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Nilotinib as First-Line Treatment of Ph+ CML in Early Chronic Phase (CML0307)
This study is currently recruiting participants.
Verified by Gruppo Italiano Malattie EMatologiche dell'Adulto, August 2007
Sponsored by: Gruppo Italiano Malattie EMatologiche dell'Adulto
Information provided by: Gruppo Italiano Malattie EMatologiche dell'Adulto
ClinicalTrials.gov Identifier: NCT00481052
  Purpose

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, beacuse the "toxicity profile" of Nilotinib may be even more convenient than that of Imatinib, due to the lower frequency of edema and fluid retention.


Condition Intervention Phase
Chronic Myeloid Leukemia
Drug: Nilotinib
Phase II

MedlinePlus related topics: Leukemia, Adult Acute Leukemia, Adult Chronic
Drug Information available for: Hydroxyurea Tyrosine Anagrelide Anagrelide hydrochloride
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label, Uncontrolled, Single Group Assignment, Safety Study
Official Title: The Protein Tyrosine Kinase Inhibitor Nilotinib as First-Line Treatment of Ph+ Chronic Myeloid Leucemia (CML) in Early Chronic Phase: a Phase II Exploratory, Multicenter Study. GIMEMA Protocol CML 0307. EUDRACT 2007-000597-22.

Further study details as provided by Gruppo Italiano Malattie EMatologiche dell'Adulto:

Primary Outcome Measures:
  • Complete cytogenetic response (CCgR ) rate [ Time Frame: At 1 year ]

Secondary Outcome Measures:
  • The complete and the partial cytogenetic response rate [ Time Frame: At 6 months ]
  • The major molecular response (MMR) rate [ Time Frame: At 1 year ]
  • The kinetics of haematologic, cytogenetic and molecular response to AMN107
  • The development of bcr-abl mutation during the treatment with AMN107 (number and type)
  • The safety and tolerability of nilotinib treatment at the dose of 400 mg b.i.d
  • To describe any SAE

Estimated Enrollment: 70
Study Start Date: June 2007
Detailed Description:

Study Phase:

Phase II, Prospective, multicentric, non randomized, open label

Objectives:

The primary objective of the trial is to investigate the cytogenetic and molecular effects of the protein tyrosine kinase (PTK) inhibitor nilotinib in the treatment of early chronic phase Ph+ CML.

The secondary objectives are:

To investigate in early CP Ph+ CML patients treated with nilotinib the clinical and the hematologic effects, the effect on bcr/abl point mutations, the kinetic of the response, the toxicity, the compliance to treatment and the dose density.

Study design:

This study is an open-label, multicenter, exploratory, Phase II study of nilotinib administered orally twice daily for one year. For the patients who will benefit an extension to 4 years is planned.

Visit Schedule and Assessments:

A visit with blood counts and differential and serum chemistry is due baseline, every 15 days for 3 months, hence every 30 days.

An ECG is due baseline, after 15 and 30 days, hence at 60, 90, 150, 240 and 360 days.

An echocardiogram is due baseline and at end-of-study (360 days) or early withdrawal.

A bone marrow aspirate is due baseline (cytology, cytogenetics and quantitative molecular biology), after 3 and 6 months (cytology and cytogenetics) and after 12 months (cytology, cytogenetics, quantitative molecular biology and mutational analysis).

A peripheral blood sample is due baseline, at 30, 60, 90, 180, 270 and 360 days for quantitative molecular biology.

After the end of the study (i.e. after one year) clinical, cytogenetic and molecular data are due every 6 months.

Biologic Monitoring:

Bone marrow and peripheral blood cells will be collected before, during and at the end of the study, stored at the central lab in Bologna and used for molecular assays that are listed in details in the protocol, with the exclusion of any test allowing the identification of patients genotype. The samples are kept for a minimum of 10 years and can be destroyed upon patient request. A specific consent form to the sample storage will be submitted to the patients.

Study duration:

Enrollment time is 6 months. Treatment time is 12 months. Total trial time is 18 months. After 12 months all patients are followed and may continue the study drug.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
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 phosporus, 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 amenorrhoic 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.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00481052

