Nilotinib first-line therapy in patients with Philadelphia chromosome-negative/BCR-ABL-positive chronic myeloid leukemia in chronic phase: ENEST1st sub-analysis

Abstract

Purpose: The ENEST1st sub-analysis presents data based on Philadelphia chromosome (Ph) status, i.e., Ph+ and Ph-/BCR-ABL1 + chronic myeloid leukemia.

Methods: Patients received nilotinib 300 mg twice daily, up to 24 months.

Results: At screening, 983 patients were identified as Ph+ and 30 patients as Ph-/BCR-ABL + based on cytogenetic and RT-PCR assessment; 76 patients had unknown karyotype (excluded from this sub-analysis). In the Ph-/BCR-ABL1 + subgroup, no additional chromosomal aberrations were reported. In the Ph+ subgroup, 952 patients had safety and molecular assessments. In the Ph-/BCR-ABL1 + subgroup, 30 patients had safety assessments and 28 were followed up for molecular assessments. At 18 months, the molecular response (MR) 4 rate [MR⁴; BCR-ABL1 ≤0.01% on International Scale (IS)] was similar in the Ph-/BCR-ABL1+ (39.3%) and Ph+ subgroups (38.1%). By 24 months, the cumulative rates of major molecular response (BCR-ABL1^IS ≤0.1%;), MR⁴, and MR^4.5 (BCR-ABL1^IS ≤0.0032%) were 85.7, 60.7, and 50.0%, respectively, in the Ph-/BCR-ABL1 + subgroup, and 80.3, 54.7, and 38.3%, respectively, in the Ph+ subgroup. In both Ph-/BCR-ABL1 + and Ph+ subgroups, rash (20 and 22%), pruritus (16.7 and 16.7%), nasopharyngitis (13.3 and 10.4%), fatigue (10 and 14.2%), headache (10 and 15.8%), and nausea (6.7 vs 11.4%) were frequent non-hematologic adverse events, whereas hypophosphatemia (23.3 and 6.8%), anemia (10 and 6.5%), and thrombocytopenia (3.3 and 10.2%) were the common hematologic/biochemical laboratory events.

Conclusion: Based on similar molecular response and safety results in both subgroups, we conclude that Ph-/BCR-ABL1 + patients benefit from nilotinib in the same way as Ph+ patients.

Keywords: Chronic myeloid leukemia; ENEST1st; Nilotinib; Philadelphia chromosome negative/BCR-ABL positive.

Fig. 1

Patient disposition

Fig. 2

Molecular responses during treatment at different time points in Ph–/BCR-ABL1 + CML (n = 28) (a) and Ph+ CML (n  = 952) (b). MMR major molecular response (BCR-ABL1^IS ≤ 0.1%), MR molecular response, MR ⁴ MR with 4-log reduction in BCR-ABL transcript (BCR-ABL1^IS ≤ 0.01%), MR ^4.5 MR with 4.5-log reduction in BCR-ABL transcript (BCR-ABL1^IS ≤ 0.0032%)

Fig. 3

Cumulative rate of MMR (a), MR⁴ (b), and MR^4.5 (c) in Ph–/BCR-ABL1 + and Ph+ subgroups by 24 months. MMR major molecular response (BCR-ABL1^IS ≤0.1%), MR molecular response, MR ⁴ MR with 4-log reduction in BCR-ABL transcript (BCR-ABL1^IS ≤0.01%), MR ^4.5 MR with 4.5-log reduction in BCR-ABL transcript (BCR-ABL1^IS ≤0.0032%)