KOSELUGO® (selumetinib) Showed Significant and Clinically Meaningful Improvement in Objective Response Rate Versus Placebo in Adults With Neurofibromatosis Type 1 who Have Symptomatic, Inoperable Plexiform Neurofibromas in Global Phase 3 KOMET Trial
Merck (MRK) announced positive topline results from the Phase 3 KOMET trial of KOSELUGO in adults with neurofibromatosis type 1 (NF1) who have symptomatic, inoperable plexiform neurofibromas. The trial demonstrated statistically significant and clinically meaningful improvement in objective response rate compared to placebo. KOSELUGO, an oral MEK inhibitor, showed a consistent safety profile with previous trials in children and adolescents, with no new safety signals identified. This rare genetic condition affects approximately 1.7 million people worldwide, with 70% being adults. Currently, there are no approved treatments for adults with NF1, making these results particularly significant for potential expanded use beyond pediatric patients.
Merck (MRK) ha annunciato risultati positivi preliminari dallo studio di Fase 3 KOMET su KOSELUGO in adulti con neurofibromatosi di tipo 1 (NF1) che presentano neurofibromi plexiformi sintomatici e inoperabili. Lo studio ha dimostrato un miglioramento statisticamente significativo e clinicamente rilevante nel tasso di risposta obiettivo rispetto al placebo. KOSELUGO, un inibitore orale di MEK, ha mostrato un profilo di sicurezza costante rispetto agli studi precedenti su bambini e adolescenti, senza segnali di sicurezza nuovi identificati. Questa rara condizione genetica colpisce circa 1,7 milioni di persone in tutto il mondo, di cui il 70% sono adulti. Attualmente, non esistono trattamenti approvati per adulti con NF1, rendendo questi risultati particolarmente significativi per un possibile utilizzo esteso oltre i pazienti pediatrici.
Merck (MRK) anunció resultados preliminares positivos del ensayo de Fase 3 KOMET de KOSELUGO en adultos con neurofibromatosis tipo 1 (NF1) que tienen neurofibromas plexiformes sintomáticos e inoperables. El ensayo demostró una mejora estadísticamente significativa y clínicamente relevante en la tasa de respuesta objetiva en comparación con el placebo. KOSELUGO, un inhibidor oral de MEK, mostró un perfil de seguridad coherente con ensayos anteriores en niños y adolescentes, sin nuevas señales de seguridad identificadas. Esta rara condición genética afecta aproximadamente a 1,7 millones de personas en todo el mundo, de las cuales el 70% son adultos. Actualmente, no hay tratamientos aprobados para adultos con NF1, lo que hace que estos resultados sean particularmente significativos para un posible uso ampliado más allá de los pacientes pediátricos.
Merck (MRK)는 증상이 있는 수술 불가능한 신경섬유종을 가진 성인 1형 신경섬유종증(NF1)을 만성으로 앓고 있는 환자를 대상으로 한 3상 KOMET 시험에서 KOSELUGO의 긍정적인 초기 결과를 발표했습니다. 이 시험은 위약에 비해 객관적 반응률에서 통계적으로 유의미하고 임상적으로 의미 있는 개선을 보여주었습니다. KOSELUGO는 경구 MEK 억제제로서, 아이들과 청소년들에 대한 이전 시험과 일관된 안전성 프로필을 보였으며, 새로운 안전 신호는 확인되지 않았습니다. 이 희귀 유전 질환은 전 세계적으로 약 170만 명에게 영향을 미치며, 그 중 70%는 성인입니다. 현재 NF1 성인을 위한 승인된 치료법이 없어, 이러한 결과는 소아 환자에 대한 잠재적 확장 사용에 대해 특별히 중요합니다.
Merck (MRK) a annoncé des résultats préliminaires positifs de l'essai de Phase 3 KOMET concernant KOSELUGO chez les adultes atteints de neurofibromatose de type 1 (NF1) présentant des neurofibromes plexiformes symptomatiques et inopérables. L'essai a démontré une amélioration statistiquement significative et cliniquement pertinente du taux de réponse objective par rapport au placebo. KOSELUGO, un inhibiteur oral de MEK, a montré un profil de sécurité cohérent avec les essais précédents chez les enfants et les adolescents, sans nouveaux signaux de sécurité identifiés. Cette condition génétique rare affecte environ 1,7 million de personnes dans le monde, dont 70 % sont des adultes. Actuellement, il n'existe aucun traitement approuvé pour les adultes atteints de NF1, rendant ces résultats particulièrement significatifs pour un éventuel usage élargi au-delà des patients pédiatriques.
