Study of NMS-03592088 in Patients With Relapsed or Refractory AML or CMML

A Phase I/II Study of NMS-03592088, a FLT3, KIT and CSF1R Inhibitor, in Patients With Relapsed or Refractory AML or CMML

The purpose of this study is to explore safety, tolerability, including the maximum tolerated dose and the recommended Phase II dose (RP2D), and antitumor activity of NMS-03592088 in adult patients with relapsed or refractory Acute Myeloid Leukemia (AML) or Chronic Myelomonocytic Leukemia (CMML).

Study Overview

• Status: Terminated
• Conditions: Acute Myeloid Leukemia (AML); Chronic Myelomonocytic Leukemia (CMML)
• Intervention / Treatment: Drug: NMS-03592088

Detailed Description

This is an open-label Phase I/II, first-in-human, multi-center clinical study in sequential cohorts of patients with relapsed or refractory AML or CMML who have exhausted standard treatment options or for whom standard therapy is considered unsuitable. The study is designed to characterize the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD) and to explore anticancer activity of NMS-03592088, a FLT3 (Fms-like tyrosine kinase 3), KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog ) and CSF1R (Colony stimulating factor-1 receptor) inhibitor. The study drug will be administered orally once daily for 21 consecutive days followed by 7 days of rest (each cycle is 28 days, schedule A) or once daily for 28 consecutive days (each cycle is 28 days, schedule B). The study will be conducted in two parts: a Phase I dose escalation and dose expansion part including patients with AML and CMML and a single-stage Phase II exploratory study comprising two parallel cohorts of selected patients that are more likely to respond to the drug: a cohort of AML FLT3 mutated patients and a second one of patients with CMML. Patients previously treated with FLT3 inhibitors are allowed to participate.

• Study Type: Interventional
• Enrollment (Actual): 63
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• France
  • Le Mans, France, 72037
    • Centre Hospitalier du Mans
  • Nantes, France, 44000
    • Centre Hospitalier Universitaire de Nantes (Chu de Nantes) - Hotel-Dieu
  • Pessac, France, 33604
    • CHU Hopitaux de Bordeaux - Hôpital Haut-Lévêque
  • Pierre-Bénite, France, 69495
    • Centre Hospitalier Lyon-Sud
• Italy
  • Bologna, Italy, 40138
    • Azienda Ospedaliero-Universitaria di Bologna - Policlinico S.Orsola-Malpighi
  • Brescia, Italy, 25123
    • Asst Spedali Civili Di Brescia
  • Roma, Italy, 00168
    • Fondazione Policlinico Universitario Agostino Gemelli
  • BG
    • Bergamo, BG, Italy, 24127
      • ASST Papa Giovanni XXIII
  • MI
    • Milan, MI, Italy, 20162
      • ASST Grande Ospedale Metropolitano Niguarda
    • Rozzano, MI, Italy, 20089
      • Istituto Clinico Humanitas
• Spain
  • Valencia, Spain, 46026
    • Hospital Universitari i Politecnic La Fe

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patients with relapsed/refractory disease who have failed standard therapy or are unsuitable for standard treatment, with one the following confirmed diagnosis: AML as defined by the European LeukemiaNet (ELN)
• Patients with confirmed diagnosis of AML as defined by the 2022 ELN recommendations
• Patients must have failed standard of care.
• Adult (age ≥ 18 years) patients
• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
• The interval from prior antitumor treatment to time of NMS-03592088 administration should be at least 2 weeks for any agents other than hydroxyurea.
• All acute toxic effects (excluding alopecia) of any prior therapy must have resolved to NCI CTCAE version 5.0 Grade ≤1
• Adequate hepatic and renal function
• Patients must use highly effective contraception.
• Signed and dated IEC or IRB-approved informed consent form.

Exclusion Criteria:

• Current enrollment in another interventional clinical study
• Diagnosis of acute promyelocytic leukemia or Breakpoint cluster region-Abelson (BCR-ABL)-positive leukaemia
• Currently active second malignancy, except for adequately treated basal or squamous cell skin cancer and/or cone biopsied in situ carcinoma of the cervix uteri and/or superficial bladder cancer.
• Patients with known leukemia involvement of central nervous system (CNS)
• Hematopoietic stem cell transplantation (HSCT) within 3 months of treatment start and/or persistent non-hematologic toxicities of Grade ≥2 related to the transplant
• Active acute or chronic graft versus host disease (GVHD) requiring immunosuppressive treatment
• Patients with QTcF interval ≥ 480 milliseconds or with risk factors for torsade de pointes
• Pregnancy.
• Breast-feeding or planning to breast feed during the study or within 3 months after study treatment.
• Any of the following in the previous 6 months: myocardial infarction, unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident or transient ischemic attack, pulmonary embolism, deep vein thrombosis
• Known active, life threatening or clinically significant uncontrolled systemic infection.
• Known active gastrointestinal disease
• Known active gastrointestinal ulcer
• Other severe or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation.
• Known diagnosis of myasthenia gravis

