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Nilotinib in PH+, BCR-, ABL+ CML Patients (CML0811)

Primary Purpose

Chronic Myeloid Leukemia

Status
Completed
Phase
Phase 3
Locations
Italy
Study Type
Interventional
Intervention
Nilotinib
Sponsored by
Gruppo Italiano Malattie EMatologiche dell'Adulto
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Myeloid Leukemia focused on measuring Chronic Myeloid Leukemia,, Nilotinib,, Philadelphia positive,, BCR-ABL+, Early chronic phase

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age ≥ 18
  • Male or female patients with diagnosis of Ph+ and/or BCR-ABL+ CML
  • Early chronic phase (within 6 months from diagnosis)
  • Pretreatment with Hydroxyurea or Anagrelide for a duration of up to 3 months and/or pretreatment with Imatinib for up to 30 days are permitted
  • Normal serum levels of potassium, magnesium, phosphorus, total calcium corrected for serum albumin or phosphorus, or correctable to within normal limits with supplements prior to the first dose of study medication
  • Written informed consent prior to any study procedures being performed
  • AST and ALT ≤ 2.5 x ULN or ≤ 5.0 x ULN if considered due to leukaemia
  • Alkaline phosphatase ≤ 2.5 x ULN unless considered due to leukaemia
  • Total direct bilirubin ≤ 1.5 x ULN, except know Mb. Gilbert
  • Serum creatinine ≤ 1.5 x ULN

Exclusion Criteria:

  • Known impaired cardiac function, including any of the following:
  • LVEF < 45%
  • Complete left bundle branch block
  • Right bundle branch block plus left anterior hemiblock, bifascicular block
  • Use of a ventricular-paced pacemaker
  • Congenital long QT syndrome
  • History of or presence of clinically significant ventricular or atrial tachyarrhythmias
  • Clinically significant resting bradycardia (<50 beats per minute)
  • QTc>450 msec on screening ECG. If QTc > 450 msec and electrolytes are not within normal ranges before Nilotinib dosing, electrolytes should be corrected and then the patient rescreened for QTc criterion.
  • Myocardial infarction within 12 months prior to starting study drugs
  • Other clinical significant heart disease (e.g. unstable angina, congestive heart failure, uncontrolled hypertension)
  • Serum lipase and amylase > 1.5 x ULN (upper limit of normal) or history of acute (i.e., within 1 year of starting study medication) or chronic pancreatitis
  • Other concurrent uncontrolled medical conditions (e.g., uncontrolled diabetes, active or uncontrolled infections, acute or chronic liver and renal disease) that could cause unacceptable safety risks or compromise compliance with the protocol
  • Impaired gastrointestinal function or disease that may alter the absorption of study drug (e.g., ulcerative disease, uncontrolled nausea, vomiting and diarrhea, malabsorption syndrome, small bowel resection or gastric by-pass surgery)
  • Concomitant medications with potential QT prolongation (see link for complete list: http://www.torsades.org/medical-pros/drug-lists/printable-drug-list.cfm)
  • Concomitant medications known to interact with CYP450 isoenzymes (CYP3A4, CYP2C9,andCYP2C8:link for complete list: http://medicine.iupui.edu/flockhart/table.html..
  • Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug or who have not recovered from side effects of such therapy
  • Patients who are pregnant or breast feeding, or women of reproductive potential not employing an effective method of birth control. (Women of childbearing potential must have a negative serum pregnancy test within 48 hours prior to administration of nilotinib).
  • Patients with a history of another primary malignancy that is currently clinically significant or currently requires active intervention.
  • Patients unwilling or unable to comply with the protocol

