New drug combo for kids with resistant leukemia shows early promise but study halted
NCT ID NCT04501614
First seen Jun 26, 2026 · Last updated Jun 27, 2026 · Updated 1 time
Summary
This study tested a targeted cancer drug called ponatinib combined with standard chemotherapy in children and young adults up to age 21 with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) that had come back or stopped responding to other treatments. The goal was to find the safest dose and see if the leukemia could go into remission. Only 11 participants were enrolled before the study was ended early, so the results are limited and should be interpreted with caution.
What this could mean
Our plain-language read of the trial. This is informational only, not medical advice or a prediction.
- Active substance
- ponatinib (a targeted cancer drug) given with standard chemotherapy drugs
- What this could lead to
- If successful, this could offer a new treatment option for children with a hard-to-treat leukemia that has stopped responding to other therapies.
- What could go wrong
- The study was terminated early with only 11 participants, so results are very limited. It is unclear if the combination is safe or effective, and side effects from chemotherapy and ponatinib can be serious.
This is an AI summary of the original study and may miss details. Read our disclaimer.
Study facts
What this study's own registry entry says, in plain language.
- Phase
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Phase 1/2
Runs two stages together: safety and dose first, then whether the treatment works.
- Participants
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11 people
The number who actually took part.
- Started
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Feb 2021
- Finished
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Jul 2024
- Lead sponsor
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A company
The lead sponsor is a pharmaceutical, biotech, or medical-device company.
Who can take part
This study's own entry requirements. Only the study team can say for certain whether you qualify.
- Ages
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1 year to 21 years
- Sex
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Anyone
- Healthy volunteers
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Not accepted
This study is not open to healthy volunteers. The entry requirements below say who it is open to.
Show the full entry requirements Hide the full entry requirements
Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.
Inclusion Criteria: 1. Participants must have a diagnosis of Ph+ ALL, Philadelphia chromosome-positive plus mixed phenotype acute leukemia (Ph+ MPAL), or Ph-like ALL with: a) Involvement of BM with ALL, including one of the following: i. M2 BM (5%-24% lymphoblasts): by morphology with confirmatory testing consisting of at least one of the following: flow cytometry lymphoblasts ≥5%, or BCR-ABL1 fluorescence in situ hybridization, or ≥10-2 leukemic clone identified by immunoglobulin heavy chain-T-cell receptor polymerase chain reaction, OR ii. M3 BM (≥25% lymphoblasts): by morphology, OR iii. Participants with combined BM (as defined above) and extramedullary disease. b) Evidence of Ph+ ALL, MPAL, or Ph-like ALL: i. Definite evidence of BCR-ABL1 fusion (Ph) for Ph+ ALL and MPAL, OR ii. Definite evidence of Ph-like ALL with targetable kinase-activating lesions involving any of the following kinase genes: ABL1, ABL2, CSF1R, and PDGFRB. Ph-like ALL diagnosis requires the identification of specified targetable kinase-activating lesions preferably by ribonucleic acid (RNA) sequencing or by alternative accredited method used by the site. c) Disease status: (i) For non-US sites: participants who have relapsed (post 0 or 1 HSCT) or are resistant or intolerant to at least one prior therapy that contained a BCR-ABL-targeted tyrosine kinase inhibitor (TKI), or for US sites: participants who have relapsed (post 0 or 1 HSCT) or are resistant or intolerant to at least one prior therapy that contained a second-generation BCR-ABL1-targeted TKI (i.e, dasatinib, nilotinib, and bosutinib); OR (ii) Have a BCR-ABL1 T315I mutation irrespective of relapse, resistance/intolerance, or transplant status and irrespective of any prior TKI use. Notes: A participant will be defined as intolerant if they had a Grade ≥3 nonhematologic toxicity or a Grade 4 hematologic toxicity considered related to the last TKI and lasting for \>2 weeks, and led to discontinuation of therapy. 2. Weight: Participants must be weighing at least 5 kg at the time of enrollment. 3. Performance Status: Karnofsky performance status ≥50% for participants ≥16 years of age or Lansky Play Scale ≥50% for participants \<16 years of age. 4. Have recovered to less than Grade 2 National Cancer Institute common terminology criteria for adverse events (NCI CTCAE) Version 5.0, or to baseline, from any nonhematologic toxicities (except alopecia) due to previous therapy. 