This is a two-part safety and efficacy study of SKI-606 in subjects who have Philadelphia chromosome positive leukemias (CML). Part 1 will be a dose-escalation study, in which an escalating dose of SKI-606 (Bosutinib), up to 600 mg, will be studied in subjects with imatinib resistant/refractory or imatinib intolerant chronic phase CML. Part 2 will evaluate the safety and efficacy of the maximum tolerated dose (MTD) of SKI-606 (Bosutinib)identified in Part 1 of the study.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
63
Formulation: 100 mg Capsule for Part 1, 100 mg tablet for Part1 and Part 2. SKI-606 (Bosutinib) will be taken by mouth with water and food as continuous once-daily dosing.
Kumamoto University Hospital
Kumamoto, Kumamoto, Japan
Number of Participants With Dose-Limiting Toxicity (DLT) - Part 1
DLT was defined as any of the following events occurring during the first 28 days of study medication and considered at least possibly-related to study medication: any grade 3 or 4 clinically-relevant non-hematologic toxicity.
Time frame: Baseline up to Day 28 (Part 1 )
Maximum Tolerated Dose (MTD) - Part 1
MTD was defined as highest dose level for which no more than 1 participant in a dose cohort experienced DLT.
Time frame: Baseline up to Day 28 (Part 1 )
Percentage of Participants With Major Cytogenetic Response (MCyR) at Week 24 in Chronic Phase Second-line Cohort - Part 2
Cytogenetic response (CyR) is based on the prevalence of Philadelphia chromosome positive (Ph+) cells. Major cytogenetic response was categorized as either complete cytogenetic response (CCyR) or partial cytogenetic response (PCyR). CCyR was achieved when there was 0 percent (%) Ph+ cells and PCyR was achieved when 1 to 35% Ph+ cells.
Time frame: Week 24
Maximum Observed Plasma Concentration (Cmax) - Part 1
Time frame: Before and 1, 2, 3, 4, 6, 8, 24 and 48 hours after administration on Day 1, and before and 1, 2, 3, 4, 6, 8, and 24 hours after administration on Day 15
Time to Reach Maximum Observed Plasma Concentration (Tmax) - Part 1
Time frame: Before and 1, 2, 3, 4, 6, 8, 24 and 48 hours after administration on Day 1, and before and 1, 2, 3, 4, 6, 8, and 24 hours after administration on Day 15
Plasma Decay Half-Life (t1/2) - Part 1
Plasma decay half-life is the time measured for the plasma concentration to decrease by one half.
Time frame: Before and 1, 2, 3, 4, 6, 8, 24 and 48 hours after administration on Day 1
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Tohoku University Hospital
Sendai, Miyagi, Japan
National Cancer Center Hospital
Chuo-ku, Tokyo, Japan
Toyohashi Municipal Hospital
Aichi, Japan
Japanese Red Cross Nagoya First Hospital
Aichi, Japan
Aichi Cancer Center
Aichi, Japan
Akita University Hospital
Akita, Japan
Chiba University Hospital
Chiba, Japan
National Hospital Organization Kyushu Cancer Center
Fukuoka, Japan
Harasanshin Hospital
Fukuoka, Japan
...and 13 more locations
Area Under the Concentration-Time Curve (AUC) - Part 1
Area under the plasma concentration time-curve from zero to infinity. AUC on Day 15 was assessed as the steady state AUC.
Time frame: Before and 1, 2, 3, 4, 6, 8, 24 and 48 hours after administration on Day 1, and before and 1, 2, 3, 4, 6, 8, and 24 hours after administration on Day 15
Apparent Oral Clearance (CL/F) - Part 1
Clearance of a drug is a measure of the rate at which a drug is metabolized or eliminated by normal biological processes. Clearance obtained after oral dose (apparent oral clearance) is influenced by the fraction of the dose absorbed. Drug clearance is a quantitative measure of the rate at which a drug substance is removed from the blood. CL/F on Day 15 was assessed as the steady state CL/F.
