An update of safety and efficacy results from phase 1 dose-escalation and expansion study of vodobatinib, a novel oral BCR-ABL1 tyrosine kinase inhibitor (TKI), in patients with chronic myeloid leukemia (CML) and philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ All) failing prior tki therapies

Introduction: Vodobatinib is a novel third generation TKI effective against wild-type and mutated BCR-ABL1 (except T315I) with limited off-target activity. We present updated results from the Phase 1 dose-escalation (DEs) and expansion (DEx) study in CML and Ph+ALL patients (pts) failing ≥ 3 prior TKIs (< 3 prior TKIs if approved TKI is not clinically advised or available);patients with T315I are not eligible (NCT02629692). Methods: This is an open-label, phase 1, multicentre, 3+3 study evaluating maximum tolerated dose (MTD), safety and efficacy of vodobatinib administered once daily in 28 day cycles (dose range: 12 to 240 mg). MTD was established at 204 mg. DEx study enrolled chronic phase CML (CP-CML) patients at 174 mg dose of vodobatinib. Treatment continued until unacceptable toxicity, disease progression, consent withdrawal or death. Adverse events were assessed using NCI-CTCAE v4.03. Results: As of 15 Jul 2021, 52 pts are enrolled in DEs and DEx cohorts. Forty one of these pts received doses from 12 to 240 mg in the DEs cohort;32 chronic phase (CP-CML), 3 accelerated phase CML (AP-CML), 4 blast phase CML (BP-CML), 2 Ph+ ALL. Eleven CPCML pts were enrolled in DEx cohort at 174 mg dose. The baseline demographics and disease history are represented in Table 1. Efficacy: Of the 32 CP-CML pts enrolled in DEs: At baseline, 21 (65%) pts had no cytogenetic response, 4 (12.5%) were in PCyR, 7 (22%) were in CCyR. On vodobatinib therapy, 11(34%) pts achieved CCyR, 3 (9%) achieved PCyR and 7 (22%) maintained baseline CCyR. Baseline major molecular response (MMR) was present in 1 (3%) pt;and 14 pts (44%) achieved MMR on study. Of the remaining 11 pts, 5 (16%) had haematologically stable disease (no CyR and molecular response) and 6 (19%) had disease progression (cytogenetic or hematological) as their best response (Table 2 and 3). Seventeen CP-CML pts had prior ponatinib treatment, of which 11 (65%) had MCyR (4 achieved CCyR, 4 maintained CCyR, 3 achieved PCyR);while 8 (47%) achieved MMR. In the remaining 15 pts ponatinib naïve CP-CML: 10 (66%) had CCyR (7 achieved CCyR, 3 maintained CCyR);with 7 (47%) with MMR (6 achieved, 1 maintained). Two of the 3, AP-CML pts had baseline hematological response (CHR) with absence of cytogenetic and molecular response. The 3 pts further deepened their responses with 1 pt achieving CCyR with MMR and 2 pts in PCyR. Of the 4 BP-CML pts, 2 achieved CHR and 2 patients had disease progression as their best response;Of the 2 Ph+ ALL pts, 1 pt maintained CCyR and MMR while the other reported disease progression as the best response. Median duration of treatment overall was 23 (0.5-51) months [CP-CML 23 (0.5-51);AP-CML 36 (9-40);BP-CML 3 (0.5-18) and Ph+ ALL 4 (0.7-7.3) months]. Twenty one pts continue in study. In the DEx cohort, 1 of the 11 CP-CML pts was in PCyR at baseline. No pts had molecular response. Of the 11 patients, 6 (54 %) pts achieved CCyR, 1(10%) pt achieved PCyR. MMR was achieved by 1 pt (10%). Data is maturing for 1 pt. Median duration of treatment is 16 (0.3-19) months and 10 pts continue in study. Safety: Forty nine of 52 pts reported at least 1 TEAE. Most common any grade TEAEs included thrombocytopenia (33%), cough (19%), anaemia & diarrhoea (17% each). Thirty one pts (60%) reported Grade 3 and 4 treatment emergent AEs: most common were thrombocytopenia (15%), neutropenia and anaemia (12%), increased amylase and lipase (8% each). Ten (19%) pts reported cardiovascular TEAEs (Grade 1: angina pectoris, palpitations, ventricular extra-systoles, arteriosclerosis, hot flush, hypotension, intermittent claudication;Grade 2: hypertension, hypotension;Grade 3: cardiac failure congestive, hypertension);with a Grade 2 hypertension being vodobatinib related. Nineteen pts (37%) reported SAEs;vodobatinib related SAEs were reported in 3 pts (fatal intracranial haemorrhage (ICH), Grade 2 back pain and Grade 3 amnesia reported in 1 pt each). There were 5 deaths on study: 1 was related to use of vodobatinib (1 ICH, confounded by disease progression to blast phase that include extra-medullary sites) and the remaining unrelated (1 sudden death, 1 disease progression, 1 pneumonia fungal, 1 suspected COVID-19). Conclusion: Vodobatinib continues to be associated with favourable long term safety and efficacy in heavily pre-treated CML failing ≥ 3 prior TKIs, including ponatinib. Phase 2 study evaluating vodobatinib in pts failing at least 3 prior lines of therapy, including ponatinib, is ongoing.

Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA Interdisciplinary Expert Consensus.

BACKGROUND: The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS: This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION: The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.

Treatment selection in cml: Effect of online education on clinician knowledge and confidence

Background: Despite the improvement in patient outcomes with the implementation of TKIs, patients still relapse on or are intolerant of initial treatment and an associated impact on quality of life. Physician choice of 2nd and 3rd line treatment is currently essentially limited to the same TKIs as are available for front-line treatment, with the exception of ponatinib. Thus physician's choice of 2nd or 3rd line therapy is not only predicated on patient disease, social and clinical characteristics, but also by which TKI the patient received previously, challenging them to make choices from a decreasing pool of options. Aims: This study determined whether online continuing medical education could improve the knowledge and confidence of clinicians in best-practice sequencing strategies for patients with CML after front line therapy with a tyrosine kinase inhibitor (TKI), using a case-based approach. Methods: A 30-minute online video panel discussion was launched for countries outside the USA in June 2020. Data were collected to September 2020. Educational effect assessed with repeated-pairs pre-/ post-activity, where individual participants served as their own control. 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed. Chi-squared test assessed pre- to post-activity change (5% significance level, P <.05). Magnitude of change in total number of correct responses overall, and for each question, were determined with Cramer's V (<.06=Modest, 0.06- 0.15=Noticeable, .16-.26=Considerable, >.26=Extensive). Results: 52 hematologist/oncologists completed pre- and post-activity questions. A considerable educational effect was observed (V=.181, P<.0001) with average % of correct responses increasing from 34 to 52%. Clinicians with 3/3 answers correct increased post-activity (4 to 12%) and for 2/3 answers correct post-activity (29-46%). Improvements in % of correct responses post-activity were seen for questions on: the patient population with the best outcomes related to clinical trials data, the application of the ELN guideline recommendations for defining response to TKI treatment, and the selection of an appropriate alternative TKI for a patient case (relative improvements, 25%, 56%, and 85%). 52% of haematologist/oncologist responses were improved or reinforced post-activity. 48% of all participants stated they would modify treatment plans. 31% had a measurable increase in confidence in selecting an appropriate BCR-ABL TKI for individual patients with CML who have failed prior lines of therapy with a total average confidence shift of 9.6%. Summary/Conclusion: This on-demand, online video panel discussion resulted in a considerable educational impact. Online medical education is valuable in improving knowledge and confidence, as well as identifying areas of continued educational need and potentially improving patient outcomes, of particular importance during the COVID-19 pandemic where in-person conference learning is inaccessible.

