Clinical Trials /

ONC201 in Relapsed/Refractory Acute Leukemias and High-Risk Myelodysplastic Syndromes (HR-MDS)

NCT02392572

Description:

The goal of Phase I of this clinical research study is to find the highest tolerable dose of ONC201 alone or in combination with low dose cytarabine (LDAC) that can be given to patients with relapsed or refractory AML, ALL, or MDS. The goal of Phase II of this study is to learn if the dose of ONC201 given alone or in combination with LDAC that is found in Phase I can help to control the disease. The safety of the study drug will be studied in both phases of this study. This is the first study using ONC201 in humans. ONC201 given alone or in combination with LDAC is in a very early stage of development for use in humans. Providing direct medical benefit to you is not the purpose of this study. While Phase II will look at the effectiveness of the study drug given alone or in combination with LDAC, the main purpose of this study is to learn about the safety of the drug.

Related Conditions:
  • Acute Leukemia
  • Acute Lymphoblastic Leukemia
  • Acute Myeloid Leukemia
  • Myelodysplastic Syndromes
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: ONC201 in Relapsed/Refractory Acute Leukemias and High-Risk Myelodysplastic Syndromes (HR-MDS)
  • Official Title: Phase I/II Study of Oral ONC201 in Patients With Relapsed or Refractory Acute Leukemias and High-Risk Myelodysplastic Syndromes

Clinical Trial IDs

  • ORG STUDY ID: 2014-0731
  • SECONDARY ID: NCI-2015-00504
  • NCT ID: NCT02392572

Conditions

  • Leukemia

Interventions

DrugSynonymsArms
ONC201Arm A: ONC201 Once Every 3 Weeks
CytarabineAra-C, Cytosar, DepoCyt, Cytosine Arabinosine HydrochlorideArm E: ONC201 Once Daily + Cytarabine

Purpose

The goal of Phase I of this clinical research study is to find the highest tolerable dose of ONC201 alone or in combination with low dose cytarabine (LDAC) that can be given to patients with relapsed or refractory AML, ALL, or MDS. The goal of Phase II of this study is to learn if the dose of ONC201 given alone or in combination with LDAC that is found in Phase I can help to control the disease. The safety of the study drug will be studied in both phases of this study. This is the first study using ONC201 in humans. ONC201 given alone or in combination with LDAC is in a very early stage of development for use in humans. Providing direct medical benefit to you is not the purpose of this study. While Phase II will look at the effectiveness of the study drug given alone or in combination with LDAC, the main purpose of this study is to learn about the safety of the drug.

Detailed Description

      Study Groups If you are found to be eligible to take part in this study, you will be enrolled
      in a study group (Arm) based on the type of disease you have and/or when you joined this
      study. Up to 15 groups of up to 6 participants per group will be enrolled in Phase I of the
      study, and up to 20 participants will be enrolled in Phase II. All will take part at MD
      Anderson.

      If you are enrolled in Phase I Arms A, B, C, D or E, the dose and frequency of ONC201 alone
      or in combination with LDAC you receive will depend on when you join the study. The first
      group of participants will receive the lowest dose level of ONC201. If no intolerable side
      effects are seen, the next group of participants will receive a higher dose than the group
      before them. This will continue until the highest tolerable dose of ONC201 is found. The dose
      you receive may be too low to have an effect on your disease, or so high that it causes bad
      side effects.

      If you are enrolled in Phase II, you will receive ONC201 alone or in combination with LDAC at
      the highest dose level that was tolerated by participants in the Phase I portion of the
      study.

      Study Drug Administration:

      In Arms A, B, C, and D, each study drug cycle is 21 days. If you are enrolled in Arm E or in
      the Phase 2 study, each cycle will be 28 days.

      You will take ONC201 capsules by mouth as directed by your doctor 2 hours before or after a
      meal. If you vomit after taking ONC201, you should not retake the dose. Your doctor will tell
      you how many capsules to take and how often to take them (either 1 or 2 times every week,
      depending on what group you are assigned to). You must not crush or chew the capsules or
      dissolve them in liquid.

      LDAC will be injected under the skin on Days 3-12 of each 4 week cycle. You or your caregiver
      will be taught how to inject the LDAC.

