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Trial record 2 of 8 for:    bosutinib | Leukemia, Myeloid | Italy

Bosutinib in Elderly Chronic Myeloid Leukemia (BEST)

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02810990
Recruitment Status : Recruiting
First Posted : June 23, 2016
Last Update Posted : September 1, 2017
Information provided by (Responsible Party):
Gruppo Italiano Malattie EMatologiche dell'Adulto

Brief Summary:
The objective of the present study is to evaluate a new drug called bosutinib as it is believed that this agent may be able to predict an excellent prognosis in patients that did not obtain any benefit with other drugs before. Still, this needs to be proved and we hope this study is able to do so.

Condition or disease Intervention/treatment Phase
Chronic Myeloid Leukemia Drug: Bosutinib Phase 2

Detailed Description:
Bosutinib is a potent tyrosine kinase inhibitor (TKI) active at nM concentration on BCR-ABL1 and most BCR-ABL1 mutations. Bosutinib has been approved by the FDA and the EMA for the treatment of patients with Ph+/BCR-ABL1+ chronic myeloid leukemia who fail treatment with other TKIs, first or second line. The goal of second-line treatment of CML is to achieve a response that would predict for a survival equal to, or very close to, the survival of non leukemic people, that is to say to achieve a complete cytogenetic response (CCyR) or a major molecular response (MMR). To achieve that goal, it is necessary to find and keep the right balance between activity, safety, and tolerability. There are no studies comparing TKIs in second-line. From phase 2, single-arm, studies, the reported efficacy of Bosutinib is similar to the reported efficacy of dasatinib and nilotinib. The median age of newly diagnosed CML patients is about 56 years, and at least 40% of all newly diagnosed patients are more than 60 years old. Particularly for these patients, the choice of the TKI must take into account the safety and the tolerability profile of the TKIs. The use of dasatinib and nilotinib is burdened by pleural and pulmonary complications, by infections, and by cardiovascular, thrombotic and metabolic (diabetes mellitus, dyslipidemia) complications. These complications are more frequent and more clinically relevant in the elderly. The safety and tolerability of Bosutinib has been reported in first- as well as in second- and third-line. The standard dose (500 mg once daily) is tolerated and safe, but at that dose several adverse events (AEs) limit the tolerability, require dose reduction or interruption, and affect patient quality of life, including diarrhea, nausea, vomiting, skin rash. Also an increase of AST, ALT and lipase are of concern and a cause of treatment discontinuation. On the contrary, an increased frequency of infections and of pleuro-pulmonary, cardiovascular, thrombotic, and metabolic AEs has not been reported. The reported hematologic toxicity of Bosutinib is at least as low as, or even lower than, that reported for the other TKIs, in spite of the fact that Bosutinib is a dual, BCR-ABL1 and src inhibitor. Until today, all studies of TKIs in CML have tested a fixed initial dose, providing for dose adjustment in case of toxicity (dose decrease) or in case of unsatisfactory response (dose increase). No study so far was designed to test the adaptation of the dose to the response, taking advantage of the fact that the efficacy of TKI treatment can be assessed rapidly and precisely by measuring the BCR-ABL1 transcripts level with real-time PCR (RT-PCR) in peripheral blood cells. An RT-PCR monthly for the first few months provides the best assessment of the response to treatment. We predict that a more flexible strategy of treatment (adapting the dose to the response) will result into a more convenient balance between activity and toxicity, hence into a better outcome. Based on these premises, it is proposed to test the activity, the safety, and the tolerability of Bosutinib, second-line, beginning with a low dose and adjusting subsequent doses based on molecular response, and on AEs, in a population of elderly patients. In almost all prior studies of TKIs in second- or third-line, the primary efficacy was assessed using cytogenetic response, both major and complete, at different time points. To make the results of this study comparable to the results of prior studies, the cytogenetic response will be evaluated as specified in section 5, but since the response to therapy and the evaluation of the efficacy of therapy are more and more based on molecular response, dose adaptation and efficacy evaluation will be based primarily on molecular response.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 65 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Bosutinib Efficacy, Safety, Tolerability (BEST) Study in Elderly Chronic Myeloid Leukemia Patients Failing Front-line Treatment With Other Tyrosine Kinase Inhibitors
Actual Study Start Date : November 2016
Estimated Primary Completion Date : November 2019
Estimated Study Completion Date : November 2021

Arm Intervention/treatment
Experimental: Bosutinib treatment Drug: Bosutinib

Bosutinib is given orally accordingly with this scheme:

A. 200 mg OD: starting dose ("wash-in" period) at week 1 and week 2 B. 300 mg OD: from week 3 to the end of week 16

At the end of week 12 evaluation of molecular response (BCR-ABL1 level by RT-Q-PCR).

