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Clinical Trial
. 2010 Jan 20;28(3):424-30.
doi: 10.1200/JCO.2009.25.3724. Epub 2009 Dec 14.

Phase III, randomized, open-label study of daily imatinib mesylate 400 mg versus 800 mg in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular end points: tyrosine kinase inhibitor optimization and selectivity study

Jorge E Cortes  1 , Michele Baccarani, François Guilhot, Brian J Druker, Susan Branford, Dong-Wook Kim, Fabrizio Pane, Ricardo Pasquini, Stuart L Goldberg, Matt Kalaycio, Beatriz Moiraghi, Jacob M Rowe, Elena Tothova, Carmino De Souza, Marc Rudoltz, Richard Yu, Tillmann Krahnke, Hagop M Kantarjian, Jerald P Radich, Timothy P Hughes
Affiliations
Clinical Trial

Phase III, randomized, open-label study of daily imatinib mesylate 400 mg versus 800 mg in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular end points: tyrosine kinase inhibitor optimization and selectivity study

Jorge E Cortes et al. J Clin Oncol. .

Erratum in

  • J Clin Oncol. 2010 May 1;28(13):2314

Abstract

Purpose: To evaluate the safety and efficacy of initial treatment with imatinib mesylate 800 mg/d (400 mg twice daily) versus 400 mg/d in patients with newly diagnosed chronic myeloid leukemia in chronic phase.

Patients and methods: A total of 476 patients were randomly assigned 2:1 to imatinib 800 mg (n = 319) or 400 mg (n = 157) daily. The primary end point was the major molecular response (MMR) rate at 12 months.

Results: At 12 months, differences in MMR and complete cytogenetic response (CCyR) rates were not statistically significant (MMR, 46% v 40%; P = .2035; CCyR, 70% v 66%; P = .3470). However, MMR occurred faster among patients randomly assigned to imatinib 800 mg/d, who had higher rates of MMR at 3 and 6 months compared with those in the imatinib 400-mg/d arm (P = .0035 by log-rank test). CCyR also occurred faster in the 800-mg/d arm (CCyR at 6 months, 57% v 45%; P = .0146). The most common adverse events were edema, gastrointestinal problems, and rash, and all were more common in patients in the 800-mg/d arm. Grades 3 to 4 hematologic toxicity also occurred more frequently in patients receiving imatinib 800 mg/d.

Conclusion: MMR rates at 1 year were similar with imatinib 800 mg/d and 400 mg/d, but MMR and CCyR occurred earlier in patients treated with 800 mg/d. Continued follow-up is needed to determine the clinical significance of earlier responses on high-dose imatinib.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
CONSORT diagram.
Fig 2.
Fig 2.
Time to first major molecular response (MMR) by treatment arm (intent-to-treat analysis).
Fig 3.
Fig 3.
Major molecular response (MMR) at 12 months by average dose intensity (evaluable patients).
See this image and copyright information in PMC

References

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