Verastem Oncology Presents Phase 3 DUO Data Evaluating COPIKTRA (Duvelisib) in Patients with CLL/SLL Who Have Progressed Following Two Prior Lines of Therapy
Verastem, Inc.?(Nasdaq:VSTM) (Verastem Oncology or the Company), a biopharmaceutical company focused on developing and commercializing medicines seeking to improve the survival and quality of life of cancer patients, today announced a poster highlighting clinical data from the Phase 3 DUO study evaluating COPIKTRA (duvelisib) in patients with relapsed or refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) after at least two prior therapies was presented at the 23rd?Annual?International Congress on Hematologic Malignancies?(ICHM), which took place?February 28???March 3, 2019, in?Miami, FL.?COPIKTRA, an oral inhibitor of phosphoinositide 3-kinase (PI3K), and the first approved dual inhibitor of PI3K-delta and PI3K-gamma, received approval from the?U.S. Food and Drug Administration?(FDA) for this same indication in?September 2018.
COPIKTRA also received accelerated approval for the treatment of adult patients with relapsed or refractory follicular lymphoma (FL) after at least two prior systemic therapies. The accelerated approval was based on overall response rate and continued approval for this indication may be contingent upon confirmatory trials.
?Although the treatment landscape in CLL/SLL has advanced in recent years, there remains an unmet need with many patients progressing or relapsing,? commented?Ian Flinn, MD, PhD, Director, Lymphoma/CLL Program at?Sarah Cannon Research Institute?and lead investigator of the DUO study. ?These data from the randomized Phase 3 DUO study, which were calculated from patients who had previously received at least two prior therapies, demonstrate that COPIKTRA achieved a 78% overall response rate and progression-free survival of 16.4 months, compared to 9.1 months for ofatumumab, in patients with relapsed or refractory CLL/SLL, including in high risk patients with the 17p deletion. With convenient oral administration COPIKTRA has been a valuable addition to the treatment landscape for CLL/SLL patients and for the physicians who treat them.?
Results of the Phase 3 DUO Study Evaluating COPIKTRA in Adult Patients with Relapsed or Refractory CLL/SLL After At Least Two Prior Therapies
The randomized, multicenter, open-label, Phase 3 DUO study, compared COPIKTRA versus ofatumumab in 319 adult patients with CLL (n=312) or SLL (n=7) after at least one prior therapy. The study randomized patients with a 1:1 ratio to receive either COPIKTRA 25mg twice daily until disease progression or unacceptable toxicity, or ofatumumab, an approved standard of care treatment for use in CLL/SLL, for 7 cycles.
The approval of COPIKTRA was based on efficacy and safety analysis of patients with at least 2 prior lines of therapy, where the benefit:risk appeared greater in this more heavily pretreated population compared to the overall trial population.
In this subset (95 randomized to COPIKTRA, 101 to ofatumumab), the median patient age was 69 years (range: 40 to 90 years), 59% were male, and 88% had an ECOG performance status of 0 or 1. Forty-six percent received 2 prior lines of therapy, and 54% received 3 or more prior lines. At baseline, 52% of patients had at least one tumor = 5 cm, and 22% of patients had a documented 17p deletion.
During randomized treatment, the median duration of exposure to COPIKTRA was 13 months (range: 0.2 to 37), with 80% of patients receiving at least 6 months and 52% receiving at least 12 months of COPIKTRA. The median duration of exposure to ofatumumab was 5 months (range: < 0.1 to 6).
Efficacy was based on progression-free survival (PFS) as assessed by an Independent Review Committee (IRC). Other efficacy measures included overall response rate (ORR). Efficacy of COPIKTRA compared to ofatumumab specifically in patients treated with at least two prior therapies is below.
Abbreviations: CR = complete response; IRC = Independent Review Committee; PFS = progression-free survival; PR = partial response; SE = standard error
a?Kaplan-Meier estimate
b?Standard Error of ln(hazard ratio) = 0.2
c?IWCLL or revised IWG response criteria, with modification for treatment-related lymphocytosis
COPIKTRA has a BOXED WARNING for four fatal and/or serious toxicities: infections, diarrhea or colitis, cutaneous reactions, and pneumonitis. Verastem Oncology has implemented a Risk Evaluation and Mitigation Strategy to provide appropriate dosing and safety information to better support physicians in managing their patients on COPIKTRA.
