary Myelofibrosis Myeloid Malignancies	Drug: Imetelstat	Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To evaluate overall response rate.

SECONDARY OBJECTIVES:

I. To evaluate the safety and tolerability of imetelstat (imetelstat sodium) in myelofibrosis (MF).

II. To evaluate the efficacy of imetelstat in the reduction of spleen size, as measured by physical examination (palpable distance from the left costal margin).

III. To evaluate the efficacy of imetelstat in improving anemia or inducing red blood cell transfusion-independence in previously transfusion-dependent patients (per International Working Group for Myelofibrosis Research and Treatment [IWG-MRT] criteria).

IV. To evaluate onset and durability of response as defined in primary and secondary endpoints

EXPLORATORY OBJECTIVES:

I. To evaluate the effect of imetelstat on bone marrow histology, karyotype and JAK2V617F allele burden II. To evaluate the effect of imetelstat on leukocytosis, circulating blast count, circulating immature myeloid cell count and thrombocytosis.

OUTLINE: Patients receive imetelstat sodium intravenously (IV) over 2 hours on day 1. Patients may continue to receive imetelstat study treatment for as long as they derive clinical benefit or until study end. The study will end when all patients have discontinued study drug, the last patient enrolled has been treated for 5 years, or imetelstat is commercially available in the United States, whichever occurs first.

After completion of study treatment, patients are followed up every 6 months for 5 years.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	81 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	A Pilot Open-Label Study of the Efficacy and Safety of Imetelstat (GRN163L) in Myelofibrosis and Other Myeloid Malignancies
Actual Study Start Date :	October 31, 2012
Actual Primary Completion Date :	May 24, 2018
Actual Study Completion Date :	May 24, 2018

Resource links provided by the National Library of Medicine

Genetics Home Reference related topics: Primary myelofibrosis

Genetic and Rare Diseases Information Center resources: Myelodysplastic Syndromes Myelofibrosis Chronic Myeloproliferative Disorders

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Experimental: Arm A Myelofibrosis (MF) participants will receive Imetelstat, 9.4 milligram per kilogram (mg/kg), intravenously [IV] as 2 hour infusion, on Day 1 of every 21-day cycle as long as they derive clinical benefit or until study end.	Drug: Imetelstat Imetelstat Sodium administered as IV over 2 hours with treatment as long as participants derive clinical benefit or until study end. with the following dose and schedule: Starting doses are 7.5 mg/kg or 9.4 mg/kg from weekly to every four weeks based on indication as per arms. Other Name: GRN163L
Experimental: Arm B MF participants will receive Imetelstat, 9.4mg/kg, IV as 2 hour infusion, on Day 1, 8, 15 of Cycle 1, then Day 1 of each subsequent 21-day cycle as long as they derive clinical benefit or until study end.	Drug: Imetelstat Imetelstat Sodium administered as IV over 2 hours with treatment as long as participants derive clinical benefit or until study end. with the following dose and schedule: Starting doses are 7.5 mg/kg or 9.4 mg/kg from weekly to every four weeks based on indication as per arms. Other Name: GRN163L
Experimental: Arm D Blast phase MF participants will receive Imetelstat, 9.4mg/kg, IV as 2 hour infusion, on Day 1, 8, 15, 22 of every 28-day cycle as long as they derive clinical benefit or until study end.	Drug: Imetelstat Imetelstat Sodium administered as IV over 2 hours with treatment as long as participants derive clinical benefit or until study end. with the following dose and schedule: Starting doses are 7.5 mg/kg or 9.4 mg/kg from weekly to every four weeks based on indication as per arms. Other Name: GRN163L
Experimental: Arm E MF participants with spliceosome mutations or ring sideroblasts will receive Imetelstat, 7.5mg/kg, IV as 2 hour infusion, on Day 1 of every 28-day cycle as long as they derive clinical benefit or until study end.	Drug: Imetelstat Imetelstat Sodium administered as IV over 2 hours with treatment as long as participants derive clinical benefit or until study end. with the following dose and schedule: Starting doses are 7.5 mg/kg or 9.4 mg/kg from weekly to every four weeks based on indication as per arms. Other Name: GRN163L
Experimental: Arm F MF participants without spliceosome mutations or ring sideroblasts will receive Imetelstat, 9.4mg/kg on Day1 of every 28-day cycle as long as they derive clinical benefit or until study end.	Drug: Imetelstat Imetelstat Sodium administered as IV over 2 hours with treatment as long as participants derive clinical benefit or until study end. with the following dose and schedule: Starting doses are 7.5 mg/kg or 9.4 mg/kg from weekly to every four weeks based on indication as per arms. Other Name: GRN163L
Experimental: Arm G Myelodysplastic syndromes (MDS)/ myeloproliferative neoplasm (MPN) or MDS participants with spliceosome mutations or ring sideroblasts will receive Imetelstat, 7.5mg/kg on Day 1 of every 28-day cycle as long as they derive clinical benefit or until study end.	Drug: Imetelstat Imetelstat Sodium administered as IV over 2 hours with treatment as long as participants derive clinical benefit or until study end. with the following dose and schedule: Starting doses are 7.5 mg/kg or 9.4 mg/kg from weekly to every four weeks based on indication as per arms. Other Name: GRN163L

Outcome Measures

Primary Outcome Measures :

MF patients: Overall response rate defined as a clinical improvement (CI), partial remission (PR), or complete remission (CR) according to the IWG-MRT consensus criteria [ Time Frame: Up to 3 years ]
Will be estimated by the number of successes divided by the total number of evaluable patients.
MDS patients: Overall response rate according to the IWG response criteria in myelodysplasia [ Time Frame: Up to 3 years ]
Will be estimated by the number of successes divided by the total number of evaluable patients.

