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Annual Meeting Proceedings Part 1 - American Society of Clinical ...

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6624 General Poster Session (Board #25C), Mon, 1:15 PM-5:15 PM<br />

Adverse events (AEs) and the return <strong>of</strong> myel<strong>of</strong>ibrosis (MF)-related symptoms<br />

after interruption or discontinuation <strong>of</strong> ruxolitinib (RUX) therapy.<br />

Presenting Author: Srdan Verstovsek, University <strong>of</strong> Texas M. D. Anderson<br />

Cancer Center, Houston, TX<br />

Background: RUX is a JAK1/JAK2 inhibitor that demonstrated significant<br />

clinical benefit in patients (pts) with MF in COMFORT-I (NCT00952289),<br />

a phase 3, randomized (1:1), double-blind, placebo (PBO)-controlled study<br />

(N�309). Methods: Pts assessed MF-related symptoms daily using the<br />

modified Myel<strong>of</strong>ibrosis Symptom Assessment Form v2.0; Total Symptom<br />

Score (TSS) was calculated from individual scores for abdominal discomfort,<br />

pain under left ribs, early satiety, night sweats, itching, and bone/<br />

muscle pain. Therapy was interrupted if platelet or absolute neutrophil<br />

count fell below 50,000/�L or 500/�L, respectively. AEs were evaluated<br />

during treatment interruption or discontinuation. The protocol suggested<br />

an optional tapering strategy and possible addition <strong>of</strong> steroids if RUX<br />

therapy was discontinued for reasons other than thrombocytopenia. Results:<br />

In RUX-treated patients with treatment interruption, TSS gradually returned<br />

to baseline levels over approximately 1 week. The most common AE<br />

leading to treatment interruption or discontinuation in each group was<br />

thrombocytopenia (n�11, RUX) and abdominal pain (n�4, PBO). Of<br />

these, only 1 RUX pt discontinued for thrombocytopenia. A summary <strong>of</strong><br />

new onset/worsening AE data after treatment interruption or discontinuation<br />

is presented (Table). Of 58 pts who discontinued study treatment, 23<br />

(n�10, RUX; n�13, PBO) experienced a total <strong>of</strong> 43 SAEs (19, RUX; 24,<br />

PBO) that showed no specific pattern or difference between treatment<br />

groups. Four <strong>of</strong> 21 RUX-treated pts had dose tapering following study drug<br />

discontinuation. Conclusions: Apart from the expected return <strong>of</strong> MF-related<br />

symptoms, there was no pattern <strong>of</strong> AEs to suggest that RUX interruption or<br />

discontinuation is associated with a specific withdrawal syndrome.<br />

RUX (N�155) PBO (N�151)<br />

Treatment interruption, n 49 54<br />

Mean duration, days 16 9<br />

Grade >3 AEs, n 8 7<br />

SAEs, n 3<br />

3<br />

Gastrointestinal hemorrhage; Anemia; pulmonary edema;<br />

fatigue and neutropenic hepatic encephalopathy<br />

fever; urosepsis<br />

and acute gout<br />

Treatment discontinuation, n 21 37<br />

Grade >3 AEs, n 12 17<br />

SAEs, n 10 13<br />

6626^ General Poster Session (Board #26B), Mon, 1:15 PM-5:15 PM<br />

Health-related quality <strong>of</strong> life (HRQoL) and symptom burden in patients<br />

(Pts) with myel<strong>of</strong>ibrosis (MF) in the COMFORT-II study. Presenting Author:<br />

Jean-Jacques Kiladjian, Hôpital Saint-Louis et Université Paris Diderot,<br />

Paris, France<br />

Background: Ruxolitinib has demonstrated rapid and durable reductions in<br />

splenomegaly and improved disease-related symptoms and QoL in 2 phase<br />

3 studies (COMFORT-I and -II) in pts with primary MF (PMF), postpolycythemia<br />

vera-MF (PPV-MF), or post-essential thrombocythemia-MF<br />

(PET-MF). The prevalence <strong>of</strong> individual symptoms among these pts has not<br />

been defined. We evaluated the baseline HRQoL and symptoms among pts<br />

enrolled in COMFORT-II. Methods: COMFORT-II is a randomized, openlabel,<br />

multicenter, phase 3 study comparing ruxolitinib with best available<br />

therapy. HRQoL and symptoms were assessed at baseline using the<br />

European Organisation for the Research and Treatment <strong>of</strong> Cancer QoL<br />

