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Study of Efficacy of CML-CP Patients Treated With ABL001 Versus Bosutinib, Previously Treated With 2 or More TKIs

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ClinicalTrials.gov Identifier: NCT03106779
Recruitment Status : Active, not recruiting
First Posted : April 10, 2017
Results First Posted : February 15, 2022
Last Update Posted : April 24, 2024
Sponsor:
Information provided by (Responsible Party):
Novartis ( Novartis Pharmaceuticals )

Study Description
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Brief Summary:

The purpose of this pivotal study was to compare the efficacy of asciminib (ABL001) with that of bosutinib in the treatment of patients with CML-CP having previously been treated with a minimum of two prior ATP-binding site TKIs.

Patients intolerant to the most recent TKI therapy must have had BCR-ABL1 ratio > 0.1% IS at screening and patients failing their most recent TKI therapy must have met the definition of treatment failure as per the 2013 European LeukemiaNet (ELN) recommendations.

Patients with documented treatment failure as per 2013 ELN recommendations while on bosutinib treatment had the option to switch to asciminib treatment within 96 weeks after the last patient has been randomized on study.


Condition or disease Intervention/treatment Phase
Chronic Myelogenous Leukemia Drug: Asciminib Drug: Bosutinib Phase 3

Detailed Description:
Patients were randomized in a 2:1 ratio to asciminib 40 mg BID or bosutinib 500 mg QD. Randomization was stratified by major cytogenetic response (MCyR) at screening. Patients with documented treatment failure (specifically meeting lack of efficacy criteria adapted from the 2013 ELN recommendations) while on bosutinib treatment were offered the option to switch to asciminib treatment within 96 weeks after the last patient was randomized to the study.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 233 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 3, Multi-center, Open-label, Randomized Study of Oral ABL001 Versus Bosutinib in Patients With Chronic Myelogenous Leukemia in Chronic Phase (CML-CP), Previously Treated With 2 or More Tyrosine Kinase Inhibitors
Actual Study Start Date : November 29, 2016
Actual Primary Completion Date : May 25, 2020
Estimated Study Completion Date : December 18, 2024

Resource links provided by the National Library of Medicine

Drug Information available for: Bosutinib

Arms and Interventions
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Arm Intervention/treatment
Experimental: Asciminib
Patients were randomized to asciminib 40mg BID
 Drug: Asciminib
40 mg tablets was taken orally twice a day (BID)
Other Name: ABL001
Active Comparator: Bosutinib
Patients were randomized to bosutinib 500mg QD
 Drug: Bosutinib
500 mg tablets was taken orally once daily (QD)


Outcome Measures
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Primary Outcome Measures :
  1. Number of Participants With Major Molecular Response (MMR) Rate at 24 Weeks [ Time Frame: 24 weeks ]
    MMR was defined as a ≥ 3.0 log reduction in BCR-ABL1 transcripts compared to the standardized baseline equivalent to ≤ 0.1% BCR-ABL1/ABL% by IS as measured by RQ-PCR.


Secondary Outcome Measures :
  1. Number of Participants With Major Molecular Response (MMR) Rate [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy asciminib versus bosutinib

  2. Complete Cytogenetic Response Rate [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib. Cytogenic response will include Complete, Partial, Major, Minor, Minimal and no response.

  3. Time to MMR [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib

  4. Duration of MMR [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib

  5. Time to CCyR [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib

  6. Duration of CCyR [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib

  7. Time to Treatment Failure [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib

  8. Progression Free Survival [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib

  9. Overall Survival [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To compare additional parameters of the efficacy of asciminib versus bosutinib

  10. Trough Plasma Concentrations [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To characterize the PK of asciminib in the CML-CP population

  11. PK Parameter: Cmax, [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To characterize the PK of asciminib in the CML-CP population

  12. PK Parameter: Tmax [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To characterize the PK of asciminib in the CML-CP population

  13. PK Parameter: AUC0-12h [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To characterize the PK of asciminib in the CML-CP population

  14. PK Parameter: CL/F [ Time Frame: 96 weeks after the last patient received the first study dose ]
    To characterize the PK of asciminib in the CML-CP population


Eligibility Criteria
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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
Criteria

Inclusion Criteria:

Male or female patients with a diagnosis of CML-CP ≥ 18 years of age

Patients must meet all of the following laboratory values at the screening visit:

  • < 15% blasts in peripheral blood and bone marrow
  • < 30% blasts plus promyelocytes in peripheral blood and bone marrow
  • < 20% basophils in the peripheral blood
  • ≥ 50 x 109/L (≥ 50,000/mm3) platelets
  • Transient prior therapy related thrombocytopenia (< 50,000/mm3 for ≤ 30 days prior to screening) is acceptable
  • No evidence of extramedullary leukemic involvement, with the exception of hepatosplenomegaly

BCR-ABL1 ratio > 0.1% IS according to central laboratory at the screening examination for patients intolerant to the most recent TKI therapy

Prior treatment with a minimum of 2 prior ATP-binding site TKIs (i.e. imatinib, nilotinib, dasatinib, radotinib or ponatinib)

Failure (adapted from the 2013 ELN Guidelines Bacarrani 2013) or intolerance to the most recent TKI therapy at the time of screening

