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Blood, 15 February 2008, Vol. 111, No. 4, pp. 1834-1839. Prepublished online as a Blood First Edition Paper on December 10, 2007; DOI 10.1182/blood-2007-04-083196.
CLINICAL TRIALS AND OBSERVATIONS Nilotinib (formerly AMN107), a highly selective BCR-ABL tyrosine kinase inhibitor, is active in patients with imatinib-resistant or -intolerant accelerated-phase chronic myelogenous leukemia1 Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin, Germany; 2 Johann Wolfgang Goethe-Universität, Frankfurt, Germany; 3 M. D. Anderson Cancer Center, Houston, TX; 4 St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea; 5 Heinrich Heine University, Düsseldorf, Germany; 6 Hammersmith Hospital, London, United Kingdom; 7 University of Chicago Cancer Center, IL; 8 Ospedale San Eugenio, Tor Vergata University, Rome, Italy; 9 Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; 10 Klinika Hematologii, Wroclaw, Poland; 11 Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany; 12 Hôpital Pellegrin, Bordeaux, France; 13 Ospedale San Luigi Gonzaga, Torino, Italy; 14 Ospedale San Martino, Genoa, Italy; 15 Queen Mary Hospital, Hong Kong, China; 16 Policlinico San Orsola Malpighi, Bologna, Italy; 17 Royal Adelaide Hospital, Adelaide, Australia; 18 Fred Hutchinson Cancer Research Center, Seattle, WA; and 19 Novartis Pharmaceuticals, East Hanover, NJ Patients with imatinib-resistant or -intolerant accelerated-phase chronic myelogenous leukemia (CML-AP) have very limited therapeutic options. Nilotinib is a highly selective BCR-ABL tyrosine kinase inhibitor. This phase 2 trial was designed to characterize the efficacy and safety of nilotinib (400 mg twice daily) in this patient population with hematologic response (HR) as primary efficacy endpoint. A total of 119 patients were enrolled and had a median duration of treatment of 202 days (range, 2–611 days). An HR was observed in 56 patients (47%; 95% confidence interval [CI], 38%-56%). Major cytogenetic response (MCyR) was observed in 35 patients (29%; 95% CI, 21%-39%). The median duration of HR has not been reached. Overall survival rate among the 119 patients after 12 months of follow-up was 79% (95% CI, 70%-87%). Nonhematologic adverse events were mostly mild to moderate. Severe peripheral edema and pleural effusions were not observed. The most common grade 3 or higher hematologic adverse events were thrombocytopenia (35%) and neutropenia (21%). Grade 3 or higher bilirubin and lipase elevations occurred in 9% and 18% of patients, respectively, resulting in treatment discontinuation in one patient. In conclusion, nilotinib is an effective and well-tolerated treatment in imatinib-resistant and -intolerant CML-AP. This trial is registered at www.clinicaltrials.gov as NCT00384228 [ClinicalTrials.gov] .
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