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A Randomized Phase Lll Study of Imatinib Dose Optimization Compared With Nilotinib in Patients With Chronic Myelogenous Leukemia and Suboptimal Response to Standard-dose Imatinib


Phase 3
16 Years
N/A
Open (Enrolling)
Both
Chronic Myelogenous Leukemia

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Trial Information

A Randomized Phase Lll Study of Imatinib Dose Optimization Compared With Nilotinib in Patients With Chronic Myelogenous Leukemia and Suboptimal Response to Standard-dose Imatinib


The comparative efficacy between imatinib dose escalation (600 mg QD) and nilotinib (400 mg
BID), in terms of CCyR after 6 months, for patients with CML in chronic phase with
suboptimal response to imatinib standard dose will be determined.

Inclusion Criteria


Inclusion criteria:

1. Male or female ≥ 18 years old;

2. ECOG of 0, 1, or 2;

3. Ph+ CML in CP defined as:

- <15% blasts in peripheral blood or bone marrow;

- <30% blasts + promyelocytes in peripheral blood or bone marrow;

- <20% basophils in the peripheral blood;

•≥100x109/L (≥ 100,000/mm3) platelets;

- no evidence of extramedullary leukemia involvement, with the exception of
hepatosplenomegaly;

4. SoR to 400 mg imatinib, defined as (min of 20 metaphases):

- No cytogenetic response at ≥ 3 to <6 months (> 95% Ph+ metaphases);or

- No PCyR at ≥ 6 to <12 months (36 to 95% Ph+ metaphases on bone marrow); or

- No CCyR at ≥ 12 to <18 months (1 to 35% Ph+ metaphases on bone marrow);
Confirmation of SoR by FISH is allowed if BMK is done outside the screening
window up to 4 wks.

5. 400mg/daily imatinib (no higher doses) for at least 3months but no longer than 18
months;

6. Previous use of IFN, taken prior to imatinib treatment, is allowed at a maximum of 90
days unless reason for switch from IFN to imatinib was intolerance.

7. Parameters must be present:

- Creatinine <2.0 X ULN

- Total bilirubin <1.5 X ULN (< 3.0 X ULN if related to disease);

- SGOT and SGPT < 2.5 X ULN;

- Serum lipase ≤1.5 X ULN;

- Alkaline phosphatase ≤2.5 X ULN

- Serum potassium, phosphorus, magnesium and calcium ≥ LLN or corrected to WNL
with supplements prior to first dose of study drug;

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

Exclusion criteria:

1. Prior accelerated phase including clonal evolution or blast crisis CML;

2. Prior therapy with imatinib in combination with any other CML drug other than
Hydroxyurea and/or Anagrelide;

4.Imatinib therapy started more than 12 months after the date of the original diagnosis;
5.Unable to tolerate imatinib at 400mg; 6.Previous treatment with any other tyrosine
kinase inhibitor except Glivec and/or CML therapy other than IFN, hydroxyurea, and /or
anagrelide; 7.Myelotoxicity ≥ Grade 2 present at the time of randomization, 8.Previously
documented T315I mutations; 9.Impaired cardiac function including one of these:

- Long QT syndrome or family history of long QT syndrome

- Clinically significant resting brachycardia (<50 bpm)

- QTcF >450 msec on screening ECG (using the QTcF formula). If QTc >450 and
electrolytes are not with normal ranges, electrolytes should be corrected and then
the patient rescreened for QTc to certify QTc <450 msec;

- Myocardial infarction ≤ 12 months prior to the first dose of study drug;

- Other clinically significant heart disease (e.g., CHF, uncontrolled hypertension,
unstable angina, significant ventricular or atrial tachyarrhythmias) 10. Impairment
of GI function or disease that may significantly alter the absorption of study drug;
11. Treated with strong CYP3A4 inhibitors that cannot be either discontinued or
switched to a different medication prior to starting study drug; 12.Currently
receiving treatment with any medications that have the potential to prolong the QT
interval and the treatment cannot be either discontinued or switched to a different
medication prior to starting study drug; 13.History of previous acute pancreatitis
within one year of study entry or medical history of chronic pancreatitis; 14.Known
cytopathologically confirmed CNS 15.Women who are pregnant, breast feeding or of a
childbearing potential without a negative urine pregnancy test at screening. Female
patients of childbearing potential unwilling to use effective contraceptive
precautions throughout the trial and for 3 months post trial end. Post-menopausal
women must be ammenorrheic for at least 12 months to be considered of
non-childbearing potential; 16. History of another primary malignancy that is
currently clinically significant or currently requires active intervention; 17.Any
other clinically significant medical or surgical condition which, according to
investigators' discretion, should preclude participation; 18.Use of investigational
agent within 28 days prior to enrollment; 19.Patients unwilling or unable to comply
with the protocol.

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

to determine the comparative efficacy between imatinib dose escalation and nilotinib, in terms of CCyR) after 6 months of treatment, for patients with CML in chronic phase with suboptimal response to imatinib standard dose

Outcome Time Frame:

6 months

Safety Issue:

No

Principal Investigator

Novartis Pharmaceuticals

Investigator Role:

Study Director

Investigator Affiliation:

Novartis Pharmaceuticals

Authority:

United States: Food and Drug Administration

Study ID:

CAMN107A2404

NCT ID:

NCT00802841

Start Date:

May 2009

Completion Date:

July 2015

Related Keywords:

  • Chronic Myelogenous Leukemia
  • Chronic
  • Myelogenous
  • Leukemia
  • CML
  • Chronic Phase
  • Suboptimal Response
  • Leukemia
  • Leukemia, Myeloid
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive

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