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Efficacy and Safety of Midostaurin in Advanced Systemic Mastocytosis
Jason Gotlib1, Hanneke C Kluin-Nelemans1, Tracy I George1
1From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.).
Background:
Advanced systemic mastocytosis comprises rare hematologic neoplasms that are associated with a poor prognosis and lack effective treatment options. The multikinase inhibitor midostaurin inhibits KIT D816V, a primary driver of disease pathogenesis.
Methods:
We conducted an open-label study of oral midostaurin at a dose of 100 mg twice daily in 116 patients, of whom 89 with mastocytosis-related organ damage were eligible for inclusion in the primary efficacy population; 16 had aggressive systemic mastocytosis, 57 had systemic mastocytosis with an associated hematologic neoplasm, and 16 had mast-cell leukemia. The primary outcome was the best overall response.
Results:
The overall response rate was 60% (95% confidence interval [CI], 49 to 70); 45% of the patients had a major response, which was defined as complete resolution of at least one type of mastocytosis-related organ damage. Response rates were similar regardless of the subtype of advanced systemic mastocytosis, KIT mutation status, or exposure to previous therapy. The median best percentage changes in bone marrow mast-cell burden and serum tryptase level were -59% and -58%, respectively. The median overall survival was 28.7 months, and the median progression-free survival was 14.1 months. Among the 16 patients with mast-cell leukemia, the median overall survival was 9.4 months (95% CI, 7.5 to not estimated). Dose reduction owing to toxic effects occurred in 56% of the patients; re-escalation to the starting dose was feasible in 32% of those patients. The most frequent adverse events were low-grade nausea, vomiting, and diarrhea. New or worsening grade 3 or 4 neutropenia, anemia, and thrombocytopenia occurred in 24%, 41%, and 29% of the patients, respectively, mostly in those with preexisting cytopenias.
Conclusions:
In this open-label study, midostaurin showed efficacy in patients with advanced systemic mastocytosis, including the highly fatal variant mast-cell leukemia. (Funded by Novartis Pharmaceuticals and others; ClinicalTrials.gov number, NCT00782067.).
Insights
Midostaurin demonstrated efficacy in advanced systemic mastocytosis, showing a 60% overall response rate. This treatment offers a new option for patients with this rare and aggressive blood cancer, including mast-cell leukemia.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Advanced systemic mastocytosis is a rare hematologic neoplasm with poor prognosis and limited treatment options.
- Midostaurin, a multikinase inhibitor, targets KIT D816V, a key driver in mastocytosis pathogenesis.
Purpose of the Study:
- To evaluate the efficacy and safety of oral midostaurin in patients with advanced systemic mastocytosis.
- To assess the overall response rate and survival outcomes in this patient population.
Main Methods:
- An open-label study involving 116 patients with advanced systemic mastocytosis.
- Oral midostaurin administered at 100 mg twice daily.
- Primary efficacy population included 89 patients with mastocytosis-related organ damage.
Main Results:
- The overall response rate was 60%, with 45% achieving a major response (resolution of organ damage).
- Median overall survival was 28.7 months and progression-free survival was 14.1 months.
- Adverse events included nausea, vomiting, diarrhea, and cytopenias; dose reductions occurred in 56% of patients.
Conclusions:
- Midostaurin shows significant efficacy in advanced systemic mastocytosis, including mast-cell leukemia.
- The drug provides a potential therapeutic option for this aggressive hematologic malignancy.
- Further research and management strategies for adverse events are warranted.
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