Description:
Evaluate the response (complete hematologic response [CHR], complete cytogenetic response
[CCyR], major molecular response [MMR] and complete molecular response [CMR] of the
combination of ponatinib with standard chemotherapy (according to PETHEMA ALL Ph08 trial) in
young patients with Ph+ (BCR-ABL) ALL.
All patients are treated with:
Pre-phase (maximum 7 days, -7 to -1):
Prednisone 60 mg/m2/day IV over 7 days (-7 a -1) and triple intrathecal therapy (TIT)
(Methotrexate [MTX]: 12 mg, ARA-C: 30 mg, hydrocortisone: 20 mg). 2. Induction (day 1 to day
28 or up to hematological recovery) Vincristine (VCR): 1.5 mg/m2 (maximum 2 mg) IV days 1, 8,
15 and 22. Daunorubicin (DNR): 45 mg/m2 IV days 1, 8, 15 and 22. Prednisone (PDN): 60
mg/m2/day, IV or PO, days 1 to 27. Ponatinib 30 mg, PO from day 1 to consolidation. TIT, days
1 and 22. 3. Consolidation (day 1 to day 63) Mercaptopurine (MP): 50 mg/m2, PO days 1 to 7,
28 to 35 and 56 to 63. MTX: 1,5 g/m2, IV (24 h continuous infusion) days 1, 28 and 56. VP-16:
100 mg/m2/12 h, IV, days 14 and 42. ARA-C: 1000 mg/m2/12 h, IV, days 14-15 and 42-43. TIT
(MTX: 12 mg, ARA-C: 30 mg, hydrocortisone: 20 mg), , days 1, 28 and 56. Ponatinib 30 mg/d PO,
from day 1 to 15 days before HSCT. 4. HSCT (performed ideally within 1 month from the end of
consolidation). AlloHSCT preferred over autoHSCT (autoHSCT only indicated if alloHSCT not
feasible). Myeloablative conditioning with cyclophosphamide and total body irradiation (TBI)
whenever possible. 5. Post HSCT therapy After alloHSCT. Frequent monitoring of MRD (every
month). I After autoHSCT: Frequent monitoring of MRD (every month).
Title
- Brief Title: Ponatinib With Chemotherapy for Young Adults Ph Positive Acute Lymphoblastic Leukemia
- Official Title: Concurrent Ponatinib With Chemotherapy for Young Adults With Newly Diagnosed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia
Clinical Trial IDs
- ORG STUDY ID:
PONALFIL
- NCT ID:
NCT02776605
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Prednisone | | Ponatinib |
Vincristine | | Ponatinib |
Daunorubicin | | Ponatinib |
Prednisone | | Ponatinib |
Ponatinib | | Ponatinib |
Mercaptopurine | | Ponatinib |
Methotrexate | | Ponatinib |
VP-16 | | Ponatinib |
ARA-C: | | Ponatinib |
TIT | | Ponatinib |
Ponatinib | | Ponatinib |
Purpose
Evaluate the response (complete hematologic response [CHR], complete cytogenetic response
[CCyR], major molecular response [MMR] and complete molecular response [CMR] of the
combination of ponatinib with standard chemotherapy (according to PETHEMA ALL Ph08 trial) in
young patients with Ph+ (BCR-ABL) ALL.
All patients are treated with:
Pre-phase (maximum 7 days, -7 to -1):
Prednisone 60 mg/m2/day IV over 7 days (-7 a -1) and triple intrathecal therapy (TIT)
(Methotrexate [MTX]: 12 mg, ARA-C: 30 mg, hydrocortisone: 20 mg). 2. Induction (day 1 to day
28 or up to hematological recovery) Vincristine (VCR): 1.5 mg/m2 (maximum 2 mg) IV days 1, 8,
15 and 22. Daunorubicin (DNR): 45 mg/m2 IV days 1, 8, 15 and 22. Prednisone (PDN): 60
mg/m2/day, IV or PO, days 1 to 27. Ponatinib 30 mg, PO from day 1 to consolidation. TIT, days
1 and 22. 3. Consolidation (day 1 to day 63) Mercaptopurine (MP): 50 mg/m2, PO days 1 to 7,
28 to 35 and 56 to 63. MTX: 1,5 g/m2, IV (24 h continuous infusion) days 1, 28 and 56. VP-16:
100 mg/m2/12 h, IV, days 14 and 42. ARA-C: 1000 mg/m2/12 h, IV, days 14-15 and 42-43. TIT
(MTX: 12 mg, ARA-C: 30 mg, hydrocortisone: 20 mg), , days 1, 28 and 56. Ponatinib 30 mg/d PO,
from day 1 to 15 days before HSCT. 4. HSCT (performed ideally within 1 month from the end of
consolidation). AlloHSCT preferred over autoHSCT (autoHSCT only indicated if alloHSCT not
feasible). Myeloablative conditioning with cyclophosphamide and total body irradiation (TBI)
whenever possible. 5. Post HSCT therapy After alloHSCT. Frequent monitoring of MRD (every
month). I After autoHSCT: Frequent monitoring of MRD (every month).
