Description:
This phase I/II trial studies the side effects and best dose of axitinib and bosutinib and
how well they work in treating patients with chronic, accelerated, or blastic phase chronic
myeloid leukemia. Axitinib and bosutinib may stop the growth of cancer cells by blocking some
of the enzymes needed for cell growth.
Title
- Brief Title: Axitinib and Bosutinib in Treating Patients With Chronic, Accelerated, or Blastic Phase Chronic Myeloid Leukemia
- Official Title: Alternating or Combined Therapy With Axitinib and Bosutinib for Patients With Chronic Myeloid Leukemia in Chronic, Accelerated, or Blastic Phases
Clinical Trial IDs
- ORG STUDY ID:
2015-0787
- SECONDARY ID:
NCI-2016-01188
- SECONDARY ID:
2015-0787
- NCT ID:
NCT02782403
Conditions
- Accelerated Phase Chronic Myelogenous Leukemia (CML)
- Blast Phase Chronic Myelogenous Leukemia (CML)
- Chronic Phase Phase Chronic Myelogenous Leukemia (CML)
- Philadelphia Chromosome Positive (Ph+) Phase Chronic Myelogenous Leukemia (CML)
Interventions
Drug | Synonyms | Arms |
---|
Axitinib | AG-013736, AG013736, Inlyta | Treatment (alternating therapy) |
Bosutinib | Bosulif, SKI 606, SKI-606 | Treatment (alternating therapy) |
Purpose
This phase I/II trial studies the side effects and best dose of axitinib and bosutinib and
how well they work in treating patients with chronic, accelerated, or blastic phase chronic
myeloid leukemia. Axitinib and bosutinib may stop the growth of cancer cells by blocking some
of the enzymes needed for cell growth.
Detailed Description
PRIMARY OBJECTIVES:
I. To assess the rate of major cytogenetic response (MCyR) of an alternating schedule of
axitinib and bosutinib in patients with chronic myeloid leukemia, chronic phase (CML-CP)
after failure of/intolerance to >= 3 tyrosine kinase inhibitors (TKIs) using standard
response criteria. (Chronic Phase Cohort) II. To determine the recommended phase II doses
(RPTDs) of axitinib and bosutinib in combination in patients with chronic myeloid leukemia
(CML) in accelerated phase (CML-AP) or blast phase (CML-BP). (Advanced phase [AP] patients
must have received >= 1 prior TKI). (Advanced Phase Cohort - Phase I Portion) III. To
evaluate the rate of major hematologic response (MaHR) of combined treatment with axitinib
and bosutinib in patients with CML-AP or CML-BP using standard response criteria. (AP
patients must have received >= 1 prior TKI). (Advanced Phase Cohort - Phase II Portion)
SECONDARY OBJECTIVES:
I. To determine the rate of complete cytogenetic response (CCyR), breast cancer gene
(BCR-ABL/ABL) =< 10% and =< 1%, major molecular response (MMR), molecular response 4-log
(MR4), molecular response 4.5-log (MR4.5), and complete molecular response (CMR), overall and
at different time points. (Chronic Phase Cohort) II. To determine the duration of response
(DOR), event-free survival (EFS), transformation-free survival (TFS), failure-free survival
(FFS) and overall survival (OS) for patients with CML-CP treated with alternating axitinib
and bosutinib after failure of/intolerance to >= 3 TKIs. (Chronic Phase Cohort) III. To
determine the safety and tolerability of alternating therapy with axitinib and bosutinib
after failure of/intolerance to >= 3 TKIs. (Chronic Phase Cohort) IV. To establish the
response rate of concurrent administration of axitinib and bosutinib to patients with CML-AP
or CML-BP. (AP patients must have received >= 1 prior TKI). (Advanced Phase Cohort - Phase I
Portion) V. To determine the rate of complete hematologic response (CHR), complete
cytogenetic response (CCyR), BCR-ABL/ABL =< 10% and =< 1%, major molecular response (MMR),
molecular response 4-log (MR4), molecular response 4.5-log (MR4.5), and complete molecular
response (CMR), overall and at different time points of combined treatment with axitinib and
bosutinib in patients with CML-AP or CML-BP. (AP patients must have received >= 1 prior TKI).
