CLINICAL TRIAL / NCT03595917
ABL001 + Dasatinib + Prednisone + Blinatumomab in BCR-ABL+ B-ALL or CML
- Interventional
- Recruiting
- NCT03595917
Contact Information
A Phase 1 Study of ABL001 in Combination With Dasatinib, Prednisone, and Blinatumomab in Patients With BCR-ABL Positive (BCR-ABL+) B-cell Acute Lymphoblastic Leukemia (B-ALL) and Chronic Myeloid Leukemia (CML)
This research study is evaluating a drug called ABL001 taken in combination with dasatinib (Sprycel®) and prednisone (a steroid) as a possible treatment for B-cell Acute Lymphoblastic Leukemia that is BCR-ABL positive (BCR-ABL+ B-ALL) or Chronic Myeloid Leukemia (CML) in lymphoid blast crisis. BCR-ABL+ B-ALL is also called Philadelphia chromosome positive Acute Lymphoblastic Leukemia (Ph+ ALL). It is expected that 25-40 people will take part in this research study. - ABL001 - Dasatinib (Sprycel®) - Prednisone - Blinatumomab
This research study is a Phase I clinical trial, which tests the safety of an
investigational drug and also tries to define the appropriate dose of the investigational
drug to use for further studies. "Investigational" means that the drug is being studied.
There is currently no clinical data on the effects of ABL001 in combination with
dasatinib and prednisone among adults with Ph+ B-ALL or CML in lymphoid blast crisis.
However, there is data on the use of ABL001 in combination with dasatinib (without
steroids) in patients with relapsed Ph+ B-ALL and Ph+ chronic myeloid leukemia (CML).
Dasatinib (Sprycel®) is currently approved for the treatment in newly diagnosed adults
with Ph+ CML in chronic phase (CP), adults with chronic, accelerated, or myeloid or
lymphoid blast phase Ph+ CML with resistance or intolerance to prior therapy including
imatinib, adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+
ALL) with resistance or intolerance to prior therapy.
ABL001 is a newly discovered compound. This drug has been used in laboratory experiments
and information from those experiments suggest that this drug may have beneficial effects
in people who have CML or Ph+ ALL, both of which are a certain type of cancer of the
blood cells. The reason for this study is to learn whether ABL001 is safe and can have
possible benefits for people with Ph+ ALL who are also being treated with dasatinib and
prednisone, two drugs which are commonly used to treat Ph+ ALL. All participants in this
study will receive all three drugs.
Prednisone, dasatinib and blinatumomab are all FDA approved and standard of care for
participants with your disease.They are not considered investigational on this study.
However, ABL001 is being tested in combination with these drugs.
Biomarker testing will also be included in this study. Biomarkers are important
biological "indicators" of whether a drug is working which can be measured from bone
marrow and blood samples.
In addition, blood and bone marrow samples may be tested to try to learn more about the
cancer, and to understand how the drug may be working in cancer.
Gender
All
Age Group
18 Years and up
Accepting Healthy Volunteers
No
Inclusion Criteria:
- Participants must meet the following criteria on screening examination to be
eligible to participate in the study:
- Participants must have cytopathologically confirmed CD19+ BCR-ABL1+ acute
leukemia (B-cell ALL, mixed phenotype acute leukemia, or CML in lymphoid blast
crisis with ≥ 5% lymphoblasts.)22
- BCR-ABL1 positive status may be confirmed by FISH, karyotype analysis, or
molecular testing for p210 (b2a2 or b3a2) or p190 (e1a2) transcripts.
- Patients with asymptomatic central nervous system (CNS) disease are
eligible and may be treated concurrently with intrathecal chemotherapy.
- Dose escalation: Participants must NOT be suitable for or willing to receive
standard intensive induction chemotherapy.
- Dose expansion: Participants aged 18 years and older will be eligible
regardless of suitability for intensive induction chemotherapy.
The following groups are not considered suitable for standard intensive induction
chemotherapy:
- Participants who have not received standard intensive induction chemotherapy and are
aged ≥ 50 years.
