A phase 3, open-label, randomized study of asciminib, a STAMP inhibitor, vs bosutinib in CML after 2 or more prior TKIs

Patients with chronic myeloid leukemia in chronic phase (CML-CP) resistant/intolerant to ≥2 tyrosine kinase inhibitors (TKIs) are at high risk of experiencing poor outcomes because of disease biology and inadequate efficacy and/or safety of current therapies. Asciminib, a first-in-class BCR-ABL1 inh...

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Published inBlood Vol. 138; no. 21; pp. 2031 - 2041
Main Authors Réa, Delphine, Mauro, Michael J., Boquimpani, Carla, Minami, Yosuke, Lomaia, Elza, Voloshin, Sergey, Turkina, Anna, Kim, Dong-Wook, Apperley, Jane F., Abdo, Andre, Fogliatto, Laura Maria, Kim, Dennis Dong Hwan, le Coutre, Philipp, Saussele, Susanne, Annunziata, Mario, Hughes, Timothy P., Chaudhri, Naeem, Sasaki, Koji, Chee, Lynette, García-Gutiérrez, Valentin, Cortes, Jorge E., Aimone, Paola, Allepuz, Alex, Quenet, Sara, Bédoucha, Véronique, Hochhaus, Andreas
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 25.11.2021
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Abstract Patients with chronic myeloid leukemia in chronic phase (CML-CP) resistant/intolerant to ≥2 tyrosine kinase inhibitors (TKIs) are at high risk of experiencing poor outcomes because of disease biology and inadequate efficacy and/or safety of current therapies. Asciminib, a first-in-class BCR-ABL1 inhibitor Specifically Targeting the ABL Myristoyl Pocket (STAMP), has the potential to overcome resistance/intolerance to approved TKIs. In this phase 3, open-label study, patients with CML-CP previously treated with ≥2 TKIs were randomized (2:1) to receive asciminib 40 mg twice daily vs bosutinib 500 mg once daily. Randomization was stratified by major cytogenetic response (MCyR) status at baseline. The primary objective was to compare the major molecular response (MMR) rate at week 24 for asciminib vs bosutinib. A total of 233 patients were randomized to asciminib (n = 157) or bosutinib (n = 76). Median follow-up was 14.9 months. The MMR rate at week 24 was 25.5% with asciminib and 13.2% with bosutinib. The difference in MMR rate between treatment arms, after adjusting for MCyR at baseline, was 12.2% (95% confidence interval, 2.19-22.30; 2-sided P = .029). Fewer grade ≥3 adverse events (50.6% vs 60.5%) and adverse events leading to treatment discontinuation (5.8% vs 21.1%) occurred with asciminib than with bosutinib. The study showed a superior efficacy of asciminib compared with that of bosutinib, together with a favorable safety profile. These results support the use of asciminib as a new therapy in patients with CML-CP who are resistant/intolerant to ≥2 prior TKIs. This trial was registered at www.clinicaltrials.gov as #NCT03106779. •Asciminib demonstrated superior efficacy vs bosutinib and an improved safety profile in patients with CML-CP after at least 2 prior TKIs.•Asciminib has the potential to transform standard of care in this population through its novel mechanism of action as a STAMP inhibitor. [Display omitted]
AbstractList Patients with chronic myeloid leukemia in chronic phase (CML-CP) resistant/intolerant to ≥2 tyrosine kinase inhibitors (TKIs) are at high risk of experiencing poor outcomes because of disease biology and inadequate efficacy and/or safety of current therapies. Asciminib, a first-in-class BCR-ABL1 inhibitor Specifically Targeting the ABL Myristoyl Pocket (STAMP), has the potential to overcome resistance/intolerance to approved TKIs. In this phase 3, open-label study, patients with CML-CP previously treated with ≥2 TKIs were randomized (2:1) to receive asciminib 40 mg twice daily vs bosutinib 500 mg once daily. Randomization was stratified by major cytogenetic response (MCyR) status at baseline. The primary objective was to compare the major molecular response (MMR) rate at week 24 for asciminib vs bosutinib. A total of 233 patients were randomized to asciminib (n = 157) or bosutinib (n = 76). Median follow-up was 14.9 months. The MMR rate at week 24 was 25.5% with asciminib and 13.2% with