Questionnaire–Core 30 (EORTC QLQ-C30) and Functional Assessment <strong>of</strong><br />

Cancer Therapy–Lymphoma (FACT-Lym); this analysis summarizes these<br />

scores for all pts, regardless <strong>of</strong> assigned treatment. Results: In COMFORT-II<br />

(N � 219), 52% <strong>of</strong> pts were aged � 65 years and 57% were male. By IPSS<br />

criteria (Cervantes et al. 2009), 40% had intermediate-2 and 60% had<br />

high-risk MF. Mean (95% CI) EORTC global health status/QoL (53.7<br />

[50.6-56.7]; median, 50.0) and FACT-General total scores (73.0 [70.8-<br />

75.2]) were comparable to those for pts <strong>of</strong> similar age with other cancers<br />

(Oliva et al. 2011: median global health status score <strong>of</strong> 50 for acute<br />

myeloid leukemia [AML]). The most frequent symptoms (reported as “quite<br />

a bit” or “very much”) were fatigue (54%), dyspnea (30%), insomnia<br />

(30%), pain (29%), night sweats (23%), and itching (21%), and there were<br />

differences in baseline symptoms across MF subtypes (Table). Conclusions:<br />

This analysis shows that pts with MF experience severe disease-related<br />

symptoms and have diminished HRQoL similar to pts with AML, but<br />

because pts with MF have a longer life expectancy (an average <strong>of</strong> 2.3 to 4<br />

years for high and intermediate-2 risk pts, respectively), they may suffer<br />

with a reduced QoL for many years.<br />

% “quite a bit” or “very much”<br />

PMF<br />

(N � 116)<br />

PPV-MF<br />

(N � 68)<br />

PET-MF<br />

(N � 35)<br />

Fatigue 59.2 46.1 53.2<br />

Dyspnea 28.7 30.2 31.2<br />

Insomnia 32.7 25.4 28.2<br />

Pain 25.9 28.6 41.9<br />

Night sweats 21.3 27.3 18.2<br />

Itching 16.8 28.8 21.3<br />

Weight loss 12.1 22.7 6.3<br />

Leukemia, Myelodysplasia, and Transplantation<br />

6625^ General Poster Session (Board #26A), Mon, 1:15 PM-5:15 PM<br />

Association <strong>of</strong> cytokine levels and reductions in spleen size in COMFORT-<br />

II, a phase III study comparing ruxolitinib to best available therapy (BAT).<br />

Presenting Author: Claire N. Harrison, Guy’s and St. Thomas’ NHS<br />

Foundation Trust, London, United Kingdom<br />

Background: Ruxolitinib is a potent and selective oral JAK1/2 inhibitor that<br />

has been approved for the treatment <strong>of</strong> myel<strong>of</strong>ibrosis (MF). Ruxolitinib has<br />

demonstrated rapid and durable reductions in splenomegaly and improved<br />

disease-related symptoms and quality <strong>of</strong> life (QoL) in 2 phase 3 studies<br />

(COMFORT-I and –II) in patients (pts) with primary MF (PMF), postpolycythemia<br />

vera-MF (PPV-MF), or post-essential thrombocythemia-MF<br />

(PET-MF). This analysis evaluated associations between cytokine levels<br />

and spleen size reductions in the COMFORT-II study. Methods: COM-<br />

FORT-II is a randomized (2:1), open-label, phase 3 study comparing the<br />

safety and efficacy <strong>of</strong> ruxolitinib with BAT. Spleen volume was measured by<br />

MRI every 12 weeks and spleen length by palpation at each study visit.<br />

Plasma samples were analyzed using Rules Based Medicines Human MAP<br />

v1.6; 89 cytokines were measured at BL and wks 4, 24, and 48. Simple<br />

linear regression was used to evaluate the correlation between BL or change<br />

from BL in cytokine levels with % change <strong>of</strong> spleen size. Results: In the<br />

ruxolitinib arm, association was found between changes in TNF-� and<br />

leptin levels and % spleen volume reduction at wk 24 (TNF-�: N� 93;<br />

correlation coefficient [R] � 0.43; false discovery rate adjusted P value [P]<br />

