MPN-478 MOMENTUM: Phase 3 Randomized Study of Momelotinib (MMB) versus Danazol (DAN) in Symptomatic and Anemic Myelofibrosis (MF) Patients Previously Treated With a JAK Inhibitor

Ruben Mesa, Aaron Gerds, Alessandro Vannucchi, Haifa Kathrin Al-Ali, David Lavie, Andrew Kuykendall, Sebastian Grosicki, Alessandra Iurlo, Yeow Tee Goh, Mihaela Lazaroiu, Miklos Egyed, Maria Laura Fox, Donal McLornan, Andrew Perkins, Sung Soo Yoon, Vikas Gupta, Jean Jacques Kiladjian, Rafe Donahue, Jun Kawashima, Srdan Verstovsek

Research output: Contribution to journalArticlepeer-review

Abstract

Background: MMB, a JAK1/2 and ACVR1/ALK2 inhibitor, showed clinical activity in the MF SIMPLIFY trials. The pivotal phase 3 MOMENTUM study of MF patients previously treated with a JAK inhibitor (JAKi) tested MMB vs DAN on key symptom, anemia, and splenic endpoints. Methods: Eligibility: Primary or post- essential thrombocythemia (ET)/polycythemia vera (PV) MF; DIPSS High/Int-2/Int-1; MF symptom assessment form total symptom score (TSS) ≥10; hemoglobin <10 g/dL; prior JAKi ≥90 days, or ≥28 days if RBC transfusions ≥4 units in 8 weeks or grade 3/4 thrombocytopenia, anemia, or hematoma; palpable spleen ≥5 cm. Stratification: TSS, palpable spleen, and RBC units transfused. JAKi taper/washout ≥21 days. Randomization: 2:1 MMB 200 mg QD+DAN placebo or DAN 600 mg QD+MMB placebo for 24 weeks. Primary endpoint: TSS response (≥50% reduction from baseline) rate at week 24. Secondary endpoints, assessed sequentially at week 24: transfusion independence (TI) rate, splenic response rate (SRR; ≥25% volume reduction from baseline), TSS change from baseline, SRR (≥35% reduction) and rate of zero transfusions since baseline. Results: 94/130 (72%) MMB and 38/65 (58%) DAN patients completed randomized treatment (RT). Mean baseline TSS were 28 (MMB) and 26 (DAN), hemoglobin levels were 8.1 (MMB) and 7.9 (DAN) g/dL, and median platelets were 97 (MMB) and 94 (DAN) x109/L. Baseline TI was 13% (MMB) and 15% (DAN). Prior JAKi was ruxolitinib in 195 (100%) and fedratinib in 9 (5%) patients. All primary and key secondary endpoints were met: TSS response (24.6% vs 9.2%), TI (30.8% vs 20.0%), SRR25 (40.0% vs 6.2%), TSS change (-9.36 vs -3.13), SRR35 (23.1% vs 3.1%), and zero transfusions (35.4% vs 16.9%). Most common grade ≥3 TEAEs in RT were thrombocytopenia (MMB, 22%; DAN, 12%) and anemia (MMB, 8%; DAN, 11%). TEAEs led to study drug discontinuation in 18% of MMB and 23% of DAN patients in RT. Trend toward improved survival up to week 24 was seen with MMB vs DAN (HR=0.506, p=0.0719). Conclusions: In symptomatic and anemic MF patients, MMB was superior to DAN for symptom responses, transfusion requirements, and spleen responses with comparable safety and favorable survival. MMB may address a critical unmet need, particularly in MF patients with anemia.

Original languageEnglish (US)
Pages (from-to)S339-S340
JournalClinical Lymphoma, Myeloma and Leukemia
Volume22
DOIs
StatePublished - Oct 2022
Externally publishedYes

Keywords

  • anemia
  • JAK inhibitor
  • momelotinib
  • MPN
  • myelofibrosis
  • Phase III

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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