Secondary Outcome Measures :

Maximum grade for each type of adverse event for each patient [ Time Frame: Up to 5 years ]
Frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration.
Spleen response defined as either a minimum 50% reduction in palpable splenomegaly of a spleen that is at least 10 cm at baseline or a spleen that is palpable at more than 5 cm at baseline becomes not palpable [ Time Frame: Up to 3 years ]
Will be calculated by the number of patients who achieve spleen response divided by the total number of evaluable patients with spleen involvement at baseline (estimated to be approximately 80% of patients).
Proportion of patients achieving transfusion independence [ Time Frame: Up to 3 years ]
Will be estimated by the number of patients who achieve transfusion independence divided by the total number of evaluable patients who were transfusion dependent at baseline.

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Diagnosis of one of the following:
- primary myelofibrosis (PMF) per the revised World Health Organization (WHO) criteria
- post-polycythemia vera/essential thrombocythemia myelofibrosis (Post-ET/PV MF) per the International Working Group for Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) criteria
High-risk or Intermediate-2 risk MF (as defined by the Dynamic International Prognostic Scoring System [DIPSS-plus])
Life expectancy of greater than or equal to (>=) 12 weeks
Able to provide informed consent and be willing to sign an informed consent form
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 2.5 x upper limit of normal (ULN) (or =< 5 x ULN if in the investigator's opinion the elevation is due to extramedullary hematopoiesis)
Serum glutamic pyruvate transaminase (SGPT) alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN) (or =<5 x ULN if in the investigator's opinion the elevation is due to extramedullary hematopoiesis)
Total bilirubin =< 3.0 mg/dL (or direct bilirubin < 1 mg/dL)
Creatinine =< 3.0 mg/dL
Absolute neutrophil count >= 1000/microliter (mcL)
Platelet count >= 50,000/mcL
Absence of active treatment with systemic anticoagulation and a baseline prothrombin time (PT) and activated partial thromboplastin time (aPTT) that does not exceed 1.5 x ULN
Females of childbearing potential must have a negative pregnancy test =< 7 days prior to registration, unless they are surgically sterile for at least 3 months (i.e., hysterectomy), OR postmenopausal for at least 12 months (follicle-stimulating hormone [FSH] >30 U/mL)
Females of childbearing potential must agree to take appropriate precautions to avoid pregnancy (with at least 99% certainty) from screening through end of study; permitted methods for preventing pregnancy must be communicated to study subjects and their understanding confirmed
Males must agree to take appropriate precautions to avoid fathering a child (with at least 99% certainty) from screening through follow-up; permitted methods for preventing pregnancy should be communicated to the subjects and their understanding confirmed

Exclusion Criteria:

Females who are pregnant or are currently breastfeeding
Any chemotherapy (e.g., hydroxyurea), immunomodulatory drug therapy (e.g., thalidomide), immunosuppressive therapy, corticosteroids > 10 mg/day prednisone or equivalent, growth factor treatment (e.g., erythropoietin) or Janus kinase (JAK) inhibitor therapy =< 14 days prior to registration
Subjects with another active malignancy
- Note: patients with early stage squamous cell carcinoma of the skin, basal cell carcinoma of the skin or cervical intraepithelial neoplasia are eligible for enrollment
Known positive status for human immunodeficiency virus (HIV)
Any unresolved toxicity greater or equal to grade 2 from previous anticancer therapy, except for stable chronic toxicities not expected to resolve
Incomplete recovery from any prior surgical procedures or had surgery =< 4 weeks prior to registration, excluding the placement of vascular access
Presence of acute active infection requiring antibiotics
Uncontrolled intercurrent illness or any concurrent condition that, in the Investigator's opinion, would jeopardize the safety of the patient or compliance with the protocol

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01731951

Locations

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United States, Minnesota

Rochester, Minnesota, United States

Sponsors and Collaborators

Geron Corporation

Investigators

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Study Director:	Faye Feller, MD	Geron Corporation

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Tefferi A, Lasho TL, Begna KH, Patnaik MM, Zblewski DL, Finke CM, Laborde RR, Wassie E, Schimek L, Hanson CA, Gangat N, Wang X, Pardanani A. A Pilot Study of the Telomerase Inhibitor Imetelstat for Myelofibrosis. N Engl J Med. 2015 Sep 3;373(10):908-19. doi: 10.1056/NEJMoa1310523.

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Responsible Party:	Geron Corporation
ClinicalTrials.gov Identifier:	NCT01731951 History of Changes
Other Study ID Numbers:	CR107110 CP14B019 ( Other Identifier: Janssen Research & Development, LLC )
First Posted:	November 22, 2012 Key Record Dates
Last Update Posted:	May 24, 2019
Last Verified:	May 2019

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

Keywords provided by Geron Corporation:


Myelofibrosis Myelodysplastic Syndromes Myeloproliferative Neoplasm Imetelstat GRN163L

Additional relevant MeSH terms:

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Neoplasms Neoplasm Metastasis Primary Myelofibrosis Neoplastic Processes Pathologic Processes Myeloproliferative Disorders Bone Marrow Diseases Hematologic Diseases Imetelstat Motesanib diphosphate	Niacinamide Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Protein Kinase Inhibitors Vitamin B Complex Vitamins Micronutrients Nutrients Growth Substances Physiological Effects of Drugs

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