Dose Optimization and Expansion Study of DFV890 in Adult Patients With Myeloid Diseases

• ClinicalTrials.gov Identifier: NCT05552469
• Recruitment Status: Recruiting
• First Posted: September 23, 2022
• Last Update Posted: March 20, 2024
• Sponsor: Novartis Pharmaceuticals
• Information provided by (Responsible Party): Novartis ( Novartis Pharmaceuticals )

Study Description

Brief Summary:

Study CDFV890G12101 is an open-label, phase 1b, multicenter study with a randomized two-dose optimization part, and a dose expansion part consisting of two groups evaluating DFV890 in patients with myeloid diseases. The purpose of this study is to assess the safety, tolerability, pharmacokinetics, pharmacodynamics, efficacy and recommended dose for single agent DFV890 in patients with lower risk (LR: very low, low or intermediate risk) myelodysplastic syndromes (LR MDS) and lower risk chronic myelomonocytic leukemia (LR CMML).

Condition or disease	Intervention/treatment	Phase
Myeloid Diseases	Drug: DFV890	Phase 1

Detailed Description:

This research study is to find out if study treatment DFV890 is safe and tolerable, and can help patients who were diagnosed with a myeloid disease such as: very low, low or intermediate risk myelodysplastic syndromes (MDS) and very low, low or intermediate risk chronic myelomonocytic leukemia (CMML). The study seeks to determine the optimal dose of DFV890 that is safe and efficacious in patients with myeloid disease. The effectiveness and safety/tolerability of the study treatment is not yet confirmed in this disease setting.

Eligible patients meeting all study entry requirements will be required to provide a sample from their bone marrow at screening and at select study timepoints. All enrolled patients will be dosed for a minimum of twenty-four weeks (6 cycles of treatment) unless they experience side effects related to the study treatment requiring dose interruption/discontinuation, worsening of the disease, and/or if treatment is discontinued at the discretion of the investigator or the patient.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 80 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 1b, Open Label, Multi-center, Dose Optimization and Dose Expansion Study to Assess the Safety and Efficacy of DFV890 in Adult Patients With Myeloid Diseases
• Actual Study Start Date: May 8, 2023
• Estimated Primary Completion Date: June 30, 2026
• Estimated Study Completion Date: June 30, 2026

Arms and Interventions

Arm	Intervention/treatment
Experimental: DFV890 low dose; DFV890 given as single agent at a low dose	Drug: DFV890; DFV890 Single Agent
Experimental: DFV890 high dose; DFV890 given as single agent at a high dose	Drug: DFV890; DFV890 Single Agent

Outcome Measures

Primary Outcome Measures :

1. Incidence of Dose-limiting Toxicities (DLTs) [ Time Frame: 28 days ]
   A dose-limiting toxicity (DLT) is defined as an adverse event or abnormal laboratory value assessed as clinically relevant, occurring during the DLT monitoring period following the first administration of study treatment.
2. Incidence and severity of Adverse Events (AEs) and Serious Adverse Events (SAEs) [ Time Frame: 13 months ]
   Incidence and severity of AEs and SAEs by treatment group, including changes in vital signs, electrocardiograms (ECGs) and laboratory values qualifying and reported as AEs.
3. Incidence of dose interruptions, discontinuations and reductions [ Time Frame: 12 months ]
   Number of patients with dose adjustments (interruptions, discontinuations and reductions) summarized by treatment group.

Secondary Outcome Measures :

