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
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
Number of Subjects With Serious and Non-serious Adverse Events
Safety and tolerability of PXS-5505 in patients with myelofibrosis will be assessed. More details on the types of AEs can be found in the safety results section.
Time frame: Day 0 to follow-up visit (28 -1/+7days post-Tx end) after up to 4wks Tx [escalation phase]; Day 0 to follow-up visit (28±3days post-Tx end) after up to 24wks Tx [expansion]); Day 0 to follow-up visit (28± 3days post-Tx end) after up to 52wks Tx [add-on].
Maximum Plasma Concentration (Cmax)
Pharmacokinetic parameters of PXS-5505 in patients with myelofibrosis. Cmax was taken to be the concentration at 1 hour post-dose.
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. Cmin was the concentration pre-dose at each visit.
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. LOX and LOXL2 inhibition expressed as a percentage of the pre-dose activity on Day 0.
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 - Reticulin
Change in bone marrow reticulin fibrosis assessed according to European Consensus on grading of bone marrow fibrosis, centrally assessed.
Time frame: Day 0, Week 12 and Week 24 (cohort expansion and add-on phase), and week 52 during add-on phase only
Change in Bone Marrow (BM) Fibrosis - Collagen
Change in bone marrow collagen fibrosis, assessed according to European Consensus on grading of bone marrow fibrosis via central review
Time frame: Day 0, Week 12 and Week 24 (cohort expansion and add-on phase), and week 52 during add-on phase only
IWG-MRT Response Rate, Investigator Assessment
Response rates as assessed by the investigator based on International Working Group (IWG)-Myeloproliferative Neoplasms Research and Treatment criteria in patients with myelofibrosis administered PXS-5505
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
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 Spleen Volume - Achievement of SVR25
Achievement of a reduction of 25% from baseline in the spleen volume in patients with myelofibrosis and enlarged spleen administered PXS-5505
Time frame: Week 12, and week 24 (cohort expansion and add-on phase), weeks 38 and 52 during add-on phase only
Changes in Spleen Volume - Achievement of SVR35
Achievement of a reduction of 35% from baseline in the spleen volume in patients with myelofibrosis and an enlarged spleen administered PXS-5505
Time frame: 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 - Achievement of TSS50
Achievement of a reduction of 50% from baseline in the Total Symptom Score (TSS) as measured by the Myelofibrosis-Symptom Assessment Form (MFSAF) v4.0, 7 day recall version, in patients with myelofibrosis administered PXS-5505. The MFSAF v4.0 assesses 7 core symptoms of myelofibrosis: fatigue, night sweats, pruritus, abdominal discomfort, pain under the left ribs, early satiety, and bone pain. Each symptom is rated on an 11-point scale from 0 (absent) to 10 (worst imaginable). The Total Symptom Score is calculated by adding the scores from each of the 7 individual symptoms. Therefore the range of possible scores is from 0 to 70, with a higher score indicating 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
Changes in Myelofibrosis Related Symptoms, Absolute Change in TSS
Absolute changes from baseline in Total Symptom Score (TSS) as measured by the Myelofibrosis-Symptom Assessment Form (MFSAF) v4.0, 7 day recall version, in patients with myelofibrosis administered PXS-5505. The MFSAF v4.0 assesses 7 core symptoms of myelofibrosis: fatigue, night sweats, pruritus, abdominal discomfort, pain under the left ribs, early satiety, and bone pain. Each symptom is rated on an 11-point scale from 0 (absent) to 10 (worst imaginable). The Total Symptom Score is calculated by adding the scores from each of the 7 individual symptoms. Therefore the range of possible scores is from 0 to 70, with a higher score indicating worse symptoms. A positive absolute change is indicative of worsened symptoms compared to baseline. A negative absolute change is indicative of improved symptoms compared to baseline.
Time frame: Screening, week 12, and week 24 (cohort expansion and add-on phase), weeks 38 and 52 during add-on phase only
Hematological Changes - % of Patients With Anemia Response, Minor Anemia Response, 50% Reduction in Transfusion Burden
Patients with hemoglobin \<100g/L at baseline who achieve an anemia response based on IWG-MRT criteria and who achieve a minor anemia response consistent with 2024 IWG-ELN criteria. Also, patients receiving transfusions at baseline who have a reduction of \>=50% in transfusion units in any rolling 12 week period from week 12 onwards, compared to the 12 weeks prior to treatment. Derived from data on hemoglobin level and transfusions.
Time frame: Any time from week 12 to week 24 (expansion phase) or to week 52 (add-on phase)
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