NCT04475731进行中（未招募）2 期
Ponatinib for the Management of Minimal Residual Disease (MRD) and Hematologic Relapse in Adult Ph+ Acute Lymphoblastic Leukemia (Ph+ ALL) Patients
适应症
干预措施
相关药物
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 入组人数
- 67
- 试验地点
- 22
- 主要终点
- MRD negativity/reduction rate
研究概览
简要总结
This is a phase II interventional trial to evaluate if the use of ponatinib, with or without chemotherapy, can induce a molecular remission in MRD-positive patients, in patients in hematologic and extra-hematologic relapse and in the few patients who never achieved an hematologic remission after whatever prior treatment.
详细描述
This is a phase II interventional multicenter study for adult patients with Ph+ALL who:
- Are MRD+ (i.e. BCR-ABL1/ABL1 >0.01) (or loose their molecular response) after whichever kind of previous treatment. MRD positivity is indeed regarded as a relapse/resistance, since it represents the early recognition of cases who will eventually experience an hematologic recurrence of disease.
- Are in hematologic relapse after whichever kind of previous treatment.
- Have never achieved an hematologic remission at least after one month of treatment.
Patients will be treated with Ponatinib at a dose of 45 mg/die per os for 28 days for 3 cycles and - if in hematologic and extra-hematologic relapse/refractoriness, clinically fit and according to medical decision - with concurrent systemic chemotherapy. In case of CMR achievement, dosing will be reduced to 30 mg. In case of toxicity, Ponatinib will be reduced to 30 (or 15) mg daily.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Ph+ ALL patients with evidence of MRD disease or in hematologic and extra-hematologic relapse/refractoriness after any previous treatment, will be considered eligible to enter the study.
- •Age ≥18 years old with no upper age limit.
- •Adequate hepatic function as defined by the following criteria:
- •total serum bilirubin ≤1.5 x upper limit of normal (ULN), unless due to Gilbert's syndrome
- •alanine aminotransferase (ALT) ≤2.5 × ULN
- •aspartate aminotransferase (AST) ≤2.5 × ULN.
- •Adequate pancreatic function as defined by the following criterion:
- •serum lipase and amylase ≤1.5 × ULN.
- •For females of childbearing potential, a negative pregnancy test must be documented prior to enrollment.
- •Female and male patients who are fertile must agree to use an effective form of contraception with their sexual partners from enrollment through 4 months after the end of treatment.
- •Signed written informed consent according to ICH/EU/GCP and national local laws.
排除标准
- •WHO performance status ≤ 50% (Karnofsky) or ≥ 3 (ECOG).
- •Uncontrolled active HBV or HCV hepatitis, or AST/ALT ≥ 2.5 x ULN and bilirubine ≥ 1.5 x ULN not due to the disease.
- •History of acute pancreatitis within 1 year of study or history of chronic pancreatitis.
- •History of alcohol abuse.
- •Ongoing or active uncontrolled infections.
- •Uncontrolled hypertriglyceridemia (triglycerides >450 mg/dL).
- •Clinically significant, uncontrolled or active cardiovascular disease, specifically including, but not restricted to:
- •any history of myocardial infarction, stroke, or revascularization
- •unstable angina or transient ischemic attack within 6 months prior to enrollment
- •congestive heart failure within 6 months prior to enrollment, or left ventricular ejection fraction (LVEF) less than lower limit of normal per local institutional standards within 6 months prior to enrollment
- •history of clinically significant (as determined by the treating physician) atrial arrhythmia
- •any history of ventricular arrhythmia
- •any history of venous thromboembolism including deep venous thrombosis or pulmonary embolism
- •uncontrolled hypertension (diastolic blood pressure >90 mm Hg; systolic >140 mm Hg). Patients with hypertension should be under treatment on study entry to effect blood pressure control.
- •Taking medications that are known to be associated with Torsades de Pointes.
- •Taking any medications or herbal supplements that are known to be strong inhibitors of CYP3A4 within at least 14 days before the first dose of ponatinib.
- •Creatinine level >2.5mg/dl or glomerular filtration rate (GFR) <20 ml/min or proteinuria >3.5 g/day.
- •Patients who are currently receiving treatment with any of the medications listed in Appendix E if the medications cannot be either discontinued or switched to a different medication prior to starting study drug. The medications listed in Appendix E have the potential to prolong QT.
研究组 & 干预措施
Experimental arm
Experimental
MRD+ Ph+ ALL adult patients will receive Ponatinib x 4 weeks x 3 courses; +/-Concomitant chemotherapy (according to hematologic status).
Patients will receive the study drug until disease relapse or progression.
干预措施: Ponatinib (Drug)
结局指标
主要结局
MRD negativity/reduction rate
时间窗: After 3 months of treatment
Rate of patients who achieve a MRD negativity/MRD reduction following treatment with either Ponatinib alone or in combination with systemic chemotherapy
次要结局
- Duration of CMR(at 24 months)
- Hematologic remission rate(at 24 months)
- Best molecular response(at 24 months)
- Rate of AE/SAEs(at 24 months)
- Mutational analysis(at 24 months)
- Correlation between biological and MRD parameters(at 24 months)
- Disease free survival(24 months)
- Overall survival(24 months)
- Cumulative incidence of relapse(24 months)
- Role of hematological profile on survival outcome(at 24 months)
研究者
研究点 (22)
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