bosutinib. The difference in MMR rate between treatment arms, after adjusting for MCyR at baseline, was 12.2% (95% confidence interval, 2.19-22.30; 2-sided P = .029). Fewer grade ≥3 adverse events (50.6% vs 60.5%) and adverse events leading to treatment discontinuation (5.8% vs 21.1%) occurred with asciminib than with bosutinib. The study showed a superior efficacy of asciminib compared with that of bosutinib, together with a favorable safety profile. These results support the use of asciminib as a new therapy in patients with CML-CP who are resistant/intolerant to ≥2 prior TKIs. This trial was registered at www.clinicaltrials.gov as #NCT03106779. •Asciminib demonstrated superior efficacy vs bosutinib and an improved safety profile in patients with CML-CP after at least 2 prior TKIs.•Asciminib has the potential to transform standard of care in this population through its novel mechanism of action as a STAMP inhibitor. [Display omitted]
Patients with chronic myeloid leukemia in chronic phase (CML-CP) resistant/intolerant to ≥2 tyrosine kinase inhibitors (TKIs) are at high risk of experiencing poor outcomes because of disease biology and inadequate efficacy and/or safety of current therapies. Asciminib, a first-in-class BCR-ABL1 inhibitor Specifically Targeting the ABL Myristoyl Pocket (STAMP), has the potential to overcome resistance/intolerance to approved TKIs. In this phase 3, open-label study, patients with CML-CP previously treated with ≥2 TKIs were randomized (2:1) to receive asciminib 40 mg twice daily vs bosutinib 500 mg once daily. Randomization was stratified by major cytogenetic response (MCyR) status at baseline. The primary objective was to compare the major molecular response (MMR) rate at week 24 for asciminib vs bosutinib. A total of 233 patients were randomized to asciminib (n = 157) or bosutinib (n = 76). Median follow-up was 14.9 months. The MMR rate at week 24 was 25.5% with asciminib and 13.2% with bosutinib. The difference in MMR rate between treatment arms, after adjusting for MCyR at baseline, was 12.2% (95% confidence interval, 2.19-22.30; 2-sided P = .029). Fewer grade ≥3 adverse events (50.6% vs 60.5%) and adverse events leading to treatment discontinuation (5.8% vs 21.1%) occurred with asciminib than with bosutinib. The study showed a superior efficacy of asciminib compared with that of bosutinib, together with a favorable safety profile. These results support the use of asciminib as a new therapy in patients with CML-CP who are resistant/intolerant to ≥2 prior TKIs. This trial was registered at www.clinicaltrials.gov as #NCT03106779.
Patients with chronic myeloid leukemia in chronic phase (CML-CP) resistant/intolerant to ≥2 tyrosine kinase inhibitors (TKIs) are at high risk of experiencing poor outcomes because of disease biology and inadequate efficacy and/or safety of current therapies. Asciminib, a first-in-class BCR-ABL1 inhibitor Specifically Targeting the ABL Myristoyl Pocket (STAMP), has the potential to overcome resistance/intolerance to approved TKIs. In this phase 3, open-label study, patients with CML-CP previously treated with ≥2 TKIs were randomized (2:1) to receive asciminib 40 mg twice daily vs bosutinib 500 mg once daily. Randomization was stratified by major cytogenetic response (MCyR) status at baseline. The primary objective was to compare the major molecular response (MMR) rate at week 24 for asciminib vs bosutinib. A total of 233 patients were randomized to asciminib (n = 157) or bosutinib (n = 76). Median follow-up was 14.9 months. The MMR rate at week 24 was 25.5% with asciminib and 13.2% with bosutinib. The difference in MMR rate between treatment arms, after adjusting for MCyR at baseline, was 12.2% (95% confidence interval, 2.19-22.30; 2-sided P = .029). Fewer grade ≥3 adverse events (50.6% vs 60.5%) and adverse events leading to treatment discontinuation (5.8% vs 21.1%) occurred with asciminib than with bosutinib. The study showed a superior efficacy of asciminib compared with that of bosutinib, together with a favorable safety profile. These results support the use of asciminib