Patient case: 4-year-old female with leukemia; genetic feature: ABL1

Clinical trial: Ponatinib for Chronic Myeloid Leukemia (CML) Evaluation and Ph+ Acute Lymphoblastic Leukemia (ALL)

Summary: The purpose of this study is to determine the efficacy of ponatinib in patients with chronic myeloid leukemia (CML) in chronic phase (CP), accelerated phase (AP) or blast phase (BP) or with Ph positive (Ph+) acute lymphoblastic leukemia (ALL) who either are resistant or intolerant to either dasatinib or nilotinib, or have the T315I mutation.

Detailed description: The preliminary analysis of the phase 1 clinical trial revealed evidence of clinical antitumor activity in patients with resistance to approved second-generation tyrosine kinase inhibitors (TKI), dasatinib and nilotinib, including patients with the T315I mutation of the BCR-ABL gene (BCR-ABL). This Phase 1 study, taken together with the strong preclinical data that characterize ponatinib, provides the rationale for moving to a pivotal phase 2 trial of this agent in a population of patients with chronic myeloid leukemia (CML) and Ph+ Acute Lymphoblastic Leukemia (ALL) who are resistant or intolerant to prior TKI therapy and in those patients with the T315I mutation.
  PACE is a multi-center, international, phase 2, uncontrolled, open-label trial of oral ponatinib in patients with Philadelphia chromosome-positive (Ph+) disease.

Eligibility: Inclusion Criteria:
  -  Patients must have CML in any phase (CP, AP, or BP of any phenotype) or Ph+ ALL
  -  Previously treated with and developed resistance or intolerance to dasatinib or nilotinib OR developed the T3151 mutation after any tyrosine kinase inhibitor (TKI) therapy
  -  ≥18 years old
  -  Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
  -  Minimum life expectancy of ≥3 months
  -  Adequate kidney function
  -  Adequate liver function
  -  Normal pancreatic function
  -  Normal QT Fridericia-corrected interval (QTcF) ≤450 ms for males and ≤470 ms for females
  -  Negative pregnancy test (if woman of childbearing potential)
  -  Agree to use effective form of contraception (as applicable)
  -  Ability to comply with study procedures, in the Investigator's opinion
  Exclusion Criteria:
  -  Received prior TKI treatment within 7 days prior to receiving the first dose of ponatinib, or have not recovered from adverse events (except alopecia) due to agents previously administered.
  -  Received other therapies as follows:
  1. For CML chronic phase (CP) and accelerated phase (AP) patients, received hydroxyurea or anagrelide within 24 hours prior to receiving the first dose of ponatinib; interferon, cytarabine, or immunotherapy within 14 days prior to first dose of ponatinib; or any other cytotoxic chemotherapy, radiotherapy, or investigational therapy within 28 days prior to receiving the first dose of ponatinib.
  2. For CML blast phase (BP) patients, received chemotherapy within 14 days prior to the first dose of ponatinib.
  3. For Ph+ ALL patients, received corticosteroids within 24 hours before the first dose of ponatinib; or vincristine within 7 days prior to the first dose of ponatinib; or received other chemotherapy within 14 days prior to the first dose of ponatinib.
  -  Underwent stem cell transplant <60 days prior to receiving first dose of ponatinib
  -  Evidence of on-going graft versus-host disease (GVHD), or GVHD requiring immunosuppressive therapy
  -  Taking medications that are known to be associated with Torsades de Pointes
  -  Require concurrent treatment with immunosuppressive agents (other than corticosteroids prescribed for a short course of therapy)
  -  Previously treated with ponatinib
  -  CML CP patients are excluded if they are in Complete cytogenetic response (CCyR)
  -  Patients with CML AP, CML BP, or Ph+ ALL are excluded if they are in Major Hematologic Response (MaHR).
  -  Have active Central Nervous System (CNS) disease
  -  Have significant or active cardiovascular disease
  -  Have a significant bleeding disorder unrelated to CML or Ph+ALL
  -  Have a history of pancreatitis or alcohol abuse
  -  Have uncontrolled hypertriglyceridemia (triglycerides >450 mg/dL)
  -  Have malabsorption syndrome or other gastrointestinal illness that could affect absorption of ponatinib
  -  Diagnosed with another primary malignancy in the past 3 years
  -  Pregnant or lactating
  -  Underwent major surgery within 14 days prior to first dose of ponatinib
  -  Have ongoing or active infection
  -  Suffer from any other condition or illness that would compromise safety or interfere with evaluation of the drug

Relevance to patient case: not relevant