On November 1, 2018 Sierra Oncology, Inc. (Nasdaq: SRRA), a clinical stage drug development company focused on advancing targeted therapeutics for the treatment of patients with significant unmet needs in hematology and oncology, reported that clinical data from a translational biology study of momelotinib in 41 transfusion dependent patients with myelofibrosis (MF) will be reported in a poster at ASH (Free ASH Whitepaper) 2018 (Press release, Sierra Oncology, NOV 1, 2018, View Source [SID1234530529]). The impact of momelotinib on serum hepcidin, along with markers of iron storage and availability, erythropoiesis and inflammation were investigated to explore the biological mechanisms underlying the favorable effects of momelotinib on MF-associated anemia.

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"The results from this translational biology clinical study provide further evidence for momelotinib’s unique anemia benefit," said Dr. Christian Hassig, Chief Scientific Officer of Sierra Oncology. "Moreover, the findings provide clinical evidence that reinforce the differentiated profile of momelotinib as a potent inhibitor of ACVR1, a principal driver of hepcidin production in the liver. As with many inflammatory diseases associated with chronic anemia, myelofibrosis is characterized by high hepcidin, resulting in functional iron deficiency. In myelofibrosis, high levels of hepcidin are inversely correlated with survival. The observed reduction in hepcidin and restoration of iron homeostasis, coupled with net increases in various measures of erythropoiesis, provide important translational biomarker data accounting for the compelling transfusion-independence rates of 34-39% achieved in this transfusion dependent study population."

"As noted in our recent KOL call* featuring Dr. Srdan Verstovsek, one of the investigators in this clinical study, almost every myelofibrosis patient develops anemia and it typically becomes worse over time, often leading to transfusion dependency, yet there are no approved therapies to treat this facet of the disease," stated Dr. Nick Glover, President and Chief Executive Officer of Sierra Oncology. "Momelotinib inhibits JAK1, JAK2 and ACVR1, and is therefore uniquely positioned to address disease-related cytopenia in myelofibrosis, including anemia and transfusion dependency, while also improving splenomegaly and constitutional symptoms."

Sierra is currently preparing for discussions with regulators to determine the registration path for momelotinib and anticipates reporting next steps in the first half of 2019.

*KOL call featuring Dr. Srdan Verstovsek:
View Source

About the study (ClinicalTrials.gov Identifier NCT02515630):
In this Phase 2 open-label, translational biology study 41 transfusion-dependent (TD; ≥4 units red blood cells [RBC] transfusion in the 8 weeks prior to first dose of momelotinib) patients with primary or post-ET/PV MF (platelets ≥50 K) received 200 mg momelotinib once daily for 24 weeks.

By week 24, 14 (34.1%, 90% CI: 22.0–48.1%) patients had a ≥12-week transfusion-independent response (TI-R) and 39.0% had no RBC transfusion for ≥8 weeks at any time (90% CI: 26.2-53.1%).
At every study visit, median blood hepcidin decreased 6 hours after dosing with momelotinib. Serum iron, transferrin, hemoglobin, reticulocytes, and hematocrit increased at week 2 in patients with TI-R. Following this peak, serum iron decreased while hemoglobin, hematocrit and platelet count increased through week 24.
Adverse events (AEs) were consistent with previous studies of momelotinib in myelofibrosis, with cough, diarrhea, nausea, and fatigue as the most common. AEs ≥Gr 3 were experienced by 21 patients, most commonly anemia and neutropenia.
Title: Hepcidin Suppression by Momelotinib Is Associated with Increased Iron Availability and Erythropoiesis in Transfusion-Dependent Myelofibrosis Patient

Authors: Stephen T. Oh, Moshe Talpaz, Aaron T. Gerds, Vikas Gupta, Srdan Verstovsek, Ruben Mesa, Carole Miller, Candido Rivera, Angela Fleischman, Swati Goel, Mark Heaney, Casey O’Connell, Murat Arcasoy, Yafeng Zhang, Jun Kawashima, Tomas Ganz, Carrie Baker Brachmann