(Advanced Phase Cohort - Phase I Portion) VI. To determine the DOR, EFS, TFS, FFS and OS for
patients with CML-AP or -BP treated with combined axitinib and bosutinib. (AP patients must
have received >= 1 prior TKI). (Advanced Phase Cohort - Phase II Portion) VII. To evaluate
the probability of developing Abl kinase domain and other somatic mutations in patients with
CML treated with alternating (CP) or concurrent (AP/BP) axitinib and bosutinib. (Advanced
Phase Cohort - Phase II Portion) VIII. To analyze differences in response rates, duration and
survival according to pre-treatment mutations and patient characteristics in both the CP and
AP/BP cohorts. (Advanced Phase Cohort - Phase II Portion) IX. To characterize mechanisms of
resistance in patients who develop resistance to alternating (CP) or concomitant (AP/BP)
therapy with axitinib and bosutinib. (Advanced Phase Cohort - Phase II Portion) X. To
evaluate symptom burden in patients with CML receiving axitinib and bosutinib, whether
alternating (CP) or in combination (AP/BP). (Advanced Phase Cohort - Phase II Portion)
OUTLINE: This is a dose-escalation followed by a phase II study. Patients are assigned to 1
of 2 cohorts.
COHORT I: Patients with chronic phase CML receive either bosutinib orally (PO) once a day
(QD) or axitinib PO twice a day (BID) alone for 3 months. Patients then switch to the other
drug for 3 months and alternate between the two every 3 months in the absence of disease
progression or unacceptable toxicity.
COHORT II: Patients with accelerated or blastic phase CML receive bosutinib PO QD and
axitinib PO BID for 3 months. Courses repeat every 3 months in the absence of disease
progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 1 month.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (alternating therapy) | Experimental | Patients with chronic phase CML receive either bosutinib PO QD or axitinib PO BID alone for 3 months. Patients then switch to the other drug for 3 months and alternate between the two every 3 months in the absence of disease progression or unacceptable toxicity. | |
Treatment (combined therapy) | Experimental | Patients with accelerated or blastic phase CML receive bosutinib PO QD and axitinib PO BID for 3 months. Courses repeat every 3 months in the absence of disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
- Diagnosis of Philadelphia chromosome positive (Ph+) (by cytogenetics or FISH) or
BCR-ABL+ (by polymerase chain reaction [PCR]) CML in CP (cohort 1), AP (cohort 2) or
BP (cohort 2)
- Patients should have failed (demonstrated resistance, intolerance or treatment
discontinuation for any other reason of) at least 3 Food and Drug Administration
(FDA)-approved TKIs if in CP (cohort 1), or at least 1 FDA-approved TKI if in AP
(cohort 2); resistance will be defined as meeting the criteria for failure or warning
by the European Leukemia Net (ELN); no prior therapy is necessary for patients in BP
(cohort 2); patients in CP who have failed < 3 TKIs, but are ineligible to receive
other FDA-approved TKIs, may also be enrolled in cohort 1; at least 10 CP patients
with the T315I mutation affecting the kinase domain of Bcr-Abl will be enrolled in
cohort 1, as well as in the phase II portion of cohort 2
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Total bilirubin =< 1.5 x upper limit of normal (ULN) (unless due to Gilbert syndrome,
in which case it should be =< 3.0 x ULN)
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x ULN
- Serum creatinine =< 1.5 x ULN
- Patients must sign the Institutional Review Board (IRB)-approved informed consent
document for this trial
- Reliable telephone access so as to be able to receive calls from an interactive voice
response (IVR) system (only applicable to patients participating in the optional
symptom burden assessment portion)
- Women of childbearing potential (WOCBP) must practice 2 effective methods of birth
control during the course of the study; male patients who are partners of WOCBP should
also practice an effective method of contraception: postmenopausal women must be
amenorrheic for >= 12 months to be considered of non-childbearing potential; women and
men must continue birth control for the duration of the trial and >= 3 months after
the last dose of study drug; all WOCBP MUST have a negative pregnancy test prior to
first receiving study medication(s)
- Patients should have discontinued therapy with imatinib, dasatinib, nilotinib,