Phase 1 Trial of Vodobatinib, a Novel Oral BCR-ABL1 Tyrosine Kinase Inhibitor (TKI): Activity in CML Chronic Phase Patients Failing TKI Therapies Including Ponatinib

Introduction: Vodobatinib, a novel 3rd generation (3G) TKI effective against wild-type and mutated BCR-ABL1 with limited off-target activity, was evaluated in a Phase I multicentre dose-escalation study in chronic myeloid leukemia (CML) patients (pts) who failed ≥ 3 TKIs or less (if not eligible for other approved 3G TKIs) (NCT02629692). The activity and safety of vodobatinib was evaluated in ponatinib treated (PT) and ponatinib naïve (PN) chronic phase (CP)-CML subjects in an exploratory analysis. Methods: Multiple escalating doses of vodobatinib (once daily) in 28-day cycles were evaluated in a 3+3 study design. The primary objective was determination of the maximal tolerated dose (MTD) or recommended phase 2 dose (RP2D) along with safety and a secondary objective was to evaluate anti-leukemic activity. Dose escalation involved dose doubling until 2 pts in a cohort experienced Grade 2 toxicity, or 1 pt experienced Grade 3 or 4 toxicity, after which dose escalation was reduced to 40% increments. Treatment continued until unacceptable toxicity, disease progression (PD), consent withdrawal, or death. Results: As of 15 Jul 2020, 31 CP-CML pts received vodobatinib at doses of 12 to 240 mg;16 pts (9 males) in ponatinib treated (PT) cohort [7 (44%) ponatinib was the immediate prior TKI] and 15 pts (7 males) in the ponatinib naïve (PN) cohort. The baseline demographics and disease history are represented in Table 1. Efficacy: Median duration of treatment was 17.3 (0.6-36) and 14.8 (0.5- 42) months in the Ponatinib treated and naive groups, respectively;11 pts in the PT group [2 in Deep molecular response (DMR), 3 in MMR;5 in MCyR (2 in CCyR and 3 in PCyR);1 in stable disease] and 10 pts in the PN group (2 in DMR, 4 in MMR and 3 in CCyR, 1 in stable disease) are continuing on treatment. Overall efficacy outcomes are included in Tables 2 and 3. Of 16 PT pts, 2 (13%) pts, both with double mutations, had disease progression. Of 15 PN pts, 4 (26%) pts (with baseline mutation of T315I at 48 mg, Y253H at 66 mg, F317L and E255V mutation at 174 mg) progressed. Safety: In ponatinib treated pts, the most commonly reported treatment emergent adverse events (TEAEs), (all grades) included nausea (4, 25%) and diarrhea (3, 25%). Other commonly reported TEAEs included thrombocytopenia (3, 19%), rash (3, 19%), non-cardiac chest pain (3, 19%), increased amylase (3, 19%), and fall (3, 19%). Grade ≥ 3 TEAEs were reported in 10 (63%) pts included 1 pt each with anemia, lymphopenia, fall, skull fracture, spinal fracture, lipase increase, fluid overload, syncope, dyspnea, and hypertension. Vodobatinib related AEs included amylase increase, lipase increase, dyspnea, fluid overload, thrombocytopenia and neutropenia. Grade ≥ 3 TEAEs reported in more than one pt included neutropenia (2, 13%) amylase increase (2, 13%) and thrombocytopenia (2, 13%). In PN pts, the most commonly reported TEAEs (all grades) included myalgia (5, 33%) and back pain (4, 27%). Other commonly reported TEAEs were thrombocytopenia (4, 27%), and nasopharyngitis (3, 20%).Grade ≥ 3 TEAEs were reported in 7 (47%) pts (1 pt with anemia, 1 pt with pneumonia, 1 pt with neutropenia, 1 pt with gout, hypokalemia, thrombocytopenia, 1 pt with increased liver and pancreatic enzymes and 1 pt each with dementia and amnesia. Vodobatinib related AEs included alanine aminotransferase increase, blood bilirubin increased, amnesia, neutropenia and thrombocytopenia. No grade ≥ 3 event was reported in more than 1 pt. Overall, three cardiovascular TEAEs were reported, in 2 pts (1 each in PT and PN), all deemed unrelated to vodobatinib. Three pts died on study: 1 due to disease progression in the PT group;1 due to pneumonia (suspected COVID-19) and 1 due to intracranial hemorrhage in the PN group. The intracranial hemorrhage event (Grade 5 AE) was considered possibly related and was confounded by disease progression to blast phase that included extra-medullary sites. At the highest dose of 240 mg, two dose limiting toxicities were reported. The next