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Ruxolitinib and Tyrosine Kinase Inhibitors for the Treatment of Recurrent Chronic Phase-Chronic Myeloid Leukemia

Trial Status: Active

This phase II trial studies how well ruxolitinib and tyrosine kinase inhibitors (TKIs), including imatinib, dasatinib, nilotinib or bosutinib, work in treating patients who are attempting to stop TKI medications for a second time for chronic phase-chronic myeloid leukemia that has come back (recurrent). Ruxolitinib and imatinib, dasatinib, nilotinib or bosutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. The purpose of this trial is to see if adding ruxolitinib to imatinib, dasatinib, nilotinib or bosutinib works better in prolonging treatment-free remission in patients with chronic phase-chronic myeloid leukemia.

Inclusion Criteria

  • Willing and able to give informed consent
  • Diagnosed with CML in chronic phase and have either the b3a2 (e14a2) or b2a2 (e13a2) variants that give rise to the p210 BCR-ABL protein
  • Must have a documented history of attempting only one prior TKI discontinuation under the guidance of a treating physician
  • Must have met ALL the following criteria prior to first attempt to discontinue their TKI: * Stable molecular response (MR4; =< 0.01% international reporting scale [IS]) for >= 2 years, as documented on at least four tests, performed at least 3 months apart * Treatment with one of the following Food and Drug Administration (FDA) approved TKIs; imatinib, dasatinib, nilotinib or bosutinib, at any dose for a minimum of 3 years prior to discontinuing TKIs * Has been on any number of TKIs, but has not been resistant to any TKI (changes made for intolerance are allowed)
  • Must have relapsed (defined as loss of major molecular response [MMR]), real-time quantitative (RQ)-polymerase chain reaction (PCR) for BCR-ABL > 0.1% IS after first attempted discontinuation of TKI
  • After first failed TFR attempt, must have a minimum duration of 1 year on a TKI, and must plan to remain on this same TKI for a minimum of 12 months during the combination treatment phase
  • Current TKI must be the same as the TKI being taken prior to the initial TFR attempt (e.g. if patient is on imatinib prior to first TFR attempt, they should be on imatinib at time of enrollment on this study)
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-3
  • Must have a RQ-PCR for BCR-ABL =< 0.0032% IS (MR4.5) reported at the time of study enrollment
  • Female patients must meet one of the following: * Postmenopausal for at least one year before the screening visit * Surgically sterile * If they are of childbearing potential, agree to practice two effective methods of contraception from the time of signing of the informed consent form through 90 days after the last dose of study drug * Must also adhere to the guidelines of any treatment-specific pregnancy prevention program, if applicable * Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, postovulation methods] and withdrawal are not acceptable contraception methods.)
  • Male patients, even if surgically sterilized (i.e., status post vasectomy), must agree to one of the following: * Practice effective barrier contraception during the entire study treatment period and through 90 days after the last study drug dose * Must also adhere to the guidelines of any treatment-specific pregnancy prevention program, if applicable * Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, postovulation methods] and withdrawal are not acceptable methods of contraception.)
  • TFR PHASE:
  • Stable molecular response (MR4.5; =< 0.0032% IS) documented on at least three tests, performed at least 3 months apart while on combination therapy
  • TFR phase screening PCR RQ-PCR for BCR-ABL =< 0.0032% IS (MR4.5)
  • ECOG 0-3
  • Completion of 12 cycles on the combination therapy phase

