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A Study of Venetoclax in Combination With Azacitidine Versus Azacitidine in Treatment Naïve Subjects With Acute Myeloid Leukemia Who Are Ineligible for Standard Induction Therapy

NCT02993523

Description:

Acute Myeloid Leukaemia (AML) is an aggressive and rare cancer of myeloid cells (a white blood cell responsible for fighting infections). Successful treatment of AML is dependent on what subtype of AML the participant has, and the age of the participant when diagnosed. Venetoclax is an experimental drug that kills cancer cells by blocking a protein (part of a cell) that allows cancer cells to stay alive. This study is designed to see if adding venetoclax to azacitidine works better than azacitidine on its own. This is a Phase 3, randomized, double-blind (treatment is unknown to participants and doctors), placebo controlled study in patients with AML who are >= 18 or more years old and have not been treated before. Participants who take part in this study should not be suitable for standard induction therapy (usual starting treatment). AbbVie is funding this study which will take place at approximately 180 hospitals globally and enroll approximately 400 participants. In this study, 2/3 of participants will receive venetoclax every day with azacitidine and the remaining 1/3 will receive placebo (dummy) tablets with azacitidine. Participants will continue to have study visits and receive treatment for as long as they are having a clinical benefit. The effect of the treatment on AML will be checked by taking blood, bone marrow, scans, measuring side effects and by completing health questionnaires. Blood and bone marrow tests will be completed to see why some people respond better than others. Additional blood tests will be completed for genetic factors and to see how long the drug remains in the body.

Related Conditions:
  • Acute Myeloid Leukemia
Recruiting Status:

Active, not recruiting

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: A Study of Venetoclax in Combination With Azacitidine Versus Azacitidine in Treatment Naïve Subjects With Acute Myeloid Leukemia Who Are Ineligible for Standard Induction Therapy
  • Official Title: A Randomized, Double-Blind, Placebo Controlled Phase 3 Study of Venetoclax in Combination With Azacitidine Versus Azacitidine in Treatment Naïve Subjects With Acute Myeloid Leukemia Who Are Ineligible for Standard Induction Therapy

Clinical Trial IDs

  • ORG STUDY ID: M15-656
  • SECONDARY ID: 2016-001466-28
  • NCT ID: NCT02993523

Conditions

  • Acute Myeloid Leukemia (AML)

Interventions

DrugSynonymsArms
AzacitidineVenetoclax followed by Azacitidine
VenetoclaxABT-199Venetoclax followed by Azacitidine
PlaceboPlacebo followed by Azacitidine

Purpose

Acute Myeloid Leukaemia (AML) is an aggressive and rare cancer of myeloid cells (a white blood cell responsible for fighting infections). Successful treatment of AML is dependent on what subtype of AML the patient has, and the age of the patient when diagnosed. Venetoclax is an experimental drug that kills cancer cells by blocking a protein (part of a cell) that allows cancer cells to stay alive. This study is designed to see if adding venetoclax to azacitidine works better than azacitidine on its own. This is a Phase 3, randomized, double-blind (treatment is unknown to patients and doctors), placebo controlled study in patients with AML who are >= 18 or more years old and have not been treated before. Patients who take part in this study should not be suitable for standard induction therapy (usual starting treatment). AbbVie is funding this study which will take place at approximately 180 hospitals globally and enroll approximately 400 patients. In this study, 2/3 of patients will receive venetoclax every day with azacitidine and the remaining 1/3 will receive placebo (dummy) tablets with azacitidine. Patients will continue to have study visits and receive treatment for as long as they are having a clinical benefit. The effect of the treatment on AML will be checked by taking blood, bone marrow, scans, measuring side effects and by completing health questionnaires. Blood and bone marrow tests will be completed to see why some people respond better than others. Additional blood tests will be completed for genetic factors and to see how long the drug remains in the body.

Trial Arms

NameTypeDescriptionInterventions
Placebo followed by AzacitidinePlacebo ComparatorMatching Placebo for Venetoclax 400 mg orally QD on Days 1 - 28 plus Azacitidine 75 mg/m^2 SC or IV QD on Days 1 - 7 (28-day cycle)
  • Azacitidine
  • Placebo
Venetoclax followed by AzacitidineActive ComparatorVenetoclax 400 mg orally every day (QD) on Days 1 - 28 plus Azacitidine 75 mg/m^2 subcutaneously (SC) or intravenous (IV) QD on Cycle Days 1 - 7 (28-day cycle)
  • Azacitidine
  • Venetoclax

Eligibility Criteria

        Inclusion Criteria:

          -  Participant must have confirmation of Acute Myeloid Leukemia (AML) by World Health
             Organization (WHO) criteria, previously untreated and be ineligible for treatment with
             a standard cytarabine and anthracycline induction regimen due age or comorbidities.

