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CMLPhase 2ENESTgoalNCT01744665

A Study That Switched Patients From Imatinib to Nilotinib and Then Was Followed by Treatment Cessation

A Phase 2 study testing nilotinib in people with CML, run by Novartis Pharmaceuticals at 54 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

To evaluate molecular relapse free rates 6 months after stopping nilotinib therapy in patients who achieve MR4.5 Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
CML
What is being tested?
nilotinib
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
59 participants
Where
54 sitesUnited States
Study dates
12 Aug 2013to 29 Sep 2018
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • diagnosis of CML
  • Treated with at least 1 year of imatinib
  • Bcr-Abl level by PCR must be less than or equal to 0.1% and greater than 0.0032% by PCR reported on the International scale confirmed during screening
  • Written informed consent obtained prior to any screening procedures performed

Who cannot join

  • T315I mutation
  • Prior imatinib failure or had accelerated phase or blast crisis CML
  • Impaired cardiac function
  • Pregnant or lactating women

Trial locations and contacts

54 sites in 1 country.

54 sites in 1 country

United States54 sites
  • Hendrick Cancer Center Hendricks Cancer Center

    Abilene, Texas, 79601

  • Billings Clinic Billings Clinic (8)

    Billings Montana, Montana, 59101

  • University of Alabama Comprehensive Cancer Center University of Alabama (8)

    Birmingham, Alabama, 35294

  • Rocky Mountain Cancer Centers USOR

    Boulder, Colorado, 80304

  • University of Virginia

    Charlottesville, Virginia, 22908

  • Stroger Cook County Hospital Division of Hematology & Onc

    Chicago, Illinois, 60612

  • University of Chicago Medical Center

    Chicago, Illinois, 60637

  • University of South Carolina-Hollings Cancer Center Medical University of SC

    Columbia, South Carolina, 29203

  • Ohio State Comprehensive Cancer Center/James Cancer Hospital OSU Medical Center

    Columbus, Ohio, 43210

  • Texas Oncology Texas Oncology - McAllen

    Dallas, Texas, 75246

  • Texas Oncology Texas Oncology - Plano West

    Dallas, Texas, 75246

  • Texas Oncology P A Texas Oncology - Midland

    Dallas, Texas, 75251

  • City of Hope National Medical Center Dept of Oncology

    Duarte, California, 91010 3000

  • Duke University Medical Center Duke University Med Ctr

    Durham, North Carolina, 27710

  • Highlands Oncology Group

    Fayetteville, Arkansas, 72703

  • Florida Cancer Specialists DeptofFloridaCancerSpecialists

    Fort Myers, Florida, 33901

  • Compassionate Care Research Group Inc CCCMG

    Fountain Valley, California, 92708

  • University of Texas Medical Branch SC

    Galveston, Texas, 77555-1188

  • Banner MD Anderson Cancer Center Banner MD Anderson (2)

    Gilbert, Arizona, 85234

  • Hackensack University Medical Center John Theurer Cancer Center

    Hackensack, New Jersey, 07601

  • Carolina Oncology Specialists, PC

    Hickory, North Carolina, 28602

  • Oncology Consultants Oncology Consultants, P.A.

    Houston, Texas, 77024

  • The Methodist Hospital Cornell University

    Houston, Texas, 77030

  • University of Iowa Hospitals and Clinics Holden Comprehensive Cancer Ct

    Iowa City, Iowa, 52242

  • University of Kansas Hospital and Medical Center Clinical Research Center

    Kansas City, Kansas, 66160

  • Kadlec Clinic Hematology and Oncology SC

    Kennewick, Washington, 99336

  • UC San Diego UC San Diego Cancer Ctr

    La Jolla, California, 92093-0987

  • Michigan State University / Breslin Cancer Center Breslin Cancer Center (3)

    Lansing, Michigan

  • South Texas Cancer Center- McAllen

    McAllen, Texas, 78503

  • Medical College of Wisconsin Med College of WI

    Milwaukee, Wisconsin, 53226

  • West Virginia University/ Mary Babb Randolph Cancer Center Mary Babb Randolph Cancer Ctr