Sites / Locations

  • Azienda Ospedaliera Nuovo Ospedale "Torrette"
  • S.G. Moscati Hospital
  • Azienda Ospedaliera Di Bologna Policlinico S. Orsola - Malpighi
  • USD Trapianti di midollo per adulti - Cattedra di Ematologia - Università degli Studi di Brescia
  • Università di Catania - Cattedra di Ematologia - Ospedale "Ferrarotto"
  • Azienda Ospedaliera Pugliese Ciaccio - Presidio Ospedaliero A.Pugliese - Unità Operativa di Ematologia
  • Sezione di Ematologia e Fisiopatologia delle Emostasi - Azienda Ospedaliera - Arcispedale S. Anna
  • Struttura Complessa di Ematologia Ospedali Riuniti Foggia - Azienda Ospedaliero-Universitaria
  • Clinica Ematologica - DiMI - Università degli Studi di Genova
  • Divisione Ematologia 1 - Azienda Ospedaliera Universitaria "San Martino"
  • U.O. di Ematologia- Ospedale dell'Angelo - Mestre
  • U.O. Ematologia e Trapianto di MIdollo - Ist.Scientifico Ospedale San Raffaele
  • Centro Oncologico Modenese - Dipartimento di Oncoematologia
  • Università degli Studi di Padova - Ematologia ed Immunologia Clinica
  • Ospedale Cervello
  • Azienda Ospedaliera Universitaria - Policlinico Paolo Giaccone
  • Div. di Ematologia di Muraglia -CTMO Ospedale San Salvatore
  • Unità Operativa Ematologia e Centro Trapianti - Dipartimento di Oncologia ed Ematologia - AUSL Ospedale di Piacenza
  • Dipartimento Oncologico - Ospedale S.Maria delle Croci
  • Dipartimento Emato-Oncologia A.O."Bianchi-Melacrino-Morelli"
  • Unità Operativa Complessa di Ematologia - Arcispedale S. Maria Nuova
  • Ospedale "Infermi"
  • IRCCS Centro di riferimento Oncologico di Basilicata
  • Complesso Ospedaliero S. Giovanni Addolorata
  • Pronto Soccorso e Accettazione Ematologica - Dipartimento Biotecnologie Cellulari ed Ematologia - Università degli Studi di Roma "Sapienza"
  • U.O.C. Ematologia Ospedale S. Eugenio
  • Università degli Studi Policlinico di Tor Vergata
  • Istituto di Ematologia - IRCCS Ospedale Casa Sollievo della Sofferenza
  • U.O.C. Ematologia e Trapianti - A.O. Senese - Policlinico " Le Scotte"
  • U.O.C. di Ematolgia - A.O. " SS Annunziata" - P.O. S.G. Moscati
  • SCDO Ematologia 2 AOU S.Giovanni Battista
  • Azienda USL 9 Treviso - U.O. di Ematologia
  • Clinica Ematologica - Policlinico Universitario
  • Università degli Studi di Verona - A. O. - Istituti Ospitalieri di Verona- Div. di Ematologia - Policlinico G.B. Rossi

Outcomes

Primary Outcome Measures

Complete molecular response
To assess the complete molecular response (CMR4) rate at 24 months of treatment. For the purpose of this protocol, CMR is defined as a negative results of quantitative RT-PCR for BCR-ABL transcripts in a peripheral blood sample of at least 10 ml with a minimum sensitivity of 1:10,000, that corresponds to at least a 4-log reduction (hence, CMR4)

Secondary Outcome Measures

Toxicity
Number of toxic events
Compliance
Number of fully compliant patients and number of patients who do not comply with treatment
The complete cytogenetic response (CCgR) rate
The rate and the degree of molecular response
The time to CCgR, the time to MMR and the time to CMR
Overall Survival (OS)
From the date of the first nilotinib dose to death
Progression Free Survival (PFS)
From the date of the first nilotinib dose to progression to AP or BP or death
Failure Free Survival (FFS)
From the date of the first nilotinib dose to failure* or progression or death
Event Free Survival (EFS)
From the date of the first nilotinib to any event. Including treatment discontinuation for adverse events, failure, progression to AP or BP, or death, whichever comes first.
Patient-reported quality of life (QoL)

Full Information

First Posted
February 9, 2012
Last Updated
August 3, 2018
Sponsor
Gruppo Italiano Malattie EMatologiche dell'Adulto
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1. Study Identification

Unique Protocol Identification Number
NCT01535391
Brief Title
Nilotinib in PH+, BCR-, ABL+ CML Patients
Acronym
CML0811
Official Title
The Protein Tyrosine Kinase Inhibitor Nilotinib as First-line Treatment of Ph+, BCR-, ABL+ Chronic Myeloid Leukemia (CML) in Early Chronic Phase: a Phase IIIb, Multicenter Study to Assess the Complete Molecular Response
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Completed
Study Start Date
January 2012 (Actual)
Primary Completion Date
November 2014 (Actual)
Study Completion Date
April 27, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Gruppo Italiano Malattie EMatologiche dell'Adulto

