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Primary MyelofibrosisPhase 3FREEDOMNCT03755518

A Trial of Fedratinib in Subjects With DIPSS, Intermediate or High-Risk Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, or Post-Essential Thrombocythemia Myelofibrosis and Previously Treated With Ruxolitinib

A Phase 3 study testing FEDRATINIB in people with Primary Myelofibrosis and Post-Polycythemia Vera Myelofibrosis, run by Celgene at 35 sites in 2 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This is Single-Arm, Open-Label Efficacy and Safety Trial of Fedratinib in Subjects with DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High- Risk Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (post-PV MF), or Post-Essential Thrombocythemia Myelofibrosis (post-ET MF) and… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
FEDRATINIB
Could I receive a placebo?
No, everyone receives an active treatment
How many people
38 participants
Where
35 sitesin 2 countries
Study dates
27 Mar 2019to 8 Nov 2023
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Main Study Inclusion Criteria
  • Subject is at least 18 years of age at the time of signing the informed consent form (ICF)
  • Subject has an Eastern Cooperative Oncology Group (ECOG) Performance Score (PS) of 0, 1 or 2
  • Subject has diagnosis of primary myelofibrosis (PMF) according to the 2016 World Health Organization (WHO) criteria, or diagnosis of post-ET or post-PV myelofibrosis according to the IWG-MRT 2007 criteria, confirmed by the most recent local pathology report
  • Subject has a DIPSS Risk score of Intermediate or High
  • Subject has a measurable splenomegaly during the screening period as demonstrated by spleen volume of ≥ 450 cm3 by MRI or CT-scan assessment or by palpable spleen measuring ≥ 5 cm below the left costal margin.
Show all 15Show fewer
  • Subject has been previously exposed to ruxolitinib, while diagnosed with MF (PMF, post-ET MF or post-PV MF), and must meet at least one of the following criteria (a or b)
  • Treatment with ruxolitinib for ≥ 3 months
  • Treatment with ruxolitinib for ≥ 28 days complicated by any of the following:
  • Development of a red blood cell transfusion requirement (at least 2 units/month for 2 months) or
  • Grade ≥ 3 AEs of thrombocytopenia, anemia, hematoma, and/or hemorrhage while on treatment with ruxolitinib
  • Subject must have treatment-related toxicities from prior therapy resolved to Grade 1 or pretreatment baseline before start of last therapy prior to fedratinib treatment.
  • Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted
  • Subject is willing and able to adhere to the study visit schedule and other protocol requirements
  • Participants must agree to use effective contraception

