CML(慢性粒细胞白血病)患者的尼罗替尼无治疗缓解研究 (ENESTfreedom)
一项针对慢性期 BCR-ABL1 阳性慢性粒细胞白血病患者的单组、多中心、无尼罗替尼治疗缓解研究,这些患者在一线尼罗替尼治疗中达到持久的微小残留病 (MRD) 状态。
研究概览
详细说明
本研究的主要目的是确定在开始 TFR 阶段后 48 周处于 MMR 状态的患者百分比(需要重新开始治疗的患者被视为无反应者)。
尼罗替尼治疗巩固期 (NTCS):满足所有纳入/排除标准的患者被纳入巩固期,并继续接受尼罗替尼治疗 52 周。 所有患者均接受了计划剂量为 300 mg BID 的尼罗替尼治疗(或者如果从毒性的角度需要,则以 400 mg QD 的降低剂量水平进行治疗)。 为了使患者有资格进入 TFR 阶段,他们必须满足持久 MRD 的协议特定定义。 最近四次季度执行的 PCR 评估必须满足以下标准:
- 最后一次评估为 MR4.5(BCR-ABL ≤ 0.0032% IS)
- 没有评估差于 MR4.0 (BCR-ABL >0.01% 是)和
- MR4.0和MR4.5之间的评估不超过两次(0.0032% IS<BCR-ABL ≤ 0.01% IS)
尼罗替尼 TFR 阶段:完成 52 周巩固阶段后有资格进入 TFR 阶段的患者,在 TFR 阶段的第一天停止服用尼罗替尼。 这一阶段的持续时间在最后一名患者进入 TFR 阶段后长达 10 年。 在前 48 周内每 4 周监测一次 BCR-ABL 水平,在接下来的 48 周内每 6 周监测一次,在最后一段时间内每 12 周监测一次。
尼罗替尼治疗重新启动 (NTRI) 阶段:如果患者在 TFR 阶段失去 MMR(BCR-ABL >0.1% IS),则患者重新开始尼罗替尼治疗。 在最后一位患者进入尼罗替尼 TFR 阶段后,患者接受尼罗替尼治疗长达 10 年。 需要重新开始尼罗替尼治疗的患者在前 24 周内每 4 周监测一次 BCR-ABL 水平,然后在恢复 MMR 的患者中每 12 周监测一次。 在重新开始治疗后的前 24 周内未恢复 MMR 的患者中,BCR-ABL 监测的频率至少每 12 周一次或根据临床指示更频繁。
研究类型
注册 (实际的)
阶段
- 阶段2
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
描述
纳入标准:
- ≥ 18 岁的男性或女性患者
- 至少 2 个日历年的尼罗替尼治疗和至少最后 12 个月的尼罗替尼治疗在预筛选之前以批准的每日总剂量 600 mg BID 或减少剂量 400 mg QD(如果从 BCR 耐受性的角度需要) -诊断时记录在案的慢性期 ABL 阳性 CML
- CML-CP 诊断时典型 BCR-ABL 转录物(b3a2 和/或 b2a2)的证据,即在第一次开始 TKI 治疗之前,可以进行标准化 RT-PCR 量化”
- 在诺华指定实验室进行预筛查的 MR4.5 患者
- ECOG 性能状态 0-2
适当的终末器官功能定义如下:
- 直接胆红素 ≤ 1.5 x ULN,除了 i) 有记录的吉尔伯特综合征患者,其任何胆红素值都是允许的,以及 ii) 无症状高胆红素血症(肝脏转氨酶和碱性磷酸酶在正常范围内)的患者。
- SGOT(AST) 和 SGPT(ALT) ≤ 3 x ULN 即相当于 ≤ 1 级 NCI-CTCAE v.4.03
- 血清脂肪酶 ≤ 2 x ULN 即相当于 ≤ 2 级 NCI-CTCAE v.4.03
- 碱性磷酸酶 ≤ 2.5 x ULN
- 血清肌酐 < 1.5 x ULN
患者的以下电解质值必须在正常范围内或在研究药物首次给药前通过补充剂纠正至正常范围内:
- 钾(建议保留以防止 QT 和/或节律异常问题)
- 镁(建议保留以防止 QT 和/或节律异常问题)
