ARIAD and the U.K. National Cancer Research Institute to Collaborate on SPIRIT 3 Clinical Study
Evaluation of the Impact of Switching CML Patients Treated with a
First-line Tyrosine Kinase Inhibitor to Ponatinib
ARIAD
Pharmaceuticals, Inc. (NASDAQ: ARIA) and Newcastle University, U.K.,
on behalf of the U.K. National Cancer Research Institute (NCRI) CML
Working Group, today announced an agreement to collaborate on a
multicenter, randomized Phase 3 trial, named SPIRIT 3, to assess the
impact of switching patients with chronic myeloid leukemia (CML) being
treated with a first-line tyrosine kinase inhibitor, upon suboptimal
response or treatment failure, to ponatinib. The NCRI expects to begin
enrollment in the trial of 1,000 patients at approximately 172 clinical
research sites in the U.K. in the second quarter of 2013.
“The SPIRIT 3 study was designed in partnership with ARIAD to provide
the scientific community and patients living with chronic-phase CML a
deeper understanding of the most effective ways to use TKIs and whether
we can improve treatment outcomes by switching patients to ponatinib,
who have failed to achieve optimal response from imatinib or nilotinib,”
stated Stephen G. O’Brien, Professor of Haematology at the Northern
Institute for Cancer Research at Newcastle University, NCRI member and
chief investigator of the SPIRIT 3 study. “We look forward to assessing
ponatinib as a treatment in this setting and evaluating its potential
clinical, economic and quality-of-life benefits.”
Trial Design and Statistical Analysis
The SPIRIT 3 trial is a randomized, two-arm, multicenter trial that
compares major molecular response (MMR) at three years in newly
diagnosed patients treated with imatinib to those treated with
nilotinib, when patients are “rescued” with ponatinib upon suboptimal
response at three or 12 months or treatment failure. The SPIRIT 3 trial
will enroll adult patients with chronic-phase CML diagnosed within three
months and previously untreated for CML with any TKI therapy.
Approximately 1,000 patients will be randomized 1:1 to standard doses of
imatinib (400 mg orally once daily) or nilotinib (300 mg orally twice
daily). Patients will be switched to ponatinib (45 mg orally once daily)
based on defined criteria of suboptimal response, treatment failure, or
intolerance to first-line therapy.
The primary endpoint of the study is the proportion of patients who have
achieved MMR at three years on their initially allocated first line of
therapy, regardless of switch to ponatinib. MMR is defined as a less
than or equal to 0.1% ratio of BCR-ABL to ABL transcripts on the
International Scale measured in peripheral blood by PCR testing.
The sample size of 500 patients per arm in the SPIRIT 3 protocol
provides over 90 percent power to show noninferiority in three-year MMR
rates between patients starting on imatinib, allowing switch to
ponatinib, and patients starting on nilotinib, allowing switch to
ponatinib. These sample size calculations use a noninferiority margin of
a 10 percent absolute difference and assume a 73 percent MMR rate at
three years in each arm.
Secondary endpoints include the proportion of patients who have achieved
therapy cessation three years from having achieved stable MMR, cost of
therapy (measured as incremental cost per quality adjusted life year
gained), overall survival, progression-free survival, event-free
survival, and treatment failure rates at five years, as well as safety
and tolerability of the TKIs. Each patient will be followed for a
minimum of five years from the time the last patient in the trial is
randomized to either treatment arm.
A key feature of the trial is that patients achieving stable MMR will be
offered the opportunity to reduce the dose of their TKI therapy or stop
treatment altogether. These patients will be monitored more closely with
monthly PCR testing and will be reverted back to full-dose TKI therapy
for loss of MMR at any time or rising BCR-ABL transcript ratio on two
consecutive tests.
“We are deeply committed to helping physicians and CML patients improve
outcomes with TKI therapy,” stated Frank G. Haluska, M.D., Ph.D., chief
medical officer at ARIAD. “The SPIRIT 3 trial will evaluate the
potential for ponatinib to improve outcomes in patients who have
sub-optimal responses early in the course of first-line therapy for CML,
by enabling those patients with a poorer prognosis to switch TKI
therapy. This should have important implications for the future
management of CML.”
