Allos Therapeutics, Inc. (NASDAQ:ALTH) today reported new
analysis of data from the Company's pivotal PROPEL trial of
FOLOTYN® (pralatrexate injection) in patients with relapsed or
refractory peripheral T-cell lymphoma (PTCL) at the 52nd American
Society of Hematology (ASH) Annual Meeting in Orlando, Florida. The
objective of this retrospective subgroup analysis was to assess the
activity and safety of single-agent FOLOTYN in patients enrolled in
PROPEL who were diagnosed with histologically confirmed relapsed or
refractory transformed mycosis fungoides (tMF), which is an
aggressive and difficult to treat T-cell lymphoma.
"The activity observed in this analysis is extremely encouraging
for patients with relapsed or refractory transformed mycosis
fungoides, which is a difficult to treat and an aggressive form of
T-cell lymphoma often associated with poor prognosis," said
Francine Foss, M.D., professor of medicine (hematology) and of
dermatology, Yale School of Medicine.
This analysis was based on assessment using International
Workshop Criteria (IWC) by an independent central review as well as
local investigator review. Of the 12 patients included in this
analysis, objective responses were observed in three patients (25%)
based on independent central review and in seven patients (58%)
based on local investigator review. The median duration of response
was 2.2 months based on independent central review and 4.4 months
based on local investigator review. Prior to enrollment, patients
with tMF received a median of 3 systemic therapies – eight patients
(67%) had received prior treatment with a CHOP-based regimen
(cyclophosphamide/doxorubicin/vincristine/prednisone).
The most common Grade 3-4 adverse events were mucositis (8%),
fatigue (8%), and nausea (8%). The most common Grade 2 adverse
events were mucositis (33%), fatigue (17%), nausea (8%), and
pyrexia (8%). No patients discontinued therapy due to an adverse
event.
“This analysis of the data from PROPEL provides important
information about the clinical activity of FOLOTYN in patients with
relapsed or refractory transformed mycosis fungoides. Results of
this subgroup analysis demonstrated the activity and safety of
single-agent FOLOTYN and its utility in patients with relapsed or
refractory transformed mycosis fungoides,” said Charles Morris, MB
ChB, MRCP, chief medical officer at Allos Therapeutics.
FOLOTYN is the first and only drug approved by the FDA for the
treatment of patients with relapsed or refractory PTCL. This
indication is based on overall response rate. Clinical benefit such
as improvement in progression free survival or overall survival has
not been demonstrated.
About PROPEL
PROPEL (Pralatrexate in Patients with Relapsed
or Refractory Peripheral T-Cell Lymphoma), an
open-label, single-arm, multicenter, international Phase 2 clinical
trial, enrolled 115 patients with relapsed or refractory PTCL, 109
of whom were considered evaluable for efficacy according to the
trial protocol. Patients were considered evaluable if they received
at least one dose of FOLOTYN, their diagnosis of PTCL was confirmed
by independent pathology review, and they had relapsed or
refractory disease after at least one prior treatment. Patients
were treated with FOLOTYN at 30 mg/m2 once weekly by IV push over
3-5 minutes for 6 weeks in 7-week cycles until disease progression
or unacceptable toxicity. In addition, patients received 1mg of
vitamin B12 intramuscularly every 8-10 weeks and 1.0-1.25 mg of
folic acid orally on a daily basis.
The primary efficacy endpoint was overall response rate (ORR) –
defined as complete response (CR), unconfirmed complete responses
(CRu), and partial response (PR) – as assessed by International
Workshop Criteria (IWC). The key secondary efficacy endpoint was
duration of response. Response assessments were scheduled at the
end of cycle 1 and then every other cycle (every 14 weeks).
Duration of response was measured from the first day of documented
response to disease progression or death. Response and disease
progression were evaluated by independent central review using the
IWC.
About Peripheral T-Cell Lymphoma
T-cell lymphomas comprise a biologically diverse group of blood
cancers that account for approximately 10% to 15% of all cases of
non-Hodgkin lymphoma (NHL) in the United States.1-3 The American
Cancer Society estimated that approximately 66,000 new cases of NHL
were expected to be diagnosed in the U.S. in 2010. The Company
estimates the current annual incidence of PTCL in the U.S. to be
approximately 5,900 patients. The outcome of patients with PTCL is
poor and the majority of patients ultimately have refractory
disease to a variety of agents, including multi-agent chemotherapy
with CHOP (cyclophosphamide, doxorubicin, vincristine, and
prednisone) or CHOP-like regimens. The 5-year overall survival rate
in these patients is 25% to 40%, depending on sub-type.4-5
About Transformed Mycosis Fungoides
Mycosis fungoides (MF) is a type of cutaneous T-cell lymphoma
(CTCL)6 that first appears as a red, scaly rash. Generally, CTCLs
are slow-growing and less aggressive than other T-cell lymphomas.