ponatinib, omacetaxine or other anti-leukemia therapy (except hydroxyurea) >= 48 hours
prior to start of study therapy and recovered from any toxicity due to these therapies
to grade =< 1; hydroxyurea may be received up to the time of enrollment and for the
first 6 weeks of study treatment if necessary
Exclusion Criteria:
- Prior therapy with axitinib; prior therapy with bosutinib is allowed, except in the
following circumstances: the subject is currently on bosutinib; bosutinib is the
subject's most recent TKI for CML; the subject has a history of intolerance to
bosutinib
- Active gastrointestinal conditions that are expected to impair absorption of orally
administered medications
- Patients who currently have or have a history of the following within 6 months
preceding study entry are not eligible: unstable angina (UA), myocardial infarction
(MI), transient ischemic attack (TIA), stroke, deep vein thrombosis (DVT), acute
peripheral or pulmonary arterial thromboembolism (PE); clinically significant
ventricular arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, or
torsades de pointes); New York Heart Association class III or IV heart failure
- Patients with active, uncontrolled psychiatric disorders including: psychosis, major
depressive, and bipolar disorders
- Patients with uncontrolled hypertension (defined as sustained systolic blood pressure
> 160 mmHg or diastolic blood pressure > 100 mmHg)
- Pregnant or breast-feeding women are excluded
- Inability to understand a written informed consent document
- Patients receiving anticoagulants that are unable to be discontinued
- Patients with active, uncontrolled infection
- Patients with a history of hypersensitivity to bosutinib or axitinib
- Patients on proton pump inhibitors, potent CYP3A or P-glycoprotein substrates,
inhibitors or inducers a minimum 7 day period washout required unless discontinuation
or substitution is not in the best interests of the patient as determined by the
investigator; in instances where use of these agents is felt to be required for
optimal management, inclusion of such patients should be discussed with the principal
investigator (PI) and the rationale documented; these patients, if enrolled on study,
may require dose modifications for both axitinib and bosutinib
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Rate of major cytogenetic response (MCyR) among patients with chronic myeloid leukemia, chronic phase status post (s/p) failure of/intolerance to >= 3 tyrosine kinase inhibitors treated with alternating axitinib and bosutinib (Chronic Phase Cohort) |
Time Frame: | Up to 4 years |
Safety Issue: | |
Description: | |
Secondary Outcome Measures
Measure: | Clinical rates analysis (Chronic Phase Cohort) |
Time Frame: | Up to 4 years |
Safety Issue: | |
Description: | Rates of CHR, complete cytogenetic response (CCyR), major molecular response (MMR), molecular response 4-log (MR4), molecular response 4.5-log (MR4.5), complete molecular response (CMR), BCR-ABL/ABL =< 10% and =< 1%, duration of response (DOR), event-free survival (EFS), transformation-free survival (TFS), failure-free survival (FFS) and overall survival (OS) among patients with CML-CP after resistance and/or intolerance to >= 2 TKIs treated with alternating axitinib and bosutinib. |
Measure: | Incidence and severity of adverse events (AEs) (Advanced phase cohort - Phase I Portion) |
Time Frame: | Up to 4 years |
Safety Issue: | |
Description: | Will be determined by history and physical examination and laboratory assessment, seen with the combination of axitinib and bosutinib among patients with CML-AP or -BP. |
Measure: | Rates of CHR, CCyR, MMR, MR4, MR4.5, CMR, BCR-ABL/ABL =< 10% and =< 1%, DOR, EFS, TFS, FFS and OS among patients with CML-AP or -BP receiving combined therapy with axitinib and bosutinib (Advanced phase cohort - Phase II Portion) |
Time Frame: | Up to 4 years |
Safety Issue: | |
Description: | |
Measure: | Percentage of participants with mutations in BCR-ABL and other genes in all patients receiving study drugs |
Time Frame: | Baseline up to 4 years |
Safety Issue: | |
Description: | Measured by analysis of each patient's multigene profile using Next Generation Sequencing (NGS) panel and/or ABL kinase domain sequencing performed at baseline.
Following the analysis of each patient's mutation profile, the number of each somatic mutation identified will be reported. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Terminated |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
November 19, 2020