BMS-354825 in Treating Patients With Chronic Phase Chronic Myelogenous Leukemia That Is Resistant to Imatinib Mesylate

A Phase I Dose-Escalation Study To Determine The Safety, Pharmacokinetics, And Pharmacodynamics Of BMS-354825 In The Treatment Of Patients With Chronic Phase Chronic Myelogenous Leukemia Who Have Hematologic Resistance To Imatinib Mesylate (Gleevec

RATIONALE: BMS-354825 may stop the growth of cancer cells by stopping the enzymes necessary for cancer cell growth.

PURPOSE: This phase I trial is studying the side effects and best dose of BMS-354825 in treating patients with chronic phase chronic myelogenous leukemia that is resistant to imatinib mesylate.

Study Overview

• Status: Completed
• Conditions: Leukemia
• Intervention / Treatment: Drug: dasatinib

Detailed Description

OBJECTIVES:

• Determine the maximum tolerated dose, maximum administered dose, dose-limiting toxicity, and a recommended phase II dose of BMS-354825 in patients with chronic phase chronic myelogenous leukemia who have hematologic resistance to imatinib mesylate.
• Determine the safety and tolerability of this drug in these patients.
• Determine the plasma pharmacokinetics of this drug in these patients.
• Determine, preliminarily, the efficacy of this drug, in terms of hematologic, cytogenetic, and molecular responses in these patients.

OUTLINE: This is an open-label, dose-escalation, multicenter study.

Patients receive oral BMS-354825 once daily on days 1-5. Courses repeat every 7 days for at least 3 months in the absence of disease progression or unacceptable toxicity. Patients may receive further treatment in the absence of disease progression.

Cohorts of 3-6 patients receive escalating doses of BMS-354825 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity.

Once the MTD is determined, 20 additional patients receive treatment as in phase I at the MTD of BMS-354825.

Patients are followed for at least 30 days.

PROJECTED ACCRUAL: Approximately 50 patients (30 for phase I and 20 for phase II) will be accrued for this study within 12-18 months.

• Study Type: Interventional
• Enrollment (Actual): 42
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90095-1781
      • Jonsson Comprehensive Cancer Center at UCLA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

INCLUSION CRITERIA:

• Diagnosis of Philadelphia chromosome positive, 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 at least 100,000/mm^3 NOTE: *Patients who previously met the criteria for accelerated phase or blast phase CML, responded to treatment, and currently meet the criteria for chronic phase CML are eligible
• Primary or acquired hematologic resistance to imatinib mesylate OR intolerance to imatinib mesylate defined as follows:

• Primary hematologic resistance is defined as failure to reach complete hematologic response (CHR) with a dose of 400 mg/day continued for at least 3 months

  • Patients with hematological progression (i.e., WBC at least 10,000/mm^3 and rising consistently on at least 2 consecutive measurements obtained at least 14 days apart) while receiving imatinib mesylate of 400 mg/day are eligible if they have received less than 3 months of therapy

• Acquired hematologic resistance is defined as achieving a CHR, but subsequently developing a rising WBC to at least 10,000/mm^3

  • WBC must be at least 10,000/mm^3 and rising on at least 2 measurements obtained at least 14 days apart with at least 1 of these measurements greater than 15,000/mm^3

• Intolerance is defined as having discontinued imatinib mesylate due to nonhematologic toxicity of any grade

  • CD4^+ T-cell count at least 350/mm^3
• 18 and over
• ECOG 0-1
• Life expectancy, At least 6 months.

• Hepatic

  • Bilirubin no greater than 1.5 mg/dL
  • ALT and AST no greater than 2.0 times upper limit of normal (ULN)

• Renal

  • Creatinine no greater than 1.5 times ULN
  • Potassium normal*
  • Magnesium normal*
  • Serum calcium or ionized calcium at least lower limit of normal NOTE: *Patients with low levels may be repleted to be eligible
• Negative pregnancy test
• Fertile patients must use effective contraception for 1 month before, during, and 1 month after study participation
• More than 14 days since prior interferon
• More than 14 days since prior cytarabine
• More than 3 days since prior hydroxyurea
• More than 28 days since other prior investigational or antineoplastic agents
• More than 7 days since prior imatinib mesylate
• At least 5 days or 5 half-lives since prior medications that inhibit platelet function, including the following:
• Aspirin
• Dipyridamole
• Epoprostenol
• Eptifibatide
• Clopidogrel
• Cilostazol
• Abciximab
• Ticlopidine
• At least 5 days or 5 half-lives since prior anticoagulants such as warfarin or heparin/low molecular weight heparin (e.g., danaparoid, dalteparin, tinzaparin, enoxaparin)
• At least 5 days or 5 half-lives since prior drugs accepted to have a risk of causing torsades de pointes, including the following:
• Class IA antiarrhythmic agents (e.g., quinidine, procainamide, or disopyramide)
• Class III antiarrhythmic agents (e.g., amiodarone, sotalol, ibutilide, or dofetilide)
• Macrolide antibiotics (e.g., erythromycin or clarithromycin)
• Antipsychotics (e.g., chlorpromazine, haloperidol, thioridazine, or pimozide)
• Tricyclic antidepressants
• Cisapride
• Bepridil
• Inapsine
• Methadone
• Arsenic
• Concurrent anagrelide for thrombocytosis due to CML allowed

