Description:
To evaluate efficacy, safety and pharmacokinetic profile of asciminib 40mg+imatinib or
asciminib 60mg+imatinib versus continued imatinib and versus nilotinib in pre-treated
patients with Chronic Myeloid Leukemia in chronic phase (CML-CP)
Title
- Brief Title: Study of Efficacy and Safety of Asciminib in Combination With Imatinib in Patients With Chronic Myeloid Leukemia in Chronic Phase (CML-CP)
- Official Title: A Phase 2, Multi-center, Open-label, Randomized Study of Oral Asciminib Added to Imatinib Versus Continued Imatinib Versus Switch to Nilotinib in Patients With CML-CP Who Have Been Previously Treated With Imatinib and Have Not Achieved Deep Molecular Response
Clinical Trial IDs
- ORG STUDY ID:
CABL001E2201
- SECONDARY ID:
2018-001594-24
- NCT ID:
NCT03578367
Conditions
- CML
- Chronic Myelogenous Leukemia
- Leukemia, Myeloid Chronic
- Hematologic Diseases
Interventions
Drug | Synonyms | Arms |
---|
Asciminib add-on | ABL001 (asciminib), STI571 (imatinib) | Asciminib 40mg QD + Imatinib 400mg QD |
Imatinib | STI571, continuation treatment | Imatinib 400mg QD |
Nilotinib | AMN107, switch to nilotinib treatment | Nilotinib 300mg BID |
Purpose
To evaluate efficacy, safety and pharmacokinetic profile of asciminib 40mg+imatinib or
asciminib 60mg+imatinib versus continued imatinib and versus nilotinib in pre-treated
patients with Chronic Myeloid Leukemia in chronic phase (CML-CP)
Detailed Description
The study is a Phase 2, multi-center, open-label, randomized study of asciminib in two
different doses (40 mg or 60 mg) in combination with imatinib 400 mg versus continued
imatinib versus switch to nilotinib in subjects with chronic myeloid leukemia in chronic
phase (CML-CP) who have been previously treated with imatinib first line therapy for at least
one year and have not achieved deep molecular response (DMR). The eligible subjects will be
randomized 1:1:1:1 to receive asciminib 60 mg QD as add-on therapy to imatinib 400 mg QD, or
40 mg QD as add-on therapy to imatinib 400 mg QD, or to continue imatinib 400 mg QD, or to
switch to nilotinib 300 mg twice a day (BID).
Subjects on the study will continue on the allocated treatment until treatment failure,
intolerability, or for up to 96 weeks after the last randomized subject received the first
dose of treatment (the end of treatment (EOT) will be the same day for all the ongoing
subjects). After the last dose received, every subject will be followed up for safety for 30
days.
An interim analysis will be performed when at least 40 (50%) patients have been randomized
and have been followed for their 24 weeks visit assessment or have discontinued treatment. At
the time of the interim analysis, if excessive toxicity without added benefit is observed in
one of the investigational arms, discontinuation of that treatment arm will be considered.
The decision to discontinue an investigational arm in the study will be taken based on the
risk benefit balance of the two investigational arms, and in context of the other two
treatment options available for the patients in the study, namely: continue on imatinib with
no potential improvement of efficacy; or switch to nilotonib with a potential to improve
efficacy however, with a relatively adverse safety profile as compared to imatinib. If a
decision is taken to discontinue asciminib 60 mg + imatinib treatment arm at interim
analysis, subjects ongoing on that treatment arm will be provided an opportunity to continue
on the study at a lower dose (asciminib 40 mg + imatinib) if the investigator considers that
is in the best interest of the patient.
Subjects on the imatinib continuation arm who have not achieved MR4.5 at 48 weeks may
cross-over (CO) to receive the add-on treatment within 4 weeks after week 48 visit. It is
planned that these subjects cross-over to receive the asciminib 60 mg combination add-on
treatment, as this dose provides higher exposure. Based on the results of the interim
analysis or emerging data, cross-over may be changed to the asciminib 40 mg add-on treatment.
