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Phase II Study Testing the Tolerability and the Efficacy of Bosutinib in Chronic Phase CML Patients (BODO)

Primary Purpose

Chronic Myelogenous Leukaemia

Status
Unknown status
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Bosulif
Sponsored by
University of Bonn
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Myelogenous Leukaemia

Eligibility Criteria

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

Inclusion Criteria:

  • Signed written informed consent
  • Male or female patients aged ≥18 years
  • ECOG performance status of 0 to 2
  • CML in 1st or late chronic phase
  • Intolerant or resistant to pretreatment with one of the approved 1st line TKIs (Imatinib, Nilotinib or Dasatinib). Imatinib therapy prior to 2nd generation TKI therapy for a maximum of 6 weeks is allowed.
  • Patients must have a serum creatinine of ≤ 2 x ULN, SGOT/SGPT ≤ 3 x ULN, total bilirubin ≤ 2 x ULN (except known Gilbert's syndrome), and Lipase ≤ 1.5 x ULN
  • Female patients of childbearing potential must have a negative pregnancy test performed during screening period
  • Male and female patients of reproductive potential must currently use a highly effective contraceptive method and be willing to keep on using it throughout the study and for 6 months following discontinuation of study drug.

Exclusion Criteria:

  • Hypersensitivity against Bosutinib or other ingredients of the medicinal product
  • Evidence of features of accelerated (AP) or blast phase (BC) at any time before inclusion
  • Patients with BCR-ABL negative CML
  • Patients having received Imatinib for more than 6 weeks prior to initiation of 2nd generation TKI (either Nilotinib or Dasatinib)
  • Patients with known T315I or V299L mutation
  • Concomitant medications known to be strong inducers or inhibitors of P450 isoenzyme CYP3A4
  • History of pancreatitis, inflammatory bowel disease requiring systemic or topical immunosuppressive therapy within the last 12 months
  • Impaired cardiac function, including any of the following:

    1. History of or presence of complete left bundle branch block, right bundle branch block plus left anterior hemiblock, bifascicular block in screening ECG
    2. ST depression of >1mm in 2 or more leads and/or T wave inversions in 2 or more contiguous leads in screening ECG
    3. Congenital long QT syndrome
    4. QTc> 450 msec in the screening ECG
    5. QT-prolonging concomitant medication
    6. History of or presence of significant ventricular or atrial tachyarrhythmias in screening ECG
    7. History of or presence of clinically significant resting bradycardia (< 50 beats per minute)
    8. Myocardial infarction within 6 months prior to inclusion
    9. Unstable angina diagnosed or treated during the past 12 months
    10. Uncontrolled hypertension, history of labile hypertension
  • Known HIV and/or active viral hepatitis (hepatitis B or C). Hepatitis B screening will be performed at screening. Patients with history of hepatitis B with negative HBV DNA may be included when using antiviral prophylaxis
  • Other malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinoma of the skin
  • Treatment with another investigational product during this study or during the last 30 days prior to study start, except treatment with Interferon alpha within the TIGER (CML V) protocol, which must be stopped at least 7 days prior to study entry
  • Any circumstance at the time of study entry that would preclude completion of the study or the required follow-up prohibits inclusion into this study
  • Patient must not have any active bacterial, viral or fungal infection at screening
  • Patient must not have severe cerebral dysfunction and/or legal incapacity
  • Conditions which interfere with the study treatment at the discretion of the investigator
  • Women who are pregnant or breast feeding

Sites / Locations

  • University Hospital BonnRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bosutinib

Arm Description

Drug: Bosulif 100 mg or 500 mg tablets step in dosing scheme

Outcomes

Primary Outcome Measures

Rate of GI-Toxicity (i.e. incidence and severity of grade 2 to 4 toxicities)
calculation of the incidence rate of grade 2 to 4 GI toxicity with and without regard to causality