- 总钙(针对血清白蛋白校正)
患者必须具有定义的正常骨髓功能:
- 中性粒细胞绝对计数 (ANC) ≥ 1.5 x 10E9/L
- 血红蛋白 ≥ 9.0 克/分升
- 血小板 ≥ 100 x 10E9/L
记录在案的慢性期 CML 必须满足以下定义的所有标准:
- < 15% 外周血和骨髓原始细胞,
- < 30% 原始细胞加上外周血和骨髓中的早幼粒细胞,
- 外周血嗜碱性粒细胞<20%,
- ≥ 100 x 109/L (≥ 100,000/mm3) 血小板,
- 除肝脾肿大外,无髓外白血病受累的证据
- 患者必须耐受 400 mg 尼罗替尼的最低每日总剂量
排除标准:
- 既往使用尼罗替尼以外的 BCR-ABL 抑制剂治疗总累积持续时间超过 4 周
- 以前接受过任何持续时间的α-干扰素治疗
- 除了尼罗替尼以外的 CML 既往抗癌药,CML 诊断后细胞减灭术除外,直至尼罗替尼首次给药后 4 周
- 先前进展为 AP/BC 后已知的 CML 第二慢性期
- 糖尿病控制不佳(定义为 HbA1c > 9%)
心脏功能受损,包括以下任何一项:
- LVEF < 45% 或低于正常范围的机构下限(以较高者为准)
- 无法确定心电图上的 QT 间期,除了在 CML 诊断时有可测量 QT 间期证据的患者(例如 在第一次开始 TKI 治疗之前)并且没有记录在案的心血管疾病临床体征和/或传导异常临床体征。
- 完全性左束支传导阻滞
- 右束支传导阻滞加左前或后半传导阻滞
- 使用心室起搏器
- 先天性长 QT 综合征或已知的长 QT 综合征家族史
- 有临床意义的室性或房性快速性心律失常的病史或存在
- 有临床意义的静息心动过缓
- QTc > 450 毫秒,三个连续基线心电图的平均值(使用 QTcF 公式)。 如果 QTcF > 450 毫秒且电解质不在正常范围内,则应纠正电解质,然后对患者重新进行 QTc 检测。此排除标准不适用于具有不可测量 QT 间期但有证据表明可测量 QT 间期的患者CML 诊断时间(例如 在第一次开始 TKI 治疗之前)并且没有记录在案的心血管疾病临床体征和/或传导异常临床体征。
- 进入研究后 1 年内有心肌梗死病史或临床体征
- 进入研究后 1 年内有不稳定型心绞痛病史
- 其他有临床意义的心脏病(例如 充血性心力衰竭、心肌病或未控制的高血压)
- 进入研究后 1 年内有急性胰腺炎病史或既往有慢性胰腺炎病史
- 已知存在与癌症无关的显着先天性或获得性出血性疾病
- 研究者认为可能导致不可接受的安全风险或损害对方案的依从性的严重和/或不受控制的并发医学疾病(例如 不受控制的糖尿病,不受控制的感染)
- 进入研究前 5 年内有另一种活动性恶性肿瘤的病史,既往或合并的基底细胞皮肤癌和既往原位癌均已治愈
- 第 1 天后 4 周内用其他研究药物治疗(定义为未按照批准的适应症使用)
- 未从先前手术中恢复的患者
- 积极接受强 CYP3A4 抑制剂和/或诱导剂治疗的患者,并且在开始研究药物之前不能停止治疗或换用不同的药物。
- 积极接受强 CYP3A4 抑制剂和/或诱导剂草药治疗的患者,并且在开始研究药物之前不能停止治疗或换用不同的药物。 这些草药可能包括紫锥花(包括紫锥菊、狭叶紫锥花和淡紫锥花)、胡椒碱、青蒿素、圣约翰草和银杏。
- 目前正在接受任何可能延长 QT 间期的药物治疗的患者,并且在开始研究药物之前不能安全地停止治疗或换用不同的药物。 (请参阅 http://www.torsades.org/medical-pros/drug-lists/printable-drug-list.cfm 以获取延长 QT 间期的药物列表)
- 胃肠 (GI) 功能受损或胃肠道疾病可能会显着改变研究药物的吸收(例如 溃疡病、无法控制的恶心、呕吐、腹泻、吸收不良综合征、小肠切除术或胃绕道手术)
