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BMS-354825 or Imatinib Mesylate in Treating Patients With Chronic Phase Chronic Myelogenous Leukemia That Did Not Respond to Previous Imatinib Mesylate
Link to the ClinicalTrials.gov recordInformation obtained from ClinicalTrials.gov on February 23, 2012
Title of trial/grant titleBMS-354825 or Imatinib Mesylate in Treating Patients With Chronic Phase Chronic Myelogenous Leukemia That Did Not Respond to Previous Imatinib Mesylate
Current status of trialActive, not recruiting
Sponsors and collaboratorsJonsson Comprehensive Cancer Center
National Cancer Institute (NCI)
Information provided byNational Cancer Institute (NCI)
ClinicalTrials.gov identifierNCT00112775
PurposeRATIONALE: BMS-354825 and imatinib mesylate may stop the growth of cancer cells by blocking
some of the enzymes needed for cell growth.

PURPOSE: This randomized phase II trial is studying BMS-354825 to see how well it works
compared to imatinib mesylate in treating patients with chronic phase chronic myelogenous
leukemia that did not respond to previous imatinib mesylate.
Condition(s)Leukemia
Intervention(s)Drug: dasatinib
Drug: imatinib mesylate
PhasePhase II
Study type and designMasking: Open Label, Primary Purpose: Treatment
Official titleA Randomized Multi-Center Open Label Study of BMS-354825 vs Imatinib Mesylate (Gleevec®) 800 mg/d in Subjects With Chronic Phase Philadelphia Chromosome-Positive Chronic Myeloid Leukemia Who Have Disease That is Resistant to Iamtinib at a Dose of 400-600 mg/d
Further study detailsOBJECTIVES:

Primary

- Determine the 12-week major cytogenetic response (MCyR) rate in patients with imatinib
mesylate-resistant Philadelphia chromosome-positive chronic phase chronic myelogenous
leukemia treated with BMS-354825 vs imatinib mesylate.

Secondary

- Determine the MCyR rate prior to crossover in patients treated with these drugs.

- Determine the durability of MCyR and time to MCyR prior to crossover in patients
treated with these drugs.

- Determine the complete hematologic response (CHR) rate prior to crossover in patients
treated with these drugs.

- Determine the durability of CHR and time to CHR prior to crossover in patients treated
with these drugs.

- Determine the major molecular response rate prior to crossover, as determined by
BCR-ABL transcripts in blood during treatment using quantitative reverse transcriptase
polymerase chain reaction, in patients treated with these drugs.

- Determine post-crossover efficacy endpoints in patients treated with these drugs who
crossover.

- Assess health-related quality of life prior to crossover in patients treated with these
drugs.

- Determine the safety and tolerability of BMS-354825 in these patients.

- Determine the pharmacokinetics of BMS-354825 in these patients.

OUTLINE: This is an open-label, multicenter, randomized, crossover study. Patients are
stratified according to study site and cytogenetic response to prior imatinib mesylate (yes
vs no). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive oral BMS-354825 twice daily in the absence of disease
progression or unacceptable toxicity. Patients experiencing disease progression or
persistent intolerance to BMS-354825 cross over to arm II after a 2-day washout period.
After crossover, patients receive oral imatinib mesylate twice daily in the absence of
further disease progression or unacceptable toxicity.

- Arm II: Patients receive oral imatinib mesylate twice daily in the absence of disease
progression or unacceptable toxicity. Patients experiencing disease progression,
intolerance to imatinib mesylate, lack of major cytogenetic response at 12 weeks, or <
30% absolute reduction in Philadelphia chromosome-positive metaphases at 12 weeks cross
over to arm I after a 1-week washout period. After crossover, patients receive oral
BMS-354825 twice daily in the absence of further disease progression or unacceptable
toxicity.

Quality of life is assessed at baseline, at day 29, every 4 weeks for 24 weeks, every 12
weeks for the remainder of study treatment, and then at the completion of study treatment.

After the completion of study treatment, patients are followed for at least 30 days.

