Description:
The main purpose of this investigational research study is to determine how safe and
tolerable the study drug volasertib is in combination with liposomal vincristine (Marqibo; an
FDA-approved drug) in patients with relapsed/refractory acute lymphoblastic leukemia. While
VSLI demonstrated an overall response rate of 35% in Acute Lymphoblastic Leukemia (ALL)
patients that had failed to respond to or relapsed after chemotherapy, combining it with
other agents may increase clinical benefit.
Volasertib inhibits proteins involved in the cell cycle that are increased in ALL. When
volasertib inhibits these proteins ALL cells die. In the laboratory, volasertib has been
shown to increase activity of vincristine against ALL cells. Therefore, we think the
combination of volasertib and VSLI will be more effective against your leukemia than either
drug used alone. This study will try to find out what effects, good and/or bad, this drug
combination has on the patient and their cancer, and to find a dose that may be used in
future studies.
Title
- Brief Title: Volasertib and Vincristine Sulfate Liposome in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia
- Official Title: A Phase I Clinical Trial Evaluating the Combination of Volasertib (BI-6727) With Vincristine Sulfate Liposomal Injections (VSLI) in Adult Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia
Clinical Trial IDs
- ORG STUDY ID:
NU 16H06
- SECONDARY ID:
STU00203179
- SECONDARY ID:
NU 16H06
- SECONDARY ID:
P30CA060553
- SECONDARY ID:
NCI-2016-01036
- NCT ID:
NCT02861040
Conditions
- Recurrent Adult Acute Lymphoblastic Leukemia
- Refractory Adult Acute Lymphoblastic Leukemia
Interventions
Drug | Synonyms | Arms |
---|
Vincristine Sulfate Liposome | Marqibo | Treatment (volasertib, vincristine sulfate liposome) |
Volasertib | BI 6727, BI-6727, Polo-like Kinase 1 Inhibitor BI 6727 | Treatment (volasertib, vincristine sulfate liposome) |
Purpose
The main purpose of this investigational research study is to determine how safe and
tolerable the study drug volasertib is in combination with liposomal vincristine (Marqibo; an
FDA-approved drug) in patients with relapsed/refractory acute lymphoblastic leukemia. While
VSLI demonstrated an overall response rate of 35% in Acute Lymphoblastic Leukemia (ALL)
patients that had failed to respond to or relapsed after chemotherapy, combining it with
other agents may increase clinical benefit.
Volasertib inhibits proteins involved in the cell cycle that are increased in ALL. When
volasertib inhibits these proteins ALL cells die. In the laboratory, volasertib has been
shown to increase activity of vincristine against ALL cells. Therefore, we think the
combination of volasertib and VSLI will be more effective against your leukemia than either
drug used alone. This study will try to find out what effects, good and/or bad, this drug
combination has on the patient and their cancer, and to find a dose that may be used in
future studies.
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the maximum tolerated dose (MTD) of the combination of volasertib and
vincristine sulfate liposomal injection (VSLI) in relapsed/refractory (RR) acute
lymphoblastic leukemia (ALL).
SECONDARY OBJECTIVES:
I. To determine the toxicity profile of volasertib and VSLI, rate of complete remission (with
or without complete hematologic recovery; complete response [CR]/CR with incomplete
hematologic recovery [CRi]), duration of remission (DOR), rate of minimal residual disease
(MRD)-negativity, progression free survival (PFS), overall survival (OS), 30-day mortality
rate.
TERTIARY OBJECTIVES:
I. To determine if volasertib and polo-like kinase (plk)-inhibition down-regulates the
mammalian target of rapamycin (mTOR) pathway.
II. Whether plk and mTOR inhibition correlates with clinical response to treatment. III. to
determine if volasertib acts synergistically to potentiate the bioavailability and
distribution of VSLI.
OUTLINE: This is a dose-escalation study of volasertib.
Patients receive volasertib intravenously (IV) over 1 hour on day 1 and vincristine sulfate
liposome IV over 1 hour on days 1, 8, 15, and 22. Treatment repeats every 28 days for up to
12 courses in the absence of disease progression, development of an inter-current illness
that prevents further administration of treatment, unacceptable toxicity, patient decides to
withdraw or treating investigator determines that the patient should be taken off treatment
for any reason.
