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479 Efficacy and Safety of Asciminib in Chronic Myeloid Leukemia in Chronic Phase (CML-CP): Interim Results from the Phase 2 ASC2ESCALATE Trial in the Cohort of Patients (Pts) after 1 Prior Tyrosine Kinase Inhibitor (TKI)

Program: Oral and Poster Abstracts
Type: Oral
Session: 632. Chronic Myeloid Leukemia: Novel Molecules in Clinical Practice
Hematology Disease Topics & Pathways:
Research, Clinical trials, Adult, Clinical Research, CML, Chronic Myeloid Malignancies, Diseases, Myeloid Malignancies, Study Population, Human
Sunday, December 8, 2024: 10:30 AM

Ehab L. Atallah, MD1, Moshe Y. Levy, MD2*, Paul B. Koller, MD3, Koji Sasaki, MD4, Srinivas K Tantravahi, MD5, David Andorsky, MD6, Celesteann T Bremer, MD7*, Joshua F. Zeidner, MD8, Marlise R. Luskin, MD9, Reinhold Munker, MD10*, Daisy Yang, Pharm.D., BCOP11*, Dramane Laine, PhD11*, John Sabo11*, Ennan Gu12*, Michael J. Mauro, MD13 and Jorge E. Cortes, MD14

1Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
2Baylor Scott & White Health, Dallas, TX
3Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
4Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
5University of Utah, Huntsman Cancer Institute, Salt lake city
6Rocky Mountain Cancer Centers, Boulder, CO
7Virginia Oncology Associates, Virginia Beach, VA
8Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
9Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
10University of Kentucky College of Medicine, Lexington, KY
11Novartis Pharmaceuticals Corporation, East Hanover, NJ
12Novartis Pharmaceuticals Corporation, Cambridge, MA
13Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York, NY
14Georgia Cancer Center, Augusta, GA

Introduction:

Resistance/intolerance is common in pts with CML-CP who have received 1 prior TKI. Pts requiring treatment switch may have limited subsequent treatment options and experience worse survival outcomes with each successive TKI. Asciminib is a BCR::ABL1 inhibitor that, unlike ATP-competitive TKIs, inhibits kinase activity by binding to the ABL myristoyl pocket. Asciminib has previously demonstrated efficacy, safety, and tolerability in CML-CP after ≥2 prior TKIs and in the recently published positive phase 3 ASC4FIRST study in newly diagnosed CML-CP. ASC2ESCALATE (NCT05384587) is the first prospective clinical trial to assess asciminib in pts with CML-CP who have received 1 prior TKI with a dose-escalation strategy for pts not meeting certain treatment milestones. ASC2ESCALATE is also further studying asciminib in a separate cohort of newly diagnosed pts as frontline therapy. These preliminary results focus on the efficacy and safety of asciminib in the cohort of pts with CML-CP after 1 prior TKI in the ASC2ESCALATE trial.

Methods:

ASC2ESCALATE is a phase 2, single-arm, open-label study of asciminib with dose escalation in adults with CML-CP who are newly diagnosed (1L cohort) or have received 1 prior ATP-competitive TKI (2L cohort) in the US. Pts with T315I are excluded. In the 2L cohort, pts must have discontinued their prior TKI due to warning response (BCR::ABL1IS >1%-10% after 6 mo or >0.1%-1% after 12 mo of 1L treatment), resistance (BCR::ABL1IS >10% during 6-12 mo, or >1% or loss of major molecular response [MMR] after >12 mo of 1L treatment), or intolerance with BCR::ABL1IS >0.1% at screening.

All pts started treatment with asciminib 80 mg once daily (QD). In pts with BCR::ABL1IS >1% at wk 24, dose was increased to 200 mg QD. Pts with BCR::ABL1IS >0.1% at wk 48 had their dose increased from 80 to 200 mg QD or from 200 mg QD to 200 mg twice daily, or could be taken off study. In pts with grade 3/4 or persistent grade 2 toxicity refractory to optimal management, dose escalation was not considered, and the same dose of asciminib was continued.

This trial aims to enroll 92 pts with CML-CP in the 2L setting and is currently recruiting.

Results:

This interim analysis included 43 pts with CML-CP in 2L who enrolled and received ≥1 dose of asciminib on or before the data cutoff (March 22, 2024). Pts had received prior treatment with imatinib (32.6%), dasatinib (48.8%), nilotinib (16.3%), or bosutinib (2.3%); 76.7% had received their prior TKI for ≥12 mo. Pts discontinued their prior TKI due to lack of efficacy (27 [62.8%]) or intolerance (16 [37.2%]). With a median duration of asciminib exposure of 11.4 (range, 0-66) wk at data cutoff, most pts (95.3%) remained on treatment; 2 (4.7%) pts had discontinued asciminib treatment, 1 due to adverse events (AEs) and 1 due to loss to follow-up.

