Acute Myeloid Leukemia Clinical Trial
A Global Study of the Efficacy and Safety of Midostaurin + Chemotherapy in Newly Diagnosed Patients With FLT3 Mutation Negative (FLT3-MN) Acute Myeloid Leukemia (AML)
Summary
The purpose of this study is to confirm the preliminary evidence from early clinical trials that midostaurin may provide clinical benefit not only to AML patients with the FLT3-mutations but also in FLT3-MN (SR<0.05) AML (FLT3 mutant to wild type signal ratio below the 0.05 clinical cut-off).
This study will evaluate the efficacy and safety of midostaurin in combination with daunorubicin or idarubicin and cytarabine for induction and intermediate-dose cytarabine for consolidation, and midostaurin single agent post-consolidation therapy in newly diagnosed patients with FLT3-MN (SR<0.05) AML.
Full Description
This was a multi-center, multinational, randomized, double-blind Phase III study using a group sequential design. Subjects were stratified according to age (<60 vs. ≥ 60 years). Subjects within each stratum were randomized in a 1:1 ratio into one of two treatment arms: Midostaurin + chemotherapy 'or' Placebo + chemotherapy.
The study consisted of the following phases:
Screening/randomization phase: Subjects had to sign informed consent form before screening for enrollment. Subjects started chemotherapy at day 1 and were randomized at day 8.
Induction phase: All subjects received at least one cycle (28 days) of induction therapy with continuous infusion cytarabine (D1 - D7) and daunorubicin or idarubicin (D1 - D3) (induction 1). Subjects who did not achieve CR or CRi with adequate blood count recovery after Induction 1 received a second cycle with intermediate-dose cytarabine (D1 - D3) and daunorubicin or idarubicin (D1 - D3) (induction 2). Subjects who did not achieve CR or CRi with adequate blood recovery after induction 2 discontinued study treatment and were followed for survival.
Consolidation phase: Subjects who achieved CR or CRi with adequate blood count recovery after induction with one or two cycles of induction proceeded to consolidation therapy with either 3 or 4 cycles respectively of intermediate-dose cytarabine (D1 - D3), or to Hematopoietic Stem Cells Transplantation (HSCT) with or without preceding consolidation cycles.
Post-consolidation phase: Subjects who maintained CR or CRi with adequate blood count recovery at the end of the consolidation phase received 12 cycles (28 days/cycle) of continuous therapy with midostaurin or placebo twice daily at 50 mg. Subjects who underwent HSCT after achieving CR or CRi with adequate blood count recovery received midostaurin or placebo twice daily 50 mg post-transplant therapy, continuously, for up to 12 cycles (28 days/cycle). Post HSCT post-consolidation therapy began >30 days but not later than 100 days following HSCT.
Follow-up phase: All enrolled subjects were followed through the treatment period and until relapse/treatment failure, thereafter for start of new line of therapy and survival.
Eligibility Criteria
Inclusion Criteria:
Diagnosis of AML (≥20% blasts in the bone marrow based on WHO 2016 classification). Patients with APL with PML-RARA are not eligible.
Suitability for intensive induction chemotherapy in the judgment of the investigator
Documented absence of an ITD and TKD activating mutation at codons D835 and I836 in the FLT3 gene, as determined by analysis in a Novartis designated laboratory using a validated clinical trial assay with clinical cutoff of 0.05 mutant to wild type signal ratio
Age ≥18 years
Laboratory values that indicate adequate organ function assessed locally at the screening visit
Exclusion Criteria:
Central nervous system (CNS) leukemia
Therapy-related secondary AML
Isolated extramedullary leukemia
Prior therapy for leukemia or myelodysplasia
AML after antecedent myelodysplasia (MDS) with prior cytotoxic treatment (e.g., azacytidine or decitabine)