Merck (MRK) hat positive erste Ergebnisse aus der Phase 3 KOMET-Studie zu KOSELUGO bei Erwachsenen mit Neurofibromatose Typ 1 (NF1) veröffentlicht, die symptomatische, operable plexiforme Neurofibrome aufweisen. Die Studie zeigte eine statistisch signifikante und klinisch bedeutsame Verbesserung der objektiven Ansprechrate im Vergleich zu Placebo. KOSELUGO, ein oraler MEK-Inhibitor, wies ein konsistentes Sicherheitsprofil im Vergleich zu früheren Studien bei Kindern und Jugendlichen auf, ohne dass neue Sicherheitszeichen erkannt wurden. Diese seltene genetische Erkrankung betrifft weltweit etwa 1,7 Millionen Menschen, von denen 70 % Erwachsene sind. Derzeit gibt es keine zugelassenen Behandlungen für Erwachsene mit NF1, was diese Ergebnisse besonders relevant für eine mögliche erweiterte Anwendung über pädiatrische Patienten hinaus macht.
- Achieved statistically significant improvement in objective response rate vs placebo
- Potential market expansion to adult patients (70% of 1.7M affected population)
- No new safety concerns identified in adult population
- First potential targeted therapy for adult NF1 patients
- None.
Insights
The Phase 3 KOMET trial results represent a significant breakthrough in NF1 treatment. KOSELUGO demonstrated statistically significant tumor volume reduction in adult patients with symptomatic, inoperable plexiform neurofibromas - a condition affecting approximately 1.7 million people globally, with
The trial's success in meeting its primary endpoint of objective response rate (ORR) is particularly noteworthy as there are currently no approved treatments for adult NF1 patients. The consistent safety profile with pediatric trials and absence of new safety signals strengthens KOSELUGO's potential market position. This expansion into adult treatment could significantly increase the drug's market opportunity, as it would address an unmet medical need in a larger patient population.
This development positions Merck to potentially capture a substantial new market segment. The expansion from pediatric to adult NF1 treatment could significantly boost KOSELUGO's commercial potential. With no current approved targeted therapies for adult NF1 patients, Merck and AstraZeneca's first-mover advantage in this space could translate to strong market penetration.
The joint development and commercialization agreement with AstraZeneca provides strategic advantages in global market reach and shared development costs. Given the rare disease status and lack of treatment alternatives, successful regulatory approval could lead to premium pricing and potential orphan drug benefits, contributing meaningfully to Merck's rare disease portfolio revenue.
These results showed reduction in tumor volume, building on the established safety and efficacy profile of KOSELUGO in certain children and has the potential to support expanded use in certain adults
Neurofibromatosis type 1 is a rare, progressive genetic condition affecting an estimated 1.7 million people worldwide, approximately
Professor Ignacio Blanco Guillermo, M.D., Ph.D., chairman, genetic counseling and clinical genetics program at the Germans Trias i Pujol University Hospital, chairman, Spanish National Reference Center for Adult Patients with Neurofibromatosis and principal investigator of the KOMET trial, said, “With limited options to manage NF1 plexiform neurofibromas in adults, many patients experience functional impairment and symptoms, which can substantially impact their lives. These clinically meaningful data show KOSELUGO has the potential to make a positive impact in patient care by reducing the size of plexiform neurofibromas.”
Marc Dunoyer, chief executive officer, Alexion, said, “These promising results demonstrate that KOSELUGO, the first and only approved targeted therapy for certain children with NF1 plexiform neurofibromas, now has the potential to benefit adult patients for whom there are no approved targeted therapies. As the largest and only global placebo-controlled Phase 3 trial in adults with NF1 plexiform neurofibromas, KOMET reinforces our leadership in advancing potential treatment options for people living with this debilitating disease. We look forward to sharing these findings with regulatory authorities.”
Dr. Scot Ebbinghaus, vice president, global clinical development, Merck Research Laboratories, said, “Adults with NF1 are in critical need of treatment options to help manage symptomatic, inoperable plexiform neurofibromas. These positive results from the Phase 3 KOMET trial demonstrate the potential to expand the use of KOSELUGO beyond pediatric patients to also treat adult patients living with this rare and challenging genetic condition.”
In the trial, ORR was defined as the percentage of patients with confirmed complete response (disappearance of PNs) or partial response (at least
The safety profile of KOSELUGO in this study was consistent with that observed in clinical trials among children and adolescents. No new safety signals were identified.
Alexion, AstraZeneca Rare Disease will share these data with regulatory authorities and present these data at a forthcoming medical meeting. AstraZeneca and Merck are jointly developing and commercializing KOSELUGO globally.
About KOMET
KOMET is a global randomized, double-blind, placebo-controlled, multi-center Phase 3 trial (ClinicalTrials.gov, NCT04924608) designed to evaluate the efficacy and safety of KOSELUGO in adults with NF1 who have symptomatic, inoperable PNs. The trial enrolled 145 adults from 13 countries across the
The primary endpoint is confirmed ORR by cycle 16 as assessed by ICR. Objective response rate is defined as the percentage of patients with confirmed complete response (disappearance of PNs) or partial response (at least
After 12 cycles, patients on placebo were switched to KOSELUGO and patients on KOSELUGO remained on treatment for an additional 12 cycles. Patients who had the opportunity to complete both treatment periods 24 cycles of treatment have the option to participate in a long-term extension period and continue to receive KOSELUGO.
