BET Inhibitor CPI-0610 Shows Potential as Treatment in MF

Lucia Masarova, MD, an assistant professor in the Department of Leukemia in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the efficacy of CPI-0610 in the phase 2 MANIFEST (NCT02158858) trial in patients with myelofibrosis.

Masarova says that CPI-0610, a bromodomain, and extra-terminal (BET) inhibitor holds promise in patients with myelofibrosis since it could alter the transcription factors and potentially overcome the patient’s resistance to ruxolitinib (Jakafi). The MANIFEST trial investigating this drug had 3 arms; the second arm combined ruxolitinib and CPI-0610 in patients who responded suboptimally to ruxolitinib monotherapy and the third looked at the combination in the front-line setting.

For Arm 2, there were 70 patients enrolled and median follow-up of 28 weeks. There were 64 patients enrolled and median follow-up of 24 weeks in Arm 3. The second arm showed that patients could achieve further improvement in their spleen or their symptoms when receiving CPI-0610 in addition to ruxolitinib. The upfront combination in previously untreated patients demonstrated superior responses in terms of spleen size and symptoms. Spleen volume reduction was seen in about 60% of these patients, which is more than what is observed in the single-agent ruxolitinib trials, according to Masarova.

CTI BioPharma: Potential Light At End Of The Rainbow

Source: Seeking Alpha

Summary

  • Today, we take our first in depth look at CTI BioPharma, that looks like it might finally garner its first FDA approval.
  • The company is aiming its primary drug candidate as a lucrative niche of the myelofibrosis market.
  • An analysis on CTI BioPharma is presented in the paragraphs below.

Today, we take our first in-depth look at a small developmental company called CTI BioPharma (CTIC). We have received occasional inquiries on this name over the years, but I believe this is our first analysis on it. Given the company might finally be close to garnering its first FDA approval, it seems an appropriate time to dig under the covers. An analysis follows below.

Company Overview

CTI BioPharma is a small ‘Tier 4‘ biotech concern out of Seattle. The company is focused on developing novel targeted therapies for blood-related cancers. The company was once known as Cell Therapeutics but changed its name in 2014 over 15 years after going public. The stock trades just above $3.00 a share currently and sports an approximate market capitalization of $240 million.

The main asset of the company is a compound called pacritinib. The company provides this description of this drug candidate on its website.

Pacritinib is an investigational oral kinase inhibitor with specificity for JAK2 and IRAK1 developed for the treatment of patients with myeloproliferative diseases including myelofibrosis. Unlike other JAK2 inhibitors pacritinib does not inhibit JAK1. Inhibition of JAK1 has been associated with immune dysfunction, lymphomas and may also worsen thrombocytopenia and anemia.”

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COVID-19 and blood cancer: Evolving science on a dangerous comorbidity

More than a year into the COVID-19 pandemic, new information emerges daily about the virus and its effects on various vulnerable populations.

The CDC’s list of underlying medical conditions that elevate risk for severe illness due to COVID-19 is described as a “living document” that will likely remain in flux as knowledge about the virus evolves.

Cancer has been identified as one disease likely to increase risk for poor COVID-19 outcomes.

Because bone marrow plays an essential role in immune function, hematologic malignancies are a particular area of concern. Individuals with blood cancers may have compromised immune systems due to the cancer, its treatment or both.

“Hematologic malignancies are diseases of the blood, the bone marrow and lymphoid organs, and that’s where most immune functions take place,” Nathan A. Berger, MD,Hanna-Payne professor of experimental medicine, professor of medicine, biochemistry and oncology, and director of the Center for Science, Health and Society at Case Western Reserve University School of Medicine, said in an interview with HemOnc Today. “We think the mechanism of that increased susceptibility is because of immune suppression or immune deficiency associated with the disease.”

However, the paucity of mechanistic data on this association reflects an overall lack of understanding about the interplay between hematologic malignancies and COVID-19. As the pandemic continues to unfold, researchers strive to make real-time treatment decisions based on limited information.

“It’s tough, because we don’t have much evidence out there,” Andrew Ip, MD, hematologist/oncologist at Hackensack Meridian Health John Theurer Cancer Center, told HemOnc Today. “We think convalescent plasma helps, but it’s still not strongly evidence-based. We’re waiting on larger research trials to publish their data. It’s very hard to make judgments when there’s not much good data.”

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MPN Patients Ask the Experts

Three Key Relationships Bring New Drugs to the MPN Community

 Byline:  Ann Brazeau, CEO & Founder

MPN Advocacy and Education International prides itself on bringing the experts to the MPN Community to ensure they are receiving accurate and updated information about clinical trials, treatment options, quality of life issues, and everything that could affect them medically.  It also brings biopharmaceutical companies together with the researchers/clinicians at all of their programs in an effort to inform both physician and patient who is doing what in the laboratories around the world that could bring a new drug to commercialization for their use.