- 孕妇或哺乳期(哺乳期)妇女,其中妊娠定义为女性受孕后直至妊娠终止的状态,由 hCG 实验室检测呈阳性证实。
有生育能力的女性,定义为所有生理上能够怀孕的女性,除非她们在研究期间和尼罗替尼最终剂量后的 14 天内使用高效避孕方法。 高效避孕被定义为:
- 完全戒断(当这符合患者喜欢的和通常的生活方式时。 定期禁欲(例如日历、排卵、症状体温、排卵后方法)和戒断是不可接受的避孕方法
- 女性绝育(在接受研究治疗之前至少六周进行过手术双侧卵巢切除术伴或不伴子宫切除术)或输卵管结扎术。 如果仅进行卵巢切除术,则仅当妇女的生育状况已通过后续激素水平评估得到确认时。
- 男性绝育(入组前至少 6 个月)。 对于研究中的女性患者,已切除输精管的男性伴侣应该是该患者的唯一伴侣。
使用以下任意两项的组合:
- 使用口服、注射或植入的激素避孕方法或具有相当功效(失败率<1%)的其他形式的激素避孕,例如激素阴道环或透皮激素避孕。
- 放置宫内节育器 (IUD) 或宫内节育系统 (IUS)
- 避孕的屏障方法:避孕套或封闭帽(隔膜或宫颈/穹窿帽)与杀精子泡沫/凝胶/薄膜/乳膏/阴道栓剂。
在使用口服避孕药的情况下,女性在接受研究治疗之前应该已经稳定服用同一种药丸至少 3 个月 如果女性有 12 个月的自然(自发)闭经,则被视为绝经后且不具有生育潜力具有适当的临床特征(例如 年龄适当,有血管舒缩症状史)或在入组前至少六周进行过双侧卵巢切除术(有或没有子宫切除术)或输卵管结扎术。 在单独进行卵巢切除术的情况下,只有当妇女的生育状况通过后续激素水平评估得到证实时,才认为她没有生育潜力。
如果研究患者在研究期间或最终服用尼罗替尼后 30 天内怀孕或怀疑怀孕,则需要立即通知研究医生,并且必须立即停止正在进行的尼罗替尼研究治疗。
学习计划
研究是如何设计的?
设计细节
- 主要用途:其他
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的:尼罗替尼后无治疗
接受至少 2 年一线尼罗替尼治疗且筛查前 PCR 结果≥ MR4.5 的患者进入研究的巩固期(52 周 - 尼罗替尼 300 mg BID)。
在此阶段结束时,具有微小残留病 (MRD) 的患者进入无治疗缓解 (TFR) 阶段,该阶段未给予任何治疗。
不符合条件的患者将进入研究的继续阶段。
在继续阶段结束时具有 MRD 的患者将进入研究的 TFR-2 阶段,该阶段不给予任何治疗。
不符合条件的患者将进入研究的长期延续阶段。
如果在 TFR 或 TFR-2 期间的任何时候患者失去 MMR,将立即重新开始尼罗替尼治疗(尼罗替尼 300 mg BID)。
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Nilotinib 被用作 150 mg 和 200 mg 强度的市售胶囊(在日本使用临床用品的除外)。
治疗发生在研究的巩固、继续、长期继续、重新开始和重新开始-2 阶段期间。
其他名称:
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Percentage of Participants in Major Molecular Response at 48 Weeks After Start of Treatment-Free Remission (TFR) Phase
大体时间:48 weeks in TFR
|
The primary endpoint was the percentage of participants in major molecular response (MMR) at 48 weeks after initiation of the treatment-free remission (TFR) phase.