Who cannot join

  • Main Study Exclusion Criteria
  • Any of the following laboratory abnormalities:
  • Platelets < 50,000/μL
  • Absolute neutrophil count (ANC) < 1.0 x 109/L
  • White blood count (WBC) > 100 x 10^9/L
  • Myeloblasts > 5 % in peripheral blood
Show all 36Show fewer
  • Estimated glomerular filtration rate < 30 mL/min/1.73 m^2 (as per the Modification of Diet in Renal Disease [MDRD] formula)
  • Serum amylase or lipase > 1.5 x ULN (upper limit of normal)
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3 x ULN
  • Total bilirubin > 1.5 x ULN, subject's total bilirubin between 1.5 - 3.0 x ULN are eligible if the direct bilirubin fraction is < 25% of the total bilirubin
  • Subject is pregnant or lactating female
  • Subject with previous splenectomy
  • Subject with previous or planned hematopoietic cell transplant
  • Subject with prior history of encephalopathy, including Wernicke's
  • Subject with signs or symptoms of encephalopathy including Wernicke's (eg, severe ataxia, ocular paralysis or cerebellar signs)
  • Subject with thiamine deficiency, defined as thiamine levels in whole blood below normal range according to institutional standard and not corrected prior to enrollment on the study
  • Subject with concomitant treatment with or use of pharmaceutical, herbal agents or food known to be strong or moderate inducers of Cytochrome P450 3A4 (CYP3A4), or dual CYP2C19 and CYP3A4 inhibitors
  • Subject on any chemotherapy, immunomodulatory drug therapy (eg, thalidomide, interferon-alpha), anagrelide, immunosuppressive therapy, systemic corticosteroids > 10 mg/day prednisone or equivalent. Subjects who have had prior exposure to hydroxyurea (eg, Hydrea) in the past may be enrolled into the study as long as it has not been administered within 14 days prior to the start of fedratinib treatment
  • Subject has received ruxolitinib within 14 days prior to the start of fedratinib
  • Subject on treatment with myeloid growth factor (eg, granulocyte-colony stimulating factor [G-CSF]) within 14 days prior to the start of fedratinib treatment
  • Subject with previous exposure to Janus kinase (JAK) inhibitor(s) for more than 1 cycle other than ruxolitinib treatment
  • Subject on treatment with aspirin with doses > 150 mg daily
  • Subject with major surgery within 28 days before starting fedratinib treatment
  • Subject with diagnosis of chronic liver disease (eg, chronic alcoholic liver disease, autoimmune hepatitis, sclerosing cholangitis, primary biliary cirrhosis, hemochromatosis, non-alcoholic steatohepatitis)
  • Subject with prior malignancy other than the disease under study unless the subject has not required treatment for the malignancy for at least 3 years prior to enrollment.
  • However, subject with the following history/concurrent conditions provided successfully treated may enroll: non-invasive skin cancer, in situ cervical cancer, carcinoma in situ of the breast, incidental histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis [TNM] clinical staging system), or is free of disease and on hormonal treatment only
  • Subject with uncontrolled congestive heart failure (New York Heart Association Classification 3 or 4)
  • Subject with known human immunodeficiency virus (HIV), known active infectious Hepatitis B (HepB), and/or known active infectious Hepatitis C (HepC)
  • Subject with serious active infection
  • Subject with presence of any significant gastric or other disorder that would inhibit absorption of oral medication
  • Subject is unable to swallow capsule
  • Subject has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study
  • Subject has any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study
  • Subject has any condition that confounds the ability to interpret data from the study
  • Subject with participation in any study of an investigational agent (drug, biologic, device) within 30 days prior to start of fedratinib treatment
  • Subject with life expectancy of less than 6 months.

Trial locations and contacts

35 sites in 2 countries.