      You will be given a study drug diary to write down any missed doses. You will give your study
      drug diary to the study doctor at each clinic visit.

      Your dose may be increased or decreased if you have any side effects, if you respond to the
      study drug, or if the doctor thinks that the next higher dose level is safe.

      Study Visits:

      On Day 1 of Cycle 1:

        -  You will have a physical exam, including vital signs, weight, and discussion about any
           other medications you are taking.

        -  Blood (about 2 tablespoons) will be drawn for routine tests.

        -  You will have 1 EKG before your dose of study drug and then 3 more times over the next 2
           hours after the first dose.

        -  Blood (about 1 teaspoon) will be drawn for PK testing 5 times over the next 24 hours
           after the dose of study drug.

        -  Blood (about 1 teaspoon) will be drawn for PD testing before your dose of study drug.

      For Arm D, during Cycle 1 and Cycle 2, blood (about 1 teaspoon) will be collected for PK
      testing at pre-dose, and at 30 minutes (± 15 minutes), 2 hours (± 30 minutes), 4 hours (± 30
      minutes), and 6 hours (± 30 minutes) after you receive ONC201 on Day 1 and Day 2.

      For Arm E, during Cycle 1, blood (about 1 teaspoon) will be collected for PK testing at
      pre-dose, and 30 minutes (± 15 minutes), 2 hours (± 30 minutes), 4 hours (± 30 minutes), and
      6 hours (± 30 minutes) after you receive ONC201 on Days 1, 2, 3, 12, 22 and 23.

      On Days 2-4 of Cycle 1:

        -  On Day 2 only, you will have an EKG.

        -  Blood (about 1 teaspoon) will be drawn for PK and/or PD testing.

      On Days 8 and 15 of Cycle 1:

        -  Blood (about 2 tablespoons) will be drawn for routine tests.

        -  You will have an EKG, vital signs, and discussion about any other medications you are
           taking.

        -  On Day 8 only, blood (about 2 teaspoons) will be drawn for PK and PD testing. On Day 22
           of Cycle 1 (Arm E only)

        -  Blood (about 2 tablespoons) will be drawn for routine tests. On Day 1 of Cycles 2 and
           beyond

        -  You will have a physical exam, including vital signs and a discussion of any other
           medications you are taking.

        -  You will have an EKG before your dose of study drug.

        -  Blood (about 2 tablespoons) will be drawn for routine tests.

        -  Blood (about 2 teaspoons) will be drawn for PK and PD testing.

        -  On Cycle 2 only, you will have a bone marrow aspirate/biopsy for PD testing.

      On Day 21 of Cycle 3, and then any time the doctor thinks it is needed after that, you will
      have a bone marrow aspirate/biopsy for cytogenetic, biomarker, and PD testing. Biomarkers are
      found in the blood/tissue and may be related to your reaction to the study drug.

      Length of Study:

      You may continue taking the study drug for as long as the doctor thinks it is in your best
      interest. You will no longer be able to take the study drug if the disease gets worse, if
      intolerable side effects occur, or if you are unable to follow study directions.

      Your participation on the study will be over after the end-of-study visit.

      End-of-Study Visit:

      About 1 month after your last dose of study drug:

        -  You will have a physical exam, including vital signs and a discussion of any other
           medications you are taking.

        -  You will have an EKG.

        -  Blood (about 2 tablespoons) will be drawn for routine tests.

        -  If the doctor thinks it is needed, blood (about 2 teaspoons) will be drawn for PK and PD
           testing.

        -  If the doctor thinks it is needed, you will have a bone marrow aspirate/biopsy to check
           for any genetic mutations.

      This is an investigational study. ONC201 is not FDA-approved or commercially available. It is
      currently being used for research purposes only. The study doctor can explain how the study
      drug is designed to work.

      Up to 120 patients will take part in this study. All will be enrolled at MD Anderson.
    

