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Phase 2 Completed N=283 Randomized Treatment

Ponatinib in Participants With Resistant Chronic Phase Chronic Myeloid Leukemia (CP-CML) to Characterize the Efficacy and Safety of a Range of Doses

Myeloid Leukemia, Chronic, Chronic Phase
Source: ClinicalTrials.gov NCT02467270 ↗
Enrolled (actual)
283
Serious AEs
33.2%
Results posted
Jun 2021
Primary outcomePrimary: Percentage of Participants With Molecular Response (MR2: <=1% Breakpoint Cluster Region-Abelson Transcript Level) as Measured by the International Scale (BCR-ABL1IS) at Month 12 — 44.1; 29.0; 23.1 percentage of participants

Summary

The purpose of this study is to characterize the efficacy of ponatinib administered in 3 starting doses (45 mg, 30 mg, and 15 mg daily) in participants with CP-CML who are resistant to prior tyrosine-kinase inhibitor (TKI) therapy or have T315I mutation, as measured by <=1 % Breakpoint Cluster Region-Abelson Transcript Level using International Scale (BCR-ABL1IS) at 12 months.

Outcome Measures

OutcomeResultp-value
PRIMARY
Percentage of Participants With Molecular Response (MR2: <=1% Breakpoint Cluster Region-Abelson Transcript Level) as Measured by the International Scale (BCR-ABL1IS) at Month 12
44.1; 29.0; 23.1
SECONDARY
Percentage of Participants With Major Molecular Response (MMR/MR3)
17.2; 20.4; 16.5; 24.7; 15.1; 19.8
SECONDARY
Percentage of Participants With Major Cytogenetic Response (MCyR)
48.4; 30.0; 43.8
SECONDARY
Duration of Major Molecular Response (MMR/MR3)
NA; NA; NA
SECONDARY
Percentage of Participants With Adjusted Incidence Rates for Treatment Emergent Arterial Occlusive Events (AOEs), Venous Thrombotic Events (VTEs), Adverse Events (AEs), and Serious AEs (SAEs)
13.8; 9.6; 5.3; 3.7; 11.8; 0
SECONDARY
Percentage of Participants With Complete Cytogenetic Response (CCyR)
34.1; 18.9; 29.2
SECONDARY
Percentage of Participants With Molecular Response 4 (MR4) and Molecular Response 4.5 (MR4.5)
1.1; 1.1; 0; 3.2; 2.2; 3.3
SECONDARY
Percentage of Participants With Molecular Response 1 (MR1)
52.7; 44.1; 42.9
SECONDARY
Percentage of Participants With Complete Hematologic Response (CHR)
87.2; 81.1; 81.9
SECONDARY
Percentage of Participants With Treatment Emergent AEs Leading to Treatment Discontinuation, Dose Reduction and Dose Interruption
24.5; 19.1; 20.2; 3.7; 0; 0
SECONDARY
Kaplan-Meier Estimate of Duration of Response (DOR) of <=1% BCR-ABL1 IS (MR2) at Months 12 and 24
79.13; 79.20; 90.10; 73.89; 77.91; 88.31
SECONDARY
Kaplan-Meier Estimate of Duration of Response (DOR) of Major Molecular Response (MMR/MR3)
88.97; 93.33; 94.74; 82.94; 74.77; 95.45
SECONDARY
Duration of Response in MR2 Responders
NA; NA; NA
SECONDARY
Time to Response (MR2)
6.00; 3.11; 6.18
SECONDARY
Percentage of Participants With Progression to Accelerated Phase (AP)-Chronic Myeloid Leukemia (CML) or Blast Phase (BP)-CML
11.7; 11.6; 13.8; 3.2; 1.1; 2.1
SECONDARY
Progression-free Survival (PFS)
NA; 75.04; NA
SECONDARY
Overall Survival (OS)
NA; NA; NA

Eligibility Criteria

Inclusion Criteria

  • Have chronic phase-chronic myelogenous leukemia/chronic myeloid leukemia (CP-CML) and have received at least two prior tyrosine kinase inhibitor (TKI) therapies and have demonstrated resistance to treatment OR have documented history of presence of T315I mutation after receiving any number of prior TKI.

o] The diagnosis of chronic myeloid leukemia (CML) will be made using standard hematopathologic and cytogenetic criteria; CP-CML will be defined by all of the following: i = 100*10^9/liter (L) platelets (>=100,000/mm^3). v No evidence of extramedullary disease except hepatosplenomegaly vi No prior diagnosis of AP-CML, and BP-CML o] Cytogenetic assessment at screening must demonstrate the BCR-ABL1 fusion by presence of the t(9;22) Philadelphia chromosome.

i Variant translocations are only allowed provided they meet inclusion criterion 1d.

o] Resistance to prior TKI therapy is defined as follows (participants must meet at least 1 criterion): i Three months after the initiation of prior TKI therapy: No cytogenetic response (>95% Ph+) or failure to achieve CHR or new mutation ii Six months after the initiation of prior TKI therapy: BCR-ABL1IS >10% and/or Ph+ >65% or new mutation iii Twelve months after the initiation of prior TKI therapy: BCR ABL1IS >10% and/or Ph+ >35% or new mutation iv At any time after the initiation of prior TKI therapy, the development of a new BCR-ABL1 kinase domain mutation(s) v At any time after the initiation of prior TKI therapy, the development of new clonal evolution vi At any time after the initiation of prior TKI therapy, the loss of CHR, or CCyR, or the confirmed loss of MMR in 2 consecutive tests, one of which has a BCR-ABL1IS transcript level of >=1% or new mutation o] >1% of BCR-ABL1IS as shown by real-time polymerase chain reaction

  • Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
  • Have adequate renal function as defined by the following criterion:

o] Serum creatinine =30 milliliter per minute (mL/min) (Cockcroft-Gault formula)

  • Have adequate hepatic function as defined by the following criteria:

o] Total serum bilirubin grade 1 by NCI CTCAE, version 4.0) from AEs (except alopecia), due to agents previously administered.

  • Have undergone autologous or allogeneic stem cell transplant 150 and >90 for systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively). Participants with hypertension should be under treatment at study entry to ensure blood pressure control. Those requiring 3 or more antihypertensive medications should be discussed with the medical monitor.
  • Have poorly controlled diabetes defined as HbA1c values of >7.5%. Participants with preexisting, well-controlled diabetes are not excluded.
  • Have a significant bleeding disorder unrelated to CML.
  • Have a history of alcohol abuse.
  • Have a history of either acute pancreatitis within 1 year of study enrollment or of chronic pancreatitis.
  • Have malabsorption syndrome or other gastrointestinal illness that could affect oral absorption of study drug.
  • Have a history of another malignancy, other than cervical cancer in situ or basal cell or squamous cell carcinoma of the skin; the exception is if participants have been disease-free for at least 5 years, and are deemed by the investigator to be at low risk for recurrence of that malignancy.
  • Are pregnant or lactating.
  • Have undergone major surgery (with the exception of minor surgical procedures, such as catheter placement or BM biopsy) within 14 days prior to first dose of ponatinib.
  • Have an active infection which requires intravenous antibiotics.
  • Have a known history of human immunodeficiency virus infection; testing is not required in the absence of prior documentation or known history.
  • Have any condition or illness that, in the opinion of the investigator, would compromise participant safety or interfere with the evaluation of the drug.
  • Have hypersensitivity to th
View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT02467270). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.

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