These three relationships are critical to new drug development.  Our Industry Partners’ research and development teams work tirelessly in their labs to find answers to perplexing questions myeloproliferative neoplasms present.  The MPN specialists who give so much of their time to speak at our programs, spend hours in their labs and also see patients throughout each day to understand the complexities of MPNs and how to best treat each patient, and many participate in heading trials at their academic and medical institutions.  Patients participate and commit to lengthy clinical trials to help discover what works and what doesn’t.  Without them, drugs would not be developed or approved. Drugs have to be tested for safety and efficacy in patients.  There is no way around this fact.  Hats off to those who volunteer to participate in clinical trials in hopes that the drug may one day benefit others who have the same condition as theirs.  Participation in a clinical trial is a major contribution to our society.

Learn more about MPN clinical trials

This intricate connection is the key to so many discoveries that have saved lives, cured the common headache, stopped seizures, and cured some cancers.  While preclinical research answers basic questions about a drug’s safety, it is not a substitute for studies of ways the drug will interact with the human body.  People living with a chronic disease, like an MPN, benefit enormously from the pipeline of medications brought to market by hard-working clinical researchers who design and carry out clinical trials that show promise after testing in animals.

Education is critical to the success of clinical trials and participation.  If physicians that treat you are not aware of the numerous trials currently underway, is it your responsibility to share what you know? We would say yes.  Our programs for physicians that treat MPN patients always includes updates about current trials to be sure they are made aware of every single trial in the MPN space.  This information coupled with site locations and trial criteria are essential to connecting the patient to a specific trial.

In this era of individualized treatment protocols and combination therapies, which will eventually be widespread in not only MPNs but other disease areas, it would be a shame to miss opportunities where potentially good therapies might fall off the grid for lack of trial participants and trial sites due to already strained programs.  With the robust activity in MPNs currently, the challenges accompany the gains.  Thus, the relationships among the three groups is even more important.

MPN Advocacy and Education International understands the challenges experienced by all three entities.  Each plays an integral role in bringing new drugs to the shelves and ultimately to patients.  Researchers who participate in trials and see patients can be overwhelmed.  Patients may have financial issues that prohibit a commitment to a trial even if they want to participate.  There are social and cultural factors that have historically left many trials with one demographic of participants, namely white, insured, and often retired.

The good news is organizations and our partners want to understand the challenges and want to help in all ways.  In the seventeen years I’ve been working in MPNs, I am seeing the fruits of our advocating and educational efforts not only for patients, but in our relationships with biopharmaceutical companies and the hundreds of physicians who are not necessarily MPN specialists that see MPN patients.  Our engagement and desire to grow a deeper understanding of the many challenges patients face has created a real interest in finding ways to close the gaps in areas of access, participation, education, and support.

Without collaboration and communication, the momentum needed for new drug development would quickly lose steam.  MPN Advocacy and Education International remains committed to providing a platform for the dialogue necessary to keep the wheels in motion.

View our MPN Clinical Trials 101 Webinar

 

 

New MPN Treatments Improve Survival and Symptom Burden

Combinations of JAK inhibitors and novel agents, such as epigenetic regulators, could help prolong survival in patients with myeloproliferative neoplasms (MPNs), providing patients with more than a reduction in spleen size and symptomatic relief, explained Shella Saint Fleur-Lominy, MD, PhD, who added that for patients who have already progressed on ruxolitinib (Jakafi), fedratinib (Inrebic), momelotinib, and pacritinib could be potential second-line options.

“A lot of these agents will probably be used in combination with ruxolitinib for the most optimal response. It’s very promising to see all those different agents emerge that have an effect on disease outcome and modulation of the bone marrow,” said Saint Fleur-Lominy. “For every symptomatic patient who gets diagnosed with myelofibrosis, polycythemia vera [PV], or essential thrombocythemia [ET], we need to determine if they’re a candidate for a clinical trial, because that’s how we advance the treatment landscape.”

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Low-Dose Ruxolitinib Improves Splenomegaly and Symptoms in Myelofibrosis

Low-dose ruxolitinib (Jakafi) appears effective as treatment of patients with myelofibrosis (MF), improving splenomegaly and symptoms with a daily dose ≤ 10 mg, according to findings from a retrospective analysis.

While the high-dose group had better outcomes to therapy, the difference in spleen length reduction between high-dose group and low-dose group was minimized. This ultimately suggests that the low-dose treatment induced slow but gradual spleen responses.