After completion of study, patients are followed up every 28 days for up to 1 year.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (volasertib, vincristine sulfate liposome) | Experimental | Patients receive volasertib IV over 1 hour on day 1 and vincristine sulfate liposome IV over 1 hour on days 1, 8, 15, and 22. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression, development of an inter-current illness that prevents further administration of treatment, unacceptable toxicity, patient decides to withdraw or treating investigator determines that the patient should be taken off treatment for any reason. | - Vincristine Sulfate Liposome
- Volasertib
|
Eligibility Criteria
Inclusion Criteria:
- Patients must have histologically confirmed diagnosis of Philadelphia-negative ALL by
bone marrow biopsy or aspirate
- Patients must have >= 5% blasts in the bone marrow
- Patients must have refractory disease, disease relapse or progression after at least
two prior systemic chemotherapy or immunotherapy regimens
- Note: Exceptions may be made if a patient is deemed unfit for first-line salvage
therapy by the treating physician; such cases should be clearly documented
- Patients with a history of CNS (central nervous system) leukemia are eligible if they
are not symptomatic from current CNS involvement; if there is CNS involvement that is
known prior to enrollment or identified subsequently, it will be treated accordingly
with intrathecal chemotherapy per the treating physician
- Patients must exhibit an Eastern Cooperative Oncology Group (ECOG) performance status
of =< 2
- Patients must have adequate organ function within 14 days prior to registration, as
defined below:
- Total bilirubin =< 2 x institutional upper limit of normal (ULN)
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT])/aspartate aminotransferase (ALT) (serum glutamic pyruvic transaminase [SPGT])
=< 3 x ULN
- Creatinine =< 2 X ULN
- Females of child-bearing potential (FOCBP) and males must agree to use adequate
contraception (hormonal or barrier method of birth control; abstinence) prior to study
entry, for the duration of study participation, and for 6 months following completion
of therapy; should a female patient become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately
- NOTE: A FOCBP is any woman (regardless of sexual orientation, having undergone a
tubal ligation, or remaining celibate by choice) who meets the following
criteria:
- Has not undergone a hysterectomy or bilateral oophorectomy
- Has had menses at any time in the preceding 12 consecutive months (and
therefore has not been naturally postmenopausal for > 12 months)
- FOCBP must have a negative pregnancy test within 14 days prior to registration on
study
- Patients must have the ability to understand and the willingness to sign a written
informed consent prior to registration on study
Exclusion Criteria:
- Patients who have had chemotherapy, immunotherapy, or radiotherapy within 2 weeks
prior to entering the study or those who have not recovered from adverse events (=<
grade 1 or patient's baseline) due to agents administered more than 2 weeks earlier
are not eligible
- Patients may not be receiving any other investigational agents within 7 days of
registration
- Patients may not be receiving any medications that are known to prolong QT interval
unless reviewed and approved by the principal investigator (PI)
- Patients who have a history of allergic reactions attributed to compounds of similar
chemical or biologic composition to volasertib or VSLI are not eligible
- Subject may not have had hematopoietic stem cell transplant (HSCT) meeting any of the
following:
- Is within 2 months of transplant from cycle 1 day 1 (C1D1)
- Has clinically significant graft-versus-host disease requiring treatment
- Has >= grade 2 persistent non-hematological toxicity related to the transplant
- Donor lymphocyte infusion (DLI) is not permitted < 30 days prior to study
registration
- Patients with >= grade 2 sensory or motor neuropathy are not eligible
- Fridericia's corrected QT (QTcF) prolongation > 470 ms or QT prolongation deemed
clinically relevant by the investigator (e.g., congenital long QT syndrome); the QTcF
will be calculated as the mean of the 3 electrocardiograms (ECGs) taken at screening
- NOTE: The formula used to calculate QTcF can be physician's choice, but it must
be used consistently throughout the study
- Patients who have an uncontrolled intercurrent illness including, but not limited to
any of the following, are not eligible:
- Ongoing or active infection requiring systemic treatment
- Symptomatic congestive heart failure (>= class 3)
- Unstable angina pectoris
- Cardiac arrhythmia
- Psychiatric illness/social situations that would, in the investigator's opinion,
limit compliance with study requirements
- Known human immunodeficiency virus (HIV) infection
- Known John Cunningham virus (JC) virus infection and/or progressive multifocal
leukoencephalopathy (PML)
- Known clinically active hepatitis A, B, or C infections
- NOTE: Patients with chronic hepatitis C virus (HCV) or hepatitis B virus
(HBV) infection may enroll if other laboratory criteria are met; those with
HBV surface antigen positivity may enroll only if maintained on appropriate
suppressive antiviral therapy for the duration of enrollment in the trial
- Second malignancy that requires active treatment
- Any other illness or condition that the treating investigator feels would
interfere with study compliance or would compromise the patient's safety or study
endpoints
- Female patients who are pregnant or nursing are not eligible
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Maximum Tolerated Dose (MTD) |
Time Frame: | Up to day 1 of cycle 2 |
Safety Issue: | |
Description: | Determine the MTD of volasertib and VSLI in RR ALL, the MTD will be defined as the highest dose level at which ≤ 1 Dose-Limiting Toxicity (DLT) occurs in 6 patients and will be assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. |
Secondary Outcome Measures
Measure: | Rate of complete remission (CR/Cri) |
Time Frame: | After every 2 even number cycles during treatment then every 28 days up to 1 year during follow-up |
Safety Issue: | |
Description: | Evaluate the rate of complete remission (with or without complete hematologic recovery; CR/CRi). Rates will be based on the number and percentage of patients that achieve a CR/CRi. Response will be assessed by bone marrow biopsy and blood counts. |
Measure: | Duration of Remission (DOR) |
Time Frame: | Up to 1 year from end of treatment |
Safety Issue: | |
Description: | DOR will be defined from the time, measured in months, of CR or CRi until disease progression. |
Measure: | Minimal Residual Disease (MRD-negativity) rate |
Time Frame: | Up to 1 year |
Safety Issue: | |
Description: | The rate of MRD-negativity will be assessed in bone marrow mononuclear cells by multi-color flow cytometry analysis. |
Measure: | Progression Free Survival (PFS) |
Time Frame: | Up to 1 year from end of treatment |
Safety Issue: | |
Description: | PFS will be defined as the time from treatment initiation until disease progression. |
Measure: | Overall Survival (OS) |
Time Frame: | Up to 1 year from end of treatment |
Safety Issue: | |
Description: | OS is defined as the time from treatment initiation until death from any cause. |
Measure: | 30-day mortality rate |
Time Frame: | Up to 30 days from the first dose of treatment |
Safety Issue: | |
Description: | Evaluated as the number of patients deceased within the first 30 days from the first dose of treatment. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Withdrawn |
Lead Sponsor: | Northwestern University |
Last Updated
December 15, 2016