Detailed Description
Objectives Primary
1. To evaluate the response (complete hematologic response [CHR], complete cytogenetic
response [CCyR], major molecular response [MMR] and complete molecular response [CMR] of
the combination of ponatinib with standard chemotherapy (according to PETHEMA ALL Ph08
trial) in young patients with Ph+ (BCR-ABL) ALL.
2. To evaluate the event free survival (EFS) of the combination of ponatinib with standard
chemotherapy (according to PETHEMA ALL Ph08 trial) in young patients with Ph+ (BCR-ABL)
ALL. Secondary
- To evaluate the rate of patients receiving an allogeneic hematopoietic stem cell
transplant (alloHSCT) in first CR
- To evaluate the frequency of MMR and CMR at the time of alloHSCT
- To evaluate the transplant-related mortality (TRM)
- To evaluate the CR duration and overall survival (OS) of the combination of
ponatinib with standard chemotherapy (according to PETHEMA ALL Ph08 trial) in young
patients with Ph+ (BCR-ABL) ALL.
- To evaluate the outcome measures (CR duration, OS and EFS) in context of those
observed in the PETHEMA ALL Ph08 trial.
- To observe the type and number of BCR-ABL kinase domain mutations developing during
and after the study.
- To evaluate side effects, adverse events (AE) and serious AE (SAE).
Interventions:
1. Pre-phase (maximum 7 days, -7 to -1):
Prednisone 60 mg/m2/day IV over 7 days (-7 a -1) and triple intrathecal therapy (TIT)
(Methotrexate [MTX]: 12 mg, ARA-C: 30 mg, hydrocortisone: 20 mg).
2. Induction (day 1 to day 28 or up to hematological recovery) Vincristine (VCR): 1.5 mg/m2
(maximum 2 mg) IV days 1, 8, 15 and 22. Daunorubicin (DNR): 45 mg/m2 IV days 1, 8, 15
and 22. Prednisone (PDN): 60 mg/m2/day, IV or PO, days 1 to 27. Ponatinib 30 mg, PO from
day 1 to consolidation. TIT, days 1 and 22.
3. Consolidation (day 1 to day 63) Mercaptopurine (MP): 50 mg/m2, PO days 1 to 7, 28 to 35
and 56 to 63. MTX: 1,5 g/m2, IV (24 h continuous infusion) days 1, 28 and 56. VP-16: 100
mg/m2/12 h, IV, days 14 and 42. ARA-C: 1000 mg/m2/12 h, IV, days 14-15 and 42-43. TIT
(MTX: 12 mg, ARA-C: 30 mg, hydrocortisone: 20 mg), , days 1, 28 and 56. Ponatinib 30
mg/d PO, from day 1 to 15 days before HSCT.
4. HSCT (performed ideally within 1 month from the end of consolidation). AlloHSCT
preferred over autoHSCT (autoHSCT only indicated if alloHSCT not feasible).
Myeloablative conditioning with cyclophosphamide and total body irradiation (TBI)
whenever possible.
5. Post HSCT therapy After alloHSCT. Frequent monitoring of MRD (every month). If MRD
negative: no therapy. If MRD positive, Ponatinib 30 mg/d, po, until 2 yr. after HSCT.
The ponatinib dose will be reduced to 15 mg/d in the second year in patients with
sustained molecular response. After autoHSCT: Frequent monitoring of MRD (every month).
All patients will receive Ponatinib: 30 mg/d, PO, mercaptopurine, (40 mg/m2/d, PO) and
methotrexate (15 mg/m2/week, IM), during the first year after HSCT. The ponatinib dose
will be reduced to 15 mg/d in the second year in patients with sustained molecular
response.
Trial Arms
Name | Type | Description | Interventions |
---|
Ponatinib | Experimental | Pre-phase (maximum 7 days, -7 to -1) with Prednisone and triple intrathecal therapy (TIT)
Induction (day 1 to day 28 or up to hematological recovery) Vincristine (VCR): 1.5 mg/m2 IV days 1, 8, 15 and 22. Daunorubicin (DNR): 45 mg/m2 IV days 1, 8, 15 and 22. Prednisone (PDN): 60 mg/m2/day, IV or PO, days 1 to 27. Ponatinib 30 mg, PO from day 1 to consolidation. TIT, days 1 and 22.