Participants who required re-initiation of treatment were considered as non-responders.
|
48 weeks in TFR
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Percentage of Participants in MR4.5 (BCR-ABL ≤ 0.0032% IS) at 48 Weeks After Start of TFR Phase
大体时间:48 weeks in TFR
|
The outcome measure was the percentage of participants in molecular response 4.5 (MR4.5) at 48 weeks after initiation of the treatment-free remission (TFR) phase.
Participants who required reinitiation of treatment were considered non-responders.
MR4.5 corresponds to a BCR-ABL transcript level ≤0.0032% on the International Scale (IS), representing a deep molecular response.
|
48 weeks in TFR
|
|
Percentage of Participants in Major Molecular Response (MMR) at Multiple Time Points After Start of the Treatment-Free Remission (TFR) Phase
大体时间:Weeks 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
This outcome measure was the percentage of participants in major molecular response (MMR) assessed at multiple timepoints after initiation of the treatment-free remission (TFR) phase.
Participants who required re-initiation of treatment at any time prior to the respective assessment were considered non-responders.
|
Weeks 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
|
Percentage of Participants in Molecular Response 4.5 (MR4.5) at Multiple Time Points After Start of the Treatment-Free Remission (TFR) Phase
大体时间:Weeks 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
This secondary outcome measure was the percentage of participants in molecular response 4.5 (MR4.5)
assessed at multiple timepoints after initiation of the treatment-free remission (TFR) phase.
Participants who required reinitiation of treatment at any time prior to the respective assessment were considered non-responders.
MR4.5 corresponds to a BCR-ABL transcript level ≤0.0032% on the International Scale (IS).
|
Weeks 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
|
Number of Participants in Major Molecular Response (MMR) at Multiple Time Points After Start of the Treatment-Free Remission (TFR) Phase
大体时间:Weeks 48, 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
This outcome measure was the number of participants in major molecular response (MMR) assessed at multiple timepoints after initiation of the treatment-free remission (TFR) phase of nilotinib.
At each assessment time point, participants with available MMR data were counted.
Participants who reinitiated nilotinib treatment for less than 12 weeks prior to the respective assessment time point were excluded from the analysis at that time point.
|
Weeks 48, 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
|
Number of Participants in Molecular Response 4.5 (MR4.5) at Multiple Time Points After Start of the Treatment-Free Remission (TFR) Phase
大体时间:Weeks 48, 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
This outcome measure was the number of participants in molecular response 4.5 (MR4.5)
assessed at multiple timepoints after initiation of the treatment-free remission (TFR) phase of nilotinib.
At each assessment time point, participants with available MR4.5 data were counted.
Participants who reinitiated nilotinib treatment for less than 12 weeks prior to the respective assessment time point were excluded from the analysis at that time point.
MR4.5 corresponds to a BCR-ABL transcript level ≤0.0032% on the International Scale (IS).
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Weeks 48, 96, 144, 192, and 264, and End of Years 6, 7, 8, 9, and 10
|
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Percentage of Participants Who Achieved Major Molecular Response (MMR) Within 12 Weeks of Reinitiation of Nilotinib Treatment
大体时间:12 weeks after reinitiation of nilotinib treatment
|
Percentage of patients who achieved MMR within 12 weeks of re-initiation of treatment with nilotinib defined as the number of patients who were in MMR at least at 1 assessment within 12 weeks after re-start of nilotinib treatment divided by the number of patients who were re-initiated for at least 12 weeks.