5. Participants must meet the following criteria related to prior therapies: * Cytoreduction with hydroxyurea: Hydroxyurea can be initiated and continued for up to 24 hours before the start of protocol therapy. * Participants who relapsed while receiving cytotoxic therapy: At least 14 days must have passed since the completion of the last dose of chemotherapy before the first dose of ponatinib can be given except for the following: intrathecal (IT) chemotherapy and/or maintenance therapy such as vincristine, mercaptopurine, methotrexate, or glucocorticoids. There is no waiting period for those relapsing on maintenance-like therapy. * HSCT: Participants who have experienced relapse after a HSCT are eligible, provided they have no evidence of acute or chronic graft-versus-host disease (GVHD), are not receiving GVHD prophylaxis or treatment, and are at least 90 days posttransplant at the time of enrollment. * Hematopoietic growth factors: Before the first dose of ponatinib, at least 7 days must have passed since completion of therapy with granulocyte colony-stimulating factor or other growth factors, and at least 14 days must have passed since completion of therapy with pegfilgrastim. * Biologics and targeted therapies: Before the first dose of ponatinib, at least 7 days must have passed since the last dose of a biologic agent. For agents that have known AEs occurring beyond 7 days after administration, this period must be extended beyond the time during which AEs are known to occur. The duration of this interval must be discussed with the sponsor's medical monitor/designee. * Monoclonal antibodies: After the last dose of monoclonal antibody, at least 3 half-lives of the administered antibody must have passed before the first dose of ponatinib. * Immunotherapy: Before the first dose of ponatinib, at least 30 days must have passed after the completion of any type of immunotherapy (eg, tumor vaccines, chimeric antigen receptor T-cell \[CAR-T-cell\]). * Immunosuppressive therapy: Before the first dose of ponatinib, at least 14 days must have passed after the completion of immunosuppressive therapy (including regimens following stem cell transplant). * Radiotherapy: No washout period is necessary for radiation given to any extramedullary site other than central nervous system (CNS); ≥90 days must have passed if participant received prior total body irradiation or craniospinal or cranial radiotherapy. * Anthracyclines: Participants must have had a lifetime exposure of \<400 milligrams per square meter (mg/m\^2) of doxorubicin equivalents of anthracyclines. 6. a) Adequate renal function defined as: Estimated glomerular filtration rate (eGFR) using the Schwartz formula, OR radioisotope glomerular filtration rate (GFR)≥70 mL/min/1.73 m\^2, OR a normal serum creatinine based on age and sex. b) Adequate liver function defined as: Direct bilirubin ≤1.5 times the upper limit of normal (ULN) for age AND ALT ≤5 times the ULN for age. 7. No clinical, radiological or laboratory evidence of pancreatitis, including: 1. Serum lipase must be \<2 times the ULN, AND 2. Serum amylase must be \<2 times the ULN. 8. Adequate cardiac function defined as shortening fraction ≥27% by echocardiogram (ECHO) OR left ventricular ejection fraction of ≥50% by ECHO or multigated acquisition scan (MUGA). 9. Normal QT interval with Fridericia correction method (QTcF) on screening electrocardiogram (ECG), defined as QTcF of ≤450 milliseconds (ms). Exclusion Criteria: 1. A history or current diagnosis of Burkitt leukemia/lymphoma or mature B-cell leukemia. 2. A history or current diagnosis of chronic myeloid leukemia (CML). 3. Diagnosis of ALL, MPAL, or Ph-like ALL with targetable kinase-activating lesions after treatment with cytotoxic therapy for another cancer. 4. Diagnosis of another concurrent primary malignancy. 5. Clinically significant cardiovascular disease, including but not limited to: 1. Any history of myocardial infarction (MI) or unstable angina. 2. History of or presence of heart block, and/or clinically significant ventricular or atrial arrhythmias. 3. Uncontrolled hypertension, defined as persistent elevation of systolic and/or diastolic blood pressures to ≥95th percentile based on age, sex, and height percentiles despite appropriate antihypertensive management. 6. Current systemic use of drug(s) that are known to have a risk of causing prolonged corrected QT interval (QTc) or torsades de pointes unless drug(s) can be changed to acceptable alternatives (ie, an alternate class of agents that do not affect the cardiac conduction system) or the participants can safely discontinue the drug(s). 7. Uncontrolled hypertriglyceridemia (triglycerides ≥450 milligrams per deciliter (mg/dL)). 8. Current systemic use of any medications or herbal supplements that are known to be strong inhibitors or strong inducers of cytochrome P450 3A (CYP3A) within 7 days before the first dose of study drug. 9. Previous treatment with ponatinib. 10. Planned non-protocol chemotherapy, radiation therapy, another investigational agent, or immunotherapy while participant is on study treatment. 