Description:
Patients will be randomized in phase II trials to continue on the same TKI versus one of the
alternative treatment approaches. If a patient is not eligible for one of the treatments, he
(she) will be randomized between the options for which he (she) is eligible.
The trial will start with current available treatment options (experimental arms). New
available treatment options may be open at any times later on. Authorized TKIs are imatinib,
nilotinib, dasatinib, bosutinib and ponatinib.
For all options the treatment duration is for a minimum of 12 months and will be continued in
the absence of adverse events following investigator decision. Each therapeutic option will
be detailed in term of combination modalities, dose, dose adaptation, specific warnings,
specific exclusion and inclusion criteria. The decision to introduce a new option will depend
on the general pace of recruitment and on the assessment of the potential efficacy and safety
of the new treatment, and will be implemented after scientific review by a protocol
amendment.
Primary objective:
A. To select molecules in combination or sequentially with imatinib, nilotinib, dasatinib,
bosutinib or ponatinib potentially able to produce a 25% increase in the Cumulative Incidence
of MR4.5 as compare to control.
Secondary objectives:
A. To determine the safety of selected therapies
B. To determine the rate of MR4 by 12, 24, 36, 48 months in experimental and control arms
C. To determine the rates of MR4.5 by 24, 36, 48 months in experimental and control arms
D. To determine the rate of undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies)
by 12, 24, 36, 48 months in experimental and control arms
E. To estimate treatment free remission (TFR) in patients eligible for discontinuation
studies
F. To investigate the relationship between biological activity and the clinical efficacy of
the selected therapies
G. To assess the effects of the treatments on the number and clonogenicity of CML stem cells
and other biological markers of interest
H. To estimate duration of response, progression-free survival, event free survival and
overall survival.
Title
- Brief Title: Therapies in Combination or Sequentially With Tyrosine Kinase Inhibitors (TKIs) in Chronic Phase Chronic Myelogenous Leukemia Patients in CCR (ACTIW)
- Official Title: Candidate Therapies in Combination or Sequentially With Tyrosine Kinase Inhibitors in Chronic Phase-chronic Myelogenous Leukemia Patients in CCR Without Achieving a Deep Molecular Response: an Adaptative Trial Based on a Drop Loser Design
Clinical Trial IDs
- ORG STUDY ID:
P13/12_ACTIW
- NCT ID:
NCT02767063
Conditions
- Leukemia, Myeloid, Chronic-Phase
Interventions
Drug | Synonyms | Arms |
---|
Pioglitazone | | Experimental Arm_ACTOS |
Avelumab | | Experimental Arm_AVELUMAB |
Purpose
Patients will be randomized in phase II trials to continue on the same TKI versus one of the
alternative treatment approaches. If a patient is not eligible for one of the treatments, he
(she) will be randomized between the options for which he (she) is eligible.
The trial will start with current available treatment options (experimental arms). New
available treatment options may be open at any times later on. Authorized TKIs are imatinib,
nilotinib, dasatinib, bosutinib and ponatinib.
For all options the treatment duration is for a minimum of 12 months and will be continued in
the absence of adverse events following investigator decision. Each therapeutic option will
be detailed in term of combination modalities, dose, dose adaptation, specific warnings,
specific exclusion and inclusion criteria. The decision to introduce a new option will depend
on the general pace of recruitment and on the assessment of the potential efficacy and safety
of the new treatment, and will be implemented after scientific review by a protocol
amendment.
Primary objective:
A. To select molecules in combination or sequentially with imatinib, nilotinib, dasatinib,
bosutinib or ponatinib potentially able to produce a 25% increase in the Cumulative Incidence
of MR4.5 as compare to control.
Secondary objectives:
A. To determine the safety of selected therapies
B. To determine the rate of MR4 by 12, 24, 36, 48 months in experimental and control arms
C. To determine the rates of MR4.5 by 24, 36, 48 months in experimental and control arms
D. To determine the rate of undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies)
by 12, 24, 36, 48 months in experimental and control arms
E. To estimate treatment free remission (TFR) in patients eligible for discontinuation
studies
F. To investigate the relationship between biological activity and the clinical efficacy of
the selected therapies
G. To assess the effects of the treatments on the number and clonogenicity of CML stem cells
and other biological markers of interest
H. To estimate duration of response, progression-free survival, event free survival and
overall survival.