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is an open-label, multicentric, phase IIIb study of NILOTINIB administered orally twice daily for 24 months and indefinitely if it is in the interest of the patient. The primary objective of the trial is to evaluate the efficacy of nilotinib, 300 mg twice daily with dose increase to 400 mg twice daily in case of suboptimal response or failure (excluding patients who will fail for progression to ABP), in a population of patients with Ph-positive, BCR-ABL positive CML in early CP.
Detailed Description
This study is an open-label, multicentric, phase IIIb study of NILOTINIB administered orally at the dose of 300 mg twice daily (total daily dose 600 mg daily) for 24 months (study core), and indefinitely if it is in the interest of the patient (the drug will be given free-of-charge after 24 months to all those patients achieving the CMR4 at 24 months and in absence of safety concerns). Nilotinib dose is increased to 400 mg BID in case of suboptimal response or failure (with the exception of patients who will fail for progression to ABP: in case of progression to ABP, the patient will not be treated with study drug and the choice of the treatment will be up to the physician). Study duration is estimated in 6 years, 1 year of estimated enrollment, 2 years therapy duration. Thereafter, information on course and survival is due for other 3 years. The main data analysis will be performed when all patients will complete 24 months of treatment (or discontinued earlier). Safety and tolerability profile will be assessed by collecting hematologic and non-hematologic adverse events, laboratory examinations and ECG data. The molecular response will be assessed using the GIMEMA standardized molecular laboratories (Labnet network).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Myeloid Leukemia
Keywords
Chronic Myeloid Leukemia,, Nilotinib,, Philadelphia positive,, BCR-ABL+, Early chronic phase