11. Known gastrointestinal disease or gastrointestinal procedure that could interfere with the oral absorption of ponatinib. 12. Participants with deoxyribonucleic acid (DNA) fragility syndromes, such as Fanconi anemia and Bloom syndrome. 13. Participants with Down syndrome. 14. Participants with uncontrolled systemic infection, or known laboratory and/or clinical evidence of active infection with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C. 15. Participants with pre-existing significant CNS pathology, including history of severe brain injury, dementia, cerebellar disease, organic brain syndrome, psychosis, coordination/movement disorder, or autoimmune disease with CNS involvement, are not eligible. 16. Participants with a history of cerebrovascular ischemia/hemorrhage with residual deficits are not eligible. (Participants with a history of cerebrovascular ischemia/hemorrhage remain eligible provided all neurologic deficits and causative factor(s) have resolved). 17. Uncontrolled seizure disorder. (Participants with seizure disorders that do not require antiepileptic drugs or are well controlled with stable doses of antiepileptic drugs are eligible). 18. History of severe coagulopathy or cardiovascular or peripheral vascular events. 19. Treatment with live attenuated vaccinations within 30 days prior to initiation of study treatment regimen.
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Conditions
The condition(s) this trial relates to.
As listed by the trial registrant
The condition terms exactly as the trial's registrant entered them.
Contacts and locations
Locations
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Alfred I Dupont Hospital For Children
Wilmington, Delaware, 19803, United States
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Ann and Robert H Lurie Childrens Hospital of Chicago
Chicago, Illinois, 60611, United States
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Arkansas Children's Hospital
Little Rock, Arkansas, 72202, United States
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Asan Medical Center - PPDS
Seoul, 5505, South Korea
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Assistance Publique Hopitaux de Marseille
Marseille, 13385, France
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Cambridge University Hospitals NHS Foundation Trust
Cambridge, CB2 0QQ, United Kingdom
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Children's Hospital Los Angeles
Los Angeles, California, 90027, United States
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Children's Hospital of Chongqing Medical University
Chongqing, 400014, China
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Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104, United States
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Children's Hospital of Shanghai
Shanghai, 200040, China
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Children's Hospital of Soochow University
Suzhou, 215025, China
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Children's Mercy Hospital and Clinica
Kansas City, Missouri, 64108, United States
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Childrens Medical Center Research Institute at UT Southwestern
Dallas, Texas, 75235-9063, United States
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Cincinnati Children's Hospital Medical Center - PIN
Cincinnati, Ohio, 45229, United States
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Fakultni nemocnice Brno
Brno, 61300, Czechia
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Fakultni nemocnice v Motole
Prague, 15006, Czechia
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Fndazione MBBM (MONZA E BRIANZA PER IL BAMBINO E LA SUA MAMMA) - c/o Centro Maria Letizia Verga
Monza, Lombardy, 20900, Italy
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Fundacao Pio XII Hospital de Cancer de Barretos
Barretos, São Paulo, 14784-400, Brazil
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Graacc Grupo de Apoio Ao Adolescente E A Crianca Com Cancer
São Paulo, 04039-001, Brazil
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Hopital Des Enfants
Toulouse, 31059, France
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Hopital Robert Debre
Paris, 75019, France
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Hopital Sud
Rennes, Ille-et-Vilaine, 35200, France
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Hospital Das Clinicas da Faculdade de Medicina de Ribeirao Preto - USP
Ribeirão Preto, 14051-140, Brazil
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Hospital Infantil Universitario Nino Jesus - PIN
Madrid, 28009, Spain
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Hospital Italiano de Buenos Aires
Buenos Aires, C1199ABB, Argentina
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Hospital Santa Marcelina
São Paulo, 08270-070, Brazil
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Hospital Universitario Austral
