RecruitingEarly Phase 1

Momelotinib in Combination With Hypomethylating Agent for Chronic Phase Myelodysplastic Syndromes/Myeloproliferative Overlap Neoplasms and Chronic Neutrophilic Leukemia

A Pilot Study of Momelotinib in Combination With Hypomethylating Agent for Chronic Phase Myelodysplastic Syndromes/Myeloproliferative Overlap Neoplasms and Chronic Neutrophilic Leukemia (M-HArbOr)

Who can join

As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.

Age
18 Years to 100 Years
Sex
All sexes
Healthy volunteers
Not accepted
Compensation
Not stated

Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.

What to expect

No one can promise a trial will help you personally — that is what the research is trying to find out.

What participation involves

  • Visits mentioned: 1 visit
  • Time periods mentioned: 24 months
  • Procedures mentioned: Blood draws, Physical exams, Injections, MRI scans, Ultrasound

Only what the study's summary and detailed description on ClinicalTrials.gov say. Time periods may describe the whole study or a part of it — ask the study team what applies to you.

Show the study's own words
  • "Participants for this study will be asked to take some screening tests which will include routine physical examination, blood tests, and imaging scans to determine eligibility for the study."
  • "Those who continue to qualify for this study will begin treatment and may be asked to remain on the study drug for up to 24 months, depending upon how they are responding to treatment."
  • "After the study drug is completed, patients will have one additional clinic visit to evaluate overall health and response to study drug."
  • "The study drug treatment on this study will include taking momelotinib by mouth in combination with azacitidine, which is given by injection for all patients for the first 5 days of each 28-day cycle."
  • "Baseline splenomegaly with greater than or equal to 5 cm below costal margin or greater than or equal to 450 cm3 on imaging (ultrasound, CT or MRI)"
Compensation
Not stated
  • Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
  • Participants are monitored closely by the research team throughout the study.
  • Some participants may receive access to an investigational treatment, which is still being studied.
  • Your participation helps researchers learn whether this approach could help future patients.

About this study

In plain language

This study tests momelotinib with azacitidine, a standard treatment, for adults with certain blood cancers called MDS/MPN or chronic neutrophilic leukemia. It looks at how well the drugs work together and how safe they are. Treatment includes momelotinib pills and azacitidine shots and may last up to 24 months.

This research is being done to evaluate effectiveness, safety, and tolerability of a study drug called momelotinib in participants with myelodysplastic/myeloproliferative neoplasms (MDS/MPNs), MDS/MPN-not otherwise specified (MDS/MPN-NOS), MDS/MPN with neutrophilia (MDS/MPN-N), also called as atypical chronic myeloid leukemia, or chronic neutrophilic leukemia. Momelotinib will be added to standard treatment which usually includes a hypomethylating agent like azacitidine. Treatment options for this diagnosis remain limited and investigators need better treatments to help control the disease, improve symptoms, and potentially help more patients become eligible for transplant. Participants for this study will be asked to take some screening tests which will include routine physical examination, blood tests, and imaging scans to determine eligibility for the study. Those who continue to qualify for this study will begin treatment and may be asked to remain on the study drug for up to 24 months, depending upon how they are responding to treatment. After the study drug is completed, patients will have one additional clinic visit to evaluate overall health and response to study drug. The study drug treatment on this study will include taking momelotinib by mouth in combination with azacitidine, which is given by injection for all patients for the first 5 days of each 28-day cycle. The most common side effect that may be related to participation in this study can include (i) infections which can present as fever, chills, cough, breathing problems, diarrhea, vomiting, pain or burning with urination; or (ii) low blood platelet count which can result in bruising or bleeding for longer than usual if the participant hurts themself.

Compensation is read from the study's own description and may be missing — always confirm with the study team.

