Chronic Myeloid Leukemia
Conditions
Keywords
Bosutinib, imatinib, CML
Brief summary
Two-arm, randomized, open-label trial designed to evaluate the efficacy and safety of bosutinib alone compared to imatinib alone in subjects newly diagnosed with chronic phase Chronic Myelogenous Leukemia (CML). The primary endpoint is cytogenetic response rate at one year.
Interventions
500 mg once daily, by mouth (tablet) with food preferably in the morning. Drug can be increased up to 600mg daily in case of lack of efficacy, and can be reduced to 300mg daily in case of toxicity. The drug will be given daily for up to 8 years until treatment failure, unacceptable toxicity, death or withdrawal of consent.
400 mg once daily, by mouth (tablet). Drug can be increased up to 600mg daily in case of lack of efficacy, and can be reduced to 300mg daily in case of toxicity. The drug will be given daily for up to 8 years until treatment failure, unacceptable toxicity, death or withdrawal of consent.
Sponsors
Study design
Eligibility
Inclusion criteria
* Cytogenetic diagnosis of chronic phase Ph+ CML diagnosed less than 6 months. * Diagnosis of CML chronic phase confirmed. * Adequate hepatic and renal function. * Able to take oral tablets.
Exclusion criteria
* Exclusions include Philadelphia negative CML. * Prior anti-leukemia treatment. * Prior stem cell transplant.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Complete Cytogenetic Response (CCyR) at Year 1 | Year 1 (48 weeks) | Cytogenetic Response (CyR) is based on the prevalence of Philadelphia chromosome positive (Ph+) metaphases among cells in metaphase on a bone marrow (BM) aspirate. CCyR was achieved when there was 0 percent (%) Ph+ metaphases among cells in a BM sample when at least 20 metaphases from a BM sample were analyzed, or less than (\<) 1% breakpoint cluster region Abelson protooncogene (Bcr-Abl) fusion product among cells in a BM sample or peripheral blood sample when at least 200 cells were analyzed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Major Molecular Response (MMR) at Year 1 | Year 1 (48 weeks) | Molecular response was assessed using Bcr-Abl transcript levels measured by reverse transcriptase polymerase chain reaction (RT-PCR) from peripheral blood. A MMR was defined as a ratio Bcr-Abl/Abl less than or equal to (≤) 0.1% on the international scale (greater than or equal to \[≥\] 3 log reduction from standardized baseline in ratio of Bcr-Abl to Abl transcripts) with at least 3000 Abl analyzed. |
| Kaplan-Meier Estimate of Probability of Retaining CCyR at 192 Weeks | 192 weeks | The Kaplan-Meier curve was generated based the time from the first date of CCyR until the first date of confirmed loss of CCyR, objectively documented, for responders only. Participants without confirmed loss of CCyR were censored at the last valid cytogenetic assessment. CyR is based on the prevalence of Ph+ metaphases among cells in metaphase on a bone marrow sample. CCyR was achieved when there was 0% Ph+ metaphases among cells in a BM sample when at least 20 metaphases from a BM sample were analyzed, or \<1% Bcr-Abl fusion product among cells in a BM sample or peripheral blood sample when at least 200 cells were analyzed. The medians have not been reached in either arm, as such, the premature estimated hazard ratio is provided. Four years rate was displayed since the majority of participants had first CCyR by Year 1. |
| Kaplan-Meier Estimate of Probability of Retaining Complete Hematologic Response (CHR) at 192 Weeks | 192 weeks | The Kaplan-Meier curve was generated based on the first date of confirmed CHR until the first date of loss of CHR, objectively documented, for responders only. Participants without confirmed loss of response were censored at the last valid hematologic assessment. CHR must have been of at least 4 weeks in duration confirmed by 2 assessments at least 4 weeks apart and was defined as follows: white blood cells ≤ institutional upper limit of normal, no peripheral blasts or promyelocytes, myelocytes + metamyelocytes \<5% in blood, absolute neutrophil count ≥1.0\*10\^9/L, platelets ≥100 but \<450\*10\^9/L unless related to therapy, \<20% basophils in blood and no extramedually involvement (including hepato- or splenomegaly). The medians have not been reached in either arm, as such, the premature estimated hazard ratio is provided. Four years rate was displayed since the majority of participants had first CHR by Year 1. |
| Kaplan-Meier Estimate of Probability of Retaining Derived MMR at 144 Weeks | 144 weeks | The Kaplan-Meier curve was generated based on the first date of MMR until the first date loss of MMR, objectively documented, for responders only. Participants without confirmed loss of response were censored at the last valid molecular assessment. Molecular response was assessed using Bcr-Abl transcript levels measured by RT-PCR from peripheral blood. MMR is defined as a ratio Bcr-Abl/Abl ≤0.1% on the international scale (≥3 log reduction from standardized baseline in ratio of Bcr-Abl to Abl transcripts) with at least 3000 Abl analyzed. The medians have not been reached in either arm, as such, the premature estimated hazard ratio is provided. Three years rate was displayed since the majority of imatinib participants had first MMR by Year 2. |
