Nilotinib as First-line Treatment of Ph+ CML in Early Chronic Phase

Chronic Myeloid Leukemia Clinical Trial

— CML0307  

Official title:

The Protein Tyrosine Kinase Inhibitor Nilotinib as First-line Treatment of Ph+ Chronic Myeloid Leucemia (CML) in Early Chronic Phase: a Phase II Exploratory, Multicenter Study. GIMEMA Protocol CML 0307. EUDRACT 2007-000597-22.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00481052
• Other study ID #: CML0307
• Status: Completed
• Phase: Phase 2
• Start date: June 23, 2007
• Est. completion date: April 30, 2018

Study information

• Verified date: January 2022
• Source: Gruppo Italiano Malattie EMatologiche dell'Adulto
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Treating Ph pos CML with Imatinib is very effective since the majority of the patients achieve a complete cytogenetic response and a major molecular response and are alive and progression-free after 5 years. However, the great majority of responding patients are not leukemia-free and may be at risk of progression, molecular, cytogenetic and clinical, at any time. In case of disease progression due to Imatinib failure, nilotinib has been found to be very effective, as expected from the preclinical profile of the drug, that is much more potent against BCR-ABL and inhibits nearly all the imatinib-resistant BCR-ABL mutants. For these reasons, nilotinib is going to be registered for the treatment of imatinib-resistant CMl patients. For the same reasons, nilotinib is expected to be more efficient than imatinib also front-line, based on the principle that we should aim at preventing the emergence of resistance better that at treating resistance once it has emerged. This expectation can be tested safely, because the "toxicity profile" of Nilotinib may be even more convenient than that of Imatinib, due to the lower frequency of edema and fluid retention.

Description:

Study Phase:

Phase II, Prospective, multicentric, non randomized, open label

Objectives:

The primary objective of the trial is to investigate the cytogenetic and molecular effects of the protein tyrosine kinase (PTK) inhibitor nilotinib in the treatment of early chronic phase Ph+ CML.

The secondary objectives are:

To investigate in early CP Ph+ CML patients treated with nilotinib the clinical and the hematologic effects, the effect on bcr/abl point mutations, the kinetic of the response, the toxicity, the compliance to treatment and the dose density.

Study design:

This study is an open-label, multicenter, exploratory, Phase II study of nilotinib administered orally twice daily for one year. For the patients who will benefit an extension to 4 years is planned.

Visit Schedule and Assessments:

A visit with blood counts and differential and serum chemistry is due baseline, every 15 days for 3 months, hence every 30 days.

An ECG is due baseline, after 15 and 30 days, hence at 60, 90, 150, 240 and 360 days.

An echocardiogram is due baseline and at end-of-study (360 days) or early withdrawal.

A bone marrow aspirate is due baseline (cytology, cytogenetics and quantitative molecular biology), after 3 and 6 months (cytology and cytogenetics) and after 12 months (cytology, cytogenetics, quantitative molecular biology and mutational analysis).

A peripheral blood sample is due baseline, at 30, 60, 90, 180, 270 and 360 days for quantitative molecular biology.

After the end of the study (i.e. after one year) clinical, cytogenetic and molecular data are due every 6 months.

Biologic Monitoring:

Bone marrow and peripheral blood cells will be collected before, during and at the end of the study, stored at the central lab in Bologna and used for molecular assays that are listed in details in the protocol, with the exclusion of any test allowing the identification of patients genotype. The samples are kept for a minimum of 10 years and can be destroyed upon patient request. A specific consent form to the sample storage will be submitted to the patients.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 74
• Est. completion date: April 30, 2018
• Est. primary completion date: April 30, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients with a cytologic and cytogenetic confirmed diagnosis of Ph+ CML.

• Age = 18 years old

• Early CP (within 6 months from diagnosis)

• No prior treatment with any antileukemic drugs with the exception of Hydroxyurea (HU) and Anagrelide.