About Iclusig™ (ponatinib)
Iclusig is a kinase inhibitor. The primary target for Iclusig is
BCR-ABL, an abnormal tyrosine kinase that is expressed in chronic
myeloid leukemia (CML) and Philadelphia-chromosome positive acute
lymphoblastic leukemia (Ph+ ALL). Iclusig was designed using ARIAD’s
computational and structure-based drug design platform specifically to
inhibit the activity of BCR-ABL. Iclusig targets not only native BCR-ABL
but also its isoforms that carry mutations that confer resistance to
treatment, including the T315I mutation, which is the most common
mutation among resistant patients. Iclusig is the only TKI that is
effective in CML and Ph+ ALL patients with this mutation.
Please see the full prescribing information, including the Boxed
Warning, for Iclusig at www.ariad.com
or www.iclusig.com.
Indication, Usage and Dosing
Iclusig is indicated for the treatment of adult patients with chronic
phase, accelerated phase, or blast phase chronic myeloid leukemia (CML)
that is resistant or intolerant to prior tyrosine kinase inhibitor (TKI)
therapy or Philadelphia chromosome-positive acute lymphoblastic leukemia
(Ph+ ALL) that is resistant or intolerant to prior TKI therapy.
This indication is based upon response rate. There are no trials
verifying an improvement in disease-related symptoms or increased
survival with Iclusig.
The recommended dose of Iclusig is a 45 mg tablet taken once-daily with
or without food.
Important Safety Information
Cardiovascular, cerebrovascular, and peripheral vascular thrombosis,
including fatal myocardial infarction and stroke have occurred in
Iclusig-treated patients. Serious arterial thrombosis occurred in 8% of
Iclusig-treated patients. Interrupt and consider discontinuation of
Iclusig in patients who develop arterial thrombotic events.
Hepatotoxicity, liver failure and death have occurred in Iclusig-treated
patients. Monitor hepatic function prior to and during treatment.
Interrupt and then reduce or discontinue Iclusig for hepatotoxicity.
Warnings and Precautions
Twenty patients treated with Iclusig (4%) experienced serious congestive
heart failure (CHF) or left ventricular dysfunction, with 4 fatalities.
Monitor patients for signs or symptoms consistent with CHF and treat as
clinically indicated, including interruption of Iclusig. Consider
discontinuation of Iclusig in patients who develop serious CHF.
Eight patients treated with Iclusig (2%) experienced treatment-emergent
symptomatic hypertension as a serious adverse reaction, including
hypertensive crisis. Treatment-emergent hypertension occurred in 67% of
patients. Monitor and manage blood pressure elevations.
Clinical pancreatitis occurred in 6% of patients (5% Grade 3) treated
with Iclusig. The incidence of treatment emergent lipase elevation was
41%. Check serum lipase every 2 weeks for the first 2 months and then
monthly thereafter or as clinically indicated. Dose interruption or
reduction may be required. In cases where lipase elevations are
accompanied by abdominal symptoms, interrupt treatment with Iclusig and
evaluate patients for pancreatitis.
Serious bleeding events occurred in 5% of patients treated with Iclusig,
including fatalities. The incidence was higher in patients with AP-CML,
BP-CML, and Ph+ ALL. Most events occurred in patients with grade 4
thrombocytopenia. Interrupt Iclusig for serious or severe hemorrhage.
Serious fluid retention events occurred in 3% of patients treated with
Iclusig. One instance of brain edema was fatal. Monitor patients for
fluid retention and manage patients as clinically indicated. Interrupt,
reduce, or discontinue Iclusig as clinically indicated.
Symptomatic bradyarrhythmias that led to a requirement for pacemaker
implantation occurred in 3 (1%) Iclusig-treated patients. Advise
patients to report signs and symptoms suggestive of slow heart rate
(fainting, dizziness, or chest pain).
Supraventricular tachyarrhythmias occurred in 5% of Iclusig-treated
patients. Atrial fibrillation was the most common supraventricular
tachyarrhythmia. Advise patients to report signs and symptoms of rapid
heart rate (palpitations, dizziness).
Severe (Grade 3 or 4) myelosuppression occurred in 48% of patients
treated with Iclusig.
Obtain complete blood counts every 2 weeks for the first 3 months and
then monthly or as clinically indicated, and adjust the dose as
recommended.
Two patients (<1%) treated with Iclusig developed serious tumor lysis
syndrome. Hyperuricemia occurred in 7% of patients. Ensure adequate
hydration and treat high uric acid levels prior to initiating therapy
with Iclusig.
