PUMPKIN BACKGROUND UPDATE ON PUMPKIN TRIAL

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Update on PumpKIN Trial
                         Max B. Mitchell, MD

                     The Children’s Hospital Heart Institute
                               Professor of Surgery
              University of Colorado Denver Health Science Center

           PumpKIN Background
• 2002: NHLBI issued a Broad Agency
  Announcement (BAA) entitled “Pediatric
                                Pediatric Circulatory
  Support Program” (PCSP)
• Key Technical requirements of PCSP:
  –   Children 2-25 kg
  –   Durability of 6 months support
  –   Functioning within 1 hour
  –   Minimal prime volume
  –   Appropriate cannulation strategies
  –   Minimal blood product exposure
  –   Minimize risks of serious adverse events
PCSP: At first there were 5
Pulsatile Pediatric VADs
Penn State University      Awarded 2004                           PediPump
                                                          Cleveland Clinic Foundation

                            $22 4 million
                            $22.4  illi

                              Infant Jarvik 2000
                              Jarvik Heart Inc.*

                                                   Pediatric Cardiopulmonary Assist System
       PediaFlow
                                                              (pCAS) Ension, Inc.
    Univ Pittsburgh*

               PCSP begets PumpKIN
 • 2004-2009: Engineering & device
   development phase of 5 PCSP devices
 • Oct 2008: NHLBI issued RFP called the
   Pumps for Kids, Infants, and Neonates
   (PumpKIN) Program
 • Purposes:
       – Support the pre-clinical work required for
         contractors to obtain IDEs from the FDA
       – Implement IDE clinical trials leading to FDA
         device approval(s) under HDE guidelines
PumpKIN: then there were 4
• Jan 2010: NHLBI issued 4 awards:
  – 3 of the PCSP Contractors:
     • PediaFlow: University of Pittsburgh
     • Infant Jarvik 2000: Jarvik Heart Corp
     • pCAS: Ension, Inc
  – 4th award went to new Contractor:
     • PediPL: Pedi Pump-Lung,
                    Pump-Lung University of Maryland
• 2 axial flow VADS, 2 ACE systems
• Awards totaled $23.6 million

          PumpKIN Program
• Dec 2010: NHLBI issued RFP for a Data
  andd Cli
       Clinical
            i l Coordinating
                C di ti C    Center
                                 t (DCCC) tto
  manage the clinical phases of the
  PumpKIN program
• April 2012: NERI (New England Research
  Institute, Inc.) awarded the DCCC contract
• NERI’s award contract worth $18.8 million
Summer 2012
                                        PediPL
   PediaFlow                         Univ Maryland
 Univ Pittsburgh

 Infant Jarvik 2000                    pCAS
 Jarvik Heart, Inc.                  Ension, Inc.

                          DCCC

                      PumpKIN 2012
• June 2012: NERI contacted potential
  clinical sites to solicit interest and
  information regarding institutional
  support for PumpKIN
• 4 devices (2 VADs, 2 ACE systems)
PumpKIN 2013: then there were 3
• Jan 2013: NERI provided an update to
  potential
    t ti l clinical
            li i l sites
                    it att th
                           the S
                               Society
                                  i t off
  Thoracic Surgeons Annual Meeting
   – 3 devices, 2 prospective randomized trials:
      • Jarvik 2000 vs. Berlin Heart Excor control group
      • pCAS & PediPL vs. conventional ECMO control
• PediaFlow absent from update documents

     PediaFlow VAD eliminated

Aug 2012
PumpKIN 2013

    • Feb 2013: clinical site applications distributed by
      NERI
    • Mar 2013: site applications submitted
    • June 2013: NERI announced selection of 22 sites

