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Report for Clinical Trial NCT03205267

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

Multicenter, Open-label Single Arm Phase II Study Testing the Tolerability and the Efficacy of Bosutinib step-in Dosing in Chronic Phase CML Patients Intolerant or Refractory to Previous Imatinib, Nilotinib or Dasatinib Therapy

Bosutinib is a 2nd generation tyrosine kinase inhibitor that has shown promising results from first up to fourth line treatment in patients with in chronic phase of chronic myelogenous leukaemia. Most patients discontinuing the treatment with Bosutinib do so because of side effects occuring early after starting the treatment. A step in dosing scheme could improve these early toxicities. The aim of this study therefore is to demonstrate that temporary lowering of the Bosutinib dose during early treatment may help to reduce or prevent side effects while preserving efficacy.

NCT03205267 Chronic Myelogenous Leukaemia
MeSH: Leukemia, Myeloid Leukemia, Myelogenous, Chronic, BCR-ABL Positive Leukemia, Myeloid, Chronic-Phase
HPO: Chronic myelogenous leukemia Myeloid leukemia

1 Interventions

Name: Bosulif

Description: Patients will start with dose-level 1 (300 mg once daily) Bosutinib. If patients do not experience any toxicity or only G1 toxicity, they will be dose-increased first to dose-level 2 (400 mg once daily ) and then to dose-level 3 (500 mg once daily). Dose will not be escalated above 500 mg which is the dose recommended by the summary of product information. If patients experience G2 toxicity, the study drug will be further continued at the same dose-level. In patients with G3 or G4 toxicities, therapy will be withheld until toxicity resolved to Type: Drug

Bosutinib


Primary Outcomes

Description: calculation of the incidence rate of grade 2 to 4 GI toxicity with and without regard to causality

Measure: Rate of GI-Toxicity (i.e. incidence and severity of grade 2 to 4 toxicities)

Time: within the first 6 months of treatment

Secondary Outcomes

Description: Apart from grade 2 to 4 GI toxicity, the occurrence of toxicity will be analyzed in general. This regards all grade toxicity, 2 to 4 grade and 3 to 4 grade toxicity (NCI CTCAE v4.0).

Measure: overall Tolerability (i.e. all grade, grade 2 to 4 and grade 3 and 4 toxicities)

Time: at month 6, 12 and 24

Description: Rating of CCyR, MMR, MR4 and MR4.5 after bone marrow aspiration and biopsy

Measure: Molecular response mesured by efficacy parametern

Time: at month 3, 6, 12, 18 and 24

Description: The EORTC QLQ-CML30 will be scored according to the respective user's guides.

Measure: Patient-reported outcome measures (QoL)

Time: at month 3 and 6

Description: Progression will be assessed according to the visit schedule at any visit.

Measure: Progression-free survival (PFS)

Time: at month 3, 6, 9, 12, 15, 18, 21 and 24

Description: Survival will be assessed according to the visit schedule at any visit.

Measure: Overall Survival (OS)

Time: at month 3, 6, 9, 12, 15, 18, 21 and 24

Description: The rate and type of mutations will be described. The rate will be given as percentage of patients developing mutations.

Measure: The rate of emerging mutations during Bosutinib treatment

Time: at month 3, 6, 9, 12, 15, 18, 21 and 24

Other Outcomes

Description: Ankle Brachial Index (ABI) will be prospectively evaluated followed by analysis of various biomarkers for vascular damage

Measure: Vascular biology substudy: analysis of clinical and laboratory vascular and metabolic risk factors

Time: baseline, at months 6, 12 and 24

Description: It is planned to analyze PK parameters sequentially by taking serum from PB and subsequent HPLC-MS/MS technology. Pharmacodynamics in different compartments will be analyzed by means of flow-cytometry of PB and BM samples.