  • Failure is defined for CML-CP patients (CP at the time of initiation of last therapy) as follows. Patients must meet at least 1 of the following criteria.
  • Three months after the initiation of therapy: No CHR or > 95% Ph+ metaphases
  • Six months after the initiation of therapy: BCR-ABL1 ratio > 10% IS and/or > 65% Ph+ metaphases
  • Twelve months after initiation of therapy: BCR-ABL1 ratio > 10% IS and/or > 35% Ph+ metaphases
  • At any time after the initiation of therapy, loss of CHR, CCyR or PCyR
  • At any time after the initiation of therapy, the development of new BCR-ABL1 mutations which potentially cause resistance to study treatment
  • At any time after the initiation of therapy, confirmed loss of MMR in 2 consecutive tests, of which one must have a BCR-ABL1 ratio ≥ 1% IS
  • At any time after the initiation of therapy, new clonal chromosome abnormalities in Ph+ cells: CCA/Ph+
  • Intolerance is defined as:
  • Non-hematologic intolerance: Patients with grade 3 or 4 toxicity while on therapy, or with persistent grade 2 toxicity, unresponsive to optimal management, including dose adjustments (unless dose reduction is not considered in the best interest of the patient if response is already suboptimal)
  • Hematologic intolerance: Patients with grade 3 or 4 toxicity (absolute neutrophil count [ANC] or platelets) while on therapy that is recurrent after dose reduction to the lowest doses recommended by manufacturer

Exclusion Criteria:

Known presence of the T315I or V299L mutation at any time prior to study entry Known second chronic phase of CML after previous progression to AP/BC Previous treatment with a hematopoietic stem-cell transplantation Patient planning to undergo allogeneic hematopoietic stem cell transplantation

Cardiac or cardiac repolarization abnormality, including any of the following:

  • History within 6 months prior to starting study treatment of myocardial infarction (MI), angina pectoris, coronary artery bypass graft (CABG)
  • Clinically significant cardiac arrhythmias (e.g., ventricular tachycardia), complete left bundle branch block, high-grade AV block (e.g., bifascicular block, Mobitz type II and third degree AV block)
  • QTcF at screening ≥450 msec (male patients), ≥460 msec (female patients)
  • Long QT syndrome, family history of idiopathic sudden death or congenital long QT syndrome, or any of the following:
  • Risk factors for Torsades de Pointes (TdP) including uncorrected hypokalemia or hypomagnesemia, history of cardiac failure, or history of clinically significant/symptomatic bradycardia
  • Concomitant medication(s) with a known risk of Torsades de Pointes per www.crediblemeds.org that cannot be discontinued or replaced 7 days prior to starting study drug by safe alternative medication.
  • Inability to determine the QTcF interval
  • Severe and/or uncontrolled concurrent medical disease that in the opinion of the investigator could cause unacceptable safety risks or compromise compliance with the protocol (e.g. uncontrolled diabetes, active or uncontrolled infection, pulmonary hypertension)
  • History of acute pancreatitis within 1 year of study entry or past medical history of chronic pancreatitis
  • History of acute or chronic liver disease
  • Treatment with medications that meet one of the following criteria and that cannot be discontinued at least one week prior to the start of treatment with study treatment
  • Moderate or strong inducers of CYP3A
  • Moderate or strong inhibitors of CYP3A
  • Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during dosing and for 3 days after last dose of ABL001 and one month after last dose of bosutinib. Highly effective contraception methods include:
  • Total abstinence (when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception
  • Female sterilization (have had surgical bilateral oophorectomy (with or without hysterectomy) total hysterectomy or bilateral tubal ligation at least six weeks before taking study treatment). In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment
  • Male sterilization (at least 6 months prior to screening). The vasectomized male partner should be the sole partner for that subject.
  • Use of oral, injected or implanted hormonal methods of contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS) or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception.
  • In case of use of oral contraception women should have been stable on the same pill for a minimum of 3 months before taking study treatment.
  • Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy), total hysterectomy or bilateral tubal ligation at least six weeks before taking study medication. In the case of oophorectomy alone, women are considered post-menopausal and not of child bearing potential only when the reproductive status of the woman has been confirmed by follow up hormone level assessment.
Contacts and Locations
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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): NCT03106779


Locations
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Sponsors and Collaborators
Novartis Pharmaceuticals
Investigators
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Study Director: Novartis Pharmaceuticals Novartis Pharmaceuticals
  Study Documents (Full-Text)

Documents provided by Novartis ( Novartis Pharmaceuticals ):
Study Protocol and Statistical Analysis Plan  [PDF] October 14, 2020

More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Novartis Pharmaceuticals
ClinicalTrials.gov Identifier: NCT03106779    
Other Study ID Numbers: CABL001A2301
First Posted: April 10, 2017    Key Record Dates
Results First Posted: February 15, 2022
Last Update Posted: April 24, 2024
Last Verified: April 2024
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent expert panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations.

This trial data is currently available according to the process described on www.clinicalstudydatarequest.com
URL: https://www.clinicalstudydatarequest.com

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Novartis ( Novartis Pharmaceuticals ):
Phase 3
Chronic Myelogenous Leukemia
CML
bosutinib
ABL001
tyrosine kinase inhibitor
Chronic myelogenous leukemia (CML)
 chronic myeloid leukemia (CML)
chronic myelocytic leukemia (CML)
chronic granulocytic leukemia (CGL)
cancer of the white blood cells
clonal bone marrow stem cell disorder
proliferation of mature granulocytes
Additional relevant MeSH terms:
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Leukemia
Leukemia, Myeloid
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Neoplasms by Histologic Type
Neoplasms
Hematologic Diseases
Myeloproliferative Disorders
Bone Marrow Diseases
Chronic Disease
 Disease Attributes
Pathologic Processes
Bosutinib
Asciminib
Tyrosine Kinase Inhibitors
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action