Flumatinib Versus Imatinib Combined With Chemotherapy for de Novo Ph+ ALL
Primary Purpose
Acute Leukemia
Status
Recruiting
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Flumatinib
Imatinib
Sponsored by
About this trial
This is an interventional treatment trial for Acute Leukemia focused on measuring acute lymphoblastic leukemia, flumatinib
Eligibility Criteria
Inclusion Criteria:
- Patients aged 18 to 65 years, male or female;
- Newly diagnosed Philadelphia chromosome positive(either t(9;22) and/or BCR-ABL positive and/ or FISH positive) acute lymphoblastic leukemia; Patients will be diagnosed according to morphologic,immunologic, cytogenetic and molecular(MICM) criteria, including bone marrow morphology, immunophenotype, cytogenetic and molecular genetic (BCR/ABL gene, qualitative and quantitative analysis) examination.
- Eastern Cooperative Oncology Group (ECOG) Performance status 0-2;
- Adequate end organ function as defined by: Total bilirubin ≤ 1.5 x upper limit of normal(ULN); serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) ≤ 2.5 x ULN or ≤5 x ULN if leukemic involvement of the liver is present; Creatinine ≤ 1.5 x ULN; Serum amylase and lipase ≤ 1.5 x ULN; Alkaline phosphatase ≤ 2.5 x ULN unless considered tumor related; normal electrolytes: Potassium ≥ LLN; Magnesium ≥ LLN; Phosphorus ≥ LLN;
- Cardiac color Doppler ultrasound ejection fraction ≥ 45%;
- Subject has provided written informed consent prior to any screening procedure;
Exclusion Criteria:
- Lymphoid blast crisis of chronic myelocytic leukemia (CML);
- Previous or ongoing systemic anti-ALL therapy (including but not restricted to TKI and/or radiotherapy, except for appropriate pre-treatment);
- Patients with clinical manifestations of central or extramedullary invasion of leukemia at diagnosis;
- Identification of T315I mutation;
- Concurrent participation in another clinical study with an investigational medical product;
- Any concurrent severe and/or uncontrolled medical condition, which could, in the opinion of the investigator, compromise participation in the study;
- History of neurological or psychiatric disorders, including epilepsy or dementia;
- Major surgery within 4 weeks or failure to recover from previous surgery;
- Patients with a history of another primary malignancy that is currently clinically significant or currently requires active intervention;
- Female patients who are pregnant or breast feeding or patients of childbearing potential and male patients whose sexual partner(s) are women of childbearing potential not willing to use a highly effective method of contraception;
- 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 enrolment; congestive heart failure within 6 months prior to enrolment or left ventricular ejection fraction (LVEF) less than lower limit of normal per local institutional standards; 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;
- Active known positive HIV serology;
- Active serious infection not controlled by oral or intravenous antibiotics;
- Patients with known allergies or contraindications to the study drug;
- Patients with bleeding disorders unrelated to ALL.
Sites / Locations
- Institute of Hematology & Blood Diseases HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
flumatinib arm
imatinib arm
Arm Description
600 mg QD oral administration, fasting (2 hours before administration and 1 hour after administration).
600 mg QD oral administration, with a meal
Outcomes
Primary Outcome Measures
Relapse free survival
From the date of complete remission(CR) until the date of documented relapse or death due to any cause or the last follow-up day
Secondary Outcome Measures
The rate of adverse events
The incidence and severity of neutropenia, anemia, rash, hypophosphatemia, edema, limb pain, and other adverse events.
