The purpose of our melflufen clinical development program is to support regulatory approval processes globally and explore safe and effective use in different patient populations, use in combination with other myeloma treatments and administration with both central and peripheral infusion, and real-world use in Germany and Spain.
Effective July 8, 2021, the U.S. Food and Drug Administration, FDA, requested a partial clinical hold of the clinical program with melflufen and OPD5 in the US, prompting Oncopeptides to refocus its clinical program to support the marketing authorization process in Europe that led to the approval of melflufen by the European Medicines Agency, EMA, and UK’s Medicines and Healthcare products Regulatory Agency, MHRA, in Aug and Nov 2022 respectively.
Clinical Development
The clinical development of targeted therapies for difficult-to-treat hematological diseases and malignancies has currently been done with our first peptide-drug candidate, melflufen. The PDC platform includes two additional compounds that are ready for clinical testing, and the SPiKE platform is aiming to initiate toxicology studies 2024 to enable clinical testing.
The purpose of our melflufen clinical development program is to support regulatory approval processes globally and explore safe and effective use in different patient populations, use in combination with other myeloma treatments and administration with both central and peripheral infusion, and real-world use in Germany.
New clinical studies may include additional non-interventional studies to explore real-life use in the market, or practice informing phase 4 studies in niche populations. Investigator initiated trials can also be practice informing and proposals are welcome and continuously reviewed for support.
Oncopeptides is currently re-starting clinical studies with melflufen, first one out being a non-interventional real-world study in Germany, called HARBOUR.
The second study is LAGOON, a non-interventional real-world study (NIS) in Spain.
Clinical Studies
The MARINA study in close collaboration with iOMEDICO. This investigator-initiated, prospective, non-interventional study (NIS) is designed to evaluate the real-world effectiveness, safety, and treatment patterns of Pepaxti (melflufen) in combination with dexamethasone for patients with relapsed, refractory multiple myeloma (RRMM).
The study focuses on adult patients in Germany who have received at least three prior lines of therapy. By observing 50 patients across approximately 25 sites, MARINA aims to bridge the gap between controlled clinical trials and routine clinical practice.
Key Objectives of the MARINA Study
The study utilizes the innovative SYNERGY operational platform, which allows for agile center activation once an eligible patient is identified. Key areas of evaluation include:
- Primary Effectiveness: Assessing the Disease Control Rate (DCR), a metric of high value for patients in late-stage disease.
- Safety & Tolerability: Continuous monitoring of (serious) adverse events and adverse drug reactions in a routine setting.
- Bridging Therapy Utility: Investigating how physicians use Pepaxti as a bridging therapy prior to other immunotherapies, such as CAR-T cells or bispecific antibodies.
- Quality of Life (QoL): Evaluating patient-reported outcomes to understand the global health status of patients during treatment.
The MARINA study is scheduled to begin enrolment with the first patient in during the second quarter of 2026.
A planned “Window-of-Opportunity” (WoO) study evaluating a Peptide Drug Conjugate (PDC) in glioblastoma. The study will be conducted in Norway, where DMP (Direktoratet for medisinske produkter, Norwegian Medical Products Agency) has granted fast-track designation.
The study will utilize Oncopeptides’ already approved drug in approximately 10 patients with glioblastoma, to provide rapid human proof-of-concept for brain penetration. This efficient study design aims to validate the mechanism in a cost-efficient manner before advancing a PDC into dose-finding and larger trials, for a global glioblastoma market estimated to be worth more than 8 billion USD in 2035 and with high unmet medical need.
Glioblastoma is the most aggressive form of brain cancer, characterized by rapid growth, invariable relapse, and lack of curative treatment options. With a median survival of only 12–15 months, there is a profound unmet medical need for therapies capable of crossing the blood-brain barrier (BBB) – the primary obstacle that causes most drugs to fail in this indication. Agents from the Oncopeptides’ PDC platform can bypass this barrier due to their lipophilicity and enter cells freely. This novel Mode of Action, results in cytotoxic activity directly within tumor cells.
The LAGOON study, OP-115, is a non-interventional study (NIS), of melphalan flufenamide (melflufen, Pepaxti®) in combination with dexamethasone in patients with relapsed and/or refractory multiple myeloma (RRMM) according to the approved label.
This NIS aims to observe the effects of the use of melflufen, in combination with dexamethasone, in clinical practice in Spain. The patients in this type of study will receive the same treatment and diagnostic procedures as they would have received if they were not included in this study.
The study started in Q1 2025 and is planning to enroll up to 50 patients in Spain in real-life clinical practice.
The HARBOUR study, OP-113, is a non-interventional study (NIS), of melphalan flufenamide (melflufen, Pepaxti®) in combination with dexamethasone in patients with relapsed and/or refractory multiple myeloma (RRMM) according to the approved label.
This NIS aims to observe the effects of the use of melflufen, in combination with dexamethasone, in clinical practice in Germany. The patients in this type of study will receive the same treatment and diagnostic procedures as they would have received if they were not included in this study.
The study started in Q4 2023 and is planning to enroll up to 100 patients in Germany in real-life clinical practice.
Read more here: German Clinical Trials Register
The phase 2 HORIZON study is a pivotal, single-arm, multicenter, phase 2 study evaluating the safety and efficacy of melflufen in combination with dexamethasone in patients with relapsed refractory multiple myeloma. The study included 157 heavily pretreated patients, who had received 2 earlier lines of therapy with immunomodulatory agents (IMiDs) and proteasome inhibitors (PIs) and were refractory to pomalidomide and/or daratumumab.