    Morgantown, West Virginia, 26506

  • Hematology Oncology Associates of Northern New Jersey PA Dept of Hem-Onc of Northern NJ

    Morristown, New Jersey, 07962

  • Wilshire Oncology Medical Group Corona Cancer Center

    Multiple Locations, California

  • Tennessee Oncology Dept. of Centennial Medical

    Nashville, Tennessee, 37203

  • Vanderbilt Univeristy Ingram Cancer Center (10)

    Nashville, Tennessee, 37232

  • Memorial Sloan Kettering Memorial Sloan Kettering (63)

    New York, New York, 10017

  • Weill Cornell Medical Center Dept. of Oncology

    New York, New York, 10021

  • Columbia University Medical Center Herbert Irving Pavilion

    New York, New York, 10032

  • MD Anderson Cancer Center - Orlando Cancer Center

    Orlando, Florida, 32806

  • Epic-Care

    Pleasant Hill, California, 94523

  • Northwest Cancer Specialists Compass Oncology -BKM

    Portland, Oregon, 97210

  • University of Rochester Medical Center

    Rochester, New York, 14642

  • Sutter Institute for Medical Research Oncology/Hematology

    Sacramento, California, 95816-5199

  • University of Utah / Huntsman Cancer Institute Huntsman Cancer Center

    Salt Lake City, Utah, 84103

  • Brooke Army Medical Center Brooke Army Medical

    San Antonio, Texas, 78234

  • St Joseph Heritage Healthcare

    Santa Rosa, California, 94503

  • Scottsdale Healthcare/TGen Clinical Research Service SC

    Scottsdale, Arizona, 85258

  • Christus Schumpert Health System

    Shreveport, Louisiana, 71101

  • H Lee Moffitt Cancer Center and Research Institute H. Lee Moffitt Cancer Ctr (67)

    Tampa, Florida, 33612

  • Montefiore Medical Center Montefiore Medicial Center

    The Bronx, New York, 10467

  • Westchester Medical Center NY Medical College

    Valhalla, New York, 10595

  • Waco Cancer and Research Center

    Waco, Texas, 76712

  • Cancer Center of Kansas

    Wichita, Kansas, 67214-3728

  • Wake Forest University Health Sciences Hematology and Oncology

    Winston-Salem, North Carolina, 27157

Other trials in United States

About this study

Official title: A Phase II Randomized, Multicenter Study of Treatment-free Remission in Chronic Myeloid Leukemia in Chronic Phase (CML-CP) Patients Who Achieve and Sustain MR4.5 After Switching to Nilotinib

To evaluate molecular relapse free rates 6 months after stopping nilotinib therapy in patients who achieve MR4.5

Read the detailed description

Study protocol included criteria for study termination that was met when > 2 patients lost CCyR during TFR phase (> 1% BCR-ABL); This study was terminated early as > 2 cases of confirmed loss of complete cytogenetic response were reported despite BCR-ABL monitoring during the TFR Phase. All cases achieved MR4.5 after Nilotinib treatment re-initiation and maintained until end of study; trial did not mandate re-initiation within 4 weeks after loss of MMR_ that was a requirement in other Nilotinib TFR trials Initial sample size was 300 patients with CML-CP; Amendment #2 in June 2015 reduced sample size to 59 due to recruitment challenges; Study endpoint analysis and interpretations of data were challenging due to small sample size for early study closure..

Conditions
CML
Being tested
nilotinib
Keywords
CML, chronic myeloid leukemia, stop, niotinib, discontinue, imatinib, switch, MR4.5, undetectable, bcr-abl
Medical subject headings
Leukemia, Myelogenous, Chronic, BCR-ABL Positive

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • nilotinibDrug

    Also called AMN107

    Nilotinib will be provided as 150 mg capsules. Patients will take nilotinib 300mg twice daily on study and dose modifications to 450mg once daily is permitted per protocol.

