Target responses were sustained over time in newly diagnosed and imatinib-resistant or -intolerant pediatric patients and treatment safety profile was comparable to that in adult patients
Largest prospective trial in pediatric chronic myeloid leukemia in chronic phase includes first formulation specifically developed for pediatric population
Bristol-Myers
Squibb Company (NYSE: BMY) today announced the first presentation of
data from two cohorts of the Phase 2 CA180-226 clinical trial evaluating Sprycel
(dasatinib) in imatinib-resistant or -intolerant (R/I to IM) and
newly diagnosed (ND) pediatric patients with chronic phase chronic
myeloid leukemia.
At minimum two-year follow-up, patients with CP-CML resistant to or
intolerant of imatinib who received Sprycel demonstrated a
cumulative major cytogenetic response (MCyR) rate of 55.2% (95% CI: 36,
74) 3 months into treatment, exceeding the defined threshold of clinical
interest (>30%) for the primary endpoint of the cohort and increasing
over time to greater than 90% (95% CI: 73, 98) at 24 months. Newly
diagnosed patients with CP-CML, who received Sprycel orally or as
powder for oral suspension (PFOS) once daily, achieved a cumulative
complete cytogenetic response (CCyR) rate, the primary endpoint in the
cohort, of 64% (95% CI: 53, 74) as early as 6 months into treatment,
exceeding the defined threshold of clinical interest (>55%) and
increasing over time to 94% (95% CI: 87, 98) at 24 months. The median
durations of response were not estimable, or not yet reached, in each
cohort at the time of follow-up (95% CI, R/I to IM: NE [54.9, NE]; ND:
NE [49.9, NE]).
The secondary endpoint of estimated progression-free survival (PFS) at
48 months was greater than 75% for patients resistant to or intolerant
of imatinib and greater than 90% for patients newly diagnosed with
CP-CML. Sprycel was shown to have a comparable safety profile in
pediatric patients with CP-CML to that reported in adults with CP-CML.
In this study, there were no reported events of pleural/pericardial
effusion, pulmonary edema/hypertension or pulmonary arterial
hypertension related to Sprycel.
“Treatments for children and adolescents with newly diagnosed CML in
chronic phase are limited, and even more so for those resistant to or
intolerant of imatinib,” said Lia Gore, MD, University of Colorado
School of Medicine and Children’s Hospital of Colorado. “The time to and
duration of responses along with the safety profile for patients studied
suggest dasatinib could become an important option for pediatric
patients with chronic phase CML.”
These data will be presented today in the Pediatric Oncology II Oral
Session from 8:24 to 8:36 a.m. CDT during the American Society of
Clinical Oncology (ASCO) Annual Meeting 2017 in Chicago.
“Chronic myeloid leukemia in pediatric patients is rare, making it
difficult to study, and is often more aggressive in children and young
adults,” said Jonathan Leith, PhD, hematology development lead,
Bristol-Myers Squibb. “As part of our commitment to advance new
treatment options for pediatric cancer patients, this study was designed
to evaluate the potential for Sprycel to address unmet needs for
those with chronic phase CML, including a formulation developed
specifically for children. The results demonstrate promising efficacy
and safety in the first- and second-line settings.”
Study CA180-226
CA180-226 is an ongoing Phase 2, open-label, nonrandomized study
evaluating Sprycel in patients aged 18 years or younger with
newly diagnosed chronic myeloid leukemia (CML) or Philadelphia
chromosome-positive (Ph+) leukemias resistant to or intolerant of
imatinib. Cohorts 1 and 3 examined 29 CP-CML pediatric patients
resistant to or intolerant of imatinib and 84 pediatric patients with
newly diagnosed CML in chronic phase (CP), respectively. Cohort 2
evaluated Sprycel in pediatric patients with accelerated/blast
phase CML or Philadelphia chromosome-positive acute lymphoblastic
leukemia.
Patients newly diagnosed with CP-CML received either Sprycel 60
mg/m2 tablets orally, once daily, or 72 mg/m2 Sprycel
powder for oral suspension (PFOS) once daily, and patients with
CP-CML resistant to or intolerant of imatinib received Sprycel tablets
60 mg/m2 orally, once daily.