Prior treatment with a FLT3 inhibitor (e.g., midostaurin, quizartinib, sorafenib)
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There are 132 Locations for this study
Chicago Illinois, 60637, United States
Boston Massachusetts, 02115, United States
Portland Oregon, 97239, United States
Caba Buenos Aires, C1118, Argentina
Westmead New South Wales, 2145, Australia
Woolloongabba Queensland, 4102, Australia
Prahran Victoria, 3181, Australia
Murdoch Western Australia, 6150, Australia
Linz , A-401, Austria
Vienna , 1140, Austria
Wien , 1090, Austria
Antwerpen , 2060, Belgium
Brugge , 8000, Belgium
Roeselare , 8800, Belgium
Porto Alegre RS, 90035, Brazil
Sao Paulo SP, 04014, Brazil
Sao Paulo , 01221, Brazil
Sofia , 1756, Bulgaria
Brno - Bohunice , 625 0, Czechia
Plzen-Bory , 30599, Czechia
Bayonne Bayonne Cedex, 64109, France
Angers Cedex 1 , 49033, France
Avignon , 84000, France
Dijon , 21034, France
Lille Cedex , 59037, France
Nantes Cedex 1 , 44093, France
Paris , 75012, France
Pierre Benite , 69495, France
Toulouse , 31059, France
Regensburg Bavaria, 93053, Germany
Schwerin Brandenburg, 19049, Germany
Bad Saarow , 15526, Germany
Berlin , 10967, Germany
Berlin , 12351, Germany
Berlin , 13125, Germany
Berlin , 13353, Germany
Bochum , 44892, Germany
Bonn , 53105, Germany
Braunschweig , 38114, Germany
Darmstadt , 64283, Germany
Duesseldorf , 40225, Germany
Duisburg , 47166, Germany
Eschweiler , 52249, Germany
Essen Werden , 45239, Germany
Flensburg , 24939, Germany
Giessen , 35392, Germany
Gottingen , 37075, Germany
Hamburg , 20099, Germany
Hamburg , 20246, Germany
Hannover , 30625, Germany
Homburg , 66421, Germany
Karlsruhe , 76133, Germany
Kiel , 24116, Germany
Leipzig , 04103, Germany
Luebeck , 23538, Germany
Magdeburg , 39120, Germany
Mainz , 55131, Germany
Muenchen , 80377, Germany
Osnabrueck , 49076, Germany
Paderborn , 33098, Germany
Rostock , 18057, Germany
Siegen , 57072, Germany
Stuttgart , 70176, Germany
Stuttgart , 70376, Germany
Ulm , 89081, Germany
Wuerzburg , 97080, Germany
Zwickau , 08060, Germany
Haifa , 31096, Israel
Petach Tikva , 49414, Israel
Tel Aviv , 64239, Israel
Alessandria AL, 15100, Italy
Ancona AN, 60126, Italy
Bergamo BG, 24127, Italy
Brescia BS, 25123, Italy
Catania CT, 95123, Italy
Milano MI, 20162, Italy
Modena MO, 41124, Italy
Palermo PA, 90146, Italy
Piacenza PC, 29100, Italy
Pescara PE, 65124, Italy
Perugia PG, 06129, Italy
Reggio Calabria RC, 89124, Italy
Roma RM, 00133, Italy
Roma RM, 00161, Italy
Roma RM, 00168, Italy
Taranto TA, 74100, Italy
Torino TO, 10126, Italy
Vicenza VI, 36100, Italy
Nagoya-city Aichi, 466-8, Japan
Matsuyama-city Ehime, 790-8, Japan
Fukuoka city Fukuoka, 812-8, Japan
Fukushima city Fukushima, 960 1, Japan
Gifu shi Gifu, 500 8, Japan
Fukuyama Hiroshima, 720-0, Japan
Tsukuba city Ibaraki, 305-8, Japan
Isehara Kanagawa, 259-1, Japan
Nagasaki-city Nagasaki, 852-8, Japan
Okayama city Okayama, 701-1, Japan
Hirakata-city Osaka, 573-1, Japan
Osaka Sayama Osaka, 589 8, Japan
Hamamatsu Shizuoka, 432-8, Japan
Shimotsuke Tochigi, 329-0, Japan
Bunkyo ku Tokyo, 113-8, Japan
Bunkyo-ku Tokyo, 113-8, Japan
Aomori , 030 8, Japan
Kyoto , 606 8, Japan
Osaka , 534-0, Japan
Yamagata , 990 9, Japan
Bergen , NO-50, Norway
Oslo , 0424, Norway
Gdansk , 80 95, Poland
Lisboa , 1099 , Portugal
Porto , 4200-, Portugal
Cordoba Andalucia, 14004, Spain
Sevilla Andalucia, 41013, Spain
Salamanca Castilla Y Leon, 37007, Spain
Hospitalet de LLobregat Catalunya, 08907, Spain
Caceres Extremadura, 10003, Spain
Barakaldo Pais Vasco, 48903, Spain
Barcelona , 08041, Spain
Madrid , 28034, Spain
Madrid , 28041, Spain
Valencia , 46026, Spain
Zaragoza , 50009, Spain
Bern , 3010, Switzerland
Zurich , 8091, Switzerland
Putzu City Chiayi Hsien, 61363, Taiwan
Kuei Shan Chiang Taoyuan Taiwan ROC, 33305, Taiwan
Kaohsiung City , 83301, Taiwan
Taipei , 10002, Taiwan
Adana , 01330, Turkey
Ankara , 06100, Turkey
Aydin , 09100, Turkey
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