� .01; leptin: N � 96; R � -0.28; P � .09) and wk 48 (TNF-�:N� 86; R<br />

� 0.43; P � .01; leptin: N � 87; R � -0.34; P � .02) that was not<br />

observed with BAT and was independent <strong>of</strong> JAK2V617F status. For<br />

ruxolitinib-treated JAK2V617F� pts, higher leptin levels at BL were<br />

associated with greater % spleen length reductions at wk 48 (N � 45; R �<br />

-0.44; P � .11). A clear trend was observed for increased leptin levels that<br />

preceded weight gain on ruxolitinib treatment. For ruxolitinib-treated<br />

JAK2V617F� pts, decreased IL-8 at wk 4 was associated with % spleen<br />

volume reductions at wk 24 (N � 68; R � 0.28; P � .24) and wk 48 (N �<br />

60; R � 0.38; P � .15). Conclusions: This analysis has shown statistically<br />

significant associations between changes in cytokine levels and spleen size<br />

reductions. Further analysis is in progress to determine associations<br />

between cytokine levels and QoL or symptoms and to confirm these<br />

observations in an independent data set.<br />

6627 General Poster Session (Board #26C), Mon, 1:15 PM-5:15 PM<br />

Post hoc analysis <strong>of</strong> association between treatment response and various<br />

indicators <strong>of</strong> efficacy and safety in a randomized phase III trial <strong>of</strong><br />

decitabine in older patients with acute myeloid leukemia. Presenting<br />

Author: Mark D. Minden, Princess Margaret Hospital, Toronto, ON, Canada<br />

Background: In a recent, large phase III trial (NCT00260832; Kantarjian,<br />

JCO; in press), 485 patients �65y with newly diagnosed acute myeloid<br />

leukemia (AML) received, every 4 wks, treatment choice (TC) <strong>of</strong> either<br />

supportive care or cytarabine (20 mg/m 2 subcutaneous injection, 10<br />

consecutive days) or decitabine (DAC) 20 mg/m2 (1-h intravenous [IV]<br />

infusion, 5 consecutive days). This post hoc analysis investigated relationships<br />

between response to treatment and indicators <strong>of</strong> efficacy and safety.<br />

Methods: Response was defined as morphologic complete remission (CR),<br />

or CR with incomplete blood count recovery (CRi) or partial response (PR).<br />

Transfusions (red blood cell [RBC] or platelets [PLT]), IV antibiotic use, and<br />

dose modifications were tabulated for responders and nonresponders to<br />

DAC or TC during the treatment period. Results: Fewer responders than<br />

nonresponders had dose modifications (30.4% vs 64.5%, respectively;<br />

P�.0001). Antibiotic use and transfusions were similar in both groups.<br />

Overall survival for responders was 16.1–18.5 mo vs 4.2–4.9 mo for<br />

nonresponders. Conclusions: These data suggest that response to DAC or TC<br />

treatment predicts clinically relevant benefits, with fewer dose modifications<br />

in older patients with newly diagnosed AML. The number <strong>of</strong><br />

transfusions and antibiotic use was impacted by the longer survival time <strong>of</strong><br />

responders vs nonresponders. Data on the impact <strong>of</strong> early response are<br />

being analyzed.<br />

Parameter*<br />

Nonresponders<br />

(n�383)<br />

447s<br />

CR�CRi�PR responders<br />

(n�102) p value †<br />

Overall survival, median, mo<br />

IV antibiotic use<br />

4.2–4.9 16.1–18.5 –<br />

Number <strong>of</strong> patients 383 102<br />

Yes, n (%)<br />

PLT transfusions<br />

77 (20.1) 14 (13.7) .143<br />

Number <strong>of</strong> patients 279 75<br />

Mean (SD) 11.64 (14.7) 13.67 (21.7) .447<br />

Median (range)<br />

RBC transfusions<br />

7 (1–110) 7 (1–136)<br />

Number <strong>of</strong> patients 342 97<br />

Mean (SD) 10.68 (12.2) 14.38 (14.5) .023<br />

Median (range)<br />

Dose modifications<br />

7 (1–102) 11 (1–89)<br />

Number <strong>of</strong> patients 383 102<br />

Yes, n (%) 247 (64.5) 31 (30.4) �.0001<br />

*All patients who had both response and parameter data. † Based on 2 sample t test to compare<br />

means; 2 proportion Z test to compare proportions.<br />

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