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Safety and Efficacy of Pegylated IFN-alpha 2B Added to Dasatinib in Newly Diagnosed Chronic Phase Myeloid Leukemia (NordCML007)

Primary Purpose

Leukemia, Myeloid, Chronic-Phase

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Dasatinib + PegIFN
Sponsored by
Norwegian University of Science and Technology
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia, Myeloid, Chronic-Phase focused on measuring dasatinib, Protein Kinase Inhibitors, pegylated IFN-alpha 2B, Interferon-alpha

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of chronic myeloid leukemia in chronic phase (CML-CP) associated with BCR-ABL1 quantifiable by RQ-PCR (IS)
  • No other current or planned anti-leukemia therapies excluding hydroxyurea treatment for up to two months.
  • ECOG Performance status 0,1, or 2
  • Adequate organ function as defined by: Total bilirubin < 1.5 x ULN (ULN = upper limit of normal in a local institution lab) in absence of Gilbert genotype; ASAT and ALAT < 2.5 x ULN. Creatinine < 2x ULN. Potassium, magnesium and phosphate not below LLN (LLN= lower level of normal)
  • Life expectancy of more than 12 months in the absence of any intervention
  • Patient has given written informed consent to participate in the study

Exclusion Criteria:

  • Prior accelerated phase or blast crisis
  • Uncontrolled or significant cardiovascular disease, including any of the following:

    • A myocardial infarction within 6 months
    • Uncontrolled angina within 3 months
    • Congestive heart failure within 3 months
    • Diagnosed or suspected congenital long QT syndrome
    • Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de Pointe)
    • Prolonged QTcF interval > 450 msec on pre-entry ECG
  • Atypical BCR-ABL1 transcript not quantifiable by RQ-PCR.
  • Another primary malignant disease, which requires systemic treatment (chemotherapy or radiation) Severe and/or life-threatening medical disease including acute liver disease
  • History of significant congenital or acquired bleeding disorder unrelated to cancer
  • Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of dasatinib
  • Patients actively receiving therapy with strong CYP3A4 inhibitors and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug
  • Patients who are currently receiving treatment with any medications that have the potential to prolong the QT interval and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug
  • Female patients who are: pregnant, breast feeding or potentially fertile without a negative pregnancy test prior to baseline or unwilling to use contraception on trial
  • Previous history of pericarditis or pleuritis
  • History of non-compliance, abuse of alcohol, illicit drugs, severe psychiatric disorders or other inability to grant informed consent.
  • Current treatment for depression.
  • Hypersensitivity to any interferon preparation;
  • Autoimmune hepatitis or a history of autoimmune disease;
  • Pre-existing thyroid disease unless it can be controlled with conventional treatment;
  • Epilepsy and/or compromised central nervous system (CNS) function;
  • HCV/HIV patients

Sites / Locations

  • Helsinki University Central Hospital
  • Bergen University Central Hospital
  • Rikshospitalet
  • Stavanger University Hospital
  • University Hospital of Northern Norway
  • St Olavs Hospital - Trondheim University Hospital
  • Linköping University Hospital
  • Sunderby Sjukhus
  • Lund University Hospital
  • Karolinska University Hospital
  • Sundsvall County Hospital
  • Umeå University Hospital
  • Uppsala University Hospital
  • Örebro University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Dasatinib + PegIFN

Arm Description

Dasatinib 100mg OD for three months single drug, with subsequent addition of PegIFN 15 μg/ week for 3 months. If well tolerated (less than grade 2 non-hematological or grade 3 hematological AE) the dose should be increased to 25μg weekly for the remaining 9 months on combination treatment. Thereafter dasatinib will be given as monotherapy. Patients will be followed for 24 months totally.

