Title

Study of Dasatinib vs Imatinib in Patients With Chronic Myeloid Leukemia (CML) Who Did Not Have Favorable Response to Imatinib
An Open Label, Randomized (2:1) Phase IIb Study of Dasatinib Versus Imatinib in Patients With Chronic Phase Chronic Myeloid Leukemia Who Have Not Achieved an Optimal Response to 3 Months of Therapy With 400 mg Imatinib
  • Phase

    Phase 2
  • Study Type

    Interventional
  • Study Participants

    262
The purpose of this study is to test the hypothesis that patients with CML who have not achieved optimal response after 3 months of treatment with imatinib will have a better response by switching to dasatinib compared to staying on their original imatinib regimen.
Study Started
Sep 12
2012
Primary Completion
Nov 08
2017
Study Completion
Apr 12
2022
Results Posted
Apr 11
2019
Last Update
Nov 10
2022

Drug Imatinib

  • Other names: Gleevec, Glivec

Drug Dasatinib

  • Other names: Sprycel

Arm 1: Imatinib (≥400 mg) Active Comparator

Imatinib ≥400 mg tablets by mouth once daily (QD) or twice daily (BID) up to 60 months

Arm 2: Dasatinib (100 mg) Active Comparator

Dasatinib 100 mg tablet by mouth QD up to 60 months

Criteria

Inclusion Criteria:

Chronic Phase (CP)-CML Ph+ patients with complete hematologic response (CHR) but without one log BCR-ABL reduction (BCR-ABL level >10% IS) 3 months of imatinib 400mg treatment. (Imatinib transient dose adjustments due to Adverse Event (AEs) are allowed with a maximum of 2 weeks interruption of treatment with imatinib (cumulative) within the 3 month period before randomization). Imatinib monotherapy must have been started within 6 months of CP-CML diagnosis (Ph + /BCR-ABL detection)
Currently tolerating imatinib 400mg QD. Patients with prior imatinib treatment interruption or dose reductions are required to be on treatment with 400 mg imatinib for two weeks immediately prior to randomization to ensure tolerance to imatinib
Eastern Co-Operative Group (ECOG) performance status = 0 - 2
Adequate renal function defined as serum creatinine ≤3 times the institutional upper limit of normal (ULN)
Adequate hepatic function defined as: total bilirubin ≤2.0 times the institutional ULN; alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 times the institutional ULN

Exclusion Criteria:

Previous diagnosis of accelerated phase or blast crisis
Subjects with clonal evolution in Ph+ cells observed in ≥2 metaphases at baseline bone marrow cytogenetic test, unless the same abnormalities were present at diagnosis. Patients with no evidence of clonal evolution, including those patients whose cytogenetic testing fails or bone marrow aspiration is a dry tap at 3 months, are eligible for the study
Subjects with less than CHR after 3 months of imatinib treatment or lost CHR after initial achievement
Documented T315I/A, F317L, or V299L mutations (if already available - not required for screening)
A serious uncontrolled medical disorder or active infection that would impair the ability of the subject to receive protocol therapy

Summary

Randomized to Dasatinib

Rand to Imatinib(Crossover to Dasatinib)

Randomized to Imatinib (No Crossover)

All Events

Event Type Organ System Event Term Randomized to Dasatinib Rand to Imatinib(Crossover to Dasatinib) Randomized to Imatinib (No Crossover)

Percentage of Patients Achieving Major Molecular Response (MMR) After 12 Months of CML Treatment

Major Molecular Response, is defined as a 3-log reduction in BCR-ABL transcripts from the standardized baseline, which represents 100% on the international scale, so a 3-log reduction is fixed at 0.1% for MMR; N/A = not applicable. 95% CI is Clopper-Pearson(Exact) two-sided 95% confidence intervals. P-value is based on Cochran-Mantel-Haenszel (CMH) test stratified by Sokal score(high, intermediate, low, and unknown) and time between 3 month molecular analysis and randomization (<=4 weeks vs >4 weeks). Month 12 is calculated fro

Arm 1: Imatinib (≥400 mg)

12.8
Percentage of Patients
95% Confidence Interval: 6.6 to 21.7

Arm 2: Dasatinib (100 mg)

28.7
Percentage of Patients
95% Confidence Interval: 22.1 to 36.1

Median Time to Major Molecular Response (MMR)

Time to MMR is how fast patients achieve optimal response. It is the time between randomization date and first date that MMR criteria are satisfied.

Outcome Measure Data Not Reported

Time to Molecular Response (MR)^4.5

Time to MR^4.5 is how fast patients achieve a deeper response. It is the time between randomization date and first date that MR^4.5 criteria are satisfied.

Outcome Measure Data Not Reported

Progression Free Survival (PFS)

PFS is how long patients are likely to live without progression of their disease. It is the time from randomization date to progression date or death date, whichever occurs first.

Outcome Measure Data Not Reported

Overall Survival (OS)

OS is how long patients are likely to remain alive. It is the time from randomization date to death date.

Outcome Measure Data Not Reported

Total

260
Participants

Age, Continuous

37.0
years (Median)
Full Range: 18.0 to 82.0

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Sex: Female, Male

Treatment Period

Arm 1: Imatinib (≥400 mg)

Arm 2: Dasatinib (100 mg)

Follow-Up Period

Arm 1: Imatinib (≥400 mg)

Arm 2: Dasatinib (100 mg)

Drop/Withdrawal Reasons

Arm 1: Imatinib (≥400 mg)

Arm 2: Dasatinib (100 mg)