Exclusion Criteria

  • History of accelerated or blast phase CML
  • History of TKI resistance
  • A second malignancy requiring active treatment
  • Subjects who have previously received treatment with a JAK inhibitor
  • Subjects with platelet (PLT) count < 100 x 10^9/L
  • Subjects with an absolute neutrophil count (ANC) of < 1 x 10^9/L
  • Subjects with hemoglobin < 8 g/dL
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) >= 3 times the institutional upper limit of normal
  • Creatinine >= 2 times the institutional upper limit of normal
  • Total bilirubin >= 1.5 times the institutional upper limit of normal (unless direct bilirubin is within normal limits)
  • Pregnant or lactating
  • Unable to comply with lab appointments schedule and patient-reported outcome (PRO) assessments
  • Another investigational drug within 4 weeks of enrollment
  • Any serious medical or psychiatric illness that could, in the investigator’s opinion, interfere with the completion of treatment according to this protocol
  • Patient has undergone a prior allogeneic transplant
  • Screening 12-lead electrocardiogram (ECG) showing a baseline corrected QT interval > 500msec (patients with a pacemaker will still be eligible with corrected QT (QTc) > 500 msec)

Florida

Tampa
Moffitt Cancer Center
Status: ACTIVE
Contact: Kendra L Sweet
Phone: 813-745-6841

Georgia

Atlanta
Emory University Hospital / Winship Cancer Institute
Status: APPROVED
Contact: Rebecca Bruner Klisovic

New Jersey

Montvale
Memorial Sloan Kettering Bergen
Status: ACTIVE
Contact: Michael John Mauro
Phone: 646-608-3744

New York

Buffalo
Roswell Park Cancer Institute
Status: ACTIVE
Contact: James Edwin Thompson
New York
Memorial Sloan Kettering Cancer Center
Status: ACTIVE
Contact: Michael John Mauro
Phone: 646-608-3744

Oregon

Portland
OHSU Knight Cancer Institute
Status: ACTIVE
Contact: OHSU Knight Cancer Institute Trials Hotline
Phone: 503-494-1080

Washington

Seattle
Fred Hutchinson Cancer Research Center
Status: ACTIVE
Contact: Vivian Gudrun Oehler

Wisconsin

Milwaukee
Medical College of Wisconsin
Status: ACTIVE
Contact: Ehab Latif Atallah
Phone: 414-805-4600

PRIMARY OBJECTIVE:

I. To determine the 1-year treatment free remission rate after 12 cycles of combination therapy with TKIs plus ruxolitinib phosphate (ruxolitinib) in subjects who have experienced molecular relapse after prior TKI discontinuation.

SECONDARY OBJECTIVES:

I. To assess the safety and tolerability of the treatment combinations.

II. To assess the impact on health-related quality of life in patients while on combination therapy and after TKI discontinuation.

III. To compare changes in phosphorylation of STAT3 (pSTAT3) in K562 and KU812 cell lines measured by the Phos-Flow (STAT3/5) platform, using plasma from chronic myeloid leukemia (CML) patients being treated with TKIs plus ruxolitinib using the plasma inhibitory assay technique.

IV. To describe multiparameter flow based assessment of the T-cell compartment (activity/polarization) as well as natural killer (NK) cells in CML patients at various time points when they are being treated with TKIs alone, TKIs plus ruxolitinib and at a time when they are off both TKIs and ruxolitinib.

V. To correlate changes in pSTAT3 and pSTAT5 with clinical response and rate of treatment free remission (TFR).

OUTLINE:

COMBINATION TREATMENT PHASE: Patients receive ruxolitinib phosphate orally (PO) twice daily (BID) and imatinib, dasatinib, nilotinib or bosutinib on day 1. Treatment repeats every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity.

TREATMENT FREE REMISSION PHASE: Patients undergo collection of blood samples at weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 58, 64, 70, 76, 82, 88, 94, and 100. Patients whose results show they are no longer in major molecular response (MMR) resume treatment with imatinib, dasatinib, nilotinib or bosutinib per physician discretion.

After completion of study treatment, patients are followed up every 6 months until 5 years from study entry.

Trial Phase Phase II

Trial Type Treatment

Lead Organization
Moffitt Cancer Center

Principal Investigator
Kendra L Sweet

  • Primary ID MCC-19660
  • Secondary IDs NCI-2019-08022, HJKC3-0002
  • Clinicaltrials.gov ID NCT03610971