Tagraxofusp (SL-401) in Patients With CMML or MF
This drug is directed towards subjects with Myeloproliferative Neoplasms. The goal of this research study is to find the safest highest dose of investigatory drug SL-401 that can be given to patients with myeloproliferative neoplasms. This study will also look at how SL-401 stops or slows cancer cell growth and how SL-401 enters and leaves the body. This study will also look at certain proteins in the blood and the bone marrow and how the amounts of them might change after receiving SL-401, or might be related to how well SL-401 does or does not function against the cancer. SL-401 is an investigational medication. This means that SL-401 is still being studied. It is not approved by the United States Food and Drug Administration (FDA). The FDA allows SL-401 to be used only in clinical studies such as this one. It is anticipated that each patient may be in the study for about 6 ½ months, although the amount of time that each patient will participate will vary, depending on potential side effects of the drug and the growth or shrinkage of the cancer. \n\n There are 2 stages involved with this research study. Stage 1 of the study is the dose escalation portion to understand the highest dose of SL-401 that may be given safely. The study doctor will monitor how patients are feeling (and laboratory tests will be taken which indicate how well blood, liver and kidneys are working) and will work with the study sponsor before additional patients are enrolled at higher doses. Stage 2 of the study will test the highest dose of SL-401 that can be administered safely, as determined during stage 1 of the study, or a lower dose if it can be determined that such a dose has a higher chance of controlling the cancer without causing side effects. During both Stages 1 and 2, the effects of SL-401 on the cancer will also be studied, as well as how SL-401 enters and leaves the body.
Adult subjects diagnosed with high risk myeloproliferative neoplasms \n\n For more information about the eligibility criteria for this trial, refer to the Health Professional version.
Abbreviated Inclusion Criteria:
All Patients (Stages 2 and 3A):
- The patient is ≥18 years old.
- The patient has a life expectancy of >6 months.
- The patient has an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-2.
- The patient has adequate baseline organ function, including cardiac, renal, and
- Left ventricular ejection fraction (LVEF) ≥ institutional lower limit of normal as measured by multigated acquisition scan (MUGA) or 2-dimensional (2-D) echocardiogram (ECHO) within 28 days prior to start of therapy and no clinically significant abnormalities on a 12-lead electrocardiogram (ECG)
- Serum creatinine ≤1.5 mg/dL
- Serum albumin ≥3.2 g/dL (or ≥32 g/L) in the absence of receipt of (IV) albumin within the previous 72 hours
- Bilirubin ≤1.5 mg/dL
- Aspartate transaminase (AST) and alanine transaminase (ALT) ≤2.5 times the upper limit of normal (ULN)
- Creatine phosphokinase (CPK) ≤2.5 times the ULN
- Absolute neutrophil count (ANC) ≥0.5 × 10⁹/L
Additional Abbreviated Inclusion Criteria Specific to Patients with MF (Stage 2):
- Patient meets the 2016 WHO diagnostic criteria for MF and has an IPSS/DIPSS/DIPSS-plus intermediate-2 or high-risk disease. Patients with IPSS/DIPSS/DIPSS-plus low or intermediate-1 risk disease who have at least one of the following symptoms are also eligible: MF-related anemia (Hb <10 g/dL), splenomegaly (palpable size >10 cm), leukocytosis (WBC >25 × 10⁹/L), marked thrombocytosis (platelet count >1000 × 10⁹/L), or constitutional symptoms (weight loss >10%, during prior 6 months or fever [>37.5ºC or drenching night sweats for >6 weeks]), as recommended by the ELN/IWG 2018 criteria.
- Patient is approved JAK therapy (JAK1/JAK2 or JAK2) resistant/refractory or intolerant, in accordance with the ELN/IWG 2018 criteria, and at least 4 weeks have elapsed between the last dose of any MF-directed drug treatments; excluding HU, and study enrollment (first dose). HU can be continued until 2 weeks prior to study enrollment.
- Patient is not eligible for an immediate allo-SCT.
Additional Abbreviated Inclusion Criteria Specific to Patients with CMML (Stage 3A):
- Patient has a 2016 WHO-defined diagnosis of CMML (persistent monocytosis ≥1 × 10⁹/L
for at least 3 months, with other causes excluded, and monocytes ≥10% of WBC in
peripheral blood, no criteria and no previous history of CML, ET, PV, and acute
promyelocytic leukemia; if eosinophilic, neither PDGFRA, PDGFRB, FGFR1 rearrangements
nor PCM1-JAK2 translocation; <20% blasts in peripheral blood and bone marrow aspirate;
1 following criteria - dysplasia in >1 myeloid lineage, acquired clonal cytogenetic or molecular abnormality in hematopoietic cells).
- Patient has 2016 WHO-defined CMML-1 (2-4% blasts in peripheral blood and/or 5-9% blasts in bone marrow) and CMML-2 (5-19% blasts in peripheral blood and/or 10-19% blasts in bone marrow, and/or presence of Auer rods).
- Patient is refractory/resistant/intolerant to HMAs, or HU, or intensive chemotherapy OR patient is classified as high-risk based on the presence of morphological features, as described by the 2016 WHO prognostic system, and the clinical and molecular features described in molecularly-integrated prognostic systems, such as the GFM, MMM, and the CMML specific prognostic model (CPSS-Mol), and thus is not expected to benefit from HMAs.
- Patient is ineligible for an immediate allo-SCT.
Abbreviated Exclusion Criteria:
All Patients (Stages 2 and 3A):
- Persistent clinically significant toxicities Grade ≥2 from previous therapies not readily controlled by supportive measures (excluding alopecia, nausea, and fatigue).
- Treatment with any disease-related therapy, including radiation therapy or investigational agent, within 14 days of study entry.
- Allogeneic SCT within 3 months of study entry.
- Previous treatment with tagraxofusp or known hypersensitivity to any components of the drug product.
- Active malignancy and/or cancer history (excluding myeloproliferative disorders and concomitant myeloid malignancies as specified in the inclusion criteria) that can confound the assessment of the study endpoints. Patients with a past cancer history (within 2 years of entry) and/or ongoing active malignancy or substantial potential for recurrence must be discussed with the Sponsor before study entry. Patients with the following neoplastic diagnoses are eligible: non-melanoma skin cancer, carcinoma in situ (including superficial bladder cancer), cervical intraepithelial neoplasia, or organ-confined prostate cancer with no evidence of progressive disease.
- Clinically significant cardiovascular disease, pulmonary disease, or known active or suspected disease involvement of the central nervous system (CNS).
- Receiving immunosuppressive therapy, with the exception of corticosteroids as specified in the inclusion criteria and tacrolimus, for treatment or prophylaxis of graft-versus-host disease (GVHD).
- Uncontrolled intercurrent illness.
- Patient is pregnant or breast feeding.
- Patient has known human immunodeficiency virus (HIV), Hepatitis B or Hepatitis C.
- Patient is oxygen-dependent.
Additional Exclusion Criteria Specific to Patients with MF and CMML (Stages 2 and 3A)
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