Study of Efficacy and Safety of Asciminib in Combination With Imatinib in Patients With Chronic Myeloid Leukemia in Chronic Phase (CML-CP)
- Conditions
- CMLLeukemia, Myeloid ChronicHematologic DiseasesChronic Myelogenous Leukemia
- Interventions
- Registration Number
- NCT03578367
- Lead Sponsor
- Novartis Pharmaceuticals
- Brief Summary
To evaluate efficacy, safety and pharmacokinetic profile of asciminib 40mg+imatinib or asciminib 60mg+imatinib versus continued imatinib and versus nilotinib versus asciminib 80mg 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 Participants 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). Eligible participants were randomized 1:1:1:1 to receive asciminib 60 mg once daily (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).
Participants on the imatinib continuation arm who had not achieved MR4.5 at 48 weeks were allowed to cross-over (CO) to receive the add-on treatment within 4 weeks after week 48 visit to receive the asciminib 60 mg combination add-on treatment, as this dose provided higher exposure. The cross-over is at the discretion of the investigator and the participant. 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. Participants on nilotinib are not allowed to cross- over to receive the add-on treatment.
Participants on the study will continue on the allocated treatment until treatment failure, intolerability, or for up to 96 weeks (in arms 1 to 4) after the last participant received the first dose of treatment. After the last dose received, every participant will be followed up for safety for 30 days.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 104
- Male or female patients ≥ 18 years of age with a confirmed diagnosis of Chronic Myeloid Leukemia in chronic phase (CML-CP).
- Minimum of one year (12 calendar months) treatment with imatinib first line for CML-CP (patients have to be on imatinib 300mg or 400 mg QD at randomization
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.
- 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
- 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
- Participantss 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
-
Treatment failure according to European Leukemia Network (ELN) criteria 2013 during imatinib treatment.
-
Known second chronic phase of CML after previous progression to Accelerated Phase (AP)/Blast Crisis (BC).
-
Previous treatment with any tyrosine kinese inhibitors (TKIs) other than imatinib.
-
History or current diagnosis of ECG abnormalities indicating significant risk or safety for participants 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.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Asciminib 60mg QD + Imatinib 400mg QD Asciminib add-on Asciminib 60 mg taken once daily in combination with Imatinib 400 mg taken once daily Asciminib 60mg QD + Imatinib 400mg QD Imatinib Asciminib 60 mg taken once daily in combination with Imatinib 400 mg taken once daily Asciminib 40mg QD + Imatinib 400mg QD Asciminib add-on Asciminib 40 mg taken once daily in combination with Imatinib 400 mg taken once daily Asciminib 40mg QD + Imatinib 400mg QD Imatinib Asciminib 40 mg taken once daily in combination with Imatinib 400 mg taken once daily Imatinib 400mg QD Imatinib Imatinib 400 mg taken once daily Nilotinib 300mg BID Nilotinib Nilotinib 300 mg taken twice daily
- Primary Outcome Measures
Name Time Method Molecular Response (MR)^4.5 Rate at 48 Weeks at Week 48 Percentage of participants 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 participants in the asciminib add-on arms vs imatinib arm.
- Secondary Outcome Measures
Name Time Method Rate of MR^4.5 at 48 Weeks at Week 48 Percentage of participants in MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 48 weeks in asciminib add-on arms vs nilotinib arm.
Rate of MR^4.5 by 48 Weeks by 48 weeks Best observed MR4.5 rate up to 48 weeks. This includes the percentage of participants who achieved MR 4.5 anytime up to 48 weeks.
Rate of MR^4.5 at 96 Weeks at 96 weeks Percentage of participants with MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 96 weeks
Rate of MR^4.5 by 96 Weeks by 96 weeks Best observed MR4.5 rate up to 96 weeks
Sustained MR^4.5 From 48 Weeks Until 96 Weeks at 96 weeks Percentage of participants who are in MR\^4.5 at 48 weeks and 96 weeks and who have no loss of MR\^4.5 in between those 2 time points.
Time to MR^4.5 96/48 weeks after the last rand./enrolled (asciminib 80mg cohort) participant received the first study dose Time to MR\^4.5 is the time from first dose to first MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) computed only for participants who achieved MR\^4.5.
Duration of MR^4.5 96/48 weeks after the last rand./enrolled (asciminib 80mg cohort) participant received the first study dose Time from first MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) until loss of MR\^4.5.
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - Cmax up to 96 weeks The maximum (peak) observed drug concentration after dose administration
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - Tmax up to 96 weeks The time to reach maximum (peak) drug concentration after dose administration
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - Cmin up to 96 weeks Minimum drug concentration
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - AUClast up to 96 weeks The AUC from time zero to the last measurable concentration sampling time (Tlast)
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - AUCtau up to 96 weeks The AUC calculated to the end of a dosing interval (tau) at steady-state
MR^4.5 Rate at 48 Weeks at 48 weeks The percentage of participants on asciminib 80mg QD with MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 48 weeks
Pharmacokinetic Profile of Asciminib 80mg QD - Cmax up to 48 weeks The maximum (peak) observed drug concentration after dose administration
Pharmacokinetic Profile of Asciminib 80mg QD - Tmax up to 48 weeks The time to reach maximum (peak) drug concentration after dose administration
Pharmacokinetic Profile of Asciminib 80mg QD - Cmin up to 48 weeks Minimum drug concentration
Pharmacokinetic Profile of Asciminib 80mg QD - AUClast up to 48 weeks The AUC from time zero to the last measurable concentration sampling time (Tlast)
Pharmacokinetic Profile of Asciminib 80mg QD - AUCtau up to 48 weeks The AUC calculated to the end of a dosing interval (tau) at steady-state
Trial Locations
- Locations (3)
Georgia Regents University
🇺🇸Augusta, Georgia, United States
Sidney Kimmel Comprehensive Cancer Center
🇺🇸Baltimore, Maryland, United States
Novartis Investigative Site
🇬🇧Oxford, United Kingdom