| Cumulative Incidence of On-Treatment Transformation to Accelerated Phase (AP) or Blast Phase (BP) at 192 Weeks | 192 weeks | The cumulative incidence curve was generated based on the time from randomization to the first date of transformation to AP or BP while on study treatment adjusting for the competing risk of treatment discontinuation without transformation, for each participant. Criteria for transformation to AP: 15 to 29% blasts; ≥30% blasts + promyelocytes; ≥20% basophils in blood or bone marrow; platelets \<100\*10\^9/L (not related to therapy), in blood. Criteria for transformation to BP: ≥30% blasts in blood or bone marrow and extramedullary involvement other than liver or spleen (example: chloromas). Time to transformation was calculated as weeks = (\[date of first documented occurrence of the event - date of randomization\] + 1)/7. If transformation was not obtained, censoring was at the last hematologic assessment or death (whichever was earliest). Participants who were not treated contributed time = 1 day/7. 95% confidence interval for the cumulative incidence is from Gray's method. |
Countries
Argentina, Belgium, Brazil, Canada, Chile, China, Colombia, France, Germany, Hong Kong, Hungary, India, Italy, Japan, Latvia, Lithuania, Mexico, Poland, Russia, Singapore, South Africa, South Korea, Spain, Taiwan, Thailand, Turkey (Türkiye), Ukraine, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Bosutinib Bosutinib 500 milligram (mg) tablet orally once daily up to 5 years or until treatment failure, unacceptable toxicity, death, withdrawal of consent. Dose adjustments, if needed, included an escalation to bosutinib 600 mg tablet orally once daily or a reduction to bosutinib 300 mg tablet orally once daily. | 250 |
| Imatinib Imatinib 400 mg tablet orally once daily up to 5 years or until treatment failure, unacceptable toxicity, death, withdrawal of consent. Dose adjustments, if needed, included an escalation to imatinib 600 mg tablet orally once daily or a reduction to imatinib 300 mg tablet orally once daily. | 252 |
| Total | 502 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Blank, site closed per local regulations | 2 | 2 |
| Overall Study | Death | 15 | 14 |
| Overall Study | Discontinuation of study by sponsor | 5 | 199 |
| Overall Study | Extension Study | 126 | 0 |
| Overall Study | Investigator request | 18 | 8 |
| Overall Study | Lost to Follow-up | 14 | 5 |
| Overall Study | Other | 40 | 4 |
| Overall Study | Withdrawal by Subject | 18 | 19 |
Baseline characteristics
| Characteristic | Bosutinib | Imatinib | Total |
|---|---|---|---|
| Age, Continuous | 47.4 years STANDARD_DEVIATION 14.39 | 45.6 years STANDARD_DEVIATION 14.8 | 46.5 years STANDARD_DEVIATION 14.61 |
| Sex: Female, Male Female | 101 Participants | 117 Participants | 218 Participants |
| Sex: Female, Male Male | 149 Participants | 135 Participants | 284 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 235 / 248 | 238 / 251 |
| serious Total, serious adverse events | 90 / 248 | 57 / 251 |
Outcome results
Percentage of Participants With Complete Cytogenetic Response (CCyR) at Year 1
Cytogenetic Response (CyR) is based on the prevalence of Philadelphia chromosome positive (Ph+) metaphases among cells in metaphase on a bone marrow (BM) aspirate. CCyR was achieved when there was 0 percent (%) Ph+ metaphases among cells in a BM sample when at least 20 metaphases from a BM sample were analyzed, or less than (\<) 1% breakpoint cluster region Abelson protooncogene (Bcr-Abl) fusion product among cells in a BM sample or peripheral blood sample when at least 200 cells were analyzed.
Time frame: Year 1 (48 weeks)
Population: Intent-to-treat (ITT) population - included all participants who were randomized to test article.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bosutinib | Percentage of Participants With Complete Cytogenetic Response (CCyR) at Year 1 | 70.0 Percentage of Participants |
| Imatinib | Percentage of Participants With Complete Cytogenetic Response (CCyR) at Year 1 | 68.3 Percentage of Participants |
Cumulative Incidence of On-Treatment Transformation to Accelerated Phase (AP) or Blast Phase (BP) at 192 Weeks
The cumulative incidence curve was generated based on the time from randomization to the first date of transformation to AP or BP while on study treatment adjusting for the competing risk of treatment discontinuation without transformation, for each participant. Criteria for transformation to AP: 15 to 29% blasts; ≥30% blasts + promyelocytes; ≥20% basophils in blood or bone marrow; platelets \<100\*10\^9/L (not related to therapy), in blood. Criteria for transformation to BP: ≥30% blasts in blood or bone marrow and extramedullary involvement other than liver or spleen (example: chloromas). Time to transformation was calculated as weeks = (\[date of first documented occurrence of the event - date of randomization\] + 1)/7. If transformation was not obtained, censoring was at the last hematologic assessment or death (whichever was earliest). Participants who were not treated contributed time = 1 day/7. 95% confidence interval for the cumulative incidence is from Gray's method.
