Therapeutic RSK1 Targeting in Myelofibrosis

The Washington University

Status and phase: Begins enrollment in 1 month; Phase 1

Conditions: Myelofibrosis

Treatments: Drug: PMD-026

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT07379125

25-x142

Details and patient eligibility

About

This is a phase Ib study evaluating PMD-026, an oral inhibitor of ribosomal protein S6 kinase A1 (RSK1), in participants with myelofibrosis (MF).The dose escalation portion utilizes a standard 3+3 design to evaluate two dose levels with an additional dose de-escalation portion to identify the recommended phase II dose (RP2D); subsequently, an additional 6 patients will be enrolled in the dose expansion portion evaluating the efficacy of PMD-026.

Enrollment: 18 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Histologically confirmed diagnosis of primary myelofibrosis, post-polycythemia vera myelofibrosis or post-essential thrombocythemia myelofibrosis in chronic phase, according to the 2016 WHO criteria

• Ineligible for or refractory to treatment with JAK inhibitor

• Presence of measurable disease as defined by

  • Splenomegaly OR
  • Baseline MFSAF v4.0 Total Symptom Score ≥ 10

• At least 18 years of age.

• ECOG performance status ≤ 2.

• Adequate organ function as defined below:

  • Total bilirubin ≤ 1.5 x IULN (unless the participant has a history of Gilbert's syndrome)
  • AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN
  • Creatinine clearance ≥ 30 mL/min by Cockcroft-Gault

• Adequate laboratory parameters:

  • Absolute Neutrophil Count (ANC) ≥ 100/mm^3
  • Platelets ≥50,000/mm^3
  • Blasts ≤ 10% on manual differential

• The effects of PMD-026 on the developing human fetus are unknown. For this reason, women of childbearing potential and men must agree to use adequate contraception prior to study entry, for the duration of study participation, and for 30 days after completion of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study or should a man suspect he has fathered a child, s/he must inform her treating physician immediately.

• Ability to understand and willingness to sign an IRB approved written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants.

Exclusion criteria

• Prior allogeneic or autologous stem cell transplantation within the previous 12 months
• Prior splenectomy
• Prior splenic irradiation if < 3 months between last radiation and screening visit.
• Prior or concurrent malignancy whose natural history has the potential to interfere with the safety or efficacy assessment of the investigational regimen. Patients with prior or concurrent malignancy that does NOT meet that definition are eligible for this trial.
• Currently receiving any other investigational agents or planning to receive any investigational agents within 28 days before the planned first dose of PMD-026.
• Currently receiving a JAK inhibitor or planning to receive a JAK inhibitor within 7 days before the planned first dose of PMD-026. In patients with ongoing JAK inhibitor therapy (i.e. ruxolitinib) at screening, it must be tapered over a period of at least 7 days. Patients on a low dose of ruxolitinib (e.g. 5 mg QD) may have a reduced taper period or no taper.
• Known active disease involving the CNS.
• A history of hypersensitivity or allergic reactions attributed to compounds of similar chemical or biologic composition to PMD-026 or other agents used in the study.
• Any major surgery within 28 days prior to the first dose of PMD-026.
• Uncontrolled intercurrent illness including, but not limited to: ongoing or active infection, autoimmune disease, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.
• Unable to swallow or retain oral medications.
• Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 35 days of study entry (repeated on C1D1).

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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18 participants in 4 patient groups

Dose Escalation Dose Level -1: PMD-026

Experimental group

Description:

PMD-026 will be taken by mouth twice daily at the assigned dose every day of each 28-day cycle.

Treatment:

Drug: PMD-026

Dose Escalation Dose Level 1 (Starting Dose): PMD-026

Experimental group

Description:

PMD-026 will be taken by mouth twice daily at the assigned dose every day of each 28-day cycle.

Dose Escalation Dose Level 2: PMD-026

Experimental group

Description:

PMD-026 will be taken by mouth twice daily at the assigned dose every day of each 28-day cycle.

Treatment:

Drug: PMD-026

Dose Expansion - Recommended Phase II Dose (RP2D): PMD-026

Experimental group

Description:

PMD-026 will be taken by mouth twice daily at the recommended phase II dose every day of each 28-day cycle.