24% were reported as Grade 3. As of the data analysis cutoff date of June 26, 2022, the Company observed no Grade 4 or Grade 5 drug-related adverse events. One patient discontinued treatment due to a drug-related adverse event (fatigue). The Company observed one Grade 5 SAE of a patient enrolled after the data cutoff date of June 26, 2022, who had rapid disease progression and massive disease burden at the time of initial treatment. The treating investigator assessed the death (unknown cause) as most likely related to disease progression, and possibly related to the study therapies. The principal investigators on the study reviewed the event and concluded that the death was most likely due to disease progression. The Company concluded that, based on the rapid clinical progression from pre-screening scan on June 1, 2022 (~40% tumor involvement) to baseline scan on July 6, 2022 (over 80% tumor involvement) and worsening clinical symptoms such as ascites through the event on July 27, 2022, the death was not likely related to study therapies and most likely due to disease progression. The Company submitted an initial report of the patient data and conclusions to FDA on August 3, 2022, along with supplemental material, and FDA acknowledged receipt. No follow-up questions have been received as of September 13, 2022 and the trial remains ongoing.
The potentially addressable patient population for metastatic uveal melanoma is estimated to include over 4,000 patients across US and Europe, based on estimated annual incidence. As an orally-administered small molecule precision medicine therapeutic, with demonstrated anti-tumor activity and manageable adverse event profile, the Company considers the darovasertib and crizotinib combination therapy to have the potential to be broadly impactful to the MUM patient population.
The Company is currently targeting to initiate a potential registration-enabling trial in the first quarter of 2023. The Company is evaluating first-line MUM as a potential registrational regulatory strategy. As of August 31, 2022, the Company has enrolled 21 first-line MUM patients at the expansion dose of the darovasertib and crizotinib combination study.
Darovasertib – (Neo)Adjuvant Uveal Melanoma and Other Potential Expansion Opportunities
The Company is also evaluating the potential for darovasertib in other oncology indications, including as (neo)adjuvant therapy in primary uveal melanoma (UM), in cMET-driven tumors and in KRAS-mutation tumors.
(Neo)Adjuvant UM represents a significant expansion opportunity for darovasertib – with a potential annual incidence of approximately 8,700 patients aggregate in US and Europe.
The Company has observed preliminary proof of concept for potential darovasertib use in the (neo)adjuvant uveal melanoma setting, including responses of the primary orbital tumor. Clinical data reflects an observed tumor shrinkage by investigator review of primary ocular lesions in 5 of 5 (100%) UM or MUM patients treated as monotherapy or in combination with Crizotinib, including preliminary observation of tumor reductions in uvea lesion of two patients after the data cut-off date of August 19, 2022:
| • | | a darovasertib monotherapy patient with metastatic disease and an intact primary lesion in the eye observed a reduction of approximately 74% in the eye lesion by PET Standard Uptake Value (SUV) at an initial scan after approximately 2 weeks on therapy, with observed improvement in visual symptoms in the affected eye; this patient remained on therapy for approximately 7 months; |
| • | | a darovasertib and crizotinib combination patient with metastatic disease and an intact primary lesion in the eye observed tumor shrinkage of approximately 67% by RECIST 1.1 as a contribution to an overall confirmed PR, with improvement in visual symptoms in the affected eye; this patient is continuing on therapy as of approximately 5 months; a second darovasertib and crizotinib combination MUM patient with an intact primary lesion observed a reduction of the ocular lesion based on preliminary scan after the data cut-off date; and |