Measure: Pharmacokinetic (PK), pharmacodynamic (PD) substudy

Time: at day 1, months 1, 2, 3, 12, 18, 24

Description: Assessment of telomere length in normal and leukemic cells as potential new biomarker for prognosis, prediction of response under Bosutinib

Measure: Telomere substudy

Time: at months 1, 2, 3, 12 and 24

Description: Documentation of subclone evolution or elimination during Bosutinib treatment

Measure: Ultra-deep next-generation sequencing (UD-NGS)

Time: at months 1, 2, 3, 12 and 24

Description: Documentation of patient´s comorbidity profile using 3 different comorbidity scales

Measure: Assessment of patients comorbidities and correlation to individual patient´s adverse side effect profile substudy

Time: through study completion, an average of 2 years

Description: Investigation the role of the 5-HT pathway in directing bosutinib induced diarrhea by assessment of 5-HT and certain cytokine levels and genetic analysis including SNP and GWAS

Measure: Transport mechanisms of Bosutinib and mechanisms of diarrhea substudy

Time: every 14 days month 1-3

Purpose: Treatment

Single Group Assignment


There are 2 SNPs

SNPs


1 T315I

Exclusion Criteria: - Hypersensitivity against Bosutinib or other ingredients of the medicinal product - Evidence of features of accelerated (AP) or blast phase (BC) at any time before inclusion - Patients with BCR-ABL negative CML - Patients having received Imatinib for more than 6 weeks prior to initiation of 2nd generation TKI (either Nilotinib or Dasatinib) - Patients with known T315I or V299L mutation - Concomitant medications known to be strong inducers or inhibitors of P450 isoenzyme CYP3A4 - History of pancreatitis, inflammatory bowel disease requiring systemic or topical immunosuppressive therapy within the last 12 months - Impaired cardiac function, including any of the following: 1. History of or presence of complete left bundle branch block, right bundle branch block plus left anterior hemiblock, bifascicular block in screening ECG 2. ST depression of >1mm in 2 or more leads and/or T wave inversions in 2 or more contiguous leads in screening ECG 3. Congenital long QT syndrome 4. QTc> 450 msec in the screening ECG 5. QT-prolonging concomitant medication 6. History of or presence of significant ventricular or atrial tachyarrhythmias in screening ECG 7. History of or presence of clinically significant resting bradycardia (< 50 beats per minute) 8. Myocardial infarction within 6 months prior to inclusion 9. Unstable angina diagnosed or treated during the past 12 months 10. --- T315I ---


2 V299L

Exclusion Criteria: - Hypersensitivity against Bosutinib or other ingredients of the medicinal product - Evidence of features of accelerated (AP) or blast phase (BC) at any time before inclusion - Patients with BCR-ABL negative CML - Patients having received Imatinib for more than 6 weeks prior to initiation of 2nd generation TKI (either Nilotinib or Dasatinib) - Patients with known T315I or V299L mutation - Concomitant medications known to be strong inducers or inhibitors of P450 isoenzyme CYP3A4 - History of pancreatitis, inflammatory bowel disease requiring systemic or topical immunosuppressive therapy within the last 12 months - Impaired cardiac function, including any of the following: 1. History of or presence of complete left bundle branch block, right bundle branch block plus left anterior hemiblock, bifascicular block in screening ECG 2. ST depression of >1mm in 2 or more leads and/or T wave inversions in 2 or more contiguous leads in screening ECG 3. Congenital long QT syndrome 4. QTc> 450 msec in the screening ECG 5. QT-prolonging concomitant medication 6. History of or presence of significant ventricular or atrial tachyarrhythmias in screening ECG 7. History of or presence of clinically significant resting bradycardia (< 50 beats per minute) 8. Myocardial infarction within 6 months prior to inclusion 9. Unstable angina diagnosed or treated during the past 12 months 10. --- T315I --- --- V299L ---



HPO Nodes


HPO:
Chronic myelogenous leukemia
Genes 9
KIT MPL ASXL1 TET2 ABL1 JAK2 THPO BCR SRSF2
Myeloid leukemia
Genes 20
KIT SETBP1 NF1 ARHGAP26 CBL TET2 KRAS PTPN11 F13A1 SAMD9L SAMD9L GATA2 CBL ASXL1 DNMT3A F13B NRAS SRSF2 TERC TERT