Detailed Description
Patients will be randomised to continue on TKI (same daily dose) versus one of the
alternative novel treatment approaches. If a patient is not eligible for one of the
treatments, he can be randomised for the options for which he is eligible. All treatment
options may be open at all times. Investigators must specify before randomization for which
treatment option they want their patient be included and randomized.
Perspectives New treatment options will be introduced over time. The decision to introduce a
new option will depend on the general pace of recruitment and the assessment of the potential
efficacy and safety of the new treatment in this patient population, and will be implemented
after scientific review by a protocol amendment.
The available treatment arms are:
1. TKI alone same daily dose (control arm)
2. TKI in combination with pioglitazone
3. TKI in combination with Avelumab (anti-PD-L1 antibody)
Planned treatment arms for the future may be :
1. TKI in combination with pegylated interferon
2. TKI in combination with arsenic trioxide
3. TKI in combination with Homoharringtonine
Protocol plan:
1. Control arm (Imatinib, nilotinib, dasatinib, bosutinib or ponatinib):
Daily dose and schedule identical to the daily dose and schedule administered during the
last 3 months
2. Pioglitazone arm
- TKI : Daily dose and schedule identical to the daily dose and schedule administered
during the last 3 months
- PIOGLITAZONE (Actos®):
30 mg per day for 12 months. The dose will be increased to 45 mg per day after 2
months in the absence of grade >1 related AE.
- After 12 Months :
Continue TKI at the same daily dose and STOP pioglitazone.
3. AVELUMAB arm
- TKI : Daily dose and schedule identical to the daily dose and schedule administered
during the last 3 months
- AVELUMAB: 10mg/kg every 2 weeks, for a maximum of 8 IV infusions over a 4 months'
period. (If MR4.5 is acheived by the first 3 months the 7th and 8th infusions will
be omitted)
- After 12 Months :Continue TKI at the same daily dose.
4. Other experimental arm TKI : Daily dose and schedule identical to the daily dose and
schedule administered during the last 3 months
- Arsenic trioxide : to be determined after amendment
- Pegylated Interferon : to be determined after amendment
- Homoharringtonine : to be determined after amendment
- Drug X
- Drug Y
Trial Arms
Name | Type | Description | Interventions |
---|
Experimental Arm_ACTOS | Experimental | TKI : Daily dose and schedule identical to the daily dose and schedule administered during the last 3 months
PIOGLITAZONE (Actos®):
30 mg per day for 12 months. The dose will be increased to 45 mg per day after 2 months in the absence of grade >1 related AE. | |
controled Arm | No Intervention | TKI : Daily dose and schedule identical to the daily dose and schedule administered during the last 3 months | |
Experimental Arm_AVELUMAB | Experimental | TKI : Daily dose and schedule identical to the daily dose and schedule administered during the last 3 months AVELUMAB: 10mg/kg every 2 weeks, for a maximum of 8 IV infusions over a 4 months' period.(If MR4.5 is acheived by the first 3 months the 7th and 8th infusions will be omitted) | |
Eligibility Criteria
Common Inclusion Criteria:
1. Patient aged 18y or more
2. Signed informed consent
3. Patient with Philadelphia chromosome positive chronic phase CML and M BCR-ABL1
transcript positivity at diagnosis
4. Treatment with imatinib, nilotinib, dasatinib or bosutinib for more than 2 years
overall
5. No switch between tyrosine kinase inhibitors within the last 3 months
6. No dose modification within the last 3 months
7. Complete cytogenetic response or BCR-ABL1IS ≤ 1%
8. Detectable BCR-ABL1 with BCR-ABL1IS > 0.0032% (less than MR4.5)
9. ECOG grade 0 to 2
10. ASAT and ALAT ≤ 2.5 N
11. Bilirubin in serum ≤ 2.5 N
12. Men and Women of childbearing potential must be using an adequate method of
contraception
These specific inclusion criteria will apply for the Avelumab arm in addition to the common
criteria.
