Nilotinib as First-line Treatment of Ph+ CML in Early Chronic Phase

• Status: Completed
• Trial end date: 2018-04-30
• Target enrollment: 0
• Participant gender: All

Summary

Treating Ph pos CML with Imatinib is very effective since the majority of the patients achieve a complete cytogenetic response and a major molecular response and are alive and progression-free after 5 years. However, the great majority of responding patients are not leukemia-free and may be at risk of progression, molecular, cytogenetic and clinical, at any time. In case of disease progression due to Imatinib failure, nilotinib has been found to be very effective, as expected from the preclinical profile of the drug, that is much more potent against BCR-ABL and inhibits nearly all the imatinib-resistant BCR-ABL mutants. For these reasons, nilotinib is going to be registered for the treatment of imatinib-resistant CMl patients. For the same reasons, nilotinib is expected to be more efficient than imatinib also front-line, based on the principle that we should aim at preventing the emergence of resistance better that at treating resistance once it has emerged. This expectation can be tested safely, because the "toxicity profile" of Nilotinib may be even more convenient than that of Imatinib, due to the lower frequency of edema and fluid retention.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Gruppo Italiano Malattie EMatologiche dell'Adulto

Criteria

Inclusion Criteria:

• Patients with a cytologic and cytogenetic confirmed diagnosis of Ph+ CML.

• Age ≥ 18 years old

• Early CP (within 6 months from diagnosis)

• No prior treatment with any antileukemic drugs with the exception of Hydroxyurea (HU) and Anagrelide.

• WHO performance status of ≤ 2

• Normal serum level of potassium, total calcium corrected for serum albumin, magnesium and phosphorus, or correctable with supplements

• ALT and AST ≤ 2.5 x ULN or ≤ 5.0 x ULN if considered due to leukaemia.

• Alkaline phosphatase ≤ 2.5 x ULN unless considered due to leukemia.

• Serum bilirubin ≤ 1.5 x ULN

• Serum creatinine ≤ 1.5 x ULN

• Serum amylase ≤ 1.5 x ULN and serum lipase ≤ 1.5 x ULN.

• Written informed consent prior to any study procedures being performed.

Exclusion criteria:

• Impaired cardiac function, including LVEF < 45% as determined by MUGA scan or echocardiogram, uncontrolled congestive heart failure, uncontrolled hypertension

• History of myocardial infarction within three months, or uncontrolled angina pectoris.

• Significant electric heart abnormalities, including history or presence of significant ventricular or atrial tachyarrhythmias, congenital long QT syndrome and/or QTc > 450 msec on screening ECG (using the QTcF formula).

• Patients with ventricular pacemakers and clinically significant bradycardias.

• Patients with heart blocks.

• History of acute or chronic pancreatitis.

• Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of nilotinib (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection)

• Use of therapeutic coumarin derivates (i.e. warfarin, acenocoumarol, phenprocoumon).

• Acute or chronic liver or renal disease considered unrelated to leukaemia

• Other concurrent severe and/or uncontrolled medical conditions (e.g., uncontrolled diabetes, active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol

• Patients who are currently receiving treatment with any of the medications listed in Appendix E and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug. The medications listed in Appendix E have the potential to prolong QT, with the exception of HU and Anagrelide.

• Patients who have received any antileukemic agents and treatments, including HSCT, with the exception of HU and Anagrelide.

• Patients who have received any investigational drug ≤ 4 weeks.

• Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug or who have not recovered from side effects of such therapy.

• Patients who are pregnant or breast feeding, or adults of reproductive potential not employing an effective method of birth control. (Women of childbearing potential must have a negative serum pregnancy test within 48 hrs prior to administration of nilotinib). Post menopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential. Male and female patients must agree to employ an effective barrier method of birth control throughout the study and for up to 3 months following discontinuation of study drug.

• Treatment with any hematopoietic colony-stimulating growth factors (e.g. G-CSF, GM-CSF) 1 week prior to starting study drug.

• Patients who have received immunotherapy 1 week prior to starting study drug or who have not recovered from side effects of such therapy.

• Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not mandatory).

• Patients with a history of another primary malignancy that is currently clinically significant or currently requires active intervention.

• Patients unwilling or unable to comply with the protocol.