A phase 2, multicenter, clinical trial of CPX‐351 in older patients with secondary or high‐risk acute myeloid leukemia: PETHEMA‐LAMVYX

Background LAMVYX was a multicenter, single‐arm, phase 2 trial designed to validate the safety and efficacy of CPX‐351 in patients aged 60–75 years with newly diagnosed, secondary acute myeloid leukemia and to generate evidence on key issues not addressed in the preceding regulatory pivotal trial. Methods The primary end point of the study was the complete remission (CR)/CR with incomplete hematologic recovery (CRi) rate after induction. Eligible patients were recommended to undergo allogeneic hematopoietic stem cell transplantation after the first consolidation cycle. Alternatively, patients could undergo up to six maintenance cycles with CPX‐351. Results Twenty‐nine patients (49%; 95% exact confidence interval [CI], 37%–62%) patients achieved a CR/CRi after one or two cycles of induction, with a measurable residual disease negativity rate of 67% as assessed by centralized, multiparameter flow cytometry. Among patients who had serial next‐generation sequencing analyses available, clearance of somatic mutations that were present at diagnosis was achieved in 7 (35%). The median follow‐up among survivors was 16.8 months (range, 8.7–24.3 months). The median event‐free survival was 3.0 months (95% CI, 1.4–7.3 months), and the median overall survival was 7.4 months (95% CI, 3.7–12.7 months). In landmark analyses at day +100 from diagnosis, the 1‐year overall and event‐free survival rate among patients who underwent allogeneic hematopoietic stem cell transplantation was 70% (95% CI, 47%–100%) and 70% (95% CI, 47%–100%), respectively. The corresponding values were 89% (95% CI, 71%–100%) and 44% (95% CI, 21%–92%), respectively, for patients who entered the maintenance phase. No significant longitudinal changes were observed in severity index or quality‐of‐life visual analog scale scores. Conclusions The current data provide novel insights that might inform the clinical positioning and optimal use of CPX‐351, complementing previous results (ClinicalTrials.gov identifier NCT04230239). In a phase 2 trial among older patients with secondary acute myeloid leukemia, treatment with CPX‐351 resulted in a complete remission/complete remission with incomplete hematologic recovery rate similar to that reported in the pivotal trial, with long‐term clinical benefit largely restricted to patients who underwent allogeneic hematopoietic stem cell transplantation.