US only:

• Signs or symptoms of myasthenia gravis or stroke during screening
• Patients with myasthenia gravis specific autoantibodies or any known history of myasthenia gravis (MG) autoantibodies at screening window
• Concomitant medications with the potential to cause de novo myasthenia gravis, worsening of myasthenia gravis or cause myasthenia gravis-like symptoms
• Uncontrolled hypertension, atrial fibrillation or flutter, ventricular arrhythmia or receiving treatment for cardiac rhythm disorder or diabetes that is not adequately controlled

Other protocol specific inclusion/exclusion criteria may apply

Study Plan

How is the study designed?

Design Details

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

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: NMS-03592088; Phase I Dose Escalation; Schedule A - Starting dose of 20 mg/day; Schedule B - Starting dose of 120 mg/day Only one dose level open for enrollment except EU backfill cohorts. Phase II Dose Expansion (Exploratory) - (EU) Recommended Phase II Dose (RP2D) of NMS-03592088 in Phase 1; Cohort 1: Patients who have failed standard of care including venetoclax and gilteritinib based therapies; Cohort 2: Patients who have failed standard of care

Drug: NMS-03592088; Route of administration: Oral

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Phase I - Number of Participants With Drug Related First-cycle Dose Limiting Toxicities (DLTs)	DLTs were classified according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.	From screening to end of first 28-days cycle (47 months)
Phase II - Number of Participants Who Achieved Composite Complete Remission (CRc) Rate i.e. Complete Remission (CR) + Complete Remission With Incomplete Hematologic Recovery (CRi).	CR = complete remission; CRc = composite complete remission rate; CRh = complete remission with partial hematologic recovery, CRi = complete remission with incomplete hematologic recovery; MLFS = morphologic leukemia free state; ORR = overall response rate; SD = stable disease Categories defined by the 2022 European LeukemiaNet (ELN) recommendations.	At Screening; Day 1 of Cycle 2 and Cycle 3; and Day 1 at subsequent even cycle; up to End of Treatment visit (within 7 days of the final dose of study drug), up to 17 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment-emergent Adverse Events (TEAEs) Graded by National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] Version 5.0 Criteria	TEAE with maximum Common Terminology Criteria (CTC) grade (graded by NCI CTCAE Version 5.0) experienced by each participant is presented. If an AE was reported for a participant more than once during treatment, the worst CTC Grade is presented here. Phase 2 started before Phase 1 completed. Grade 1 Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental activities of daily living. Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care activities of daily living. Grade 4 Life-threatening consequences; urgent intervention indicated.	Adverse events were collected from screening visit and assessed up to 18 months
Pharmacokinetic Parameters: Maximum Plasma Concentration (Cmax), Last Measurable Concentration (Clast), and Average Concentration (Cavg) of NMS-03592088	Plasma samples were collected and used for pharmacokinetics assessments. Mean values of PK parameters are presented with the coefficient of variation (CV%)	Schedule A: Day 1 and Day 21 Schedule B: Day 1 and Day 28
Pharmacokinetic Parameters: Time to Maximum Plasma Concentration (Tmax), Time to Last Measurable Concentration (Tlast), and Terminal Elimination Half-life (t½,z) of NMS-03592088	Plasma samples were collected and used for pharmacokinetics (PK) assessments. Mean values of PK parameters are presented with the coefficient of variation (CV%)	Schedule A: Day 1 and 21 Schedule B: Day 1 and 28
Pharmacokinetic Parameter: Area Under the Concentration-time Curve to the Last Measurable Concentration (AUClast) and Area Under the Concentration-time Curve From Time Zero to 24 Hour (AUC0-24) of NMS-03592088	Plasma samples were collected and used for pharmacokinetics (PK) assessments. Mean values of PK parameters are presented with the coefficient of variation (CV%)	Schedule A: Day 1 and Day 21 Schedule B: Day 1 and Day 28
Pharmacokinetic Parameters: Apparent Volume of Distribution (V/F) and Apparent Volume of Distribution at Steady State (Vss/F)	Plasma samples were collected and used for pharmacokinetics (PK) assessments. Mean values of PK parameters are presented with the coefficient of variation (CV%)	Schedule A: Day 21