Bosutinib dose is then managed as follows :

C1. if BCR-ABL1 ≤1% at week 12: 300 mg OD from week 17 to week 52 C2. if BCR-ABL1 > 1% at week 12: 400 mg OD from week 17 to week 52

All the responsive patients who are still on Bosutinib at the end of week 52, will continue Bosutinib at the same dose (300 mg OD or 400 mg OD) for the next two years ( if tolerated and in absence of safety concerns).

Primary Outcome Measures :
  1. Number of patients who are in major molecular response (MMR) [ Time Frame: One year treatment ]

Secondary Outcome Measures :
  1. Number of patients who obtain molecular response [ Time Frame: At 6 and 12 months from treatment start ]
  2. Number of patients discontinuing treatment for failure, adverse events or other reasons [ Time Frame: At 12 and 36 months ]
  3. Number of Adverse Events (AEs) [ Time Frame: At 36 months ]
  4. Number of patients alive [ Time Frame: At 36 months ]
  5. Number of patients on treatment at 200, 300 and 400 mg or more daily [ Time Frame: At 6, 12 and 36 months ]
  6. Number and type of BCR-ABL1 mutations [ Time Frame: At 36 months ]
  7. Patient reported quality of life [ Time Frame: At 3, 6, and 12 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   60 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Molecular confirmed diagnosis of BCR-ABL1+ CML
  2. Chronic phase CML (ELN 2013 criteria)
  3. 60 years of age or older
  4. Prior first-line treatment with any other TKIs
  5. Intolerance to prior treatment, based on investigator and patient assessment or failure of prior treatment according to any one of the ELN 2013 criteria, as listed below

    • Non complete hematologic response (CHR) at 3 months
    • No cytogenetic response (Ph+ > 95%) at 6 months
    • Less than Partial Cytogenetic Response (PCyR) (Ph+ >35%) at 6 months
    • BCR-ABL1 > 10% at 6 months
    • Non complete CyR (CCyR) (Ph+ > 0) at 12 months
    • BCR-ABL1 > 1% at 12 months
    • Loss of CHR at any time
    • Loss of CCyR at any time
    • Confirmed loss of major molecular response (MMR) (BCR-ABL1 > 0.1%) in two consecutive tests, of which one > 1%, at any time
  6. An effective form of contraception from enrolment through 30 days after the end of treatment
  7. Signed written informed consent according to ICH/EU/GCP and national and local laws prior to any study procedures
  8. Willingness and ability to comply with scheduled visits and study procedures.

Exclusion Criteria:

  1. Accelerated or blastic phase CML (according to ELN 2013 criteria)
  2. Patients with the T315I or the V299L mutation
  3. Patients previously treated with 2 TKIs or more
  4. Compelled to take medications that are known to be associated with Torsades de Pointes and/or with significant QTc prolongation
  5. Any condition or illness that, in the opinion of the Investigator, would compromise patient safety or interfere with the evaluation of the drug
  6. HBV markers positivity
  7. Lack of informed consent

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 identifier (NCT number): NCT02810990

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Contact: Paola Fazi
Contact: Enrico Crea