Secondary Outcome Measures

overall Tolerability (i.e. all grade, grade 2 to 4 and grade 3 and 4 toxicities)
Apart from grade 2 to 4 GI toxicity, the occurrence of toxicity will be analyzed in general. This regards all grade toxicity, 2 to 4 grade and 3 to 4 grade toxicity (NCI CTCAE v4.0).
Molecular response mesured by efficacy parametern
Rating of CCyR, MMR, MR4 and MR4.5 after bone marrow aspiration and biopsy
Patient-reported outcome measures (QoL)
The EORTC QLQ-CML30 will be scored according to the respective user's guides.
Progression-free survival (PFS)
Progression will be assessed according to the visit schedule at any visit.
Overall Survival (OS)
Survival will be assessed according to the visit schedule at any visit.
The rate of emerging mutations during Bosutinib treatment
The rate and type of mutations will be described. The rate will be given as percentage of patients developing mutations.

Full Information

First Posted
May 29, 2017
Last Updated
June 28, 2017
Sponsor
University of Bonn
Collaborators
RWTH Aachen University, Ludwig-Maximilians - University of Munich, University of Jena, Heidelberg University, Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT03205267
Brief Title
Phase II Study Testing the Tolerability and the Efficacy of Bosutinib in Chronic Phase CML Patients
Acronym
BODO
Official Title
Multicenter, Open-label Single Arm Phase II Study Testing the Tolerability and the Efficacy of Bosutinib step-in Dosing in Chronic Phase CML Patients Intolerant or Refractory to Previous Imatinib, Nilotinib or Dasatinib Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
June 2017
Overall Recruitment Status
Unknown status
Study Start Date
March 2016 (undefined)
Primary Completion Date
October 2019 (Anticipated)
Study Completion Date
October 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Bonn
Collaborators
RWTH Aachen University, Ludwig-Maximilians - University of Munich, University of Jena, Heidelberg University, Pfizer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Bosutinib is a 2nd generation tyrosine kinase inhibitor that has shown promising results from first up to fourth line treatment in patients with in chronic phase of chronic myelogenous leukaemia. Most patients discontinuing the treatment with Bosutinib do so because of side effects occuring early after starting the treatment. A step in dosing scheme could improve these early toxicities. The aim of this study therefore is to demonstrate that temporary lowering of the Bosutinib dose during early treatment may help to reduce or prevent side effects while preserving efficacy.
Detailed Description
Objectives: The objective of the BODO trial is to assess the tolerability and efficacy of a step-in dosing concept of the dual SRC-ABL kinase inhibitor Bosutinib in CP-CML patients who either developed intolerance or treatment failure to previous Imatinib, Dasatinib or Nilotinib as 1st line therapy. Primary endpoint: • Rate of GI-Toxicity (i.e. incidence and severity of grade 2 to 4 toxicities) within the first 6 months of treatment Secondary endpoints: Tolerability (i.e. all grade, grade 2 to 4 and grade 3 and 4 toxicities) at month 6, 12 and 24 Efficacy parameters: CCyR, MMR, MR4 and MR4.5 rate at month 3, 6, 12, 18 and 24 Patient-reported outcome measures (QoL) Progression-free survival (PFS) Overall survival (OS) The rate of emerging mutations during Bosutinib treatment Exploratory endpoints linked to substudies: Vascular biology substudy: Effects of previous therapy on the baseline vascular risk profile (i.e. Nilotinib- vs. Dasatinib-pre-treatment) Biological and clinical surrogates for vascular alterations during Bosutinib therapy at baseline, months 6, 12, and 24 Pharmacokinetic (PK), pharmacodynamic (PD) and immunology sub- study: Correlation of PK with response and toxicity Correlation of PK with PD (i.e. phosphoproteomic changes) in immune cell populations Correlation of PD changes in immune cell populations with response Evaluation of the effects of Bosutinib on frequency and phenotype of immune cells Evaluation whether Bosutinib-induced changes of immune cells correlate to response Ultra-deep next-generation sequencing (UD-NGS) and telomere substudy: Documentation of subclone evolution or elimination during Bosutinib treatment Evaluation of telomere length in leukemic and non-leukemic cells as a prognostic indicator for depth and kinetics of response to and tolerability of Bosutinib

