Leukemia, Myelogenous, Chronic, BCR-ABL Positive Clinical Trial
Official title:
A Prospective Randomized Phase II Study Evaluating the Monitoring of Imatinib Mesylate (Glivec®) Plasmatic Through Level in Patients Newly Diagnosed With Chronic Phase Chronic Myelogenous Leukaemia (CP-CML).
Imatinib mesylate (Gleevec/Glivec, IM) is currently the gold standard or CML-CP front line
therapy. The recommended dose of IM is 400 mg/day. The rates of complete cytogenetic
responses at 3, 6 and 12 months are 27%, 50% and 69% respectively. The optimal IM daily dose
is not yet determined and randomized studies addressing this question are on-going. First
results from the TOPS trial (EHA 2008 congress) suggest a more rapid kinetic of response for
patients treated with imatinib high dose. Recent studies revealed that initial Imatinib
plasmatic dosage is predictive for achieving complete cytogenetic responses (CCR) and that a
dosage of 1000 ng/ml is associated with a higher proportion of major molecular responses
(MMR) (Picard et al., Blood 2007, Larson et al. Blood 2007).
Results from the study of Larson et al. indicate that around 40% of the patients had a trough
plasmatic level below 1000 ng/ml after day 28 of imatinib 400 mg/d. The major molecular
response rate at 12 months for the patients with the lower plasmatic through level is 25.4%
compared to 40.1% for the patients with a plasmatic dosage over 800 to 1000 ng/ml.
Investigators propose to adapt the imatinib daily dose in case of imatinib through plasmatic
level at day 28 below 1000 ng/ml. Patients with a trough plasmatic dosage ≤ 1000 ng/ml will
be randomized between a prospective adaptation strategy of the imatinib daily dose (cohort 1)
versus observation only (cohort 2). The patients with adequate imatinib dosage (> 1000 ng/ml)
will be followed up according the ELN recommendation (cohort 3). Imatinib trough plasmatic
level will then be rechecked every month thereafter for patients in cohort 1 and cohort 2 and
every three months in cohort 3. The first endpoint of the study will be the rate of major
molecular response at 12 months in cohort 1. Our hypothesis is to improve the 12 months MMR
rate with the optimized strategy (cohort 1) from 25% of MMR at 12 months to 40% of MMR at 12
months.
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