Outcomes

Primary Outcome Measures

major molecular response rates
defined as ≤0.1% BCR-ABL1 on the MMR International Scale

Secondary Outcome Measures

overall survival
quality of life
Rate of CCgR
Rate of MR4.0 and MR4.5

Full Information

First Posted
November 8, 2012
Last Updated
September 21, 2017
Sponsor
Norwegian University of Science and Technology
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1. Study Identification

Unique Protocol Identification Number
NCT01725204
Brief Title
Safety and Efficacy of Pegylated IFN-alpha 2B Added to Dasatinib in Newly Diagnosed Chronic Phase Myeloid Leukemia
Acronym
NordCML007
Official Title
A Safety and Efficacy Study of Adding Low Dose Pegylated IFN-alpha 2B to Standard Dose Dasatinib in Patients With Newly Diagnosed Chronic Phase Myeloid Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
September 2017
Overall Recruitment Status
Completed
Study Start Date
September 2012 (Actual)
Primary Completion Date
May 2016 (Actual)
Study Completion Date
May 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Norwegian University of Science and Technology

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Patients with newly diagnosed CML have excellent outcomes with tyrosine kinase inhibitors (TKI). However, a few patients will be cured with TKIs alone, and thus need continued life-long treatment. Some patients achieve complete molecular remission (CMR), and this rate is higher with second generation TKIs compared with imatinib. Some experience with drug discontinuation in CMR has been derived from a few small studies, most notably the French STIM study. Approximately 40 % of patients with a minimum of two years in MR4.5 (4.5 log reduction in molecular response) can stop imatinib without relapse, indicating possible cure. To increase the non-relapse rate is of major importance. To achieve a permanent "cure" without stem cell transplantation is presently the most relevant goal of clinical studies in CML. The investigators hypothesize that to significantly increase cure rates in CML, therapy should eradicate leukemic stem cells and/or induce or restore anti-CML immunity. Second generation TKIs may have a more profound effect on the stem cell pool as compared to imatinib. This is assessed in our current randomized study with a reduction in leukemic stem cell burden as the primary endpoint (NordCML006). Interferon-alpha (IFN) has a prominent immunomodulatory and antiproliferative mode of action, and has also activity in stem cells. Pegylated IFN in combination with imatinib results in improved therapy responses as compared to imatinib monotherapy. This advantage may translate into higher cure rates. Dasatinib has a unique dual mechanism of action: it is the most potent of available TKIs and induces immunological effects that are different from those of IFN. Both of these drugs may have immunological adverse-effects when used as a monotherapy. However, immunological adverse-effects may also be markers of anti-leukemia efficacy. A combination of dasatinib and pegylated IFN (PegIFN) may have additive or synergistic effects and should be tested in a clinical study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Myeloid, Chronic-Phase
Keywords
dasatinib, Protein Kinase Inhibitors, pegylated IFN-alpha 2B, Interferon-alpha