Time frame: 192 weeks
Population: ITT population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bosutinib | Cumulative Incidence of On-Treatment Transformation to Accelerated Phase (AP) or Blast Phase (BP) at 192 Weeks | 1.6 Percentage of Participants |
| Imatinib | Cumulative Incidence of On-Treatment Transformation to Accelerated Phase (AP) or Blast Phase (BP) at 192 Weeks | 4.4 Percentage of Participants |
Kaplan-Meier Estimate of Probability of Retaining CCyR at 192 Weeks
The Kaplan-Meier curve was generated based the time from the first date of CCyR until the first date of confirmed loss of CCyR, objectively documented, for responders only. Participants without confirmed loss of CCyR were censored at the last valid cytogenetic assessment. CyR is based on the prevalence of Ph+ metaphases among cells in metaphase on a bone marrow sample. CCyR was achieved when there was 0% Ph+ metaphases among cells in a BM sample when at least 20 metaphases from a BM sample were analyzed, or \<1% Bcr-Abl fusion product among cells in a BM sample or peripheral blood sample when at least 200 cells were analyzed. The medians have not been reached in either arm, as such, the premature estimated hazard ratio is provided. Four years rate was displayed since the majority of participants had first CCyR by Year 1.
Time frame: 192 weeks
Population: Subgroup of participants from ITT population who had CCyR.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bosutinib | Kaplan-Meier Estimate of Probability of Retaining CCyR at 192 Weeks | 92.9 Percentage of Participants |
| Imatinib | Kaplan-Meier Estimate of Probability of Retaining CCyR at 192 Weeks | 88.9 Percentage of Participants |
Kaplan-Meier Estimate of Probability of Retaining Complete Hematologic Response (CHR) at 192 Weeks
The Kaplan-Meier curve was generated based on the first date of confirmed CHR until the first date of loss of CHR, objectively documented, for responders only. Participants without confirmed loss of response were censored at the last valid hematologic assessment. CHR must have been of at least 4 weeks in duration confirmed by 2 assessments at least 4 weeks apart and was defined as follows: white blood cells ≤ institutional upper limit of normal, no peripheral blasts or promyelocytes, myelocytes + metamyelocytes \<5% in blood, absolute neutrophil count ≥1.0\*10\^9/L, platelets ≥100 but \<450\*10\^9/L unless related to therapy, \<20% basophils in blood and no extramedually involvement (including hepato- or splenomegaly). The medians have not been reached in either arm, as such, the premature estimated hazard ratio is provided. Four years rate was displayed since the majority of participants had first CHR by Year 1.
Time frame: 192 weeks
Population: Subgroup of participants from ITT population who had CHR.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bosutinib | Kaplan-Meier Estimate of Probability of Retaining Complete Hematologic Response (CHR) at 192 Weeks | 91.6 Percentage of Participants |
| Imatinib | Kaplan-Meier Estimate of Probability of Retaining Complete Hematologic Response (CHR) at 192 Weeks | 86.0 Percentage of Participants |
Kaplan-Meier Estimate of Probability of Retaining Derived MMR at 144 Weeks
The Kaplan-Meier curve was generated based on the first date of MMR until the first date loss of MMR, objectively documented, for responders only. Participants without confirmed loss of response were censored at the last valid molecular assessment. Molecular response was assessed using Bcr-Abl transcript levels measured by RT-PCR from peripheral blood. MMR is defined as a ratio Bcr-Abl/Abl ≤0.1% on the international scale (≥3 log reduction from standardized baseline in ratio of Bcr-Abl to Abl transcripts) with at least 3000 Abl analyzed. The medians have not been reached in either arm, as such, the premature estimated hazard ratio is provided. Three years rate was displayed since the majority of imatinib participants had first MMR by Year 2.
Time frame: 144 weeks
Population: Subgroup of participants from ITT population who had MMR.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bosutinib | Kaplan-Meier Estimate of Probability of Retaining Derived MMR at 144 Weeks | 94.7 Percentage of Participants |
| Imatinib | Kaplan-Meier Estimate of Probability of Retaining Derived MMR at 144 Weeks | 98.0 Percentage of Participants |
Percentage of Participants With Major Molecular Response (MMR) at Year 1
Molecular response was assessed using Bcr-Abl transcript levels measured by reverse transcriptase polymerase chain reaction (RT-PCR) from peripheral blood. A MMR was defined as a ratio Bcr-Abl/Abl less than or equal to (≤) 0.1% on the international scale (greater than or equal to \[≥\] 3 log reduction from standardized baseline in ratio of Bcr-Abl to Abl transcripts) with at least 3000 Abl analyzed.
Time frame: Year 1 (48 weeks)
Population: ITT Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bosutinib | Percentage of Participants With Major Molecular Response (MMR) at Year 1 | 38.0 Percentage of Participants |
| Imatinib | Percentage of Participants With Major Molecular Response (MMR) at Year 1 | 25.4 Percentage of Participants |