An Efficacy Study Comparing Ponatinib Versus Imatinib, Administered in Combination with Reduced-Intensity Chemotherapy, in Participants with Newly Diagnosed Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL)

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Takeda Development Center Americas Inc.

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Hemic and Lymphatic Diseases [C15]

Trial duration

30 Nov 2018 → ongoing

Decision date (initial)

2024-05-10

Transition trial

Yes

Low-intervention

No

Rare-disease indication

Yes

Vulnerable population

Yes

Funding sources

Takeda Development Center Americas, Inc.

External identifiers

EU CT number

2023-508463-71-00

EudraCT number

2018-000397-30

WHO UTN

U1111-1206-2370

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Dose response, Pharmacogenomic, Therapy, Safety, Efficacy, Pharmacokinetic

To compare the efficacy of ponatinib versus imatinib, administered as first-line therapy in combination with reduced-intensity chemotherapy, in patients with newly diagnosed Ph+ ALL, as measured by the MRD-negative CR rate at the end of induction.

Secondary objectives 1

1. To compare EFS between the 2 cohorts

Conditions and MedDRA coding

Newly Diagnosed Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL)

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 9

1. Male or female patients aged 18 years or older. • In Argentina, male or female patients 40 years and older. • In South Korea, male or female patients who are either: a) aged ≥18 through <65 years with comorbidities and/or poor functional status that, after discussion/agreement with the medical monitor/designee, are considered to make the patient unfit for any intensive therapy, or b) aged ≥65 years.
2. Newly diagnosed Ph+ or BCR-ABL1 positive ALL, as defined by the 2017 National Comprehensive Cancer Network guidelines.
3. Eastern Cooperative Oncology Group performance status of ≤2.
4. Clinical laboratory values as follows, within 30 days before randomization: a) Total serum bilirubin ≤1.5× the upper limit of normal (ULN), unless due to Gilbert's syndrome. b) Alanine aminotransferase (ALT) or aspartate aminotransferase ≤2.5× the ULN. c) Serum creatinine ≤1.5× the ULN and estimated creatinine clearance ≥ 30 mL/minute (Cockcroft-Gault formula). d) Serum lipase <1.5× the ULN.
5. Normal QT interval corrected per Fridericia method (QTcF) on screening electrocardiogram, defined as QTcF of ≤450 ms in males or ≤ 470 ms in females.
6. Female patients who: a) Are postmenopausal for at least 1 year before the screening visit, OR b) Are surgically sterile, OR c) If they are of childbearing potential, agree to practice 1 highly effective method of contraception (such as any form of hormonal contraception, eg, birth control pills or hormonal intra-uterine device [IUD]) and 1 additional effective (barrier) method at the same time, from the time of signing the informed consent through 1 month after the last dose of study drug or a longer period per any local regulation, eg, 35 days for patients in France), OR d) Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the patient. (Periodic abstinence [eg, calendar, ovulation, symptothermal, postovulation methods], withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used together.)
7. Male patients, even if surgically sterilized (ie, status postvasectomy), who: a) Agree to practice effective barrier contraception during the entire study treatment period and through 120 days after the last dose of study drug, OR b) Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the patient. (Periodic abstinence [eg, calendar, ovulation, symptothermal, postovulation methods], withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception. Female and male condoms should not be used together.)
8. Voluntary written consent must be given before performance of any study-related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to future medical care.
9. Willingness and ability to comply with scheduled visits and study procedures

