Description:
The purpose of this study is to find what effects, good and/or bad, treatment with two drugs
has on leukemia. The first medicine is tretinoin (also called all-trans retinoic acid, ATRA,
or Vesanoid). It is an approved medicine that causes the leukemia cells in APL to mature. It
is related to vitamin A. The second is arsenic trioxide (Trisenox). It is an approved
medicine for APL that comes back after earlier treatment.
APL is most often treated with tretinoin and standard chemotherapy drugs. These chemotherapy
drugs can cause infection and bleeding. They can also damage the heart and normal bone marrow
cells. This can lead to a second leukemia years later.
In this study, the investigators are using tretinoin and arsenic trioxide together. Both
drugs work to treat APL. They have been used together in only a limited number of people. The
investigators want to use these drugs together to reduce the amount of standard chemotherapy
and decrease side effects. The patient will receive standard chemotherapy with a drug called
idarubicin only if they have a higher chance of the leukemia coming back or a higher risk of
side effects.
Title
- Brief Title: Combined Tretinoin and Arsenic Trioxide for Patients With Newly Diagnosed Acute Promyelocytic Leukemia Followed by Risk-Adapted Postremission Therapy
- Official Title: Phase II Study of Combined Tretinoin and Arsenic Trioxide for Patients With Newly Diagnosed Acute Promyelocytic Leukemia Followed by Risk-Adapted Postremission Therapy
Clinical Trial IDs
- ORG STUDY ID:
11-040
- NCT ID:
NCT01404949
Conditions
- Acute Promyelocytic Leukemia
Interventions
Drug | Synonyms | Arms |
---|
Tretinoin and Arsenic Trioxide | | Tretinoin and Arsenic Trioxide |
Purpose
The purpose of this study is to find what effects, good and/or bad, treatment with two drugs
has on leukemia. The first medicine is tretinoin (also called all-trans retinoic acid, ATRA,
or Vesanoid). It is an approved medicine that causes the leukemia cells in APL to mature. It
is related to vitamin A. The second is arsenic trioxide (Trisenox). It is an approved
medicine for APL that comes back after earlier treatment.
APL is most often treated with tretinoin and standard chemotherapy drugs. These chemotherapy
drugs can cause infection and bleeding. They can also damage the heart and normal bone
marrow cells. This can lead to a second leukemia years later.
In this study, the investigators are using tretinoin and arsenic trioxide together. Both
drugs work to treat APL. They have been used together in only a limited number of people.
The investigators want to use these drugs together to reduce the amount of standard
chemotherapy and decrease side effects. The patient will receive standard chemotherapy with
a drug called idarubicin only if they have a higher chance of the leukemia coming back or a
higher risk of side effects.
Detailed Description
Induction will consist of tretinoin 45 mg/m2 po daily (rounded up to the nearest 10mg) in
two divided doses (25 mg/m2 in patients <20 years of age) for 35 days and ATO 0.15 mg/kg IV
daily for 35 doses given 5-7 days per week. The drugs will then be discontinued, and the
patient will be followed until a clinical complete remission is achieved. Idarubicin 12
mg/m2 IV for 4 doses will be added during induction on day 2 if the presenting WBC is
>10,000/μl, or if the WBC increases to 5,000/μl on day 5, 10,000/μl on day 10, or 15,000/μl
on day 15, because of the increased risk of the APL differentiation syndrome and relapse in
these patients. Dexamethasone 10 mg twice daily with be given on days 1-14 of induction as
prophylaxis for the APL differentiation syndrome. All patients will then receive four
courses of consolidation with tretinoin 45 mg/m2 po daily (rounded up to the nearest 10mg)
(25 mg/m2 in patients <20 years of age) for 15 days and ATO 0.15 mg/kg IV for 25 doses.
Patients with high-risk disease or who received Idarubicin during Induction may receive
intrathecal cytarabine as CNS prophylaxis given by the treating physician during
consolidation, at the discretion of the site PI. High-risk patients will also receive
maintenance therapy with additional courses of tretinoin and ATO every 3 months for 2 years.
Each maintenance course will consist of tretinoin 45 mg/m2 po daily (25 mg/m2 in patients
<20 years of age) for 15 days and ATO 0.15 mg/kg IV for 10 doses. Disease status will be
monitored with serial analyses of peripheral blood samples using RT-PCR for PML-RARα mRNA.
Patients will be followed until relapse, death, loss to follow-up, or removal from study.
