This phase II trial studies how well dasatinib works in treating patients with chronic lymphocytic leukemia (CLL). Dasatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVES: I. To estimate the biologic target activity of dasatinib in CLL patients found to have pre-treatment in vitro dasatinib cytotoxicity (as defined by a \>= 50% decrease in absolute lymphocyte count and/or bone marrow CLL count and/or lymph node or spleen size). SECONDARY OBJECTIVES: I. To evaluate overall objective response rates per CLL National Cancer Institute (NCI) working group. II. To determine drug safety and tolerability of dasatinib in patients with CLL. III. To determine overall (OS) and progression-free survival (PFS). TERTIARY OBJECTIVES: I. To determine if v-src avian sarcoma (Schmidt-Ruppin A-2) viral oncogene homolog (SRC), Bruton agammaglobulinemia tyrosine kinase (BTK), or tec protein tyrosine kinase (TEC) family kinase inhibition correlates with clinical response. II. To determine which prognostic subgroups (presence of \>= 1 of the following: 11q or 17p deletion; cluster of differentiation \[CD\]38 or zeta-chain-associated protein kinase 70 \[Zap 70\] expression; unmutated immunoglobulin heavy chain \[IgVH\]) respond to dasatinib therapy. III. To evaluate differences in baseline CLL gene expression between CLL samples that are sensitive or in-sensitive to dasatinib. IV. To analyze changes in CLL gene expression after dasatinib treatment. V. To evaluate dasatinib pharmacokinetics. VI. To evaluate changes in type I receptor tyrosine kinase-like orphan receptor (ROR-1) expression with dasatinib treatment. VII. To correlate response to pre-clinical IC50 in the presence/absence of HS-5 conditioned media. VIII. To explore role of possible kinase mutations related to dasatinib response. IX. To measure chemokines before and during treatment. OUTLINE: Patients receive dasatinib orally (PO) once daily (QD) during course 1 and if tolerated, twice daily (BID) in subsequent courses. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
19
OHSU Knight Cancer Institute
Portland, Oregon, United States
The Number of Participants With In Vitro Dasatinib Sensitivity in Predicting Clinical Activity
Defined by a decrease in absolute lymphocyte count, as determined by peripheral blood complete blood count (CBC) with differential or by bone marrow examination of 50 % and/or a decrease of detectable total lymph node size or spleen size by 50% (either by clinical examination contrast enhanced computed tomography \[CT\]).
Time frame: 8 weeks
Objective Response
Proportion of patients achieving the endpoint along with its 95% exact binomial confidence interval will be presented. Complete Response (CR): present \>=2 mos: no symptoms of CLL, normal findings on exam, ALC \< 4.000/mm3, ANC \>1.500/ mm3, platelet (PLT) count (ct) \>100.000/ mm3, hemoglobin (Hgb) concentration \>11 g/dL (untransfused), bone marrow (BM) lymphocytosis \<30%, and no nodules (lymphoid aggregates) on BM biopsy. Partial Response (PR): present \>=2 months: a reduction in prev. enlarged nodes, spleen, \& liver by at least 50%. ANC \>= 1.500/ mm3 or PLT ct \>= 100.000/ mm3 or Hgb concentration \>=11 g/dL or 50% improvement over pre-therapy reductions in Hgb concentration and/or PLT ct. Nodular PR: persistent BM nodules or infiltrates seen on BM biopsy those achieving a CR or PR. Stable Disease (SD): Does not meet CR or PR, but also not progressive disease (PD). PD: 50% size increase of lymph node, spleen, liver; or histologic (e.g. Richter's) transformation (per NCI and iwCLL).
Time frame: Up to 2 years
Overall Survival
Kaplan-Meier method will be used to estimate the survival curve.
Time frame: Up to 2 years
Progression-free Survival
Kaplan-Meier method will be used to estimate the survival curve.
Time frame: Up to 2 years
Incidence of Adverse Events (Number of Participants Affected)
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Assessed According to the NCI Common Terminology Criteria for Adverse Events Version 4.0. Adverse events will be tabulated and summarized according to key reporting criteria (i.e., grade or seriousness, unanticipated, treatment attribution). Refer to the Adverse Event tables below for specific details.
Time frame: Up to 4 years