Advances in Chronic Myeloid Leukemia (CML) therapy led to an expected survival prolongation of \> 20 years after diagnosis. So far, discontinuation of tyrosine kinase inhibitors led to recurrence of disease in the majority of patients. The trial aims to improve treatment strategies in CML by improving induction therapy and deescalating maintenance therapy using low dose IFN as inducer of immunosurveillance. The trial will provide important data on the duration of active therapy in CML patients. Considering the rapidly increasing prevalence of CML this is of individual but also socioeconomic importance.
Objectives Primary: * Evaluation of the major molecular response (MMR) rate at 18 months of nilotinib compared to nilotinib+pegylated Interferon alpha (IFN) in adult patients with newly diagnosed Ph/BCR-ABL CML in chronic phase. * Evaluation of the feasibility to discontinue drug therapy in stable deep molecular response (MR4) after nilotinib versus IFN maintenance therapy. Secondary: * Evaluation of the efficacy and tolerability of IFN added to nilotinib 2x300 mg/day. * Evaluation of the efficacy and tolerability of a maintenance therapy with nilotinib versus IFN after stable MMR after at least 24 months of nilotinib therapy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
717
Patients will receive nilotinib 300 mg BID given as two 150 mg capsules twice daily with at a starting target dose of 30μg/week. After confirmed MMR or at least 24 mo. after start of therapy, maintenance therapy (nilotinib will be discontinued) will start for a study duration of up to 5 years.
Patients will receive nilotinib 300 mg BID given as two 150 mg capsules twice daily for a study duration of up to 5 years.
University Hospital and Masaryk University Brno
Brno, Czechia
Universitätsklinikum Aachen Medizinische Klinik IV
Aachen, Germany
Gesundheitszentrum St. Marien GmbH, Onkologie/ Hämatologie Onkologisches Zentrum
Amberg, Germany
MVZ am Klinikum Arnsberg GmbH, Hämatologie - Internistische Onkologie
Arnsberg, Germany
Studienzentrum Drs. Klausmann
Aschaffenburg, Germany
MMR rate at 18 months of nilotinib monotherapy versus nilotinib+pegylated interferon alpha
rate of MMR 18 months after randomization for each study treatment
Time frame: at least 18 months after start of study treatment
rate of continuous MMR after discontinuation of nilotinib versus pegylated interferon alpha
rate of patients with molecular relapse (loss of MMR) 12 months after discontinuation of any treatment for CML
Time frame: at least 12 months after stopping all therapy
rate of CCyR and MMR
Time frame: at 12, 18 and 24 months after start of treatment
Time to CCyR, MMR, MR4 and MR4.5
this time to-event endpoints give an impression of the velocity of drug response and of the time until a certain remission should be waited for
Time frame: date of randomization until time to endpoints or end of study duration (at least 36 months)
rate of MR4 and MR4.5 during maintenance therapy and after discontinuation
Time frame: start of maintenance therapy (after at least 24 months of treatment) until end of study duration (at least 36 months)
Progression-Free Survival (PFS)
Time frame: at 12, 24 and 60 months after start of treatment
Rate of patients off treatment for at least 6 months
all patients and comparison of treatment arms
Time frame: at 60 months after start of treatment
safety and tolerability profile of nilotinib in comparison with nilotinib+pegylated interferon alpha and pegylated interferon alpha
the time of risk is the time while receiving the therapy plus 28 days thereafter
Time frame: time of first study treatment until 28 days after stop of study treatment (expected 36 months)
patients compliance to nilotinib based therapies
Time frame: until stop of study treatment (at least 36 months)
quality of life during induction therapy with ilotinib versus nilotinib+pegylated interferon alpha and during maintenance therapy with nilotinib versus pegylated interferon alpha
Time frame: during induction therapy (until at least 24 months), during maintenance therapy (until at least 36 months)
pharmacoeconomics of the treatment strategies
Time frame: after end of study (expected in December 2020) (up to 8 years)
Overall Survival (OS)
Time frame: at 12, 24 and 60 months after start of treatment
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Klinikum Augsburg
Augsburg, Germany
Klinikum Bayreuth GmbH
Bayreuth, Germany
Vivantes Netzwerk für Gesundheit GmbH, Klinikum Neukölln, Klinik für Innere Medizin - Hämatologie und Onkologie
Berlin, Germany
Charité CVK, CC14, Klinik für Hämatologie und Onkologie
Berlin, Germany
Evangelisches Klinikum Bethel
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