1. Reduction in red blood cell (RBC) / platelet transfusions from baseline for transfusion-dependent (TD) patients [ Time Frame: Baseline, 12 months ]
   The number of red cell or platelet transfusions a patient receives over the course of study treatment will be compared to the patient's baseline transfusion requirements based on the transfusions received during the 16-weeks period prior to the start of study treatment.
2. Percentage of patients developing transfusion independence (TI) for ≥8 weeks, ≥12 weeks, ≥16 weeks or ≥24 weeks for TD patients [ Time Frame: Baseline, 8 weeks, 12 weeks, 16 weeks and 24 weeks ]
   Percentage of patients who develop red cell or platelet transfusion independence (defined as no red cell or platelet transfusions with a duration lasting for 8, 12, 16, or 24 weeks)
3. Best overall response (BOR) per 2006 IWG criteria for MDS and CMML [ Time Frame: Baseline, 12 months ]
   BOR is defined as the proportion of patients with best response recorded from the start of the treatment until disease progression/recurrence as per local investigator review and according to 2006 International Working Group (IWG) criteria
4. Hematological improvement per 2006 IWG criteria for MDS and CMML [ Time Frame: 12 months ]
   Number of participants with hematologic response will be based on erythroid response (HI-E), platelet response (HI-P), or neutrophil response (HI-N) as per local investigator review and according to 2006 IWG criteria
5. Time to onset of transfusion independence [ Time Frame: 12 months ]
   Time to onset of either red cell transfusion independence or platelet transfusion independence
6. Duration of response (DOR) [ Time Frame: 12 months ]
   DOR is defined as the duration from the first documented onset of any response to the date of progressive disease/relapse or death due to MDS/CMML
7. Change from baseline in hemoglobin (Hb) [ Time Frame: Baseline, 12 months ]
   Hemoglobin levels over the course of the study will be compared to the patient's baseline to monitor for improvements in anemia
8. Change from baseline in platelet count [ Time Frame: Baseline, 12 months ]
   Platelet count over the course of the study will be compared to the patient's baseline to monitor for improvements in thrombocytopenia
9. Change from baseline in Absolute Neutrophil Count/White Blood Cells (ANC/WBC) [ Time Frame: Baseline, 12 months ]
   Ratio ANC/WBC over the course of the study will be compared to the patient's baseline to monitor for improvements in neutropenia
10. Overall response rate (ORR) [ Time Frame: 12 months ]
    ORR is the proportion of patients with a BOR of Complete Remission (CR) or Partial Remission (PR). Response is based on 2006 IWG criteria per local investigator review.
11. Progression free survival (PFS) [ Time Frame: 12 months ]
    PFS is defined as the time from the date of start of treatment to the date of the first documented progression, or death due to any cause. Response is based on 2006 IWG criteria per local investigator review.
12. Time to progression (TTP) [ Time Frame: 12 months ]
    TTP is defined as the time between date of first documented CR or PR to the date of first documented progression/relapse or death due to any cause, whichever occurs first. Response is based on 2006 IWG criteria per local investigator review.
13. For CMML: reduction in spleen volume [ Time Frame: Baseline, 12 months ]
    Spleen volume over the course of the study will be compared to the patient's baseline
14. For CMML: MPN-SAF total symptom score (TSS) [ Time Frame: Baseline, 12 months ]
    The Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) Total Symptom Score (TTS) will be used for the assessment of symptom burden at baseline and monitoring symptom status during the course of treatment. MPN-SAF TSS includes the assessment of 10 symptoms (fatigue, concentration, early satiety, inactivity, night sweats, itching, bone pain, abdominal discomfort, weight loss, and fevers). Severity of each symptom is rated on a 0 (absent/as good as it can be) to 10 (worst-imaginable/as bad as it can be) scale. MPN-SAF TSS has a possible range of scores of 0 to 100 with 100 representing the highest level of symptom severity.
15. Maximum plasma concentration (Cmax) of DFV890 [ Time Frame: 15 days ]
    Pharmacokinetic parameters will be calculated based on DFV890 plasma concentrations by using non-compartmental method(s). Cmax is defined as the maximum (peak) observed concentration following a dose.
16. Area under the plasma concentration-time curve from time zero to the last measurable concentration sampling time (AUClast) of DFV890 [ Time Frame: 15 days ]
    Pharmacokinetic parameters will be calculated based on DFV890 plasma concentrations by using non-compartmental method(s). AUClast is defined as the area under the plasma concentration-time curve from time zero to the last measurable concentration sampling time.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Key Inclusion Criteria:

1. Patients must be ≥ 18 years of age at the time of signing the informed consent form (ICF)
2. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 2
3. Patient must be a candidate for serial bone marrow aspirate and/or biopsy according to the institutions guidelines and must be willing to undergo a bone marrow aspirate.

4. Patients must have one of the following for eligibility into the study:

   1. In dose optimization and expansion: IPSS-R defined very low, low or intermediate risk Myelodysplastic Syndrome (LR MDS) who failed to respond to or did not tolerate ESAs or luspatercept or HMAs and patients with del 5q who failed to respond to or did not tolerate lenalidomide; or
   2. In dose optimization and expansion: IPSS-R defined very low, low or intermediate risk Chronic Myelomonocytic Leukemia (LR CMML) who failed to respond to or did not tolerate hydroxyurea or HMAs.

Key Exclusion Criteria:

1. Systemic antineoplastic therapy (including cytotoxic chemotherapy, alpha-interferon, kinase inhibitors or other targeted small molecules, and toxin-immunoconjugates) or any experimental therapy within 28 days or 5 half-lives, whichever is longer, and recovered from the toxicities before the first dose of study treatment. For patients that received antibodies the washout period is 4 weeks prior to study treatment.
2. History of hypersensitivity to the study treatment or its excipients or to drugs of similar chemical classes.
3. Patients who have previously been treated with agents that have the same mechanism of action as DFV890 as defined in Table 6-8, list of prohibited medications (e.g., drugs targeting the NLRP3 inflammasome pathway and the IL-1 pathway (canakinumab and anakinra)).
4. Use of hematopoietic colony-stimulating growth factors (e.g., G-CSF, GM-CSF, M-CSF), thrombopoietin mimetics or erythroid stimulating agents anytime ≤ 1 week (or 5 half lives, whichever is longer) prior to start of study treatment.