One patient had a Sprycel-related AE leading to discontinuation,
and one patient died from gastrointestinal bleeding unrelated to
treatment. The most commonly reported AEs in newly diagnosed patients
treated with Sprycel were nausea/vomiting (20%), rash (19%) and
diarrhea (18%), and in imatinib-intolerant or -resistant patients were
nausea/vomiting (31%), myalgia/arthralgia (17%), fatigue (14%) and rash
(14%).
About Sprycel
Sprycel first received FDA approval in 2006 for the treatment of
adults with Philadelphia chromosome-positive (Ph+) chronic myeloid
leukemia (CML) in chronic phase (CP) who are resistant or intolerant to
prior therapy including imatinib. At that time, Sprycel was also
approved for adults with Ph+ acute lymphoblastic leukemia (ALL) who are
resistant or intolerant to prior therapy. Sprycel is approved and
marketed worldwide for these indications in more than 60 countries.
Sprycel is also an FDA-approved treatment for adults with newly
diagnosed CP Ph+ CML (since October 2010). Sprycel received
accelerated FDA approval for this indication. Additional country
approvals for this indication total more than 50.
U.S. FDA-APPROVED INDICATIONS FOR SPRYCEL
®
SPRYCEL® (dasatinib) is indicated for the treatment of adults
with:
-
Newly diagnosed adults with Philadelphia chromosome-positive (Ph+)
chronic myeloid leukemia (CML) in chronic phase.
-
Chronic, accelerated, or myeloid or lymphoid blast phase Ph+ CML with
resistance or intolerance to prior therapy including imatinib.
-
Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+
ALL) with resistance or intolerance to prior therapy.
IMPORTANT SAFETY INFORMATION
Myelosuppression
Treatment with SPRYCEL is associated with severe (NCI CTC Grade 3/4)
thrombocytopenia, neutropenia, and anemia, which occur earlier and more
frequently in patients with advanced phase CML or Ph+ ALL than in
patients with chronic phase CML. Myelosuppression was reported in
patients with normal baseline laboratory values as well as in patients
with pre-existing laboratory abnormalities.
-
In patients with chronic phase CML, perform complete blood counts
(CBCs) every 2 weeks for 12 weeks, then every 3 months thereafter, or
as clinically indicated
-
In patients with advanced phase CML or Ph+ ALL, perform CBCs weekly
for the first 2 months and then monthly thereafter, or as clinically
indicated
-
Myelosuppression is generally reversible and usually managed by
withholding SPRYCEL temporarily and/or dose reduction
-
In clinical studies, myelosuppression may have also been managed
by discontinuation of study therapy
-
Hematopoietic growth factor has been used in patients with
resistant myelosuppression
Bleeding-Related Events
SPRYCEL caused thrombocytopenia in human subjects. In addition,
dasatinib caused platelet dysfunction in vitro. In all CML
or Ph+ ALL clinical studies, ≥grade 3 central nervous system (CNS)
hemorrhages, including fatalities, occurred in <1% of patients receiving
SPRYCEL. Grade 3 or greater gastrointestinal hemorrhage, including
fatalities, occurred in 4% of patients and generally required treatment
interruptions and transfusions. Other cases of ≥grade 3 hemorrhage
occurred in 2% of patients.
-
Most bleeding events in clinical studies were associated with severe
thrombocytopenia
-
Concomitant medications that inhibit platelet function or
anticoagulants may increase the risk of hemorrhage
Fluid Retention
SPRYCEL may cause fluid retention. After 5 years of follow-up in the
randomized newly diagnosed chronic phase CML study (n=258), grade 3/4
fluid retention was reported in 5% of patients, including 3% of patients
with grade 3/4 pleural effusion. In patients with newly diagnosed or
imatinib resistant or intolerant chronic phase CML, grade 3/4 fluid
retention occurred in 6% of patients treated with SPRYCEL at the
recommended dose (n=548). In patients with advanced phase CML or Ph+ ALL
treated with SPRYCEL at the recommended dose (n=304), grade 3/4 fluid
retention was reported in 8% of patients, including grade 3/4 pleural
effusion reported in 7% of patients.