35 sites in 2 countries

United States28 sites
  • Local Institution - 103

    Ann Arbor, Michigan, 48109

  • Local Institution - 113

    Augusta, Georgia, 30912

  • Local Institution - 117

    Aurora, Colorado, 80045

  • Local Institution - 123

    Baltimore, Maryland, 21229-5299

  • Local Institution - 118

    Bethesda, Maryland, 20817

  • Local Institution - 130

    Brooklyn, New York, 11212

  • Local Institution - 105

    Chapel Hill, North Carolina, 27514

  • Local Institution - 112

    Chicago, Illinois, 60612

  • Local Institution - 109

    Chicago, Illinois, 60637

  • Local Institution - 111

    Cincinnati, Ohio, 45219

  • Local Institution - 127

    Columbia, Maryland, 21044

  • Local Institution - 119

    Dallas, Texas, 75390-8852

  • Local Institution - 114

    Durham, North Carolina, 27705

  • Local Institution - 132

    Fort Worth, Texas, 76104

  • Local Institution - 110

    Houston, Texas, 77303

  • Local Institution - 100

    Kansas City, Kansas, 66160-7314

  • Local Institution - 129

    Madison, Wisconsin, 53792-2454

  • Local Institution - 126

    Miami, Florida, 33176

  • Local Institution - 115

    New York, New York, 10029

  • Local Institution - 124

    New York, New York, 10032

  • Local Institution - 128

    Newark, New Jersey, 07112-2027

  • Local Institution - 121

    Park Ridge, Illinois, 60068

  • Local Institution - 106

    Pittsburgh, Pennsylvania, 15224

  • Local Institution - 120

    San Antonio, Texas, 78229

  • Local Institution - 116

    Seattle, Washington, 98109

  • Local Institution - 108

    Sioux Falls, South Dakota, 57105

  • Local Institution - 101

    St Louis, Missouri, 63110

  • SUNY Upstate Medical University

    Syracuse, New York, 13210

Other trials in United States

Canada7 sites
  • Local Institution - 207

    London, Ontario, N6C 6B5

  • Local Institution - 201

    Montreal, Quebec, H1T 2M4

  • Local Institution - 202

    Montreal, Quebec, H3T 1E2

  • Local Institution - 205

    Ottawa, Ontario, K1H 8L6

  • Local Institution - 204

    Sherbrooke, Quebec, J1K 2R1

  • Local Institution - 200

    Toronto, Ontario, M5G 2M9

  • Local Institution - 203

    Vancouver, British Columbia, V6Z 2A5

Other trials in Canada

About this study

Official title: A Phase 3b, Multicenter, Single-Arm, Open-Label Efficacy and Safety Study of Fedratinib in Subjects With DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High-Risk Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (Post-PV MF), or Post-Essential Thrombocythemia Myelofibrosis (Post-ET MF) and Previously Treated With Ruxolitinib

This is Single-Arm, Open-Label Efficacy and Safety Trial of Fedratinib in Subjects with DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High- Risk Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (post-PV MF), or Post-Essential Thrombocythemia Myelofibrosis (post-ET MF) and Previously Treated with Ruxolitinib.

The primary objective of the study is to evaluate the percentage of subjects with at least a 35% reduction in spleen size and one of the secondary objectives is to evaluate the safety of fedratinib.

Read the detailed description

This is Single-Arm, Open-Label Efficacy and Safety Trial of Fedratinib in Subjects with DIPSS (Dynamic International Prognostic Scoring System)-Intermediate or High- Risk Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (post-PV MF), or Post-Essential Thrombocythemia Myelofibrosis (post-ET MF) and Previously Treated with Ruxolitinib.

The spleen volume reduction at the end of Cycle 6 as the primary objective. The secondary objectives of the study are to further evaluate the safety and to assess and implement mitigation strategies for WE and for gastrointestinal (GI) adverse events.

The study will be at multiple centers to provide access to a broad population and have assurance the results are likely to have general applicability.

This is also conducted as an open-label study to collect efficacy and safety data with fedratinib use, no randomization or stratification will occur.

Being tested
FEDRATINIB
Keywords
Myelofibrosis (MF), Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (Post-PV), Post-essential thrombocythemia Myelofibrosis (Post-ET), Myeloproliferative neoplasms (MPN)
Medical subject headings
Primary Myelofibrosis, Myeloproliferative Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • FEDRATINIBDrug

    A potent and selective inhibitor of JAK2 kinase activity

Study groups in NCT03755518
Study groupRoleWhat they receive
Administration of Fedratinib 400mg/dayExperimentalSelf-administered Investigational Product (IP) (400 mg/day) on an outpatient basis, once daily preferably with food during an evening meal at the same time each day in consecutive 4-week (28-day) cycles.
Receives: Drug: FEDRATINIB

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants Who Have a ≥ 35% Spleen Volume Reduction (SVR) at End of Cycle 6

    Percentage of participants who have a ≥ 35% SVR at end of Cycle 6 as compared to baseline. Participants with a missing MRI/CT spleen volume at the end of Cycle 6 including those who meet the criteria for progression of splenomegaly before the end of Cycle 6 will be considered non-responders. Baseline value is defined as the last value or measurement taken prior to the first dose in the study

    Measured: From First Dose to end of Cycle 6 (approximately 168 days)

Secondary outcomes (17)
  1. Number of Participants of All Grade Adverse Events (AEs) and Grade 3/4 AEs

    Number of participants and severity of all grade adverse events (AEs) and grade 3/4 AEs as per National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 5.

    Measured: From first dose up to 30 days post last dose. (an average of 50.3 weeks up to a maximum of 128 weeks)

  2. Number of Participants and Severity of Treatment Related All Grade Adverse Events (AEs) and Grade 3/4 AEs

    Number of participants and severity of treatment related all grade adverse events (AEs) and grade 3/4 AEs as per NCI CTCAE.