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Myelogenous Leukaemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
127 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Bosutinib
Arm Type
Experimental
Arm Description
Drug: Bosulif 100 mg or 500 mg tablets step in dosing scheme
Intervention Type
Drug
Intervention Name(s)
Bosulif
Other Intervention Name(s)
Bosutinib
Intervention Description
Patients will start with dose-level 1 (300 mg once daily) Bosutinib. If patients do not experience any toxicity or only G1 toxicity, they will be dose-increased first to dose-level 2 (400 mg once daily ) and then to dose-level 3 (500 mg once daily). Dose will not be escalated above 500 mg which is the dose recommended by the summary of product information. If patients experience G2 toxicity, the study drug will be further continued at the same dose-level. In patients with G3 or G4 toxicities, therapy will be withheld until toxicity resolved to <G2.
Primary Outcome Measure Information:
Title
Rate of GI-Toxicity (i.e. incidence and severity of grade 2 to 4 toxicities)
Description
calculation of the incidence rate of grade 2 to 4 GI toxicity with and without regard to causality
Time Frame
within the first 6 months of treatment
Secondary Outcome Measure Information:
Title
overall Tolerability (i.e. all grade, grade 2 to 4 and grade 3 and 4 toxicities)
Description
Apart from grade 2 to 4 GI toxicity, the occurrence of toxicity will be analyzed in general. This regards all grade toxicity, 2 to 4 grade and 3 to 4 grade toxicity (NCI CTCAE v4.0).
Time Frame
at month 6, 12 and 24
Title
Molecular response mesured by efficacy parametern
Description
Rating of CCyR, MMR, MR4 and MR4.5 after bone marrow aspiration and biopsy
Time Frame
at month 3, 6, 12, 18 and 24
Title
Patient-reported outcome measures (QoL)
Description
The EORTC QLQ-CML30 will be scored according to the respective user's guides.
Time Frame
at month 3 and 6
Title
Progression-free survival (PFS)
Description
Progression will be assessed according to the visit schedule at any visit.
Time Frame
at month 3, 6, 9, 12, 15, 18, 21 and 24
Title
Overall Survival (OS)
Description
Survival will be assessed according to the visit schedule at any visit.
Time Frame
at month 3, 6, 9, 12, 15, 18, 21 and 24
Title
The rate of emerging mutations during Bosutinib treatment
Description
The rate and type of mutations will be described. The rate will be given as percentage of patients developing mutations.
Time Frame
at month 3, 6, 9, 12, 15, 18, 21 and 24
Other Pre-specified Outcome Measures:
Title
Vascular biology substudy: analysis of clinical and laboratory vascular and metabolic risk factors
Description
Ankle Brachial Index (ABI) will be prospectively evaluated followed by analysis of various biomarkers for vascular damage
Time Frame
baseline, at months 6, 12 and 24
Title
Pharmacokinetic (PK), pharmacodynamic (PD) substudy
Description
It is planned to analyze PK parameters sequentially by taking serum from PB and subsequent HPLC-MS/MS technology. Pharmacodynamics in different compartments will be analyzed by means of flow-cytometry of PB and BM samples.
Time Frame
at day 1, months 1, 2, 3, 12, 18, 24
Title
Telomere substudy
Description
Assessment of telomere length in normal and leukemic cells as potential new biomarker for prognosis, prediction of response under Bosutinib
Time Frame
at months 1, 2, 3, 12 and 24
Title
Ultra-deep next-generation sequencing (UD-NGS)
Description
Documentation of subclone evolution or elimination during Bosutinib treatment
Time Frame
at months 1, 2, 3, 12 and 24
Title
Assessment of patients comorbidities and correlation to individual patient´s adverse side effect profile substudy
Description
Documentation of patient´s comorbidity profile using 3 different comorbidity scales
Time Frame
through study completion, an average of 2 years
Title
Transport mechanisms of Bosutinib and mechanisms of diarrhea substudy
Description
Investigation the role of the 5-HT pathway in directing bosutinib induced diarrhea by assessment of 5-HT and certain cytokine levels and genetic analysis including SNP and GWAS
Time Frame
every 14 days month 1-3