Time frame: Before and 1, 2, 3, 4, 6, 8, 24 and 48 hours after administration on Day 1, and before and 1, 2, 3, 4, 6, 8, and 24 hours after administration on Day 15
Apparent Volume of Distribution (Vz/F) - Part 1
Volume of distribution is defined as the theoretical volume in which the total amount of drug would need to be uniformly distributed to produce the desired plasma concentration of a drug. Apparent volume of distribution after oral dose (Vz/F) is influenced by the fraction absorbed.
Time frame: Before and 1, 2, 3, 4, 6, 8, 24 and 48 hours after administration on Day 1
Accumulation Ratio (R) - Part 1
R=accumulation ratio (AUCss on Day 15/AUC\[0-24\] on Day 1)
Time frame: Before and 1, 2, 3, 4, 6, 8, 24 and 48 hours after administration on Day 1, and before and 1, 2, 3, 4, 6, 8, and 24 hours after administration on Day 15
Percentage of Participants With Maintained Major Cytogenetic Response (MCyR) at Week 24 in Chronic Phase Second-line and Third-line Cohort - Part 2
Cytogenetic response (CyR) is based on the prevalence of Philadelphia positive (Ph+) cells. Major cytogenetic response was categorized as either complete cytogenetic response (CCyR) or partial cytogenetic response (PCyR). CCyR was achieved when there was 0 percent (%) Ph+ cells and PCyR was achieved when 1 to 35% Ph+ cells. The responder for maintained MCyR included 'participants without baseline response who had a response at a specified time' and 'participants with baseline response who had a post-baseline response either maintained or improved at a specified time'.
Time frame: Week 24
Percentage of Participants With Major Cytogenetic Response (MCyR) at Week 24 - Part 1
Cytogenetic response (CyR) is based on the prevalence of Philadelphia positive (Ph+) cells. Major cytogenetic response was categorized as either complete cytogenetic response (CCyR) or partial cytogenetic response (PCyR). CCyR was achieved when there was 0 percent (%) Ph+ cells and PCyR was achieved when 1 to 35% Ph+ cells.
Time frame: Week 24
Percentage of Participants With Major Cytogenetic Response (MCyR) at Week 24 in Chronic Phase Third-line Cohort - Part 2
Cytogenetic response (CyR) is based on the prevalence of Philadelphia positive (Ph+) cells. Major cytogenetic response was categorized as either complete cytogenetic response (CCyR) or partial cytogenetic response (PCyR). CCyR was achieved when there was 0 percent (%) Ph+ cells and PCyR was achieved when 1 to 35% Ph+ cells.
Time frame: Week 24
Time to Major Cytogenetic Response (MCyR) in Chronic Phase Second-line and Third-line Cohort - Part 2
Time to MCyR was the interval from the date of first dose of study medication until the first date of achieving a given response. Time to response in weeks = (event date minus first dose date plus 1)/7, where the event date is the non-missing date of the first attained response or last cytogenetic assessment date of a participants.
Time frame: 204 weeks in the second-line participants and 48 weeks in the third-line participants
Duration of Major Cytogenetic Response (MCyR) in Chronic Phase Second-line and Third-line Cohort - Part 2
Duration of MCyR was defined as the interval from the date of the earliest demonstration of a response, until the earliest date of loss of that response. Duration of response in weeks = (date of confirmed loss of first attained response minus date of first attained response)/7 days.
Time frame: 204 weeks in the second-line participants and 48 weeks in the third-line participants
Percentage of Participants With Complete Hematologic Response (CHR) up to Week 192 in Advance Phase Second-line Cohort - Part 2
CHR response was considered to be achieved if participants met all of the following criteria: White Blood Cells =\< institutional upper limit of normal, no peripheral blood blasts or promyelocytes, myelocytes+metamyelocytes \<5% in blood, absolute neutrophil count \>=1.0\*10\^9 per liter (/L), platelets \>=100 but \<450\*10\^9/L, \<20% basophils in blood and no extramedulary involvement (including hepato- or splenomegaly), =\<5% BM blasts.