          -  Participant must be >= 18 years of age.

          -  Participant must have a projected life expectancy of at least 12 weeks.

          -  Participant must be considered ineligible for induction therapy defined by the
             following:

             a. >= 75 years of age; or b. >= 18 to 74 years of age with at least one of the
             following comorbidities: i. Eastern Cooperative Oncology Group (ECOG) Performance
             Status of 2 or 3; ii. Cardiac history of Congestive Heart Failure (CHF) requiring
             treatment or Ejection Fraction <= 50% or chronic stable angina; iii. Diffusing
             capacity of the Lung for Carbon Monoxide (DLCO) <= 65% or Forced Expiratory Volume in
             1 second (FEV1) <= 65%; iv. Creatinine clearance >= 30 mL/min to < 45 ml/min; v.
             Moderate hepatic impairment with total bilirubin > 1.5 to <= 3.0 × Upper Limit of
             Normal (ULN); vi. Any other comorbidity that the physician judges to be incompatible
             with intensive chemotherapy must be reviewed and approved by the AbbVie Therapeutic
             Medical Director during screening and before study enrollment.

          -  Participant must have an ECOG Performance status:

               1. 0 to 2 for Participants >= 75 years of age or

               2. 0 to 3 for Participants >= 18 to 74 years of age.

          -  Participant must have adequate renal function as demonstrated by a creatinine >= 30
             mL/min; calculated by the Cockroft Gault formula or measured by 24 hours urine
             collection.

          -  Participant must have adequate liver function as demonstrated by:

               1. aspartate aminotransferase (AST) <= 3.0 x ULN*

               2. alanine aminotransferase (ALT) <= 3.0 x ULN*

               3. bilirubin <= 1.5 x ULN* * Unless considered to be due to leukemic organ
                  involvement

             i. Subjects who are < 75 years of age may have a bilirubin of <= 3.0 x ULN

          -  Female participants must be either postmenopausal defined as:

               1. Age > 55 years with no menses for 12 or more months without an alternative
                  medical cause.

               2. Age ≤ 55 years with no menses for 12 or more months without an alternative
                  medical cause AND an FSH level > 40 IU/L; or

               3. Permanently surgical sterile (bilateral oophorectomy, bilateral salpingectomy or
                  hysterectomy); or

               4. Women of Childbearing Potential (WOCBP) practicing at least one protocol
                  specified method of birth control, starting at Study Day 1 through at least 90
                  days after the last dose of study drug.

          -  Male Participants who are sexually active, must agree, from Study Day 1 through at
             least 90 days after the last dose of study drug, to practice the protocol specified
             contraception. Male subjects must agree to refrain from sperm donation from initial
             study drug administration through at least 90 days after the last dose of study drug.

          -  Female participants of childbearing potential must have negative results for pregnancy
             test performed:

               1. At Screening with a serum sample obtained within 14 days prior to the first study
                  drug administration, and

               2. Prior to dosing with urine sample obtained on Cycle 1 Day 1, if it has been > 7
                  days since obtaining the serum pregnancy test results.

          -  Participant must voluntarily sign and date an informed consent, approved by an
             Independent Ethics Committee (IEC)/Institutional Review Board (IRB), prior to the
             initiation of any screening or study-specific procedures.

        Exclusion Criteria:

          -  Participant has received treatment with the following:

               1. A hypomethylating agent, venetoclax and/or chemo therapeutic agent for
                  Myelodysplastic syndrome (MDS).

               2. Chimeric Antigen Receptor (CAR)-T cell therapy.

               3. Experimental therapies for MDS or Acute Myeloid Leukemia (AML).

               4. Current participation in another research or observational study.

          -  Participant has history of myeloproliferative neoplasm (MPN) including myelofibrosis,
             essential thrombocythemia, polycythemia vera, chronic myeloid leukemia (CML) with or
             without BCR-ABL1 translocation and AML with BCR-ABL1 translocation.

          -  Participant has the following:

             a. Favorable risk cytogenetics such as t(8;21), inv(16) or t(16;16) or t(15;17) as per
             the National Comprehensive Cancer Network (NCCN) Guidelines Version 2, 2016 for Acute
             Myeloid Leukemia.

          -  Participant has acute promyelocytic leukemia

          -  Participant has known active central nervous system (CNS) involvement with AML.

          -  Participant has known HIV infection (due to potential drug-drug interactions between
             antiretroviral medications and venetoclax) HIV testing will be performed at Screening,
             only if required per local guidelines or institutional standards.