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12 weeks after reinitiation of nilotinib treatment
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Percentage of Participants With Stable Major Molecular Response (MMR) at Multiple Time Points After First Achievement of MMR During Nilotinib Re-Initiation
大体时间:Weeks 48, 96, 144, 192, 240, 288, 336, 384, and 432 after first achievement of MMR during the nilotinib re-initiation phase
|
The percentage of patients who were in stable MMR after achieving a response in the NTRI phase at multiple timepoints was calculated by dividing the number of participants achieving MMR any time during the NTRI phase and having the same response at those timepoints after the first achievement of MMR, irrespective of whether there was loss of MMR in between, by the number of patients who achieved MMR at any time during the NTRI phase.
|
Weeks 48, 96, 144, 192, 240, 288, 336, 384, and 432 after first achievement of MMR during the nilotinib re-initiation phase
|
|
Percentage of Participants With Stable Molecular Response 4.5 (MR4.5) at Multiple Time Points After First Achievement During Nilotinib Re-Initiation
大体时间:Weeks 48, 96, 144, 192, 240, 288, 336, 384, and 432 after first achievement of MR4.5 during the nilotinib re-initiation phase
|
The proportion of patients who were in stable MR4.5 after achieving a response in the NTRI phase at multiple timepoints was calculated by dividing the number of participants achieving MR4.5 any time during the NTRI phase and having the same response at those timepoints after the first achievement of MR4.5, irrespective of whether there was loss of MR4.5 in between, by the number of patients who achieved MR4.5 at any time during the NTRI phase.
|
Weeks 48, 96, 144, 192, 240, 288, 336, 384, and 432 after first achievement of MR4.5 during the nilotinib re-initiation phase
|
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BCR-ABL Ratio (%) Over Time in Nilotinib Treatment Re-initiation Phase (NTRI)
大体时间:Baseline; every 4 weeks up to Week 24; and every 12 weeks thereafter, up to Week 528
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The BCR-ABL ratio (%) represents the level of BCR-ABL fusion gene transcripts relative to a control gene (ABL) measured in peripheral blood samples using quantitative reverse transcription polymerase chain reaction (RT-PCR).
Results are expressed as a percentage on the International Scale (IS), a standardized reporting method that allows comparison across laboratories.
The BCR-ABL ratio is used to assess the molecular response to treatment, with lower values indicating a reduced disease burden.
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Baseline; every 4 weeks up to Week 24; and every 12 weeks thereafter, up to Week 528
|
|
Duration of Re-Initiated Nilotinib Treatment Required to Regain Major Molecular Response (MMR) After Loss of MMR
大体时间:Every 4 weeks up to Week 24, and every 12 weeks thereafter, up to Week 528
|
This outcome measure was defined as the time from the date of reinitiation of nilotinib treatment following loss of major molecular response (MMR) to the date of first documented achievement of MMR.
Participants who did not regain MMR after reinitiation of treatment on or before the data cut-off date were censored at the date of their last available BCR-ABN PCR assessment.
|
Every 4 weeks up to Week 24, and every 12 weeks thereafter, up to Week 528
|
|
Duration of Re-Initiated Nilotinib Treatment Required to Regain Molecular Response 4.5 (MR4.5) After Loss of MMR
大体时间:From start of Nilotinib treatment re-initiation up to Week 528
|
This outcome measure was defined as the time from the date of reinitiation of nilotinib treatment following loss of major molecular response (MMR) to the date of first documented achievement of molecular response 4.5 (MR4.5).
Participants who did not regain MR4.5 after reinitiation of treatment on or before the data cut-off date were censored at the date of their last available BCR-ABN PCR assessment.
MR4.5 corresponds to a BCR-ABN transcript level ≤0.0032% on the International Scale (IS).
