Ponatinib vs Imatinib for Acute Lymphoblastic Leukemia

Not currently recruiting at 155 trial locations

Overseen By Takeda Call center

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: Takeda

Must be taking: Ponatinib, Imatinib

Must not be taking: QTc drugs, CYP3A4 drugs

Disqualifiers: CML, HIV, Hepatitis, CNS pathology, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 3

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two treatments, ponatinib and imatinib, for adults with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), a type of blood cancer. The goal is to determine which treatment helps more participants achieve remission. Participants will take either ponatinib or imatinib daily with chemotherapy for up to 20 months, followed by continued treatment with just ponatinib or imatinib. Individuals newly diagnosed with Ph+ ALL who haven't received other cancer treatments may be suitable for this trial. As a Phase 3 trial, this study represents the final step before potential FDA approval, offering participants a chance to contribute to a critical stage of research.

Do I have to stop taking my current medications for the trial?

You may need to stop taking certain medications, especially if they are known to affect heart rhythm or interact with the trial drugs. It's best to discuss your current medications with the trial team to see if any changes are needed.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that ponatinib is generally safe. In a study with 583 participants, 56 experienced skin issues and 80 had digestive problems. The safety profile of ponatinib has improved since its introduction.

Imatinib, on the other hand, is a well-established treatment with a long history of use. It is widely used for certain types of leukemia and is usually easy for patients to tolerate. Most side effects are mild and manageable.

Both treatments have their own side effects but are generally well-tolerated. Participants should discuss any concerns with their healthcare provider to better understand what to expect. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about these treatments for acute lymphoblastic leukemia (ALL) because Ponatinib and Imatinib have the potential to offer improved outcomes. Ponatinib is unique as it is a third-generation tyrosine kinase inhibitor, specifically designed to target the BCR-ABL mutation, which is often associated with resistance to other treatments like Imatinib. Unlike the standard treatments, which may take longer to show effectiveness, Ponatinib can potentially target resistant cancer cells more effectively, offering hope for patients who have seen limited success with earlier therapies. Meanwhile, Imatinib, a well-known first-generation tyrosine kinase inhibitor, remains a staple due to its effectiveness in targeting the Philadelphia chromosome-positive ALL, providing a reliable option that has transformed treatment outcomes for many.

What evidence suggests that this trial's treatments could be effective for acute lymphoblastic leukemia?

Research has shown that ponatinib, one of the treatments in this trial, holds promise for treating Philadelphia Chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Studies have found that patients taking ponatinib, especially with chemotherapy, often respond well, with about 73% surviving for at least five years. Another treatment option in this trial is imatinib, which has also proven effective for Ph+ ALL. In some studies, 90% of patients experienced complete remission, showing no signs of cancer, when using imatinib with chemotherapy. Both treatments have demonstrated significant potential in treating this type of leukemia. ^{6 7 8 9 10}

Who Is on the Research Team?

Study Director

Principal Investigator

Takeda

Are You a Good Fit for This Trial?

Adults newly diagnosed with Philadelphia Chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) who are in good enough health to perform daily activities with slight limitations (ECOG <=2). They can't join if they have HIV, hepatitis B or C, recent major surgery, certain heart diseases, other cancers within the last 5 years, severe nervous system conditions, or are taking specific drugs that affect liver enzymes or cause heart rhythm problems.

Inclusion Criteria

My leukemia is newly diagnosed and positive for Philadelphia chromosome or BCR-ABL1.

I can take care of myself but might not be able to do heavy physical work.

Exclusion Criteria

I have no history of major brain-related health issues like epilepsy, stroke, or dementia.

I have HIV or active hepatitis B or C.

