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Efficacy and Safety Assessment of NIlotinib in CML Patients With Suboptimal Response on Imatinib Therapy (NISRI)

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: NCT02086487
Recruitment Status : Terminated (Because of many unseen obstacles resulted in poor accrual, study is terminated.)
First Posted : March 13, 2014
Last Update Posted : March 7, 2017
Sponsor:
Collaborator:
Novartis
Information provided by (Responsible Party):
King Abdullah International Medical Research Center

Brief Summary:
whether Nilotinib at the two sequential dosage forms will induce quicker and deeper response in those patients, and if FISH on PB (Peripheral blood) would be an effective way to monitor response compared to conventional cytogenetics on bone marrow (BM) sample

Condition or disease Intervention/treatment Phase
Myeloid Leukemia, Chronic Drug: Nilotinib 300 mg. Phase 4

Detailed Description:

This is a multicenter, open label trial which will be conducted within Kingdom of saudi Arabia for which CML (Chronic Myeloid Leukemia) patients who meet eligibility criteria and showing sub optimal response to Imatinib therapy as per European leukemia Net ELN 2013 guidelines will be recruited and switched to Nilotinib 300 mg twice a day therapy.

Efficacy assessments of hematologic and cytogenetic response and disease progression, will be performed every 6 months at a minimum, including hematologic analysis, bone marrow cytogenetics, and molecular studies to ensure that nilotinib is being provided to patients who were responding and that patients who progressed could discontinue therapy.

Safety assessments include evaluation of adverse events, hematologic assessment, biochemical testing, cardiac enzyme assessment, serial electrocardiogram evaluation, and physical examination. Adverse events are graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0. Survival will be dated from start of nilotinib therapy until death from any cause and censored at last follow-up for patients who were alive.

The data will be summarized with respect to demographic and baseline characteristics, efficacy evaluation, and safety observations and measurements.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 98 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy and Safety Assessment of NIlotinib in CML Patients With Suboptimal Response on Imatinib Therapy (NISRI)
Study Start Date : March 2013
Actual Primary Completion Date : August 2016
Actual Study Completion Date : August 2016


Arm Intervention/treatment
Experimental: Nilotinib 300 mg

Patients diagnosed with chronic myeloid leukemia receiving treatment of Imatinib 400 mg but show sub-optimal response on Imatinib therapy as per the ELN 2013 guidelines will be switched to Nilotinib 300 mg twice daily and will be assessed for timely.

In the absence of safety concerns, nilotinib could be escalated to 400 mg twice daily if patients had not obtained any of the following milestones:

  1. BCR-ABL1 transcript level ≤ 10% at 3 months;
  2. CCyR at 6 months,
  3. BCR/ABL1 ≤ 1% at 6 months
  4. MMR at 12 months, or
  5. if they showed loss of cytogenetic or molecular response or disease progression at any time. Failure and thus, stopping nilotinib will be considered if any of above milestones happened while on the 400mg twice daily dose.
Drug: Nilotinib 300 mg.

Patients diagnosed with chronic myeloid leukemia receiving treatment of Imatinib 400 mg once a day but are determined to be sub-optimally responding to Imatinib therapy as per the ELN 2013 guidelines will be switched to Nilotinib 300 mg BID and then will be assessed for therapy response. ELN guidelines 2013 for imatinib therapy response states as:

Minor cytogenetic response mCyR or minimal response at 3 months (Ph+ metaphases in BM 35 to 95 %); BCR-ABL1 transcript > 10% at 3 months; Partial cytogenetic response at 6 months Ph+ metaphases in BM 0to 35); BCR-ABL1 transcript is 1 to 10% at 6 months. Less than a major molecular response at > 12 months; i.e (BCR-ABL1 0.1 -1%)

Other Name: Tasigna 300 mg




Primary Outcome Measures :
  1. The primary efficacy variable of this study is the overall Major molecular response at 12 month after starting Nilotinib 300mg twice daily for patient who suboptimally responded to Imatinib as per the ELN guidelines [ Time Frame: 12 Months ]

Secondary Outcome Measures :
  1. Rate of cytogenetic response (complete cytogenetic response CCyR and Major cytogenetic response MCyR) and Major molecular response MMR at 3, 6 and 12 months of starting Nilotinib in patients who had a suboptimal response on Imatinib. [ Time Frame: 12Months ]
  2. Rate of CCyR at 6 months and MMR at 6 and 12 months from Nilotinib dose escalating to 400 mg BID. [ Time Frame: 12 months ]
  3. Rate and duration of Complete Hematologic Response CHR. [ Time Frame: 12 months ]
  4. Rate of CMR at 12 months of Nilotinib. [ Time Frame: 12 months ]
  5. Comparison of FISH results with conventional cytogenetics at 3, 6 & 12 months. [ Time Frame: 12 ]
  6. Overall survival. [ Time Frame: 12 ]

