Switching patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP) with residual disease on long-term imatinib (IM) to nilotinib (NIL): ENESTcmr 24-mo follow-up.

Authors

null

Nelson Spector

Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Nelson Spector , Brian Leber , Jeffrey Howard Lipton , Carmino De Souza , Beatriz Moiraghi , Juan Luis Steegmann , Anthony P. Schwarer , Francisco Cervantes , Timothy P. Hughes , Das Purkayastha , LaTonya R Collins , Tomasz K. Szczudlo , Delphine Rea

Organizations

Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, McMaster University, Hamilton, ON, Canada, Princess Margaret Hospital, Toronto, ON, Canada, University of Campinas - SP, Campinas, Brazil, Hospital Jose Maria Ramos Mejia, Buenos Aires, Argentina, Hospital Universitario de la Princesa, Madrid, Spain, Alfred Hospital, Melbourne, Australia, IDIBAPS University of Barcelona, Barcelona, Spain, Centre for Cancer Biology, SA Pathology, University of Adelaide, Adelaide, Australia, Novartis Pharmaceuticals Corp, East Hanover, NJ, Novartis Pharmaceuticals, East Hanover, NJ, Service des Maladies du Sang, Hôpital Saint-Louis, Paris, France

Research Funding

Pharmaceutical/Biotech Company

Background: The 12-mo results of ENESTcmr demonstrated that switching pts on IM with sustained BCR-ABL positivity to NIL leads to faster, deeper molecular responses (MRs)vs remaining on IM. These deeper molecular responses (MR4.5 [BCR-ABL ≤ 0.0032%IS] or greater) are a prerequisite to enter most treatment-free remission studies. Here, we report 24-mo f/u of ENESTcmr. Methods: Philadelphia chromosome–positive CML-CP pts (N = 207) who achieved a complete cytogenetic response, but had detectable BCR-ABL transcripts after ≥ 2 y on IM, were randomized to receive NIL 400 mg twice daily (BID; n = 104) or continue their IM dose (400/600 mg once daily [QD]; n = 103). Results: By 24 mo, significantly more pts achieved confirmed undetectable BCR-ABL (by RQ-PCR with ≥ 4.5 log sensitivity in 2 consecutive samples) with a switch to NIL vs continuing IM (22.1% vs 8.7%; P = .0087). The increase in the rate of undetectable BCR-ABL from mo 12 to 24 was higher for pts on NIL vs IM (9.6 vs 2.9 percentage points). In pts without MR4.5 at baseline (BL), MR4.5 was achieved by 24 mo in 42.9% vs 20.8% of pts (NIL vs IM; P = .0006). In pts without major molecular response (MMR; ≤ 0.1%IS) at BL, MR4.5 was achieved by 24 mo in 29.2% vs 3.6% of pts (P = .016). No progressions to accelerated phase/blast crisis or deaths occurred on study since the 12-mo f/u. Event-free survival at 24 mo was 96.6% vs 92.8% in the NIL and IM arms, respectively. Discontinuations due to adverse events occurred in 11.5% and 2.9% of pts in the NIL and IM arms. The NIL safety profile was consistent with prior switch studies. Conclusions: By 24 mo, significantly more pts achieved deeper responses (MR4.5and undetectable BCR-ABL) with switch to NIL vs remaining on IM, and the difference between arms in these endpoints increased between 12 and 24 mo. Clinical trial information: NCT00760877.

NIL
400 mg BID
(n = 104)
IM
400 or 600 mg QD
(n = 103)
P value
Confirmed undetectable BCR-ABL (ITT), %
By 12 mo 12.5 5.8 .108
By 24 mo 22.1 8.7 .0087
MR by 24 mo (in pts without the response of interest at BL), %
MR4.5 (n = 94)
42.9
(n = 91)
20.8
.0006
Undetectable BCR-ABL (n = 101)
31.7
(n = 100)
17.0
.0106
MR by 24 mo (in pts without MMR at BL), %
MMR (n = 24)
83.3
(n = 28)
53.6
.0342
MR4.5 (n = 24)
29.2
(n = 28)
3.6
.016

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Abstract Details

Meeting

2013 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Leukemia, Myelodysplasia, and Transplantation

Track

Hematologic Malignancies—Leukemia, Myelodysplastic Syndromes, and Allotransplant

Sub Track

Leukemia

Clinical Trial Registration Number

NCT00760877

Citation

J Clin Oncol 31, 2013 (suppl; abstr 7053^)

DOI

10.1200/jco.2013.31.15_suppl.7053

Abstract #

7053^

Poster Bd #

36E

Abstract Disclosures