-
Patients who develop symptoms of pleural effusion or other fluid
retention, such as new or worsened dyspnea on exertion or at rest,
pleuritic chest pain, or dry cough should be evaluated promptly with a
chest x-ray or additional diagnostic imaging as appropriate
-
Fluid retention events were typically managed by supportive care
measures that may include diuretics or short courses of steroids
-
Severe pleural effusion may require thoracentesis and oxygen therapy
-
Consider dose reduction or treatment interruption
Cardiovascular Events
After 5 years of follow-up in the randomized newly diagnosed chronic
phase CML trial (n=258), the following cardiac adverse events occurred:
-
Cardiac ischemic events (3.9% dasatinib vs 1.6% imatinib), cardiac
related fluid retention (8.5% dasatinib vs 3.9% imatinib), and
conduction system abnormalities, most commonly arrhythmia and
palpitations (7.0% dasatinib vs 5.0% imatinib). Two cases (0.8%) of
peripheral arterial occlusive disease occurred with imatinib and 2
(0.8%) transient ischemic attacks occurred with dasatinib
Monitor patients for signs or symptoms consistent with cardiac
dysfunction and treat appropriately.
Pulmonary Arterial Hypertension (PAH)
SPRYCEL may increase the risk of developing PAH, which may occur any
time after initiation, including after more than 1 year of treatment.
Manifestations include dyspnea, fatigue, hypoxia, and fluid retention.
PAH may be reversible on discontinuation of SPRYCEL.
-
Evaluate patients for signs and symptoms of underlying cardiopulmonary
disease prior to initiating SPRYCEL and during treatment. If PAH is
confirmed, SPRYCEL should be permanently discontinued
QT Prolongation
In vitro data suggest that dasatinib has the potential to prolong
cardiac ventricular repolarization (QT interval).
-
In clinical trials of patients treated with SPRYCEL at all doses
(n=2440), 16 patients (<1%) had QTc prolongation reported as an
adverse reaction. Twenty-two patients (1%) experienced a QTcF >500 ms
-
In 865 patients with leukemia treated with SPRYCEL in five Phase 2
single-arm studies, the maximum mean changes in QTcF (90% upper bound
CI) from baseline ranged from 7.0 to 13.4 ms
-
SPRYCEL may increase the risk of prolongation of QTc in patients
including those with hypokalemia or hypomagnesemia, patients with
congenital long QT syndrome, patients taking antiarrhythmic medicines
or other medicinal products that lead to QT prolongation, and
cumulative high-dose anthracycline therapy
-
Correct hypokalemia or hypomagnesemia prior to and during SPRYCEL
administration
Severe Dermatologic Reactions
Cases of severe mucocutaneous dermatologic reactions, including
Stevens-Johnson syndrome and erythema multiforme, have been reported in
patients treated with SPRYCEL.
-
Discontinue permanently in patients who experience a severe
mucocutaneous reaction during treatment if no other etiology can be
identified
Tumor Lysis Syndrome (TLS)
TLS has been reported in patients with resistance to prior imatinib
therapy, primarily in advanced phase disease.
-
Due to potential for TLS, maintain adequate hydration, correct uric
acid levels prior to initiating therapy with SPRYCEL, and monitor
electrolyte levels
-
Patients with advanced stage disease and/or high tumor burden may be
at increased risk and should be monitored more frequently
Embryo-Fetal Toxicity
Based on limited human data, SPRYCEL can cause fetal harm when
administered to a pregnant woman. Hydrops fetalis, fetal leukopenia and
fetal thrombocytopenia have been reported with maternal exposure to
SPRYCEL. Transplacental transfer of dasatinib has been measured in fetal
plasma and amniotic fluid at concentrations comparable to those in
maternal plasma.
-
Advise females of reproductive potential to avoid pregnancy, which may
include the use of effective contraception, during treatment with
SPRYCEL and for 30 days after the final dose
Lactation
No data are available regarding the presence of dasatinib in human milk,
the effects of the drug on the breastfed infant or the effects of the
drug on milk production. However, dasatinib is present in the milk of
lactating rats.