1. Hematologic:
1. Absolute neutrophil count (ANC) ≥ 1.5 × 109/L,
2. Platelet count ≥ 100 × 109/L,
3. Hemoglobin ≥ 9 g/dL. (may have been transfused).
2. Hepatic:
a. Total bilirubin level ≤ 1.5 × the upper limit of normal (ULN) range.
3. Renal: Estimated creatinine clearance ≥ 30 mL/min according to the Cockcroft-Gault
formula (or local institutional standard method)
4. Pregnancy test: Negative serum or urine pregnancy test at screening for women of
childbearing potential.
5. Contraception: Highly effective contraception for both male and female subjects
throughout the study and for at least 30 days after last Avelumab treatment
administration if the risk of conception exists.
Common Exclusion Criteria:
1. Pregnant or lactating women,
2. Participation in another clinical trial with any investigative drug within 30 days
prior to study enrolment,
3. Prior history of hematopoietic stem cell transplantation (autologous or allogenic)
4. Cardiovascular disease:
- Stage II to IV congestive heart failure (CHF) as determined by the New York Heart
Association (NYHA) classification system for heart failure.
- Myocardial infarction within the previous 6 months
- Symptomatic cardiac arrhythmia requiring treatment
5. Grade III or IV fluid retention
6. Known BCR-ABL kinase domain mutation
7. CML patient not in chronic phase at diagnosis
8. Individuals with an active malignancy
9. Known HIV-positivity
These specific exclusion criteria will apply for the pioglitazone arm in addition to the
common criteria.
1. Known osteoporosis with curative therapy (prophylactic therapy is not an exclusion
criteria)
2. Patient requiring anti-diabetic medication
These specific exclusion criteria will apply for the Avelumab arm in addition to the common
criteria:
1. IMMUNOSUPRESSANTS: Current use of immunosuppressive medication, EXCEPT for the
following:
1. intranasal, inhaled, topical steroids, or local steroid injection (e.g.,
intra-articular injection);
2. Systemic corticosteroids at physiologic doses ≤ 10 mg/day of prednisone or
equivalent;
3. Steroids as premedication for hypersensitivity reactions (e.g., CT scan
premedication).
2. AUTOIMMUNE DISEASE: Active autoimmune disease that might deteriorate when receiving an
immuno-stimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo-
or hyperthyroid diseases not requiring immunosuppressive treatment are eligible.
3. ORGAN TRANSPLANTATION: Prior organ transplantation including allogenic stem-cell
transplantation.
4. INFECTIONS: Active infection requiring systemic therapy.
5. HIV/AIDS: Known history of testing positive for HIV or known acquired immunodeficiency
syndrome.
6. HEPATITIS: Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening
(positive HBV surface antigen or HCV RNA if anti-HCV antibody screening test positive)
7. VACCINATION: Vaccination within 4 weeks of the first dose of Avelumab and while on
trials is prohibited except for administration of inactivated vaccines
8. HYPERSENSITIIVTY TO STUDY DRUG: Known prior severe hypersensitivity to investigational
product or any component in its formulations, including known severe hypersensitivity
reactions tomonoclonal antibodies (NCI CTCAE v4.03 Grade ≥ 3)
9. CARDIOVASCULAR DISEASE: Clinically significant (i.e., active) cardiovascular disease:
cerebral vascular accident/stroke (< 6 months prior to enrolment), myocardial
infarction (< 6 months prior to enrolment), unstable angina, congestive heart failure
(≥ New York Heart Association Classification Class II), or serious cardiac arrhythmia
equiring medication.
10. OTHER PERSISTING TOXICITIES: Persisting toxicity related to prior therapy (NCI CTCAE
v. 4.03 Grade > 1); however, alopecia, sensory neuropathy Grade ≤ 2, or other Grade ≤
2 not constituting a safety risk based on investigator's judgment are acceptable.
