Genomics Study in CML Patients With Ponatinib Treatment

Completed

• Conditions: Chronic Myelogenous Leukemia, BCR-ABL1 Positive
• Interventions: Drug: Ponatinib

• Registration Number: NCT06945146
• Lead Sponsor: Dong-Wook Kim

Brief Summary

This study will evaluate whether responsiveness and adverse events (AEs) to second-line or later ponatinib treatment are associated with genetic variations as measured by real-time quantitative polymerase chain reaction (qRT-PCR) and next-generation sequencing (NGS) in patients with CML of any stage who failed prior multiple targeted therapies except ponatinib.

Detailed Description

Ponatinib treatment will be initiated per usual treatment procedure at 45 mg once daily p.o., which will be gradually decreased to 30 mg and 15 mg according to the predefined criteria based on responsiveness to treatment and AEs in the course of the treatment. A total of 100 subjects will be enrolled within 24 months after the first subject enrollment, and ponatinib treatment will continue for 24 months after the initial dosing of ponatinib in each enrolled subject. Routine ponatinib treatment will continue at the investigator's discretion until disease progression, the occurrence of unacceptable toxicity, subject's withdrawal of consent, or occurrence of any reason for discontinuation specified in the protocol.

All molecular analysis samples will be collected, transferred, and managed by the Catholic Leukemia Research Institute, and NGS will be performed.

\<Eligibility\>

1. Adults with BCR-ABL1-positive CML

2. Subjects who were resistant or intolerant to prior targeted therapy other than ponatinib and with an indication for ponatinib treatment according to the acceptance criteria by the Ministry of Food and Drug Safety (MFDS)

3. Women of childbearing potential (WOCBP) should have a negative serum or urine pregnancy test (with a sensitivity of at least 25 IU/L or equivalent to HCG) within 24 hours before initiating ponatinib treatment

4. Written informed consent to ponatinib treatment

\<Outcome Measures\>

1. Primary endpoint

- 24 months dynamics of BCR-ABL1 gene expression by qRT-PCR

2. Secondary endpoints

* Type and frequency of novel genetic variations (mutations, gene expressions, CNV, INDEL, etc.)

* Cobll1/GCA/novel gene network identification: functional tests using Western blot/Knock-down assay

3. Safety endpoints : To explore the dynamics of adverse events according to dose changes up to 24 months

* Frequency and severity of skin rash, fever, hypertension, pancreatitis and vascular events as common adverse events

* Frequency and severity of rare adverse events

* Treatment intolerance is defined as recurrence of a Grade ≥3 hematologic AE, or a Grade ≥2 non-hematologic AE requiring permanent discontinuation of ponatinib per protocol despite dose reduction

Study Timeline

• Study Start: 2020-09-01
• Primary Completion: 2024-08-31
• Study Completion: 2024-09-25
• Status Verified: 2024-12
• Study First Submitted: 2025-04-18
• Study First Submitted QC: 2025-04-18
• Last Update Submitted: 2025-04-18
• Study First Posted: 2025-04-25
• Last Update Posted: 2025-04-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 65

Inclusion Criteria

• Patients who are willing to and capable of providing informed consent

• Adults with BCR-ABL1-positive CML

  1. Males and females aged 18 years and above
  2. Adequate organ function

• Subjects who were resistant or intolerant to prior targeted therapy other than ponatinib and with an indication for ponatinib treatment according to the acceptance criteria by the Ministry of Food and Drug Safety (MFDS)

• Women of childbearing potential (WOCBP) should have a negative serum or urine pregnancy test (with a sensitivity of at least 25 IU/L or equivalent to HCG) within 24 hours before initiating ponatinib treatment

• Female subjects who are not breastfeeding

Exclusion Criteria

• Patients who were previously treated with ponatinib
• Patients aged below 18 years of age
• Diagnosis of severe comorbidity at baseline
• Any other cancers within 3 years

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
CML patients failed to TKIs except Ponatinib	Ponatinib	The study will involve 100 patients with BCR-ABL1-positive CML who failed to prior targeted therapy other than ponatinib. Patients receiving ponatinib 45 mg once daily as a second-line or later therapy will be enrolled.

Primary Outcome Measures

Name	Time	Method
Dynamics of BCR-ABL1 gene expression by qRT-PCR	24 months	To explore the dynamics of BCR-ABL1 kinetics by Ponatinib

Secondary Outcome Measures

Name	Time	Method
Type and frequency of novel genetic variations (mutations, gene expressions, CNV, INDEL, etc.)	24 months	To explore the dynamics of various genetic variations in Ponatinib failed patients
Cobll1/GCA/novel gene network identification: functional tests using Western blot/Knock-down assay	24 months	To identify novel genetic networks in Ponatinib failed patients

Trial Locations

Locations (1)

Seoul St. Mary's Hospital; 🇰🇷 Seoul, Korea, Republic of