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Front-line Treatment of BCR-ABL+ Chronic Myeloid Leukemia (CML) With Dasatinib (CML1113)

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ClinicalTrials.gov Identifier: NCT01761890
Recruitment Status : Recruiting
First Posted : January 7, 2013
Last Update Posted : October 23, 2018
Sponsor:
Information provided by (Responsible Party):
Gruppo Italiano Malattie EMatologiche dell'Adulto

Brief Summary:

The GIMEMA CML Working Party promotes a multicentric, observational, non company sponsored, prospective study of Chronic Myeloid Leukemia (CML) patients treated frontline with dasatinib. Patients will be followed for 5 years. This study will help the definition of guidelines for the treatment of CML patients in early phases.

The primary objective of the study is to describe, in the clinical practice, the rate of events leading to permanent discontinuation after 2 years of treatment with dasatinib as frontline therapy in newly diagnosed CML patients.


Condition or disease Intervention/treatment
Chronic Myeloid Leukemia Behavioral: Dasatinib discontinuation

Detailed Description:

The primary objective is to describe, in the clinical practice, the rate of events leading to permanent discontinuation after 2 years of treatment with dasatinib as frontline therapy in newly diagnosed CML patients. Imatinib mesylate, a protein tyrosine kinase inhibitor (TKI) targeting BCR-ABL, has become in the last decade the standard of care for Chronic Myeloid Leukaemia (CML) in chronic phase (CP)1-3. Dasatinib is a second generation TKI, effective in imatinib-resistant and imatinib-intolerant patients, which demonstrated superior efficacy to imatinib in early CP BCR-ABL+ CML patients 4,6,7. Most data on second generation TKIs are from company-sponsored studies, generally implemented in selected referral centres. The long-term outcome is still unknown. The high rate of study discontinuation observed within the phase 3 study may influence the mid-term and the long-term data interpretation6,7. A long-term post-marketing surveillance in large independent trial is extremely important to confirm the feasibility of a frontline treatment with the second generation TKI dasatinib and to evaluate the efficacy in a nationwide experience. Moreover, obtaining a deep molecular response is extremely relevant in order to consider TKIs discontinuation. This condition is known as "Complete Molecular Response" (CMR) and is further defined according to the sensitivity achieved (for the definition see the "Criteria of evaluation" section). As far as treatment discontinuation, two experiences have been published so far, aimed at evaluating the persistence of the CMR after imatinib discontinuation. The first was a pilot study32 where 12 patients were included. These 12 patients discontinued imatinib after at least 2 years of CMR (median duration of negativity, 32 months). Six patients displayed a molecular relapse with a detectable BCR-ABL transcript at 1, 2, 3, 4, and 5 months. Imatinib was then reintroduced and led to a novel molecular response. Six other patients (50%) still have an undetectable level of BCR-ABL transcript after a median follow-up of 18 months (range, 9-24 months). The results of this pilot trial have been confirmed and extended in a second trial, the STIM trial33: 100 patients were enrolled, median follow-up 17 months, 69 patients with at least 12 months follow-up: 42 (61%) of these 69 patients relapsed (40 before 6 months, one patient at month 7, and one at month 19). At 12 months, the probability of persistent CMR for these 69 patients was 41% (95% CI 29-52). All patients who relapsed responded to reintroduction of imatinib. An increase of the CMR rate could possibly translate in a higher proportion of patients candidate to stopping anti-CML treatment, with higher probability of remaining disease-free in the long term. Interestingly, dasatinib was able to induce higher 36-month cumulative MR4 and MR4.5 rates than imatinib7. The advantages of this possible future scenario could be: first, the possibility of treatment discontinuation at least in patients with chronic clinical adverse events; second, a potential reduction of the costs of TKI treatment (after the introduction of TKI, the costs of CML treatment is increasing year by year, with the increasing prevalence of CML patients).

In summary, 1) Most data on second generation TKIs are from company-sponsored studies; 2) The high rate of study discontinuation observed within the phase III study may influence the data interpretation; 3) A long-term post-marketing surveillance in large independent trial is extremely important to confirm the efficacy in a nationwide experience; 4) The persistence of CMR after TKI discontinuation have been described in selected patients with "deep" molecular response; 5) A stable CMR is a pre-requisite for treatment discontinuation; 6) A detailed description of the kinetic of the molecular response, potentially related to a subsequent treatment discontinuation, will be done.

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Study Type : Observational
Estimated Enrollment : 133 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: Front-line Treatment of BCR-ABL+ Chronic Myeloid Leukemia (CML) With Dasatinib. An Observational Multicentric Study.
Actual Study Start Date : January 2014
Estimated Primary Completion Date : December 2018
Estimated Study Completion Date : November 2020


Group/Cohort Intervention/treatment
CML patients Behavioral: Dasatinib discontinuation
Treatment decision is at the discretion of the investigator and must not be made on the basis of this observational study. Patients should have their treatment initiated in accordance with the summary of product characteristics.




Primary Outcome Measures :
  1. Number of dasatinib permanent discontinuing patients. [ Time Frame: After 2 years from study entry. ]
    The cumulative rate of dasatinib permanent discontinuation by 2 years.