However, in 11 to 23 percent of cases, MF transforms into a more
difficult to treat disease referred to as transformed mycosis
fungoides (tMF)7. tMF is an aggressive disease which is generally
associated with poor prognosis for patients; the median overall
survival in patients with tMF is 12-22 months from the time of
diagnosis8. Based on the aggressive nature of tMF, these patients
were eligible for the PROPEL study.
About FOLOTYN
FOLOTYN, a folate analogue metabolic inhibitor, was discovered
by Sloan-Kettering Institute for Cancer Research, SRI International
and Southern Research Institute and developed by Allos
Therapeutics. In September 2009, the U.S. Food and Drug
Administration (FDA) granted accelerated approval for FOLOTYN for
use as a single agent for the treatment of patients with relapsed
or refractory (PTCL). This indication is based on overall response
rate. Clinical benefit such as improvement in progression free
survival or overall survival has not been demonstrated. FOLOTYN has
been available to patients in the U.S. since October 2009.
About Allos Therapeutics
Allos Therapeutics, Inc. (Nasdaq: ALTH) is a biopharmaceutical
company committed to the development and commercialization of
innovative anti-cancer therapeutics. Allos is currently focused on
the development and commercialization of FOLOTYN® (pralatrexate
injection), a folate analogue metabolic inhibitor. FOLOTYN is the
first and only drug approved in the U.S. for the treatment of
patients with relapsed or refractory peripheral T-cell lymphoma.
Allos is also developing FOLOTYN in other hematologic malignancies
and solid tumors. Allos retains exclusive worldwide rights to
FOLOTYN for all indications. Allos is headquartered in Westminster,
CO. For additional information, please visit www.allos.com.
IMPORTANT SAFETY INFORMATION
Warnings and Precautions
FOLOTYN may suppress bone marrow function, manifested by
thrombocytopenia, neutropenia, and anemia. Monitor blood counts and
omit or modify dose for hematologic toxicities.
Mucositis may occur. If ≥Grade 2 mucositis is observed, omit or
modify dose. Patients should be instructed to take folic acid and
receive vitamin B12 to potentially reduce treatment-related
hematological toxicity and mucositis.
FOLOTYN can cause fetal harm. Women should avoid becoming
pregnant while being treated with FOLOTYN and pregnant women should
be informed of the potential harm to the fetus.
Use caution and monitor patients when administering FOLOTYN to
patients with moderate to severe renal function impairment.
Elevated liver function test abnormalities may occur and require
monitoring. If liver function test abnormalities are ≥Grade 3, omit
or modify dose.
Dermatologic reactions may occur. Patients with dermatologic
reactions should be monitored closely, and if skin reactions are
severe, FOLOTYN should be withheld or discontinued.
Adverse Reactions
The most common adverse reactions were mucositis (70%),
thrombocytopenia (41%), nausea (40%), and fatigue (36%). The most
common serious adverse events are pyrexia, mucositis, sepsis,
febrile neutropenia, dehydration, dyspnea, and
thrombocytopenia.
Use in Specific Patient Population
Nursing mothers should be advised to discontinue nursing or the
drug, taking into consideration the importance of the drug to the
mother.
Drug Interactions
Co-administration of drugs subject to renal clearance (e.g.,
probenecid, NSAIDs, and trimethoprim/sulfamethoxazole) may result
in delayed renal clearance.
Please see FOLOTYN Full Prescribing Information at
www.FOLOTYN.com.
Note: The Allos logo and FOLOTYN name are trademarks of Allos
Therapeutics, Inc.
References:
- Savage KJ. Peripheral T-cell Lymphomas.
Blood Rev. 2007; 21:201-216.
- Hennessy BT, Hanrahan EO, Daly PA.
Non-Hodgkin lymphoma: an update [review]. Lancet Oncol.
2004;5(6):341-353.
- O'Leary HM, Savage KJ. Novel therapies
in peripheral T-cell lymphomas [review]. Curr Oncol Rep.
2008;134(5):202-207.
- Savage KJ, Chhanabhai M, Gascoyne RD,
et al. Characterization of peripheral T-cell lymphomas in a single
North American institution by the WHO classification. Ann Oncol
2004;15(10):1467-75.
- The Non-Hodgkin's Lymphoma
Classification Project. A clinical evaluation of the International
Lymphoma Study Group classification of non-Hodgkin's lymphoma.
Blood. 1997;89(11):3909-3908.
- Cutaneous T-Cell Lymphoma Fact Sheet.
Lymphoma Research Foundation.
http://www.lymphoma.org/site/pp.asp?c=bkLTKaOQLmK8E&b=6300151.
Accessed: November 10, 2010.
- Pralatrexate Is An Effective Treatment
for Heavily Pretreated Patients with Relapsed/Refractory
Transformed Mycosis Fungoides (tMF). Abstract. Accessed: November
18, 2010.
- Arulogun, SO et al. Long-term outcomes
of patients with advanced-stage cutaneous T-cell lymphoma and large
cell transformation. Blood. 2008; 112:3082-7.
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