Description:
This is a randomized phase III open-label, multicenter trial evaluating standard induction
therapy (daunorubicin [DNR] and cytarabine [Ara-C]) and consolidation therapy (high-dose
cytarabine [HDAC]) with or without dasatinib in adult patients with newly diagnosed CBF-AML
Title
- Brief Title: Randomized Phase III Study of Intensive Chemotherapy With or Without Dasatinib (Sprycel™)
- Official Title: Randomized Phase III Study of Intensive Chemotherapy With or Without Dasatinib (Sprycel™) in Adult Patients With Newly Diagnosed Core-Binding Factor Acute Myeloid Leukemia (CBF-AML)
Clinical Trial IDs
- ORG STUDY ID:
AMLSG 21-13
- NCT ID:
NCT02013648
Conditions
- Acute Myeloid Leukemia (AML)
Interventions
Drug | Synonyms | Arms |
---|
Dasatinib | Sprycel | Investigational arm |
Cytarabine | ARA-cell | Investigational arm |
Daunorubicin | Daunoblastin | Investigational arm |
Idarubicin | | Investigational arm |
Purpose
This is a randomized phase III open-label, multicenter trial evaluating standard induction
therapy (daunorubicin [DNR] and cytarabine [Ara-C]) and consolidation therapy (high-dose
cytarabine [HDAC]) with or without dasatinib in adult patients with newly diagnosed CBF-AML
Detailed Description
This is a randomized phase III open-label, multicenter trial evaluating standard induction
therapy (daunorubicin [DNR] and cytarabine [Ara-C]) and consolidation therapy (high-dose
cytarabine [HDAC]) with or without dasatinib in adult patients with newly diagnosed CBF-AML;
in the investigational arm, consolidation therapy is followed by a one-year maintenance
therapy with dasatinib. Patients with molecular disease persistence or molecular relapse as
assessed by quantitative RQ-PCR for the CBF fusion transcripts will be eligible for
hematopoietic stem cell transplantation before overt hematologic relapse occurs. Primary
endpoint is event-free survival.
AML patients will be assessed for the CBF fusion genes in one of two AMLSG central
laboratories within 48 hours of diagnosis, and only patients with CBF-AML will be enrolled.
Trial Arms
Name | Type | Description | Interventions |
---|
Standard arm | Active Comparator | Patients will receive induction therapy with daunorubicin 60 mg/m2/day administered on days 1-3 (when daunorubicin is not available due to supply shortage: Idarubicin 12mg²/day on days 1,3,5) and cytarabine 200 mg/m2/day administered by continuous IV infusion on days 1-7.
Patients achieving PR only at the end of cycle 1 will receive a second induction cycle with daunorubicin 50 mg/m2/day (when daunorubicin is not available due to supply shortage: Idarubicin 10 mg²/day on days 1 and 3) administered on days 1-3 and cytarabine 200 mg/m2/day administered by cont. IV infusion daily on days 1-5.
Patients will receive 4 cycles of consolidation therapy. Consolidation therapy consists of high-dose cytarabine 3 g/m2 (>60 years: 1 g/m2) q12h, days 1-3 administered intravenously over three hours.
Follow-up period: There is no maintenance therapy in the standard arm. Patients will be closely followed, in particular for molecular disease persistence or molecular relapse. | - Cytarabine
- Daunorubicin
- Idarubicin
|
Investigational arm | Experimental | Patients will receive induction therapy with daunorubicin 60 mg/m2/day on days 1-3 (when daunorubicin is not available due to supply shortage: Idarubicin 12mg²/day on days 1,3,5) and cytarabine 200 mg/m2/day by cont. IV infusion on days 1-7. Patients will receive dasatinib 100 mg QD on days 8-21. Patients achieving PR only at the end of cycle 1 will receive a 2nd induction cycle with daunorubicin 50 mg/m2/day on days 1-3 (when daunorubicin is not available due to supply shortage: Idarubicin 10 mg²/day on days 1 and 3) and cytarabine 200 mg/m2/day by cont. IV infusion on days 1-5. Patients will receive dasatinib 100 mg QD on days 6-21.