Secondary Outcome Measures :
  1. Number of dasatinib permanent discontinuing patients. [ Time Frame: After 5 years from study entry. ]
    The cumulative rate of dasatinib permanent discontinuation by 5 years.

  2. Number of confirmed MR4 and MR4.5. [ Time Frame: After 2 years from study entry. ]
    The rate of confirmed MR4 and MR4.5 by 24 months.

  3. Number of confirmed MR4 and MR4.5. [ Time Frame: After 60 months from study entry. ]
    The rate of confirmed MR4 and MR4.5 by 60 months.

  4. Number of stable MR4 and MR4.5 and characteristics. [ Time Frame: After 60 months from study entry. ]
    The stability of MR4 and MR4.5.

  5. Number of Complete Cytogenetic Responses (CCgR) [ Time Frame: After one year from study entry. ]
    The rate of Complete Cytogenetic Response (CCgR) at 1 year.

  6. Number of Major Molecular Response (MMR). [ Time Frame: After one year from study entry. ]
    The rate of Major Molecular Response (MMR) at 1 year.

  7. Number of days to response (CCgR, MMR, MR4, MR4.5). [ Time Frame: After 4 years from study entry. ]
    The median time to response and the overall estimated probability of response (CCgR, MMR, MR4, MR4.5).

  8. Number of overal surviving patients [ Time Frame: After five years from study entry. ]
  9. Number of progression-free survival patients. [ Time Frame: After five years from study entry. ]
  10. Number of failure-free survival patients. [ Time Frame: After five years from study entry. ]
  11. Number of event-free survival patients. [ Time Frame: After five years from study entry. ]
  12. Number of responses [ Time Frame: After 7 years from study entry. ]
    Overall responses and long-term outcome according to baseline prognostic factors (including: Sokal score34, Euro score35 and EUTOS score36; presence of additional chromosomal abnormalities in Ph+ cells; BCR-ABL transcript type; comorbidity score index).

  13. Number of responses according to BCR-ABL transcript levels. [ Time Frame: After 3 and 6 months from study entry. ]
    Overall responses and long-term outcome according to BCR-ABL transcript levels and CgR at 3 months and at 6 months.

  14. Number of patients with fasting glucose modifications. [ Time Frame: After 24 months from study entry. ]
    Fasting glucose modifications (diabetic and normo-glycemic patients) and HbA1C modifications (diabetic patients only) during the first 24 months.

  15. Number of patients with modifications of body mass index during treatment compared to baseline. [ Time Frame: After 7 years from study entry. ]
    Modifications of body mass index during treatment compared to baseline.

  16. Number of patients with modifications of serum lipids during treatment compared to baseline. [ Time Frame: After 7 years from study entry. ]
    Modifications of serum lipids during treatment compared to baseline.

  17. Patient reported quality of life. [ Time Frame: At 3, 6, 9, 12, 18, 24 months from study entry. ]
  18. Number of adverse events. [ Time Frame: At 3, 6, 9, 12, 18, 24 months from study entry. ]


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
Sampling Method:   Non-Probability Sample
Study Population
This is a multicentre, observational, prospective study of newly diagnosed chronic phase CML patients treated frontline with Dasatinib 100 mg QD.
Criteria

Inclusion Criteria:

  • Cytogenetic and/or molecular confirmed diagnosis of Ph+ and/or BCR-ABL+ CML; Age 18 years;
  • Early chronic phase, less than 6 months from diagnosis. Prior treatment with Hydroxyurea or Anagrelide is allowed;
  • Signed written informed consent according to ICH/EU/GCP and national local laws prior to any study procedures.

Exclusion Criteria:

  • Prior treatment with any protein tyrosin-kinase inhibitor (TKI) or interferon;
  • Recommendations and precautions before allocating a new CML case to dasatinib are fully described in the prescribing information.

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): NCT01761890


Contacts
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Contact: Paola Fazi, Dr. p.fazi@gimema.it
Contact: Enrico Crea e.crea@gimema.it

Locations
Show Show 37 study locations
Sponsors and Collaborators
Gruppo Italiano Malattie EMatologiche dell'Adulto
Investigators
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Study Chair: Michele Baccarani, Pr. Orsola Malpighi, Bologna
Additional Information:
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Responsible Party: Gruppo Italiano Malattie EMatologiche dell'Adulto
ClinicalTrials.gov Identifier: NCT01761890    
Other Study ID Numbers: CML1113
RSO ID 714 ( Other Identifier: Observational Study Register )
First Posted: January 7, 2013    Key Record Dates
Last Update Posted: October 23, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Gruppo Italiano Malattie EMatologiche dell'Adulto:
Chronic Myeloid Leukemia
Early phase
CML
Dasatinib
Additional relevant MeSH terms:
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Leukemia
Leukemia, Myeloid
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Neoplasms by Histologic Type
Neoplasms
Myeloproliferative Disorders
Bone Marrow Diseases
Hematologic Diseases
Dasatinib
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action