This is a single-arm phase II study that will enroll a minimum of 41 subjects with a maximum
of 51. All patients will have a confirmed diagnosis of chronic phase chronic myeloid Leukemia
and must have previously attempted to discontinue imatinib. All patients must be restarted on
imatinib at the time of relapse in order to be eligible for this trial.
This trial will use a combination of asciminib 40 mg by mouth (PO) twice daily (BID) plus
imatinib (maximum dose of 400 mg PO once daily) in the combination treatment phase. The
BCR-ABL tyrosine kinase inhibitor (TKI) that will be used for this trial is imatinib. All
eligible patients will begin asciminib in combination with imatinib on cycle 1 day 1 of the
combination phase. They will continue combination therapy for a total of 12 cycles (minimum
of 12 months). Each cycle will be ~28 days. At the end of 12 cycles asciminib will be
discontinued and any patient who has met the criteria for the treatment-free remission (TFR)
screening phase will enter into the TFR phase. Once in the TFR phase, patients will
discontinue their imatinib and be monitored off treatment. The primary endpoint of this study
is the 12-month "second" TFR rate after completion of 12 cycles of combination therapy.
Patients will remain in the TFR phase of the study for up to three years and will have
central polymerase chain reaction (PCR) testing during the first two years. Therefore, the
total duration of the subject participation trial will be approximately five years (one year
on combination treatment phase plus three years in the TFR phase plus one year of long-term
follow-up post TFR or early discontinuation.
Inclusion Criteria:
1. Age ≥18 years old.
2. Willing and able to give informed consent.
3. Diagnosed with CML in chronic phase and have either the b3a2 (e14a2) or b2a2 (e13a2)
variants that give rise to the p210 BCR-ABL protein. Subtype classification whether
b3a2 (e14a2) or b2a2 (e13a2) is not required for study eligibility.
4. Must have a documented history of attempting only one prior imatinib discontinuation
under the guidance of a treating physician.
5. Must have met all the following criteria prior to first attempt to discontinue their
imatinib:
- Stable molecular response (MR4; < 0.01% IS) for > 2 years, as documented on at
least four tests, performed at least three months apart (e.g. If a patient has
had >4 PCR tests performed during the two years leading up to their initial TKI
discontinuation, any value between 0.01 and 0.05% IS is considered a stable
result, however, at least four tests must be < 0.01% IS).
- Treatment with imatinib for a minimum of three years prior to discontinuing
imatinib.
6. Must have relapsed (defined as loss of major molecular response (MMR), real-time
quantitative polymerase chain reaction (RQ-PCR) for BCR-ABL >0.1% IS after first
attempted imatinib discontinuation.
7. After first failed TFR attempt, must have a minimum duration of one year of
retreatment with imatinib (up to 400mg PO QD), and must plan to remain on imatinib for
a minimum of 12 months during the combination treatment phase.
8. Eastern Cooperative Oncology Group (ECOG) performance status 0-3.
9. Must have a RQ-PCR for BCR-ABL < 0.0032% IS (MR4.5) reported by the trial designated
central lab at the time of study enrollment.
10. Female patients must meet one of the following:
- Postmenopausal for at least one year before the screening visit,
- Surgically sterile,
- If they are of childbearing potential, agree to practice two effective methods of
contraception from the time of signing of the informed consent form through 90
days after the last dose of study drug,
- Must also adhere to the guidelines of any treatment-specific pregnancy prevention
program, if applicable
- Agree to practice true abstinence when this is in line with the preferred and
usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation,
symptothermal, postovulation methods] and withdrawal are not acceptable
contraception methods.)
11. Male patients, even if surgically sterilized (i.e., status post vasectomy), must agree
to one of the following:
- Practice effective barrier contraception during the entire study treatment period
and through 90 days after the last study drug dose,
- Must also adhere to the guidelines of any treatment-specific pregnancy prevention
program, if applicable,
- Agree to practice true abstinence when this is in line with the preferred and
usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation,
symptothermal, postovulation methods] and withdrawal are not acceptable methods
of contraception.)
Exclusion Criteria:
A potential subject who meets any of the following exclusion criteria is ineligible to
participate in the study.
1. History of accelerated or blast phase CML.
2. A second malignancy requiring active treatment.
3. History of recent (within 12 months) acute pancreatitis or chronic pancreatitis
4. Subjects who have previously received treatment with asciminib.
5. Subjects with platelet (PLT) count < 100 × 109/L or an absolute neutrophil count (ANC)
of < 1 × 109/L or hemoglobin < 8 g/dL.
6. Aspartate aminotransferase (AST) and alanine transaminase (ALT) ≥3 times the
institutional upper limit of normal.
7. Creatinine ≥ 2 times the institutional upper limit of normal.
8. Total bilirubin ≥ 1.5 times the institutional upper limit of normal (unless direct
bilirubin is within normal limits).
9. Lipase > institutional upper limit of normal.
10. Pregnant or lactating.
11. Unable to comply with lab appointment schedule and patient-reported outcome (PRO)
assessments.
12. Another investigational drug within four weeks of enrollment.
13. Any serious medical or psychiatric illness that could, in the investigator's opinion,
interfere with the completion of treatment according to this protocol.
14. Patient has undergone a prior allogeneic stem cell transplant.
15. Screening 12-lead ECG showing a baseline corrected QT interval >480msec (patients with
a pacemaker will still be eligible with QTc>500msec).