Study groups in NCT01744665
Study groupRoleWhat they receive
Treatment Free RemissionExperimentalPatients entered a monitoring phase for 2 years and received 300 mg nilotinib mg bid. Patients who achieved MR4.5 entered a Consolidation Phase and were treated with nilotinib for 2 years. If MR4.5 was sustained during the Consolidation phase, patients were eligible to stop taking niltoinib during the treatment-free remission (TFR) phase.
Receives: Drug: nilotinib

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants Without Molecular Relapse Within 6 Months After Starting the TFR Phase

    Percentage of particpants without confirmed loss of MMR within 6 months following nilotinib TFR is calculated by dividing the number of patients with no documented confirmed loss of MR4, in the first 6 months after starting nilotinib TFR phase by the number of patients who entered nilotinib TFR phase. Molecular relapse is defined as having a confirmed BCR-ABL ratio above MMR (2 consecutive BCR-ABL levels >0.1% IS taken approximately 4 weeks apart).

    Measured: 6 months after stopping nilotinib therapy

Secondary outcomes (13)
  1. Relapse Free Survival is Defined as Time From the Date of Nilotinib Treatment Discontinuation to the First Documented Molecular Relapse (Confirmed Loss of MR4.5).

    Relapse-free survival after the start of the TFR phase was summarized using the product-limit (Kaplan-Meier) estimates. The median for the relapse free survival and its 95% confidence intervals were provided. This analysis was performed on the FAS. Patients who dropped out without relapse were treated as censored observations.

    Measured: 7 years

  2. Percentage of Participants Without Molecular Relapse Within 12 and 24 Months After Starting the Treatment -Free Remission (TFR) Phase

    The percentage of participants without confirmed loss of MRR at 12 and 24 months is calculated by dividing the number of patients with no documented confirmed loss of MR4 at 12 and 24 months after starting the nilotinib TFR phase by the number of patients who entered nilotinib TFR phase.

    Measured: 12 and 24 months after starting the TFR

  3. Percentage of Participants Who Regained MR4.5 After Restarting Nilotinib Due to Molecular Relapse

    The percentage of participants who regained MR4.5 after restarting nilotinib will be calculated as the number of patients who achieved MR4.5 after having lost MR4 divided by the number of patients who lost MR4.

    Measured: Restart of nilotinib up to month 6, 12 and 24

  4. Number of Participants Who Progressed to Accelerated Phase/Blastic Crisis (AP/BC) or Died From From Any Cause.

    Progression to AP/BC and death where the "failure" event is the earliest occurrence of the following event: progression to AP/BC date.

    Measured: Baseline up to approximately 5 years

  5. Overall Survival (OS)

    OS was defined as the time from the date of cessation of nilotinib therapy to the date of death from any cause.

    Measured: Baseline up to approximately 5 years

  6. Change in Symptom-burden Scores by the M.D. Anderson Symptom Inventory - Chronic Myeloid Leukemia (MDASI-CML) Assessment

    The M.D. Anderson Symptom Inventory for CML patients (MDASI-CML) was used to assess the nature and impact of symptom burden on life. It consisted of 20 validated symptom items and 6 validated interference items. Each item was assessed on an 11 point scale with responses from 0-10, 0=not present and 10=as bad as you can imagine. Symptom score (SS) was calculated when a patient scored at least 8 items of the symptom items using the formula: (sum of scores for the items answered) / number of items answered. If a subject responded to < 8 symptom items, the score was considered missing. Interference score (IS) was calculated when a patient scored at least 4 items using the formula: (sum of scores for the items answered)/number of items answered. If a subject responded to < 4 interference items, the score was considered missing. The total symptom score was 0-200 and total interference score was 0-60. Mean change from baseline was summarized at all post-baseline time points

    Measured: From baseline to time to when MR4.5 is confirmed, up to 24 months, and from end of Consolidation Phase to 6 and 12 months into the TFR Phase

  7. Change in Health Utility Assessed by EuroQol Group-5D-3L (EQ-5D-3L) Visual Analogue - Safety Set

    The EQ-5D-3L questionnaire comprises 5 items: mobility, self-care, usual activities, pain/discomfort and anxiety/depression and visual analog has a scale 0 to 100 (0=worst imaginable health state, 100=best imaginable health state).

