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NEW INDICATIONS

FDA Approves Avapritinib for Advanced Systemic Mastocytosis

Web Exclusives - FDA Oncology Update

On June 16, 2021, the FDA approved a new indication for avapritinib (Ayvakit; Blueprint Medicines) for the treatment of adults with advanced systemic mastocytosis (AdvSM), including patients with aggressive systemic mastocytosis, systemic mastocytosis with an associated hematologic neoplasm, and mast-cell leukemia. The FDA granted this indication a priority review and breakthrough therapy and orphan drug designations.

Avapritinib was previously approved by the FDA for the treatment of adults with unresectable or metastatic gastrointestinal stromal tumor harboring a PDGFRA exon 18 mutation, including PDGFRA D842V mutations.

The new indication was based on the results of 2 studies—EXPLORER and PATHFINDER—2 multicenter, single-arm, open-label clinical trials of patients with AdvSM. The primary end point was overall response rate (ORR). Additional end points were duration of response (DOR), time to response, and changes in individual measures of mast-cell burden. A total of 53 patients received up to 200 mg daily doses of avapritinib.

The combined ORR in all evaluable patients in both studies was 57% (95% confidence interval [CI], 42-70), including 28% complete remissions and 28% partial remissions. The median DOR was 38.3 months (95% CI, 19-not estimable), and the median time to response was 2.1 months.

The most common (≥20%) adverse reactions in patients with AdvSM were edema, diarrhea, nausea, and fatigue/asthenia.

Avapritinib is not recommended for the treatment of patients with AdvSM with platelet counts of less than 50 × 109/L.

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