Uncontrolled hypertriglyceridemia (triglycerides >450 milligram per deciliter [mg/dL])

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Induction

Participants receive ponatinib or imatinib with reduced-intensity chemotherapy for up to 3 cycles

3 months

Multiple visits per cycle

Consolidation

Participants continue with ponatinib or imatinib and additional chemotherapy agents for cycles 4 to 9

6 months

Multiple visits per cycle

Maintenance

Participants receive ponatinib or imatinib as a single agent for cycles 10 to 20

11 months

Monthly visits

Follow-up

Participants are monitored for safety and effectiveness after treatment

Up to 6 years

Every 3 months

What Are the Treatments Tested in This Trial?

Interventions

• Imatinib
• Ponatinib

Trial Overview

The trial is testing Ponatinib against Imatinib in adults with Ph+ ALL. Participants will take one of these drugs as a pill every day along with less intense chemotherapy for up to 20 months and then continue just the pills unless they need to stop according to study rules.

How Is the Trial Designed?

Group I: Cohort A: Ponatinib 30 milligram (mg) Experimental Treatment 6 Interventions

Ponatinib 30 mg, tablets, orally, once daily (QD), with vincristine 1.4 mg/m\^2 (max 2 mg) intravenous (IV), on Days 1 and 14 and dexamethasone 40 mg (\<60 years \[yrs\]) and 20 mg (≥60 yrs), orally, once on Days 1 to 4, Days 11 to 14 for up to 3 cycles (each cycle=28 days) in induction phase (reduced dose of ponatinib 15 mg upon achievement of MRD-negative CR at end of induction) followed by ponatinib last induction phase dose with cytarabine, 1000 mg/m\^2 as 2-hour IV infusion (\<60 yrs) and 250 mg/m\^2 (≥60 yrs) every 12 hours, IV on Days 1, 3, 5 of Cycles 2,4,6 and methotrexate, 1000 mg/m\^2 (\<60 yrs) and 250 mg/m\^2 (≥60 yrs), IV infusion, on Day 1 of cycles 1, 3, 5 in consolidation phase followed by ponatinib last consolidation phase dose with vincristine 1.4 mg/m\^2 (max 2 mg), IV, on Day 1 and prednisone 200 mg (\<60 yrs), 100 mg (≥60-69 yrs) and 50 mg(≥70 yrs) on Days 1 to 5 for up to 11 cycles in maintenance phase up to data cut-off date: 12 August 2022.

Group II: Cohort B: Imatinib 600 mg Active Control 6 Interventions

Imatinib 600 mg, tablets, orally, QD, with vincristine 1.4 mg/m\^2 (max 2 mg), IV, on Days 1 and 14 and dexamethasone 40 mg (\<60 yrs) and 20 mg (≥60 yrs), orally, once on Days 1 to 4 and Days 11 to 14 in each 28-day cycle for up to 3 cycles in the induction phase followed by imatinib 600 mg, tablets, orally, QD, with cytarabine, 1000 mg/m\^2 every 12 hours as a 2-hour-IV infusion (\<60 yrs) and 250 mg/m\^2 every 12 hours (≥60 yrs), IV on Days 1, 3, and 5 of each 28-day even cycles (Cycles 2, 4, and 6), and methotrexate, 1000 mg/m\^2 (\<60 yrs) and 250 mg/m\^2 (≥60 yrs), IV infusion, on Day 1 of each 28-day odd cycles (Cycle 1, 3, and 5) in consolidation phase followed by imatinib 600 mg, tablets, orally, QD, along with vincristine 1.4 mg/m\^2 (max 2 mg), IV, on Day 1 and prednisone 200 mg (\<60 yrs), 100 mg (≥60-69 yrs) and 50 mg (≥70 yrs) on Days 1 through 5 in each 28-day cycle up to 11 cycles in maintenance phase up to data cut-off date: 12 August 2022.

