Luspatercept for Anemia in Lower Risk MDS or Non-proliferative MDS/MPN Neoplasms

Anemia Clinical Trial

Official title:

A Phase 2, Single Arm Study of Luspatercept for the Treatment of Anemia in Lower Risk Myelodysplastic Syndromes (MDS) or Non-Proliferative Myelodysplastic Syndromes/ Myeloproliferative Neoplasms (MDS/MPN)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05732961
• Other study ID #: MCC-21405
• Status: Recruiting
• Phase: Phase 2
• Start date: February 21, 2023
• Est. completion date: May 2025

Study information

• Verified date: May 2024
• Source: H. Lee Moffitt Cancer Center and Research Institute
• Contact: Rami Komrokji, MD
• Phone: 813-745-4748
• Email: Rami.Komrokji[@]moffitt.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of the study is to see if participants with anemia due to their type of MDS or MDS/MPN will experience a more decreased need for regular blood transfusions if they take luspatercept plus best supportive care, and what effect, good and/or bad, luspatercept has on them and their anemia due to MDS or MDS/MPN. The safety and tolerability of luspatercept will also be evaluated in this study.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 70
• Est. completion date: May 2025
• Est. primary completion date: May 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Participant is =18 years at the time of signing the informed consent form

2. Participant is willing and able to adhere to the study visit schedule and other protocol requirements

3. Documented diagnosis of MDS or non-proliferative MDS/MPN (WBC < 13,000 U/L)

1. According to WHO 2016 classification

2. Meets IPSS-R classification of very low, low, or intermediate risk disease

4. Documented acquired splicing gene mutation

1. Cohort 1: detectable splicing mutation other than SF3B1: (SRSF2, U2AF1, ZRSR2)

2. Cohort 2: SF3B1 mutation with prior treatment with hypomethylating agent and or lenalidomide

5. <5% blasts in bone marrow

6. Refractory, intolerant to, or ineligible for, prior ESA treatment, as defined by any one of the following:

1. Refractory to prior ESA treatment - non-response or response that is no longer maintained. ESA regimen must have been either:

• rHu EPO = 40,000 IU/wk for at least 8 doses or equivalent Or darbepoetin alpha = 500 µg Q3W for at least 4 doses or equivalent

2. Intolerant to prior ESA treatment - discontinuation of prior ESA-containing regimen, at any time after introduction due to intolerance or AE

3. ESA ineligible - Low chance of response to ESA based on endogenous serum EPO > 200 U/L for subjects not previously treated with ESAs

7. Discontinuation of ESAs, G-CSF, GM-CSF = 4 weeks prior to start of study treatment

8. Require RBC transfusions

a. Average of = 2 units/8 weeks of pRBCs confirmed for a minimum of 16 weeks immediately preceding registration

9. Applies to on treatment subjects only - females of childbearing potential (FCBP) defined as a sexually mature woman 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) and must:

• Have two negative pregnancy tests 48 hours apart as verified by the investigator prior to starting study therapy. She must agree to ongoing pregnancy testing during the course of the study, and after end of study therapy. This applies even if the subject practices true abstinence* from heterosexual contact.

• 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, 35 days prior to starting

10. investigational product (IP), during the study therapy (including dose interruptions), and for 84 days after discontinuation of study therapy

11. Applies to on treatment subjects only - Male subjects must:

1. 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 84 days following investigational product discontinuation even if he has undergone a successful vasectomy. * True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception).

Exclusion Criteria:

1. Prior allogeneic or autologous stem cell transplant

2. MDS associated with del 5q cytogenetic abnormality if no prior lenalidomide treatment

3. Uncontrolled hypertension, defined as repeated elevations of diastolic blood pressure (DBP) = 100 mmHg despite adequate treatment

4. ANC < 500/µL (0.5 x 109/L)

5. Platelet count ?50,000/µL (50 x 109/L)

6. Active other malignancies

7. Severe renal impairment (eGFR < 30 mL/min/1.73 m2)

8. ALT or AST = 3 × ULN

9. Prior treatment with Luspatercept or Sotatercept

10. Pregnant or breastfeeding females

Related Conditions & MeSH terms

• Anemia
• Myelodysplastic Syndromes
• Myeloproliferative Disorders
• Myeloproliferative Neoplasm
• Neoplasms
• Preleukemia
• Syndrome

Intervention

Drug:
• Luspatercept
Participants will be treated with Luspatercept, with a starting dose of 1.0 mg/kg subcutaneous injection every 3 weeks (administered on Day 1 of each 21-day treatment cycle)

Locations

Country	Name	City	State
United States	Moffitt Cancer Center	Tampa	Florida

Sponsors (2)

Lead Sponsor	Collaborator
H. Lee Moffitt Cancer Center and Research Institute	Bristol-Myers Squibb

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	RBC Transfusion Independence	RBC transfusion independence (RBC-TI) as defined by IWG 2006 MDS response criteria	From start of treatment to up to 18 months
Secondary	Incidence of treatment related adverse events	To determine the number of participants with treatment related AEs using CTCAE v5	From start of treatment to 30 days after the last day of treatment, up to 19 months
Secondary	Hematological Improvement	Hematological improvement as defined by using IWG 2006 MDS response criteria	From start of treatment to up to 18 months
Secondary	Duration of Response	The duration of response is measured from the time measurement criteria are met for RBC TI or HI by IWG 2006 criteria until the first date of loss of response or progressive disease is objectively documented.	From start of treatment to up to 18 months
Secondary	ASC specks changes with response	ASC specks as biomarker of response, investigators will compare mean baseline percentage of ASC specks among responders and non-responders (t-test) and use paired t-test to compare change in mean percentage of ASC specks with treatment among responders and non-responders	End of treatment, up to 18 months