    Measured: From first dose up to 30 days post last dose. (an average of 50.3 weeks up to a maximum of 124 weeks)

  3. Mean Change From Baseline in Hematology Laboratory Analysis - Hemoglobin

    Mean change from baseline in hematology laboratory analysis - hemoglobin

    Measured: at Cycle 4 Day 1 and Cycle 7 Day 1

  4. Mean Change From Baseline in Hematology Laboratory Analysis - Erythrocytes

    Mean change from baseline in hematology laboratory analysis - erythrocytes.

    Baseline value is defined as the last value or measurement taken prior to the first dose in the study

    Measured: at Cycle 4 Day 1 and Cycle 7 Day 1

  5. Mean Change From Baseline in Hematology Laboratory Analysis - Platelets, Leukocytes and Neutrophils

    Mean change from baseline in hematology laboratory analysis - platelets, leukocytes and neutrophils.

    Baseline value is defined as the last value or measurement taken prior to the first dose in the study

    Measured: at Cycle 4 Day 1 and Cycle 7 Day 1

  6. Mean Change From Baseline in the Percentage of Blasts/Leukocytes in Hematology Laboratory Analysis

    Mean change from baseline in hematology laboratory analysis - blasts/leukocytes

    Baseline value is defined as the last value or measurement taken prior to the first dose in the study

    Measured: at Cycle 4 Day 1 and Cycle 7 Day 1

  7. Mean Change From Baseline in Chemistry Parameters Analysis - ALT, AST, Amylase, Lipase

    Mean change from baseline in chemistry parameters analysis - ALT, AST, Amylase, Lipase

    Baseline value is defined as the last value or measurement taken prior to the first dose in the study

    Measured: at Cycle 4 Day 1 and Cycle 7 Day 1

  8. Mean Change From Baseline in Chemistry Parameters Analysis - Creatinine

    Mean change from baseline in chemistry parameters analysis - Creatinine.

    Baseline value is defined as the last value or measurement taken prior to the first dose in the study

    Measured: at Cycle 4 Day 1 and Cycle 7 Day 1

  9. Spleen Response Rate by Palpation

    Spleen response rate by palpation is the percentage of participants with a spleen response according to the IWG-MRT 2013 at the end of Cycle 6 as compared to baseline. This will be calculated for participants that have an enlarged spleen (≥ 5 cm below LCM) at baseline. Participants with a missing spleen size assessment at the end of Cycle 6 including those who meet the criteria for progression of splenomegaly before the end of Cycle 6 will be considered not to be responders.

    Measured: From First Dose to end of Cycle 6 (approximately 168 days)

  10. Symptom Response Rate

    Symptom response rate (SRR) is defined as the percentage of participants with ≥ 50% reduction from baseline to the end of Cycle 6 in total symptom score (TSS) measured by MFSAF version 4.0. The TSS will be defined as the sum of each of the 7 symptom scores. Participants without a baseline TSS > 0 will be considered non-evaluable (due to no place for symptom reduction) for the SRR analysis. Participants with a missing TSS at the end of Cycle 6 or who had disease progression before the end of the Cycle 6 will be considered non-responders.

    Measured: From First Dose to end of Cycle 6 (approximately 168 days)

  11. Durability of Spleen Volume Response by MRI/CT (DR)

    Durability of spleen volume response (DR) by MRI/CT is defined as time from the first documented spleen response (ie, ≥ 35% reduction in spleen volume) to the date of subsequent progressive disease (PD) (ie, ≥ 25% increase in spleen volume from baseline) or death, whichever is earlier. In the absence an event (ie, subsequent spleen volume reduction < 35% before the analysis is performed), the DR will be censored at the date of the last valid assessment performed before the analysis performed date. Durability of spleen volume response by MRI/CT scan will be analyzed using Kaplan-Meier method.