11. Other severe acute or chronic medical conditions including immune colitis,
inflammatory bowel disease, immune pneumonitis, pulmonary fibrosis or psychiatric
conditions including recent (within the past year) or active suicidal ideation or
behaviour; or laboratory abnormalities that may increase the risk associated with
study participation or study treatment administration or may interfere with the
interpretation of study results and, in the judgment of the investigator, would make
the patient inappropriate for entry into this study.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Cumulative incidence of patients achieving a deep molecular response |
Time Frame: | 12 months |
Safety Issue: | |
Description: | The cumulative incidence of patients achieving a deep molecular response defined by MR4.5 or deeper (BCR-ABLIS ≤ 0.0032 %) by 12 months |
Secondary Outcome Measures
Measure: | Adverse events |
Time Frame: | 12 Months |
Safety Issue: | |
Description: | Adverse events |
Measure: | The cumulative rate of patients achieving MR4.5 by 24months in experimental and control arms |
Time Frame: | 24 months |
Safety Issue: | |
Description: | The cumulative rate of patients achieving MR4.5 by 24months in experimental and control arms |
Measure: | The cumulative rate of patients achieving MR4.5 by 36 months in experimental and control arms |
Time Frame: | 36 months |
Safety Issue: | |
Description: | The cumulative rate of patients achieving MR4.5 by 36 months in experimental and control arms |
Measure: | The cumulative rate of patients achieving MR4.5 by 48 months in experimental and control arms |
Time Frame: | 48 months |
Safety Issue: | |
Description: | The cumulative rate of patients achieving MR4.5 by 48months in experimental and control arms |
Measure: | The cumulative rate of patients achieving MR4 by 12months in experimental and control arms |
Time Frame: | 12 months |
Safety Issue: | |
Description: | The cumulative rate of patients achieving MR4 by 12,months in experimental and control arms |
Measure: | The cumulative rate of patients achieving MR4 by 24 months in experimental and control arms |
Time Frame: | 24 months |
Safety Issue: | |
Description: | The cumulative rate of patients achieving MR4 by 24 months in experimental and control arms |
Measure: | The cumulative rate of patients achieving MR4 by 36 months in experimental and control arms |
Time Frame: | 36 months |
Safety Issue: | |
Description: | The cumulative rate of patients achieving MR4 by 36 months in experimental and control arms |
Measure: | The cumulative rate of patients achieving MR4 by 48 months in experimental and control arms |
Time Frame: | 48 months |
Safety Issue: | |
Description: | The cumulative rate of patients achieving MR4 by 48 months in experimental and control arms |
Measure: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 12months in experimental and control arms |
Time Frame: | 12 months |
Safety Issue: | |
Description: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 12months in experimental and control arms |
Measure: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 24months in experimental and control arms |
Time Frame: | 24 months |
Safety Issue: | |
Description: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 24, months in experimental and control arms |
Measure: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 36 months in experimental and control arms |
Time Frame: | 36 months |
Safety Issue: | |
Description: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 36 months in experimental and control arms |
Measure: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 48 months in experimental and control arms |
Time Frame: | 48 months |
Safety Issue: | |
Description: | The cumulative rate of patients with undetectable BCR-ABL1 transcript (sensitivity 40000 ABL copies) by 48 months in experimental and control arms |
Measure: | The rate of patients in treatment free remission during follow-up |
Time Frame: | 48 months |
Safety Issue: | |
Description: | The rate of patients in treatment free remission during follow-up |
Measure: | Quantification of CML- and normal-CFU in bone marrow by clonogenic assays and RTQ- PCR |
Time Frame: | 12 months |
Safety Issue: | |
Description: | |
Measure: | Survival |
Time Frame: | 48 months |
Safety Issue: | |
Description: | Survival |
Measure: | duration of response |
Time Frame: | 48 months |
Safety Issue: | |
Description: | duration of response |
Measure: | event free survival |
Time Frame: | 48 months |
Safety Issue: | |
Description: | event free survival |
Measure: | progression free survival |
Time Frame: | 48 months |
Safety Issue: | |
Description: | progression free survival |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Versailles Hospital |
Last Updated
August 7, 2020