Nilotinib ± Peg-IFN for First Line Chronic Phase CML Patients (PETALs)
Randomized Multicenter Phase III Study Comparing the Rate of Molecular Response 4.5 at 12 Months in Newly Diagnosed Philadelphia Positive Chronic Phase Chronic Myelogenous Leukemia Patients Receiving Either Frontline Nilotinib 600 mg Daily or Nilotinib 600 mg Daily Combined to Pegylated Interferon-alfa 2a (Peg-IFN)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Contact
Study Contact
- Name: Madeleine ETIENNE, CRA
- Phone Number: +33 4 78 86 22 32
- Email: madeleine.etienne@chu-lyon.fr
Study Contact Backup
- Name: jérémy MONFRAY, CRA
- Phone Number: +33 4 78 86 22 27
- Email: jeremy.monfray@chu-lyon.fr
Study Locations
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-
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Lyon, France, 04 78 86 22 50
- Franck NICOLINI
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Male and female patients
- CP-CML, positive Philadelphia chromosome or positive BCR-ABL (M-bcr transcript), diagnosed less than 3 months prior to study entry
- Age of at least 18 years-old and less than 65 years
- Patient for whom treatment with Nilotinib is expected
- No other CML treatment except for hydroxyurea and/or anagrelide
- No previous TKI treatment.
- No previous treatment with IFN even for other purposes.
- SGOT and SGPT < 2.5 UNL
- Serum creatinine < 2 UNL
- No planned allogeneic stem cell transplantation
- Signed informed consent
- ECOG score 0 to 2
Exclusion Criteria:
- Contra-indication to IFN
- Transcripts other than M-Bcr
- Pregnancy, lactation
- HIV positivity, chronic hepatitis B or C.
- Prior or concurrent malignancy other than CML (exceptions to be mentioned)
- History of arterial occlusive disease or (peripheral, carotids or severe coronary heart disease).
- Permanent elevation of total cholesterol and triglycerides despite treatment
- Severe psychiatric/neurological disease (previous or ongoing)
- Concomitant auto-immune disease
- Other investigational product ongoing
- Ongoing immunosuppressive treatment
- Ongoing treatment at risk for inducing torsades de pointes
- QTcF > 450ms despite correction of predisposing factors (i.e electrolytes…)
- Congenital long QTcF
- Unstabilised thyroid disorder
- No health insurance coverage
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Nilotinib
Control arm, this compound been licensed in this indication.
|
Nilotinib 2 capsules of 150 mg orally twice daily at 12 hours difference, fasting (minimum 1 hour before or 2 hours after a meal) for at least 36 months
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Experimental: Peg-IFN alfa 2a (Pegasys®) and Nilotinib
Arm testing the efficacy of a combination of nilotinib and Peg-IFN alfa 2a as frontline therapy for first line chronic phase CML patients.
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Nilotinib 2 capsules of 150 mg orally twice daily at 12 hours difference, fasting (minimum 1 hour before or 2 hours after a meal) for at least 36 months
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Molecular response (MR) 4.5 at 12 months of nilotinib 300 mg twice a day versus a combination of low-dose Peg-Interferon (Peg-IFN) to nilotinib 300 mg twice a day in newly diagnosed CP-CML Chronic Phase Chronic Myelogenous Leukemia patients.
Time Frame: 12 months
|
Centralised assessment of the BCR-ABL transcripts at 12 months since nilotinib initiation
|
12 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Molecular Response 4.5 at 1, 2, 3, 6, 9, 12 months of nilotinib, and duration of MR4.5 during the second year of treatment (18, 24 and 36 months).
Time Frame: 36 months
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Centralised assessment of the BCR-ABL transcripts every month for 3 months and every three months until 12 months and thereafter every 6 months until 36 months assessment.
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36 months
|
|
Major Molecular Response at 1, 2, 3, 6, 9, 12 months of nilotinib, and duration of MMR during the second year of treatment (18, 24 and 36 months).
Time Frame: 36 months
|
Centralised assessment of the BCR-ABL transcripts every month for 3 months and every three months until 12 months and thereafter every 6 months until 36 months assessment.
|
36 months
|
|
Rate of patients with BCR-ABL/ABL (IS) ≥10% at 3 months.
Time Frame: 3 months after nilotinib initiation
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Centralised assessment of the BCR-ABL transcripts at 3 months.
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3 months after nilotinib initiation
|
|
Rate of CCyR (complete cytogenetic responses: bone marrow Philadelphie positive at 0 % on at least 20 metaphases) at 3, 6, 12 months of nilotinib.