Contacts
Contact: Gianantonio ROSTI +39 051-6364076 gianantonio.rosti@unibo.it

Locations
Italy
Dipartimento Area Medica P.O. Not yet recruiting
Ascoli Piceno, Italy, 63100
Contact: Pietro GALIENI            
Unità Operativa Ematologica - Università degli Studi di Bari Not yet recruiting
Bari, Italy, 70124
Contact: Vincezo LISO            
Ospedali Riuniti Not yet recruiting
Bergamo, Italy, 24100
Contact: Angelo RAMBALDI            
Azienda Ospedaliera Pugliese Ciaccio Recruiting
Catanzaro, Italy, 88100
Contact: Antonio PETA            
Azienda Spedali Civili Not yet recruiting
Brescia, Italy, 25100
Contact: Domenico RUSSO            
Clinica Ematologica - Università degli Studi Not yet recruiting
Genova, Italy
Contact: Marco GOBBI            
Div. di Ematologia IRCCS Policlinico S. Matteo Not yet recruiting
Pavia, Italy, 27100
Contact: Mario LAZZARINO            
U.O. Ematologia Clinica - Azienda USL di Pescara Not yet recruiting
Pescara, Italy, 65100
Contact: Giuseppe FIORITONI            
Ospedale Ferrarotto Not yet recruiting
Catania, Italy, 95124
Contact: Rosario GIUSTOLISI, Pr.            
Ospedale S. Luigi Gonzaga Not yet recruiting
Orbassano, Italy, 10043
Contact: Giuseppe SAGLIO            
Ospedale S.Eugenio Not yet recruiting
Rome, Italy, 00144
Contact: Paolo DE FABRITIIS            
Azienda USL 9 Treviso - U.O. di Ematologia Not yet recruiting
Treviso, Italy, 31100
Contact: Filippo GHERLINZONI            
Policlinico di Tor Vergata Not yet recruiting
Rome, Italy, 00133
Contact: Sergio AMADORI, Pr            
Policlinico G.B. Rossi Not yet recruiting
Verona, Italy, 37134
Contact: Giovanni PIZZOLO            
Policlinico Universitario - Clinica Ematologia Not yet recruiting
Udine, Italy, 33100
Contact: Renato FANIN, Pr            
Complesso Ospedaliero S. Giovanni Addolorata Not yet recruiting
Roma, Italy, 00184
Contact: Luciana ANNINO            
Università La Cattolica del Sacro Cuore Not yet recruiting
Roma, Italy, 00168
Contact: Giuseppe LEONE            
Sez.Ematologia e Dip. scienze Biomediche Arcispedale S. Anna Not yet recruiting
Ferrara, Italy, 44100
Contact: Antonio CUNEO            
U.O. Ematologia, Azienda Ospedaliera Universitaria Senese Not yet recruiting
Siena, Italy, 53100
Contact: Francesco LAURIA            
Sezione di Ematologia e Trapianti Spedali Civili Recruiting
Brescia, Italy, 21125
Contact: Giuseppe ROSSI            
Ematologia 1 - Centro Trapianto di Midollo Not yet recruiting
Milano, Italy, 20122
Contact: Giorgio LAMBERTENGHI            
Ospedale S.Maria delle Croci Not yet recruiting
Ravenna, Italy, 48100
Contact: Alfonso ZACCARIA            
Sponsors and Collaborators
Gruppo Italiano Malattie EMatologiche dell'Adulto
Investigators
Principal Investigator: Michele BACCARANI Azienda Ospedaliera Universitaria -Policlincio S. Orsola-Malpighi
  More Information

GIMEMA's Web page  This link exits the ClinicalTrials.gov site

Publications:
Calabretta B, Perrotti D. The biology of CML blast crisis. Blood. 2004 Jun 1;103(11):4010-22. Epub 2004 Feb 24. Review.
Barnes DJ, Melo JV. Management of chronic myeloid leukemia: targets for molecular therapy. Semin Hematol. 2003 Jan;40(1):34-49. Review.
Goldman JM, Melo JV. Chronic myeloid leukemia--advances in biology and new approaches to treatment. N Engl J Med. 2003 Oct 9;349(15):1451-64. Review. No abstract available.
Goldman JM, Marin D, Olavarria E, Apperley JF. Clinical decisions for chronic myeloid leukemia in the imatinib era. Semin Hematol. 2003 Apr;40(2 Suppl 2):98-103; discussion 104-13. Review.
Goldman JM, Marin D. Management decisions in chronic myeloid leukemia. Semin Hematol. 2003 Jan;40(1):97-103. Review.
Goldman JM, Druker BJ. Chronic myeloid leukemia: current treatment options. Blood. 2001 Oct 1;98(7):2039-42.
Baccarani M, Russo D, Rosti G, Martinelli G. Interferon-alfa for chronic myeloid leukemia. Semin Hematol. 2003 Jan;40(1):22-33. Review.
Martinelli G, Soverini S, Rosti G, Cilloni D, Baccarani M. New tyrosine kinase inhibitors in chronic myeloid leukemia. Haematologica. 2005 Apr;90(4):534-41.
Rosti G, Martinelli G, Bassi S, Amabile M, Trabacchi E, Giannini B, Cilloni D, Izzo B, De Vivo A, Testoni N, Cambrin GR, Bonifazi F, Soverini S, Luatti S, Gottardi E, Alberti D, Pane F, Salvatore F, Saglio G, Baccarani M; Study Committee, Italian Cooperative Study Group for Chronic Myeloid Leukemia; Writing Committee, Italian Cooperative Study Group for Chronic Myeloid Leukemia. Molecular response to imatinib in late chronic-phase chronic myeloid leukemia. Blood. 2004 Mar 15;103(6):2284-90. Epub 2003 Nov 26.

Study ID Numbers: CML0307
Study First Received: May 31, 2007
Last Updated: August 28, 2007
ClinicalTrials.gov Identifier: NCT00481052  
Health Authority: Italy: The Italian Medicines Agency

Keywords provided by Gruppo Italiano Malattie EMatologiche dell'Adulto:
Adult
CML
Philadelphia positive
Nilotinib
early chronic phase
untreated or treated only with Hydroxyurea or Anagrelide
Chronic Myeloid Leukemia

Study placed in the following topic categories:
Leukemia
Chronic myelogenous leukemia
Hydroxyurea
Hematologic Diseases
Myeloproliferative Disorders
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid
Bone Marrow Diseases
Anagrelide

Additional relevant MeSH terms:
Neoplasms
Neoplasms by Histologic Type

ClinicalTrials.gov processed this record on January 13, 2009