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
109 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Nilotinib
Intervention Description
Administered orally at the dose of 300 mg twice daily (total daily dose 600 mg daily) for 24 months (study core), and indefinitely if it is in the interest of the patient (the drug will be given free-of-charge after 24 months to all those patients achieving the CMR4 at 24 months and in absence of safety concerns). Nilotinib dose is increased to 400 mg BID in case of suboptimal response or failure (with the exception of patients who will fail for progression to ABP: in case of progression to ABP, the patient will not be treated with study drug and the choise of the treatment will be up to the physician).
Primary Outcome Measure Information:
Title
Complete molecular response
Description
To assess the complete molecular response (CMR4) rate at 24 months of treatment. For the purpose of this protocol, CMR is defined as a negative results of quantitative RT-PCR for BCR-ABL transcripts in a peripheral blood sample of at least 10 ml with a minimum sensitivity of 1:10,000, that corresponds to at least a 4-log reduction (hence, CMR4)
Time Frame
At 24 months of treatment
Secondary Outcome Measure Information:
Title
Toxicity
Description
Number of toxic events
Time Frame
At three years from study entry
Title
Compliance
Description
Number of fully compliant patients and number of patients who do not comply with treatment
Time Frame
At 3 years from study entry
Title
The complete cytogenetic response (CCgR) rate
Time Frame
At 3, 6, 12, 18 and 24 months from study entry
Title
The rate and the degree of molecular response
Time Frame
At 3, 6, 12, 18 and 24 months from study entry
Title
The time to CCgR, the time to MMR and the time to CMR
Time Frame
baseline
Title
Overall Survival (OS)
Description
From the date of the first nilotinib dose to death
Time Frame
At three years from study entry
Title
Progression Free Survival (PFS)
Description
From the date of the first nilotinib dose to progression to AP or BP or death
Time Frame
At three years from study entry
Title
Failure Free Survival (FFS)
Description
From the date of the first nilotinib dose to failure* or progression or death
Time Frame
At three years from study entry
Title
Event Free Survival (EFS)
Description
From the date of the first nilotinib to any event. Including treatment discontinuation for adverse events, failure, progression to AP or BP, or death, whichever comes first.
Time Frame
At three years from study entry
Title
Patient-reported quality of life (QoL)
Time Frame
At baseline and then at 3, 6, 12, 18 and 24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 Male or female patients with diagnosis of Ph+ and/or BCR-ABL+ CML Early chronic phase (within 6 months from diagnosis) Pretreatment with Hydroxyurea or Anagrelide for a duration of up to 3 months and/or pretreatment with Imatinib for up to 30 days are permitted Normal serum levels of potassium, magnesium, phosphorus, total calcium corrected for serum albumin or phosphorus, or correctable to within normal limits with supplements prior to the first dose of study medication Written informed consent prior to any study procedures being performed AST and ALT ≤ 2.5 x ULN or ≤ 5.0 x ULN if considered due to leukaemia Alkaline phosphatase ≤ 2.5 x ULN unless considered due to leukaemia Total direct bilirubin ≤ 1.5 x ULN, except know Mb. Gilbert Serum creatinine ≤ 1.5 x ULN Exclusion Criteria: Known impaired cardiac function, including any of the following: LVEF < 45% Complete left bundle branch block Right bundle branch block plus left anterior hemiblock, bifascicular block Use of a ventricular-paced pacemaker Congenital long QT syndrome History of or presence of clinically significant ventricular or atrial tachyarrhythmias Clinically significant resting bradycardia (<50 beats per minute) QTc>450 msec on screening ECG. If QTc > 450 msec and electrolytes are not within normal ranges before Nilotinib dosing, electrolytes should be corrected and then the patient rescreened for QTc criterion. Myocardial infarction within 12 months prior to starting study drugs Other clinical significant heart disease (e.g. unstable angina, congestive heart failure, uncontrolled hypertension) Serum lipase and amylase > 1.5 x ULN (upper limit of normal) or history of acute (i.e., within 1 year of starting study medication) or chronic pancreatitis Other concurrent uncontrolled medical conditions (e.g., uncontrolled diabetes, active or uncontrolled infections, acute or chronic liver and renal disease) that could cause unacceptable safety risks or compromise compliance with the protocol Impaired gastrointestinal function or disease that may alter the absorption of study drug (e.g., ulcerative disease, uncontrolled nausea, vomiting and diarrhea, malabsorption syndrome, small bowel resection or gastric by-pass surgery) Concomitant medications with potential QT prolongation (see link for complete list: http://www.torsades.org/medical-pros/drug-lists/printable-drug-list.cfm) Concomitant medications known to interact with CYP450 isoenzymes (CYP3A4, CYP2C9,andCYP2C8:link for complete list: http://medicine.iupui.edu/flockhart/table.html.. Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug or who have not recovered from side effects of such therapy Patients who are pregnant or breast feeding, or women of reproductive potential not employing an effective method of birth control. (Women of childbearing potential must have a negative serum pregnancy test within 48 hours prior to administration of nilotinib). Patients with a history of another primary malignancy that is currently clinically significant or currently requires active intervention. Patients unwilling or unable to comply with the protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gianantonio Rosti
