CHRONIC MYELOGENOUS LEUKEMIA
Conditions
Keywords
MYELOGENOUS, LEUKEMIA, Chronic Phase, CML
Brief summary
The primary goal of this study was to determine the rate of confirmed best cumulative complete molecular response (CMR) within the first year of study therapy with imatinib or nilotinib. The study also explored the impact and significance of the achieved CMR on patient outcomes (progression free survival (PFS), event free survival (EFS) and overall survival (OS), characterized the kinetics of CMR achieved in both treatment arms and after the cross-over.
Interventions
Supplied in 200 mg capsules
Supplied in 100 mg and 400 mg capsules
Sponsors
Study design
Eligibility
Inclusion criteria
Diagnosis of chronic myeloid leukemia associated with BCR-ABL quantifiable by RQ-PCR Documented CCyR by bone marrow or BCR-ABL\<1% IS in the past 12 months Persistent disease demonstrated by two PCR positive tests 3 months apart both during the past 6 months. Treatment with imatinib for at least 2 years with 400 mg or 600 mg and a stable dose No other current or planned anti-leukemia therapies
Exclusion criteria
Patient has evidence of rising PCR (a confirmed \>1 log increase in previous 6 months) Patient has received another investigational agent within last 6 months or tyrosine kinase inhibitors (TKIs) other than imatinib Prior allogeneic stem cell transplantation Impaired cardiac function including any one of the following: Inability to monitor the QT interval on electrocardiogram (ECG) Long QT syndrome or a known family history of long QT syndrome. Clinically significant resting brachycardia (\<50 beats per minute) QTc \> 450 msec on baseline ECG (using the QTcF formula). If QTcF \>450 msec and electrolytes are not within normal ranges, electrolytes should be corrected and then the patient re-screened for QTc Myocardial infarction within 12 months prior to starting study Other clinically significant uncontrolled heart disease (e.g. unstable angina, congestive heart failure or uncontrolled hypertension) History of or presence of clinically significant ventricular or atrial tachyarrhythmias Administration of cytokine therapy (e.g. G-CSF, GM-CSF or SCF) within 4 weeks prior to study entry
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Confirmed Best Cumulative Complete Molecular Response (CMR) | 12 months | The rate of confirmed best cumulative CMR was defined as the number of participants who had confirmed CMR during the first 12 months of treatment after the randomization date. Participants who achieved confirmed best cumulative CMR during the first 12 months were considered responders. Participants who dropped out early or who did not provide sufficient data for any reason were considered to be non-responders. The definition of CMR is undetectable BCR-ABL (fusion gene formed between bcr gene from chromosome 22 and abl gene from chromosome 9) where BCR-ABL ratio in % international scale (IS) ≤ 0.00001 by real-time quantitative polymerase chain reaction (RQ-PCR) where there was no detectable BCR-ABL and 1) the test had a sensitivity of at least 4.5 logs below the standardized baseline; 2) RQ-PCR negativity was confirmed on the next RQ-PCR sample (usually 3 months later); and 3) the date of confirmed CMR was the date of the first of two negative results with sensitivity \>4.5 logs. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Confirmed Best Cumulative CMR | 24 months, 36 month, 48 months | The rate of confirmed best cumulative CMR was defined as the number of participants who had confirmed CMR during the 24, 36 and 48 months post treatment after the randomization date. Participants who achieved confirmed best cumulative CMR during the first 12 months were considered responders. Participants who dropped out early or who did not provide sufficient data for any reason were considered to be non-responders. The definition of CMR is undetectable BCR-ABL (fusion gene formed between bcr gene from chromosome 22 and abl gene from chromosome 9) where BCR-ABL ratio in % international scale (IS) ≤ 0.00001 by RQ-PCR where there was no detectable BCR-ABL and 1) the test had a sensitivity of at least 4.5 logs below the standardized baseline; 2) RQ-PCR negativity was confirmed on the next RQ-PCR sample (usually 3 months later); and 3) the date of confirmed CMR was the date of the first of two negative results with sensitivity \>4.5 logs. |
| Number of Cross-over Participants With CMR | 24 months, 36 months, 48 months | The definition of CMR is undetectable BCR-ABL (fusion gene formed between bcr gene from chromosome 22 and abl gene from chromosome 9) where BCR-ABL ratio in % international scale (IS) ≤ 0.00001 by RQ-PCR where there was no detectable BCR-ABL and 1) the test had a sensitivity of at least 4.5 logs below the standardized baseline; 2) RQ-PCR negativity was confirmed on the next RQ-PCR sample (usually 3 months later); and 3) the date of confirmed CMR was the date of the first of two negative results with sensitivity \>4.5 logs. |
| Progression Free Survival (PFS) | 48 months | PFS was defined as the time from the date of randomization to the date of the earliest documented progression-defining event as follows: transformation to blast crisis or accelerated phase disease, or death from any cause. |
| Event-free Survival | 48 months | Event-free survival was defined as the time from the date of randomization to the date of first occurrence of any of the following events on study treatment: loss of complete hematological response, confirmed loss of complete cytogenetic response (CCyR), confirmed loss of major molecular response (MMR), death from any cause during treatment, progression to the accelerated phase or blast crisis of chronic myelogenous leukemia (CML) per European Leukemia Network (ELN) criteria, whichever was earliest. |
| Overall Survival | 48 months | Overall survival was defined as the time from the date of randomization to the date of death due to any cause at any time during the study, including the follow-up period after discontinuation of treatment. |
Countries
Argentina, Australia, Brazil, Canada, France, Spain
Participant flow
Pre-assignment details
Participants were randomized 1:1. Participants in the imatinib arm were permitted to cross-over to nilotinib after 2 years on study if complete molecular response (CMR) was not achieved, or at any time during the study if participants experienced treatment failure, had confirmed loss of major molecular response (MMR) or had confirmed loss of CMR.