The composite CR rate
Both CR and molecular CR are obtained at the end of induction
The complete remission (CR) rate,CRi rate and overall remission rate(ORR)
The minimal residual disease (MRD) negative rate by Flow Cytometry (FCM)
The molecular CR rate
The rate of primary induction failure(PIF)
The duration of molecular CR
The duration of CR
Time to treatment failure
The cumulative recurrence rate
The CNS recurrence rate
Event free survival(EFS)
Overall survival(OS)
The rate of interruption and discontinuation due to AE
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05071482
Brief Title
Flumatinib Versus Imatinib Combined With Chemotherapy for de Novo Ph+ ALL
Official Title
Flumatinib Versus Imatinib Combined With Multiagent Chemotherapy for Newly Diagnosed Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia: A Prospective, Open-label,Randomized,Multi-center Clinical Trial
Study Type
Interventional
2. Study Status
Record Verification Date
September 2021
Overall Recruitment Status
Recruiting
Study Start Date
September 16, 2021 (Actual)
Primary Completion Date
October 30, 2025 (Anticipated)
Study Completion Date
October 30, 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
wang, jianxiang
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Compared with patients with philadelphia chromosome-negative Acute Lymphoblastic Leukemia (Ph- ALL), patients with Ph-positive (Ph+) ALL exhibit a comparatively poor prognosis. Fortunately, significant improvements have been found in response rates, disease-free survival (DFS), and overall survival (OS) for patients with Ph+ ALL with the introduction of tyrosine kinase inhibitor (TKI) therapy to treatment regimens. Based on improvements in efficacy and tolerability, next-generation TKIs have been widely used in first-line treatment for chronic myeloid leukemia (CML). Flumatinib, a TKI with more potent binding affinity for BCR-ABL1 tyrosine kinase than imatinib, demonstrated higher rates of responses, faster and deeper responses in FESTnd trial, which suggested that flumatinib might show improved clinical efficacy for treating Ph+ ALL compared with imatinib. The investigators therefore hypothesized that the addition of flumatinib to combinatorial chemotherapy regimen would demonstrate greater efficacy compared with the prior use of imatinib in treating Ph+ ALL. This study explored the safety and efficacy of flumatinib versus imatinib when combined with multi-agent chemotherapy in patients with newly diagnosed Ph+ ALL.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Leukemia
Keywords
acute lymphoblastic leukemia, flumatinib
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
238 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
flumatinib arm
Arm Type
Experimental
Arm Description
600 mg QD oral administration, fasting (2 hours before administration and 1 hour after administration).
Arm Title
imatinib arm
Arm Type
Active Comparator
Arm Description
600 mg QD oral administration, with a meal
Intervention Type
Drug
Intervention Name(s)
Flumatinib
Intervention Description
Flumatinib 600 mg qd will be given orally along with combination chemotherapy starting day 8 of induction chemotherapy. Flumatinib will be given continuously (if it's tolerable) for 2 years since achievement of complete remission (CR) as part of consolidation chemotherapy and maintenance therapy. Patients can receive allogeneic hematopoietic stem cell transplantation (HSCT),or patients in whom MCR was achieved within 3 months after treatment and continued until transplantation can receive autologous HSCT whenever possible during their first CR. Otherwise, they will finish the consolidation and maintenance chemotherapy.
Intervention Type
Drug
Intervention Name(s)
Imatinib
Intervention Description
Imatinib 600 mg qd will be given orally along with combination chemotherapy starting day 8 of induction chemotherapy. Imatinib will be given continuously (if it's tolerable) for 2 years since achievement of complete remission (CR) as part of consolidation chemotherapy and maintenance therapy. Patients can receive allogeneic hematopoietic stem cell transplantation (HSCT),or patients in whom MCR was achieved within 3 months after treatment and continued until transplantation can receive autologous HSCT whenever possible during their first CR. Otherwise, they will finish the consolidation and maintenance chemotherapy.
Primary Outcome Measure Information:
Title
Relapse free survival
Description
From the date of complete remission(CR) until the date of documented relapse or death due to any cause or the last follow-up day
Time Frame
up to 24 months
Secondary Outcome Measure Information:
Title
The rate of adverse events
Description
The incidence and severity of neutropenia, anemia, rash, hypophosphatemia, edema, limb pain, and other adverse events.