Organizational Affiliation
Dpt of Hematology and Oncology, "Seràgnoli", Sant'Orsola-Malpighi. University Hospital of Bologna
Official's Role
Study Chair
Facility Information:
Facility Name
Azienda Ospedaliera Nuovo Ospedale "Torrette"
City
Ancona
Country
Italy
Facility Name
S.G. Moscati Hospital
City
Avellino
Country
Italy
Facility Name
Azienda Ospedaliera Di Bologna Policlinico S. Orsola - Malpighi
City
Bologna
ZIP/Postal Code
40138
Country
Italy
Facility Name
USD Trapianti di midollo per adulti - Cattedra di Ematologia - Università degli Studi di Brescia
City
Brescia
ZIP/Postal Code
25123
Country
Italy
Facility Name
Università di Catania - Cattedra di Ematologia - Ospedale "Ferrarotto"
City
Catania
Country
Italy
Facility Name
Azienda Ospedaliera Pugliese Ciaccio - Presidio Ospedaliero A.Pugliese - Unità Operativa di Ematologia
City
Catanzaro
Country
Italy
Facility Name
Sezione di Ematologia e Fisiopatologia delle Emostasi - Azienda Ospedaliera - Arcispedale S. Anna
City
Ferrara
Country
Italy
Facility Name
Struttura Complessa di Ematologia Ospedali Riuniti Foggia - Azienda Ospedaliero-Universitaria
City
Foggia
Country
Italy
Facility Name
Clinica Ematologica - DiMI - Università degli Studi di Genova
City
Genova
Country
Italy
Facility Name
Divisione Ematologia 1 - Azienda Ospedaliera Universitaria "San Martino"
City
Genova
Country
Italy
Facility Name
U.O. di Ematologia- Ospedale dell'Angelo - Mestre
City
Mestre
Country
Italy
Facility Name
U.O. Ematologia e Trapianto di MIdollo - Ist.Scientifico Ospedale San Raffaele
City
Milano
Country
Italy
Facility Name
Centro Oncologico Modenese - Dipartimento di Oncoematologia
City
Modena
Country
Italy
Facility Name
Università degli Studi di Padova - Ematologia ed Immunologia Clinica
City
Padova
Country
Italy
Facility Name
Ospedale Cervello
City
Palermo
ZIP/Postal Code
90146
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria - Policlinico Paolo Giaccone
City
Palermo
Country
Italy
Facility Name
Div. di Ematologia di Muraglia -CTMO Ospedale San Salvatore
City
Pesaro
Country
Italy
Facility Name
Unità Operativa Ematologia e Centro Trapianti - Dipartimento di Oncologia ed Ematologia - AUSL Ospedale di Piacenza
City
Piacenza
Country
Italy
Facility Name
Dipartimento Oncologico - Ospedale S.Maria delle Croci
City
Ravenna
Country
Italy
Facility Name
Dipartimento Emato-Oncologia A.O."Bianchi-Melacrino-Morelli"
City
Reggio Calabria
Country
Italy
Facility Name
Unità Operativa Complessa di Ematologia - Arcispedale S. Maria Nuova
City
Reggio Emilia
Country
Italy
Facility Name
Ospedale "Infermi"
City
Rimini
Country
Italy
Facility Name
IRCCS Centro di riferimento Oncologico di Basilicata
City
Rionero in Vulture
Country
Italy
Facility Name
Complesso Ospedaliero S. Giovanni Addolorata
City
Roma
Country
Italy
Facility Name
Pronto Soccorso e Accettazione Ematologica - Dipartimento Biotecnologie Cellulari ed Ematologia - Università degli Studi di Roma "Sapienza"
City
Roma
Country
Italy
Facility Name
U.O.C. Ematologia Ospedale S. Eugenio
City
Roma
Country
Italy
Facility Name
Università degli Studi Policlinico di Tor Vergata
City
Roma
Country
Italy
Facility Name
Istituto di Ematologia - IRCCS Ospedale Casa Sollievo della Sofferenza
City
San Giovanni Rotondo
Country
Italy
Facility Name
U.O.C. Ematologia e Trapianti - A.O. Senese - Policlinico " Le Scotte"
City
Siena
Country
Italy
Facility Name
U.O.C. di Ematolgia - A.O. " SS Annunziata" - P.O. S.G. Moscati
City
Taranto
Country
Italy
Facility Name
SCDO Ematologia 2 AOU S.Giovanni Battista
City
Torino
Country
Italy
Facility Name
Azienda USL 9 Treviso - U.O. di Ematologia
City
Treviso
ZIP/Postal Code
31100
Country
Italy
Facility Name
Clinica Ematologica - Policlinico Universitario
City
Udine
Country
Italy
Facility Name
Università degli Studi di Verona - A. O. - Istituti Ospitalieri di Verona- Div. di Ematologia - Policlinico G.B. Rossi
City
Verona
Country
Italy

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
27470600
Citation
Castagnetti F, Breccia M, Gugliotta G, Martino B, D'Adda M, Stagno F, Carella AM, Avanzini P, Tiribelli M, Trabacchi E, Visani G, Gobbi M, Salvucci M, Levato L, Binotto G, Capalbo SF, Bochicchio MT, Soverini S, Cavo M, Martinelli G, Alimena G, Pane F, Saglio G, Rosti G, Baccarani M; GIMEMA CML Working Party. Nilotinib 300 mg twice daily: an academic single-arm study of newly diagnosed chronic phase chronic myeloid leukemia patients. Haematologica. 2016 Oct;101(10):1200-1207. doi: 10.3324/haematol.2016.144949. Epub 2016 Jul 28.
Results Reference
derived
Links:
URL
http://www.gimema.it
Description
GIMEMA Foundation website

Learn more about this trial

Nilotinib in PH+, BCR-, ABL+ CML Patients

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