This study will be an open-label phase 1/2a study to evaluate the safety and tolerability of PXS-5505 in patients with primary, postpolycythemia vera (PV) or post-essential thrombocythemia (ET) myelofibrosis.
The study consists of three phases: a dose escalation phase, a cohort expansion phase, and an add-on phase. The dose escalation phase will follow a 3+3 design with a starting dose of 100 mg twice daily, and a treatment duration of 4 weeks. Patients will be able to participate in more than one dose level. During the cohort expansion phase, up to 24 patients will be treated at the dose determined appropriate based on safety, pharmacokinetic and pharmacodynamic results from the dose escalation phase, for a period of up to 6 months. Patients from the dose escalation phase will be able to participate in the cohort expansion phase. In the add-on phase PXS-5505 will be given to patients, already receiving a stable dose of ruxolitinib, for a period of 12 months. Up to 15 patients will enrol in the add-on phase in order to obtain 12 patients with at least 1 month's exposure to PXS-5505 on top of ruxolitinib. Note: The decision to include an add-on phase, where PXS-5505 is to be given on top of a stable ruxolitinib dose, was taken following a review of the data (safety, PK and PD) from the cohort expansion phase. There will be no washout period between dose escalation and dose expansion cohorts.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
43
PXS-5505 is a hard capsule (size 0) with the additional excipients mannitol and magnesium stearate.
Comprehensive Cancer Center (UAB CCC)
Birmingham, Alabama, United States
Number of subjects with serious and non-serious adverse events
Safety and tolerability of PXS-5505 in patients with myelofibrosis will be assessed
Time frame: Day 0 to follow-up visit (28 days -1 to +7days post-Tx discontinuation [dose escalation phase]; Day 0 to 28 days ± 3 days post-Tx discontinuation [cohort expansion phase]); Day 0 to follow-up visit (28 days ± 3 days post-Tx discontinuation [add-on phase]
Maximum plasma concentration (C1hr=Cmax)
Pharmacokinetic parameters of PXS-5505 in patients with myelofibrosis will be assessed.
Time frame: Day 0, week 1 and week 4 (dose escalation), and Day 0, week 4, 12 and 24 (cohort expansion and add-on phase), and week 52 during add-on phase only
Minimum plasma concentration (Cmin)
Pharmacokinetic parameters of PXS-5505 in patients with myelofibrosis will be assessed.
Time frame: Day 0, week 1 and week 4 (dose escalation), and Day 0, week 4, 12 and 24 (cohort expansion and add-on phase), and week 52 during add-on phase only
Lysyl oxidase and lysyl oxidase-like 2 inhibition in plasma
Pharmacodynamic parameters of PXS-5505 in patients with myelofibrosis will be assessed.
Time frame: Day 0, week 1 and week 4 dose escalation, and at week 0, 4, 12, 24 (cohort expansion and add-on phase), and week 52 during add-on phase only
Change in bone marrow (BM) fibrosis
Change in bone marrow fibrosis will be assessed according to European Consensus on grading of bone marrow fibrosis
Time frame: Day 0, Week 12 and Week 24 (cohort expansion and add-on phase), and week 52 during add-on phase only
Response rate
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Novant Health Cancer Institute
Winston-Salem, North Carolina, United States
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Liverpool Hospital
Liverpool, New South Wales, Australia
Ashford Cancer Centre Research
Adelaide, South Australia, Australia
St Vincent's Hospital Melbourne
Fitzroy, Victoria, Australia
One Clinical Research
Perth, Western Australia, Australia
The Perth Blood Institute
West Perth, Western Australia, Australia
Inje University Busan Paik Hospital - Internal Medicine
Busan, Busan Gwang'yeogsi [Pusan-Kwan, South Korea
Keimyung University Dongsan Hospital
Daegu, Daegu Gwang'yeogsi [Taegu-Kwangyokshi], South Korea
...and 13 more locations
Response rates as defined by International Working Group (IWG)-Myeloproliferative Neoplasms Research and Treatment criteria in patients with myelofibrosis administered PXS-5505 will be determined.
Time frame: At week 12 and week 24 (cohort expansion and add-on phase), weeks 38 and 52 during add-on phase only
Changes in spleen volume
Changes in spleen volume, as measured by computed tomography (CT) or magnetic resonance imaging (MRI) scan, in patients with myelofibrosis administered PXS-5505 will be determined.
Time frame: Day 0, week 12, and week 24 (cohort expansion and add-on phase), weeks 38 and 52 during add-on phase only
Changes in myelofibrosis related symptoms
Changes in myelofibrosis related symptoms based on Myelofibrosis-Symptom Assessment Form (MFSAF) v4.0 scores, in patients with myelofibrosis administered PXS-5505 will be determined. A higher score indicates worse symptoms.
Time frame: Screening, week 12, and week 24 (cohort expansion and add-on phase), weeks 38 and 52 during add-on phase only
Percentage of patients with hematological changes
Hematological changes will be determined
Time frame: Day 0, week 12, and 24 (cohort expansion and add-on phase), weeks 38 and 52 during add-on phase only