A Phase 1 Study of Nilotinib in Steroid Dependent/Refractory Chronic Graft Versus Host Disease
PRIMARY OBJECTIVES: Determine the safety and tolerability of nilotinib in steroid dependent / refractory cGVHD. SECONDARY OBJECTIVES: Determine the clinical efficacy of nilotinib in steroid dependent / refractory cGVHD.
Stanford is not currently accepting new patients for this trial. You may want to check clinicaltrials.gov to see if other locations are recruiting.
- drug : Nilotinib
Phase: Phase 1
Ages Eligible For Study:
5.1.1 Steroid dependent/refractory cGVHD defined as: 1. Dependent disease - Persistent cGVHD manifestations requiring a glucocorticoid dose >= prednisone 0.25 mg/kg/day (0.5 mg/kg po qod) for at least 12 weeks. 2. Refractory disease - Progressive cGVHD manifestations despite treatment with a glucocorticoid dose >= prednisone 0.5 mg/kg/day (1 mg/kg po qod) for at least 4 weeks. 5.1.2 Any previous treatments for cGVHD (except nilotinib). Participants may have received nilotinib for other reasons besides cGVHD such as leukemia or solid tumor. 5.1.3 Participants must be receiving baseline systemic glucocorticoid therapy for cGVHD at study entry. The dose of steroids must be stable for 14 days prior to starting nilotinib. 5.1.4 At the time of trial enrollment, participants may be receiving one or two other immunosuppressive therapies in addition to glucocorticoids. Immunosuppressant doses must be stable for 14 days prior to starting nilotinib. Monoclonal T or B cell antibodies must be discontinued at least 28 days before starting nilotinib. 5.1.5 Chronic GVHD manifestations that can be followed on physical or laboratory exam. A list of potential manifestations is presented in Appendix D. 1. Skin changes 2. Oral mucosa changes 3. Hepatic dysfunction 5.1.6 >= 18 years old 5.1.7 Life expectancy >= 6 months. 5.1.8 Karnofsky performance status >= 60 (defined as being unable to work, able to live at home, and able to care for most personal needs but requiring occasional assistance from others). 5.1.9 Laboratory parameters: 1. Creatinine < 1.5 x ULN 2. ANC > 1.5 x 10^9/L 3. Platelets > 100 x 10^9/L 4. Total bilirubin < 1.5 x ULN 5. AST (SGOT) and ALT (SGPT) < 2.5 x ULN 6. Serum amylase and lipase <= 1.5 x ULN 7. Alkaline phosphatase <= 2.5 x ULN 8. Patients must have the following laboratory values within normal limits at the local institution lab or corrected to within normal limits with supplements prior to the first dose of study medication: Potassium Magnesium Phosphorus Calcium 5.1.10 Oxygen saturation during exertion maintained at >= 88% on room air. 5.1.11 Ability to understand and willingness to sign a written informed consent form. 5.1.12 Females with reproductive potential must have a negative pregnancy test <= 7 days before starting nilotinib. Reproductive potential will be defined as having at least 1 menstrual period in the past 12 months. Male and female subjects with reproductive potential agree to the use of barrier contraception during their treatment and for up to 3 months after the last dose. 5.1.13 Careful rationalization of concomitant medications with the intent to discontinue or change to alternative medications when any concomitant medications are identified that have the potential to prolong the QTcB interval or are associated with an increased risk of torsades de pointes. (Appendix B) 5.1.14 . Careful rationalization of concomitant medications with the intent to discontinue or change to alternative medications if any concomitant medications are identified to be strong CYP3A4 inhibitors. (Appendix C) 5.1.15 Myeloablative or non-myeloablative allogeneic hematopoietic cell transplant.