Since Iclusig may compromise wound healing, interrupt Iclusig for at
least 1 week prior to major surgery. Serious gastrointestinal
perforation (fistula) occurred in one patient 38 days
post-cholecystectomy.
Iclusig can cause fetal harm. Advise women to avoid pregnancy while
taking Iclusig.
Adverse Reactions
The most common non-hematologic adverse reactions (≥20%) were
hypertension, rash, abdominal pain, fatigue, headache, dry skin,
constipation, arthralgia, nausea, and pyrexia. Hematologic adverse
reactions included thrombocytopenia, anemia, neutropenia, lymphopenia,
and leukopenia. Please see the full Prescribing
Information for Iclusig, including the Boxed Warning.
About CML and Ph+ ALL
CML is characterized by an excessive and unregulated production of white
blood cells by the bone marrow due to a genetic abnormality that
produces the BCR-ABL protein. After a chronic phase of production of too
many white blood cells, CML typically evolves to the more aggressive
phases referred to as accelerated phase and blast crisis. Ph+ ALL is a
subtype of acute lymphoblastic leukemia that carries the Ph+ chromosome
that produces BCR-ABL. It has a more aggressive course than CML and is
often treated with a combination of chemotherapy and tyrosine kinase
inhibitors. The BCR-ABL protein is expressed in both of these diseases.
About the NCRI
The U.K. National Cancer Research Institute (NCRI) was established in
April 2001. It is a U.K-wide partnership between the government, charity
and industry which promotes co-operation in cancer research among the
twenty-two member organisations for the benefit of patients, the public
and the scientific community. For more information visit www.ncri.org.uk
NCRI members are: the Association of the British Pharmaceutical Industry
(ABPI); Association for International Cancer Research; Biotechnology and
Biological Sciences Research Council; Breakthrough Breast Cancer; Breast
Cancer Campaign; Cancer Research UK; CHILDREN with CANCER UK; Department
of Health; Economic and Social Research Council; Leukaemia & Lymphoma
Research; Ludwig Institute for Cancer Research; Macmillan Cancer
Support; Marie Curie Cancer Care; Medical Research Council; Northern
Ireland Health and Social Care (Research & Development Office); Prostate
Cancer UK; Roy Castle Lung Cancer Foundation; Scottish Government Health
Directorates (Chief Scientist Office); Tenovus; The Wellcome Trust;
Welsh Government (National Institute for Social Care and Health
Research); and Yorkshire Cancer Research.
About ARIAD
ARIAD Pharmaceuticals, Inc. is a global oncology company focused on the
discovery, development and commercialization of medicines to transform
the lives of cancer patients. ARIAD’s first medicine, Iclusig™, is
approved in the U.S. for the treatment of adult patients with chronic,
accelerated or blast phase chronic myeloid leukemia that is resistant or
intolerant to prior tyrosine kinase inhibitor (TKI) therapy or
Philadelphia chromosome-positive acute lymphoblastic leukemia that is
resistant or intolerant to prior TKI therapy. Additional clinical trials
of Iclusig in other cancers are ongoing. ARIAD is also studying AP26113,
another molecularly targeted medicine, in certain forms of lung cancer.
For additional information, visit http://www.ariad.com
or follow ARIAD on Twitter
(@ARIADPharm).
This press release contains “forward-looking statements” including, but
not limited to, potential regulatory approvals, new indications or
labeling for, or potential future sales of Iclusig. Forward-looking
statements are based on management's expectations and are subject to
certain factors, risks and uncertainties that may cause actual results,
outcome of events, timing and performance to differ materially from
those expressed or implied by such statements. These risks and
uncertainties include, but are not limited to, preclinical data and
early-stage clinical data that may not be replicated in later-stage
clinical studies, the costs associated with our research, development,
manufacturing and other activities, the conduct, timing and results of
pre-clinical and clinical studies of our product candidates, the
adequacy of our capital resources and the availability of additional
funding, and other factors detailed in the Company's public filings with
the U.S. Securities and Exchange Commission. The information contained
in this press release is believed to be current as of the date of
original issue. The Company does not intend to update any of the
forward-looking statements after the date of this document to conform
these statements to actual results or to changes in the Company's
expectations, except as required by law.
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