as a new therapy in patients with CML-CP who are resistant/intolerant to ≥2 prior TKIs. This trial was registered at www.clinicaltrials.gov as #NCT03106779.Patients with chronic myeloid leukemia in chronic phase (CML-CP) resistant/intolerant to ≥2 tyrosine kinase inhibitors (TKIs) are at high risk of experiencing poor outcomes because of disease biology and inadequate efficacy and/or safety of current therapies. Asciminib, a first-in-class BCR-ABL1 inhibitor Specifically Targeting the ABL Myristoyl Pocket (STAMP), has the potential to overcome resistance/intolerance to approved TKIs. In this phase 3, open-label study, patients with CML-CP previously treated with ≥2 TKIs were randomized (2:1) to receive asciminib 40 mg twice daily vs bosutinib 500 mg once daily. Randomization was stratified by major cytogenetic response (MCyR) status at baseline. The primary objective was to compare the major molecular response (MMR) rate at week 24 for asciminib vs bosutinib. A total of 233 patients were randomized to asciminib (n = 157) or bosutinib (n = 76). Median follow-up was 14.9 months. The MMR rate at week 24 was 25.5% with asciminib and 13.2% with bosutinib. The difference in MMR rate between treatment arms, after adjusting for MCyR at baseline, was 12.2% (95% confidence interval, 2.19-22.30; 2-sided P = .029). Fewer grade ≥3 adverse events (50.6% vs 60.5%) and adverse events leading to treatment discontinuation (5.8% vs 21.1%) occurred with asciminib than with bosutinib. The study showed a superior efficacy of asciminib compared with that of bosutinib, together with a favorable safety profile. These results support the use of asciminib as a new therapy in patients with CML-CP who are resistant/intolerant to ≥2 prior TKIs. This trial was registered at www.clinicaltrials.gov as #NCT03106779.
Author Minami, Yosuke
Voloshin, Sergey
Kim, Dennis Dong Hwan
Turkina, Anna
Bédoucha, Véronique
Fogliatto, Laura Maria
Cortes, Jorge E.
Lomaia, Elza
Annunziata, Mario
Kim, Dong-Wook
Aimone, Paola
Sasaki, Koji
Boquimpani, Carla
Quenet, Sara
Abdo, Andre
Chee, Lynette
Mauro, Michael J.
Apperley, Jane F.
Chaudhri, Naeem
Réa, Delphine
García-Gutiérrez, Valentin
Saussele, Susanne
Hochhaus, Andreas
Allepuz, Alex
le Coutre, Philipp
Hughes, Timothy P.
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  orcidid: 0000-0001-5379-7461
  surname: Réa
  fullname: Réa, Delphine
  email: delphine.rea@aphp.fr
  organization: DMU Hématologie, Hôpital Saint-Louis, Paris, France
– sequence: 2
  givenname: Michael J.
  orcidid: 0000-0002-2251-4032
  surname: Mauro
  fullname: Mauro, Michael J.
  organization: Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York, NY
– sequence: 3
  givenname: Carla
  surname: Boquimpani
  fullname: Boquimpani, Carla
  organization: HEMORIO, State Institute of Hematology Arthur de Siquiera Cavalcanti, Rio de Janeiro, Brazil
– sequence: 4
  givenname: Yosuke
  surname: Minami
  fullname: Minami, Yosuke
  organization: Department of Hematology, National Cancer Center Hospital East, Kashiwa, Japan
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  givenname: Elza
  orcidid: 0000-0003-3290-7961
  surname: Lomaia
  fullname: Lomaia, Elza
  organization: Institute of Oncology and Hematology, Almazov National Medical Research Centre, St Petersburg, Russia
– sequence: 6
  givenname: Sergey
  orcidid: 0000-0003-1784-0375
  surname: Voloshin
  fullname: Voloshin, Sergey
  organization: Hematology and Bone Marrow Transplantation, Russian Research Institute of Hematology and Transfusiology, St Petersburg, Russia
– sequence: 7
  givenname: Anna
  surname: Turkina
  fullname: Turkina, Anna
  organization: Scientific and Advisory Department of Hemotherapy of Myeloproliferative Disorders, National Research Center for Hematology, Moscow, Russia
– sequence: 8
  givenname: Dong-Wook
  surname: Kim
  fullname: Kim, Dong-Wook
  organization: Hematologic Tumor Medicine Department, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
– sequence: 9
  givenname: Jane F.
  orcidid: 0000-0002-1710-1794
  surname: Apperley
  fullname: Apperley, Jane F.
