Evolution of bosutinib (BOS) toxicity in patients (pts) with Ph+ leukemia after resistance/intolerance to prior therapy.

Authors

null

Carlo Gambacorti-Passerini

University of Milan-Bicocca, Monza, Italy

Carlo Gambacorti-Passerini , Tim H. Brummendorf , Jorge E. Cortes , Jeffrey H. Lipton , Dong-Wook Kim , Eric Leip , Kathleen Wyant Turnbull , Hagop M. Kantarjian , Hanna Jean Khoury

Organizations

University of Milan-Bicocca, Monza, Italy, Universitäts-Klinikum Aachen, Universitäts-Klinikum Hamburg-Eppendorf, RWTH, Aachen & Hamburg, Germany, The University of Texas MD Anderson Cancer Center, Houston, TX, Princess Margaret Hospital, Toronto, ON, Canada, Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea, Pfizer Inc., Cambridge, MA, Emory University, Winship Cancer Institute, Atlanta, GA

Research Funding

Pharmaceutical/Biotech Company

Background: BOS is an oral dual Src/Abl tyrosine kinase inhibitor (TKI) approved for treatment of Ph+ CML following resistance/intolerance to prior therapy. Prior reports from this phase I/II trial indicated the BOS safety profile was primarily characterized by myelosuppression, gastrointestinal events, and rash. The current analysis compares the incidence of toxicity in Year 1 (Y1) for pts on treatment ≤1 y and within Y1 and Year 2 (Y2) for pts on treatment for >1 y. Methods: BOS 500 mg/d was evaluated in 3 cohorts: chronic phase (CP) CML after imatinib only (CP 2L cohort; n = 286); CP CML after imatinib + dasatinib and/or nilotinib (CP 3L cohort; n = 119); and accelerated/blast phase CML or ALL after prior TKI therapy (ADV cohort; n = 164). Results: The most common treatment-emergent adverse events (TEAEs) in each cohort occurred more frequently within Y1 than Y2 (Table). The incidence for grade 3/4 events followed a similar pattern. AEs were the most common reason for BOS discontinuation in Y1 (CP 2L, 53%; CP 3L, 32%; ADV, 41%). Of the pts whose primary reason for discontinuing BOS was an AE during the first 2 y, most did so during Y1 (CP 2L, n = 51/60 [85%]; CP 3L, n = 22/24 [92%]; ADV, n = 24/25 [96%]); the most common reasons during Y1 were thrombocytopenia (12%; 9%; 4%), increased ALT (6%; 4%; 2%), neutropenia (3%; 6%; 0%), diarrhea (4%; 3%; 0%), and vomiting (3%; 4%; 1%). Serious AEs were more common among pts who discontinued BOS ≤1 y versus on treatment >1 y in the CP 3L and ADV cohorts, but similar in the CP 2L cohort (Table). Conclusions: Discontinuation due to AEs was observed primarily in Y1. For pts on BOS for >1 y, the incidence of common TEAEs decreased substantially after Y1, suggesting BOS tolerability improves after long-term exposure. Clinical trial information: NCT00261846.

CP 2L
CP 3L
ADV
BOS ≤1 y
(n = 97)
BOS >1 y
(n = 189)
BOS ≤1 y
(n = 69)
BOS >1 y
(n = 50)
BOS ≤1 y
(n = 125)
BOS >1 y
(n = 40)
Y1 Y1 Y2 Y1 Y1 Y2 Y1 Y1 Y2
TEAE, %
Diarrhea 90 81 40 83 82 50 69 90 28
Nausea 41 45 12 51 36 18 42 58 15
Vomiting 40 31 7 41 32 8 41 43 8
Thrombocytopenia 34 28 19 28 36 20 34 30 18
Rash 29 33 12 23 24 12 22 53 13
Abdominal pain 24 21 8 19 16 14 16 30 8
Fatigue 23 19 10 25 16 14 19 10 10
Increased ALT 23 19 7 12 18 6 9 13 5
Anemia 22 14 13 15 12 8 36 35 18
Pyrexia 21 18 10 15 12 8 40 20 18
Headache 16 12 9 29 20 6 18 20 8
Serious AE, % 25 25 23 30 20 18 60 33 33

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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

NCT00261846

Citation

J Clin Oncol 31, 2013 (suppl; abstr 7099)

DOI

10.1200/jco.2013.31.15_suppl.7099

Abstract #

7099

Poster Bd #

42C

Abstract Disclosures