• WHO performance status of = 2

• Normal serum level of potassium, total calcium corrected for serum albumin, magnesium and phosphorus, or correctable with supplements

• ALT and AST = 2.5 x ULN or = 5.0 x ULN if considered due to leukaemia.

• Alkaline phosphatase = 2.5 x ULN unless considered due to leukemia.

• Serum bilirubin = 1.5 x ULN

• Serum creatinine = 1.5 x ULN

• Serum amylase = 1.5 x ULN and serum lipase = 1.5 x ULN.

• Written informed consent prior to any study procedures being performed.

Exclusion criteria:

• Impaired cardiac function, including LVEF < 45% as determined by MUGA scan or echocardiogram, uncontrolled congestive heart failure, uncontrolled hypertension

• History of myocardial infarction within three months, or uncontrolled angina pectoris.

• Significant electric heart abnormalities, including history or presence of significant ventricular or atrial tachyarrhythmias, congenital long QT syndrome and/or QTc > 450 msec on screening ECG (using the QTcF formula).

• Patients with ventricular pacemakers and clinically significant bradycardias.

• Patients with heart blocks.

• History of acute or chronic pancreatitis.

• Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of nilotinib (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection)

• Use of therapeutic coumarin derivates (i.e. warfarin, acenocoumarol, phenprocoumon).

• Acute or chronic liver or renal disease considered unrelated to leukaemia

• Other concurrent severe and/or uncontrolled medical conditions (e.g., uncontrolled diabetes, active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol

• Patients who are currently receiving treatment with any of the medications listed in Appendix E and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug. The medications listed in Appendix E have the potential to prolong QT, with the exception of HU and Anagrelide.

• Patients who have received any antileukemic agents and treatments, including HSCT, with the exception of HU and Anagrelide.

• Patients who have received any investigational drug = 4 weeks.

• Patients who have undergone major surgery = 2 weeks prior to starting study drug or who have not recovered from side effects of such therapy.

• Patients who are pregnant or breast feeding, or adults of reproductive potential not employing an effective method of birth control. (Women of childbearing potential must have a negative serum pregnancy test within 48 hrs prior to administration of nilotinib). Post menopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential. Male and female patients must agree to employ an effective barrier method of birth control throughout the study and for up to 3 months following discontinuation of study drug.

• Treatment with any hematopoietic colony-stimulating growth factors (e.g. G-CSF, GM-CSF) 1 week prior to starting study drug.

• Patients who have received immunotherapy 1 week prior to starting study drug or who have not recovered from side effects of such therapy.

• Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not mandatory).

• Patients with a history of another primary malignancy that is currently clinically significant or currently requires active intervention.

• Patients unwilling or unable to comply with the protocol.

Related Conditions & MeSH terms

• Chronic Myeloid Leukemia
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive
• Leukemia, Myeloid

Intervention

Drug:
• Nilotinib

Locations

Country	Name	City	State
Italy	Dipartimento Area Medica P.O.	Ascoli Piceno
Italy	Unità Operativa Ematologica - Università degli Studi di Bari	Bari
Italy	Ospedali Riuniti	Bergamo
Italy	stituto di Ematologia "Lorenzo e A. Seragnoli" - Università degli Studi di Bologna - Policlinico S. Orsola - Malpighi	Bologna
Italy	Azienda Spedali Civili	Brescia
Italy	Sezione di Ematologia e Trapianti Spedali Civili	Brescia
Italy	ASL N.8 - Ospedale "A. Businco" - Struttura Complessa di Ematologia e CTMO	Cagliari
Italy	Ospedale Ferrarotto	Catania
Italy	Azienda Ospedaliera Pugliese Ciaccio	Catanzaro
Italy	Sezione di Ematologia e Fisiopatologia delle Emostasi - Azienda Ospedaliera - Arcispedale S. Anna	Ferrara
Italy	Azienda Ospedaliera Universitaria - Università degli Studi di Napoli "Federico II" - Facoltà di Medicina e Chirurgia	Napoli
Italy	Ospedale S. Luigi Gonzaga	Orbassano
Italy	La Maddalena Casa di Cura di Alta Specialità Dipartimento Oncologico di III Livello	Palermo
Italy	Unità Operativa Ematologia e Centro Trapianti - Dipartimento di Oncologia ed Ematologia - AUSL Ospedale di Piacenza	Piacenza
Italy	Ospedale S.Maria delle Croci	Ravenna
Italy	Calabria Dipartimento Emato-Oncologia A.O."Bianchi-Melacrino-Morelli"	Reggio Calabria
Italy	Complesso Ospedaliero S. Giovanni Addolorata	Roma
Italy	Università degli Studi "Sapienza" - Dip Biotecnologie Cellulari ed Ematologia - Divisione di Ematologia	Roma
Italy	Università La Cattolica del Sacro Cuore	Roma
Italy	U.O. Ematologia, Azienda Ospedaliera Universitaria Senese	Siena
Italy	Policlinico Universitario - Clinica Ematologia	Udine
Italy	Policlinico G.B. Rossi	Verona