-
Because of the potential for serious adverse reactions in nursing
infants from SPRYCEL, breastfeeding is not recommended during
treatment with SPRYCEL and for 2 weeks after the final dose
Drug Interactions
SPRYCEL is a CYP3A4 substrate and a weak time-dependent inhibitor of
CYP3A4.
-
Drugs that may increase SPRYCEL plasma concentrations
are:
-
CYP3A4 inhibitors: Concomitant use of SPRYCEL and
drugs that inhibit CYP3A4 should be avoided. If administration of
a potent CYP3A4 inhibitor cannot be avoided, close monitoring for
toxicity and a SPRYCEL dose reduction should be considered
-
Strong CYP3A4 inhibitors (eg, ketoconazole,
itraconazole, clarithromycin, atazanavir, indinavir, nefazodone,
nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole).
If SPRYCEL must be administered with a strong CYP3A4 inhibitor, a
dose decrease or temporary discontinuation should be considered
-
Grapefruit juice may also increase plasma
concentrations of SPRYCEL and should be avoided
-
Drugs that may decrease SPRYCEL plasma concentrations
are:
-
CYP3A4 inducers: If SPRYCEL must be administered with a
CYP3A4 inducer, a dose increase in SPRYCEL should be considered
-
Strong CYP3A4 inducers (eg, dexamethasone, phenytoin,
carbamazepine, rifampin, rifabutin, phenobarbital) should be
avoided. Alternative agents with less enzyme induction potential
should be considered. If the dose of SPRYCEL is increased, the
patient should be monitored carefully for toxicity
-
St John’s Wort may decrease SPRYCEL plasma
concentrations unpredictably and should be avoided
-
Antacids may decrease SPRYCEL drug levels.
Simultaneous administration of SPRYCEL and antacids should be
avoided. If antacid therapy is needed, the antacid dose should be
administered at least 2 hours prior to or 2 hours after the dose
of SPRYCEL
-
H
2
antagonists/proton pump
inhibitors (eg, famotidine and omeprazole): Long-term
suppression of gastric acid secretion by use of H2 antagonists
or proton pump inhibitors is likely to reduce SPRYCEL exposure.
Therefore, concomitant use of H2 antagonists or proton
pump inhibitors with SPRYCEL is not recommended
-
Drugs that may have their plasma concentration altered by SPRYCEL are:
-
CYP3A4 substrates (eg, simvastatin) with a narrow
therapeutic index should be administered with caution in patients
receiving SPRYCEL
Adverse Reactions
The safety data reflects exposure to SPRYCEL at all doses tested in
clinical studies including 324 patients with newly diagnosed chronic
phase CML and 2388 patients with imatinib resistant or intolerant
chronic or advanced phase CML or Ph+ ALL.
The median duration of therapy in all 2712 SPRYCEL-treated patients was
19.2 months (range 0–93.2 months). Median duration of therapy in:
-
1618 patients with chronic phase CML was 29 months (range 0–92.9
months)
-
Median duration for 324 patients in the newly diagnosed chronic
phase CML trial was approximately 60 months
-
1094 patients with advanced phase CML or Ph+ ALL was 6.2 months (range
0–93.2 months)
In the newly diagnosed chronic phase CML trial, after a minimum of 60
months of follow-up, the cumulative discontinuation rate for 258
patients was 39%.
In the overall population of 2712 SPRYCEL-treated patients, 88% of
patients experienced adverse reactions at some time and 19% experienced
adverse reactions leading to treatment discontinuation.
Among the 1618 SPRYCEL-treated patients with chronic phase CML,
drug-related adverse events leading to discontinuation were reported in
329 (20.3%) patients.
-
In the newly diagnosed chronic phase CML trial, drug was discontinued
for adverse reactions in 16% of SPRYCEL-treated patients with a
minimum of 60 months of follow-up
Among the 1094 SPRYCEL-treated patients with advanced phase CML or Ph+
ALL, drug-related adverse events leading to discontinuation were
reported in 191 (17.5%) patients.