- Participants who have not received standard intensive induction chemotherapy and are
aged 18 to 49 years and unfit due to co-morbidity or other factors to receive
intensive chemotherapy. Specific criteria that would suggest that a patient is
unsuitable for intensive induction chemotherapy include:
- Severe cardiac comorbidity (congestive heart failure or documented
cardiomyopathy with EF ≤50%).
- Severe pulmonary comorbidity (documented pulmonary disease with DLCO ≤ 65% or
FEV1 ≤ 65%, or dyspnea at rest, or requiring oxygen).
- ECOG performance status of 2 due to medical conditions unrelated to leukemia.
- Any other comorbidity that the physician judges to be incompatible with
intensive cytotoxic chemotherapy.
- Participants aged ≥ 18 years with disease that is relapsed or refractory to 1 or
more cycles of standard intensive induction chemotherapy.
- ECOG performance status 0-3 (Appendix A). ECOG value of 3 is allowed after
documented discussion with PI, if poor performance status is attributed to
underlying disease.
- Participants must have normal organ function as defined below:
- Creatinine ≤ 1.5x institutional upper limit of normal.
- Amylase and lipase values ≤ 3.0x institutional upper limit of normal.
- Alkaline phosphatase ≤ 2.5x institutional upper limit of normal (unless considered
to be not of hepatic origin) (any level permitted), and/or unless felt to be clearly
related to disease where ≤ 5x institutional upper limit of normal is permitted,
after discussion with the overall PI.
- AST(SGOT)/ALT(SGPT) ≤ 3x institutional upper limit of normal unless felt to be
clearly related to disease where ≤ 5x institutional upper limit of normal is
permitted, after discussion with the overall PI.
- Total bilirubin - ≤1.5x institutional upper limit of normal (≤ 3x upper limit of
normal in patients with known or suspected Gilbert's syndrome).
The effects of ASCIMINIB on the developing human fetus are unknown. For this reason,
women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry and for
the duration of study participation.
- Women of child-bearing potential must agree to use highly effective methods of
contraception during dosing and for 30 days after study treatment. Should a woman
become pregnant or suspect she is pregnant while she or her partner is participating
in this study, she should inform her treating physician immediately.
- Allowable methods of birth control:
- Total abstinence (when this is in line with the preferred and usual lifestyle
of the subject). Periodic abstinence (e.g., calendar, ovulation, symptothermal,
post ovulation methods) and withdrawal are not acceptable methods of
contraception.
- Female sterilization (have had surgical bilateral oophorectomy with or without
hysterectomy), total hysterectomy, or tubal ligation at least six weeks before
taking study treatment. In case of oophorectomy alone, only when the
reproductive status of the woman has been confirmed by follow up hormone level
assessment.
- Male sterilization (at least 6 months prior to screening). The vasectomized
male partner should be the sole partner for that subject.
- Use of oral, injected or implanted hormonal methods of contraception or
placement of an intrauterine device (IUD) or intrauterine system (IUS), or
other forms of hormonal contraception that have comparable efficacy (failure
rate <1%), for example hormone vaginal ring or transdermal hormone
contraception.
- Sexually active males must use a condom during intercourse while taking the drug and
for 30 days after stopping treatment and should not father a child in this period. A
condom is required to be used also by vasectomized men in order to prevent delivery
of the drug via seminal fluid. -- Ability to understand and the willingness to sign
a written informed consent document and comply with all study procedures.
Exclusion Criteria:
- For dose escalation only: Participants suitable for and willing to receive standard
intensive induction chemotherapy.
- Patients with a known ABL T315I mutation are excluded. ABL kinase mutation analysis
is not recommended for newly diagnosed patient. ABL kinase mutation analysis is
recommended for patients with relapsed disease or CML progressed to blast phase on
prior TKI, and results should be reviewed prior to enrollment.
- Prior treatment of ALL or CML with dasatinib or ASCIMINIB. Prior receipt of other
TKIs and chemotherapy for the treatment of ALL or CML is permitted.
