Ruxolitinib Phosphate and Danazol in Treating Anemia in Patients With Myelofibrosis

• Survival time [ Time Frame: From registration to death due to any cause, assessed up to 2 years ] [ Designated as safety issue: No ]
  The distribution of survival time will be estimated using the method of Kaplan-Meier.
• Adverse event rate(s), assessed using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 [ Time Frame: Up to 2 years ] [ Designated as safety issue: Yes ]
  The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration.

This phase II pilot trial studies how well ruxolitinib phosphate and danazol work in treating anemia in patients with myelofibrosis. Ruxolitinib phosphate and danazol may cause the body to make more red blood cells. They are used to treat anemia in patients with myelofibrosis

PRIMARY OBJECTIVES:

I. To evaluate the efficacy (best overall response) of ruxolitinib (ruxolitinib phosphate) and danazol in patients with myelofibrosis suffering from anemia.

SECONDARY OBJECTIVES:

I. To evaluate the overall survival of patients with myelofibrosis suffering from anemia initiating ruxolitinib and danazol.

II. To evaluate the adverse event profile of ruxolitinib and danazol in patients with myelofibrosis suffering from anemia.

TERTIARY OBJECTIVES:

I. To evaluate quality of life (QOL) and patient-reported symptoms using the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) with ruxolitinib and danazol for patients with myelofibrosis suffering from anemia.

OUTLINE:

Patients receive ruxolitinib phosphate orally (PO) twice daily (BID) and danazol PO thrice daily (TID) on days 1-56. Treatment repeats every 56 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

• Anemia
• Primary Myelofibrosis
• Secondary Myelofibrosis

• Drug: ruxolitinib phosphate
  Given PO
  Other Names:

  • INCB18424
  • Jakafi
  • oral JAK inhibitor INCB18424
  • oral Janus-associated kinase inhibitor INCB18424
• Drug: danazol
  Given PO
  Other Names:

  • Chronogyn
  • DAN
  • Danocrine

Inclusion Criteria:

• Histological confirmation of primary myelofibrosis (MF), post polycythemia vera (PV) or post essential thrombocythemia (ET) myelofibrosis (intermediate 1, intermediate II or high risk) requiring medical therapy
• Anemia is required for trial entry (defined as hemoglobin < 10g/dL or transfusion dependent)
• Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 at study entry
• Absolute neutrophil count (ANC) >= 1000 x 10^3
• Platelet count >= 50,000 × 10^3
• Serum creatinine =< 1.5 x the upper limit of normal (ULN)
• Total bilirubin =< 1.5 x ULN; if total bilirubin is > 1.5 x ULN, a direct bilirubin should be performed and must be < 1.5mg/dL
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN; higher values (i.e., =< 5 x ULN) are allowed if clinically compatible with hepatic extramedullary hematopoiesis
• Life expectancy of >= 6 months
• Patient able to provide voluntary written informed consent to participate
• Willing to comply with scheduled visits, treatment plans, laboratory assessments, and other study-related procedures
• Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only

Exclusion Criteria:

• Any chemotherapy (e.g., hydroxyurea), immunomodulatory drug therapy (e.g., thalidomide, interferon-alpha), immunosuppressive therapy, corticosteroids > 10 mg/day prednisone or equivalent, or growth factor treatment (e.g., erythropoietin), hormones (e.g., androgens, danazol) =< 14 days prior to registration
• Major surgery =< 28 days or radiation =< 6 months prior to registration
• Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
• Active acute infection requiring antibiotics
• Uncontrolled congestive heart failure (New York Heart Association classification 3 or 4), angina, myocardial infarction, cerebrovascular accident, coronary/peripheral artery bypass, graft surgery, transient ischemic attack, or pulmonary embolism within 3 months prior to registration
• Participation in any study of an investigational agent (drug, biologic, device) =< 30 days, unless during non-treatment phase

• Any of the following because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects:

  • Pregnant women
  • Nursing women
  • Men or women of childbearing potential who are unwilling to employ adequate contraception
• Known human immunodeficiency virus or acquired immunodeficiency syndrome-related illness
• Clinically active hepatitis B or C
• Active malignancy other than MF, except adequately treated basal cell carcinoma and squamous cell carcinoma of the skin, cervical carcinoma in situ or other malignancies that have been stable and off therapy for 5 years
• Patient currently taking simvastatin, or lovastatin at a dose greater than 10 mg/day
• Men with prostate specific antigen (PSA) > 4 ng/ml or with uncontrolled benign prostatic hypertrophy

• Receiving any medications or substances that are strong or moderate inhibitors of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4); use of the following strong or moderate inhibitors are prohibited =< 7 days prior to registration

  • Strong inhibitors of CYP3A4:

    • Indinavir (Crixivan)
    • Nelfinavir (Viracept)
    • Atazanavir (Reyataz)
    • Clarithromycin (Biaxin, Biaxin XL)
    • Itraconazole (Sporanox)
    • Ketoconazole (Nizoral)
    • Nefazodone (Serzone)
    • Saquinavir (Fortovase, Invirase)
    • Telithromycin (Ketek)

  • Moderate inhibitors of CYP3A4

    • Erythromycin (Erythrocin, E.E.S., Ery-Tab, Eryc, EryPed, PCE)
    • Fluconazole (Diflucan)
    • Grapefruit juice
    • Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)
    • Verelan PM
    • Diltiazem (Cardizem, Cardizem CD, Cardizem LA, Cardizem SR, Cartia XT, Dilacor XR, Diltia XT, Taztia XT, Tiazac)