About NF1
Neurofibromatosis type 1 is a rare, progressive, genetic condition that is caused by a spontaneous or inherited mutation in the NF1 gene. Neurofibromatosis type 1 is associated with a variety of symptoms, including soft lumps on and under the skin (cutaneous neurofibromas) and, in 30
About KOSELUGO® (selumetinib)
KOSELUGO is a kinase inhibitor that blocks specific enzymes (MEK1 and MEK2), which are involved in stimulating cells to grow. In NF1, these enzymes are overactive, causing tumor cells to grow in an unregulated way creating so-called plexiform neurofibromas (PN). By blocking these enzymes, KOSELUGO slows down the growth of tumor cells, and, therefore, the PN growth.
KOSELUGO is approved in the
KOSELUGO (selumetinib) Indication in the
KOSELUGO is indicated for the treatment of pediatric patients 2 years of age and older with neurofibromatosis type 1 (NF1) who have symptomatic, inoperable plexiform neurofibromas (PN).
IMPORTANT SAFETY INFORMATION
WARNINGS AND PRECAUTIONS
Cardiomyopathy. A decrease in left ventricular ejection fraction (LVEF) ≥
Ocular Toxicity. Blurred vision, photophobia, cataracts, and ocular hypertension occurred. Retinal pigment epithelial detachment (RPED) occurred in the pediatric population during treatment with single agent KOSELUGO and resulted in permanent discontinuation. Conduct ophthalmic assessments prior to initiating KOSELUGO, at regular intervals during treatment, and for new or worsening visual changes. Permanently discontinue KOSELUGO in patients with retinal vein occlusion (RVO). Withhold KOSELUGO in patients with RPED, conduct ophthalmic assessments every 3 weeks until resolution, and resume KOSELUGO at a reduced dose.
Gastrointestinal Toxicity. Diarrhea occurred, including Grade 3. Diarrhea resulting in permanent discontinuation, dose interruption or dose reduction occurred. Advise patients to start an anti-diarrheal agent (eg, loperamide) and to increase fluid intake immediately after the first episode of diarrhea. Withhold, reduce dose, or permanently discontinue KOSELUGO based on severity of adverse reaction.
Skin Toxicity. Rash occurred in
Increased Creatinine Phosphokinase (CPK). Increased CPK occurred, including Grade 3 or 4 resulting in dose reduction. Increased CPK concurrent with myalgia occurred, including one patient who permanently discontinued KOSELUGO for myalgia. Obtain serum CPK prior to initiating KOSELUGO, periodically during treatment, and as clinically indicated. If increased CPK occurs, evaluate for rhabdomyolysis or other causes. Withhold, reduce dose, or permanently discontinue KOSELUGO based on severity of adverse reaction.
Increased Levels of Vitamin E and Risk of Bleeding. KOSELUGO capsules contain vitamin E which can inhibit platelet aggregation and antagonize vitamin K-dependent clotting factors. Supplemental vitamin E is not recommended if daily vitamin E intake (including the amount of vitamin E in KOSELUGO and supplement) will exceed the recommended or safe limits due to increased risk of bleeding. An increased risk of bleeding may occur in patients who are coadministered vitamin-K antagonists or anti-platelet antagonists with KOSELUGO. Monitor for bleeding in these patients and increase international normalized ratio (INR) in patients taking a vitamin-K antagonist. Perform anticoagulant assessments more frequently and adjust the dose of vitamin K antagonists or anti-platelet agents as appropriate.
Embryo-Fetal Toxicity. Based on findings from animal studies, KOSELUGO can cause fetal harm when administered during pregnancy. In animal studies, administration of selumetinib to mice during organogenesis caused reduced fetal weight, adverse structural defects, and effects on embryo-fetal survival at approximate exposures >5 times the human exposure at the clinical dose of 25 mg/m2 twice daily. Advise patients of reproductive potential of the potential risk to a fetus and to use effective contraception during treatment with KOSELUGO and for 1 week after the last dose.
ADVERSE REACTIONS
Common adverse reactions ≥
DRUG INTERACTIONS
Effect of Other Drugs on KOSELUGO
Concomitant use of KOSELUGO with a strong or moderate CYP3A4 inhibitor or fluconazole increased selumetinib plasma concentrations, which may increase the risk of adverse reactions. Avoid coadministration with KOSELUGO. If coadministration cannot be avoided, reduce KOSELUGO dosage.
Concomitant use of KOSELUGO with a strong or moderate CYP3A4 inducer decreased selumetinib plasma concentrations, which may reduce KOSELUGO efficacy. Avoid concomitant use with KOSELUGO.
SPECIAL POPULATIONS
Pregnancy & Lactation. Verify the pregnancy status of patients of reproductive potential prior to initiating KOSELUGO. Due to the potential for adverse reactions in a breastfed child, advise patients not to breastfeed during treatment with KOSELUGO and for 1 week after the last dose.
About the AstraZeneca and Merck strategic collaboration
In July 2017, AstraZeneca and Merck, known as MSD outside of
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About Merck
At Merck, known as MSD outside of
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Please see Prescribing Information and Patient Information (Medication Guide) for KOSELUGO (selumetinib) at https://alexion.com/Documents/koselugo_uspi.pdf
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FAQ
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