                       PumpKIN Clinical Sites
                         Site                                      Surgical PI                            Cardiology PI
           A.I. duPont Hospital for Children                    Christian Pizarro, MD                  Michael McCullogh, MD
             Arkansas Children's Hospital                    Michiaki Imamura, MD, PhD                  Elizabeth Frazier, MD
              Boston Children's Hospital                    Francis Fynn-Thompson, MD                 Christina VanderPluym, MD
            Children's Healthcare of Atlanta                       Kirk Kanter, MD                    Shriprasad Deshpande, MD
             Children's Hospital Colorado                         Max Mitchell, MD            Scott Auerbach, MD & Shannon Buckvold, MD
      Children's Hospital of Philadelphia (CHOP)                 William Gaynor, MD                     Joseph Rossano, MD
           Children's Hospital of Wisconsin                     James Tweddell, MD                      Nancy Ghanayem, MD
             Children's Medical Ctr, Dallas                    Kristine Guleserian, MD                   Aliessa Barnes, MD
     CHONY-Columbia University Medical Center                     Emile Bacha, MD                     Marc E. Richmond, MD, MS
             Cincinnati Children's Hospital                      David Morales, MD                        Angela Lorts, MD
               Duke University Hospital                          Andrew Lodge, MD                        Michael Carboni, MD
          Hospital for Sick Children, Toronto                   Glen Van Arsdell, MD                   Tilman Humpl, MD, PhD
Lucile Packard Chidlren's Hospital, Stanford University          Olaf Reinhartz, MD                      David Rosenthal, MD
Monroe Carell Children
              Children's
                       s Hospital
                         Hospital, Vanderbilt University           Bret Mettler,
                                                                        Mettler MD                         Debra Dodd,
                                                                                                                 Dodd MD
            Nationwide Children's Hospital                     Patrick McConnell, MD                    Timothy Hoffman, MD
              Seattle Children's Hospital                      David M. McMullan, MD                      Sabrina Law, MD
    St. Louis Children's Hospital Wash U. St. Louis          Pirooz Eghtesady, MD, PhD                   Charles Canter, MD
        Stollery Children's Hospital, Edmonton                   Ivan Rebeyka, MD                        Holger Buchholz, MD
                                                           Charles Fraser, MD & Iki Adachi,
               Texas Children's Hospital                                 MD                               Aamir Jeewa, MD
          University of Alabama, Birmingham                       James Kirklin, MD                     F. Bennett Pearce, MD
  University of Michigan C.S. Mot Children's Hospital            Richard Ohye, MD                        Robert Gajarski, MD
 University of Minnesota Amplatz Children's Hospital           James D. St. Louis, MD                  Rebecca K. Ameduri, MD
PumpKIN 2013: then there were 2
 • June 2013 site announcement indicated
   th t P
   that  PumpKIN
             KIN will
                   ill iinvolve
                            l 2ddevices,
                                   i     2
   trials:
    • VAD: Jarvik 2000 vs. Berlin Heart Excor
    • ACE: PediPL vs. conventional ECMO
 • All sites will participate in each trial (VAD, &
   ACE)
 • Ension’s pCAS eliminated

        Ension pCAS eliminated

• Additional Costs and Time
  needed for preclinical
  development
• Ension determined they would
  not be able to meet the
  contracted IDE application
  timeline
Where does PumpKIN stand
             now?

 Nov 2013: and then there was 1

• L
  Lastt weekk Th
              Thoratec
                   t withdrew
                       ithd   th
                              the P
                                  PediPL
                                    diPL from
                                         f
  PumpKIN
• Technical issues?
The last man standing

Planned PumpKIN VAD
       Protocol
                                   PumpKIN
                              (Infant Jarvik 2000)
                                  Prospective
       Trial Design
                                    Two-Arm
                                Randomized to
         Control
                              Berlin Heart EXCOR
       Patient Size                 ≤ 0.8 m2
     Patient Weight           > 4 Kg and < 15 Kg
      HF Diagnosis             Severe 2 Vent
                               Severe,  Vent. HF
      Sample Size                  44/group*
         Centers                       22

 Primary Probable Benefit   Survival w/out new severe
        Endpoint                  NI at 180 days

 Primary Safety Endpoint     SAE rate for 180 days
Latest PumpKIN Timeline

                    IDE Applications
                        IDE Approvals (Contingent on FDA Decision)

      2013        2014            2015          2016          2017         2018

      Phase I                          Phase II                       Phase III
                                   Clinical
                                   Cli  i l Trials
                                            Ti l

Protocol Development                                                Data Analyses
Clinical Site Prep                                                  Publications
Training                                                            HDE Applications

                 Summary of current
                  PumpKIN status
  •   NHLBI review of protocols complete
  •   FDA Pre-IDE review of protocols complete
  •   Clinical sites selected
  •   DSMB Appointed
  •   Site training planned (March 2014)
  •   Devices and Timing of IDE(s) uncertain
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