Imatinib is already approved in European Union, United States, Canada, Japan, Switzerland for the following indications:

Approved in European Union as Gleevec for:

• Chronic myeloid leukemia
• Gastrointestinal stromal tumors
• Dermatofibrosarcoma protuberans
• Systemic mastocytosis
• Hypereosinophilic syndrome

Approved in United States as Gleevec for:

• Chronic myeloid leukemia
• Gastrointestinal stromal tumors
• Dermatofibrosarcoma protuberans
• Systemic mastocytosis
• Hypereosinophilic syndrome

Approved in Canada as Glivec for:

• Chronic myeloid leukemia
• Gastrointestinal stromal tumors
• Dermatofibrosarcoma protuberans
• Systemic mastocytosis
• Hypereosinophilic syndrome

Approved in Japan as Glivec for:

• Chronic myeloid leukemia
• Gastrointestinal stromal tumors
• Dermatofibrosarcoma protuberans
• Systemic mastocytosis
• Hypereosinophilic syndrome

Approved in Switzerland as Gleevec for:

• Chronic myeloid leukemia
• Gastrointestinal stromal tumors
• Dermatofibrosarcoma protuberans
• Systemic mastocytosis
• Hypereosinophilic syndrome

Who Is Running the Clinical Trial?

Takeda

Lead Sponsor

Trials

1,255

Recruited

4,219,000+

Dr. Naoyoshi Hirota

Takeda

Chief Medical Officer since 2020

MD from University of Tokyo

Christophe Weber

Takeda

Chief Executive Officer since 2015

PhD in Molecular Biology from Université de Montpellier

Published Research Related to This Trial

In the phase 3 TOWER study, blinatumomab showed a significant overall survival benefit compared to standard-of-care chemotherapy in adults with relapsed or refractory Philadelphia chromosome-negative B-precursor acute lymphoblastic leukemia, involving 267 patients who received a median of 2 cycles of treatment.

After adjusting for treatment duration, blinatumomab had lower exposure-adjusted event rates for serious adverse events compared to standard chemotherapy, particularly for infections and cytopenias, indicating it is a well-tolerated treatment option despite a higher rate of cytokine-release syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exposure-adjusted adverse events comparing blinatumomab with chemotherapy in advanced acute lymphoblastic leukemia. Stein, AS., Larson, RA., Schuh, AC., et al.[2020]

Blinatumomab, a bispecific T-cell engager, has been successfully used in 11 pediatric patients with relapsed/refractory acute lymphoblastic leukemia (ALL) after they experienced severe chemotherapy-induced toxicity, leading to recovery in all cases.

This treatment offers a nonmyelotoxic alternative for patients who cannot tolerate traditional cytotoxic therapies, suggesting it could be a valuable option in managing severe toxicity during leukemia treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blinatumomab as a bridge to further therapy in cases of overwhelming toxicity in pediatric B-cell precursor acute lymphoblastic leukemia: Report from the Israeli Study Group of Childhood Leukemia. Elitzur, S., Arad-Cohen, N., Barzilai-Birenboim, S., et al.[2020]

In a phase II clinical trial, the combination of ponatinib, a third-generation tyrosine kinase inhibitor, and blinatumomab, a bispecific T-cell engager, achieved complete molecular remissions in most patients with Philadelphia chromosome-positive acute lymphoblastic leukemia.

These early results suggest a promising therapeutic strategy for this challenging type of leukemia, highlighting the potential efficacy of combining targeted therapies with immunotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TKI-BiTE Combo Produces CMRs in Most with ALL. [2022]

Blinatumomab represents a significant advancement in immunotherapy for relapsed or refractory acute lymphoblastic leukemia (ALL), demonstrating unprecedented efficacy by stimulating a strong T-cell response, which is a departure from traditional chemotherapy.

While blinatumomab offers promising benefits, it also presents unique immunological toxicities and complex administration requirements, necessitating careful consideration of its use compared to other emerging therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blinatumomab: enlisting serial killer T-cells in the war against hematologic malignancies. Rogala, B., Freyer, CW., Ontiveros, EP., et al.[2023]

Recent advancements in treatments for acute lymphoblastic leukemia (ALL), including inotuzumab ozogamicin, blinatumomab, and CAR T-cell therapy, have significantly improved patient outcomes for both younger and older adults.

