Phase III Study of SAR302503 in Intermediate-2 and High Risk Patients With Myelofibrosis

Study Overview
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Brief Summary
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Primary Objective: To evaluate the efficacy of daily oral doses of 400 mg or 500 mg of SAR302503 (Investigational Medicinal Product, IMP) compared to placebo in the reduction of spleen volume as determined by magnetic resonance imaging (MRI) (or computed tomography scan in patients with contraindications for MRI). Secondary Objectives: To evaluate the effect on Myelofibrosis (MF)-associated symptoms (key MF symptoms) as measured by the modified Myelofibrosis Symptom Assessment Form (MFSAF) diary. To evaluate the Overall Survival of patients treated with either 400 mg/day or 500 mg/day of IMP as compared to placebo. To evaluate the Progression Free Survival of patients treated with either 400 mg/day or 500 mg/day of IMP as compared to placebo. To evaluate the durability of splenic response. To evaluate the safety of IMP.

Detailed Description
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The expected duration of a patient's treatment in this study is approximately 8 months, based on a maximum 28-day screening period, followed by a ≥6-month (6-cycle) treatment period, and an End Of Treatment (EOT) visit, which should be performed at least 30 days following the last administration of IMP or placebo. Patients who continue to benefit clinically will be allowed to remain on IMP or placebo beyond the 6-month treatment period until the occurrence of disease progression or unacceptable toxicity.

Official Title
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A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled, 3-Arm Study of SAR302503 in Patients With Intermediate-2 or High-Risk Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, or Post-Essential Thrombocythemia Myelofibrosis With Splenomegaly

Conditions
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Hematopoietic Neoplasm

Intervention / Treatment
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* Drug: SAR302503
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Diagnosis of Primary Myelofibrosis (MF) or Post-Polycythemia Vera MF or Post-Essential Thrombocythemia MF, according to the 2008 World Health Organization and International Working Group of Myelofibrosis Research and Treatment (IWG-MRT) criteria. MF classified as high-risk or intermediate-risk level 2, as defined by modified IWG-MRT criteria (IPSS) (according to Cervantes F. et. al.; at screening). Enlarged spleen, palpable at least 5 cm below costal margin. At least 18 years of age. Eastern Cooperative Oncology Group performance status of 0, 1, or 2 at study entry. The following laboratory values within 14 days prior to the initiation of IMP or placebo: Absolute Neutrophil Count (ANC) ≥1.0 x 10exp9/L Platelet count ≥50 x 10exp9/L Serum creatinine ≤1.5 x Upper Limit of Normal (ULN) Serum amylase and lipase ≤1.5 x ULN Exclusion criteria: Splenectomy. Any chemotherapy (eg, hydroxyurea), immunomodulatory drug therapy (eg, thalidomide, interferon-alpha), Anagrelide, immunosuppressive therapy, corticosteroids >10 mg/day prednisone or equivalent, or growth factor treatment (eg, erythropoietin), or hormones (eg, androgens, danazol) within 14 days prior to initiation of IMP or placebo; darbepoetin use within 28 days prior to initiation of IMP or placebo. Patients who have had exposure to hydroxyurea (eg, hydrea) in the past may be enrolled into the study as long as it has not been administered within 14 days prior to initiation of IMP or placebo. Major surgery within 28 days or radiation within 6 months prior to initiation of IMP or placebo. Prior treatment with a Janus Kinase 2 (JAK2) inhibitor. Known active (acute or chronic) Hepatitis A, B, or C; and hepatitis B and C carriers AST or ALT ≥2.5 x ULN Total Bilirubin: Exclude if ≥3.0 x ULN Patients with total bilirubin between 1.5-3.0 x ULN must be excluded if the direct bilirubin fraction is ≥25% of the total Prior history of chronic liver disease (eg, chronic alcoholic liver disease, autoimmune hepatitis, sclerosing cholangitis, primary biliary cirrhosis, hemachromatosis, non-alcoholic steatohepatitis [NASH]) The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Placebo comparator<br>once daily X 28 days, orally, empty stomach, approximately same time each day | Drug: Placebo<br>* Pharmaceutical form:capsule Route of administration: oral<br>|
| Experimental: SAR302503 400 mg<br>once daily X 28 days, orally, empty stomach, approximately same time each day | Drug: SAR302503<br>* Pharmaceutical form:capsule Route of administration: oral<br>|
| Experimental: SAR302503 500 mg<br>once daily X 28 days, orally, empty stomach, approximately same time each day | Drug: SAR302503<br>* Pharmaceutical form:capsule Route of administration: oral<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Response Rate (RR), defined as the proportion of patients who have a ≥35% reduction in volume of spleen size at the end of Cycle 6, and confirmed 4 weeks thereafter |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Symptom Response Rate (SRR): Proportion of patients with ≥50% reduction from baseline to the end of Cycle 6 in the total symptom score. | This assessment will be conducted through the modified MFSAF diary, which will be completed during the week prior to Day 1 of each treatment cycle up to Cycle 6, and during the week prior to the end of Cycle 6. | 6 months | 
| OS (overall survival) of either 400 mg/day or 500 mg/day of IMP as compared to placebo. |  | approximately 5 years | 
| PFS (progression free survival) of either 400 mg/day or 500 mg/day of IMP as compared to placebo. |  | approximately 5 years | 
| Proportion of patients who have ≥25% reduction in volume of spleen size at end of Cycle 6, and confirmed 4 weeks thereafter. |  | 6 months | 
| Duration of spleen response, measured by MRI (or CT scan in patients with contraindications for MRI. |  | 2 years | 
| Clinical and laboratory events graded by the NCI CTCAE v4.03. |  | approximately 5 years |