Exclusion criteria 24

1. Patients with a history or current diagnosis of chronic phase, accelerated phase, or blast phase chronic myeloid leukemia
2. Prior/current treatment with any systemic anticancer therapy and/or radiotherapy for ALL, with the exception of an optional prephase therapy or chemotherapy induction (no more than 1 cycle), which should be discussed with the sponsor's medical monitor/designee
3. Treatment with any investigational products within 30 days before randomization or 6 half-lives of the agent, whichever is longer
4. Currently taking drugs that are known to have a risk of causing prolonged QTc or TDP (unless these can be changed to acceptable alternatives or discontinued)
5. Taking any medications or herbal supplements that are known to be strong inhibitors or strong inducers of cyt P450 3A4 within at least 14 days before the first dose of study drug
6. Uncontrolled active serious infections that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol
7. Major surgery within 28 days before randomization (minor surgical procedures such as catheter placement or BM biopsy are not exclusionary criteria)
8. Known seropositive HIV, known active hepatitis B or C infection
9. History of acute pancreatitis within 1 year of study screening or history of chronic pancreatitis
10. Uncontrolled hypertriglyceridemia (tg >450 mg/dL)
11. Diagnosed and treated for another malignancy within 5 years before randomization or previously diagnosed with another malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection
12. History or presence of clinically relevant CNS pathology such as epilepsy, childhood or adult seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis
13. Clinical manifestations of CNS or extramedullary involvement with ALL other than lymphadenopathy or hepatosplenomegaly
14. Autoimmune disease with potential CNS involvement
15. Known significant neuropathy of Grade≥2 severity
16. Clinically significant, uncontrolled, or active cardiovascular, cerebrovascular, or peripheral vascular disease, or history of or active VTE disease, including, but not restricted to: a) Complete left bundle branch block b) Right bundle branch block plus left anterior hemiblock or bifascicular block c) History of or presence of clinically significant ventricular or atrial tachyarrhythmias d) Clinically significant resting bradycardia (<50 beats per min) e) Uncontrolled HTN (systolic blood pressure [BP] ≥150mmHg and/or diastolic BP ≥90mmHg). Patients with Stage 2 HTN (systolic BP ≥ 140mmHg and/or diastolic BP ≥90 mmHg) should be under treatment at study entry per the current AHA guidelines to ensure BP control. Patients requiring 3 or more antihypertensive medications should have controlled HTN for the past 6 months. Isolated elevation(s) of systolic and/or diastolic BP during screening are not exclusionary f) Any history of myocardial infarction, unstable angina, coronary artery disease, cerebrovascular accident, ischemic stroke, or transient ischemic attack. Note: patients with any history of these events, whether considered clinically significant or not, are excluded g) History of congestive heart failure or left ventricular ejection fraction <40%, within 6 months before randomization h) Symptomatic peripheral vascular disease or history of infarction, including visceral infarction i) History of any revascularization procedure, including the placement of a stent j) Patients with documented significant pleural or pericardial effusions unless thought to be secondary to leukemia k) Any history of venous thromboembolism, including but not limited to deep venous thrombosis or pulmonary embolism within 6 months before randomization
17. Poorly controlled diabetes, defined as glycosylated hemoglobin values of >7.5%. Patients with preexisting, well-controlled diabetes are not excluded
18. Known GI disease or GI procedure that could interfere with the oral absorption or tolerance of study drug, including difficulty swallowing
19. Ongoing uncontrolled nausea or vomiting of any severity
20. Have a significant bleeding disorder unrelated to ALL
21. Life-threatening illness unrelated to cancer, such as severe CNS, pulmonary, renal, or hepatic disease unrelated to cancer
22. Female patients who are lactating or breastfeeding or have a positive serum pregnancy test during the screening period or have a positive urine pregnancy test on D1 before the first dose of study drug is administered
23. Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol
24. Admission or evidence of illicit drug or alcohol abuse

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. Primary efficacy endpoint: MRD-negative CR (BCR-ABL/ABL1 ≤0.01% and meeting criteria for CR)

Secondary endpoints 14

1. EFS is defined as the dates of randomization until death due to any cause or failure to achieve CR by end of induction or relapse from CR.
2. CR is defined as meeting all of the following for at least 4 weeks (ie, no recurrence): 1. No circulating blasts and <5% blasts in the BM. 2. Normal maturation of all cellular components in the BM. 3. No extramedullary disease (CNS involvement, lymphadenopathy, splenomegaly, skin/gum infiltration, testicular mass). 4. ANC >1000/μl (or >1.0*10^9/L). 5. Platelets >100,000/μl (or >100*10^9/L).
3. CRi is defined as hematologic complete remission with incomplete hematologic recovery and meeting all criteria for CR except platelet count and/or ANC.
4. ORR is defined as CR + CRi.
5. Duration of MRD-negative CR is defined as the interval between the first assessment at which the criteria for MRD-negative CR are met until the earliest date at which loss of MRD negativity or relapse from CR occurs.
6. Duration of CR is defined as the interval between the first assessment at which the criteria for CR are met until the earliest date at which relapse from CR occurs.
7. Time to treatment failure is defined as time to end of study-randomized treatment (except for hematopoietic stem cell transplantation [HSCT] without loss of MRD-negative CR) due to safety and/or efficacy reasons.
8. Molecule response is assessed by 3-Log Reduction (MR3), Molecular Response 4-Log Reduction (MR4) and Molecular Response 4.5-Log Reduction (MR4.5).
9. PIF is defined as participants who received treatment for chromosomepositive acute lymphoblastic leukemia (ALL) but never achieved CR or CRi by the end of induction. PIF is not limited by the number of unsuccessful treatments; this disease status only applies to recipients who have never been in CR or CRi.
10. MR4.5 is molecular response 4.5-log reduction (≤0.0032% BCRABL1/ABL1), or undetectable BCR-ABL1 transcripts in cDNA with ≥ 32,000 ABL1 transcripts.
11. On-study participants with or without HSCT will be evaluated. OS is defined as the interval between randomization and death due to any cause, censored at the last contact date when the participant was alive.
12. On-study participants with or without HSCT will be evaluated. Relapse from CR is defined as reappearance of blasts in the blood or BM (>5%) or in any extramedullary site after a CR.
13. OS is defined as interval between randomization and death due to any cause, censored at the last contact date when the participant was alive.
14. Exploratory end point: Biomarkers of disease sensitivity and resistance to ponatinib and imatinib and/or biomarkers affecting ponatinib efficacy or safety.

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 3

Comparator 2

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Takeda Development Center Americas Inc.

Sponsor organisation

Takeda Development Center Americas Inc.

Address

500 Kendall Street

City

Cambridge

Postcode

02142-1108

Country

United States

Scientific contact point

Organisation

Takeda Development Center Americas Inc.

Contact name

Kaveri Suryanarayan

Public contact point

Organisation

Takeda Development Center Americas Inc.

Contact name

Takeda

Third parties 8

Locations

6 EU/EEA countries · 26 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 45 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

4 submissions — initial application plus substantial / non-substantial modifications