Consolidation therapy (4 cycles). Treatment consists of high-dose cytarabine 3 g/m2 (>60 years: 1 g/m2) q12h, days 1-3 iv over 3 hours. Patients will receive dasatinib 100 mg QD on days 4-21. Maintenance therapy: Patients completing consolidation therapy will continue to receive single agent dasatinib 100 mg QD for one year (or until relapse). | - Dasatinib
- Cytarabine
- Daunorubicin
- Idarubicin
|
Eligibility Criteria
Inclusion Criteria:
- Core-binding factor (CBF) AML with molecular diagnosis of RUNX1-RUNX1T1 fusion
transcript resulting from t(8;21)(q22;q22.1) (or a variant form) or of CBFB-MYH11
fusion transcript resulting from inv(16)(p13.1q22)/t(16;16)(p13.1;q22) as assessed in
one of the central AMLSG reference laboratories (Ulm, Hannover)
- Age ≥ 18; there is no upper age limit
- No prior chemotherapy for leukemia except hydroxyurea for up to 5 days during the
diagnostic screening phase
- Non-pregnant and non-nursing. Due to the unknown teratogenic potential of dasatinib in
humans, pregnant or nursing patients may not be enrolled. Women of childbearing
potential (WOCBP) must have a negative serum or urine pregnancy test within a
sensitivity of at least 25 mIU/mL with-in 72 hours prior to registration. Women of
child-bearing potential must either commit to continued abstinence from heterosexual
intercourse or begin TWO acceptable methods of birth control - one highly effective
method (e.g., IUD, hormonal, tubal ligation, or partner's vasectomy), and one
additional effective method (e.g., latex condom, diaphragm, or cervical cap) - AT THE
SAME TIME, at least four weeks before she begins dasatinib therapy. "Women of
childbearing potential" is defined as a sexually active mature woman who has not
undergone a hysterectomy or who has had menses at any time in the preceding 24
consecutive months.
- Men must agree not to father a child and must use a latex condom during any sexual
contact with women of childbearing potential while taking dasatinib and for 3 months
after therapy is stopped, even if they have undergone a successful vasectomy.
- Signed written informed consent.
Exclusion Criteria:
- Performance status WHO >2
- Pulmonary edema and/or pleural/pericardial effusion within 14 days of day 1. If
edema/effusion resolves to CTC Grade ≤1, patients can be treated with dasatinib.
- Patients with ejection fraction <50% by echocardiography within 14 days of day 1
- Organ insufficiency (creatinine >1.5x upper normal serum level; bilirubin, AST or AP
>2.5x upper normal serum level; heart failure NYHA III/IV; severe obstructive or
restrictive ventilation disorder)
- Uncontrolled infection
- Patients with a "currently active" second malignancy other than non-melanoma skin
cancers. Patients are not considered to have a "currently active" malignancy, if they
have completed therapy and are considered by their physician to be at less than 30%
risk of relapse within one year.
- Severe neurological or psychiatric disorder interfering with ability of giving an
informed consent
- Known positive for HIV, active HBV, HCV, or Hepatitis A infection
- Bleeding disorder independent of leukemia
- No consent for registration, storage and processing of the individual disease
characteristics and course as well as information of the family physician and/or other
physicians involved in the treatment of the patient about study participation.
- No consent for biobanking.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Event-free Survival |
Time Frame: | 4 years |
Safety Issue: | |
Description: | To assess event-free survival (EFS) after intensive induction (daunorubicin and cytarabine) and consolidation (high-dose cytarabine) chemotherapy with or without dasatinib in patients with CBF-AML |
Secondary Outcome Measures
Measure: | Cumulative incidence of relapse (CIR) |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | Cumulative incidence of death (CID) |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | overall survival |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | relapse-free survival |
Time Frame: | 4 years |
Safety Issue: | |
Description: | |
Measure: | PIA analysis |
Time Frame: | 4 years |
Safety Issue: | |
Description: | Pharmacodynamic inhibition of KIT as assessed by the KIT plasma inhibitory assay (PIA) |
Measure: | toxicity |
Time Frame: | 7 months (standard arm) / 19 months (investigational arm) |
Safety Issue: | |
Description: | Type, frequency, severity (graded using the National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] version 4.03), timing and relatedness of non-hematologic toxicity observed during different treatment cycles. |
Details
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | University of Ulm |
Trial Keywords
- AML
- Dasatinib
- Core Binding Factor (CBF)
Last Updated
April 28, 2021