5. Patients receiving:

   1. concomitant medications that are known to be modulators of cytochrome P450 enzymes CYP2C9 and/or CYP3A (specifically strong or moderate inducers of CYP2C9, strong inducers of CYP3A enzymes, strong inhibitors of CYP2C9 and/or strong or moderate dual inhibitors of CYP2C9/CYP3A); and
   2. patients, who are poor CYP2C9 metabolizers receiving concomitant medications known to be strong or moderate inhibitors of CYP3A, whose concomitant medications cannot be discontinued or switched to a different medication within 5 half-lives or 1 week (whichever is longer) prior to start of study treatment and for duration of the study. See Section 6.8 and list of prohibited drugs in Appendix 8 for more details.

Other protocol-defined inclusion/exclusion criteria may apply.

Contacts and Locations

Contacts

Contact: Novartis Pharmaceuticals; 1-888-669-6682; novartis.email@novartis.com

Contact: Novartis Pharmaceuticals; +41613241111

Locations

United States, California

Stanford Cancer Center Stanford Cancer Institute (2); Recruiting

Stanford, California, United States, 94305

Contact: Mani Gupta 650-723-4000 mgupta4@stanford.edu

Principal Investigator: Peter Greenberg

United States, Florida

H Lee Moffitt Cancer Center and Research Institute; Recruiting

Tampa, Florida, United States, 33612

Contact: Cyril Patra 813-972-8391 cyril.patra@moffitt.org

Principal Investigator: Zhuoer Xie

United States, Illinois

Northwestern University; Recruiting

Chicago, Illinois, United States, 60611

Contact 410-328-6896

Principal Investigator: Yasmin Abaza

United States, Maryland

Sidney Kimmel CCC At JH; Recruiting

Baltimore, Maryland, United States, 21231

Contact: Matthew Gagaring +1 410 955 5222 mgagari1@jhmi.edu

Principal Investigator: Amy Elizabeth DeZern

United States, Massachusetts

Dana Farber Cancer Institute .; Recruiting

Boston, Massachusetts, United States, 02115

Contact: Carly Mc Lanahan 617-632-5136 carlinc_mclanahan@dfci.harvard.edu

Principal Investigator: Max Stahl

United States, Minnesota

Mayo Clinic - Rochester; Recruiting

Rochester, Minnesota, United States, 55905

Contact 507-284-2467

Principal Investigator: Abhishek Mangaonkar

United States, New York

Weill Cornell Medicine NY-Presb .; Recruiting

New York, New York, United States, 10021

Contact: Helena Digney 212-746-0743 hed4004@med.cornell.edu

Principal Investigator: Pinkal Desai

Memorial Sloan Kettering Cancer Ctr; Recruiting

New York, New York, United States, 10065

Contact: Marissa Giuliani 212-639-3854 giuliam1@mskcc.org

Principal Investigator: Tamanna Haque

United States, Tennessee

Vanderbilt University Medical Ctr; Recruiting

Nashville, Tennessee, United States, 37232

Contact 615-322-5000

Principal Investigator: Ashwin Kishtagari

United States, Texas

Univ of TX MD Anderson Cancer Cntr; Recruiting

Houston, Texas, United States, 77030

Contact +1 713 792 2828

Principal Investigator: Guillermo Montalban Montalban-Bravo

France

Novartis Investigative Site; Recruiting

Grenoble, France, 38043

Novartis Investigative Site; Recruiting

Nantes Cedex 1, France, 44093

Germany

Novartis Investigative Site; Recruiting

Velbert, North Rhine-Westphalia, Germany, 42551

Novartis Investigative Site; Recruiting

Dresden, Germany, 01307

Novartis Investigative Site; Recruiting

Leipzig, Germany, 04103

Hong Kong

Novartis Investigative Site; Recruiting

Hong Kong, Hong Kong

Italy

Novartis Investigative Site; Recruiting

Brescia, BS, Italy, 25123

Novartis Investigative Site; Recruiting

Rozzano, MI, Italy, 20089

Singapore

Novartis Investigative Site; Recruiting

Singapore, Singapore, 119228

Novartis Investigative Site; Recruiting

Singapore, Singapore, 169608

Spain

Novartis Investigative Site; Recruiting

Madrid, Spain, 28034

Novartis Investigative Site; Recruiting

Madrid, Spain, 28041

Sponsors and Collaborators

Novartis Pharmaceuticals

More Information

• Responsible Party: Novartis Pharmaceuticals
• ClinicalTrials.gov Identifier: NCT05552469
• Other Study ID Numbers: CDFV890G12101
• First Posted: September 23, 2022
• Last Update Posted: March 20, 2024
• Last Verified: March 2024

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Novartis ( Novartis Pharmaceuticals ):

MDS; CMML; NLRP3; Myelodysplastic Syndromes; Chronic Myelomonocytic Leukemia; inflammasome