The review emphasizes the need for optimal combinations and sequences of these new therapies, as well as their integration into standard treatment regimens, to enhance the effectiveness of ALL management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimizing the treatment of acute lymphoblastic leukemia in younger and older adults: new drugs and evolving paradigms. Short, NJ., Kantarjian, H., Jabbour, E.[2022]

Imatinib, a tyrosine kinase inhibitor, has significantly improved the prognosis for patients with chronic myeloid leukaemia (CML) and gastrointestinal stromal tumours (GIST), showing high rates of cytogenetic and molecular responses across all phases of CML.

The drug is well tolerated, with only mild adverse effects such as joint pain and gastrointestinal symptoms, primarily occurring in the first two years of treatment, making it a safe and effective oral option for these cancers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A benefit-risk assessment of imatinib in chronic myeloid leukaemia and gastrointestinal stromal tumours. Wolf, D., Rumpold, H.[2021]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC5479612/

final results of the GIMEMA LAL 0904 study - PubMed Central

Overall survival and disease-free survival at 60 months are 48.8% and 45.8%, respectively. At day +50 (end of imatinib induction), a more than 1.3 log-reduction ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC2805727/

Concurrent intensive chemotherapy and imatinib before and ...

Of the 30 patients included, 27 (90%) achieved complete remission, one was resistant to treatment and two died during induction therapy. The percentages of ...

3.

ashpublications.org

ashpublications.org/blood/article/100/6/1965/16459/A-phase-2-study-of-imatinib-in-patients-with

A phase 2 study of imatinib in patients with relapsed or ...

Grade 4 neutropenia and thrombocytopenia occurred in 54% and 27% of patients, respectively. Imatinib therapy resulted in a clinically relevant hematologic ...

4.

haematologica.org

haematologica.org/article/view/7373

Final report of a phase II study of imatinib mesylate with ...

HyperCVAD chemotherapy and imatinib is an effective regimen for Philadelphia-positive acute lymphoblastic leukemia.

5.

ashpublications.org

ashpublications.org/blood/article/123/6/843/32592/UKALLXII-ECOG2993-addition-of-imatinib-to-a

addition of imatinib to a standard treatment regimen enhances ...

The complete remission (CR) rate was 92% in the imatinib cohort vs 82% in the preimatinib cohort (P = .004). At 4 years, the overall survival ( ...

6.

ascopubs.org

ascopubs.org/doi/10.1200/JCO.2025.43.16_suppl.e18531

Investigating the efficacy and safety of ponatinib in acute ...

Out of 583 individuals, there were 56 reports of adverse dermatologic events, 80 adverse events affecting the gastrointestinal tract, and 141 ...

7.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8195783/

Clinical outcomes in patients with Philadelphia chromosome ...

The 5-year follow-up data of this trial showed deep and durable responses to ponatinib therapy in CP-CML patients [8]. In total, 60% of the evaluable CP-CML ...

8.

ashpublications.org

ashpublications.org/blood/article/144/Supplement%201/3816/533600/Ponatinib-Safety-Profile-An-Analysis-of-10-Years

Ponatinib Safety Profile: An Analysis of 10 Years of Real ...

Conclusion: Our study findings suggest the safety profile of ponatinib has improved since it first became commercially available, with ...

9.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S2152265025028939

Molecular Milestones and Survival Outcomes of Ponatinib ...

Among 52 patients (27 CML and 25 Ph+ ALL; median follow-up: 50.7 months), 94% received ponatinib due to relapsed or refractory disease. Among ...

10.

iclusig.com

iclusig.com/cml/how-iclusig-may-help

ICLUSIG® (ponatinib) Clinical Trial Results in CML

Based on 5-year data from PACE, ICLUSIG was shown to help control CML in adult patients whose disease was considered resistant or intolerant to prior TKI ...