Participants by arm
| Arm | Count |
|---|---|
| Nilotinib Participants received Nilotinib 400 mg orally twice daily (bid) for 48 months. | 104 |
| Imatinib Participants received Imatinib 400 mg or 600 mg once daily (qd) (based on the participant's dose prior to randomization) for 48 months. | 103 |
| Total | 207 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 19 | 12 |
| Overall Study | Death | 2 | 1 |
| Overall Study | Non-compliance with protocol treatment | 2 | 1 |
| Overall Study | Participant diagnosed with AML | 0 | 1 |
| Overall Study | Participant not eligible to cross-over | 0 | 1 |
| Overall Study | Participants transferred to AMN107A2408 | 11 | 1 |
| Overall Study | Physician Decision | 1 | 2 |
| Overall Study | Pregnancy | 1 | 4 |
| Overall Study | Protocol Violation | 1 | 0 |
| Overall Study | Treatment failure | 1 | 0 |
| Overall Study | Withdrawal by Subject | 7 | 3 |
Baseline characteristics
| Characteristic | Nilotinib | Imatinib | Total |
|---|---|---|---|
| Age, Continuous | 48.3 Years STANDARD_DEVIATION 13.26 | 49.9 Years STANDARD_DEVIATION 13.07 | 49.1 Years STANDARD_DEVIATION 13.16 |
| Sex: Female, Male Female | 33 Participants | 38 Participants | 71 Participants |
| Sex: Female, Male Male | 71 Participants | 65 Participants | 136 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 99 / 101 | 79 / 103 | 39 / 46 |
| serious Total, serious adverse events | 21 / 101 | 16 / 103 | 8 / 46 |
Outcome results
Rate of Confirmed Best Cumulative Complete Molecular Response (CMR)
The rate of confirmed best cumulative CMR was defined as the number of participants who had confirmed CMR during the first 12 months of treatment after the randomization date. Participants who achieved confirmed best cumulative CMR during the first 12 months were considered responders. Participants who dropped out early or who did not provide sufficient data for any reason were considered to be non-responders. The definition of CMR is undetectable BCR-ABL (fusion gene formed between bcr gene from chromosome 22 and abl gene from chromosome 9) where BCR-ABL ratio in % international scale (IS) ≤ 0.00001 by real-time quantitative polymerase chain reaction (RQ-PCR) where there was no detectable BCR-ABL and 1) the test had a sensitivity of at least 4.5 logs below the standardized baseline; 2) RQ-PCR negativity was confirmed on the next RQ-PCR sample (usually 3 months later); and 3) the date of confirmed CMR was the date of the first of two negative results with sensitivity \>4.5 logs.
Time frame: 12 months
Population: The intent-to-treat analysis set, which included all randomized participants, was analyzed.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Nilotinib | Rate of Confirmed Best Cumulative Complete Molecular Response (CMR) | Responders | 13 Participants |
| Nilotinib | Rate of Confirmed Best Cumulative Complete Molecular Response (CMR) | Non-responders | 91 Participants |
| Imatinib | Rate of Confirmed Best Cumulative Complete Molecular Response (CMR) | Responders | 6 Participants |
| Imatinib | Rate of Confirmed Best Cumulative Complete Molecular Response (CMR) | Non-responders | 97 Participants |
Event-free Survival
Event-free survival was defined as the time from the date of randomization to the date of first occurrence of any of the following events on study treatment: loss of complete hematological response, confirmed loss of complete cytogenetic response (CCyR), confirmed loss of major molecular response (MMR), death from any cause during treatment, progression to the accelerated phase or blast crisis of chronic myelogenous leukemia (CML) per European Leukemia Network (ELN) criteria, whichever was earliest.