Time Frame: Assessment at 3, 6 and 12 months
|
Local bone marrow cytogenetic assessment (on 20 metaphases)
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Assessment at 3, 6 and 12 months
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Safety of the nilotinib combined to Peg-IFN or not (hematological and non-hematological adverse events (AE) graded according to the NCI CTC AE v3).
Time Frame: 36 months
|
Continuous evaluation of the AEs and SAEs reported during 36 months
|
36 months
|
|
Quality of life of patients treated in both arms
Time Frame: 36 months
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EORTC-QLQ C30 and C24 questionnaire at months -1 (Arm B), month 0, 1, 6, 12, 24, 36.
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36 months
|
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Doses-reductions/interruptions of drugs in both arms. Mean daily doses of nilotinib and Peg-IFN administered.
Time Frame: 24 months for Peg-IFN, and 36 months for both drugs
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Continuous recording of dose intensity along the study for 24-36 months.
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24 months for Peg-IFN, and 36 months for both drugs
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Compliance to drugs in each arms
Time Frame: 36 months
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Morisky questionnaire to be fulfilled at 1, 6, 12, 24 and 36 months after nilotinib initiation.
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36 months
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Molecular relapse rate at 6 and 12 months after nilotinib withdrawal in patients obtaining 2-year stable MR4.5.
Time Frame: 36 months
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Local (but standardized) assessment of the BCR-ABL transcripts every months for 3 months.
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36 months
|
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Event-free survival.
Time Frame: 36 months
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Survival since randomization without any event defined as loss of CHR, loss of PCyR or CCyR, death from any cause, progression towards accelerated phase or blast crisis.
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36 months
|
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Progression-free survival
Time Frame: 36 months
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Survival without progression towards accelerated of blast phase, death.
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36 months
|
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Overall survival.
Time Frame: 36 months
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Survival without death from any cause
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36 months
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Franck NICOLINI, MD, Hopsices Civils de Lyon
Publications and helpful links
General Publications
- Abstract We evaluated whether adding pegylated interferon-α2a (Peg-IFNα2a) to nilotinib affected dose intensity, molecular response kinetics, and long-term outcomes in newly diagnosed chronic myeloid leukemia. Delivered nilotinib doses remained comparable between treatment arms up to 72 months, indicating no dose reduction from Peg-IFNα2a-related toxicity. At diagnosis, 8.5 % of 199 patients had additional cytogenetic abnormalities (ACAs). At 3 months, complete and partial cytogenetic response (CCyR/PCyR) rates did not differ between nilotinib alone and the combination (CCyR 72.5 % vs 76 %; PCyR 16.5 % vs 11.5 %). Molecular kinetics showed faster early BCR::ABL1 transcript decline with the combination, but cumulative incidence (CI) curves for major molecular response (MMR) converged by 36 months. Two-year CI of MMR was 80.5 % with nilotinib and 91 % with the combination; five-year CI 93 % vs 97 % (global p = 0.155). The primary endpoint, MR4.5 at 12 months, was reached in 15 % vs 24 % (p = 0.048), but long-term deep molecular response rates (MR4/MR4.5) were ultimately similar at 5 years. In exploratory analyses, female sex (HR 3.06) and higher cumulative Peg-IFNα2a dose in the first 9 months (HR 2.89) predicted early MR4.5, whereas high Sokal or ELTS scores and elevated BCR::ABL1 at month 3 were adverse. ABL1 kinase domain mutations emerged in 10 patients overall (8 nilotinib, 2 combination). Conclusion Peg-IFNα2a with nilotinib accelerated early molecular responses and increased 12-month MR4.5 rates without impairing nilotinib exposure or long-term outcomes. Female sex and Peg-IFNα2a dose intensity correlated with deep early response, supporting potential personalization of combination strategies.
Study record dates
Study Major Dates
Study Start
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Estimated)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Neoplasms
- Chronic Disease
- Disease Attributes
- Neoplasms by Histologic Type
- Hematologic Diseases
- Leukemia, Myeloid
- Bone Marrow Diseases
- Leukemia
- Myeloproliferative Disorders
- Pathological Conditions, Signs and Symptoms
- Hemic and Lymphatic Diseases
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive
- Physiological Effects of Drugs
- Anti-Infective Agents
- Antiviral Agents
- Antineoplastic Agents
- Immunologic Factors
- nilotinib
- peginterferon alfa-2a
Other Study ID Numbers
Other Study ID Numbers
- 2013.837
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