Trial Arms

NameTypeDescriptionInterventions
Arm A: ONC201 Once Every 3 WeeksExperimentalONC201 dosed orally once every three weeks. One cycle defined as 21 days (3 weeks). Phase I: Cohorts consisting of one new patient per dosing level treated sequentially at rising dose levels starting at 125 mg. Enrollment at each dose level requires that all patients enrolled at the prior dose level have completed one cycle of treatment (21 days) and that dose level is deemed safe. Dose escalation continues until an maximum tolerated dose (MTD) is reached or dose level 5 is reached (625 mg), which will be declared the maximum administered dose (MAD). Phase II: Starting dose is MTD dose from Phase I.
  • ONC201
Arm B: ONC201 Once Every 1 WeekExperimentalONC201 dosed orally once every 1 week. One cycle defined as 21 days (3 weeks). Phase I: Cohorts consisting of one new patient per dosing level treated sequentially at rising dose levels starting at 125 mg. Enrollment at each dose level requires that all patients enrolled at the prior dose level have completed one cycle of treatment (21 days) and that dose level is deemed safe. Dose escalation continues until an maximum tolerated dose (MTD) is reached or dose level 5 is reached (625 mg), which will be declared the maximum administered dose (MAD). Phase II: Starting dose is MTD dose from Phase I.
  • ONC201
Arm C: ONC201 On First Two Consecutive Days of Every WeekExperimentalONC201 dosed orally on the first two consecutive days of every week. One cycle defined as 21 days (3 weeks). Phase I: Cohorts consisting of one new patient per dosing level treated sequentially at rising dose levels starting at 125 mg. Enrollment at each dose level requires that all patients enrolled at the prior dose level have completed one cycle of treatment (21 days) and that dose level is deemed safe. Dose escalation continues until an maximum tolerated dose (MTD) is reached or dose level 5 is reached (625 mg), which will be declared the maximum administered dose (MAD). Phase II: Starting dose is MTD dose from Phase I.
  • ONC201
Arm D: ONC201 Once DailyExperimentalONC201 dosed orally once daily. One cycle defined as 21 days (3 weeks). Phase I: Cohorts consisting of one new patient per dosing level treated sequentially at rising dose levels starting at 125 mg. Enrollment at each dose level requires that all patients enrolled at the prior dose level have completed one cycle of treatment (21 days) and that dose level is deemed safe. Dose escalation continues until an maximum tolerated dose (MTD) is reached or dose level 5 is reached (625 mg), which will be declared the maximum administered dose (MAD). Phase II: Starting dose is MTD dose from Phase I.
  • ONC201
Arm E: ONC201 Once Daily + CytarabineExperimentalONC201 orally once daily in combination with low Cytarabine 20 mg subcutaneous twice daily for 10 days. One cycle defined as 28 days (4 weeks). Once the highest dose for Arm D (625 mg) are deemed safe (<2/6 DLTs) or the MTD is reached before that, then Phase I part of the study for Arm E will begin. The starting dose of ONC201 will be 625 mg or the MTD with the same schedule as that in Arm D. 3 + 3 algorithm will be applied for dose de-escalation.
  • ONC201
  • Cytarabine

Eligibility Criteria

        Inclusion Criteria:

          1. For Arms A, B, C, D patients must have relapsed or refractory acute leukemias or
             high-risk MDS for which no standard therapies are anticipated to result in a durable
             remission. For Arm E, in addition to patients with relapsed or refractory acute
             leukemias or high-risk MDS, patients with untreated high-risk MDS or acute leukemias
             will also be eligible provided they are not eligible for more intensive therapies.

          2. Age >/=18 years.

          3. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.

          4. Women of child-bearing potential (i.e., women who are pre-menopausal or not surgically
             sterile) must use acceptable contraceptive methods (abstinence, intrauterine device
             [IUD], oral contraceptive or double barrier device, such as a condom, diaphragm, or
             cervical/vault cap), for 16 weeks after the last dose of study drug, and must have a
             negative serum or urine pregnancy test within 1 week prior to beginning treatment on
             this trial. Nursing patients are excluded. Sexually active men must also use
             acceptable contraceptive methods for the duration of time on study and for at least 16
             weeks after the last dose of study drug. Pregnant and nursing patients are excluded
             because the effects of ONC201on a fetus or nursing child are unknown.

          5. Must be able and willing to give written informed consent.

          6. The interval from prior treatment to time of study drug administration should be at
             least 2 weeks for cytotoxic agents or at least 5 half-lives for noncytotoxic agents.
             If the patient is on hydroxyurea to control peripheral blood leukemic cell counts, the
             patient must be off hydroxyurea for at least 24 hours before initiation of treatment
             on this protocol. Persistent clinically significant toxicities from prior therapy must
             not be greater than grade 1.