    Measured: From baseline to time to when MR4.5, up to 24 months, is confirmed and from end of Consolidation Phase to 6 and 12 months into the TFR Phase

  8. Change in Observed Scores for Patient Quality of Life Assessed by SF-8 - Safety Set

    The SF-8 questionnaire consisted of 8 items (general health, physical functioning, role physical, bodily pain, vitality, social functioning, role-emotional and mental health) and was used to assess the impact of nilotinib treatment discontinuation on the quality of life. Each item had a 1 to 5 or 1 to 6 point response range and the higher number in the raw scores indicated poorer quality of life. The physical and mental component summary measures were calculated using a norm-based scoring method given in the instrument guidelines. These norm-based scores were summarized at baseline and mean change from baseline for post-baseline time points. The norm-based scores (based on the US population) had a mean of 50 and standard deviation of 10. Higher norm-based summary scores indicated better health

    Measured: From baseline to time to when MR4.5 is confirmed and from end of Consolidation Phase to 6 and 12 months into the TFR Phase

  9. Percentage of Participants' Scores at Each Level Assessed by EQ-5D-3L for Month 3 in Consolidation Phase - Safety Set

    The EuroQol Five Dimensional Three-level (EQ-5D-3L) questionnaire comprises 5 items: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each item has 3 levels (no problems, some problems and extreme problems). The percentages of patients at each level of the five items of the EQ-5D-3L will be summarized at each time point

    Measured: At month 3 in Consolidation Phase

  10. Percentage of Participants' Scores at Each Level Assessed by EQ-5D-3L for Month 12 in Consolidation Phase - Safety Set

    The EuroQol Five Dimensional Three-level (EQ-5D-3L) questionnaire comprises 5 items: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each item has 3 levels (no problems, some problems and extreme problems). The percentages of patients at each level of the five items of the EQ-5D-3L will be summarized at each time point

    Measured: Month 12 in Consolidation Phase

  11. Percentage of Participants' Scores at Each Level Assessed by EQ-5D-3L for Month 24 in Consolidation Phase - Safety Set

    The EuroQol Five Dimensional Three-level (EQ-5D-3L) questionnaire comprises 5 items: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each item has 3 levels (no problems, some problems and extreme problems). The percentages of patients at each level of the five items of the EQ-5D-3L will be summarized at each time point

    Measured: Month 24 in Consolidation Phase

  12. Percentage of Participants' Scores at Each Level Assessed by EQ-5D-3L for Month 6 in Treatment Free Remission Phase - Safety Set

    The EuroQol Five Dimensional Three-level questionnaire (EQ-5D-3L) comprises 5 items: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each item has 3 levels (no problems, some problems and extreme problems). The percentages of patients at each level of the five items of the EQ-5D-3L will be summarized at each time point

    Measured: Month 6 in in Treatment Free Remission Phase

  13. Percentage of Participants' Scores at Each Level Assessed by EQ-5D-3L for Month 12 in Treatment Free Remission Phase - Safety Set

    The EuroQol Five Dimensional Three-level questionnaire (EQ-5D-3L) comprises 5 items: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each item has 3 levels (no problems, some problems and extreme problems). The percentages of patients at each level of the five items of the EQ-5D-3L will be summarized at each time point

    Measured: Month 12 in in Treatment Free Remission Phase

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Dec 2012 (estimated)
  2. Study start12 Aug 2013
  3. Primary completion28 Sep 2018
  4. Study completion29 Sep 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
59 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01744665
Sponsor's protocol ID
CAMN107AUS37
Acronym
ENESTgoal
Status last verified
Feb 2020
First submitted
5 Dec 2012
Last updated
10 Mar 2020
Data monitoring committee
No
Individual data sharing
Yes: Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing nilotinib in people with CML, run by Novartis Pharmaceuticals at 54 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 54 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Mar 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants Without Molecular Relapse Within 6 Months After Starting the TFR Phase (time frame: 6 months after stopping nilotinib therapy). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Mar 2020.

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