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Dasatinib + PegIFN
Arm Type
Experimental
Arm Description
Dasatinib 100mg OD for three months single drug, with subsequent addition of PegIFN 15 μg/ week for 3 months. If well tolerated (less than grade 2 non-hematological or grade 3 hematological AE) the dose should be increased to 25μg weekly for the remaining 9 months on combination treatment. Thereafter dasatinib will be given as monotherapy. Patients will be followed for 24 months totally.
Intervention Type
Drug
Intervention Name(s)
Dasatinib + PegIFN
Primary Outcome Measure Information:
Title
major molecular response rates
Description
defined as ≤0.1% BCR-ABL1 on the MMR International Scale
Time Frame
1 year
Secondary Outcome Measure Information:
Title
overall survival
Time Frame
2 years
Title
quality of life
Time Frame
up to 18 months (after 3, 6, 12, 18 months)
Title
Rate of CCgR
Time Frame
up to 18 months (after 3, 6, 12 and 18 months)
Title
Rate of MR4.0 and MR4.5
Time Frame
up to 24 months (after 3, 6, 12, 15, 18, and 24 months)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of chronic myeloid leukemia in chronic phase (CML-CP) associated with BCR-ABL1 quantifiable by RQ-PCR (IS) No other current or planned anti-leukemia therapies excluding hydroxyurea treatment for up to two months. ECOG Performance status 0,1, or 2 Adequate organ function as defined by: Total bilirubin < 1.5 x ULN (ULN = upper limit of normal in a local institution lab) in absence of Gilbert genotype; ASAT and ALAT < 2.5 x ULN. Creatinine < 2x ULN. Potassium, magnesium and phosphate not below LLN (LLN= lower level of normal) Life expectancy of more than 12 months in the absence of any intervention Patient has given written informed consent to participate in the study Exclusion Criteria: Prior accelerated phase or blast crisis Uncontrolled or significant cardiovascular disease, including any of the following: A myocardial infarction within 6 months Uncontrolled angina within 3 months Congestive heart failure within 3 months Diagnosed or suspected congenital long QT syndrome Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de Pointe) Prolonged QTcF interval > 450 msec on pre-entry ECG Atypical BCR-ABL1 transcript not quantifiable by RQ-PCR. Another primary malignant disease, which requires systemic treatment (chemotherapy or radiation) Severe and/or life-threatening medical disease including acute liver disease History of significant congenital or acquired bleeding disorder unrelated to cancer Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of dasatinib Patients actively receiving therapy with strong CYP3A4 inhibitors and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug Patients who are currently receiving treatment with any medications that have the potential to prolong the QT interval and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug Female patients who are: pregnant, breast feeding or potentially fertile without a negative pregnancy test prior to baseline or unwilling to use contraception on trial Previous history of pericarditis or pleuritis History of non-compliance, abuse of alcohol, illicit drugs, severe psychiatric disorders or other inability to grant informed consent. Current treatment for depression. Hypersensitivity to any interferon preparation; Autoimmune hepatitis or a history of autoimmune disease; Pre-existing thyroid disease unless it can be controlled with conventional treatment; Epilepsy and/or compromised central nervous system (CNS) function; HCV/HIV patients
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Henrik Hjorth-Hansen, MD PhD
Organizational Affiliation
Norwegian University of Science and Technology
Official's Role
Study Chair
Facility Information:
Facility Name
Helsinki University Central Hospital
City
Helsinki
Country
Finland
Facility Name
Bergen University Central Hospital
City
Bergen
Country
Norway
Facility Name
Rikshospitalet
City
Oslo
Country
Norway
Facility Name
Stavanger University Hospital
City
Stavanger
Country
Norway
Facility Name
University Hospital of Northern Norway
City
Tromsø
Country
Norway
Facility Name
St Olavs Hospital - Trondheim University Hospital
City
Trondheim
Country
Norway
Facility Name
Linköping University Hospital
City
Linköping
Country
Sweden
Facility Name
Sunderby Sjukhus
City
Luleå
Country
Sweden
Facility Name
Lund University Hospital
City
Lund
Country
Sweden
Facility Name
Karolinska University Hospital
City
Stockholm
Country
Sweden
Facility Name
Sundsvall County Hospital
City
Sundsvall
Country
Sweden
Facility Name
Umeå University Hospital
City
Umeå
Country
Sweden
Facility Name
Uppsala University Hospital
City
Uppsala
Country
Sweden
Facility Name
Örebro University Hospital
City
Örebro
Country
Sweden

12. IPD Sharing Statement

Citations:
PubMed Identifier
27133821
Citation
Hjorth-Hansen H, Stentoft J, Richter J, Koskenvesa P, Hoglund M, Dreimane A, Porkka K, Gedde-Dahl T, Gjertsen BT, Gruber FX, Stenke L, Eriksson KM, Markevarn B, Lubking A, Vestergaard H, Udby L, Bjerrum OW, Persson I, Mustjoki S, Olsson-Stromberg U. Safety and efficacy of the combination of pegylated interferon-alpha2b and dasatinib in newly diagnosed chronic-phase chronic myeloid leukemia patients. Leukemia. 2016 Sep;30(9):1853-60. doi: 10.1038/leu.2016.121. Epub 2016 May 2.
Results Reference
result
PubMed Identifier
36047494
Citation
Huuhtanen J, Ilander M, Yadav B, Dufva OM, Lahteenmaki H, Kasanen T, Klievink J, Olsson-Stromberg U, Stentoft J, Richter J, Koskenvesa P, Hoglund M, Soderlund S, Dreimane A, Porkka K, Gedde-Dahl T, Gjertsen BT, Stenke L, Myhr-Eriksson K, Markevarn B, Lubking A, Dimitrijevic A, Udby L, Bjerrum OW, Hjorth-Hansen H, Mustjoki S. IFN-alpha with dasatinib broadens the immune repertoire in patients with chronic-phase chronic myeloid leukemia. J Clin Invest. 2022 Sep 1;132(17):e152585. doi: 10.1172/JCI152585.
Results Reference
derived

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Safety and Efficacy of Pegylated IFN-alpha 2B Added to Dasatinib in Newly Diagnosed Chronic Phase Myeloid Leukemia

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