Venetoclax After TKI to Target Persisting Stem Cells in CML

• Status: Not yet recruiting
• Trial end date: 2025-07-01
• Target enrollment: 0
• Participant gender: All

Summary

There is currently no available treatment, capable to increase the rate of sustained deep molecular remissions after TKI discontinuation in CML. Venetoclax could be such a drug. The study will provide unprecedented biological insights on the effects of venetoclax in controlling minimal residual stem cell disease induced by long-term prior TKI therapy. If the study would be positive, the findings could become practice changing for patients in deep molecular remission under TKI and willing to tolerate a temporary additional treatment.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Thomas Ernst, PD Dr. med.
• Collaborators: AbbVie; Ludwig-Maximilians - University of Munich
• Treatments: Venetoclax

Criteria

Inclusion Criteria:

1. Patients with diagnosis of chronic phase CML with cytogenetic confirmation of Philadelphia (Ph) chromosome

2. Ph negative cases or patients with variant translocations who are BCR::ABL1 positive in multiplex PCR are also eligible

3. Typical b2a2 and/or b3a2 BCR::ABL1 transcripts

4. Subject must be ≥ 18 years of age

5. Stored DNA from initial diagnosis (prior TKI treatment) for BCR::ABL1 breakpoint analysis

6. BCR::ABL1 transcript level according to the international scale (IS) of MR4 or better which has been confirmed three times within the past 13 months and was assessed by an IS-certified reference laboratory, such as of the University Jena , the University Mannheim, or another MR4-certified laboratory in Germany

7. At least 3 years of TKI therapy

8. Patients who failed to discontinue TKI in a prior discontinuation attempt are still eligible if they fulfill criteria 6. after retreatment with TKI

9. WHO performance status 0-2

10. Laboratory assessments within normal limits

11. Aspartate transaminase (AST) and alanine transaminase (ALT) < 3.0X ULN

12. Bilirubin ≤1.5 x ULN (unless bilirubin rise is due to Gilbert's syndrome or of non-hepatic origin)

13. Subject must have adequate renal function as demonstrated by a creatinine clearance ≥ 30 mL/min; calculated by the Cockcroft Gault formula or measured by 24 hours urine collection

14. Patients with reproductive potential agree to use effective contraceptive measures throughout the study

15. Negative pregnancy test in women of childbearing potential

16. Subject must voluntarily sign and date an informed consent

Exclusion Criteria:

1. Concomitant use of strong CYP3A-Inhibtors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, clarithromycin, ritonavir) is contraindicated 7 days prior to venetoclax.

2. Concomitant use of moderate CYP3A-Inhibitors (e.g., ciprofloxacin, diltiazem, erythromycin, fluconazole, verapamil) should be avoided.

3. Grapefruit products, Seville oranges, and starfruit (carambola) should be avoided during treatment with venetoclax as they contain inhibitors of CYP3A

4. Concomitant use of venetoclax with P-gp and BCRP inhibitors

5. Concomitant use of venetoclax with strong CYP3A inducers (e.g., carbamazepine, phenytoin, rifampin) or moderate CYP3A inducers (e.g., bosentan, efavirenz, etravirine, modafinil, nafcillin) should be avoided

6. Patients with severe renal impairment (Crea-Clearance < 30 ml/min) or on dialysis

7. Patients with severe hepatic impairment

8. Patients who are pregnant or breast feeding, or females of reproductive potential not employing an effective method of birth control. Female patients must agree to employ an effective barrier method of birth control throughout the study and for and for at least 30 days after ending venetoclax treatment

9. Known impaired cardiac function

10. Impaired gastrointestinal function or disease that may alter the absorption of study drug

11. Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug or who have not recovered from side effects of such therapy

12. Active or uncontrolled infections at the time of enrolment

13. Known HIV sero-positivity or known active hepatitis B or C infection (HIV testing is not required)

14. Participation in another clinical study with other investigational drugs within 14 days prior to enrolment

15. Any medical, mental, psychological or psychiatric condition that in the opinion of the investigator would not permit the patient to complete the study or understand the patient information

16. Subject has acute leukemia

17. Subject has known active CNS involvement