Patients ≥65 years are more likely to experience the commonly reported
adverse reactions of fatigue, pleural effusion, diarrhea, dyspnea,
cough, lower gastrointestinal hemorrhage, and appetite disturbance, and
more likely to experience the less frequently reported adverse reactions
of abdominal distention, dizziness, pericardial effusion, congestive
heart failure, hypertension, pulmonary edema and weight decrease, and
should be monitored closely.
-
In newly diagnosed chronic phase CML patients:
-
Drug-related serious adverse events (SAEs) were reported for 16.7%
of SPRYCEL-treated patients. Serious adverse reactions reported in
≥5% of patients included pleural effusion (5%)
-
The most common adverse reactions (≥15%) included
myelosuppression, fluid retention, and diarrhea
-
Grade 3/4 laboratory abnormalities included neutropenia (29%),
thrombocytopenia (22%), anemia (13%), hypophosphatemia (7%),
hypocalcemia (4%), elevated bilirubin (1%), and elevated
creatinine (1%)
-
In patients resistant or intolerant to prior imatinib therapy:
-
Drug-related SAEs were reported for 26.1% of SPRYCEL-treated
patients treated at the recommended dose of 100 mg once daily in
the randomized dose-optimization trial of patients with chronic
phase CML resistant or intolerant to prior imatinib therapy.
Serious adverse reactions reported in ≥5% of patients included
pleural effusion (10%)
-
The most common adverse reactions (≥15%) included
myelosuppression, fluid retention events, diarrhea, headache,
fatigue, dyspnea, skin rash, nausea, hemorrhage and
musculoskeletal pain
-
Grade 3/4 hematologic laboratory abnormalities in chronic phase
CML patients resistant or intolerant to prior imatinib therapy who
received SPRYCEL 100 mg once daily with a minimum follow up of 60
months included neutropenia (36%), thrombocytopenia (24%), and
anemia (13%). Other grade 3/4 laboratory abnormalities included:
hypophosphatemia (10%), and hypokalemia (2%)
-
Among chronic phase CML patients with resistance or intolerance to
prior imatinib therapy, cumulative grade 3/4 cytopenias were
similar at 2 and 5 years including: neutropenia (36% vs 36%),
thrombocytopenia (23% vs 24%), and anemia (13% vs 13%)
-
Grade 3/4 elevations of transaminases or bilirubin and Grade 3/4
hypocalcemia, hypokalemia, and hypophosphatemia were reported in
patients with all phases of CML
-
Elevations in transaminases or bilirubin were usually managed with
dose reduction or interruption
-
Patients developing Grade 3/4 hypocalcemia during the course of
SPRYCEL therapy often had recovery with oral calcium
supplementation
Please see the full Prescribing Information for SPRYCEL.
About Bristol-Myers Squibb
Bristol-Myers Squibb is a global biopharmaceutical company whose mission
is to discover, develop and deliver innovative medicines that help
patients prevail over serious diseases. For more information about
Bristol-Myers Squibb, visit us at BMS.com
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Bristol-Myers Squibb Forward-Looking Statement
This press release contains "forward-looking statements" as that term
is defined in the Private Securities Litigation Reform Act of 1995
regarding the research, development and commercialization of
pharmaceutical products. Such forward-looking statements are based on
current expectations and involve inherent risks and uncertainties,
including factors that could delay, divert or change any of them, and
could cause actual outcomes and results to differ materially from
current expectations. No forward-looking statement can be guaranteed.
Among other risks, there can be no guarantee that Sprycel will receive
regulatory approval for an additional indication described herein. Forward-looking
statements in this press release should be evaluated together with the
many uncertainties that affect Bristol-Myers Squibb's business,
particularly those identified in the cautionary factors discussion in
Bristol-Myers Squibb's Annual Report on Form 10-K for the year ended
December 31, 2016 in our Quarterly Reports on Form 10-Q and our Current
Reports on Form 8-K. Bristol-Myers Squibb undertakes no obligation to
publicly update any forward-looking statement, whether as a result of
new information, future events or otherwise.
Bristol-Myers Squibb Company Media: Audrey Abernathy, cell: 919-605-4521 audrey.abernathy@bms.com or Investor: Bill Szablewski, 609-252-5894 william.szablewski@bms.com Tim Power, 609-252-7509 timothy.power@bms.com