          7. Patients must have the following clinical laboratory values unless considered due to
             leukemic organ involvement: (1) Serum creatinine < 2.0 mg/dl; (2) Total bilirubin </=
             1.5 x the upper limit of normal (ULN) unless considered due to Gilbert's syndrome; (3)
             Alanine aminotransferase (ALT), or aspartate aminotransferase (AST) </= 3 x the ULN
             unless considered due to organ leukemic involvement.

          8. Patients with known central nervous system (CNS) disease are allowed if there is no
             evidence of active CNS disease as documented by negative imaging or spinal fluid
             analysis carried out at least 2 weeks prior to study drug administration. Information
             obtained from standard of care historical data will be used for this purpose.

          9. Relapse > 6 months since autologous or allogeneic stem cell transplantation provided:
             (1) No active graft-versus-host disease (GVHD > grade 1); (2) No treatment with high
             dose steroids for GVHD (up to >/= 20 mg Prednisolone or equivalent per day); (3) No
             treatment with immunosuppressive drugs with the exception of low dose cyclosporine and
             tacrolimus.

        Exclusion Criteria:

          1. Uncontrolled intercurrent illness including, but not limited to uncontrolled
             infection, symptomatic congestive heart failure (New York Heart Association class III
             and IV), uncontrolled cardiac arrhythmia, or psychiatric illness/social situations
             that would limit compliance with study requirements.

          2. Active heart disease including myocardial infarction within previous 3 months,
             symptomatic coronary artery disease, arrhythmias not controlled by medication, or
             uncontrolled congestive heart failure (New York Heart Association class III and IV).

          3. Patients receiving any other standard or investigational treatment for their
             hematologic malignancy within past 2 weeks for cytotoxic agents or at least 5
             half-lives for noncytotoxic agents.

          4. Subject has been diagnosed or treated for another malignancy within 3 years of
             enrolment, except in situ malignancy, or low-risk prostate, skin or cervix cancer
             after curative therapy.

          5. Known history of seropositive for human immunodeficiency virus (HIV) antibodies (HIV1
             and HIV2), Hepatitis C antibody (Hep C Ab) or a Hepatitis B carrier (positive for
             Hepatitis B surface antigen [HBsAg])

          6. Active drug use or alcoholism.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum Tolerated Dose (MTD) of ONOC201 in Relapsed or Refractory Acute Myelogenous Leukemia (AML), Myelodysplastic Syndrome (MDS) or Acute Lymphoblastic Leukemia (ALL)
Time Frame:21 days
Safety Issue:
Description:MTD is defined as the highest dose level in which 6 patients have been treated with at most 1 instance of dose limiting toxicity (DLT). Toxicities defined according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. DLT defined as a clinically significant adverse event or abnormal laboratory value assessed as unrelated to disease progression, intercurrent illness, or concomitant medications and occurring during the first cycle on study that meets any of the following criteria: CTCAE grade 3 AST (SGOT) or ALT (SGPT) for > 7 days CTCAE grade 4 AST (SGOT) or ALT (SGPT) of any duration All other clinically significant NCI common terminology criteria that are CTCAE grade 3 or 4 (except for electrolyte disturbances responsive to correction within 24 h, diarrhea, nausea and vomiting that responds to standard medical care)

Secondary Outcome Measures

Measure:Objective Response (OR)
Time Frame:63 days
Safety Issue:
Description:Objective responses for patients with AML and ALL include Complete Remission (CR), Complete Remission with Incomplete Blood Count Recovery (CRi), Partial Remission (PR) and morphologic leukemia-free state(Cheson and others, 2003).

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Trial Keywords

  • Leukemia
  • Acute myelogenous leukemia
  • AML
  • Myelodysplastic syndrome
  • MDS
  • Acute lymphoblastic leukemia
  • ALL
  • Relapsed
  • Refractory
  • ONC201
  • Cytarabine
  • Ara-C
  • Cytosar
  • DepoCyt
  • Cytosine Arabinosine Hydrochloride

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