On March 19, the U.S. Food and Drug Administration (FDA) granted accelerated approval to the multitarget kinase inhibitor (Iclusig) with chemotherapy for adult patients with newly diagnosed Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL).
PhALLCON
Efficacy was evaluated in PhALLCON (ClinicalTrials.gov identifier NCT03589326), a randomized, active-controlled, multicenter, open-label trial of 245 adult patients with newly diagnosed Philadelphia chromosome–positive ALL. Patients were randomly assigned 2:1 to receive either ponatinib at 30 mg orally once daily or imatinib at 600 mg orally once daily with chemotherapy (imatinib with chemotherapy is an unapproved regimen). Chemotherapy consisted of 3 cycles of induction with vincristine and dexamethasone, 6 cycles of consolidation alternating between methotrexate and cytarabine, and 11 cycles of maintenance with vincristine and prednisone. The ponatinib dose was reduced to 15 mg once daily after completion of the induction phase and achievement of undetectable measurable residual disease (MRD) complete remission.
Efficacy was based on the undetectable MRD complete remission rate at the end of induction. The undetectable MRD complete remission rate at the end of induction was 30% in the ponatinib arm and 12% in the imatinib arm (risk difference = 0.18, 95% confidence interval [CI] = 0.08%–0.28%, P = .0004).
The most common adverse reactions were hepatic dysfunction, arthralgia, rash and related conditions, headache, pyrexia, abdominal pain, constipation, fatigue, nausea, oral mucositis, hypertension, pancreatitis/elevated lipase, peripheral neuropathy, hemorrhage, febrile neutropenia, fluid retention and edema, vomiting, paresthesia, and cardiac arrhythmias.
The recommended ponatinib dose is 30 mg orally once daily with a reduction to 15 mg orally once daily upon achievement of undetectable MRD complete remission at the end of induction. Continue ponatinib with chemotherapy for up to 20 cycles until loss of response or unacceptable toxicity. For a description of dosing agents administered with ponatinib, see the prescribing information.
This review used the Real-Time Oncology Review pilot program, which streamlined data submission prior to the filing of the entire clinical application, and the Assessment Aid, a voluntary submission from the applicant to facilitate the FDA’s assessment.
This application was granted Priority Review and Orphan Drug designation.
