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Compare Bosutinib To Imatinib In Subjects With Newly Diagnosed Chronic Phase Philadelphia Chromosome Positive CML

A PHASE 3 RANDOMIZED, OPEN-LABEL STUDY OF BOSUTINIB VERSUS IMATINIB IN SUBJECTS WITH NEWLY DIAGNOSED CHRONIC PHASE PHILADELPHIA CHROMOSOME POSITIVE CHRONIC MYELOGENOUS LEUKEMIA

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00574873
Enrollment
502
Registered
2007-12-17
Start date
2008-02-05
Completion date
2015-05-27
Last updated
2019-01-08

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Chronic Myeloid Leukemia

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

DRUGBosutinib

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.

DRUGimatinib

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

Wyeth is now a wholly owned subsidiary of Pfizer
CollaboratorINDUSTRY
Pfizer
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Percentage of Participants With Complete Cytogenetic Response (CCyR) at Year 1Year 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

MeasureTime frameDescription
Percentage of Participants With Major Molecular Response (MMR) at Year 1Year 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 Weeks192 weeksThe 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 Weeks192 weeksThe 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 Weeks144 weeksThe 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 Weeks192 weeksThe 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

ArmCount
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
Total502

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyBlank, site closed per local regulations22
Overall StudyDeath1514
Overall StudyDiscontinuation of study by sponsor5199
Overall StudyExtension Study1260
Overall StudyInvestigator request188
Overall StudyLost to Follow-up145
Overall StudyOther404
Overall StudyWithdrawal by Subject1819

Baseline characteristics

CharacteristicBosutinibImatinibTotal
Age, Continuous47.4 years
STANDARD_DEVIATION 14.39
45.6 years
STANDARD_DEVIATION 14.8
46.5 years
STANDARD_DEVIATION 14.61
Sex: Female, Male
Female
101 Participants117 Participants218 Participants
Sex: Female, Male
Male
149 Participants135 Participants284 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
235 / 248238 / 251
serious
Total, serious adverse events
90 / 24857 / 251

Outcome results

Primary

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.

ArmMeasureValue (NUMBER)
BosutinibPercentage of Participants With Complete Cytogenetic Response (CCyR) at Year 170.0 Percentage of Participants
ImatinibPercentage of Participants With Complete Cytogenetic Response (CCyR) at Year 168.3 Percentage of Participants
p-value: 0.667Stratified Cochran-Mantel-Haenszel
Secondary

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

ArmMeasureValue (NUMBER)
BosutinibCumulative Incidence of On-Treatment Transformation to Accelerated Phase (AP) or Blast Phase (BP) at 192 Weeks1.6 Percentage of Participants
ImatinibCumulative Incidence of On-Treatment Transformation to Accelerated Phase (AP) or Blast Phase (BP) at 192 Weeks4.4 Percentage of Participants
95% CI: [0.13, 1.29]
Secondary

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.

ArmMeasureValue (NUMBER)
BosutinibKaplan-Meier Estimate of Probability of Retaining CCyR at 192 Weeks92.9 Percentage of Participants
ImatinibKaplan-Meier Estimate of Probability of Retaining CCyR at 192 Weeks88.9 Percentage of Participants
95% CI: [0.31, 1.31]
Secondary

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.

ArmMeasureValue (NUMBER)
BosutinibKaplan-Meier Estimate of Probability of Retaining Complete Hematologic Response (CHR) at 192 Weeks91.6 Percentage of Participants
ImatinibKaplan-Meier Estimate of Probability of Retaining Complete Hematologic Response (CHR) at 192 Weeks86.0 Percentage of Participants
95% CI: [0.32, 1.08]
Secondary

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.

ArmMeasureValue (NUMBER)
BosutinibKaplan-Meier Estimate of Probability of Retaining Derived MMR at 144 Weeks94.7 Percentage of Participants
ImatinibKaplan-Meier Estimate of Probability of Retaining Derived MMR at 144 Weeks98.0 Percentage of Participants
95% CI: [0.9, 11.72]
Secondary

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

ArmMeasureValue (NUMBER)
BosutinibPercentage of Participants With Major Molecular Response (MMR) at Year 138.0 Percentage of Participants
ImatinibPercentage of Participants With Major Molecular Response (MMR) at Year 125.4 Percentage of Participants
p-value: 0.002Stratified Cochran-Mantel-Haenszel

Source: ClinicalTrials.gov · Data processed: Mar 8, 2026