Time Frame
through study completion, up to 24 months
Title
The composite CR rate
Description
Both CR and molecular CR are obtained at the end of induction
Time Frame
up to 2 month
Title
The complete remission (CR) rate,CRi rate and overall remission rate(ORR)
Time Frame
up to 2 month
Title
The minimal residual disease (MRD) negative rate by Flow Cytometry (FCM)
Time Frame
up to 24 months
Title
The molecular CR rate
Time Frame
up to 6 months
Title
The rate of primary induction failure(PIF)
Time Frame
up to 6 months
Title
The duration of molecular CR
Time Frame
up to 24 months
Title
The duration of CR
Time Frame
up to 24 months
Title
Time to treatment failure
Time Frame
up to 24 months
Title
The cumulative recurrence rate
Time Frame
up to 24 months
Title
The CNS recurrence rate
Time Frame
up to 24 months
Title
Event free survival(EFS)
Time Frame
up to 24 months
Title
Overall survival(OS)
Time Frame
up to 24 months
Title
The rate of interruption and discontinuation due to AE
Time Frame
up to 24 months
Other Pre-specified Outcome Measures:
Title
ABL kinase region mutation status at molecular relapse (MREL) and hematologic relapse (HREL)
Time Frame
up to 24 months
Title
The plasma and cerebrospinal fluid (CSF) level of flumatinib
Time Frame
up to 3 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients aged 18 to 65 years, male or female;
Newly diagnosed Philadelphia chromosome positive(either t(9;22) and/or BCR-ABL positive and/ or FISH positive) acute lymphoblastic leukemia; Patients will be diagnosed according to morphologic,immunologic, cytogenetic and molecular(MICM) criteria, including bone marrow morphology, immunophenotype, cytogenetic and molecular genetic (BCR/ABL gene, qualitative and quantitative analysis) examination.
Eastern Cooperative Oncology Group (ECOG) Performance status 0-2;
Adequate end organ function as defined by: Total bilirubin ≤ 1.5 x upper limit of normal(ULN); serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) ≤ 2.5 x ULN or ≤5 x ULN if leukemic involvement of the liver is present; Creatinine ≤ 1.5 x ULN; Serum amylase and lipase ≤ 1.5 x ULN; Alkaline phosphatase ≤ 2.5 x ULN unless considered tumor related; normal electrolytes: Potassium ≥ LLN; Magnesium ≥ LLN; Phosphorus ≥ LLN;
Cardiac color Doppler ultrasound ejection fraction ≥ 45%;
Subject has provided written informed consent prior to any screening procedure;
Exclusion Criteria:
Lymphoid blast crisis of chronic myelocytic leukemia (CML);
Previous or ongoing systemic anti-ALL therapy (including but not restricted to TKI and/or radiotherapy, except for appropriate pre-treatment);
Patients with clinical manifestations of central or extramedullary invasion of leukemia at diagnosis;
Identification of T315I mutation;
Concurrent participation in another clinical study with an investigational medical product;
Any concurrent severe and/or uncontrolled medical condition, which could, in the opinion of the investigator, compromise participation in the study;
History of neurological or psychiatric disorders, including epilepsy or dementia;
Major surgery within 4 weeks or failure to recover from previous surgery;
Patients with a history of another primary malignancy that is currently clinically significant or currently requires active intervention;
Female patients who are pregnant or breast feeding or patients of childbearing potential and male patients whose sexual partner(s) are women of childbearing potential not willing to use a highly effective method of contraception;
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 enrolment; congestive heart failure within 6 months prior to enrolment or left ventricular ejection fraction (LVEF) less than lower limit of normal per local institutional standards; 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;
Active known positive HIV serology;
Active serious infection not controlled by oral or intravenous antibiotics;
Patients with known allergies or contraindications to the study drug;
Patients with bleeding disorders unrelated to ALL.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jianxiang Wang, Dr.
Phone
86-22-23909120
Email
wangjx@medmail.com.cn
Facility Information:
Facility Name
Institute of Hematology & Blood Diseases Hospital
City
Tianjin
ZIP/Postal Code
300020
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jianxiang Wang, Dr.
Phone
86-22-23909120
Email
wangjx@medmail.com.cn
First Name & Middle Initial & Last Name & Degree
Jianxiang Wang, Dr.
First Name & Middle Initial & Last Name & Degree
Ying Wang, Dr.
12. IPD Sharing Statement
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Flumatinib Versus Imatinib Combined With Chemotherapy for de Novo Ph+ ALL
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