PROJECTED ACCRUAL: A minimum of 150 patients (100 in arm I and 50 in arm II) will be accrued
for this study within 6-12 months.
Primary outcomeMajor cytogenic response (MCyR) rate at 12 weeks No
Secondary outcomeMCyR at any time No
Duration of MCyR No
Time to MCyR No
Complete hematologic response rate No
Study startMarch 2005
Minimum age18 Years
Maximum ageN/A
GenderBoth
Eligibility criteriaDISEASE CHARACTERISTICS:

- Diagnosis of chronic phase chronic myelogenous leukemia (CML), meeting all of the
following criteria:

- Less than 15% blasts in peripheral blood and bone marrow

- Less than 20% basophils in peripheral blood

- Less than 30% blasts and promyelocytes in peripheral blood and bone marrow

- Platelet count ⿥ 100,000/mm3 (unless thrombocytopenia is due to recent therapy)

- No extramedullary involvement (other than liver or spleen)

- Philadelphia chromosome (Ph)-positive disease by cytogenetic analysis

- Must have developed resistant disease during prior treatment with imatinib mesylate*
at a dose of 400-600 mg/day**, as defined by 1 of the following:

- Loss of major cytogenetic response (MCyR)

- Achieved a confirmed MCyR and subsequently no longer meets the MCyR
criteria

- Documented increase in Ph-positive metaphases by 30% on 2 cytogenetic
analyses performed ⿥ 4 weeks apart during treatment with imatinib mesylate

- Loss of complete hematologic response (CHR)

- Achieved a confirmed CHR and subsequently no longer meets the CHR criteria
on all asessments over a consecutive 2-week period during treatment with
imatinib mesylate

- Continuously increasing WBC count on ⿥ 2 consecutive evaluations ⿥ 2 weeks apart
with the final assessment showing a doubling of WBC from the nadir to ⿥
20,000/mm3 OR an absolute increase in WBC by > 50,000/mm3 above the lowest
count after starting imatinib mesylate

- No CHR after 3 months of treatment with imatinib mesylate at a dose of 400-600
mg/day

- No cytogenetic response after 6 months of treatment with imatinib mesylate at a
dose of 400-600 mg/day

- No MCyR after 12 months of treatment with imatinib mesylate at a dose of 400-600
mg/day NOTE: *Imatinib mesylate does not need to be the most recent treatment
for CML

NOTE: **Imatinib mesylate dose ⿤ 600 mg/day

- Able to tolerate chronic administration of imatinib mesylate at the highest dose
received during prior treatment

- No imatinib mesylate-related non-hematologic toxicity ⿥ grade 3

- No grade 4 imatinib mesylate-related hematologic toxicity lasting more than 7
days

- No imatinib mesylate-related toxicity that led to discontinuation or disruption
of dosing for > 4 weeks

- No previously identified BCR-ABL mutation of 1 of the following types:

- L248V

- G250E

- Q252H/R

- Y253H/F

- E255K/V

- T315I/D

- F317L

- H369P/R

- No prior diagnosis of accelerated phase or blast crisis CML

- Patients who previously met the criteria for accelerated phase or blast crisis
CML who achieved CHR during treatment with imatinib mesylate and then
subsequently progressed to chronic phase CML are not eligible

- Ineligible for or unwilling to undergo hematopoietic stem cell transplantation

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- ECOG 0-1

Life expectancy

- At least 3 months

Hematopoietic

- See Disease Characteristics

- No history of a significant bleeding disorder unrelated to CML, including any of the
following:

- Congenital bleeding disorder (e.g., von Willebrand's disease)

- Acquired bleeding disorder diagnosed within the past year (e.g. acquired
anti-factor VIII antibodies)

Hepatic

- Bilirubin ⿤ 2.0 times upper limit of normal (ULN)

- ALT and AST ⿤ 2.5 times ULN

Renal

- Creatinine ⿤ 1.5 times ULN

- Total serum or ionized calcium normal (supplementation allowed)

Cardiovascular

- Heart rate ⿥ 50 beats/minute by EKG

- No myocardial infarction within the past 6 months

- No uncontrolled angina within the past 3 months

- No congestive heart failure within the past 3 months

- No diagnosed or suspected congenital long QT syndrome

- No history of clinically significant ventricular arrhythmias (e.g., ventricular
tachycardia, ventricular fibrillation, or torsades de Pointes)

- No prolonged QTc interval (i.e., > 450 msec) by EKG using Bazett's correction

- High Bazett's correction (i.e., > 450 msec) allowed provided Fridericia
correction is ⿤ 450 msec

- No history of second or third degree heart block

- Pacemaker allowed

- No uncontrolled hypertension

- No other uncontrolled or significant cardiovascular disease

Other

- Not pregnant

- No nursing during and for ⿥ 3 months after study participation

- Negative pregnancy test

- Fertile patients must use effective contraception for ⿥ 1 month before, during, and
for ⿥ 3 months after study participation

- Magnesium and potassium normal (supplementation allowed)

- No serious uncontrolled medical disorder or active infection that would preclude
study participation

