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Report for Clinical Trial NCT02888990

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

An Open Label Phase II Study to Evaluate the Efficacy and Safety of Induction and Consolidation Therapy With Dasatinib in Combination With Chemotherapy in Patients Aged 55 Years and Over With Philadelphia Chromosome Positive (Ph+ or BCR-ABL+) Acute Lymphoblastic Leukemia (ALL).

1. The use of imatinib in combination or in association with chemotherapy is now considered as the gold standard for the treatment of Ph+ ALL. The complete remission (CR) rate is 90% versus 20% to 40% with chemotherapy alone. The combination of imatinib, vincristine and dexamethasone is a well tolerated regimen in aged patients and is also associated with a high CR rate of 80% to 90% in patient aged 55 years and over. 2. However, despite high CR rates, the progression free survival rate at 12 months of patients treated with the combination of imatinib and chemotherapy is 30% to 50%. Relapses remain frequent and only patients intensified with allogenic haematopoietic stem cell transplantation are in long term remission. This strategy is not fully applicable to most patients aged 55 years and over. 3. Relapses after or during imatinib therapy in patients with Ph+ ALL are associated with BCR-ABL tyrosine kinase domain mutation in 80% of cases, predominantly of the p-loop. The exact incidence of the T315I mutation is controversial and can be estimated to be near 50%. Conversely, the detection of the T315I or F317 mutation in a patient is a very strong predictor of relapse. 4. Dasatinib is a potent SCR and BCR-ABL tyrosine kinase inhibitor with preserved in vitro activity in most of the BCR-ABL mutated cell lines, except for the T315I and F317 mutations. This is also the case in vivo, with patients harbouring BCR-ABL TK domain mutations remaining sensitive to dasatinib. The CHR rate in Ph+ ALL resistant to imatinib is 33% and the median progression-free survival is 3.7 months. Progression free survival (PFS) rate at 12 months is 22%. The goal of this trial is to evaluate the efficacy and the tolerance of the combination of dasatinib with chemotherapy in the front-line setting as induction and consolidation therapy in Ph+ ALL patient aged 55 years and over. A European consensus has been reached to adopt a common chemotherapeutic schedule for patients aged 55 years and over. This schedule will be used in this trial with the addition of dasatinib as concomitant therapy during induction and alternating with chemotherapy during consolidation and maintenance. A CR rate of 90% and a progression free survival of 60% at 12 months are expected. The patients will be prospectively monitored for minimal residual disease and mutation.

NCT02888990 Leukemia, Lymphoblastic, Acute
MeSH:Leukemia Precursor Cell Lymphoblastic Leukemia-Lymphoma Leukemia, Lymphoid
HPO:Leukemia Lymphoid leukemia

1 Interventions

Name: Dasatinib

Type: Drug
Group Labels: 1

Treatment Arm


Primary Outcomes

Measure: Progression free survival at 12 months

Time: 12 months

Secondary Outcomes

Measure: The proportion of Complete haematological remission

Time: 5 years

Measure: The proportion of Major molecular response defined by a BCR-ABL/ABL ≤ 0.1% in bone marrow

Time: 5 years

Measure: The proportion of Complete molecular response

Time: 5 years

Measure: Event free survival

Time: 5 years

Measure: Relapse free survival

Time: 5 years

Measure: Progression free survival

Time: 5 years

Measure: The proportion of Detection of a T315I or F317 BCR-ABL TK mutation

Time: 5 years

Measure: The proportion of Molecular progression

Time: 5 years

Measure: Overall survival

Time: 5 years

Measure: Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

Time: 5 years

Measure: Death during induction

Time: 2 months

Measure: Death in complete remission

Time: 5 years

Purpose: Treatment

Allocation: N/A

Single Group Assignment


There is one SNP

SNPs


1 T315I

The exact incidence of the T315I mutation is controversial and can be estimated to be near 50%. --- T315I ---

Conversely, the detection of the T315I or F317 mutation in a patient is a very strong predictor of relapse. --- T315I ---

4. Dasatinib is a potent SCR and BCR-ABL tyrosine kinase inhibitor with preserved in vitro activity in most of the BCR-ABL mutated cell lines, except for the T315I and F317 mutations. --- T315I ---

The proportion of Detection of a T315I or F317 BCR-ABL TK mutation. --- T315I ---



HPO Nodes


HPO: