Description:
Adult male and female patients with newly diagnosed Philadelphia chromosome positive (Ph+)
and/or BCR-ABL1 positive CML can be included in the study until 3 months after diagnosis. A
<4 week pretreatment with hydroxyurea is permitted. Patients treated for <6 weeks with
nilotinib 300 mg BID, imatinib 400 mg QD, or dasatinib 100 mg QD are eligible for recruitment
and will be allocated to the respective cohort. All patients must provide written informed
consent to be enrolled in the trial. Cohorts were designed to allow assessment of QD and BID
asciminib based combinations to optimize quality of life and compliance. Patients will not be
randomized. In general, cohorts will be filled consecutively. Asciminib therapy will be
commenced 12 weeks after start of nilotinib, imatinib or dasatinib and after recovery of
hematopoiesis. Referred patients already treated with imatinib, nilotinib or dasatinib will
remain on the initial drug and will be allocated to the respective cohort.
Title
- Brief Title: Frontline Asciminib Combination in Chronic Phase CML
- Official Title: Frontline Asciminib Combination in Chronic Phase CML
Clinical Trial IDs
- ORG STUDY ID:
Fascination
- SECONDARY ID:
2018-002256-33
- NCT ID:
NCT03906292
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Imatinib | Imatinib 400 mg QD and asciminib 60 mg QD | Asciminib 60mg QD |
Nilotinib 300 mg | Nilotinib 300 mg BID and asciminib 20 mg BID or 40 mg QD | Asciminb 20 mg BID |
Dasatinib | Dasatinib 100 mg QD and asciminib 80 mg QD | Asciminib 80 mg QD |
Asciminib | | Asciminb 20 mg BID |
Purpose
Adult male and female patients with newly diagnosed Philadelphia chromosome positive (Ph+)
and/or BCR-ABL1 positive CML can be included in the study until 3 months after diagnosis. A
<4 week pretreatment with hydroxyurea is permitted. Patients treated for <6 weeks with
nilotinib 300 mg BID, imatinib 400 mg QD, or dasatinib 100 mg QD are eligible for recruitment
and will be allocated to the respective cohort. All patients must provide written informed
consent to be enrolled in the trial. Cohorts were designed to allow assessment of QD and BID
asciminib based combinations to optimize quality of life and compliance. Patients will not be
randomized. In general, cohorts will be filled consecutively. Asciminib therapy will be
commenced 12 weeks after start of nilotinib, imatinib or dasatinib and after recovery of
hematopoiesis. Referred patients already treated with imatinib, nilotinib or dasatinib will
remain on the initial drug and will be allocated to the respective cohort.
Detailed Description
Despite the dramatic progress made over the past decade with TKIs in the treatment of CML,
allogeneic stem cell transplant remains the only proven curative therapy. To achieve cure or
benefit from treatment-free remissions with pharmacologically-based therapies, it is
estimated that patients will likely need to achieve a sustained reduction in tumor burden
corresponding to a deep molecular response of at least 4 logs (MR4). Currently, only 30.8% of
patients achieve a deep molecular response after 12 months of treatment with single agent
nilotinib.
The development of the novel and potent BCR-ABL1 allosteric inhibitor, asciminib, presents an
opportunity to assess the effect of a different mechanism of inhibition of BCR-ABL1 in the
first-line treatment of CML to enhance speed of response and to increase the patient
population benefitting from deep molecular response. Dosing a combination of asciminib with
an ATP-site inhibitor also has the potential to prevent the emergence of resistance due to
point mutations being acquired in one of the binding sites.
The safety, tolerability and pharmacokinetic profile of asciminib as a single agent and in
combination with either nilotinib or imatinib or dasatinib was assessed in a phase-I study.
At the doses chosen here, all three combination treatments were well tolerated.
Since in all patient cohorts the standard of care therapy will remain the backbone of initial
therapy, there is no reason to expect an efficacy problem with the combination therapies.
Trial Arms
Name | Type | Description | Interventions |
---|
Asciminib 60mg QD | Experimental | Standard therapy of Imatinib 400 mg QD and asciminib 60 mg QD | |
Asciminb 20 mg BID | Experimental | Standard therapy of Nilotinib 300 mg BID and asciminib 20 mg BID | - Nilotinib 300 mg
- Asciminib
|
Asciminib 40 mg QD | Experimental | Standard therapy of Nilotinib 300 mg BID and asciminib 40 mg QD | - Nilotinib 300 mg
- Asciminib
|
Asciminib 80 mg QD | Experimental | Standard therapy of Dasatinib 100 mg QD and asciminib 80 mg QD | |
Eligibility Criteria
Inclusion Criteria:
- Male or female patients with diagnosis of CP-CML with cytogenetic confirmation of the
Ph+ chromosome [t(9;22)(q34;q11)].
