Description:
The purpose of this two-stage Phase 2 study is to assess the clinical response (Complete
Remission) of ACM (Alvocidib/Cytarabine/Mitoxantrone) compared to CM
(Cytarabine/Mitoxantrone) treatment in refractory or relapsed AML patients with demonstrated
MCL-1 dependence of ≥ 30% by mitochondrial profiling in bone marrow.
Title
- Brief Title: Alvocidib Biomarker-driven Phase 2 AML Study
- Official Title: Phase 2, Randomized, Biomarker-driven Clinical Study in Patients With Relapsed or Refractory Acute Myeloid Leukemia (AML) With MCL-1 Dependence ≥30%
Clinical Trial IDs
- ORG STUDY ID:
TPI-ALV-201
- NCT ID:
NCT02520011
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Alvocidib | | ACM (Stage 1 / Stage 2) |
Cytarabine | ara-c | ACM (Stage 1 / Stage 2) |
Mitoxantrone | mitoxantrone hydrochloride | ACM (Stage 1 / Stage 2) |
Purpose
The purpose of this two-stage Phase 2 study is to assess the clinical response (Complete
Remission) of ACM (Alvocidib/Cytarabine/Mitoxantrone) compared to CM
(Cytarabine/Mitoxantrone) treatment in refractory or relapsed AML patients with demonstrated
MCL-1 dependence of ≥ 30% by mitochondrial profiling in bone marrow.
Detailed Description
In Stage 1 of the study, all eligible AML patients with demonstrated MCL-1 dependence of ≥
30% by mitochondrial profiling in bone marrow will receive treatment with ACM.
In Stage 2, all eligible AML patients with demonstrated MCL-1 dependence of ≥ 30% by
mitochondrial profiling in bone marrow will be randomized 1:1 to receive either treatment
with ACM or CM.
Trial Arms
Name | Type | Description | Interventions |
---|
ACM (Stage 1 / Stage 2) | Experimental | A: alvocidib, 30 mg/m2 as a 30 minute intravenous (IV) bolus followed by 60 mg/m2 over 4 hours as an IV infusion administered daily on Days 1-3; C: cytarabine (ara-c), 2 gm/m2 by continuous IV infusion over 72 hours on Days 6-8; M: mitoxantrone (mitoxantrone hydrochloride), 40 mg/m2 by IV infusion over 1-2 hours starting 12 hours after completing cytarabine | - Alvocidib
- Cytarabine
- Mitoxantrone
|
CM (Stage 2) | Active Comparator | C: cytarabine (ara-c), 2 gm/m2 by continuous IV infusion over 72 hours on Days 1-3; M: mitoxantrone (mitoxantrone hydrochloride), 40 mg/m2 by IV infusion over 1-2 hours starting 12 hours after completing cytarabine | |
Eligibility Criteria
Inclusion Criteria:
1. Be between the ages of ≥18 and ≤65 years
2. Have an established, pathologically confirmed diagnoses of AML by World Health
Organization (WHO) criteria excluding acute promyelocytic leukemia (APL-M3) with a
bone marrow of >5% blasts based on histology or flow cytometry
3. Be in first relapse (within 24 months of CR) or have failed induction therapy* (no CR
or CRi after treatment with an intensive regimen (eg, anthracycline/cytarabine ±
etoposide, gemtuzumab ozogamicin, or cladribine).
*Induction therapy may involve 1 or 2 cycles of the same regimen. Efficacy assessment
of induction therapy must be >21 days from the start of the previous induction cycle.
4. Demonstrate MCL-1 dependence of ≥30% by mitochondrial profiling in bone marrow.
5. Have an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤2
6. Have a serum creatinine level ≤1.8 mg/dL
7. Have an alanine aminotransferase (ALT)/aspartate aminotransferase (AST) level ≤5 times
upper limit of normal (ULN)
8. Have a total bilirubin level ≤2.0 mg/dL (unless secondary to Gilbert syndrome,
hemolysis, or leukemia)
9. Have a left ventricular ejection fraction (LVEF) >45% by echocardiogram (ECHO) or
multigated acquisition (MUGA) scan
10. Be nonfertile or agree to use an adequate method of contraception. Sexually active
patients and their partners must use an effective method of contraception associated
with a low failure rate during and for at least 6 months after completion of study
therapy.
11. Be able to comply with the requirements of the entire study.
12. Provide written informed consent prior to any study related procedure.
Exclusion Criteria:
1. Received more than 2 cycles of induction therapy for AML. Investigational agents as
part of front-line therapy for AML may by acceptable following discussion with the
Medical Monitor. Hydroxyurea is permitted (see #5 below).
2. Received any previous treatment with alvocidib or any other CDK inhibitor
3. Received a hematopoietic stem cell transplant within the previous 2 months
4. Have clinically significant graft versus host disease (GVHD), or GVHD requiring
initiation or escalation of treatment within the last 21 days
5. Require concomitant chemotherapy, radiation therapy, or immunotherapy. Hydroxyurea is
allowed up to the evening before starting (but not within 12 hours) of starting
treatment on either arm.
6. Received >360 mg/m2 equivalents of daunorubicin
7. Have a peripheral blast count of >30,000/mm3 (may use hydroxyurea as in #5 above)
8. Received antileukemic therapy within the last 3 weeks (with the exception of
hydroxyurea or if the patient has definite refractory disease). Refractory patients
who received therapy within the last 3 weeks may be eligible with prior approval of
the Medical Monitor.
9. Diagnosed with acute promyelocytic leukemia (APL, M3)
10. Have active central nervous system (CNS) leukemia
11. Have evidence of uncontrolled disseminated intravascular coagulation
12. Have an active, uncontrolled infection
13. Have other life-threatening illness
14. Have other active malignancies or diagnosed with other malignancies within the last 6
months, except nonmelanoma skin cancer or cervical intraepithelial neoplasia
15. Have mental deficits and/or psychiatric history that may compromise the ability to
give written informed consent or to comply with the study protocol.
16. Are pregnant and/or nursing
17. Have received any live vaccine within 14 days prior to first study drug
administration.
Maximum Eligible Age: | 65 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Complete Response (CR) Rate in Patients With Relapsed or Refractory AML |
Time Frame: | Best response after at least 1 cycle through study completion approximately 4 years |
Safety Issue: | |
Description: | Complete Remission (CR) rate = Percentage of patients achieving CR after Cycle 1 as defined in Stage 1 by the International Working Group (IWG) Criteria and 2010 European LeukemiaNet (EN) criteria in patients with relapsed or refractory AML with MCL-1 dependence >30% and in Stage 2 by the 2017 ELN criteria.
The study was terminated in January 2020 due to a steady and marked reduction in enrollment. Thus, the efficacy endpoints could not be analyzed. As sufficient efficacy results were not available to analyze patients based on the percentage of MCL-1 dependency the treatment efficacy was summarized by distributing the safety population into 6 groups based on whether the patients received the ACM vs CM regimen and their disease stages at study entry. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Terminated |
Lead Sponsor: | Sumitomo Dainippon Pharma Oncology, Inc |
Trial Keywords
- Refractory AML
- Relapsed AML
- AML
Last Updated
July 15, 2021