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Nilotinib Versus Standard Imatinib (400/600 mg Every Day (QD)) Comparing the Kinetics of Complete Molecular Response for Chronic Myelogenous Leukemia in Chronic Phase (CML-CP) Pts With Evidence of Persistent Leukemia by Real-time Quantitative Polymerase Chain Reaction (RQ-PCR)

An Open Label, Randomized Study of Nilotinib vs. Standard Imatinib (400/600 mg QD) Comparing the Kinetics of Complete Molecular Response for CML-CP Patients With Evidence of Persistent Leukemia by RQ-PCR.

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00760877
Enrollment
207
Registered
2008-09-26
Start date
2009-06-30
Completion date
2015-07-31
Last updated
2016-11-08

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

Conditions

CHRONIC MYELOGENOUS LEUKEMIA

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

DRUGNilotinib

Supplied in 200 mg capsules

DRUGImatinib

Supplied in 100 mg and 400 mg capsules

Sponsors

Novartis Pharmaceuticals
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

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

MeasureTime frameDescription
Rate of Confirmed Best Cumulative Complete Molecular Response (CMR)12 monthsThe 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

MeasureTime frameDescription
Rate of Confirmed Best Cumulative CMR24 months, 36 month, 48 monthsThe 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 CMR24 months, 36 months, 48 monthsThe 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 monthsPFS 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 Survival48 monthsEvent-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 Survival48 monthsOverall 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

ArmCount
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
Total207

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event1912
Overall StudyDeath21
Overall StudyNon-compliance with protocol treatment21
Overall StudyParticipant diagnosed with AML01
Overall StudyParticipant not eligible to cross-over01
Overall StudyParticipants transferred to AMN107A2408111
Overall StudyPhysician Decision12
Overall StudyPregnancy14
Overall StudyProtocol Violation10
Overall StudyTreatment failure10
Overall StudyWithdrawal by Subject73

Baseline characteristics

CharacteristicNilotinibImatinibTotal
Age, Continuous48.3 Years
STANDARD_DEVIATION 13.26
49.9 Years
STANDARD_DEVIATION 13.07
49.1 Years
STANDARD_DEVIATION 13.16
Sex: Female, Male
Female
33 Participants38 Participants71 Participants
Sex: Female, Male
Male
71 Participants65 Participants136 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
99 / 10179 / 10339 / 46
serious
Total, serious adverse events
21 / 10116 / 1038 / 46

Outcome results

Primary

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.

ArmMeasureGroupValue (NUMBER)
NilotinibRate of Confirmed Best Cumulative Complete Molecular Response (CMR)Responders13 Participants
NilotinibRate of Confirmed Best Cumulative Complete Molecular Response (CMR)Non-responders91 Participants
ImatinibRate of Confirmed Best Cumulative Complete Molecular Response (CMR)Responders6 Participants
ImatinibRate of Confirmed Best Cumulative Complete Molecular Response (CMR)Non-responders97 Participants
p-value: 0.108395% CI: [0.766, 5.738]Cochran-Mantel-Haenszel
Secondary

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.

ArmMeasureValue (MEDIAN)
NilotinibEvent-free SurvivalNA Months
ImatinibEvent-free SurvivalNA Months
Secondary

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.

ArmMeasureGroupValue (NUMBER)
NilotinibNumber of Cross-over Participants With CMR24 months3 Participants
NilotinibNumber of Cross-over Participants With CMR36 months6 Participants
NilotinibNumber of Cross-over Participants With CMR48 months9 Participants
Secondary

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.

ArmMeasureValue (MEDIAN)
NilotinibOverall SurvivalNA Months
ImatinibOverall SurvivalNA Months
Secondary

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

ArmMeasureValue (MEDIAN)
NilotinibProgression Free Survival (PFS)NA months
ImatinibProgression Free Survival (PFS)NA months
Secondary

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.

ArmMeasureGroupValue (NUMBER)
NilotinibRate of Confirmed Best Cumulative CMR48 months, Non-responders72 Participants
NilotinibRate of Confirmed Best Cumulative CMR24 months, Non-responders80 Participants
NilotinibRate of Confirmed Best Cumulative CMR48 months, Responders32 Participants
NilotinibRate of Confirmed Best Cumulative CMR36 months, Responders29 Participants
NilotinibRate of Confirmed Best Cumulative CMR24 months, Responders24 Participants
NilotinibRate of Confirmed Best Cumulative CMR36 months, Non-responders75 Participants
ImatinibRate of Confirmed Best Cumulative CMR24 months, Responders11 Participants
ImatinibRate of Confirmed Best Cumulative CMR48 months, Responders21 Participants
ImatinibRate of Confirmed Best Cumulative CMR48 months, Non-responders82 Participants
ImatinibRate of Confirmed Best Cumulative CMR36 months, Non-responders82 Participants
ImatinibRate of Confirmed Best Cumulative CMR24 months, Non-responders92 Participants
ImatinibRate of Confirmed Best Cumulative CMR36 months, Responders21 Participants

Source: ClinicalTrials.gov · Data processed: Mar 7, 2026