Time frame: 48 months
Population: The intent-to-treat analysis set, which included all randomized participants, was analyzed.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nilotinib | Event-free Survival | NA Months |
| Imatinib | Event-free Survival | NA Months |
Number of Cross-over Participants With CMR
The definition of CMR is undetectable BCR-ABL (fusion gene formed between bcr gene from chromosome 22 and abl gene from chromosome 9) where BCR-ABL ratio in % international scale (IS) ≤ 0.00001 by RQ-PCR where there was no detectable BCR-ABL and 1) the test had a sensitivity of at least 4.5 logs below the standardized baseline; 2) RQ-PCR negativity was confirmed on the next RQ-PCR sample (usually 3 months later); and 3) the date of confirmed CMR was the date of the first of two negative results with sensitivity \>4.5 logs.
Time frame: 24 months, 36 months, 48 months
Population: Participants from the Imatinib treatment group who crossed over to the Nilotinib treatment group were analyzed.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Nilotinib | Number of Cross-over Participants With CMR | 24 months | 3 Participants |
| Nilotinib | Number of Cross-over Participants With CMR | 36 months | 6 Participants |
| Nilotinib | Number of Cross-over Participants With CMR | 48 months | 9 Participants |
Overall Survival
Overall survival was defined as the time from the date of randomization to the date of death due to any cause at any time during the study, including the follow-up period after discontinuation of treatment.
Time frame: 48 months
Population: The intent-to-treat analysis set, which included all randomized participants, was analyzed.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nilotinib | Overall Survival | NA Months |
| Imatinib | Overall Survival | NA Months |
Progression Free Survival (PFS)
PFS was defined as the time from the date of randomization to the date of the earliest documented progression-defining event as follows: transformation to blast crisis or accelerated phase disease, or death from any cause.
Time frame: 48 months
Population: 24 months, Non-responders
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nilotinib | Progression Free Survival (PFS) | NA months |
| Imatinib | Progression Free Survival (PFS) | NA months |
Rate of Confirmed Best Cumulative CMR
The rate of confirmed best cumulative CMR was defined as the number of participants who had confirmed CMR during the 24, 36 and 48 months post treatment after the randomization date. Participants who achieved confirmed best cumulative CMR during the first 12 months were considered responders. Participants who dropped out early or who did not provide sufficient data for any reason were considered to be non-responders. The definition of CMR is undetectable BCR-ABL (fusion gene formed between bcr gene from chromosome 22 and abl gene from chromosome 9) where BCR-ABL ratio in % international scale (IS) ≤ 0.00001 by RQ-PCR where there was no detectable BCR-ABL and 1) the test had a sensitivity of at least 4.5 logs below the standardized baseline; 2) RQ-PCR negativity was confirmed on the next RQ-PCR sample (usually 3 months later); and 3) the date of confirmed CMR was the date of the first of two negative results with sensitivity \>4.5 logs.
Time frame: 24 months, 36 month, 48 months
Population: The intent-to-treat analysis set, which included all randomized participants, was analyzed.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Nilotinib | Rate of Confirmed Best Cumulative CMR | 48 months, Non-responders | 72 Participants |
| Nilotinib | Rate of Confirmed Best Cumulative CMR | 24 months, Non-responders | 80 Participants |
| Nilotinib | Rate of Confirmed Best Cumulative CMR | 48 months, Responders | 32 Participants |
| Nilotinib | Rate of Confirmed Best Cumulative CMR | 36 months, Responders | 29 Participants |
| Nilotinib | Rate of Confirmed Best Cumulative CMR | 24 months, Responders | 24 Participants |
| Nilotinib | Rate of Confirmed Best Cumulative CMR | 36 months, Non-responders | 75 Participants |
| Imatinib | Rate of Confirmed Best Cumulative CMR | 24 months, Responders | 11 Participants |
| Imatinib | Rate of Confirmed Best Cumulative CMR | 48 months, Responders | 21 Participants |
| Imatinib | Rate of Confirmed Best Cumulative CMR | 48 months, Non-responders | 82 Participants |
| Imatinib | Rate of Confirmed Best Cumulative CMR | 36 months, Non-responders | 82 Participants |
| Imatinib | Rate of Confirmed Best Cumulative CMR | 24 months, Non-responders | 92 Participants |
| Imatinib | Rate of Confirmed Best Cumulative CMR | 36 months, Responders | 21 Participants |