          -  Participant is known to be positive for hepatitis B or C infection [HCV Ab indicative
             of a previous or current infection; and/or positive HBs Ag or detected sensitivity on
             HBV DNA PCR test for HBc Ab and/or HBs Ab positivity] with the exception of those with
             an undetectable viral load within 3 months screening. Hepatitis B or C testing is not
             required.

          -  Participant has received strong and/or moderate CYP3A inducers within 7 days prior to
             the initiation of study treatment; additional details as described in the protocol.

          -  Participant has consumed grapefruit, grapefruit products, Seville oranges (including
             marmalade containing Seville oranges) or Starfruit within 3 days prior to the
             initiation of study treatment.

          -  Participant has a cardiovascular disability status of New York Heart Association Class
             > 2. Class 2 is defined as cardiac disease in which patients are comfortable at rest
             but ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal
             pain.

          -  Participant has chronic respiratory disease that requires continuous oxygen, or
             significant history of renal, neurologic, psychiatric, endocrinologic, metabolic,
             immunologic, hepatic, cardiovascular disease, any other medical condition or known
             hypersensitivity to any of the study medications including excipients of azacitidine
             that in the opinion of the investigator would adversely affect his/her participating
             in this study.

          -  Participant has a malabsorption syndrome or other condition that precludes enteral
             route of administration.

          -  Participant exhibits evidence of other clinically significant uncontrolled systemic
             infection requiring therapy (viral, bacterial or fungal).

          -  Participant has a history of other malignancies within 2 years prior to study entry,
             with the exception of:

               1. Adequately treated in situ carcinoma of the cervix uteri or carcinoma in situ of
                  breast;

               2. Basal cell carcinoma of the skin or localized squamous cell carcinoma of the
                  skin;

               3. Previous malignancy confined and surgically resected (or treated with other
                  modalities) with curative intent; requires discussion with TA MD.

          -  Participant has a white blood cell count > 25 × 10^9/L. (Hydroxyurea or leukapheresis
             are permitted to meet this criterion.)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall survival (OS)
Time Frame:Measured up to 2 years after the last participant is randomized
Safety Issue:
Description:OS is defined as the number of days from the date of randomization to the date of death.

Secondary Outcome Measures

Measure:Event-free survival (EFS)
Time Frame:Measured up to 2 years after the last participant is randomized
Safety Issue:
Description:EFS will be defined as the number of days from randomization to the date of progressive disease, relapse from CR or CRi, treatment failure or death from any cause.
Measure:Global health status/quality of life (GHS/QoL)
Time Frame:Measured at participant's Day 1 of Cycle 1 (each cycle is 28 days) and at Day 1 of every Cycle thereafter for up to 2 years following the last subject last visit
Safety Issue:
Description:Improvement in GHS/QoL will be assessed using the Patient Reported Outcomes Measurement Information System (PROMIS) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30).
Measure:Proportion of participants achieving composite complete remission (CR or CRi)
Time Frame:Up to 6 months after the first 225 subjects are randomized
Safety Issue:
Description:This will be calculated based on current International Working Group (IWG) criteria. CR is defined as absolute neutrophil count > 10^3/mcL, platelets >= 10^5/mcL, red cell transfusion independence, and bone marrow with < 5% blasts. CRi is defined as bone marrow with less than 5% blasts, and absolute neutrophils of < 10^3/mcL or platelets < 10^5/mcL.
Measure:Complete remission or complete remission with partial hematologic recovery rate (CR+CRh)
Time Frame:Measured up to 2 years after the last participant is randomized
Safety Issue:
Description:A response of CRh is defined as Bone marrow with <5% blasts, peripheral blood neutrophil count >0.5*10^3/mcL and peripheral blood platelet count >0.5*10^5/mcL.
Measure:Post baseline transfusion independence rate
Time Frame:Measured up to 2 years after the last participant is randomized
Safety Issue:
Description:Transfusion Independence is defined as a period of 56 days with no transfusion between first dose of study drug and the last dose of study drug + 30 days.
Measure:Complete remission (CR) rate
Time Frame:Measured up to 2 years after the last participant is randomized
Safety Issue:
Description:The proportion of subjects with complete remission (CR) will be calculated based on the modified IWG criteria for AML.
Measure:Fatigue/quality of life (QoL)
Time Frame:Measured at participant's Day 1 of Cycle 1 (each cycle is 28 days) and at Day 1 of every Cycle thereafter for up to 2 years following the last subject last visit
Safety Issue:
Description:Fatigue QoL will be assessed using the Patient Reported Outcomes Measurement Information System (PROMIS) and Cancer Fatigue Short Form (SF) 7a global fatigue score

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:AbbVie

Trial Keywords

  • Acute Myeloid Leukemia
  • Venetoclax
  • Treatment Naïve
  • Azacitidine

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