The cross-over is at the discretion of the investigator and the patient. Apart from a
polymerase chain reaction (PCR) result of below MR4.5 at Week 48 visit, there are no other
entry criteria for the cross-over part. Subjects on nilotinib are not allowed to cross- over
to receive the add-on treatment.
Trial Arms
Name | Type | Description | Interventions |
---|
Asciminib 60mg QD + Imatinib 400mg QD | Experimental | Asciminib 60 mg taken once daily in combination with Imatinib 400 mg taken once daily | |
Asciminib 40mg QD + Imatinib 400mg QD | Experimental | Asciminib 40 mg taken once daily in combination with Imatinib 400 mg taken once daily | |
Imatinib 400mg QD | Active Comparator | Imatinib 400 mg taken once daily | |
Nilotinib 300mg BID | Active Comparator | Nilotinib 300 mg taken twice daily | |
Eligibility Criteria
Inclusion Criteria:
1. Male or female patients ≥ 18 years of age with a confirmed diagnosis of Chronic
Myeloid Leukemia in chronic phase (CML-CP).
2. Minimum of one year (12 calendar months) treatment with imatinib first line for CML-CP
(patients have to be on imatinib 400 mg QD at randomization and had no dose change in
the past three months).
For Korea only: (i)a minimum of one year (12 calendar months) of prior treatment with
imatinib for patients with BCR-ABL levels > 0.1%, ≤ 1% IS at the time of
randomization. (ii) a minimum of two years (24 calendar months) of prior treatment
with imatinib for patients with BCR-ABL levels > 0.01%, ≤ 0.1% IS at the time of
randomization.
3. BCR-ABL1 levels > 0.01% IS (International Scale) and ≤ 1% IS at the time of
randomization as confirmed with a central assessment at screening; patients must not
have achieved deep molecular response (MR4 IS) confirmed by 2 consecutive tests at any
time during prior imatinib treatment. An isolated, single test result with BCR-ABL1
levels < 0.01 % (MR4 IS) is allowed, however, it should not have been observed within
the 9 months prior to randomization
4. Patient must meet the following laboratory values before randomization:
- Absolute Neutrophil Count ≥ 1.5 x 10E9/L
- Platelets ≥ 75 x 10E9/L
- Hemoglobin ≥ 9 g/dL
- Serum creatinine < 1.5 mg/dL
- Total bilirubin ≤ 1.5 x ULN (Upper Limit of Normal) except for patients with
Gilbert's syndrome who may only be included with total bilirubin ≤ 3.0 x ULN
- Aspartate transaminase (AST) ≤ 3.0 x ULN
- Alanine transaminase (ALT) ≤ 3.0 x ULN
- Alkaline phosphatase ≤ 2.5 x ULN
- Serum lipase ≤ 1.5 x ULN
5. Patients must have the following laboratory values ≥ Lower Limit of Normal or
corrected to within normal limits with supplements prior to randomization: potassium
increase of up to 6.0 mmol/L is acceptable if associated with creatinine clearance
within normal limits ; calcium increase of up to 12.5 mg/dl or 3.1 mmol/L is
acceptable if associated with creatinine clearance* within normal limits) ; magnesium
increase up to 3.0 mg/dL or 1.23 mmol/L if associated with creatinine clearance within
normal limits.
Key Exclusion Criteria:
1. Treatment failure according to European Leukemia Network (ELN) criteria 2013 during
imatinib treatment.
2. Known second chronic phase of CML after previous progression to Accelerated Phase
(AP)/Blast Crisis (BC).
3. Previous treatment with any tyrosine kinese inhibitors (TKIs) other than imatinib.
4. History or current diagnosis of ECG abnormalities indicating significant risk or
safety for subjects participating in the study such as:
- History of myocardial infarction, angina pectoris, coronary artery bypass graft
within 6 months prior to randomization
- Concomitant clinically significant arrhythmias
- Resting QTcF ≥ 450 msec (male) or ≥ 460 msec (female) prior to randomization
- Long QT syndrome, family history of idiopathic sudden death or congenital long QT
syndrome, or any of the following:
- Risk factors for Torsades de Pointes
- Concomitant medications with a "known" risk of Torsades de Pointes
- inability to determine the QTcF interval
5. Severe and/or uncontrolled concurrent medical disease that in the opinion of the
investigator could cause unacceptable safety risks or compromise compliance with the
protocol (e.g. uncontrolled diabetes, active or uncontrolled infection, uncontrolled
clinically significant hyperlipidemia and high serum amylase)
6. History of acute pancreatitis within 1 year prior to randomization or medical history
of chronic pancreatitis; on-going acute liver disease or history of chronic liver
disease
7. History of other active malignancy within 3 years prior to randomization with the
exception of basal cell skin cancer, indolent prostate cancer and carcinoma in situ
treated curatively.