The analysis, published in Annals of Hematology, aimed to explore the treatment outcomes of patients with MF using low-dose regimens of ruxolitinib compared with high-dose treatment. The study included patients in the Department of Hematology of West China Hospital of Sichuan University between July 2017 and January 2020 who had received ruxolitinib therapy, all of whom met the 2016 World Health Organization diagnostic criteria for primary MF (PMF), post-essential thrombocythemia (ET) MF, or post-polycythemia vera (PV) MF.

The initial ruxolitinib dose for patients was determined based on the baseline platelet count and patient’s willingness. The dose was adjusted during treatment according to the changes observed in the blood cell count, as well as the therapeutic effect.

Eighty-eight patients were included in the study, of which 68 had PMF, 13 post-ET MF, and 7 post-PV MF. The median time from diagnosis to the start of treatment was 0.5 months. Forty-four patients received low-dose ruxolitinib, which was ≤ 10 mg daily. In this group, 2 patients received a 5 mg dose daily, while the remaining 42 patients had received 10 mg. The dose was individually titrated in 22 patients in order to optimize the safety and efficacy, while dose adjustments mainly occurred during weeks 10 through 16 following initiation of treatment. Final titrated doses were increased in 15 patients and decreased in 7.

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Carriers of CALR Mutations at Decreased Risk for Thrombotic Events Among ET Patients

Mutations of calreticulin (CALR) are associated with lower risk for thrombotic events in patients with essential thrombocythemia (ET). These findings, from a multicenter retrospective study, were published in the European Journal of Haematology.

In patients with ET, higher levels of platelets, lower hemoglobin levels, and fewer thrombotic complications, with a two-fold reduced risk of thrombosis, are characteristics of a driver mutation in the CALR gene. In this study, researchers sought to determine the impact of CALR mutation type on thrombotic risk.

Medical records from 983 patients treated at 11 hospitals in Spain and 4 in Poland since 2000 were assessed for major thrombotic events 2 years prior to and a median 7.6 years after an ET diagnosis and for CALR and Janus kinase 2 (JAK2V617F mutations.

Patients were aged median 54 years, 36.2% were men, 64.8% had JAK2V617F mutation, and 27.6% had CALR mutation (53.3% type 1; 36.4% type 2; 10.3% other).

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PharmaEssentia Announces New Trial for ET Patients

PHARMAESSENTIA INITIATES PIVOTAL TRIAL OF ROPEGINTERFERON ALFA-2B TO TREAT ESSENTIAL THROMBOCYTHEMIA

With a diversifying pipeline, the company is evaluating applications for pegylated interferon to address underserved hematologic cancers

January 7, 2021, Burlington, MA – PharmaEssentia Corporation (TPEx: 6446), a global biopharmaceutical innovator leveraging deep expertise and proven scientific principles to deliver new biologics in hematology and oncology, today announced the initiation of SURPASS ET, a Phase 3 pivotal clinical trial of its investigational ropeginterferon alfa-2b (P1101), a novel mono-pegylated proline interferon under evaluation for the treatment of the essential thrombocythemia (ET), one form of myeloproliferative neoplasms (MPNs).

MPNs are caused by specific genetic mutations that lead to overproduction of blood components, including white or red blood cells. ET is one of the group of MPNs, caused by an overproduction of platelets. The disease, which is estimated to affect up to 57 per 100,000 people in the U.S, initially presents with symptoms such as fatigue, anemia and splenomegaly. Over time, ET is known to evolve into myelofibrotic phases with increasingly debilitating symptoms and greater mortality.1

“Through our advanced technology, we are working to introduce a new perspective for treating hematologic malignancies such as ET, which need new therapies with the potential to modify and better control the disease,” said Dr. Albert Qin, Chief Medical Officer of PharmaEssentia. “Our goal with this important study is to determine if ropeginterferon alfa-2b may represent a potential solution that can help physicians significantly improve the therapy outcomes for patients in need.” Read more

View Clinical Trial Details

Learn more about PharmaEssentia

An Introduction to MPN Advocacy & Education International

Welcome, MPN Advocacy & Education International works with the Patient Access Network (PAN) Foundation to provide resources to the patients, caregivers, physicians and healthcare teams to improve their understanding of essential thrombocythemia (ET), polycythemia vera (PV) and myelofibrosis (MF) known as myeloproliferative neoplasms (MPN).

We host patient educational programs across the country, with MPN specialists presenting on a wide range of topics impacting the MPN community, including treatments, clinical trials, and emerging research. Our advocacy efforts focus on identifying the unmet needs of the MPN community, as well as creating initiatives that improve the overall quality of care for MPN patients. View videos from our past events.

In addition, take a minute to tour our website, mpnadvocacy.com, it provides a wealth of information on MPNs, including videos from our MPN patient education programs, FAQs, local support group contacts, and many other useful resources.  You can also view and sign up for our online monthly newsletter.

If we can be of any help or you wish to receive additional materials, please do not hesitate to contact us.