Pilar, Buenos Aires, B1629AHJ, Argentina
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Hospital Universitario Dr. Jose Eleuterio Gonzalez
Monterrey, Nuevo León, 64460, Mexico
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Hospital Universitario Vall d'Hebron - PPDS
Barcelona, 8035, Spain
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Hospital Universitario Virgen del Rocio - PPDS
Seville, 41013, Spain
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Hospital de Clinicas de Porto Alegre (HCPA) - PPDS
Porto Alegre, Rio Grande Du Sul, 90035-903, Brazil
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IRCCS Ospedale Pediatrico Bambino Gesu - INCIPIT - PIN
Rome, Lazio, 165, Italy
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Institute of Hematology and Blood Diseases Hospital Chinese Academy of Medical Sciences
Tianjin, 300020, China
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Instituto Nacional de Pediatria
Mexico City, 4530, Mexico
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Instituto Portugues de Oncologia Do Porto Francisco Gentil Epe - PPDS
Porto, 4200-072, Portugal
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Instituto Portugues de Oncologia de Lisboa Francisco Gentil, E.P.E.
Lisbon, Lisbon District, 1099-023, Portugal
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Irmandade Da Santa Casa de Misericordia de Porto Alegre
Porto Alegre, Rio Grande Du Sul, 90020-090, Brazil
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Istituto G Gaslini Ospedale Pediatrico IRCCS - INCIPIT - PIN
Genoa, Liguria, 16147, Italy
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Nationwide Children's Hospital
Columbus, Ohio, 43205, United States
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Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca
Guadalajara, 44340, Mexico
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Ospedale Infantile Regina Margherita - INCIPIT - PIN
Turin, Piedmont, 10126, Italy
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Perth Childrens Hospital
Nedlands, Western Australia, 6009, Australia
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Princess Maxima Center for Pediatric Oncology - PIN
Utrecht, 3584 CS, Netherlands
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Qilu Hospital of Shandong University
Jinan, 250012, China
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Queensland Childrens Hospital
South Brisbane, Queensland, 4101, Australia
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Rady Childrens Hospital San Diego - PIN
San Diego, California, 92123, United States
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Riley Hospital For Children
Indianapolis, Indiana, 46202-5128, United States
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Royal Children's Hospital Melbourne - PIN
Parkville, Victoria, 3052, Australia
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Royal Hospital for Children (Glasgow) - PPDS - PIN
Glasgow, G3 8SJ, United Kingdom
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Royal Marsden Hospital - Surrey
Surrey Quays, Sutton, SM2 5PT, United Kingdom
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Rua Ramiro Barcelos, 2350
Curitiba, Paraná, 81520-060, Brazil
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SPSK Nr 1 im. Prof.Stanislawa Szyszko Slaskiego Uniwersytetu Medycznego
Zabrze, 41-800, Poland
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Seoul National University Hospital
Seoul, 3080, South Korea
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Severance Hospital Yonsei University Health System
Seoul, 3722, South Korea
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Shanghai Childrens Medical Center
Shanghai, 200127, China
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St Jude Children's Research Hospital
Memphis, Tennessee, 38105, United States
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The Affiliated Hospital of Guizhou Medical University
Guiyang, 550004, China
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The Catholic University of Korea, Seoul St. Mary's Hospital
Seoul, 6591, South Korea
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The Second Hospital of Anhui Medical University
Hefei, 230601, China
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Tongji Hospital Tongji Medical College Huazhong University of Science and Technology
Wuhan, 430030, China
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UCSF Medical Comprehensive Cancer
San Francisco, California, 94143-3010, United States
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Union Hospital Tongji Medical College Huazhong University of Science and Technology
Wuhan, 430022, China
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Uniwersytecki Szpital Dzieciecy
Krakow, 30-663, Poland
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West China Second University Hospital, Sichuan Univesity
Chengdu, 610041, China
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