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Protocol Number: HJKC3-0003. Treatment Free Remission After Combination Therapy With Asciminib (ABL001) Plus Imatinib in Chronic Phase Chronic Myeloid Leukemia (CP-CML) Patients Who Relapsed After a Prior Attempt at TKI Discontinuation

NCT04838041

Description:

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.

Related Conditions:
  • Chronic Myeloid Leukemia
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Protocol Number: HJKC3-0003. Treatment Free Remission After Combination Therapy With Asciminib (ABL001) Plus Imatinib in Chronic Phase Chronic Myeloid Leukemia (CP-CML) Patients Who Relapsed After a Prior Attempt at TKI Discontinuation
  • Official Title: Protocol Number: HJKC3-0003. Treatment Free Remission After Combination Therapy With Asciminib (ABL001) Plus Imatinib in Chronic Phase Chronic Myeloid Leukemia (CP-CML) Patients Who Relapsed After a Prior Attempt at TKI Discontinuation

Clinical Trial IDs

  • ORG STUDY ID: PRO00040685
  • NCT ID: NCT04838041

Conditions

  • Chronic Phase Chronic Myelogenous Leukemia

Interventions

DrugSynonymsArms
AsciminibABL001Combination Therapy and Remission Phase
ImatinibGleevec, GlivecCombination Therapy and Remission Phase

Purpose

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.

Detailed Description

      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.
    

Trial Arms

NameTypeDescriptionInterventions
Combination Therapy and Remission PhaseExperimentalAll eligible patients will begin a combination of asciminib plus imatinib cycle 1 day 1 in the combination treatment phase. They will continue combination therapy for a total of 12 cycles (minimum of 12 months). 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.
  • Asciminib
  • Imatinib

Eligibility Criteria

        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).
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:One-year "second" treatment-free remission.
Time Frame:1 years
Safety Issue:
Description:This will be measured by the number of subjects who achieve one-year treatment-free remission after 12 months of combination therapy with imatinib plus asciminib. These subjects have previously failed a first treatment free remission attempt.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Medical College of Wisconsin

Trial Keywords

  • chronic myelogenous leukemia
  • treatment-free remission
  • tyrosine kinase inhibitors
  • H. Jean Khoury Cure CML Consortium

Last Updated

August 20, 2021