- Any TKI therapy must be discontinued for 5 half-lives prior to initiation of
protocol therapy.
- Patient may not have received other chemotherapy, including antibody-based therapy,
within 2 weeks of the initiation of protocol therapy with the exception of steroids,
hydroxyurea, ATRA, and/or intrathecal chemotherapy.
- Participants who are receiving any other investigational agents for conditions other
than ALL must have discontinued those agents 2 weeks prior to the start of study
treatment.
- 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). Patients who have had a gastrectomy are
not excluded.
- History of prior or concurrent malignancy requiring current treatment and/or whose
natural history has the potential to interfere with the safety or efficacy
assessment of the investigational regimen. Indolent or low risk cancers (i.e. early
stage prostate cancer, early stage breast cancer, asymptomatic meningioma) judged to
not require treatment and/or have low potential for progression/recurrence after
appropriate therapy may be permitted after discussion with overall PI.
- Acute or chronic liver disease (including known active hepatitis B and C
infections).
Screening for hepatitis is not required. Patients with known treated or past exposure
viral hepatitis may participate after confirmation of absence of active infection (i.e.
negative viral load).
- History of pulmonary arterial hypertension.
- Significant pleural effusions leading to respiratory compromise and need for
intervention (i.e. thoracentesis).
- Alcohol abuse requiring medical treatment.
- Participants with a history of or current acute pancreatitis, chronic pancreatitis,
or any ongoing pancreatic disease.
- Known human immunodeficiency virus (HIV). Screening is not required.
- History of a serious bleeding disorder unrelated to ALL.
- It is suggested that participants receiving treatment with medications that meet one
of the following criteria discontinue the relevant drug prior to the start of
treatment with ASCIMINIB and for the duration of the study. If the medication is
medically necessary, review with PI before enrollment.
- Strong inducers of CYP3A4/5.
- Moderate and strong inhibitors CYP3A4/5.
- CYP3A4/5, CYP2C8 and CYP2C9 substrates with narrow therapeutic index. All other
substrates of the enzymes should be used with caution.
- H2 antagonists/proton-pump inhibitors.
- Grapefruit products are not permitted while on study.
- Because the lists of these agents are constantly changing, it is important to
regularly consult a frequently-updated list such as
http://medicine.iupui.edu/clinpharm/ddis/table.aspx; medical reference texts
such as the Physicians' Desk Reference may also provide this information.
As part of the enrollment/informed consent procedures, the patient will be counseled on
the risk of interactions with other agents, and what to do if new medications need to be
prescribed or if the patient is considering a new over-the-counter medicine or herbal
product.
- Corrected QT interval (QTc) of > 480 milliseconds (ms) on baseline electrocardiogram
(ECG) (using corrected QT interval per institutional standard).
- Major surgery within 2 weeks before the first dose of ASCIMINIB.
- Uncontrolled intercurrent illness including, but not limited to:
- Uncontrolled infection.
- Unstable cardiovascular condition including symptomatic congestive heart
failure (NYHA class 3 or 4), unstable angina pectoris, ongoing clinically
significant cardiac arrhythmia uncontrolled by medication, and myocardial
infarction or stroke within the past 3 months.
- Psychiatric illness/social situations that would limit compliance with study
requirements.
- Currently requiring supplemental oxygen, mechanical ventilation, vasopressors,
and/or hemodialysis (life-support).
- History of significant congenital or acquired bleeding disorder unrelated to
cancer.
- Unable to comply with an oral regimen.
- Are pregnant or nursing at the time of screening. Pregnant women are excluded from
this study because ASCIMINIB is an agent with the potential for teratogenic or
abortifacient effects. Because there is an unknown but potential risk for adverse
events in nursing infants secondary to treatment of the mother with ASCIMINIB,
breastfeeding should be discontinued if the mother is treated with ASCIMINIB. These
potential risks may also apply to other agents used in this study. Urine or serum
pregnancy test must be performed within 14 days of Day 1 for women of childbearing
potential.