Sponsors (1)

Lead Sponsor	Collaborator
Gruppo Italiano Malattie EMatologiche dell'Adulto

Country where clinical trial is conducted

Italy, 

References & Publications (9)

Baccarani M, Russo D, Rosti G, Martinelli G. Interferon-alfa for chronic myeloid leukemia. Semin Hematol. 2003 Jan;40(1):22-33. Review. — View Citation

Barnes DJ, Melo JV. Management of chronic myeloid leukemia: targets for molecular therapy. Semin Hematol. 2003 Jan;40(1):34-49. Review. — View Citation

Calabretta B, Perrotti D. The biology of CML blast crisis. Blood. 2004 Jun 1;103(11):4010-22. Epub 2004 Feb 24. Review. — View Citation

Goldman JM, Druker BJ. Chronic myeloid leukemia: current treatment options. Blood. 2001 Oct 1;98(7):2039-42. — View Citation

Goldman JM, Marin D, Olavarria E, Apperley JF. Clinical decisions for chronic myeloid leukemia in the imatinib era. Semin Hematol. 2003 Apr;40(2 Suppl 2):98-103; discussion 104-13. Review. — View Citation

Goldman JM, Marin D. Management decisions in chronic myeloid leukemia. Semin Hematol. 2003 Jan;40(1):97-103. Review. — View Citation

Goldman JM, Melo JV. Chronic myeloid leukemia--advances in biology and new approaches to treatment. N Engl J Med. 2003 Oct 9;349(15):1451-64. Review. — View Citation

Martinelli G, Soverini S, Rosti G, Cilloni D, Baccarani M. New tyrosine kinase inhibitors in chronic myeloid leukemia. Haematologica. 2005 Apr;90(4):534-41. — View Citation

Rosti G, Martinelli G, Bassi S, Amabile M, Trabacchi E, Giannini B, Cilloni D, Izzo B, De Vivo A, Testoni N, Cambrin GR, Bonifazi F, Soverini S, Luatti S, Gottardi E, Alberti D, Pane F, Salvatore F, Saglio G, Baccarani M; Study Committee, Italian Cooperative Study Group for Chronic Myeloid Leukemia; Writing Committee, Italian Cooperative Study Group for Chronic Myeloid Leukemia. Molecular response to imatinib in late chronic-phase chronic myeloid leukemia. Blood. 2004 Mar 15;103(6):2284-90. Epub 2003 Nov 26. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Complete cytogenetic response (CCgR ) rate		At 1 year
Secondary	The complete and the partial cytogenetic response rate		At 6 months
Secondary	The major molecular response (MMR) rate		At 1 year
Secondary	The kinetics of haematologic, cytogenetic and molecular response to AMN107		At 1 year
Secondary	The development of bcr-abl mutation during the treatment with AMN107 (number and type)		At 1 year
Secondary	The safety and tolerability of nilotinib treatment at the dose of 300 mg b.i.d		At 1 year
Secondary	To describe any SAE		At 1 year

External Links

•   GIMEMA's Web page