Article
作者: Balasubramanian, Suresh ; Schwarzer, Adrian ; Altman, Jessica K. ; Garcia, Olga Salamero ; Redner, Robert L. ; Papayannidis, Cristina ; Foran, James ; Heidel, Florian ; Fathi, Amir T. ; Madanat, Yazan F. ; Riches, Marcie ; Heidel, Florian H. ; Bergeron, Julie ; Pettit, Kristen ; de la Fuente Burguera, Adolfo ; Issa, Ghayas C. ; Corum, Daniel ; Rodríguez-Arbolí, Eduardo ; Deeren, Dries ; Zhang, Zijing ; del Castillo, Teresa Bernal ; Salamero Garcia, Olga ; Heiblig, Maël ; Ades, Lionel ; Venditti, Adriano ; Esteve Reyner, Jordi ; Soifer, Harris S. ; Walter, Roland B. ; Peterlin, Pierre ; Lanza, Francesco ; Ulrickson, Matthew ; Penedo, Agustín ; Wang, Eunice S. ; Giannini, Caterina ; Berthon, Céline ; Khawandanah, Mohamad ; Baer, Maria R. ; Elsawy, Mahmoud ; Erba, Harry ; Tabachri, Marilyn ; Roboz, Gail J. ; Pigneux, Arnaud ; Leoni, Mollie ; Shah, Mithun ; McCloskey, James ; Redner, Robert ; Shah, Mithun V. ; Mitra, Amitava ; Fedorov, Kateryna ; Montesinos, Pau ; Barabé, Frederic
PURPOSE:
Ziftomenib—a potent, highly selective, oral menin inhibitor—was well tolerated and demonstrated encouraging clinical activity as monotherapy for relapsed/refractory
NPM1
-mutated (
NPM1
-m) and
KMT2A
-rearranged AML in the KOMET-001 phase I trial.
METHODS:
In the registration-enabling phase II part of KOMET-001, patients with relapsed/refractory
NPM1
-m AML received ziftomenib 600 mg once daily. The primary end point was the rate of complete remission with full hematologic recovery (CR)/CR with partial hematologic recovery (CRh).
RESULTS:
From January 26, 2023, to May 13, 2024, 92 patients (median age, 69 years [range, 33-84]) were treated. The primary end point was met, with a CR/CRh rate of 22% (95% CI, 14 to 32;
P
= .0058); 61% were negative for measurable residual disease. Overall response rate was 33% (95% CI, 23 to 43), with a median duration of 4.6 months (95% CI, 2.8 to 7.4). Prespecified subgroup analyses showed comparable CR/CRh regardless of previous therapy, including venetoclax, or type of comutations. Median overall survival was 6.6 months (95% CI, 3.6 to 8.6). Common grade ≥3 treatment-emergent adverse events were febrile neutropenia (26%), anemia (20%), and thrombocytopenia (20%). Differentiation syndrome occurred in 25% of patients (15% grade 3; no grade 4-5) and was manageable with protocol-defined mitigation. Three patients (3%) discontinued treatment because of ziftomenib-related adverse events.
CONCLUSION:
Ziftomenib demonstrated significant clinical benefit and deep responses in patients with heavily pretreated, relapsed/refractory
NPM1
-m AML. Ziftomenib was well tolerated with a safety profile consistent with previous studies, including manageable differentiation syndrome, lack of clinically significant QTc prolongation, and low rates of myelosuppression.