Additionally, COPIKTRA is also associated with adverse reactions which may require dose reduction, treatment delay or discontinuation of COPIKTRA. WARNINGS AND PRECAUTIONS are provided for infections, diarrhea or colitis, cutaneous reactions, pneumonitis, hepatotoxicity, neutropenia, and embryo-fetal toxicity. The most common ADVERSE REACTIONS (reported in = 20% of patients) were diarrhea or colitis, neutropenia, rash, fatigue, pyrexia, cough, nausea, upper respiratory infection, pneumonia, musculoskeletal pain, and anemia.
Please see the Important Safety Information below and the full?Prescribing Information, including BOXED WARNING, and patient?Medication Guide?found on?www.COPIKTRA.com
COPIKTRA has been added to the National Comprehensive Cancer Network? (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines) for CLL/SLL, FL and Marginal Zone Lymphoma (MZL). The NCCN Guidelines are the standard physician resource for determining the appropriate course of treatment for patients. COPIKTRA is not approved for use in MZL.
A PDF copy of this poster presentation is available?here.
Verastem Oncology is committed to helping patients with CLL/SLL and FL access COPIKTRA through our Verastem Cares? program. Verastem Cares is a comprehensive, personalized program designed to provide information and assistance to patients who have been prescribed COPIKTRA.
Patients, physicians, pharmacists, or other healthcare professionals with questions about COPIKTRA should contact 1-833-570-2273 (CARE) or visit?www.COPIKTRA.com.
Important Safety Information
WARNING: FATAL AND SERIOUS TOXICITIES: INFECTIONS, DIARRHEA OR COLITIS, CUTANEOUS REACTIONS, and PNEUMONITIS
See full prescribing information for complete boxed warning
Outcome per IRC | COPIKTRA
N = 95 |
Ofatumumab
N = 101 |
|||||||||
PFS | |||||||||||
Number of events, n (%) | 55 (58) | 70 (69) | |||||||||
Progressive disease | 44 | 62 | |||||||||
Death | 11 | 8 | |||||||||
Median PFS (SE), months?a | 16.4 (2.1) | 9.1 (0.5) | |||||||||
Hazard Ratio (SE),?b
COPIKTRA/ofatumumab |
0.40 (0.2) | ||||||||||
Response rate | |||||||||||
ORR, n (%)?c | 74 (78) | 39 (39) | |||||||||
CR | 0 (0) | 0 (0) | |||||||||
PR | 74 (78) | 39 (39) | |||||||||
Difference in ORR, % (SE) | 39 (6.4) | ||||||||||
- Fatal and/or serious infections occurred in 31% of COPIKTRA-treated patients. Monitor for signs and symptoms of infection. Withhold COPIKTRA if infection is suspected.
- Fatal and/or serious diarrhea or colitis occurred in 18% of COPIKTRA-treated patients. Monitor for the development of severe diarrhea or colitis. Withhold COPIKTRA.
- Fatal and/or serious cutaneous reactions occurred in 5% of COPIKTRA-treated patients. Withhold COPIKTRA.
- Fatal and/or serious pneumonitis occurred in 5% of COPIKTRA-treated patients. Monitor for pulmonary symptoms and interstitial infiltrates. Withhold COPIKTRA.
- CYP3A Inducers: Coadministration with a strong CYP3A inducer may reduce COPIKTRA efficacy. Avoid coadministration with strong CYP3A4 inducers.
- CYP3A Inhibitors: Coadministration with a strong CYP3A inhibitor may increase the risk of COPIKTRA toxicities. Reduce COPIKTRA dose to 15 mg BID when coadministered with a strong CYP3A4 inhibitor.
- CYP3A Substrates: Coadministration of COPIKTRA with sensitive CYP3A4 substrates may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.