The HORIZON study started in January 2017 and was completed in November 2021. The study results led to an accelerated approval by the FDA in Feb 2021 and full approval in EU and UK in Aug and Nov 2022, respectively.
The complete top-line results from the pivotal phase 2 HORIZON study were presented at the European Hematology Association meeting, in June 2020. The results have also been published in the Journal of Clinical Oncology.
The phase 3 OCEAN study is a global, randomized, head-to-head, open-label study, evaluating the efficacy and safety of melflufen and dexamethasone, versus pomalidomide and dexamethasone in patients with relapsed refractory multiple myeloma who have received 2-4 prior therapies.
The patients enrolled have previously been treated with at least an immunomodulatory agent (IMiD), and a proteasome inhibitor (PI). They have all developed resistance to their last line of therapy, and within 18 months from the study start to lenalidomide (IMiD), the most used drug for the treatment of multiple myeloma.
The primary objective of the study was to compare progression free survival of melflufen+dexamethasone and pomalidomide+dexamethasone. Secondary objectives included response rates and overall survival.
The study started in Q2 2017 and included 495 patients in several countries across Europe, USA, South Korea and Taiwan. The last patient was enrolled in September 2020. OCEAN study continued with an additional 2-year long-term follow-up after the primary analysis and was completed in February 2023. Final long-term follow-up results was presented at the 65th American Society of Hematology meeting (ASH) in December 2023.
ANCHOR is a phase 1/2 open label multicenter study evaluating the safety and efficacy of melflufen plus dexamethasone in combination with either daratumumab or bortezomib in patients with relapsed refractory multiple myeloma, who have undergone 1-4 prior lines of therapy. The patients were refractory to an immunomodulatory drug and/or a proteasome inhibitor. Patients included in the daratumumab arm had not received any prior anti-CD38 monoclonal antibody therapy.
The primary objective with the study was to measure overall response rates of the different combinations. A secondary objective was progression free survival. The study was conducted in several hospitals in Europe and USA.
The study was started in Q2 2018 and was terminated in February 2022, without the last 10 planned patients in the bortezomib+melflufen arm. Data from the 56 enrolled patients were sufficient to draw scientific conclusions.
Final data have been presented and published in the journal Haematologica 2023.
The phase 2 PORT study is an open-label, randomized, cross-over study which compared pharmacokinetics, safety and tolerability of peripheral or central intravenous administration of melflufen in combination with dexamethasone in patients with relapsed refractory multiple myeloma who had received at least two lines of prior therapy and were refractory to a proteasome inhibitor and an immunomodulatory drug.
The study was fully recruited in April 2021, and top line results were presented in Q3 2021. The study was terminated in January 2022 during long-term follow-up.
The phase 3 LIGHTHOUSE study is a randomized, open-label, phase 3 study of melflufen and dexamethasone in combination with daratumumab compared to daratumumab with supporting dexamethasone in patients with relapsed and refractory multiple myeloma (RRMM) who are refractory to an immunomodulatory agent (IMiD) and a proteasome inhibitor (PI) or who have had at least three prior lines of therapy, including an IMiD and a PI.
The aim was to investigate the efficacy and safety of a combination therapy with melflufen plus daratumumab compared to daratumumab.
The clinical study was planned to include 240 patients and started in December 2020. 54 patients were included in the study before it was prematurely terminated in February 2022. 27 patients were randomized to each treatment arm. Patient characteristics were balanced between the two study arms. Top-line data was presented in November 2022.
The phase 2 BRIDGE study is an open-label, single-arm study, designed to evaluate the pharmacokinetics, safety and efficacy of melflufen in combination with dexamethasone in multiple myeloma patients with reduced renal function.
Patients with Multiple myeloma commonly have impaired renal function. The BRIDGE study intended to demonstrate how melflufen can be used in relapsed refractory multiple myeloma patients with renal impairment.
The study started in Q3 2018 and included 35 patients. The study was terminated in December 2021 and the results have been presented.
ASCENT was a Phase 1/2 study with the objective of exploring the safety and tolerability of melflufen in patients with AL amyloidosis following at least one prior line of therapy. The study was prematurely terminated on 04 November 2021.
Three patients each were enrolled and treated with 20 mg or 30 mg melflufen and dexamethasone, but the study was terminated before Cohort 3 (40 mg melflufen) was initiated. The Sponsor’s review of the 6 enrolled patients treated did not reveal any DLTs or SAEs. All AEs observed were Grade 1 or 2. There were no treatment-related dose modifications or dose delays. One patient died during long-term FU.
Due to the premature termination and limited data yield as a result, no conclusions could be drawn from this study.
Rationale and study design
O-12-M1 was an international, multicenter, open-label phase 1/2 study, run in Europe and USA, to establish the dose of melflufen in combination with dexamethasone and investigate the treatment response in patients with relapsed refractory multiple myeloma, who were refractory to the last line of therapy.
The Phase 1 part established 40 mg melflufen+dexamethasone as the recommended Phase 2 dose. The phase 2 part included 45 relapsed refractory multiple myeloma patients who were heavily pre-treated. They had received a median of 4 prior lines of therapy and were refractory to lenalidomide (an immunomodulatory drug, IMiD) and bortezomib (a proteasome inhibitor, PI).
The study started mid 2013, completed the enrollment of patients in late 2016 and presented final results in 2017.
Read more on ClinicalTrial.gov