Induction therapy can be given as an inpatient or outpatient. Consolidation and maintenance
treatments will be given as an outpatient. Consolidation may also be given at the patient's
local institution. Intrathecal cytarabine treatments will be administered as an outpatient.
Trial Arms
Name | Type | Description | Interventions |
---|
Tretinoin and Arsenic Trioxide | Experimental | This is a multicenter, phase II trial to study the efficacy of combined tretinoin and ATO in the treatment of newly diagnosed APL in an effort to reduce or eliminate the amount of standard chemotherapy required for long-term remission. | - Tretinoin and Arsenic Trioxide
|
Eligibility Criteria
Inclusion Criteria:
- Previously untreated patients with a morphologic diagnosis of APL, confirmed by
demonstration of t(15;17) using conventional cytogenetics OR florescence in situ
hybridization (FISH), OR a positive RT-PCR assay for PML-RAR at the subject's local
institution.
- Age ≥18 years. Karnofsky performance status of ≥ 60%.
- Adequate renal function as demonstrated by a serum creatinine ≤ 2.0 mg/dl or a
creatinine clearance of > 60 ml/min.
- Adequate hepatic function as demonstrated by a bilirubin < 2.0 mg/dl (unless
attributable to Gilbert's disease) and an alkaline phosphatase, AST, and ALT ≤ 2.5
times the upper limit of normal.
- Normal cardiac function as demonstrated by a left ventricular ejection fraction ≥ 50%
on echocardiogram or MUGA scan.
- QTc ≤ 500 msec on baseline ECG.
- Negative serum pregnancy test in women of childbearing potential.
- Ability to swallow oral medication.
- Men and women of child-bearing potential must be willing to practice an effective
method of birth control during treatment and at least 4 months after treatment is
finished.
- Patients with central nervous system involvement by APL are eligible and may receive
concomitant treatment with radiation therapy and/or intrathecal chemotherapy in
accordance with standard medical practice.
Exclusion Criteria:
- Previous treatment for APL, except tretinoin, which may be given for up to 7 days
prior to study entry.
- Active serious infections not controlled by antibiotics.
- Pregnant women or women who are breast-feeding.
- Concurrent active malignancy requiring immediate therapy.
- Clinically significant cardiac disease (NY Heart Association Class III or IV),
including chronic arrhythmias, or pulmonary disease.
- Other serious or life-threatening conditions deemed unacceptable by the principal
investigator.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | To determine the rate of molecular remission |
Time Frame: | 4 years |
Safety Issue: | |
Description: | after induction with combined tretinoin and ATO (along with idarubicin in patients with high-risk disease or who develop leukocytosis) in APL. |
Secondary Outcome Measures
Measure: | To determine the rate of clinical complete remission (CR) and the time to remission |
Time Frame: | 4 years |
Safety Issue: | |
Description: | after induction with tretinoin and ATO (with idarubicin in patients with high-risk disease or who develop leukocytosis). |
Measure: | To determine the proportion of patients in molecular remission |
Time Frame: | 4 years |
Safety Issue: | |
Description: | after each course of postremission therapy. |
Measure: | To determine the disease-free and event-free survival of patients |
Time Frame: | 4 years |
Safety Issue: | |
Description: | treated with this program. |
Measure: | To determine the toxicity of this treatment program |
Time Frame: | 4 years |
Safety Issue: | |
Description: | including the early death rate (within 30 days), the incidence of APL differentiation syndrome, the number and length of hospitalizations, the incidence of secondary myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML), and the effects of treatment on left ventricular ejection fraction (LVEF) Frequencies of toxicities based on the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 4.0 will be tabulated. |
Measure: | To characterize the differentiation of APL cells during treatment |
Time Frame: | 4 years |
Safety Issue: | |
Description: | with combined tretinoin and ATO using serial immunophenotyping studies of peripheral blood |
Measure: | Explore the in vivo induction of telomerase-dependent cell death |
Time Frame: | 4 years |
Safety Issue: | |
Description: | by ATRA (Tretinoin) and ATO (Arsenic Trioxide). Bone marrow samples will be analyzed at baseline and at the time of clinical CR for telomerase activity, telomere length and TERT expression |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Memorial Sloan Kettering Cancer Center |
Trial Keywords
- Tretinoin
- all-trans retinoic acid
- ATRA
- Vesanoid
- Arsenic Trioxide
- ATO
- Trisenox
- 11-040
Last Updated
December 21, 2016