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S.O.C. di Ematologia - Azienda Ospedaliera - SS. Antonio e Biagio e Cesare Arrigo Not yet recruiting
Alessandria, Italy
Contact: Pini         
Principal Investigator: Pini         
Azienda Ospedaliero - Universitaria Ospedali Riuniti Umberto I - G.M. LANCISI - G. SALESI Recruiting
Ancona, Italy
Contact: Rupoli         
Principal Investigator: Rupoli         
UO Ematologia con trapianto-Università degli Studi di Bari Aldo Moro Not yet recruiting
Bari, Italy
Contact: Specchia         
Principal Investigator: Specchia         
Department of Oncology and Hematology, O.U. of Hematology, S. Orsola-Malpighi University Hospital, Bologna Recruiting
Bologna, Italy
Contact: Gianantonio Rosti         
Principal Investigator: Gianantonio Rosti         
Istituto di Ematologia "Lorenzo e A. Seragnoli" - Policlinico S. Orsola - Malpighi Recruiting
Bologna, Italy
Contact: Rosti         
Principal Investigator: Rosti         
ASL N.8 - Ospedale "A. Businco" - Struttura Complessa di Ematologia e CTMO Recruiting
Cagliari, Italy
Contact: Usala         
Principal Investigator: Usala         
Università di Catania - Cattedra di Ematologia - Ospedale "Ferrarotto" Recruiting
Catania, Italy
Contact: Stagno         
Principal Investigator: Stagno         
S.C. Ematologia ASO S. Croce e Carle Not yet recruiting
Cuneo, Italy
Contact: Rapezzi         
Principal Investigator: Rapezzi         
Arcispedale Sant'Anna Dipartimento di Scienze Mediche Sezione di Ematologia Not yet recruiting
Ferrara, Italy
Contact: Cavazzini         
Principal Investigator: Cavazzini         
Policlinico di Careggi Not yet recruiting
Firenze, Italy
Contact: Bosi         
Principal Investigator: Bosi         
Struttura Complessa di Ematologia Ospedali Riuniti Foggia Not yet recruiting
Foggia, Italy
Contact: Capalbo         
Principal Investigator: Capalbo         
IRCCS_AOU San Martino-IST-Ematologia 1-Monoblocco 11°piano- lato ponente Recruiting
Genova, Italy
Contact: Gobbi         
Principal Investigator: Gobbi         
ASL Le/1 P.O. Vito Fazzi - U.O. di Ematologia ed UTIE Recruiting
Lecce, Italy
Contact: Di Renzo         
Principal Investigator: Di Renzo         
Istituto Scientifico Romagnoli per lo Studio e la Cura dei Tumori- IRST Recruiting
Meldola, Italy
Contact: Lucchesi         
Principal Investigator: Lucchesi         
Policlinico G. Martino Dipartimento di Medicina Interna - U.O. Messina Recruiting
Messina, Italy
Contact: Musolino         
Principal Investigator: Musolino         
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico UOC Oncoematologia Recruiting
Milano, Italy
Contact: Iurlo         
Principal Investigator: Iurlo         
U.O. Ematologia e Trapianto di MIdollo - Ist.Scientifico Ospedale San Raffaele Recruiting
Milano, Italy
Contact: Ciceri         
Principal Investigator: Ciceri         
Unità Trapianto di Midollo Ist. Nazionale Tumori Recruiting
Milano, Italy
Contact: Corradini         
Principal Investigator: Corradini         
Azienda Ospedaliera "S.Gerardo" Not yet recruiting
Monza, Italy
Contact: Gambacorti         
Principal Investigator: Gambacorti         
Azienda Università degli Studi di Napoli "Federico II" - Facoltà di Medicina e Chirurgia Recruiting
Napoli, Italy
Contact: Pane         
Principal Investigator: Pane         
S.C.D.U. Ematologia - Università del Piemonte Orientale Amedeo Avogadro Recruiting
Novara, Italy
Contact: Lunghi         
Principal Investigator: Lunghi         
Dip. di Scienze Cliniche e Biologiche - Ospedale S. Luigi Gonzaga-Medicina Interna 2 Recruiting
Orbassano, Italy
Contact: Rege Cambrin         
Principal Investigator: Rege Cambrin         
Università degli Studi di Padova - Ematologia ed Immunologia Clinica Not yet recruiting
Padova, Italy
Contact: Binotto         
Principal Investigator: Binotto         
U.O. di Ematologia con trapianto - A.U. Policlinico "Paolo Giaccone" Not yet recruiting
Palermo, Italy
Contact: Siragusa         
Principal Investigator: Siragusa         
Cattedra di Ematologia CTMO Università degli Studi di Parma Recruiting
Parma, Italy
Contact: Crugnola         
Principal Investigator: Crugnola         