- Ph-negative cases or patients with variant translocations who are BCR-ABL1 positive in
multiplex PCR 35 will be also considered eligible.
- ECOG performance status of ≤2.
- Age ≥ 18 years old (no upper age limit is given)
- Serum levels of potassium, magnesium, total calcium within the normal limits (≥LLN
[lower limit of normal] and ≤ULN [upper limit of normal]). Correction of electrolytes
levels with supplements to fulfil enrolment criteria is allowed.
- AST and ALT ≤2.5 x ULN or 5.0 x ULN if considered due to leukemia
- Alkaline phosphatase ≤2.5 x ULN unless considered due to leukemia
- Total bilirubin ≤1.5 x ULN, except known Gilbert disease
- Serum creatinine ≤2 x ULN
- Written informed consent prior to any study procedures being performed.
Exclusion Criteria:
- Allogeneic stem cell transplantation
- Known impaired cardiac function, including any of the following:
- Congenital long QT syndrome
- History of or presence of clinically significant ventricular or atrial
tachyarrhythmia
- QTc >450 msec on screening ECG
- Myocardial infarction within 12 months prior to starting therapy
- Other clinical significant heart disease (e.g. unstable angina, congestive heart
failure)
- Acute or chronic viral hepatitis with moderate or severe hepatic impairment
(Child-Pugh scores >6), even if controlled
- Other concurrent uncontrolled medical conditions (e.g., active or uncontrolled
infections, acute or chronic liver and renal disease) that could cause unacceptable
safety risks or compromise compliance with the protocol
- Impaired gastrointestinal function or disease that may alter the absorption of study
drug (e.g., ulcerative disease, uncontrolled nausea, vomiting and diarrhea,
malabsorption syndrome, small bowel resection or gastric by-pass surgery)
- Concomitant medications known to be strong inducers or inhibitors of the CYP450
isoenzyme CYP3A4
- 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 breastfeeding or women of reproductive potential not
employing an effective method of birth control. Women of childbearing potential must
have a negative serum pregnancy test within 14 days of study start. Post-menopausal
women must be amenorrheic for at least 12 months in order to be considered of
non-childbearing potential. Male and female patients must agree to employ an effective
method of birth control throughout the study and for up to 2 weeks following
discontinuation of study drug
- Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not
mandatory)
- Known serious hypersensitivity reactions to asciminib, imatinib, nilotinib or
dasatinib
- 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: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | deep molecular response (Rate of MR4) |
Time Frame: | at month 12 after Start of Standard-Therapy |
Safety Issue: | |
Description: | Achievement of deep molecular response (MR4) throught standardized testing of BCR-ABL-transcript Levels |
Secondary Outcome Measures
Measure: | molecular response (MMR and MR4.5) |
Time Frame: | at and by 6, 12, 18, 24, 36 and 60 months after Start of Therapy |
Safety Issue: | |
Description: | Achievement of deep molecular response throught standardized testing of BCR-ABL-transcript levels |
Measure: | Adverse Events |
Time Frame: | at and by baseline, 3, 6, 12, 15, 18, 21, 24, 36 and 60 months after Start of Therapy |
Safety Issue: | |
Description: | Incidence of adverse events grade 1-5 and 3-5 |
Measure: | Progression free survival |
Time Frame: | at month 60 after Start of Therapy |
Safety Issue: | |
Description: | Progression free survival at the end of the study |
Measure: | Overall survival |
Time Frame: | at month 60 after Start of Therapy |
Safety Issue: | |
Description: | Overall survival at the end of the study |
Measure: | Maintenance of MR4.5 during Asciminib-monotherapy |
Time Frame: | at month 36 and 60 after Start of Therapy |
Safety Issue: | |
Description: | Achievement of deep molecular response (MR4.5) throught standardized testing of BCR-ABL-transcript Levels |
Measure: | Achievement and durability of treatment-free remission |
Time Frame: | months 37 and 60 after Start of Therapy |
Safety Issue: | |
Description: | Achievement of deep molecular response (MR4) throught standardized testing of BCR-ABL-transcript Levels |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | University of Jena |
Last Updated
August 18, 2021