Phase II Study of the Sequential Combination of Low-Intensity Chemotherapy and Ponatinib Followed by Blinatumomab and Ponatinib in Patients With Philadelphia Chromosome (Ph)-Positive and/or BCR-ABL Positive Acute Lymphoblastic Leukemia (ALL)
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 入组人数
- 22
- 试验地点
- 1
- 主要终点
- Overall response (OR) in participants with relapsed/refractory acute lymphoblastic leukemia
研究概览
简要总结
This phase II trial studies how well low-intensity chemotherapy and ponatinib work in treating patients with Philadelphia chromosome-positive and/or BCR-ABL positive acute lymphoblastic leukemia that may have come back or is not responding to treatment. Drugs used in chemotherapy, such as cyclophosphamide, vincristine, dexamethasone, methotrexate, and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Immunotherapy with rituximab and blinatumomab, may induce changes in body's immune system and may interfere with the ability of cancer cells to grow and spread. Ponatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Granulocyte colony stimulating factor helps the bone marrow make recover after treatment. Giving low-intensity chemotherapy, ponatinib, and blinatumomab may work better in treating patients with acute lymphoblastic leukemia.
详细描述
PRIMARY OBJECTIVES:
I. To evaluate the complete molecular response (CMR) rate of ponatinib and blinatumomab in combination with low-intensity chemotherapy in patients with newly diagnosed Philadelphia chromosome (Ph)-positive and/or BAR-ABL-positive acute lymphoblastic leukemia (ALL). (Cohort 1) II. To evaluate the overall response (OR; complete response [CR] + complete response with hematologic improvement [CRi]) in patients with relapsed/refractory disease. (Cohort 2)
SECONDARY OBJECTIVES:
I. To evaluate other clinical efficacy endpoints (complete cytogenetic response, complete molecular response [CMR] [for relapsed/refractory population], event-free survival and overall survival) and safety of the combination regimen.
EXPLORATORY OBJECTIVES:
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
- •Patients >= 18 years of age with previously untreated Ph-positive ALL (either t(9;22) and/or BCR-ABL positive) (includes patients initiated on first cycle of hyper-CVAD before cytogenetics known. These patients could have received one or two cycles of chemotherapy with or without other TKIs and still eligible.
- •If they achieved CR, they are assessable only for event-free and overall survival, or
- •If they failed to achieve CR, they are assessable for CR, event-free, and overall survival.
- •Patients >= 18 years of age with relapsed/refractory Ph-positive ALL or lymphoid accelerated or blast phase chronic myelogenous leukemia (CML)
- •Performance status =< 2 (Eastern Cooperative Oncology Group [ECOG] scale)
- •Total serum bilirubin =< 2 x upper limit of normal (ULN), unless due to Gilbert's syndrome
- •Alanine aminotransferase (ALT) =< 3 x ULN
- •Aspartate aminotransferase (AST) =< 3 x ULN
- •Serum lipase and amylase =< 1.5 x ULN
- •Creatinine =< 2.0 mg/dl
- •Female patients who: are postmenopausal for at least 1 year before the screening visit, OR are surgically sterile, OR if they are of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent through 4 months after the last dose of study drug, or agree to completely abstain from heterosexual intercourse
- •Male patients, even if surgically sterilized (i.e., status post-vasectomy), who: agree to practice effective barrier contraception during the entire study treatment period and through 4 months after the last dose of study drug, or agree to completely abstain from heterosexual intercourse
- •Adequate cardiac function as assessed clinically by history and physical examination
- •Signed informed consent
排除标准
- •Active serious infection not controlled by oral or intravenous antibiotics
- •Known active hepatitis B. Patients with chronic hepatitis B who are on appropriate viral suppressive therapy may be allowed after discussion with the principal investigator (PI)
- •History of acute pancreatitis within 1 year of study or history of chronic pancreatitis
- •History of alcohol abuse
- •Uncontrolled hypertriglyceridemia
- •Active secondary malignancy other than skin cancer (e.g., basal cell carcinoma or squamous cell carcinoma) that in the investigator's opinion will shorten survival to less than 1 year
- •Active grade III-V cardiac failure as defined by the New York Heart Association criteria