Other Outcome Measures:
  1. Mutational analysis for the patients with suboptimal response at the pre defined end points as per the ELN guidelines. [ Time Frame: 12 months ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Written informed consent prior to any study procedures being performed.
  2. Age 18 or above of male or female CML patients in chronic phase.
  3. Eastern Cooperative Oncology Group ECOG Performance status 0, 1 or 2
  4. Sub-optimal response on Imatinib therapy as determined by any of the following criteria: 4.1) Minor cytogenetic response mCyR or minimal response at 3 months (Ph+ metaphases in BM 35 to 95 %) 4.2) BCR-ABL1 transcript >10% at 3 months; 4.3) Partial cytogenetic response PCyR at 6 months; (i.e Ph+ metaphases in BM 0 to 35%) 4.4) BCR-ABL1 transcript 1 - 10% at 6 months 4.5) Less than a major molecular response at > 12 months; i.e (BCR-ABL1 0.1 - 1%)
  5. Normal serum levels of potassium, magnesium and calcium ≥ LLN (lower limit of normal) or corrected to within normal limits with supplements, prior to the first dose of study medication,
  6. Aspartate aminotransferase AST and Alanine aminotransferase ALT ≤ 2.5 x ULN (upper limit of normal)
  7. Alkaline phosphatase ≥ 2.5 x ULN
  8. Total bilirubin ≤ 1.5 x ULN;
  9. Serum amylase ≤ 1.5 x ULN Performance status ECOG 0,1,2

Exclusion Criteria:

  1. Previous Exposure to Tyrosine Kinase Inhibitor (TKI) other than Imatinib for more than 2 weeks
  2. Patients who are already participating in any other clinical trial.Patients who were not compliant to Imatinib therapy.
  3. Optimal response to Imatinib therapy as determined by any one of the criteria: 3.1. CCyR or PCyR at 3 months (Ph+ metaphases in BM ≤ 35 %). 3.2. BCR-ABL1 transcript ≤ 10 % at 3 months. 3.3. CCyR at 6 months (Ph+ metaphases in BM 0 %). 3.4. BCR-ABL1 transcript < 1% at 6 months. 3.5. BCR-ABL1 transcript ≤ 0.1 % at 12 months. 3.6. BCR-ABL1 transcript ≤ 0.1 % at any time.
  4. Failure response to Imatinib therapy as per ELN guidelines 2013 as determined by any of the criteria: 4.1. Non- complete hematologic response (Non- CHR) or no cytogenetic response CyR at 3 months (Ph+ metaphases in BM > 95 %). 4.2. Less than Partial cytogenetic response PCyR at 6 months (Ph+ metaphases in BM > 35%). 4.3. BCR-ABL1 transcript >10 % at 6 months. 4.4. Less than complete cytogenetic response CCyR at 12 months (Ph+ metaphases in BM > 0 %). 4.5. BCR-ABL1 transcript >1 % at 12 months. 4.6. Loss of CHR or loss of CCyR or confirmed loss of MMR* or development of partially imatinib - sensitive BCR-ABL mutation or CCA in Ph- positive cells at any time.
  5. Pregnant or lactating females
  6. Patients with prolonged QT intervals
  7. Patient with history of pancreatitis
  8. Previously documented T315I mutations;
  9. Uncontrolled congestive heart failure or hypertension;
  10. Myocardial infarction or unstable angina pectoris within past 12 months;
  11. Significant arrhythmias, including history or presence of clinically significant ventricular or atrial tachyarrhythmias, clinically -significant bradycardias, long QT syndrome and/or corrected QT interval (QTc) > 450 msec on screening ECG. Patients with complete LBBB (Left Bundle Branch Block);
  12. Patients concurrently on strong CYP3A4 inhibitors.
  13. Other concurrent uncontrolled medical conditions (e.g. uncontrolled diabetes, active or uncontrolled infections, acute or chronic liver and renal disease) that could cause unacceptable safety risks or compromise compliance with the protocol;
  14. Impaired gastrointestinal function or GI disease that may alter the absorption of study drug (e.g. ulcerative disease, uncontrolled nausea, vomiting and diarrhea, malabsorption syndrome, small bowel resection or gastric by-pass surgery);
  15. Patients with another primary malignancy that is currently clinically significant or requires active intervention.

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): NCT02086487


Locations
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Saudi Arabia
National Guard Hospital
Riyadh, Central, Saudi Arabia, 11426
King Fahad specialist Hospital
Dammam, Eastern, Saudi Arabia
Sponsors and Collaborators
King Abdullah International Medical Research Center
Novartis
Investigators
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Principal Investigator: Dr. Ahmad S. Alaskar, MD,FACP,FRCP King Abdulaziz Medical City

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Responsible Party: King Abdullah International Medical Research Center
ClinicalTrials.gov Identifier: NCT02086487    
Other Study ID Numbers: RC12/052
First Posted: March 13, 2014    Key Record Dates
Last Update Posted: March 7, 2017
Last Verified: March 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Keywords provided by King Abdullah International Medical Research Center:
NIlotinib , Suboptimal Response , Imatinib
Additional relevant MeSH terms:
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Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid
Leukemia
Neoplasms by Histologic Type
Neoplasms
Myeloproliferative Disorders
Bone Marrow Diseases
Hematologic Diseases
Imatinib Mesylate
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action