    Measured: From Cycle 1 Day 1 up to 30 days after last dose (Approximately an average of 59.40 Weeks)

  12. Durability of Spleen Response by Palpation (DRP)

    Durability of spleen response by palpation (DRP) is defined as time from the date of first documented palpable spleen response, according to the IWG-MRT 2013 to the date of subsequent PD according to the IWG-MRT 2013 or death, whichever is earlier. Durability of spleen response by palpation according to the IWG-MRT 2013 criteria will be calculated for subjects that have an enlarged spleen at baseline (≥ 5 cm below LCM), and that have a spleen response by palpation. In the absence of an event (ie, no loss of spleen response by palpation) before the analysis is performed, the DRP will be censored at the date of the last valid assessment performed before the analysis performed date. Durability of spleen response by palpation will be analyzed using Kaplan-Meier (K-M) method.

    Measured: From Cycle 1 Day 1 up to 30 days after last dose (Approximately an average of 59.32 Weeks)

  13. Durability of Symptom Response (DSR)

    Durability of symptoms response is defined as time from the first documented response in TSS (ie, reduction in TSS ≥ 50%) measured by MFSAF version 4.0 to the first documented TSS reduction < 50%. In the absence of TSS reduction < 50% before the analysis performed, the DSR will be censored at the date of the last valid assessment performed before the analysis performed date.

    Measured: From Cycle 1 Day 1 up to 30 days after last dose (Approximately an average of 31.33 Weeks)

  14. Number of Participants With Grade 3 or Higher AEs: Nausea, Vomiting, Diarrhea and Encephalopathy Including Wernicke's.

    Number of participants with grade 3 or higher AEs: Nausea, Vomiting, Diarrhea and Encephalopathy including Wernicke's.

    Measured: From first dose to end of treatment (an average of 50.3 weeks up to a maximum of 124 weeks)

  15. Number of Participants With Thiamine Levels < Lower Limit of Normal (LLN).

    Number of participants with thiamine levels < LLN.

    LLN of thiamine is 70 nmol/L.

    Measured: At Cycle 1, 2, 3, and every 3 cycles afterwards till End of Treatment (an average of 50.3 weeks up to a maximum of 124 weeks)

  16. Number of Participants With Thiamine Levels > Upper Limit of Normal (ULN).

    Number of participants with thiamine levels > ULN.

    ULN of thiamine is 180 nmol/L.

    Measured: At Cycle 1, 2, 3, and every 3 cycles afterwards till End of Treatment (an average of 50.3 weeks up to a maximum of 124 weeks)

  17. Number of Participants With Clinically Notable Laboratory Results, Grade 3 or 4

    Number of participants with clinically notable laboratory results, Grade 3 or 4

    Measured: From first dose up to 30 days post last dose. (an average of 50.3 weeks up to a maximum of 124 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Nov 2018
  2. Study start27 Mar 2019
  3. Primary completion26 Nov 2021
  4. Study completion8 Nov 2023

Why it stopped: Slow accrual.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
38 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03755518
Sponsor's protocol ID
FEDR-MF-001
Other IDs
U1111-1223-2862, 2018-002237-38, 2018
Acronym
FREEDOM
Status last verified
Dec 2024
First submitted
8 Nov 2018
Last updated
12 Dec 2024
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Expanded access
Available

Publications

  • Gupta V, Yacoub A, Mesa RA, Harrison CN, Vannucchi AM, Kiladjian JJ, Deeg HJ, Fazal S, Foltz L, Mattison RJ, Miller CB, Parameswaran V, Brown P, Hernandez C, Wang J, Talpaz M. Safety and efficacy of fedratinib in patients with myelofibrosis previously treated with ruxolitinib: primary analysis of FREEDOM trial. Leuk Lymphoma. 2024 Sep;65(9):1314-1324. doi: 10.1080/10428194.2024.2346733. Epub 2024 Jun 5.

    PubMed 38838026

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing FEDRATINIB in people with Primary Myelofibrosis and Post-Polycythemia Vera Myelofibrosis, run by Celgene at 35 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 36 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 12 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 35 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 9 Mar 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants Who Have a ≥ 35% Spleen Volume Reduction (SVR) at End of Cycle 6 (time frame: From First Dose to end of Cycle 6 (approximately 168 days)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03755518, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Dec 2024.

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