To evaluate efficacy, safety and pharmacokinetic profile of asciminib 40mg+imatinib or asciminib 60mg+imatinib versus continued imatinib and versus nilotinib versus asciminib 80mg in pre-treated patients with Chronic Myeloid Leukemia in chronic phase (CML-CP)
The study is a Phase 2, multi-center, open-label, randomized study of asciminib in two different doses (40 mg or 60 mg) in combination with imatinib 400 mg versus continued imatinib versus switch to nilotinib in Participants with chronic myeloid leukemia in chronic phase (CML-CP) who have been previously treated with imatinib first line therapy for at least one year and have not achieved deep molecular response (DMR). Eligible participants were randomized 1:1:1:1 to receive asciminib 60 mg once daily (QD) as add-on therapy to imatinib 400 mg QD, or 40 mg QD as add-on therapy to imatinib 400 mg QD, or to continue imatinib 400 mg QD, or to switch to nilotinib 300 mg twice a day (BID). Participants on the imatinib continuation arm who had not achieved MR4.5 at 48 weeks were allowed to cross-over (CO) to receive the add-on treatment within 4 weeks after week 48 visit to receive the asciminib 60 mg combination add-on treatment, as this dose provided higher exposure. The cross-over is at the discretion of the investigator and the participant. Apart from a polymerase chain reaction (PCR) result of below MR4.5 at Week 48 visit, there are no other entry criteria for the cross-over part. Participants on nilotinib are not allowed to cross- over to receive the add-on treatment. Participants on the study will continue on the allocated treatment until treatment failure, intolerability, or for up to 96 weeks (in arms 1 to 4) after the last participant received the first dose of treatment. After the last dose received, every participant will be followed up for safety for 30 days.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
Asciminib 60 mg or 40 mg taken orally once daily.
Imatinib 400 mg taken orally once daily
Nilotinib 300 mg taken orally twice daily (total daily dose of 600 mg)
Molecular Response (MR)^4.5 Rate at 48 Weeks
Percentage of participants still treated with the randomized treatment at 48 weeks and are in MR4.5 (BCR::ABL1 ratio of ≤ 0.0032%) at 48 weeks (± assessment window), among all participants in the asciminib add-on arms vs imatinib arm.
Time frame: at Week 48
Rate of MR^4.5 at 48 Weeks
Percentage of participants in MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 48 weeks in asciminib add-on arms vs nilotinib arm.
Time frame: at Week 48
Rate of MR^4.5 by 48 Weeks
Best observed MR\^4.5 rate (BCR-ABL1 ratio of ≤ 0.0032%) up to 48 weeks. This includes the percentage of participants who achieved MR 4.5 anytime up to 48 weeks.
Time frame: by 48 weeks
Rate of MR^4.5 at 96 Weeks
Percentage of participants with MR\^4.5 rate (BCR-ABL1 ratio of ≤ 0.0032%) at 96 weeks
Time frame: at 96 weeks
Rate of MR^4.5 by 96 Weeks
Best observed MR4.5 rate (BCR-ABL1 ratio of ≤ 0.0032%) up to 96 weeks
Time frame: by 96 weeks
Sustained MR^4.5 From 48 Weeks Until 96 Weeks
Percentage of participants who are in MR\^4.5 at 48 weeks and 96 weeks and who have no loss of MR\^4.5 in between those 2 time points.
Time frame: at 96 weeks
Time to MR^4.5
Time to MR\^4.5 is the time from first dose to first MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) computed only for participants who achieved MR\^4.5.
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Georgia Regents University
Augusta, Georgia, United States
Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland, United States
Novartis Investigative Site
Vienna, Austria
Novartis Investigative Site
Montreal, Quebec, Canada
Novartis Investigative Site
Brno, Czechia
Novartis Investigative Site
Copenhagen, Denmark
Novartis Investigative Site
Bordeaux, France
Novartis Investigative Site
Dresden, Germany
Novartis Investigative Site
Milan, MI, Italy
Novartis Investigative Site
Roma, RM, Italy
...and 20 more locations
Time frame: 96/48 weeks after the last rand./enrolled (asciminib 80mg cohort) participant received the first study dose
Duration of MR^4.5
Time from first MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) until loss of MR\^4.5.
Time frame: 96/48 weeks after the last rand./enrolled (asciminib 80mg cohort) participant received the first study dose
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - Cmax
The maximum (peak) observed drug concentration after dose administration
Time frame: up to 96 weeks
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - Tmax
The time to reach maximum (peak) drug concentration after dose administration
Time frame: up to 96 weeks
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - Cmin
Minimum drug concentration
Time frame: up to 96 weeks
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - AUClast
The AUC from time zero to the last measurable concentration sampling time (Tlast)
Time frame: up to 96 weeks
Pharmacokinetic Profile of Asciminib and Imatinib When Administered in Combination - AUCtau
The AUC calculated to the end of a dosing interval (tau) at steady-state
Time frame: up to 96 weeks
MR^4.5 Rate at 48 Weeks
The percentage of participants on asciminib 80mg QD with MR\^4.5 (BCR-ABL1 ratio of ≤ 0.0032%) at 48 weeks
Time frame: at 48 weeks
Pharmacokinetic Profile of Asciminib 80mg QD - Cmax
The maximum (peak) observed drug concentration after dose administration
Time frame: up to 48 weeks
Pharmacokinetic Profile of Asciminib 80mg QD - Tmax
The time to reach maximum (peak) drug concentration after dose administration
Time frame: up to 48 weeks
Pharmacokinetic Profile of Asciminib 80mg QD - Cmin
Minimum drug concentration
Time frame: up to 48 weeks
Pharmacokinetic Profile of Asciminib 80mg QD - AUClast
The AUC from time zero to the last measurable concentration sampling time (Tlast)
Time frame: up to 48 weeks
Pharmacokinetic Profile of Asciminib 80mg QD - AUCtau
The AUC calculated to the end of a dosing interval (tau) at steady-state
Time frame: up to 48 weeks