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

Clinical trial: A Phase l/ll Study of AMN107 in Adult Patients With Glivec-intolerant CML or Relapsed-refractory Ph+ALL

Summary: This study will investigate if nilotinib provides an improved safety and efficacy profile over that seen in patients receiving Imatinib.


Eligibility: Inclusion Criteria:
  -  Diagnosed as Ph+ ALL who are either relapsed after or refractory to standard therapy
  -  Diagnosed as CML in blast crisis or accelerated phase or chronic phase who are resistant or intolerant to imatinib
  -  Performance status is normal or ambulatory and capable of all self-care Exclusion Criteria
  -  A history of significant or serious uncontrolled cardiovascular disease
  -  Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of nilotinib
  -  Patients who are pregnant or breast feeding, or adults of reproductive potential not employing an effective method of birth control
  Exclusion Criteria:
  -  Cytopathologically confirmed CNS infiltration NB: in absence of suspicion of CNS involvement, lumbar puncture is not required
  -  Impaired cardiac function, including any one of the following
  -  LVEF < 45% as determined by echocardiogram
  -  Complete left bundle branch block
  -  Use of a cardiac pacemaker
  -  ST depression of > 1mm in 2 or more leads and/or T-wave inversions in 2 or more contiguous leads
  -  Congenital long QT syndrome
  -  History of or presence of significant ventricular or atrial tachyarrhythmias
  -  Clinically significant resting bradycardia (< 50 beats per minute)
  -  QTc > 480 msec on screening ECG (using the QTcF formula)
  -  Right bundle branch block plus left anterior hemiblock, bifascicular block
  -  Myocardial infarction within 3 months prior to starting AMN107
  -  Uncontrolled angina pectoris
  -  Other clinically significant heart disease (e.g., congestive heart failure, uncontrolled hypertension, history of labile hypertension, or history of poor compliance with an antihypertensive regimen)
  -  Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of AMN107 (e.g. ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection)
  -  Use of therapeutic warfarin
  -  Acute or chronic liver or renal disease considered unrelated to tumor (e.g., hepatitis, cirrhosis, renal insufficiency, etc.)
  -  Other concurrent severe and/or uncontrolled medical conditions (e.g., uncontrolled diabetes, active or uncontrolled infection) that could cause unacceptable safety risks or compromise compliance with the protocol
  -  Treatment with any hematopoietic colony-stimulating growth factors (e.g., G-CSF) ≤ 1 week prior to starting study drug.
  -  Patients who are currently receiving treatment with any of the medications listed in (cf. Post-text suppl. 5) that cannot be either discontinued or switched to a different medication prior to starting study drug. The medications listed in (cf. Post-text suppl. 5) have the potential to prolong the Q-T interval.
  -  Patients who have received chemotherapy ≤ 1 week or who are within 5 half-lives of their last dose chemotherapy (6 weeks for nitrosurea or mitomycin-C) prior to starting study drug or who have not recovered from side effects of such therapy. Hydroxyurea is permitted at the investigator's discretion prior to enrollment.
  -  Patients who have received Glivec® ≤ 1 week or who have not recovered from side effects of such therapy.
  -  Patients who have received immunotherapy ≤ 1 week prior to starting study drug or who have not recovered from side effects of such therapy.
  -  Patients who have received any investigational drug (excluding STI571/Glivec) ≤ 4 weeks or investigational cytotoxic agent within 1 week (or who are within 5 half-lives of a previous investigational cytotoxic agent) prior to starting study drug or who have not recovered from side effects of such therapy.
  -  Patients who have received wide field radiotherapy ≤ 4 week or limited field radiation for palliation ≤ 2 week prior to starting study drug or who have not recovered from side effects of such therapy.
  -  Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug or who have not recovered from side effects of such therapy.
  -  Patients who are pregnant or breast feeding, or adults of reproductive potential not employing an effective method of birth control. (Women of childbearing potential must have a negative serum pregnancy test within 48 hrs prior to administration of AMN107). Post-menopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential. Male and female patients must agree to employ an effective barrier method of birth control throughout the study and for up to 3 months following discontinuation of study drug
  -  Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not mandatory)
  -  Patients with a history of another primary malignancy that is currently clinically significant or currently requires active intervention.
  -  Patients unwilling or unable to comply with the protocol
  Other protocol-defined inclusion and exclusion criteria may apply.

Relevance to patient case: not relevant