Pharmacokinetic Parameters: Apparent Plasma Clearance (CL/F) and Apparent Plasma Clearance at Steady State (CLss/F)	Plasma samples were collected and used for pharmacokinetics (PK) assessments. Mean values of PK parameters are presented with the coefficient of variation (CV%)	Schedule A: Day 1 and Day 21 Schedule B: Day 1 and Day 28 CL/F: Evaluation of CL/F for Day 1 of all arms in Schedule A and Schedule B and Day 28 of Schedule B has not been performed
Pharmacokinetic Parameters: Accumulation Ratios (RA) for AUC0-24 and Cmax	Plasma samples were collected and used for pharmacokinetics assessments. Mean values of PK parameters are presented with the coefficient of variation (CV%).	Schedule A: Day 21 Schedule B: Day 28 Evaluation of Accumulation ratios (RA) for AUC0-24 and Cmax on Day 1 of all arms in Schedule A and Schedule B has not been performed.
Pharmacokinetic Parameters: Fraction Excreted Unchanged (FE) of NMS-03592088	Urine samples were collected and used for pharmacokinetics (PK) assessments. Only cohorts with available data are presented. The assessment was performed only during the Phase I of the study. Mean values of PK parameters are presented with the coefficient of variation (CV%)	Schedule A: Day 21 Schedule B: Day 28 Evaluation of Fraction excreted unchanged (FE) for Arms 20, 40, 80, 120 and 180 mg of Schedule A and Arm 360+150 mg of Schedule B has not been performed.
Best Response Rate for Participants With Acute Myeloblastic Leukemia (AML).	For participants with AML diagnosis the number and percentage of participants with best response achieved on treatment in the following categories: CR, CRi, CRh, PR, MLFS, SD, No Response and Progressive Disease (PD). CR= complete response; CRh= Complete Remission with Partial Hematologic Recovery, CRi= Complete Remission with Incomplete Hematologic Recovery; CRc= Complete Remission Rate; MLFS= Morphologic leukemia free state; ORR= Overall Response Rate; PR= Partial Remission; SD= Stable Disease	From the date of treatment initiation up to end of study (approximately 1.5 years)
For AML and in Phase II Only: Number of Participants Who Achieved Complete Remission (CR)	Number of participants who achieved a CR as Best Response.	From the date of first response up to end of study (approximately 1.5 years)
For AML and in Phase II Only: Complete Remission and Complete Remission With Partial Hematologic Recovery (CR/CRh) Rate	Defined as the number of participants who achieved a CR or CRh or CRi as best response, divided by the number of participants in the analysis population.	From the date of first response up to end of study (approximately 1.5 years)
For AML and in Phase II Only: Overall Response Rate (ORR: CRc + CRh + MLFS + PR)	Defined as the number of participants who achieved CRi or MLFS as best response, divided by the number of participants in the analysis population.	From the date of first response up to end of study (approximately 1.5 years)
Rate of Participants Bridged To Hemopoietic Stem Cell Transplantation	Defined as proportion of participants bridged to hemopoietic stem cell transplantation	From the date of first response up to end of study (approximately 1.5 years)

Collaborators and Investigators

• Sponsor: Nerviano Medical Sciences
• Investigators: Principal Investigator: Alessandro Rambaldi, MD, ASST Papa Giovanni XXIII

Study record dates

Study Major Dates

• Study Start (Actual): April 3, 2019
• Primary Completion (Actual): August 29, 2024
• Study Completion (Actual): August 29, 2024

Study Registration Dates

• First Submitted: April 4, 2019
• First Submitted That Met QC Criteria: April 18, 2019
• First Posted (Actual): April 19, 2019

Study Record Updates

• Last Update Posted (Actual): March 18, 2026
• Last Update Submitted That Met QC Criteria: February 24, 2026
• Last Verified: February 1, 2026

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; Myelodysplastic-Myeloproliferative Diseases; Bone Marrow Diseases; Leukemia; Pathological Conditions, Signs and Symptoms; Hemic and Lymphatic Diseases; Leukemia, Myeloid, Acute; Leukemia, Myelomonocytic, Chronic
• Other Study ID Numbers: MKIA-088-001; 2018-002793-47 (EudraCT Number)

Drug and device information, study documents

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