Time frame: Baseline up to Week 192
Time to Achieve Complete Hematologic Response (CHR) in Advanced Phase Second-line Cohort - Part 2
The time to CHR was measured from the date of first dosing to the first date of response. Time to response in weeks = (event date - first dose date plus 1)/7, where the event date is the non-missing date of the first attained response or last assessment date of a participant.
Time frame: Baseline up to Week 192
Duration of Complete Hematologic Response (CHR) in Advanced Phase Second-line Cohort - Part 2
The duration of CHR was defined as the interval from the first date of response until the first date of confirmed loss of response. Duration of response in weeks =(date of confirmed loss of first attained response - date of first attained response)/7.
Time frame: Baseline up to Week 192
Percentage of Participants With Overall Hematologic Response (OHR) Up to Week 192 in Accelerated Phase/Blast Phase Third-line Cohort - Part 2
OHR included CHR, no evidence of leukemia (NEL), minor hematologic response (MiHR) or return to chronic phase (RCP), participants had to meet at least 1 of this criterion. Criteria for RCP: disappearance of features defining AP/BP, but still in CP and persistence of clonal evolution. Criteria for MiHR: \<15% blasts in blood and bone marrow, \<30% blasts+promyelocytes in blood and bone marrow, \<20% basophils in blood, no extramedullary disease other than liver/spleen. Criteria for CHR and NEL: \<20% basophils in blood, no extramedullary involvement including liver/spleen, no peripheral blasts or promyelocytes, myelocytes + metamyelocytes \<5% in blood, \<5% (NEL) and \<=5% (CHR) marrow blasts, 0.5\*10\^9 \<= Absolute neutrophil count (ANC) \<1.0\*10\^9/L (NEL) and ANC\>=1.0\*10\^9/L (CHR), 20\*10\^9 \<=platelets\<100 \*10\^9/L (NEL) and platelets\>=100 but \<450x10\^9/L (CHR), white blood cells \<=institutional upper limit of the normal range.
Time frame: Baseline up to Week 192
Time to Achieve Overall Hematologic Response (OHR) in Accelerated Phase/Blast Phase Third-line Cohort - Part 2
The time to OHR was measured from the date of first dosing to the first date of response. Time to response in weeks = (event date - first dose date plus 1)/7, where the event date is the non-missing date of the first attained response or last assessment date of a participant.
Time frame: Baseline up to Week 192
Duration of Overall Hematologic Response (OHR) in Accelerated Phase/Blast Phase Third-line Cohort - Part 2
The duration of OHR was defined as the interval from the first date of response until the first date of confirmed loss of response. Duration of response in weeks =(date of confirmed loss of first attained response - date of first attained response)/7.
Time frame: Baseline up to Week 192
Time to Treatment Failure (TTF) Rate - Part 2
TTF was the interval from the date of first dose of bosutinib until the earlier date of progression or death (any cause), withdrawal from treatment owing to an AE, subject refusal, or loss to follow-up (censored at the last contact date), or further anti-tumor therapy before documented progression (whichever occurred first). TTF rate indicates the probability of no treatment failure. Percent of participants with no treatment failure were estimated.
Time frame: Date of first dose of study drug up to Week 336 in primary second line participants; up to Week 192 in advanced second line and exploratory third line participants
Progression-free Survival (PFS) Rate - Part 2
PFS was based on Kaplan-Meier estimates. PFS was defined as time in weeks from start of study treatment to treatment discontinuation due to disease progression as assessed by the investigator. Tumor progression was determined from oncologic assessment data (where data meet the criteria for progressive disease \[PD\]), or from death case report forms (CRFs). Percent of participants with PFS were estimated.
Time frame: Date of first dose of study drug up to Week 336 in primary second line participants; up to Week 192 in advanced second line and exploratory third line participants
Overall Survival (OS) Rate - Part 2
OS was based on Kaplan-Meier method. Survival was defined as the time period from the date of first dose of bosutinib to the date of death, censored at the participant's last contact date. Percent of participants with OS were estimated.
Time frame: Date of first dose of study drug up to Week 336 in primary second line participants; up to Week 192 in advanced second line and exploratory third line participants