Exclusion Criteria:

• extramedullary involvement (other than liver or spleen)
• significant bleeding disorder unrelated to CML
• acquired bleeding disorder within the past year (e.g., acquired antifactor VIII antibodies)
• congenital bleeding disorders (e.g., von Willebrand disease)
• uncontrolled or significant cardiovascular disease
• uncontrolled angina within the past 6 months
• congestive heart failure within the past 6 months
• myocardial infarction within the past 12 months
• history of clinically significant ventricular arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, or torsades de pointes)
• history of second or third degree heart block (may be eligible if patient has a pacemaker)
• diagnosed or suspected congenital long QT syndrome
• prolonged QTc interval on pre-entry EKG (i.e., greater than 450 msec)
• heart rate less than 50/minute on pre-entry EKG
• uncontrolled hypertension
• vasculitis
• pregnant or nursing
• gastrointestinal tract bleeding within the past 6 months
• connective tissue disorders
• other serious uncontrolled medical disorder or active infection that would impair the ability to receive study therapy
• dementia or altered mental status that would preclude giving informed consent
• evidence of organ dysfunction or any clinically significant deviation from normal in physical examination, vital signs, EKG, or clinical laboratory determinations unrelated to CML
• prisoners or patients who are compulsorily detained (e.g., involuntary incarceration for treatment of either a psychiatric or physical [e.g., infectious disease] illness)
• concurrent drugs accepted to have a risk of causing torsades de pointes
• other concurrent treatment for CML
• concurrent dolasetron or droperidol
• concurrent anticoagulants
• concurrent medications that inhibit platelet function

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Masking: None (Open Label)

Collaborators and Investigators

• Sponsor: Jonsson Comprehensive Cancer Center
• Collaborators: Bristol-Myers Squibb
• Investigators: Principal Investigator: Charles Sawyers, MD, Jonsson Comprehensive Cancer Center

Publications and helpful links

General Publications

• Talpaz M, Shah NP, Kantarjian H, Donato N, Nicoll J, Paquette R, Cortes J, O'Brien S, Nicaise C, Bleickardt E, Blackwood-Chirchir MA, Iyer V, Chen TT, Huang F, Decillis AP, Sawyers CL. Dasatinib in imatinib-resistant Philadelphia chromosome-positive leukemias. N Engl J Med. 2006 Jun 15;354(24):2531-41. doi: 10.1056/NEJMoa055229.
• Cortes J, Sawyers CL, Kantarjian HM, et al.: Long-term efficacy of dasatinib in chronic-phase CML: results from the phase I trial (CA180002). [Abstract] Blood 110 (11): A-1026, 2007.
• Talpaz M, Kantarjian HM, Paquette R, et al.: A phase I study of BMS-354825 in patients with imatinib-resistant and intolerant chronic phase chronic myeloid leukemia (CML): results from CA180002. [Abstract] J Clin Oncol 23 (Suppl 16): A-6519, 564s, 2005.

Study record dates

Study Major Dates

• Study Start: November 1, 2003
• Primary Completion (Actual): October 1, 2006
• Study Completion (Actual): October 1, 2006

Study Registration Dates

• First Submitted: July 8, 2003
• First Submitted That Met QC Criteria: July 8, 2003
• First Posted (Estimate): July 9, 2003

Study Record Updates

• Last Update Posted (Actual): August 3, 2020
• Last Update Submitted That Met QC Criteria: July 30, 2020
• Last Verified: August 1, 2012

More Information

Terms related to this study

• Keywords: chronic phase chronic myelogenous leukemia; relapsing chronic myelogenous leukemia; Philadelphia chromosome positive chronic myelogenous leukemia
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Bone Marrow Diseases; Hematologic Diseases; Myeloproliferative Disorders; Leukemia; Leukemia, Myeloid; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid, Chronic-Phase; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Protein Kinase Inhibitors; Dasatinib
• Other Study ID Numbers: CDR0000310142; UCLA-0303035; BMS-CA180002