Retrospective analysis of arterial occlusive events in the PACE trial by an independent adjudication committee

• Main Authors: Berman, E. (Author), Cortes, J. (Author), Croce, K. (Author), DeAngelo, D.J (Author), Deininger, M. (Author), Garasic, J.M (Author), Hall, T. (Author), Hochhaus, A. (Author), Januzzi, J.L (Author), Kantarjian, H. (Author), Kasner, S.E (Author), Kim, D.-W (Author), Mauro, M. (Author), McDonald, V. (Author), Naranjo, D. (Author), Nicolini, F. (Author), Petrie, M.C (Author), Pinilla-Ibarz, J. (Author), Seltzer, J. (Author), Srivastava, S. (Author), Xu, J. (Author)
• Format: Article
• Language: English
• Published: BioMed Central Ltd 2022
• Subjects: acute lymphoblastic leukemia; Acute lymphoblastic leukemia; adult; Adult; aged; Aged; Aged, 80 and over; antineoplastic agent; Antineoplastic Agents; Arterial Occlusive Diseases; artery occlusion; Article; cardiovascular risk; chronic myeloid leukemia; Chronic myeloid leukemia; clinical trial; female; Female; follow up; human; Humans; imidazole derivative; Imidazoles; incidence; Incidence; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; major clinical study; male; Male; middle aged; Middle Aged; peripheral occlusive artery disease; phase 2 clinical trial; Philadelphia 1 chromosome; ponatinib; Precursor Cell Lymphoblastic Leukemia-Lymphoma; protein kinase inhibitor; Protein Kinase Inhibitors; protein tyrosine kinase inhibitor; pyridazine derivative; Pyridazines; Retrospective Studies; retrospective study; risk factor; Safety; standardization; Tyrosine kinase inhibitor; very elderly; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 Background: The phase 2 PACE (Ponatinib Ph+ ALL and CML Evaluation) trial of ponatinib showed robust long-term benefit in relapsed Philadelphia chromosome-positive (Ph+) leukemia; arterial occlusive events (AOEs) occurred in ≥ 25% of patients based on investigator reporting. However, AOE rates vary depending on the definitions and reporting approach used. Methods: To better understand clinically relevant AOEs with ponatinib, an independent cardiovascular adjudication committee reviewed 5-year AOE data from the PACE trial according to a charter-defined process and standardized event definitions. Results: A total of 449 patients with chronic myeloid leukemia (CML) or Ph+ acute lymphoblastic leukemia (ALL) received ponatinib (median age 59 y; 47% female; 93% ≥ 2 prior tyrosine kinase inhibitors (TKIs); median follow-up, 37.3 months). The adjudicated AOE rate (17%) was lower than the non-adjudicated rate (i.e., rate before adjudication; 25%). The only adjudicated AOE in > 2% of patients was peripheral arterial occlusive disease (4%). Exposure-adjusted incidence of newly occurring adjudicated AOEs decreased over time. Patients with multiple baseline cardiovascular risk factors had higher adjudicated AOE rates than those without risk factors. Conclusions: This independent adjudication study identified lower AOE rates than previously reported, suggesting earlier overestimation that may inaccurately reflect AOE risk with ponatinib. This trial was registered under ClinicalTrials.gov identifier NCT01207440 on September 23, 2010 (https://clinicaltrials.gov/ct2/show/NCT01207440). © 2022, The Author(s).