Description:
This study will include patients suffering from chronic myeloid leukemia (CP-CML), who were
treated with tyrosine kinase inhibitor (TKI, a substance that blocks the action of enzymes)
in a previous therapy but which has not been effective. Patients will be treated with
Ponatinib 30 mg in in this study. The aim of the study is to evaluate the safety and efficacy
of Ponatinib as a second line treatment in patients failing or not tolerating first line
therapy with any other approved TKIs. It is expected that Ponatinib, due to its efficacy, may
be more effective as second line therapy than other approved TKIs and lead to improved
overall survival. The effect will be determined by the molecular response rate (MMR) as the
primary objective after 12 months of treatment. The safety of the drug will be evaluated on
the basis if routine medical and laboratory examinations.
Title
- Brief Title: Study in Patients With Chronic Leukemia, Where Previous Therapy Failed, and Who Will be Treated With Ponatinib as Second Line Therapy
- Official Title: Phase 2 Clinical Trial With Ponatinib as a Second Line Therapy for Patients With Chronic Myeloid Leukemia in Chronic Phase Resistant or Intolerant to Prior First Line Tyrosine Kinase Inhibitor Treatment
Clinical Trial IDs
- ORG STUDY ID:
PONS_11272
- NCT ID:
NCT03807479
Conditions
- Leukemia, Myeloid, Chronic-Phase
Interventions
Drug | Synonyms | Arms |
---|
Ponatinib | Iclusig | Ponatinib |
Purpose
This study will include patients suffering from chronic myeloid leukemia (CP-CML), who were
treated with tyrosine kinase inhibitor (TKI, a substance that blocks the action of enzymes)
in a previous therapy but which has not been effective. Patients will be treated with
Ponatinib 30 mg in in this study. The aim of the study is to evaluate the safety and efficacy
of Ponatinib as a second line treatment in patients failing or not tolerating first line
therapy with any other approved TKIs. It is expected that Ponatinib, due to its efficacy, may
be more effective as second line therapy than other approved TKIs and lead to improved
overall survival. The effect will be determined by the molecular response rate (MMR) as the
primary objective after 12 months of treatment. The safety of the drug will be evaluated on
the basis if routine medical and laboratory examinations.
Detailed Description
Despite significant progress in the treatment of patients with chronic phase CML, there is
still need to further optimize therapy to reach the goal of disease eradication for almost
all patients. In case of imatinib failure, dasatinib and nilotinib are effective treatment
options after an individualized treatment selection. Although MMR rates of around 30% after 2
years of therapy are a significant achievement, options that may improve response rates in
depth are still desirable. Ponatinib is a third generation TKI with very high anti-clonal
activity in all CML phases. Moreover, it also eradicates most of the known and problematic
mutations and only very few (compound) mutations may induce ponatinib-resistance.
Based on its favourable target spectrum, it is expected that Ponatinib may be more effective
than 2nd line dasatinib or nilotinib in achieving early (i.e., at 6 months) cytogenetic and
molecular responses in patients after inappropriate response to imatinib, and more effective
as 2nd line treatment after failure of initial treatment with dasatinib or nilotinib than a
cross-over between the 2nd generation TKIs. The basic hypothesis underlying therapeutic
programs in CML is to be able to achieve meaningful and long-lasting suppression of the
Philadelphia chromosome and breakpoint cluster region-abelson fusion gen (BCR-ABL). Complete
cytogenetic responses have been associated with improved survival in CML, while major
molecular responses are associated with improved event-free survival.
