A Phase I/II Multicenter, Dose-escalation Study of Oral Nilotinib on a Continuous Daily Dosing Schedule in Adult Patients With Imatinib-resistant or Imatinib-intolerant CML, or Relapse/Refractory Ph+ALL
Inclusion Criteria:
- Diagnosed as Ph+ ALL who are either relapsed after or refractory to standard therapy
- Diagnosed as CML in blast crisis or accelerated phase or chronic phase who are
resistant or intolerant to imatinib
- Performance status is normal or ambulatory and capable of all self-care Exclusion
Criteria
- A history of significant or serious uncontrolled cardiovascular disease
- Impairment of gastrointestinal (GI) function or GI disease that may significantly
alter the absorption of nilotinib
- Patients who are pregnant or breast feeding, or adults of reproductive potential not
employing an effective method of birth control
Exclusion Criteria:
- Cytopathologically confirmed CNS infiltration NB: in absence of suspicion of CNS
involvement, lumbar puncture is not required
- Impaired cardiac function, including any one of the following
- LVEF < 45% as determined by echocardiogram
- Complete left bundle branch block
- Use of a cardiac pacemaker
- ST depression of > 1mm in 2 or more leads and/or T-wave inversions in 2 or more
contiguous leads
- Congenital long QT syndrome
- History of or presence of significant ventricular or atrial tachyarrhythmias
- Clinically significant resting bradycardia (< 50 beats per minute)
- QTc > 480 msec on screening ECG (using the QTcF formula)
- Right bundle branch block plus left anterior hemiblock, bifascicular block
- Myocardial infarction within 3 months prior to starting AMN107
- Uncontrolled angina pectoris
- Other clinically significant heart disease (e.g., congestive heart failure,
uncontrolled hypertension, history of labile hypertension, or history of poor
compliance with an antihypertensive regimen)
- Impairment of gastrointestinal (GI) function or GI disease that may significantly
alter the absorption of AMN107 (e.g. ulcerative diseases, uncontrolled nausea,
vomiting, diarrhea, malabsorption syndrome, or small bowel resection)
- Use of therapeutic warfarin
- Acute or chronic liver or renal disease considered unrelated to tumor (e.g.,
hepatitis, cirrhosis, renal insufficiency, etc.)
- 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
- Treatment with any hematopoietic colony-stimulating growth factors (e.g., G-CSF) ≤ 1
week prior to starting study drug.
- Patients who are currently receiving treatment with any of the medications listed in
(cf. Post-text suppl. 5) that cannot be either discontinued or switched to a
different medication prior to starting study drug. The medications listed in (cf.
Post-text suppl. 5) have the potential to prolong the Q-T interval.
- Patients who have received chemotherapy ≤ 1 week or who are within 5 half-lives of
their last dose chemotherapy (6 weeks for nitrosurea or mitomycin-C) prior to
starting study drug or who have not recovered from side effects of such therapy.
Hydroxyurea is permitted at the investigator's discretion prior to enrollment.
- Patients who have received Glivec® ≤ 1 week or who have not recovered from side
effects of such therapy.
- Patients who have received immunotherapy ≤ 1 week prior to starting study drug or who
have not recovered from side effects of such therapy.
- Patients who have received any investigational drug (excluding STI571/Glivec) ≤ 4
weeks or investigational cytotoxic agent within 1 week (or who are within 5
half-lives of a previous investigational cytotoxic agent) prior to starting study
drug or who have not recovered from side effects of such therapy.
- Patients who have received wide field radiotherapy ≤ 4 week or limited field
radiation for palliation ≤ 2 week prior to starting study drug or who have not
recovered from side effects of such therapy.
- 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
AMN107). 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
- 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
Other protocol-defined inclusion and exclusion criteria may apply.