Final results of a phase 2 clinical trial of LCL161, an oral SMAC mimetic for patients with myelofibrosis

Naveen Pemmaraju, Bing Z. Carter, Prithviraj Bose, Nitin Jain, Tapan M. Kadia, Guillermo Garcia-Manero, Carlos E. Bueso-Ramos, Courtney D. DiNardo, Sharon Bledsoe, Naval G. Daver, Uday Popat, Marina Y. Konopleva, Lingsha Zhou, Sherry Pierce, Zeev E. Estrov, Gautam M. Borthakur, Maro Ohanian, Wei Qiao, Lucia Masarova, Xuemei WangPo Yee Mak, Jorge Cortes, Elias Jabbour, Srdan Verstovsek

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Outcomes in patients with high-risk and treatment-resistant myelofibrosis (MF) post-JAK inhibitor therapy remain poor, with no approved drug therapies beyond the JAK inhibitor class. In certain clinical situations, such as severe thrombocytopenia, administration of most JAK inhibitors are contraindicated. Thus, there is an unmet medical need for the development of novel agents for patients with MF. SMAC mimetics [or inhibitor of apoptosis (IAP) antagonists] induce apoptosis in cancer cells. Because these agents are hypothesized to have increased activity in a tumor necrosis factor-A cytokine-rich microenvironment, as is the case with MF, we conducted a single-center, investigator-initiated phase 2 clinical trial, with a monovalent SMAC mimetic LCL161 (oral, starting dose, 1500 mg per week) in patients with intermediate to high-risk MF. In an older group, 66% with $2 prior therapies and a median baseline platelet count of 52 3 103/mL and 28% with ASXL1 mutations, we observed a 30% objective response by Revised International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) 2013 criteria. Notably, 6 responding patients achieved clinical improvement of anemia: 4, hemoglobin response; 2, transfusion independence. Median OS was 34 months (range, 2.2-60.11). Reductions of cIAPs were observed in all responders. The most common toxicity was nausea/vomiting (N/V) in 64% (mostly grade 1/2); fatigue in 46%; and dizziness/vertigo in 30%. There were 4 grade 3/4 adverse events (2, syncope; 1, N/V; 1, skin eruption/pruritis). There were 2 deaths during the study period, both unrelated to the study drug. SMAC mimetics may represent an option for older patients with thrombocytopenia or for those in whom prior JAK inhibitors has failed. This trial was registered at www.clinicaltrials.gov as #NCT02098161.

Original languageEnglish (US)
Pages (from-to)3163-3173
Number of pages11
JournalBlood Advances
Volume5
Issue number16
DOIs
StatePublished - Aug 24 2021

ASJC Scopus subject areas

  • Hematology

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