Trial Arms
Name | Type | Description | Interventions |
---|
Ponatinib | Experimental | Patients in this treatment arm receive Ponatinib: starting dose 30 mg once-daily. Doses may be increased in case of inappropriate response and reduced to manage drug-related adverse events (AEs) and may be re-escalated once events resolve. | |
Eligibility Criteria
Inclusion Criteria:
1. Male or female patients ≥18 years old
2. Diagnosis of Ph-positive (by cytogenetics) or BCR-ABL-positive (by PCR) CP-CML
3. Patients should have demonstrated to have
- a failure of a prior 1st line TKI treatment with either imatinib, dasatinib or
nilotinib. Failure is defined as per European LeukemiaNet (ELN) recommendations:
- Less than Complete Hematologic Response (CHR) and/or Ph+ > 95% at or beyond
3 months
- No cytogenetic response (Ph+>35%) and/or Abelson murine leukemia viral
oncogene homolog 1 (BCR-ABL1) >10% at or beyond 6 months
- BCR-ABL (on international scale) >1% and/or PH+ >0%
- Less than MMR at or beyond 18 months
- Loss of response or development of mutations or other clonal chromosomal
abnormalities at any time during the first line TKI treatment
- or intolerance to prior TKI treatment defined as grade 3 or 4 toxicity, or
persistent grade 2 toxicity despite optimal management including dose adjustment,
or in a patient where dose reductions are considered to be not in the patient's
best interest to obtain an adequate response. Intolerant patients should not have
achieved or have lost major molecular response at the time of enrollment
4. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
Exclusion Criteria:
1. Any 1st line anti-CML treatment other than TKI (apart from therapy with hydroxyurea)
2. Any 2nd line therapy with a tyrosine kinase inhibitor (>1 European Medicines Agency
(EMA) approved TKI for CML, or any investigational non EMA-approved TKI)
3. Concurrent participation in any other clinical trial involving another investigational
drug within 4 weeks prior to enrollment and throughout participation in PONS-Study
4. New York Heart Association (NYHA) cardiac class 3-4 heart disease
5. Cardiac Symptoms within the past 12 months prior recruitment
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Major Molecular Response (MMR) of treatment |
Time Frame: | by 12 moths |
Safety Issue: | |
Description: | To estimate the proportion of CP-CML patients with tyrosine kinase inhibitor (TKI)-resistance or intolerance to first line therapy with TKI, attaining MMR by 12 months of treatment with second line Ponatinib therapy. |
Secondary Outcome Measures
Measure: | Time to toxicity |
Time Frame: | up to 24 months |
Safety Issue: | |
Description: | To evaluate the toxicity profile of ponatinib in patients with CML in chronic phase after one TKI failure toxicities will be followed up at each visit during the treatment phase and will be assessed using CTCAE v.5.0. Type of toxicity (hematologic or non-hematologic) along with the grading will be followed up on. |
Measure: | Time to response |
Time Frame: | at 3, 6, 9, 12, 18 and 24 months |
Safety Issue: | |
Description: | To estimate the time to CCyR, MMR, MCyR and MR4 for patients treated with Ponatinib as second line therapy for CP-CML (chronic phase-chronic myelogenous leukemia). |
Measure: | Durations of response |
Time Frame: | at 3, 6, 9, 12, 18 and 24 month |
Safety Issue: | |
Description: | To evaluate the duration of hematologic, cytogenetic and molecular response to Ponatinib after one TKI failure. |
Measure: | Occurrence of BCR-ABL-mutations |
Time Frame: | at 3, 6, 9, 12, 18 and 24 months |
Safety Issue: | |
Description: | To evaluate the occurrence of BCR-ABL-mutations in patients with failure of Ponatinib 2nd line therapy. |
Measure: | Time to progression |
Time Frame: | at 3, 6, 9, 12, 18 and 24 months |
Safety Issue: | |
Description: | To define the time to progression for patients with CML in chronic phase treated with Ponatinib after one TKI failure. |
Measure: | Time to overall survival |
Time Frame: | at 3, 6, 9, 12, 18 and 24 month |
Safety Issue: | |
Description: | To define the time to overall survival for patients with CML in chronic phase treated with Ponatinib after one TKI failure. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | GWT-TUD GmbH |
Trial Keywords
- CP-CML
- CML in chronic phase
- Chronic Myelogenous Leukemia
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Last Updated
May 5, 2021