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Publications

Journal Article Randomized Controlled Trial Multicenter Study Clinical Trial, Phase III Ppublish

PubMed: 42069411 DOI: 10.1016/S2352-3026(26)00043-8

Final results of nilotinib versus nilotinib combined with pegylated interferon alfa-2a as first-line therapy in chronic phase chronic myeloid leukaemia in France (PETALs): an open-label, multicentre, randomised phase 3 trial.

Lancet Haematol 13(5):e315-e326

Authors: Franck E Nicolini, Gabriel Etienne, Françoise Huguet, Aude Charbonnier, Gabrielle Roth-Guépin, Martine Escoffre-Barbe, Viviane Dubruille, Hyacinthe Johnson-Ansah, Philippe Rousselot, Laurence Legros, Anne Parry, Lydia Roy, Valérie Coiteux, Pascal Lenain, Jean-Christophe Ianotto, Charlotte Doublet, Corentin Orvain, Marion Simonet-Boissard, Marie-Lorraine Chrétien, Amélie Penot, Mathieu Meunier, Shanti Amé, Eric Hermet, Philippe Quittet, Simona Lapusan, Vérane Schwiertz, Jean-Michel Cayuela, Carole Mauté, Delphine Réa, Stéphane Morisset, François-Xavier Mahon, Stéphanie Dulucq

Affiliations

  • Haematology Department, Centre Léon Bérard, Lyon Cédex, France; INSERM U1052, CRCL, Lyon, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Institut Bergonié, INSERM1213 Bordeaux University, Bordeaux, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Institut Universitaire du Cancer de Toulouse, CHU de Toulouse, Toulouse, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Institut Paoli-Calmettes, Marseille, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Service Hématologie CHRU Nancy, Nancy, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital de Pontchaillou, Rennes, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôtel Dieu, Nantes, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Clémenceau, Caen, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Centre Hospitalier de Versailles, Le Chesnay Rocquencourt, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, AP-HP, Hôpital Bicêtre, Kremlin-Bicêtre, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • LYSARC, Pierre Bénite (formerly centre hospitalier Annecy-Genevois, Pringy), France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Universitaire Henri Mondor-AP-HP and Faculté de Santé-UPEC, Créteil, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Huriez, Lille, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Centre Henri Becquerel, Rouen, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology and Clinical Haemostasis, Hopital de la Cavale Blanche, Brest, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Etienne, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Universitaire, Angers, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Jean Minjoz, Besançon, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Clinical Haematology Department, Institut de Cancérologie de Bourgogne, Polyclinique du Parc Drevon, Dijon, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Dupuytren, Limoges, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Université Grenoble Alpes, INSERM U1209, CNRS UMR 5309, CHU Grenoble; Alpes, Institut pour l'Avancée des Biosciences, Grenoble, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Institut de Cancérologie Strasbourg Europe, Strasbourg, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, CHU Estaing, Clermont-Ferrand, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Lapeyronie, Montpellier, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Hôpital Saint Antoine, Paris, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Pharmacy, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
  • Laboratory of Haematology, University Hospital Saint-Louis, AP-HP, EA3518, Université Paris Cité, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Laboratory of Haematology, University Hospital Saint-Louis, AP-HP, EA3518, Université Paris Cité, France.
  • University Medical Department of Haematology and Immunology, Hôpital Saint Louis, Paris, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Haematology Department, Centre Léon Bérard, Lyon Cédex, France; Fi-LMC, Institut Bergonié, Bordeaux, France.
  • Laboratory of Haematology and Molecular Biology, University Hospital of Bordeaux, Pessac, INSERM, BRIC, U 1312, F-33000 Bordeaux, France; Fi-LMC, Institut Bergonié, Bordeaux, France.

Abstract

BACKGROUND

Second generation tyrosine kinase inhibitors (TKIs) have improved response rates in patients with chronic phase chronic myeloid leukaemia (CP-CML). Phase 2 trials demonstrated increased deep molecular response rates when combining second generation TKIs with pegylated interferon alfa (Peg-IFN). This trial aimed to evaluate the efficacy and the safety of combining nilotinib with Peg-IFN alfa-2a in patients with newly diagnosed CP-CML.

METHODS

In PETALs, this open-label, randomised, multicentre phase 3 trial, we enrolled patients with newly diagnosed CP-CML from 27 French academic institutions via a centrally-generated electronic system in a 1:1 ratio to two groups: 300 mg oral nilotinib alone twice a day (the nilotinib only group) or 300 mg nilotinib twice a day combined with subcutaneous Peg-IFN (30 μg per week for the first month of treatment and 45 μg per week thereafter) for a maximum of 2 years. The randomly allocated patients were stratified by their Sokal index and European Treatment and Outcome Study long-term survival index. Eligible patients had major BCR::ABL1 transcripts, an Eastern Cooperative Oncology Group performance score of two or lower, who had never received TKIs, and were aged between 18 and 65 years. The primary endpoint was the cumulative rate of molecular response 4·5 (MR4·5; defined as BCR::ABL1 international scale [IS] of 0·0032% and lower), analysed in the intention-to-treat population (n=200). This trial is registered at ClinicalTrials.gov, NCT02201459, and is completed.

FINDINGS

205 patients were enrolled between Aug 6, 2014, and Sept 29, 2016, after which five patients were declared ineligible and excluded, resulting in 200 patients being randomly allocated (99 to the nilotinib group and 101 to the combination group). The median age at diagnosis was 45 years (IQR 36-55); 130 patients (65%) were male and 70 (35%) were female. Median follow-up in this cohort was 67 months (IQR 32·6-70·6). The primary objective was met, with higher rates of MR4·5 in the combination group (24% [95% CI 16·0-34·1] vs 15% [8·6-24·2], p=0·048) at month 12. There were equivalent grade 3-4 haematological side effects in the both groups (14 vs 14) with a predominance for grade 3-4 thrombocytopenia without haemorrhages (six in the combination group vs five in the nilotinib group). Psychiatric grade 3-4 events occurred in six (6%) patients in the combination group (including three unsuccessful suicide attempts) compared with five (5%) in the nilotinib group (including one unsuccessful suicide attempt). Six vascular events also occurred in six patients in the combination group and seven vascular events in five patients in the nilotinib group (all grades 3-4).

INTERPRETATION

In this setting, Peg-IFN combined with nilotinib induced higher initial rates of MR4·5 compared to TKI monotherapy, despite additional side effects. The onset of psychiatric events might promote immediate cease of Peg-IFN and psychiatrist advice Whether this early molecular response translates into sustained treatment-free survival should be studied in a randomised trial sufficiently powered for this outcome.

FUNDING

Novartis Pharma.

MeSH

Interferon-Alpha, Therapeutics, Suicide, Attempted, Suicide