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Phase 2 Midostaurin in Aggressive Systemic Mastocytosis and Mast Cell Leukemia

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT00233454
Recruitment Status : Completed
First Posted : October 5, 2005
Results First Posted : July 9, 2015
Last Update Posted : September 20, 2018
Novartis Pharmaceuticals
Information provided by (Responsible Party):
Jason Robert Gotlib, Stanford University

Brief Summary:
The safety and efficacy of midostaurin (PKC412), a novel investigational drug, will be evaluated on the basis of response rate, when administered to patients with aggressive systemic mastocytosis (ASM) or mast cell leukemia (MCL)

Condition or disease Intervention/treatment Phase
Systemic Mastocytosis, Aggressive (ASM) Leukemia, Mast Cell Hematological Non-mast Cell Lineage Disease (AHNMD) Drug: Midostaurin Phase 2

Detailed Description:

This study assesses the activity and safety profile of twice-daily oral doses of midostaurin in patients with aggressive systemic mastocytosis (ASM) or mast cell leukemia (MCL) with or without associated clonal hematological non-mast cell lineage disease (AHNMD).

Aggressive systemic mastocytosis (ASM) and mast cell leukemia (MCL) are characterized by excessive bone marrow production of mast cells which can can infiltrate tissues and release harmful substances, resulting in organ damage. These diseases have very limited treatment options and poor prognosis. Existing treatments for in advanced mast cell disease, eg, interferon-alpha; corticosteroids; and/or cladribine, exhibit low response rates that are usually partial in nature.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 26 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Single Arm, Phase 2, Open-Label Study to Determine the Efficacy of Twice Daily Oral Dosing of PKC412 <Midostaurin> Administered to Patients With Aggressive Systemic Mastocytosis (ASM) and Mast Cell Leukemia (MCL)
Actual Study Start Date : March 2005
Actual Primary Completion Date : June 18, 2010
Actual Study Completion Date : April 16, 2011

Arm Intervention/treatment
Experimental: Midostaurin
100 mg midostaurin twice daily as oral capsules
Drug: Midostaurin
Midostaurin is a broad-spectrum protein kinase inhibitor, acting on conventional PKC isoforms (α, β, γ); PDFRβ; VEGFR2; Syk; PKCη; Flk-1; Flt3; Cdk1/B; PKA; c-Kit; c-Fgr; c-Src; VEGFR1; and EGFR
Other Names:
  • PKC412
  • CGP41251
  • CGP41231

Primary Outcome Measures :
  1. Subjects With Clinical Response [Partial Response (PR) + Complete Response (CR)] [ Time Frame: 2 months ]

    Clinical Response [PR + CR] will be assessed after 2 cycles of treatment, with each cycle being 28 days (4 weeks) in length.

    Except as otherwise noted, the minimum criteria for PR is improvement by at least 50% from the baseline value towards the indicated value for one or more of the criteria below:


    • ANC <1000/uL
    • Hb <10 g/dL
    • Platelets >100,000/uL LIVER
    • If hepatomegaly with ascites, decrease in frequency of paracenteses by 50%
    • Elevated enzyme levels > upper limit of normal (ULN)
    • Hypoalbuminemia < ULN
    • Portal hypertension > ULN SPLEEN
    • If palpable splenomegaly with hypersplenism/thrombocytopenia, hypersplenism markers improved GI TRACT
    • If malabsorption with hypoalbuminemia and/or weight loss, albumin improved BONES
    • If huge osteolyses or/and severe osteoporosis with pathologic fractures, partial resolution of osteolyses

    Subjects with PR or greater continue, those without response discontinue.

Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: 11 months ]
    Overall survival will be assessed after 12 cycles of treatment, with each cycle being 28 days (4 weeks) in length. 12 cycles of treatment is considered to be about 11 months.

  2. Overall Survival (OS) [ Time Frame: 40 months ]
    Overall survival was assessed as the median duration of survival at the time of data cut-off, and reported with 95% confidence interval.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion criteria

  • At least 18 years of age.
  • Karnofsky performance status (KPS) of > 30% (equivalent to ECOG 0 to 3)
  • Mast cell disease, histologically confirmed and documented to be

    • Aggressive systemic mastocytosis (ASM) OR
    • Mast cell leukemia (MCL) meeting the following criteria