At wk 4, 12, and 24, respectively, 36, 22, and 14 pts were evaluable for efficacy analyses, defined as having completed assessments for the respective timepoint or having discontinued earlier. BCR::ABL1IS ≤1% was achieved in 17 (47.2%), 15 (68.2%), and 12 (85.7%) pts at wk 4, 12, and 24, respectively. Deeper responses were also achieved at wk 12 (MMR, 6 [27.3%]; MR4, 2 [9.1%]; MR4.5, 1 [4.5%]) and wk 24 (MMR, 8 [57.1%]; MR4, 4 [28.6%]; MR4.5, 1 [7.1%]). Two pts had dose escalation from 80 to 200 mg QD per protocol (1 at wk 24 and 1 at wk 48).

The safety profile of asciminib is consistent with the current established safety profile, with no new or worsening safety concerns. The most common (>15%) all-grade AEs were fatigue and hypertension (16.3% each). Grade ≥3 AEs occurred in 16.3% of pts; the only grade ≥3 AE occurring in >1 pt was hypertension (11.6%). Dose interruptions due to AEs occurred in 3 pts and included platelet count decreased (grade 3), tooth abscess (grade 2), and cough (grade 1) (n=1 each). AEs leading to discontinuation occurred in 1 (2.3%; grade 3 nausea) pt. No arterial-occlusive events or on-study deaths were reported.

Conclusions:

In this interim analysis of the first prospective trial of asciminib in 2L CML-CP, asciminib demonstrated high molecular response rates at wk 24, including BCR::ABL1IS ≤1%, MMR, and early deep molecular responses (MR4 and MR4.5), with consistent safety and tolerability. These promising results support asciminib as a potential treatment option in these pts. Updated data (data cutoff June 28, 2024) will be presented at the ASH 2024 Annual Meeting.

Disclosures: Atallah: Novartis Pharmaceuticals Corporation: Honoraria. Levy: AbbVie: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Bristol Myers Squibb: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Karyopharm: Consultancy, Speakers Bureau; MorphoSys: Consultancy, Speakers Bureau; Seagen: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; AstraZeneca: Consultancy, Speakers Bureau; BeiGene: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Kite: Consultancy, Speakers Bureau; TG Therapeutics: Consultancy, Speakers Bureau; Epizyme: Consultancy, Speakers Bureau; GSK: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau. Koller: Ascentage: Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Consultancy, Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Travel, Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Sasaki: Daiichi-Sankyo: Consultancy; Otsuka: Other: Lecture fees; Enliven: Research Funding; Chugai: Other: Lecture fees; Pfizer: Consultancy; Novartis: Consultancy, Research Funding. Tantravahi: GSK: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Karyopharm Therapeutics: Consultancy, Honoraria, Research Funding; Partnership for Health Analytic Research LLC: Consultancy, Honoraria; CTI Biopharma: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria. Andorsky: AbbVie: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; AstraZeneca: Research Funding; Novartis: Research Funding. Luskin: Pfizer: Honoraria; KITE: Honoraria; Jazz: Honoraria; AbbVie: Research Funding; Novartis: Honoraria, Research Funding. Munker: Incyte Corporation: Current equity holder in publicly-traded company; Gilead Sciences: Current equity holder in publicly-traded company; Novartis: Research Funding; Merck: Research Funding; Ono Pharmaceutical: Research Funding; Lilly Pharmaceutical: Research Funding. Yang: Novartis Pharmaceuticals Corporation: Current Employment, Current equity holder in publicly-traded company. Laine: Novartis Pharmaceuticals Corporation: Current Employment. Sabo: Novartis Pharmaceuticals Corporation: Current Employment. Gu: Novartis Pharmaceuticals Corporation: Current Employment. Mauro: Takeda: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Research Funding; Sun Pharma/SPARC: Research Funding; Bristol Myers Squibb: Consultancy, Honoraria, Research Funding. Cortes: Novartis: Consultancy, Research Funding; Rigel: Consultancy; Nerviano: Consultancy; AbbVie: Research Funding; Ascentage: Research Funding; Biopath Holdings: Consultancy, Current holder of stock options in a privately-held company, Membership on an entity's Board of Directors or advisory committees; Lilly: Consultancy; Syndax: Consultancy; Sun Pharma: Consultancy, Research Funding; Pfizer: Consultancy.

*signifies non-member of ASH