Eligibility

Who can join

  • Be age 18 or older with an eligible blood cancer: chronic myelomonocytic leukemia, MDS/MPN with neutrophilia, chronic neutrophilic leukemia, or MDS/MPN not otherwise specified.
  • Have chronic-phase disease, with fewer than 10% blasts (very young blood cells) in blood and bone marrow, tested within 1 month before treatment.
  • Be able to care for yourself and be out of bed for at least half the day. Be expected to live more than 24 weeks.
  • Have enough platelets (cells that help stop bleeding) and neutrophils (infection-fighting cells), without transfusions or medicines to raise these counts.
  • Have an enlarged spleen that meets the study's size rules, and kidney, liver, and blood-clotting test results that meet study limits.
  • You may be new to treatment or have had certain past treatments. Required waiting times depend on the treatment and why it was stopped.
  • Be willing and able to sign a consent form and answer health questions on an electronic device.
  • Follow the study's birth control rules during and after treatment. If you can become pregnant, have a negative blood pregnancy test within 24 hours before the first dose. Do not breastfeed during treatment or for 1 week after the last dose.

Who can't join

  • Have MDS/MPN with an SF3B1 gene change and high platelet counts, or more than 10% blasts in blood or bone marrow.
  • Have ever taken momelotinib, have a known allergy to it, or had no benefit from a hypomethylating drug, such as azacitidine.
  • Have used certain medicines too recently, including other study drugs, drugs that raise red blood cells, drugs that weaken the immune system, or certain drugs that affect momelotinib levels.
  • Have had your spleen removed, or cannot or will not have scans to measure it.
  • Have another active cancer that could affect study safety or results. Some treated or removed cancers are allowed.
  • Have active hepatitis A, B, or C; certain HIV-related test results or treatments; or an infection needing antibiotics through a vein.
  • Have liver tests above study limits, lasting side effects from past treatment above the allowed level, or moderate or worse nerve damage.
  • Be pregnant, be unable to swallow medicine, or have a health condition, major surgery, radiation, or procedure that the study doctor believes would make participation unsafe or affect study results.

Simplified for readability. The official criteria below are what the study team uses.