  organization: Department of Immunology and Inflammation, Centre for Haematology Imperial College London, London, United Kingdom
– sequence: 10
  givenname: Andre
  orcidid: 0000-0002-7486-3525
  surname: Abdo
  fullname: Abdo, Andre
  organization: Hemato-Oncology Department, Instituto do Câncer do Estado de São Paulo (ICESPSP), São Paulo, Brazil
– sequence: 11
  givenname: Laura Maria
  surname: Fogliatto
  fullname: Fogliatto, Laura Maria
  organization: Hematology and Hemotherapy Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
– sequence: 12
  givenname: Dennis Dong Hwan
  surname: Kim
  fullname: Kim, Dennis Dong Hwan
  organization: Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
– sequence: 13
  givenname: Philipp
  surname: le Coutre
  fullname: le Coutre, Philipp
  organization: Department of Oncology and Hematology, Charité–Universitätsmedizin Berlin, Berlin, Germany
– sequence: 14
  givenname: Susanne
  orcidid: 0000-0003-0357-5785
  surname: Saussele
  fullname: Saussele, Susanne
  organization: Department of Haematology and Oncology, III. Medizinische Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
– sequence: 15
  givenname: Mario
  orcidid: 0000-0001-9993-947X
  surname: Annunziata
  fullname: Annunziata, Mario
  organization: Division of Hematology, AORN Cardarelli, Naples, Italy
– sequence: 16
  givenname: Timothy P.
  surname: Hughes
  fullname: Hughes, Timothy P.
  organization: South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, Australia
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  givenname: Naeem
  orcidid: 0000-0001-8623-1798
  surname: Chaudhri
  fullname: Chaudhri, Naeem
  organization: Hematology, Stem Cell Transplant and Cellular Therapy Section, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
– sequence: 18
  givenname: Koji
  orcidid: 0000-0002-9140-0610
  surname: Sasaki
  fullname: Sasaki, Koji
  organization: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
– sequence: 19
  givenname: Lynette
  orcidid: 0000-0002-4250-4448
  surname: Chee
  fullname: Chee, Lynette
  organization: Haematology Department, Peter MacCallum Cancer Center–The Royal Melbourne Hospital, Melbourne, Australia
– sequence: 20
  givenname: Valentin
  orcidid: 0000-0003-4752-0815
  surname: García-Gutiérrez
  fullname: García-Gutiérrez, Valentin
  organization: Servicio de Hematología, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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  givenname: Jorge E.
  surname: Cortes
  fullname: Cortes, Jorge E.
  organization: Georgia Cancer Center, Augusta, GA
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  surname: Aimone
  fullname: Aimone, Paola
  organization: Novartis Pharma AG, Basel, Switzerland
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  givenname: Alex
  surname: Allepuz
  fullname: Allepuz, Alex
  organization: Novartis Pharma AG, Basel, Switzerland
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  surname: Quenet
  fullname: Quenet, Sara
  organization: Novartis Pharma AG, Basel, Switzerland
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  surname: Bédoucha
  fullname: Bédoucha, Véronique
  organization: Novartis Pharma AG, Basel, Switzerland
– sequence: 26
  givenname: Andreas
  surname: Hochhaus
  fullname: Hochhaus, Andreas
  organization: Department of Hematology and Internal Oncology, Universitätsklinikum Jena, Jena, Germany
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34407542$$D View this record in MEDLINE/PubMed
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Snippet Patients with chronic myeloid leukemia in chronic phase (CML-CP) resistant/intolerant to ≥2 tyrosine kinase inhibitors (TKIs) are at high risk of experiencing...
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SubjectTerms Adult
Aged
Aged, 80 and over
Aniline Compounds - adverse effects
Aniline Compounds - therapeutic use
Antineoplastic Agents - adverse effects
Antineoplastic Agents - therapeutic use
Female
Humans
Leukemia, Myeloid, Chronic-Phase - drug therapy
Male
Middle Aged
Niacinamide - adverse effects
Niacinamide - analogs & derivatives
Niacinamide - therapeutic use
Nitriles - adverse effects
Nitriles - therapeutic use
Protein Kinase Inhibitors - adverse effects
Protein Kinase Inhibitors - therapeutic use
Pyrazoles - adverse effects
Pyrazoles - therapeutic use
Quinolines - adverse effects
Quinolines - therapeutic use
Treatment Outcome
Young Adult
Title A phase 3, open-label, randomized study of asciminib, a STAMP inhibitor, vs bosutinib in CML after 2 or more prior TKIs
URI https://dx.doi.org/10.1182/blood.2020009984
https://www.ncbi.nlm.nih.gov/pubmed/34407542
https://www.proquest.com/docview/2562831044
Volume 138
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