Multicenter Single-arm Pilot Study Evaluating Efficacy of Nilotinib in CML Patients With Molecular Relapse After Glivec Discontinuation Within the Context of the STIM Trials (STIM and STIM2) (NiloPost-STIM)
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|ClinicalTrials.gov Identifier: NCT01774630|
Recruitment Status : Active, not recruiting
First Posted : January 24, 2013
Last Update Posted : August 5, 2019
Chronic myeloid leukemia (CML) is a hematopoietic neoplasm characterized by the reciprocal translocation t(9;22). The resulting oncoprotein, bcr-abl is an essential trigger for growth and survival of leukemic cells. In the past decade, the bcr-abl tyrosine kinase inhibitor (TKI) imatinib (IM or Glivec©) has been the standard of care for patients with CML, inducing durable responses. However, requiring continuing IM indefinitely and the ability of IM to eradicate the CML clone was uncertain.
In a small proportion of patients, IM can induce complete molecular response (CMR) defined by the disappearance of the bcr-abl transcript in conventional quantitative RT-PCR. The question whether or not these patients are cured and can discontinue drug therapy has been assessed by Mahon and coll, in the STIM study. He demonstrates that IM can be safely discontinued in patient with a CMR of at least 2 year duration and all patients who relapsed after IM discontinuation mainly did it in the first 6 months and responded to reintroduction of imatinib.
Nilotinib is a rationally designed second generation tyrosine kinase inhibitor with improved target specificity over imatinib. Its efficacy and safety in the treatment of patients who are resistant or intolerant to imatinib as well as patients with newly diagnosed CML-CP led to the registration in second and first line treatment of CML-CP patients. Nilotinib produces even faster and deeper responses with more occurrence of CMR than does Imatinib. Consequently, one can assume that a more potent drug such nilotinib could induce deeper and sustained CMR allowing longer period off treatment than IM.
The objective of this pilot trial is to assess if Nilotinib can rescue STIM patients in molecular relapse after IM discontinuation and to provide an estimation about duration of CMR after nilotinib discontinuation in 2nd line therapy among patients experiencing 2 years of stable CMR with nilotinib.
|Condition or disease||Intervention/treatment||Phase|
|Leukemia, Myelogenous, Chronic, BCR-ABL Positive||Drug: Nilotinib||Phase 2|
Patients with CML included in STIM trials, stopped their treatment by imatinib because the signal was not detectable. In case of reappearance of this transcript Bcr-Abl, the patient relapses. The trial Nilo Post STIM is suggested to the patient to assess if Nilotinib can rescue STIM patients in molecular relapse after IM discontinuation and to provide an estimation about duration of CMR after nilotinib discontinuation in 2nd line therapy among patients experiencing 2 years of stable CMR with nilotinib.
The treatment/strategy for this study:
- Inclusion/exclusion criteria
- CML history
- Confirm molecular relapse after discontinuation of imatinib (quantitative RT-PCR on two consecutive assessments from peripheral blood samples)
• Nilotinib 300mg BID for 2 years
- Premature treatment discontinuation while on study: primary or secondary resistance progression to accelerated phase or blast crisis, AE (to be defined later).
- In case of unsatisfactory response: transcript stability or increase on two consecutive PCR: nilotinib blood monitoring, and nilotinib dose escalation up to 400mg BID will be proposed
- Discontinuation at 2 years for patients who resumed confirmed CMR
Follow-up while on treatment with nilotinib:
- Physical exam, basic laboratory parameters, monthly during the first 3 months then every 3 months.
- Centralized quantitative RT-PCR for Bcr-Abl monthly for 6 months then every 3 months for 24 months
- Follow AE management guidelines for nilotinib reduction/interruptions
Follow-up after nilotinib discontinuation
Patients in confirmed molecular relapse
- Physical exam, event collection, basic laboratory parameters (including glycemic and lipid profile) every 2 months during the first year then every 3 months
- Hematology and centralized quantitative RT-PCR monthly the first year then every 3 months for 12 months
- Patients without confirmed molecular relapse will take another treatment (dasatinib for example) and will stop their follow-up in the trial
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||31 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Multicenter Single-arm Pilot Study Evaluating Efficacy of Nilotinib in CML Patients With Molecular Relapse After Glivec Discontinuation Within the Context of the STIM Trials (STIM and STIM2)|
|Actual Study Start Date :||April 10, 2013|
|Estimated Primary Completion Date :||April 2020|
|Estimated Study Completion Date :||April 2020|
300 mg/twice a day
300 mg/twice a day
- Estimated survival rate of patients without molecular relapse 3 years after enrollment [ Time Frame: Evaluation by RTq-PCR monthly the first year of treatment with nilotinib then every 3 months until 24 months, date of discontinuation of Nilotinib for patients in sustained complete molecular response (CMR). After discontinuation of Nilotinib patie ]CMR is defined as >5 log reduction in Bcr-Abl and Abl levels and undetectable transcripts on quantitative RTq-PCR
- Rate and kinetics of CMR while on treatment with nilotinib [ Time Frame: at 6 and 12 months of treatment with nilotinib ]Same definition of CMR as above
- Duration of CMR while on treatment with nilotinib [ Time Frame: Any time ]Defined as the time from the date of first documented CMR to the date of first confirmed molecular relapse defined as positivity of Bcr-Abl transcripts in quantitative RT-PCR with a ratio of bcr-abl to Abl ≥ 10-5, as confirmed by a second analysis point at two successive assessments
- Event free survival (EFS) [ Time Frame: Any time ]Events include loss of major molecular response (MMR) , loss of complete cytogenetic response (CCyR) loss of complete hematologic response (CHR), progression to accelerated phase and blst crisis (AP-BC), death whatever the cause, adverse-event leading to premature discontinuation of nilotinib
- Safety tolerability of nilotinib and compliance [ Time Frame: Any time ]Haematological and non-haematological adverse events (AE) graded will be according to the NCI CTC AE v4. Compliance will be estimated using the 4 items Morisky scale
- Duration of CMR after nilotinib discontinuation [ Time Frame: Measured from the start of nilotinib discontinuation to the date of first confirmed molecular relapse as defined above ]
- Event free survival (EFS) [ Time Frame: Overall and after nilotinib discontinuation ]Same events as for EFS described above
- Predictive factors of maintained CMR after nilotinib discontinuation: sex, Sokal risk score at diagnosis, duration of previous treatment with imatinib, CMR duration before and after discontinuation of imatinib [ Time Frame: After discontinuation of nilotinib ]Parameters will be recorded before and after both sequences of treatment imatinib and nilotinib
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): NCT01774630
|Study Chair:||Viviane DUBRUILLE||Nantes University Hospital|
|Study Chair:||Gabriel ETIENNE||University Hospital Bordeaux, France|
|Study Chair:||Franck NICOLINI||Hospices Civils de Lyon|
|Study Chair:||Delphine REA||APHP, St Louis Hospital|