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed written informed consent Male or female patients aged ≥18 years ECOG performance status of 0 to 2 CML in 1st or late chronic phase Intolerant or resistant to pretreatment with one of the approved 1st line TKIs (Imatinib, Nilotinib or Dasatinib). Imatinib therapy prior to 2nd generation TKI therapy for a maximum of 6 weeks is allowed. Patients must have a serum creatinine of ≤ 2 x ULN, SGOT/SGPT ≤ 3 x ULN, total bilirubin ≤ 2 x ULN (except known Gilbert's syndrome), and Lipase ≤ 1.5 x ULN Female patients of childbearing potential must have a negative pregnancy test performed during screening period Male and female patients of reproductive potential must currently use a highly effective contraceptive method and be willing to keep on using it throughout the study and for 6 months following discontinuation of study drug. Exclusion Criteria: Hypersensitivity against Bosutinib or other ingredients of the medicinal product Evidence of features of accelerated (AP) or blast phase (BC) at any time before inclusion Patients with BCR-ABL negative CML Patients having received Imatinib for more than 6 weeks prior to initiation of 2nd generation TKI (either Nilotinib or Dasatinib) Patients with known T315I or V299L mutation Concomitant medications known to be strong inducers or inhibitors of P450 isoenzyme CYP3A4 History of pancreatitis, inflammatory bowel disease requiring systemic or topical immunosuppressive therapy within the last 12 months Impaired cardiac function, including any of the following: History of or presence of complete left bundle branch block, right bundle branch block plus left anterior hemiblock, bifascicular block in screening ECG ST depression of >1mm in 2 or more leads and/or T wave inversions in 2 or more contiguous leads in screening ECG Congenital long QT syndrome QTc> 450 msec in the screening ECG QT-prolonging concomitant medication History of or presence of significant ventricular or atrial tachyarrhythmias in screening ECG History of or presence of clinically significant resting bradycardia (< 50 beats per minute) Myocardial infarction within 6 months prior to inclusion Unstable angina diagnosed or treated during the past 12 months Uncontrolled hypertension, history of labile hypertension Known HIV and/or active viral hepatitis (hepatitis B or C). Hepatitis B screening will be performed at screening. Patients with history of hepatitis B with negative HBV DNA may be included when using antiviral prophylaxis Other malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinoma of the skin Treatment with another investigational product during this study or during the last 30 days prior to study start, except treatment with Interferon alpha within the TIGER (CML V) protocol, which must be stopped at least 7 days prior to study entry Any circumstance at the time of study entry that would preclude completion of the study or the required follow-up prohibits inclusion into this study Patient must not have any active bacterial, viral or fungal infection at screening Patient must not have severe cerebral dysfunction and/or legal incapacity Conditions which interfere with the study treatment at the discretion of the investigator Women who are pregnant or breast feeding
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Dominik GF Wolf, Prof. Dr.
Phone
+49 228 287 17233
Email
dominik.wolf@ukb.uni-bonn.de
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dominik GF Wolf, Prof. Dr.
Organizational Affiliation
University of Bonn Medical Faculty
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Brümmendorf H Tim, Prof. Dr.
Organizational Affiliation
University of Aachen Medical Faculty
Official's Role
Study Chair
Facility Information:
Facility Name
University Hospital Bonn
City
Bonn
ZIP/Postal Code
53127
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dominik Wolf, Prof. Dr.
Phone
+49 228 287 17233
Email
dominik.wolf@ukb.uni-bonn.de

12. IPD Sharing Statement

Plan to Share IPD
No

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Phase II Study Testing the Tolerability and the Efficacy of Bosutinib in Chronic Phase CML Patients

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