Clinical trial NCT01275196: Safety and Efficacy of Nilotinib vs. Imatinib in the Treatment of Newly Diagnosed Chinese Ph+ CML-CP Patients
Official title: ENESTChina: A Phase III Multi-center, Open-label, Randomized Study of Nilotinib Versus Imatinib in Chinese Adult Patients With Newly Diagnosed Philadelphia Chromosome Positive (Ph+) Chronic Myelogenous Leukemia in Chronic Phase (CML-CP)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Chronic Myeloid Leukemia
Keywords: Newly diagnosed,
Ph+ chronic myeloid leukemia,
CML-CP
Lead sponsor: Novartis
Sponsor class: INDUSTRY
First posted: 2011-01-12
Enrollment: 267
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The study will compare the efficacy and safety of Nilotinib versus Imatinib in newly diagnosed Chinese patients with CML-CP.


Eligibility criteria: Inclusion Criteria:

* Patients of Chinese ethnicity greater than or equal to 18 years of age
* ECOG 0, 1, or 2.
* Patients with CML-CP (Ph+) within 6 months of diagnosis (date of initial diagnosis is the date of first cytogenetic analysis). Standard conventional cytogenetic analysis must be done on bone marrow. (FISH cannot be used)
* Diagnosis of chronic myelogenous leukemia in chronic phase with cytogenetic confirmation for the presence of Philadelphia chromosome of (9;22 translocation; less than 20 metaphases may be used for diagnosis
* Documented chronic phase CML will meet all the criteria defined by:

  * \< 15% blasts in peripheral blood and bone marrow
  * \< 30% blasts plus promyelocytes in peripheral blood and bone marrow
  * \< 20% basophils in the peripheral blood
  * ≥ 100 x 109/L (≥ 100,000/mm3) platelets
* No evidence of extramedullary leukemic involvement, with the exception of hepatosplenomegaly
* Adequate organ function as defined by:

  * Total bilirubin \< 1.5 x ULN
  * SGOT and SGPT \< 2.5 x ULN
  * Creatinine \< 1.5 x ULN
  * Serum amylase and lipase ≤ 1.5 x ULN
  * Alkaline phosphatase ≤ 2.5 x ULN unless considered tumor related.
* Patients must have the following laboratory values (≥ LLN (lower limit of normal) or corrected to within normal limits with supplements prior to the first dose of study medication.):

  * Potassium ≥ LLN
  * Magnesium ≥ LLN
  * Phosphate ≥ LLN
  * Total calcium (corrected for serum albumin) ≥ LLN.
* Ability to provide written informed consent prior to any study related screening procedures being performed.

Exclusion Criteria:

* Patients with previously documented T315I mutations;
* Treatment with tyrosine kinase inhibitor(s) prior to study entry is not allowed, except in the following situation: in emergent cases where the patient requires disease management while awaiting study start, commercial supplies of Gleevec/Glivec at any dose may be prescribed to the patient but for no longer than 2 weeks in duration.
* Treatment with IFN for more than 3 months.
* Impaired cardiac function including any one of the following:
* Complete left bundle branch block
* Long QT syndrome or a known family history of long QT syndrome.
* History of or presence of clinically significant ventricular or atrial tachyarrhythmias
* Clinically significant resting bradycardia (\<50 beats per minute)
* QTc \> 450 msec If QTcF \>450 msec and electrolytes are not within normal ranges, electrolytes should be corrected and then the patient re-screened for QTc
* History of clinically documented myocardial infarction within past 12 months
* History of unstable angina (during the last 12 months)
* Other clinically significant heart disease (e.g., congestive heart failure or uncontrolled hypertension).
* Known cytopathologically confirmed CNS infiltration (in absence of suspicion of CNS involvement, lumbar puncture not required).
* Severe or uncontrolled medical conditions (i.e. uncontrolled diabetes, active or uncontrolled infection).
* History of significant congenital or acquired bleeding disorder unrelated to cancer.
* Major surgery within 4 weeks prior to Day 1 of study or who have not recovered from prior surgery.
* Treatment with other investigational agents (defined as not used in accordance with the approved indication) within 30 days of Day 1.
* History of non-compliance to medical regimens or inability to grant consent.
* Patients with another primary malignancy except if the other primary malignancy is neither currently clinically significant or requiring active intervention
* Patients actively receiving therapy with strong CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, itraconazole, voriconazole, clarithromycin, telithromycin, ritonavir, mibefradil) and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug. See link for complete list of these medications: http://medicine.iupui.edu/flockhart/table.htm or reference Protocol post text appendix 1.
* Patients actively receiving therapy with strong CYP3A4 inducers (e.g., dexamthasone, phenytoin, carbamazepine, rifampin, rifabutin, rifapentin, phenobarbitol, St. John's Wort) and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug. See link for complete list of these medications: http://medicine.iupui.edu/flockhart/table.htm or reference Protocol post text appendix 1.
* Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of study drug (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, small bowel resection, or gastric bypass surgery)
* History of acute pancreatitis within 1 year of study entry or past medical history of chronic pancreatitis.
* Acute or chronic liver, pancreatic or severe renal disease considered unrelated to disease.
* Patients who are currently receiving treatment with any medications that have the potential to prolong the QT interval and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug (Please see http://www.torsades.org/medical-pros/drug-lists/printable-drug-list.cfm for a comprehensive list of agents that prolong the QT interval).
* Patients who are: (a) pregnant, (b) breast feeding, (c) of childbearing potential without a negative pregnancy test prior to baseline and (d) female of childbearing potential unwilling to use contraceptive precautions throughout the trial (post-menopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential)

