Ponatinib as Second Line Therapy for Patients With Chronic Myeloid Leukemia in Chronic Phase Resistant or Intolerant to Imatinib, Dasatinib or Nilotinib
Summary
This phase II trial studies how well ponatinib hydrochloride works as second line therapy in treating patients with chronic myeloid leukemia in chronic phase that has not responded to initial treatment (first line) with imatinib mesylate, dasatinib, or nilotinib or cannot tolerate imatinib mesylate, dasatinib, or nilotinib. Ponatinib hydrochloride may stop or control the growth of cancer cells by blocking a protein needed for cell growth.
Detailed description
Primary Objectives: * To estimate the proportion of participants with tyrosine kinase inhibitor (TKI)-resistant, chronic phase CML (CP-CML) attaining major cytogenetic response (MCyR) at 6 months of treatment with second line ponatinib therapy. * To estimate the time to toxicity related to ponatinib for patients with TKI-resistant CP-CML. Secondary Objectives: * To estimate the proportion of participants achieving a MCyR, complete cytogenetic response (CCyR), major molecular response (MMR) and complete molecular response (CMR) at 3, 6, 12, 18 and 24 months of treatment with ponatinib after one second generation TKI failure (by resistance). * To estimate the time to CCyR, MMR, MCyR and CMR for participants treated with ponatinib as second line therapy for CP-CML * To evaluate the durations of hematologic, cytogenetic and molecular response to ponatinib after one second generation TKI failure. * To define the time to progression and overall survival for participants with CML in chronic phase treated with ponatinib after one second generation TKI failure. * To evaluate the toxicity profile of ponatinib in participants with CML in chronic phase after one second generation TKI failure. * To evaluate the probability of developing ABL mutations for participants with CML in chronic phase treated with ponatinib after one second generation TKI failure. * To analyze differences in response rates and in prognosis according to pre-treatment mutations and patient characteristics. * To investigate mechanisms of resistance in patients who develop resistance to ponatinib used as second line therapy for CP-CML. * To evaluate symptom burden in participants with CP-CML receiving ponatinib. Exploratory Objectives: • To investigate the presence of miRNA that may be predictive of outcome
Arms & interventions
- OtherLaboratory Biomarker Analysis
Blood draws.
- DrugPonatinib Hydrochloride
Starting dose: 30 mg by mouth once a day.
- OtherQuality-of-Life Assessment
Surveys completed.
Outcome measures
Primary
MCyR at 6 months (MCyR6)
The method of Kaplan and Meier will be used to estimate the unadjusted distribution of duration of MCyR. An appropriate time-to-event regression model will be fit to the event time data to assess the effects of patient covariates on the event time variable, with the particular model determined by preliminary goodness-of-fit analyses. The distribution of MCyR6 will be tabulated and effects of baseline patient covariates on this variable will be assessed by logistic regression.
Time frame: At 6 months
Time-to-toxicity defined as any grade 3 or 4 drug-related adverse event that is not responsive to standard therapeutic management and requires permanent treatment discontinuation
Time-to-toxicity will be monitored using the Bayesian method of Thall, et al. The method of Kaplan and Meier will be used to estimate the unadjusted distribution of time to toxicity. An appropriate time-to-event regression model will be fit to the event time data to assess the effects of patient covariates on the event time variable, with the particular model determined by preliminary goodness-of-fit analyses.
Time frame: Up to 30 days post-treatment
Secondary
Duration of MCyR
Time frame: Up to 24 months
Time to transformation to accelerated phase CML
Time frame: Up to 5 years
Time to transformation to blastic phase CML
Time frame: Up to 5 years
MMR
Time frame: Up to 24 months
Eligibility criteria
Study locations (1)
M D Anderson Cancer Center
Houston, Texas, 77030