Phase 2 study of CEP-701, an orally available JAK2 inhibitor, in patients with primary or post-polycythemia vera/essential thrombocythemia myelofibrosis.
Few treatment options exist for patients with myelofibrosis (MF), and their survival is significantly shortened. Activating mutation of the JAK2 tyrosine kinase (JAK2(V617F)) is found in approximately 50% of MF patients. CEP-701 is a tyrosine kinase inhibitor that inhibits JAK2 in in vitro and in vivo experiments. We conducted a phase 2 clinical study of CEP-701 in 22 JAK2(V617F)-positive MF patients (80 mg orally twice daily), and 6 (27%) responded by International Working Group criteria (clinical improvement in all cases): reduction in spleen size only (n = 3), transfusion independency (n = 2), and reduction in spleen size with improvement in cytopenias (n = 1). Median time to response was 3 months, and duration of response was more than or equal to 14 months. No improvement was seen in bone marrow fibrosis or JAK2(V617F) allele burden. Phosphorylated STAT3 levels decreased from baseline in responders while on therapy. Eight patients (36%) experienced grade 3 or 4 toxicity, and 6 (27%) required dose reduction. Main side effects were myelosuppression (grade 3 or 4 anemia, 14%; and thrombocytopenia, 23%) and gastrointestinal disturbances (diarrhea, any grade, 72%; grade 3 or 4, 9%; nausea, grade 1 or 2 only, 50%; vomiting, grade 1 or 2 only, 27%). In conclusion, CEP-701 resulted in modest efficacy and mild but frequent gastrointestinal toxicity in MF patients. The study was registered at http://clinicaltrials.gov as NCT00494585.
Santos
Fabio P S
FP
Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Kantarjian
Hagop M
HM
Jain
Nitin
N
Manshouri
Taghi
T
Thomas
Deborah A
DA
Garcia-Manero
Guillermo
G
Kennedy
Debra
D
Estrov
Zeev
Z
Cortes
Jorge
J
Verstovsek
Srdan
S
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015153:Blotting, Western; D002227:Carbazoles / Q000627:therapeutic use*; D016207:Cytokines / Q000378:metabolism; D005260:Female; D005663:Furans; D006801:Humans; D053614:Janus Kinase 2 / Q000037:antagonists & inhibitors*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011087:Polycythemia Vera / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D055728:Primary Myelofibrosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D015996:Survival Rate; D013920:Thrombocythemia, Essential / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D002227:Carbazoles; D016207:Cytokines; D005663:Furans; C119379:lestaurtinib; D011505:Protein-Tyrosine Kinases; C507924:JAK2 protein, human; D053614:Janus Kinase 2