Other protocol-defined inclusion/exclusion criteria may apply

Primary outcomes:
measure: Major Molecular Response (MMR) at 12 Months - With Imputation.
timeFrame: 12 months
Secondary outcomes:
measure: MMR Rate at Each Time Point
timeFrame: Months 3,6,9,12,15, 18, 21, 24, 36
measure: Best MMR by Each Timepoint
timeFrame: Months 3,6,9,12,15, 18, 21, 24, 36
measure: Kaplan-Meier Estimates of Time to First MMR
timeFrame: End of study (up to 40 months)
measure: Durable MMR Rate at 24 Months
timeFrame: 24 months
measure: Kaplan-Meier Estimates of Duration of First MMR Among Patients Who Achieved MMR
timeFrame: End of Study (Up to 40 months)
measure: Best Complete Cytogenic Response (CCyR) Rate by Each Time Point
timeFrame: Months 6, 12, 18, 30, 24, 36
measure: Kaplan-Meier Estimates of Time to First CCYR
timeFrame: End of study (up to 40 months)
measure: Kaplan-Meier Estimates of Duration of First CCyR Among Patients Who Achieved CCyR
timeFrame: End of Study (up to 40 months)
measure: Kaplan-Meier Estimates of Time to Progression to Accelerated Phase/Blast Crisis (AP/BC) on Treatment
timeFrame: End of study (up to 40 months)
measure: Kaplan-Meier Estimates of Event-free Survival (EFS) on Treatment
timeFrame: End of Study (up to 40 months)
measure: Kaplan-Meier Estimates of Progression-free Survival (PFS) on Treatment
timeFrame: End of study (up to 40 months)
measure: Kaplan-Meier Estimates of Overall Survival (OS) on Treatment
timeFrame: End of Study (up to 40 months)
measure: Best Complete Hematologic Response (CHR)
timeFrame: Months 1, 3, 4, 5, 6, 9,12, 15,18, 21, 24, 30, 36
measure: Modified ELN2009 Criteria
timeFrame: End of Study (up to 40 months)
measure: Actual Dose Intensity
timeFrame: End of Study (up to 40 months)
measure: Summary Statistics of Trough Imatinib and Major Metabolite CGP74588 of Imatinib and Nilotinib PK Concentration by Time Point
timeFrame: 12 Months
Other outcomes:
Locations:
city: Guangzhou
country: China
facility: Novartis Investigative Site
state: Guangdong
city: Guangzhou
country: China
facility: Novartis Investigative Site
state: Guangdong
city: Wuhan
country: China
facility: Novartis Investigative Site
state: Hubei
city: Chengdu
country: China
facility: Novartis Investigative Site
state: Sichuan
city: Tianjin
country: China
facility: Novartis Investigative Site
state: Tianjin
city: Hangzhou
country: China
facility: Novartis Investigative Site
state: Zhejiang
city: Beijing
country: China
facility: Novartis Investigative Site
city: Fuzhou
country: China
facility: Novartis Investigative Site
city: Jinan
country: China
facility: Novartis Investigative Site
city: Nan Jing
country: China
facility: Novartis Investigative Site
city: Shanghai
country: China
facility: Novartis Investigative Site
city: Shanghai
country: China
facility: Novartis Investigative Site
Study officials:
affiliation: Novartis Pharmaceuticals
name: Novartis Pharmaceuticals
role: STUDY_DIRECTOR
References:
citation: Wang J, Shen ZX, Saglio G, Jin J, Huang H, Hu Y, Du X, Li J, Meng F, Zhu H, Hu J, Wang J, Hou M, Hertle S, Menssen HD, Ortmann CE, Tribouley C, Yuan Y, Baccarani M, Huang X. Phase 3 study of nilotinib vs imatinib in Chinese patients with newly diagnosed chronic myeloid leukemia in chronic phase: ENESTchina. Blood. 2015 Apr 30;125(18):2771-8. doi: 10.1182/blood-2014-09-601674. Epub 2015 Mar 12.