Ruben A. Mesa, MD, on Myelofibrosis: Phase III Results on Momelotinib vs Danazol
2022 ASCO Annual Meeting
Ruben A. Mesa, MD, of Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, discusses new findings from the MOMENTUM study. This trial showed that in symptomatic and anemic patients with myelofibrosis, momelotinib was superior to danazol for symptom and spleen responses, as well as transfusion requirements (Abstract 7002).
Transcript
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Myelofibrosis in 2022 continues to have significant unmet needs. We currently have now three approved drugs in the disease's background, ruxolitinib, fedratinib, and now pacritinib most recently. Still the issue of anemia remains a difficult issue in myelofibrosis as we try to holistically treat patients with the disease. The MOMENTUM study, which I presented on behalf of investigators at the 2022 ASCO meeting in Chicago was a phase three randomized clinical trial. The third phase three trial performed for momelotinib, where two prior studies that had demonstrated benefits in terms of improving splenomegaly symptoms, and anemia. The SIMPLIFY-1 study, which was a frontline study and the SIMPLIFY-2 study. Now there was still critical additional data, which was required to really fulfill the momelotinib story. So the MOMENTUM study was designed. As background momelotinib is a JAK 1 and JAK 2 inhibitor, but also inhibits ACVR1, which we feel inhibits hepcidin that helps to improve potentially anemia in myelofibrosis. So the MOMENTUM study is a randomized study of momelotinib versus an active control arm of danazol for patients who were symptomatic, they were anemic and they had previously failed JAK inhibitor therapy with ruxolitinib. They were randomized two to one between momelotinib and danazol. We found that the study was positive and met all of its primary endpoints as we reported at the ASCO meeting. First, it was clearly superior for control of symptoms as measured by the MPN symptom assessment form. Second, it was non-inferior for anemia by its primary endpoint, as it related to anemia with an improvement in transfusion independence from 13% to 31% on the momelotinib arm and 15 to 20% on the danazol arm. So danazol had activity, it was an active control arm. We felt that it was a very valuable, appropriate comparator for momelotinib. And overall the trend was certainly superior for momelotinib versus danazol, but at least non-inferior, which had been the endpoint on the study. By additional analysis as we look at transfusion free for the whole study period, it was clear that momelotinib was superior to danazol for that piece. Finally, it was clearly superior for improvement in splenomegaly. Whether we look at a 35% cut off by volume, which is the traditional endpoint or this being a second line study, we also looked at a 25% improvement in splenomegaly, which was 40% versus a much smaller percentage from danazol was highly statistically significant. So the takeaways, momelotinib was clearly superior to danazol on randomized phase three blinded clinical-controlled trial in terms of improvements in splenomegaly symptoms and anemia. We believe that in addition with the data which we already have from momelotinib and SIMPLIFY-1, and SIMPLIFY-2, this really constitutes a very profound, robust set of data for momelotinib to have it hopefully become registered as an option for patients with myelofibrosis, particularly if they suffer from splenomegaly symptoms and anemia. We presented additional data at the ASCO 2022 meeting, as it related to momelotinib and momentum. My colleague, Dr. Aaron Gerds presented an additional analysis where we were looking at the data for individuals who had significant thrombocytopenia and the anemia of thrombocytopenia are sometimes concurrent. On the MOMENTUM study. Anyone was eligible who had a platelet count of over 25,000. So looking at both individuals with a platelet count of under a hundred thousand and under 50,000, one we saw significant efficacy and safety in both of those groups, superiority versus danazol, which we had fully expected, but also really there could be used safely, even in those settings with significant thrombocytopenia. We think that's particularly helpful in that this phenotype of cytopenic myelofibrosis sometimes both anemia and thrombocytopenia can be concurrent and it makes it more relevant and a broader option, potentially for momelotinib in these patients.
Related Videos
The ASCO Post Staff
Manali I. Patel, MD, MPH, of Stanford University School of Medicine, discusses clinical trial findings on the best ways to integrate community-based interventions into cancer care delivery for low-income and minority populations. Such interventions may improve quality of life and patient activation (often defined as patients having the knowledge, skills, and confidence to manage their health), as well as reduce hospitalizations and the total costs of care (Abstract 6500).
The ASCO Post Staff
Sumanta K. Pal, MD, of City of Hope National Medical Center, discusses findings from the COSMIC-021 study, which showed that cabozantinib plus atezolizumab demonstrated encouraging clinical activity with manageable toxicity in patients with inoperable locally advanced or metastatic urothelial carcinoma. The combination was administered as first-line therapy in cisplatin-based chemotherapy–eligible and –ineligible patients and as second- or later-line treatment in those who received prior immune checkpoint inhibitors (Abstract 4504).
The ASCO Post Staff
Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, and Takayuki Yoshino, PhD, MD, of the National Cancer Center Hospital East, Japan, discuss results from the PARADIGM trial, the first prospective study to test the superiority of panitumumab vs bevacizumab in combination with standard doublet first-line chemotherapy for patients with RAS wild-type and left-sided metastatic colorectal cancer. The study showed that panitumumab improved overall survival in combination with mFOLFOX6, which may establish a standard first-line combination regimen for this population (Abstract LBA1).
The ASCO Post Staff
Nabil F. Saba, MD, of Winship Cancer Institute of Emory University, discusses new data from a trial of pembrolizumab and cabozantinib in patients with recurrent metastatic head and neck squamous cell carcinoma. The study met its primary endpoint of overall response rate. The regimen was well tolerated and exhibited encouraging clinical activity in this patient population (Abstract 6008).
Lisa A. Carey, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center, and Hope S. Rugo, MD, of the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discuss phase III results from the TROPiCS-02 trial. This study showed that sacituzumab govitecan-hziy was more beneficial than single-agent chemotherapy in terms of progression-free survival in heavily pretreated patients with hormone receptor–positive/HER2-negative and unresectable advanced breast cancer (LBA1001).