lower dose level of 204 mg was est blished as MTD with a favorable safety profile in heavily pre-treated CP-CML pts. Conclusion: Vodobatinib was evaluated over 9 escalating doses. Comparable and promising efficacy was noted in both PT (50% CCyR) and PN (67% CCyR) groups, meriting further study of vodobatinib as a potential new agent for treatment of previously treated CP-CML. [Formula presented] Disclosures: Cortes: Daiichi Sankyo: Consultancy, Research Funding;Jazz Pharmaceuticals: Consultancy, Research Funding;Immunogen: Research Funding;Merus: Research Funding;Bristol-Myers Squibb: Research Funding;Takeda: Consultancy, Research Funding;Sun Pharma: Research Funding;BioPath Holdings: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Telios: Research Funding;Astellas: Research Funding;Amphivena Therapeutics: Research Funding;Arog: Research Funding;BiolineRx: Consultancy, Research Funding;Pfizer: Consultancy, Research Funding;Novartis: Consultancy, Research Funding. Kim: Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau;Takeda: Research Funding;BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau;Sun Pharma.: Research Funding;Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau;ILYANG: Consultancy, Honoraria, Research Funding. Alvarado: BerGenBio ASA: Research Funding;MEI Pharma: Research Funding;Astex Pharmaceuticals: Research Funding;Sun Pharma: Research Funding;FibroGen: Research Funding;Tolero Pharmaceuticals: Research Funding;Jazz Pharmaceuticals: Research Funding;Daiichi-Sankyo: Research Funding. Nicolini: Sun Pharma Ltd: Consultancy;Incyte: Research Funding, Speakers Bureau;Novartis: Research Funding, Speakers Bureau. Apperley: Bristol Myers Squibb: Honoraria, Speakers Bureau;Incyte: Honoraria, Research Funding, Speakers Bureau;Novartis: Honoraria, Speakers Bureau;Pfizer: Honoraria, Research Funding, Speakers Bureau. Deininger: DisperSol: Consultancy;Pfizer: Honoraria, Other, Research Funding;Leukemia & Lymphoma Society: Research Funding;Ariad: Consultancy, Honoraria, Other;Medscape: Consultancy;Novartis: Consultancy, Other, Research Funding;Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Fusion Pharma: Consultancy;Blueprint Medicines Corporation: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: part of a study management committee, Research Funding;Incyte: Consultancy, Honoraria, Other, Research Funding;Sangamo: Consultancy, Membership on an entity's Board of Directors or advisory committees;SPARC: Research Funding;Gilead Sciences: Research Funding;Bristol-Myers Squibb: Consultancy, Honoraria, Other, Research Funding;Galena: Consultancy, Honoraria, Other;Celgene: Research Funding. de Lavallade: Incyte: Honoraria, Research Funding;Bristol Myers Squibb: Honoraria, Research Funding;Novartis: Honoraria;Pfizer: Honoraria. Charbonnier: Incyte: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartts: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Gambacorti-Passerini: Pfizer: Honoraria, Research Funding;Bristol-Myers Squibb: Consultancy. Lucchesi: Pfizer: Honoraria;Incyte: Honoraria;Novartis: Honoraria. Mauro: Takeda: Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding;Novartis: Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding;Sun Pharma/SPARC: Research Funding;Bristol-Myers Squibb: Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding;Pfizer: Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding. Whiteley: Novartis: Consultancy;Dova: Consultancy;Jazz: Speakers Bureau;Seattle Genetics: Consultancy Speakers Bureau;GlaxoSmithKline: Speakers Bureau;Epizyme: Current equity holder in publicly-traded company, Speakers Bureau;Karyopharm: Current equity holder in publicly-traded company;Aprea: Current equity holder in publicly-traded company;MorphoSys: Consultancy;Agios: Consultancy, Speakers Bureau;Pfizer: Consultancy;Rigel: Consultancy. Yao: Sun Pharma Industries Incorporated: Current Employment. Kothekar: Sun Pharma Advanced Research Company Limited: Current Employment. Sreenivasan: Sun Pharma Advanced Research Company Limited: Current Employment. HV: Sun Pharma Advanced Research Company Limited: Current Employment. Chimote: Sun Pharma Advanced Research Company Limited: Current Employment.