      • Meets criteria for systemic mastocytosis
      • Biopsy indicates diffuse infiltration by atypical, immature mast cells
      • Bone marrow aspirate smears show at least 20% mast cells
  • Confirmed availability of tissue sample within 6 months prior to entry into study, for evaluation of KIT mutation status of the tumor cells. Subjects who have systemic mastocytosis PLUS eosinophilia AND known positivity for FIP1L1-PDGFR-alpha fusion are eligible only if they have demonstrated relapse or disease progression on prior imatinib therapy
  • Blood levels of liver enzymes within normal limits (EXCEPTION: If the sole cause of elevated blood levels of liver enzymes is ASM/MCL, then AST and ALT ≤ 4X upper limit of normal (ULN), and/or bilirubin ≤ 4X ULN)
  • Serum creatinine < 2.0 mg/dL
  • If ANC < 1500/mm3; Hb < 10 g/dL; platelets < 75,000/mm3; AND/OR other blood values are > grade 2, then the relationship of these cytopenia(s) should be established as related to ASM or MCL on the basis of presence of mast cell infiltrate in the screening bone marrow exam and/or the presence of disease-related hypersplenism
  • Prior use of glucocorticoids must be tapered off within 14 days of Day 1 of midostaurin treatment (EXCEPTION: If in the opinion of the investigator, the subject can be tapered off glucocorticoids, then dosage should be tapered to the minimal dose possible before first treatment with midostaurin)
  • Negative serum pregnancy test for women of childbearing potential within 48 hours prior to administration of study drug
  • Written informed consent.
  • Anyone of reproductive potential must agree to use barrier contraceptives for the duration of the study
  • Women of childbearing potential must have a negative serum pregnancy test 48 hours prior to administration of study drug, and must agree to:

    • Use barrier contraception for the duration of the study
    • Use barrier contraception for 3 months post-study
    • Not breast-feed

Exclusion criteria

  • Active pulmonary disease based on physical assessment or lateral chest X-ray, considered by the investigator to be unrelated to mastocytosis
  • Any pulmonary infiltrate or abnormality on the baseline chest X-ray known to be new in the previous 4 weeks (EXCEPTION: pleural effusion related to systemic mastocytosis, eg, secondary to ascites, AND not causing symptomatic respiratory complaints, may be eligible)
  • Cardiovascular disease, including congestive heart failure
  • Myocardial infarction within 6 months
  • Poorly-controlled hypertension with any Grade 3/4 cardiac problems (per New York Heart Association Criteria)
  • Uncontrolled diabetes
  • Chronic renal disease
  • Active uncontrolled infection
  • Known malignant disease involving the central nervous system (CNS)
  • Known confirmed diagnosis of HIV infection or active viral hepatitis.
  • Any other known disease, or concurrent severe and/or uncontrolled medical condition which could compromise participation in the study, including but not limited to:
  • Received any investigational agent, chemotherapy, or 2-chlorodeoxyadenosine (2-CdA) within 30 days prior to Day 1 of PKC412 treatment.
  • Received interferon-alpha within 30 days prior to Day 1 of midostaurin treatment.
  • Received hematopoietic growth factor support within 14 days of Day 1 of midostaurin treatment.
  • Any surgical procedure, excluding central venous catheter placement or other minor procedures (eg, skin biopsy) within 14 days of Day 1 of midostaurin treatment
  • Pregnant or breast-feeding
  • Unwilling or unable to comply with the protocol

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00233454

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United States, California
Stanford University School of Medicine
Stanford, California, United States, 94305
United States, Massachusetts
Dana Farber Cancer Institute
Boston, Massachusetts, United States, 02115
United States, Missouri
Washington University-St. Louis
Saint Louis, Missouri, United States, 63110
Sponsors and Collaborators
Jason Robert Gotlib
Novartis Pharmaceuticals
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Principal Investigator: Jason Robert Gotlib Stanford University
Publications of Results:
Gotlib JR, George TI, Linder A, et al. "Phase II Trial of the Tyrosine Kinase Inhibitor PKC412 in Advanced Systemic Mastocytosis: Preliminary Results." Blood. 16 November 2006;108(11)16:abs3609
Gotlib JR, George TI, Corless C, et al. "The KIT Tyrosine Kinase Inhibitor Midostaurin (PKC412) Exhibits a High Response Rate in Aggressive Systemic Mastocytosis(ASM): Interim Results of a Phase 2 Trial." Blood. 16 November 2007;110(11):abs 3536
Gotlib JR, DeAngelo DJ, George TI, et al. "KIT Inhibitor Midostaurin Exhibits a High Rate of Clinically Meaningful and Durable Responses in Advanced Systemic Mastocytosis: Report of a Fully Accrued Phase II Trial." Blood. 19 November 2010;116(21):abs316

Other Publications:
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Responsible Party: Jason Robert Gotlib, Professor of Medicine, Stanford University
ClinicalTrials.gov Identifier: NCT00233454    
Other Study ID Numbers: IRB-13704
95242 ( Other Identifier: Stanford University Secondary IRB Approval Number )
HEMMPD0003 ( Other Identifier: OnCore )
CPKC412D2201 ( Other Identifier: Novartis, Inc )
2213 ( Other Identifier: Novartis, Inc )
First Posted: October 5, 2005    Key Record Dates
Results First Posted: July 9, 2015
Last Update Posted: September 20, 2018
Last Verified: September 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Additional relevant MeSH terms:
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Mastocytosis, Systemic
Leukemia, Mast-Cell
Neoplasms by Histologic Type
Behavioral Symptoms
Neoplasms, Connective Tissue
Neoplasms, Connective and Soft Tissue
Skin Diseases
Immune Complex Diseases
Immune System Diseases
Leukemia, Myeloid, Acute
Leukemia, Myeloid
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action