- No dementia or altered mental status that would preclude giving informed consent

- No significant bleeding from the gastrointestinal tract within the past 6 months

- No evidence of organ dysfunction or any clinically significant deviation from normal
on physical examination, vital signs, EKG, or clinical laboratory determinations
unrelated to CML that would preclude study participation

- No prisoners or patients who are involuntarily incarcerated for treatment of either a
psychiatric or physical (e.g., infectious disease) illness

PRIOR CONCURRENT THERAPY:

Biologic therapy

- More than 14 days since prior interferon

Chemotherapy

- More than 14 days since prior cytarabine

- Prior or concurrent hydroxyurea for elevated WBC (i.e., WBC > 50,000/mm3) allowed

Endocrine therapy

- Not specified

Radiotherapy

- Not specified

Surgery

- Not specified

Other

- More than 7 days since prior imatinib mesylate

- At least 7 days since prior and no concurrent low-dose aspirin (⿤ 325 mg/day)

- At least 14 days since prior and no concurrent high-dose aspirin (> 325 mg/day)

- More than 14 days since prior targeted small molecule anticancer agents

- More than 28 days since prior investigational or antineoplastic agents except
hydroxyurea or anagrelide

- At least 5 days or 5 half-lives (whichever is greater) since prior and no concurrent
drugs that carry a risk of causing torsades de Pointes, including any of the
following:

- Quinidine

- Procainamide

- Disopyramide

- Amiodarone

- Sotalol

- Ibutilide

- Dofetilide

- Erythromycin

- Clarithromycin

- Chlorpromazine

- Haloperidol

- Mesoridazine

- Thioridazine

- Pimozide

- Ziprasidone

- Cisapride

- Bepridil

- Droperidol

- Methadone

- Arsenic trioxide

- Chloroquine

- Domperidone

- Halofantrine

- Levomethadyl

- Pentamidine

- Sparfloxacin

- Lidoflazine

- At least 5 days or 5 half-lives (whichever is greater) since prior and no concurrent
medication that directly inhibits platelet function (except anagrelide for
thrombocytosis due to CML), including any of the following:

- Dipyridamole

- Epoprostenol

- Epitifibatide

- Clopidogrel

- Cilostazol

- Abciximab

- Ticlopidine

- At least 5 days or 5 half-lives (whichever is greater) since prior and no concurrent
anticoagulants (e.g., warfarin, heparin, or low molecular weight heparin [e.g.,
danaparoid, dalteparin, tinzaparin, or enoxaparin])

- Concurrent prophylactic low-dose warfarin for prevention of catheter thrombosis
and heparin-flush for IV lines allowed

- No prior BMS-354825

- No concurrent CYP3A4 inhibitors or inducers, including any of the following:

- Ketoconazole

- Ritonavir

- Rifampin

- Efavirenz

- No other concurrent therapy for CML
Study chairs or principal investigatorsRonald Paquette, MD, Principal Investigator, Jonsson Comprehensive Cancer Center
LocationsCalifornia, United States

Jonsson Comprehensive Cancer Center at UCLA
Los Angeles
California
90095-1781
LinksClinical trial summary from the National Cancer Institute's PDQ® database
ResultsKantarjian H, Pasquini R, Lévy V, Jootar S, Holowiecki J, Hamerschlak N, Hughes T, Bleickardt E, Dejardin D, Cortes J, Shah NP. Dasatinib or high-dose imatinib for chronic-phase chronic myeloid leukemia resistant to imatinib at a dose of 400 to 600 milligrams daily: two-year follow-up of a randomized phase 2 study (START-R). Cancer. 2009 Sep 15;115(18):4136-47.

Kantarjian H, Pasquini R, Hamerschlak N, Rousselot P, Holowiecki J, Jootar S, Robak T, Khoroshko N, Masszi T, Skotnicki A, Hellmann A, Zaritsky A, Golenkov A, Radich J, Hughes T, Countouriotis A, Shah N. Dasatinib or high-dose imatinib for chronic-phase chronic myeloid leukemia after failure of first-line imatinib: a randomized phase 2 trial. Blood. 2007 Jun 15;109(12):5143-50. Epub 2007 Feb 22.
Study ID numbersCDR0000428457; UCLA-0501047-01; BMS-CA180017; EUDRACT-2004-004450-96
Last updatedJune 4, 2011
Record first receivedJune 2, 2005
ClinicalTrials.gov identifierNCT00112775
Download dateInformation obtained from ClinicalTrials.gov on February 23, 2012
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