- •Uncontrolled, or active cardiovascular disease, specifically including, but not restricted to: myocardial infarction (MI), stroke, or revascularization within 3 months; unstable angina or transient ischemic attack; congestive heart failure prior to enrollment, or left ventricular ejection fraction (LVEF) less than lower limit of normal per local institutional standards prior to enrollment; diagnosed or suspected congenital long QT syndrome; clinically significant atrial or ventricular arrhythmias as determined by the treating physician; prolonged corrected QT (QTc) interval on pre-entry electrocardiogram (> 470 msec) unless corrected after electrolyte replacement. or approved by cardiologist; Significant venous or arterial thromboembolism including deep venous thrombosis or pulmonary embolism. Patients with a history of treated prior superficial or catheter associated phlebitis will not be considered as significant embolism and after discussion with principal investigator (PI) will not be excluded from eligibility. Uncontrolled hypertension (diastolic blood pressure > 90 mmHg; systolic > 140mmHg). Patients with hypertension should be under treatment on study entry to effect blood pressure control
- •Taking any medications or herbal supplements that are known to be strong inhibitors of CYP3A4 within at least 14 days or 5 half-lives before the first dose of ponatinib in patients with newly diagnosed only
- •History or presence of clinically relevant central nervous system (CNS) pathology such as epilepsy, childhood or adult seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis. Patients with active CNS leukemia will NOT be excluded
- •Current autoimmune disease or history of autoimmune disease with potential CNS involvement
- •Treatment with any investigational antileukemic agents or chemotherapy agents in the last 7 days before study entry, unless full recovery from side effects has occurred or patient has rapidly progressive disease judged to be life-threatening by the investigator
- •Pregnant and lactating women will not be eligible; women of childbearing potential should have a negative pregnancy test prior to entering on the study and be willing to practice methods of contraception. Women do not have childbearing potential if they have had a hysterectomy or are postmenopausal without menses for 12 months. In addition, men enrolled on this study should understand the risks to any sexual partner of childbearing potential and should practice an effective method of birth control
- •History of significant bleeding disorder unrelated to cancer, including: diagnosed congenital bleeding disorders (e.g., von Willebrand's disease); and diagnosed acquired bleeding disorder within one year (e.g., acquired anti-factor VIII antibodies)
- •Patients with documented significant pleural or pericardial effusions unless they are thought to be secondary to their leukemia
研究组 & 干预措施
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Rituximab (Biological)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Filgrastim (Biological)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Cytarabine (Drug)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Blinatumomab (Biological)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Cyclophosphamide (Drug)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Methotrexate (Drug)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Pegfilgrastim (Biological)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Ponatinib (Drug)
Treatment (chemotherapy, ponatinib, blinatumomab)
See Detailed Description.
干预措施: Vincristine (Drug)
结局指标
主要结局
Overall response (OR) in participants with relapsed/refractory acute lymphoblastic leukemia
时间窗: Up to 6 years
Overall response is defined as complete response (CR) + complete response with hematologic improvement (CRi) in participants with relapsed/refractory disease.
Complete molecular response (CMR) in newly diagnosed Philadelphia chromosome (Ph)-positive and/or BCR-ABL-positive participants
时间窗: Up to 84 days (3 courses)
The CMR rate within the first 3 courses for cohort 1 or rate within the first 2 courses for cohort 2 will be estimated along with the 95% credible intervals. Similar analyses will be performed for estimating the rate of complete cytogenetic response and major molecular response rates.
次要结局
- Complete cytogenetic response(Up to 6 years)
- Overall survival (OS)(From the first day of treatment to time of death from any cause, assessed up to 6 years)
- CMR for relapsed/refractory population(Up to 6 years)
- Event-free survival (EFS)(From the first day of treatment until any failure (resistant disease, relapse, or death), assessed up to 6 years)
- Incidence of adverse events (AEs)(Up to 6 years)