Other protocol defined inclusion/exclusion may apply.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Molecular Response (MR)^4.5 rate between asciminib+imatinib and imatinib alone |
Time Frame: | at 48 weeks |
Safety Issue: | |
Description: | Proportion of subjects still treated with the randomized treatment at 48 weeks and are in MR4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 48 weeks (± assessment window), among all subjects randomized to the respective treatment arm. |
Secondary Outcome Measures
Measure: | MR^4.5 rate at 48 weeks |
Time Frame: | at 48 weeks |
Safety Issue: | |
Description: | Difference in the proportion of subjects with MR^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 48 weeks between asciminib+imatinib and nilotinib |
Measure: | Rate of MR^4.5 at 96 weeks |
Time Frame: | at 96 weeks |
Safety Issue: | |
Description: | Proportion of subjects with MR^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 96 weeks |
Measure: | Rate of MR^4.5 by 48 and 96 weeks |
Time Frame: | by 48 weeks and 96 weeks |
Safety Issue: | |
Description: | Best observed rate of MR^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) under randomized treatment up to the specific time point |
Measure: | Sustained MR^4.5 from 48 weeks until 96 weeks |
Time Frame: | from 48 weeks until 96 weeks |
Safety Issue: | |
Description: | Percentage of participants who are in MR^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at both 48 and 96 weeks and who have no loss of MR^4.5 in between those two time points. This endpoint will be analyzed at 96 weeks. |
Measure: | Time to MR^4.5 |
Time Frame: | up to 96 weeks |
Safety Issue: | |
Description: | Time to MR^4.5 is the time from randomization to first MR^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) computed only for subjects who achieved MR^4.5 |
Measure: | Difference in rate of MR^4.5 at 48 weeks |
Time Frame: | at 48 weeks |
Safety Issue: | |
Description: | Difference in the proportion of subjects with MR^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 48 weeks between asciminib+imatinib and nilotinib |
Measure: | Pharmacokinetic profile of asciminib and imatinib when administered in combination - Cmax |
Time Frame: | up to Week 4 Day 28 |
Safety Issue: | |
Description: | The maximum (peak) observed drug concentration after dose administration |
Measure: | Pharmacokinetic profile of asciminib and imatinib when administered in combination - Tmax |
Time Frame: | up to Week 4 Day 28 |
Safety Issue: | |
Description: | The time to reach maximum (peak) drug concentration after dose administration |
Measure: | Pharmacokinetic profile of asciminib and imatinib when administered in combination - Cmin |
Time Frame: | up to 96 weeks |
Safety Issue: | |
Description: | Minimum drug concentration |
Measure: | Pharmacokinetic profile of asciminib and imatinib when administered in combination - AUClast |
Time Frame: | up to Week 4 Day 28 |
Safety Issue: | |
Description: | The AUC from time zero to the last measurable concentration sampling time (Tlast) |
Measure: | Pharmacokinetic profile of asciminib and imatinib when administered in combination - AUCtau |
Time Frame: | up to Week 4 Day 28 |
Safety Issue: | |
Description: | The AUC calculated to the end of a dosing interval (tau) at steady-state |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Novartis Pharmaceuticals |
Trial Keywords
- CML
- Chronic Myelogenous Leukemia
- leukemia, myeloid chronic
- Hematologic Diseases
- Asciminib
- ABL001
- Imatinib
- Nilotinib
- deep molecular response
- DMR
- Ph+ CML
- chronic phase
- cancer of the white blood cells
- tyrosine kinase inhibitor
- leukemia, myeloid
- leukemia
Last Updated
July 20, 2021