Phase II Front-line Ponatinib in Adult Philadelphia+/BCR-ABL+ Acute Lymphoblastic Leukemia. (LAL1811)
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|ClinicalTrials.gov Identifier: NCT01641107|
Recruitment Status : Completed
First Posted : July 16, 2012
Last Update Posted : November 30, 2021
|Condition or disease||Intervention/treatment||Phase|
|Philadelphia Positive BCR-ABL Positive Acute Lymphoblastic Leukemia||Drug: Ponatinib||Phase 2|
This is a multi-center, phase 2, single arm unblinded trial of oral Ponatinib in patients with Ph+ Acute Lymphoblastic Leukemia. Patients will receive daily oral administration of Ponatinib at a dose of 45 mg/day for 6 weeks (defined as one course) for 8 courses, same dose and schedule, for a total of 48 weeks. Each patient will be followed for the subsequent 24 months, every 3 month, providing survival information and monitoring serious adverse event.
Each patient should be treated for a minimum of 6 weeks. Then a patient can be discontinued in the following situation:
- at the end of first course (6 weeks), in case of lack of CHR;
- at the end of third course (18 weeks), in case of lack of CCgR;
- any time in case of loss of CHR or CCgR.
If they remain on therapy after 48 weeks, they will be able to continue treatment during the extension phase of the study, if it is of interest of the patient, or they will be allowed to receive any treatment that is in their interest. For all the patients remaining on trial, response, outcome and toxicity will be followed for the subsequent 24 months.The 6-weeks periodicity must be rigidly respected, irrespective of the temporary discontinuation of study drug (eg, if a patient will take Ponatinib only for 4 weeks and will remain off-treatment for the subsequent two weeks because of AE, when the 7th week begins this patient will restart Ponatinib as a second course, as per protocol). Prednisone (P) will be administered to all patients for 7-14 days, before Ponatinib, so as to make it possible to wait for the results of cytogenetic and molecular tests, and to evaluate the response to P alone, hence for another 21 days. Intrathecal therapy (IT) with MTX/AraC/DEX is mandatory, every 28 days, in patients without clinical-cytologic evidence of meningeal involvement. In patients with CNS disease, IT is performed twice weekly until a complete clearance of cerebrospinal fluid blast cells is achieved, hence once weekly for 4 weeks, hence once monthly.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||44 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Front-line Treatment of Philadelphia Positive/BCR-ABL Positive Acute Lymphoblastic Leukemia With Ponatinib, a New Potent Tyrosine Kinase Inhibitor.|
|Actual Study Start Date :||December 4, 2014|
|Actual Primary Completion Date :||April 24, 2020|
|Actual Study Completion Date :||September 30, 2021|
Patients will receive daily oral administration of Ponatinib at a dose of 45 mg/day for 6 weeks (defined as one course) for 8 courses, same dose and schedule, for a total of 48 weeks. Each patient will be followed for the subsequent 24 months, every 3 month, providing survival information and monitoring serious adverse event. Each patient should be treated for a minimum of 6 weeks. Patients must be discontinued from the trial in the event of myocardial infarction or stroke, or for development or progression of arterial disease necessitating revascularization. Once a complete hematologic response has been achieved, with a platelet count ≥ 50x109/L, patients can be treated with aspirin and/or a statin as clinically indicated, at investigator discretion.
- Proportion of patients who are in Complete Hematological Response (CHR). [ Time Frame: At 6 months from study entry. ]The primary endpoint is the proportion of patients who are in CHR at 6 months, calculated on the total number of patients who have been enroled and have received at least one dose of the first drug (prednisone).
- The rate of Complete Hematological Response (CHR). [ Time Frame: At 6, 12, 24, 36 and 48 weeks from study entry. ]
CHR requires that all of the following are present:
- Bone marrow with less than 5% blast cells
- Peripheral blood differential without blasts
- PMN ≥ 1.5 x 109/L
- PLT ≥ 100 x 109/L
- No evidence of extramedullary involvement from leukemia
- The rate of complete Cytogenetic Response (CgR). [ Time Frame: At 6, 12, 24, 36 and 48 weeks from study entry. ]
CgR is defined based on the percentage of Ph pos metaphases, as evaluated by chromosome banding analysis (CBA) of at least 20 marrow cell metaphases:
- Complete (CCgR) if Ph pos 0
- Partial (PCgR) if Ph pos 1-34%
- Minor (mCgR) if Ph pos 35-65%
- Minimal or none (min/none CgR) if Ph pos > 65% If only interphase FISH data are available, the response can be defined only as non-complete or complete - to be complete by FISH, it is required that less than 1% of nuclei (minimum number 200) have a positive signal.
- Duration of Complete Cytogenetic Response (CCgR). [ Time Frame: After four years from study entry. ]Duration of CCgR is measured by the date of the achievement of CCgR to the date of CCgR loss.
- The rate of Complete Molecular Response (CMoIR). [ Time Frame: At 12, 24, 36 and 48 weeks from study entry. ]
Molecular response is classified as:
• Complete if by RT-Q-PCR the BCR-ABL: ABL ratio is below 0.01, with a sensitivity of at least 30,000 molecules of ABL.
- The rate of major molecular response. [ Time Frame: At 12, 24, 36 and 48 weeks from study entry. ]
Molecular response (MR) is classified as:
• Major (MMolR) if by RT-Q-PCR the BCR-ABL: ABL ratio is lower than 0.10, with a sensitivity of at least 30,000 molecules of ABL.
- Duration of Complete molecular response (CMR). [ Time Frame: After four years from study entry. ]Duration of CMR is measured by the date of the achievement of CMR to the date of CMR loss.
- Type and number of BCR-ABL kinase domain mutations. [ Time Frame: At the end of the study. At four years after enrollment of first patient. ]
- Percentage of relationships between the response and the biomarkers. [ Time Frame: At six months from study entry. ]
- Event Free Survival. [ Time Frame: After four years from study entry. ]Events are induction failure, relapse and death whichever comes first.
- Overall survival [ Time Frame: At the end of study. After four years from enrolment. ]Overall survival is measured in all patients from the data of enrolment to the date of death, by any causes.
- Failure Free Survival [ Time Frame: After four years from study entry. ]
- Rate of Rate of side effects, adverse events and serious adverse events. [ Time Frame: After four years from study entry. ]
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): NCT01641107
|Principal Investigator:||Michele Baccarani, Pr.||Dpt of Hematology and Oncology "Seràgnoli", "Sant'Orsola-Malpighi" University Hospital of Bologna|