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From start of Nilotinib treatment re-initiation up to Week 528
|
|
Treatment-Free Survival (TFS) After Start of the Treatment-Free Remission (TFR) Phase
大体时间:From start of the treatment-free remission (TFR) phase up to Week 528
|
Treatment-free survival (TFS) was defined as the time from the start of the treatment-free remission (TFR) phase to the earliest occurrence of loss of major molecular response (MMR), reinitiation of treatment for any reason, progression to accelerated phase (AP) or blast crisis (BC), or death due to any cause.
Participants without an event on or before the data cut-off date were censored at the date of their last available disease assessment (polymerase chain reaction, cytogenetic, hematologic, or extramedullary assessment).
|
From start of the treatment-free remission (TFR) phase up to Week 528
|
|
Progression-Free Survival (PFS) After Start of the Treatment-Free Remission (TFR) Phase
大体时间:From start of the treatment-free remission (TFR) phase up to Week 528
|
Progression-free survival (PFS) was defined as the time from the start of the treatment-free remission (TFR) phase to the earliest occurrence of disease progression to accelerated phase (AP) or blast crisis (BC), or death due to any cause.
Participants without an event on or before the data cut-off date were censored at the date of their last available disease assessment (cytogenetic, hematologic, or extramedullary assessment) or last contact for participants in follow-up.
|
From start of the treatment-free remission (TFR) phase up to Week 528
|
|
Overall Survival (OS) After Start of the Treatment-Free Remission (TFR) Phase
大体时间:From start of the treatment-free remission (TFR) phase up to Week 528
|
Overall survival (OS) was defined as the time from the start of the treatment-free remission (TFR) phase to death due to any cause.
Participants who were alive on or before the data cut-off date were censored at the date of their last assessment or last known alive date for participants in follow-up.
|
From start of the treatment-free remission (TFR) phase up to Week 528
|
|
Percentage of Participants With Treatment-emergent Adverse Events During the Entire Study
大体时间:From first dose of nilotinib through up to approximately 11 years of study participation, including the NTCS, TFR, and NTRI phases
|
This outcome measure summarized the overall occurrence of adverse events related to nilotinib during the study.
A study drug-related adverse event was defined as any adverse event assessed by the investigator as related to nilotinib and reported during the nilotinib treatment consolidation (NTCS) phase, the treatment-free remission (TFR) phase, or the nilotinib treatment re-initiation (NTRI) phase.
|
From first dose of nilotinib through up to approximately 11 years of study participation, including the NTCS, TFR, and NTRI phases
|
|
Number of Participants With BCR-ABL1 Mutations Associated With Resistance to Nilotinib After Loss of Major Molecular Response
大体时间:From loss of major molecular response after nilotinib suspension through up to 528 weeks of study participation
|
This outcome measure was the number of participants who developed BCR-ABL1 mutations associated with resistance to nilotinib following loss of major molecular response (MMR) after suspension of nilotinib treatment.
Mutations assessed included, but were not limited to, T315I, E255K, Y253H, F359V, F359C, and F359I.
The endpoint was calculated as the number of participants with at least one detected BCR-ABL1 mutation divided by the number of participants who experienced loss of MMR after nilotinib suspension.
|
From loss of major molecular response after nilotinib suspension through up to 528 weeks of study participation
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合作者和调查者
调查人员
- 研究主任:Novartis Pharmaceuticals、Novartis Pharmaceuticals
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他相关的 MeSH 术语
其他研究编号
- CAMN107I2201
- 2012-004092-40 (EudraCT编号)
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)?
IPD 计划说明
诺华致力于与合格的外部研究人员共享患者水平数据的访问权限,并支持符合条件的研究的临床文件。 这些请求由独立审查小组根据科学价值审查和批准。 所提供的所有数据均已匿名处理,以根据适用的法律法规尊重参与试验的患者的隐私。
此试验数据的可用性是根据 www.clinicalstudydatarequest.com 上描述的标准和过程
药物和器械信息、研究文件
研究美国 FDA 监管的药品
研究美国 FDA 监管的设备产品
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