Consolidation Mercaptopurine (MP): 50 mg/m2, PO days 1 to 7, 28 to 35 and 56 to 63. MTX: 1,5 g/m2, IV days 1, 28 and 56. VP-16: 100 mg/m2/12 h, IV, days 14 and 42. ARA-C: 1000 mg/m2/12 h, IV, days 14-15 and 42-43. TIT days 1, 28 and 56. Ponatinib 30 mg/d PO, from day 1 to day 7 before HSCT".
HSCT (performed ideally within 1 month from the end of consolidation).
Post HSCT therapy (MRD monitoring) | - Prednisone
- Vincristine
- Daunorubicin
- Prednisone
- Ponatinib
- Mercaptopurine
- Methotrexate
- VP-16
- ARA-C:
- TIT
- Ponatinib
|
Eligibility Criteria
Inclusion Criteria:
- Age 18-55 yr.
- De novo Ph+ (BCR-ABL)ALL
- ECOG score ≤2 unless due to ALL
- Absence of significant liver disease, as defined by the following criteria: total
serum bilirubin ≤1.5 x upper limit of normal (ULN), unless due to Gilbert's syndrome,
alanine aminotransferase (ALT) ≤2.5 × ULN or ≤5 x ULN if leukemic involvement of the
liver is present, and aspartate aminotransferase (AST) ≤2.5 × ULN or ≤5 x ULN if
leukemic involvement of the liver is present.
- Adequate pancreatic function as defined by serum lipase and amylase ≤1.5 × ULN.
- No history of dyslipidemia, hypertension, thrombotic events or cardiac disease.
- For females of childbearing potential, a negative pregnancy test must be documented
prior to randomization. Female and male patients who are fertile must agree to use an
effective form of contraception with their sexual partners from randomization through
4 months after the end of treatment.
- informed consent signed, according to national regulation
- Patients aged between 56 and 60 years may be selected who could be included in the
study with the authorization of the Coordinating Investigator with the consolidation
treatment modified as follows:
Mercaptopurine (MP): 50 mg / m2, PO on days 1 to 7, 28 to 35 and 56 to 63 MTX: 0.75 g / m2,
IV (continuous infusion 24 h) on days 1, 28 and 56 ARA-C: 500 mg / m2 / 12 h, IV, days
14-15 and 42-43 TIT (MTX: 12 mg, ARA-C: 30 mg, hydrocortisone: 20 mg), days 1, 28 and 56
Ponatinib 30 mg / d PO, from day 1 to 7 days before HSCT
Exclusion Criteria:
- Lymphoid blast crisis of CML,
- WHO performance status ≤ 50% (Karnofsky) or ≥ 3 (ECOG).
- Active HBV or HCV hepatitis, or AST/ALT ≥ 2.5 x ULN and bilirubin ≥ 1.5 x ULN.
- History of acute pancreatitis within 1 year of study or history of chronic
pancreatitis.
- History of alcohol abuse.
- Ongoing or active infections.
- Uncontrolled hypertriglyceridemia (triglycerides >450 mg/dL).
- Clinically significant, uncontrolled or active cardiovascular disease, specifically
including, but not restricted to: Any history of myocardial infarction, stroke, or
revascularization, Unstable angina or transient ischemic attack within 6 months prior
to enrollment Congestive heart failure within 6 months prior to enrollment, or left
ventricular ejection fraction (LVEF) less than lower limit of normal per local
institutional standards History of clinically significant (as determined by the
treating physician) atrial arrhythmia Any history of ventricular arrhythmia Any
history of venous thromboembolism including deep venous thrombosis or pulmonary
embolism.
- Uncontrolled hypertension (diastolic blood pressure >90 mm Hg; systolic >140 mm Hg).
Patients with hypertension should be under treatment on study entry to effect blood
pressure control.
- Taking medications that are known to be associated with torsades de pointes.
- Taking any medications or herbal supplements that are known to be strong inhibitors of
CYP3A4 within at least 14 days before the first dose of ponatinib.
- Creatinine levels > 2.5mg/dl or glomerular filtration rate (GFR) < 20 ml/min or
proteinuria >3.5 g/day.
- Gastrointestinal (GI) function impairment, or a GI disease that may significantly
alter the absorption of study drugs.
- Patients who are currently receiving treatment with any of the medications with
potential to prolong QT interval (listed in Appendix 4) if the medications cannot be
either discontinued or switched to a different medication prior to starting study
drug.
- 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 and 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
Ponatinib). Postmenopausal 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
4 months following discontinuation of study drugs.
- 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
Maximum Eligible Age: | 55 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall response |
Time Frame: | 2 years |
Safety Issue: | |
Description: | To evaluate the response (complete hematologic response [CHR], complete cytogenetic response [CCyR], major molecular response [MMR] and complete molecular response [CMR] of the combination of ponatinib with standard chemotherapy (according to PETHEMA ALL Ph08 trial) in young patients with Ph+ (BCR-ABL) ALL. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | PETHEMA Foundation |
Last Updated
February 11, 2021