S.C. Ematologia - Fondazione IRCCS Policlinico S. Matteo Recruiting
Pavia, Italy
Contact: Cazzola         
Principal Investigator: Cazzola         
Dipartimento di Oncologia ed Ematologia - AUSL Ospedale G. da Saliceto Recruiting
Piacenza, Italy
Contact: Vallisa         
Principal Investigator: Vallisa         
Ematologia - Ospedale San Carlo Not yet recruiting
Potenza, Italy
Contact: Pizzuti         
Principal Investigator: Pizzuti         
Dipartimento Oncologico - Ospedale S.Maria delle Croci Recruiting
Ravenna, Italy
Contact: Salvucci         
Principal Investigator: Salvucci         
Unità Operativa Complessa di Ematologia - Arcispedale S. Maria Nuova Recruiting
Reggio Emilia, Italy
Contact: Capodanno         
Principal Investigator: Capodanno         
Ospedale "Infermi" Recruiting
Rimini, Italy
Contact: Molinari         
Principal Investigator: Molinari         
U.O. di Ematologia - Centro Oncologico Basilicata Not yet recruiting
Rionero in Vulture, Italy
Contact: Pietrantonio         
Principal Investigator: Pietrantonio         
Complesso Ospedaliero S. Giovanni Addolorata Recruiting
Roma, Italy
Contact: Cedrone         
Principal Investigator: Cedrone         
Divisione Ematologia - Università Campus Bio-Medico Not yet recruiting
Roma, Italy
Contact: De Muro         
Principal Investigator: De Muro         
Padiglione Cesalpino - I piano - Divisione di Ematologia - Ospedale S. Camillo Recruiting
Roma, Italy
Contact: Mancini         
Principal Investigator: Mancini         
Università Cattolica del Sacro Cuore - Policlinico A. Gemelli Recruiting
Roma, Italy
Contact: Sorà         
Principal Investigator: Sorà         
UOC Pronto Soccorso - Dipartimento Biotecnologie Cellulari Università di Roma "Sapienza" Not yet recruiting
Roma, Italy
Contact: Breccia         
Principal Investigator: Breccia         
Istituto di Ematologia - IRCCS Ospedale Casa Sollievo della Sofferenza Recruiting
S. G. Rotondo, Italy
Contact: Cascavilla         
Principal Investigator: Cascavilla         
U.O.C. Ematologia e Trapianti - A.O. Senese - Policlinico " Le Scotte" Not yet recruiting
Siena, Italy
Contact: Bocchia         
Principal Investigator: Bocchia         
A.O. Santa Maria - Terni S.C Oncoematologia Not yet recruiting
Terni, Italy
Contact: Liberati         
Principal Investigator: Liberati         
Divisione di Ematologia - "Città della Salute e della Scienza di Torino" Recruiting
Torino, Italy
Contact: Ferrero         
Principal Investigator: Ferrero         
S.C. Ematologia 2 A.O. Città della Salute e della Scienza di Torino San Giovanni Battista Recruiting
Torino, Italy
Contact: Pregno         
Principal Investigator: Pregno         
Clinica Ematologica-Centro Trapianti e Terapie cellulari Not yet recruiting
Udine, Italy
Contact: Tiribelli         
Principal Investigator: Tiribelli         
Medicina Interna I - Ospedale di Circolo Not yet recruiting
Varese, Italy
Contact: Passamonti         
Principal Investigator: Passamonti         
A. O. - Istituti Ospitalieri di Verona- Div. di Ematologia - Policlinico G.B. Rossi Recruiting
Verona, Italy
Contact: Bonifacio         
Principal Investigator: Bonifacio         
Sponsors and Collaborators
Gruppo Italiano Malattie EMatologiche dell'Adulto
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Study Chair: Gianantonio Rosti Department of Oncology and Hematology, O.U. of Hematology, S. Orsola-Malpighi University Hospital, Bologna

Additional Information:
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Responsible Party: Gruppo Italiano Malattie EMatologiche dell'Adulto Identifier: NCT02810990     History of Changes
Other Study ID Numbers: CML1516
2016-002216-40 ( EudraCT Number )
First Posted: June 23, 2016    Key Record Dates
Last Update Posted: September 1, 2017
Last Verified: August 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Gruppo Italiano Malattie EMatologiche dell'Adulto:
chronic myeloid leukemia
Additional relevant MeSH terms:
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Leukemia, Myeloid
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Neoplasms by Histologic Type
Myeloproliferative Disorders
Bone Marrow Diseases
Hematologic Diseases