Official eligibility criteria

* Patients of age 18 or older * Has a diagnosis of MDS/MPN or CNL by WHO or ICC diagnostic criteria: 1. Chronic myelomonocytic leukemia 2. MDS/MPN with neutrophilia, previously known as atypical chronic myeloid leukemia 3. Chronic neutrophilic leukemia 4. MDS/MPN -not otherwise specified * Chronic phase disease with \<10% blasts in peripheral blood and marrow within 1 month from planned start of treatment * Eastern Cooperative Oncology Group (ECOG) Performance Score44 of 0-2 * Patients can be treatment naïve or could have undergone prior treatments for MDS/MPN as below: 1. Prior treatment with non-JAK inhibitors or hypomethylating agents are allowed (e.g., hydroxyurea, immunomodulatory agents, steroids). Hydroxyurea can be continued until or even beyond initiation of treatment for 2 months if needed for cytoreduction 2. If non-MMB JAK inhibitors were used for treatment and stopped due to side effects (e.g., anemia from ruxolitinib, gastrointestinal toxicity from fedratinib, etcetera), these patients will be allowed to enroll on this study as long as JAK inhibitor was stopped at least 2 weeks prior to anticipated start date of treatment 3. If prior hypomethylating agent was used and stopped longer than 3 months prior to anticipated start date of treatment due to side effects, these patients will be eligible. However, if hypomethylating agents were stopped due to lack of clinical benefit, these patients will not be deemed eligible 4. Prior treatment with erythropoietic stimulating agents is allowed if last treatment was more than 4 weeks prior to anticipated start date of treatment 5. Splenic radiation should have been performed more than 2 months before anticipated start date of treatment 6. Any prior or ongoing investigation therapy or agents should be stopped longer than 4 weeks of anticipated start date of treatment * Blood counts with platelets ≥25,000/microL, ANC ≥0.75 x 10\^9/L (without transfusion or growth factor support) * Baseline splenomegaly with ≥5 cm below costal margin or ≥450 cm3 on imaging (ultrasound, CT or MRI) * Adequate organ function with creatinine clearance measured by Cockcroft-Gault calculation ≥30 mL/min, total bilirubin ≤1.5×ULN (isolated bilirubin \>1.5 x ULN is acceptable if bilirubin is fractionated and direct bilirubin \<35%), INR ≤1.5 × ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within the therapeutic range of intended use of anticoagulants, albumin ≥2.5 g/dL. * Willing and able to sign the informed consent form * Life expectancy \> 24 weeks * Willing and able to complete patient-reported outcome assessments using an ePRO device according to protocol * Patients of child-bearing potential, or those with partners of child-bearing potential or pregnant or lactating partners, who are willing to follow highly effective contraceptive requirements. Females of reproductive potential should use effective contraception during study treatment and for 6 months following the last dose for HMA-MMB and 1 week following the last dose for MMB monotherapy. Males with female partners of reproductive potential should use effective contraception during study treatment and for 3 months following the last dose for HMA-MMB and 1 week following the last dose for MMB monotherapy. Patients should not breastfeed during treatment and for 1 week after the last dose. * Patients of child-bearing potential with a negative highly sensitive serum pregnancy test within 24 hours before the first dose of momelotinib. Exclusion criteria * Diagnosis of MDS/MPN with SF3B1 gene mutation and thrombocytosis (excluded due to unclear role of ACRV1 in the development of anemia) * Peripheral blood or marrow (by immunohistochemistry) blast percentage \>10% * Prior lack of response to MMB or hypomethylating agents. * Known history of allergic reaction to momelotinib * AST or ALT above 2.5 x ULN (above 5 X ULN if liver is involved by extramedullary hematopoiesis as judged by the investigator or if related to iron chelator therapy that was started within the prior 60 days) * The following treatments within the time periods as specified: 1. Momelotinib at any time prior to screening 2. Erythropoietic stimulating agents within 4 weeks of treatment 3. Investigational agent within 4 weeks of the first dose of study treatment 4. Immunosuppressive agents within 28 days (low dose steroids ≤10 mg daily prednisone or equivalent is allowed) 5. Potent cytochrome P450 3A4 (CYP3A4) inducers, except for rifampin and rifampicin, within 14 days prior to the first dose of momelotinib. Strong CYP3A4 inducers can lead to decreased MMB exposure and risk a lack of efficacy. Therefore, alternative medicinal product to strong CYP3A4 inducer should be considered. * Unsuitable for spleen volume measurements due to prior splenectomy or unwilling or unable to undergo any imaging (ultrasound, CT without contrast or MRI without contrast) for spleen volume measurement per requirements * Patients with an active invasive concurrent malignancy, whose natural history or treatment has a significant potential to interfere with the safety or efficacy assessment of the investigational regimen. * Localized prostate cancer that has been treated surgically or by radiotherapy with curative intent and presumed cured is allowed. * History of non-melanoma skin cancers such as basal cell carcinoma or squamous cell carcinoma are also allowed. * Completely resected intraepithelial carcinoma of cervix or papillary thyroid or follicular thyroid cancers are also allowed at the investigator's discretion. * Untreated or active infections are excluded as below: 1. Chronic active or acute viral hepatitis A, B, or C infection. Participants with positive hepatitis C antibody due to prior resolved disease can be enrolled, only if a confirmatory negative hepatitis C RNA test is obtained. 2. HIV with CD4+ cell count under 400 cells/ μL or on treatment with anti-retroviral therapy that is specifically excluded per the criteria above. HIV patients on established anti-retroviral therapy allowed per protocol for at least 4 weeks and CD4+ count above or equal to 400 cells/ μL 3. Infections requiring intravenous antibiotics * Nonhematologic toxicities from prior therapies that are unresolved and are of grade \>1 * Presence of peripheral neuropathy of grade ≥2 * Pregnant women are excluded from this study because the effects of momelotinib on embryotoxicity, survival, and teratogenicity remain unclear. * Patients unable to swallow medications * Patient has any medical condition that puts the patient at an acceptable high risk with participation in the study per physician assessment or has any condition that confounds the ability to interpret data from the study. * Any major surgery or radiation or intervention that interferes with safety or feasibility of enrollment per investigator assessment

Study sites (1)

MD