ROP-ET: a prospective phase III trial investigating the efficacy and safety of ropeginterferon alfa-2b in essential thrombocythemia patients with limited treatment options

Abstract

Interferon-based therapies, such as ropeginterferon alfa-2b have emerged as promising disease-modifying agents for myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET). Current ET treatments aim to normalize hematological parameters and reduce the thrombotic risk, but they do not modify the natural history of the disease and hence, have no impact on disease progression. Ropeginterferon alfa-2b (trade name BESREMi®), a novel, monopegylated interferon alfa-2b with an extended administration interval, has demonstrated a robust and sustained efficacy in polycythemia vera (PV) patients. Given the similarities in disease pathophysiology and treatment goals, ropeginterferon alfa-2b holds promise as a treatment option for ET. The ROP-ET trial is a prospective, multicenter, single-arm phase III study that includes patients with ET who are intolerant or resistant to, and/or are ineligible for current therapies, such as hydroxyurea (HU), anagrelide (ANA), busulfan (BUS) and pipobroman, leaving these patients with limited treatment options. The primary endpoint is a composite response of hematologic parameters and disease-related symptoms, according to modified European LeukemiaNet (ELN) criteria. Secondary endpoints include improvements in symptoms and quality of life, molecular response and the safety profile of ropeginterferon alfa-2b. Over a 3-year period the trial assesses longer term outcomes, particularly the effects on allele burden and clinical outcomes, such as disease-related symptoms, vascular events and disease progression. No prospective clinical trial data exist for ropeginterferon alfa-2b in the planned ET study population and this study will provide new findings that may contribute to advancing the treatment landscape for ET patients with limited alternatives. TRIAL REGISTRATION: EU Clinical Trials Register; EudraCT, 2023-505160-12-00; Registered on October 30, 2023.

Keywords: Disease modification; Essential thrombocythemia (ET); Myeloproliferative neoplasms (MPNs); Phase III; ROP-ET; Ropeginterferon alfa-2b.

Fig. 1

Schedule of enrolment and assessments (SPIRIT 2013 Figure). T1: Baseline assessments, start of treatment, T2: 2 wks after treatment start, T3: 4 wks after treatment start, T4: 6 wks after treatment start, T5: 8 wks after treatment start, T6-13: 3, 6, 9,12, 18, 24, 30, 36 months after treatment start; *except T6; **except T6 and T8. Abbreviations: CALR, Calreticulin; EQ-5D-5L, EuroQol 5-Dimensions 5-Levels; HADS, Hospital Anxiety and Depression Scale; JAK2, Janus Kinase 2; MPL, Myeloproliferative Leukemia Virus Oncogene; MPN-SAF TSS, Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score; PLT, Platelet; WBC, White Blood Cell