Safety and Efficacy of Pegylated IFN-alpha 2B Added to Dasatinib in Newly Diagnosed Chronic Phase Myeloid Leukemia (NordCML007)

A Safety and Efficacy Study of Adding Low Dose Pegylated IFN-alpha 2B to Standard Dose Dasatinib in Patients With Newly Diagnosed Chronic Phase Myeloid Leukemia

Patients with newly diagnosed CML have excellent outcomes with tyrosine kinase inhibitors (TKI). However, a few patients will be cured with TKIs alone, and thus need continued life-long treatment. Some patients achieve complete molecular remission (CMR), and this rate is higher with second generation TKIs compared with imatinib. Some experience with drug discontinuation in CMR has been derived from a few small studies, most notably the French STIM study. Approximately 40 % of patients with a minimum of two years in MR4.5 (4.5 log reduction in molecular response) can stop imatinib without relapse, indicating possible cure. To increase the non-relapse rate is of major importance. To achieve a permanent "cure" without stem cell transplantation is presently the most relevant goal of clinical studies in CML.

The investigators hypothesize that to significantly increase cure rates in CML, therapy should eradicate leukemic stem cells and/or induce or restore anti-CML immunity. Second generation TKIs may have a more profound effect on the stem cell pool as compared to imatinib. This is assessed in our current randomized study with a reduction in leukemic stem cell burden as the primary endpoint (NordCML006). Interferon-alpha (IFN) has a prominent immunomodulatory and antiproliferative mode of action, and has also activity in stem cells. Pegylated IFN in combination with imatinib results in improved therapy responses as compared to imatinib monotherapy. This advantage may translate into higher cure rates.

Dasatinib has a unique dual mechanism of action: it is the most potent of available TKIs and induces immunological effects that are different from those of IFN. Both of these drugs may have immunological adverse-effects when used as a monotherapy. However, immunological adverse-effects may also be markers of anti-leukemia efficacy. A combination of dasatinib and pegylated IFN (PegIFN) may have additive or synergistic effects and should be tested in a clinical study.

Study Overview

• Status: Completed
• Conditions: Leukemia, Myeloid, Chronic-Phase
• Intervention / Treatment: Drug: Dasatinib + PegIFN

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Phase 2

Contacts and Locations

Study Locations

• Finland
  • Helsinki, Finland
    • Helsinki University Central Hospital
• Norway
  • Bergen, Norway
    • Bergen University Central Hospital
  • Oslo, Norway
    • Rikshospitalet
  • Stavanger, Norway
    • Stavanger University Hospital
  • Tromsø, Norway
    • University Hospital of Northern Norway
  • Trondheim, Norway
    • St Olavs Hospital - Trondheim University Hospital
• Sweden
  • Linköping, Sweden
    • Linköping University Hospital
  • Luleå, Sweden
    • Sunderby Sjukhus
  • Lund, Sweden
    • Lund University Hospital
  • Stockholm, Sweden
    • Karolinska University Hospital
  • Sundsvall, Sweden
    • Sundsvall County Hospital
  • Umeå, Sweden
    • Umea University Hospital
  • Uppsala, Sweden
    • Uppsala University Hospital
  • Örebro, Sweden
    • Örebro University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosis of chronic myeloid leukemia in chronic phase (CML-CP) associated with BCR-ABL1 quantifiable by RQ-PCR (IS)
• No other current or planned anti-leukemia therapies excluding hydroxyurea treatment for up to two months.
• ECOG Performance status 0,1, or 2
• Adequate organ function as defined by: Total bilirubin < 1.5 x ULN (ULN = upper limit of normal in a local institution lab) in absence of Gilbert genotype; ASAT and ALAT < 2.5 x ULN. Creatinine < 2x ULN. Potassium, magnesium and phosphate not below LLN (LLN= lower level of normal)
• Life expectancy of more than 12 months in the absence of any intervention
• Patient has given written informed consent to participate in the study

Exclusion Criteria:

• Prior accelerated phase or blast crisis

• Uncontrolled or significant cardiovascular disease, including any of the following:

  • A myocardial infarction within 6 months
  • Uncontrolled angina within 3 months
  • Congestive heart failure within 3 months
  • Diagnosed or suspected congenital long QT syndrome
  • Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de Pointe)
  • Prolonged QTcF interval > 450 msec on pre-entry ECG
• Atypical BCR-ABL1 transcript not quantifiable by RQ-PCR.
• Another primary malignant disease, which requires systemic treatment (chemotherapy or radiation) Severe and/or life-threatening medical disease including acute liver disease
• History of significant congenital or acquired bleeding disorder unrelated to cancer
• Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of dasatinib
• Patients actively receiving therapy with strong CYP3A4 inhibitors and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug
• Patients who are currently receiving treatment with any medications that have the potential to prolong the QT interval and the treatment cannot be either discontinued or switched to a different medication prior to starting study drug
• Female patients who are: pregnant, breast feeding or potentially fertile without a negative pregnancy test prior to baseline or unwilling to use contraception on trial
• Previous history of pericarditis or pleuritis
• History of non-compliance, abuse of alcohol, illicit drugs, severe psychiatric disorders or other inability to grant informed consent.
• Current treatment for depression.
• Hypersensitivity to any interferon preparation;
• Autoimmune hepatitis or a history of autoimmune disease;
• Pre-existing thyroid disease unless it can be controlled with conventional treatment;
• Epilepsy and/or compromised central nervous system (CNS) function;
• HCV/HIV patients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Dasatinib + PegIFN; Dasatinib 100mg OD for three months single drug, with subsequent addition of PegIFN 15 μg/ week for 3 months. If well tolerated (less than grade 2 non-hematological or grade 3 hematological AE) the dose should be increased to 25μg weekly for the remaining 9 months on combination treatment. Thereafter dasatinib will be given as monotherapy. Patients will be followed for 24 months totally.

Drug: Dasatinib + PegIFN

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
major molecular response rates	defined as ≤0.1% BCR-ABL1 on the MMR International Scale	1 year

Secondary Outcome Measures

Outcome Measure	Time Frame
overall survival	2 years
quality of life	up to 18 months (after 3, 6, 12, 18 months)
Rate of CCgR	up to 18 months (after 3, 6, 12 and 18 months)
Rate of MR4.0 and MR4.5	up to 24 months (after 3, 6, 12, 15, 18, and 24 months)

Collaborators and Investigators

• Sponsor: Norwegian University of Science and Technology
• Investigators: Study Chair: Henrik Hjorth-Hansen, MD PhD, Norwegian University of Science and Technology

Publications and helpful links

General Publications

• Hjorth-Hansen H, Stentoft J, Richter J, Koskenvesa P, Hoglund M, Dreimane A, Porkka K, Gedde-Dahl T, Gjertsen BT, Gruber FX, Stenke L, Eriksson KM, Markevarn B, Lubking A, Vestergaard H, Udby L, Bjerrum OW, Persson I, Mustjoki S, Olsson-Stromberg U. Safety and efficacy of the combination of pegylated interferon-alpha2b and dasatinib in newly diagnosed chronic-phase chronic myeloid leukemia patients. Leukemia. 2016 Sep;30(9):1853-60. doi: 10.1038/leu.2016.121. Epub 2016 May 2.
• Huuhtanen J, Ilander M, Yadav B, Dufva OM, Lahteenmaki H, Kasanen T, Klievink J, Olsson-Stromberg U, Stentoft J, Richter J, Koskenvesa P, Hoglund M, Soderlund S, Dreimane A, Porkka K, Gedde-Dahl T, Gjertsen BT, Stenke L, Myhr-Eriksson K, Markevarn B, Lubking A, Dimitrijevic A, Udby L, Bjerrum OW, Hjorth-Hansen H, Mustjoki S. IFN-alpha with dasatinib broadens the immune repertoire in patients with chronic-phase chronic myeloid leukemia. J Clin Invest. 2022 Sep 1;132(17):e152585. doi: 10.1172/JCI152585.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2012
• Primary Completion (Actual): May 1, 2016
• Study Completion (Actual): May 1, 2016

Study Registration Dates

• First Submitted: November 8, 2012
• First Submitted That Met QC Criteria: November 9, 2012
• First Posted (Estimate): November 12, 2012

Study Record Updates

• Last Update Posted (Actual): September 25, 2017
• Last Update Submitted That Met QC Criteria: September 21, 2017
• Last Verified: September 1, 2017

More Information

Terms related to this study

• Keywords: dasatinib; Interferon-alpha; Protein Kinase Inhibitors; pegylated IFN-alpha 2B
• 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: NordCML007; 2011-005989-38 (EudraCT Number)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No