Clinical Trials /

CX-01 Combined With Azacitidine in the Treatment of Relapsed or Refractory Myelodysplastic Syndrome and Acute Myeloid Leukemia

NCT02995655

Description:

The investigators hypothesize that CX-01 will disrupt the bone marrow microenvironment and increase the cytotoxic effects of azacitidine on myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) hematopoietic stem cells by disrupting the High-mobility group box protein 1 (HMGB1) interaction with toll-like receptor 4 (TLR4) and receptors for advanced glycation end products (RAGE), the CXC chemokine CXCL12/chemokine receptor 4 (CXCR4) axis, and by disrupting other leukocyte and vascular adhesion molecules. In addition, CX-01 may also help promote count recovery after treatment given its affinity for platelet factor-4 (PF4). The selection of CX-01 dose for study in relapsed or refractory MDS and AML has been based upon the dual requirements to have sufficient drug administered to have potential activity but without clinically significant anticoagulation. The study dose chosen (4 mg/kg bolus followed by 0.25 mg/kg/hour) fulfills both of these criteria. In addition, this dose is expected to result in serum levels of CX-01 which are significantly higher than the IC90 identified in preclinical studies for inhibition of HMGB1-RAGE, toll-like receptor 2 (TLR2) and TLR4 interaction. Therefore, the chosen dose represents a rational balance between effective dosing and safety in thrombocytopenic patients with MDS and AML. This dose was previously established to be safe and tolerable when combined with cytarabine and idarubicin in patients with AML.

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

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: CX-01 Combined With Azacitidine in the Treatment of Relapsed or Refractory Myelodysplastic Syndrome and Acute Myeloid Leukemia
  • Official Title: A Pilot Study of CX-01 Combined With Azacitidine in the Treatment of Relapsed or Refractory Myelodysplastic Syndrome and Acute Myeloid Leukemia

Clinical Trial IDs

  • ORG STUDY ID: 201608032
  • SECONDARY ID: CNTX-CX-01-2016-MDS-1
  • NCT ID: NCT02995655

Conditions

  • Myelodysplastic Syndromes
  • Acute Myeloid Leukemia
  • AML
  • MDS

Interventions

DrugSynonymsArms
CX-012-O, 3-O desulfated heparin, ODSHCX-01 + Azacitidine
AzacitidineVidaza®, LadakamycinCX-01 + Azacitidine

Purpose

The investigators hypothesize that CX-01 will disrupt the bone marrow microenvironment and increase the cytotoxic effects of azacitidine on myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) hematopoietic stem cells by disrupting the High-mobility group box protein 1 (HMGB1) interaction with toll-like receptor 4 (TLR4) and receptors for advanced glycation end products (RAGE), the CXC chemokine CXCL12/chemokine receptor 4 (CXCR4) axis, and by disrupting other leukocyte and vascular adhesion molecules. In addition, CX-01 may also help promote count recovery after treatment given its affinity for platelet factor-4 (PF4). The selection of CX-01 dose for study in relapsed or refractory MDS and AML has been based upon the dual requirements to have sufficient drug administered to have potential activity but without clinically significant anticoagulation. The study dose chosen (4 mg/kg bolus followed by 0.25 mg/kg/hour) fulfills both of these criteria. In addition, this dose is expected to result in serum levels of CX-01 which are significantly higher than the IC90 identified in preclinical studies for inhibition of HMGB1-RAGE, toll-like receptor 2 (TLR2) and TLR4 interaction. Therefore, the chosen dose represents a rational balance between effective dosing and safety in thrombocytopenic patients with MDS and AML. This dose was previously established to be safe and tolerable when combined with cytarabine and idarubicin in patients with AML.

Trial Arms

NameTypeDescriptionInterventions
CX-01 + AzacitidineExperimentalCX-01 will be administered as a 5-minute bolus infusion at a dose of 4mg/kg on Day 1 of each 28-day cycle, followed by a continuous intravenous infusion at a dose of 0.25 mg/kg/hour for Days 1 through 7 of each cycle. The dose of CX-01 should be calculated based on actual body weight (kg) as measured on Day 1 of each cycle. Azacitidine will be administered as a 15-minute intravenous infusion at a dose of 75mg/m^2 on Days 1-7 of each 28-day cycle. Azacitidine dose should be calculated based on actual body weight and height to determine BSA. CX-01 may be administered before or after azacitidine, at the discretion of the treating physician. Up to 6 cycles of treatment allowed
  • CX-01
  • Azacitidine

Eligibility Criteria

        Inclusion Criteria:

          -  One of the following diagnoses:

               -  MDS with International Prostate Symptom Score (IPSS) score of INT-1 or higher and
                  one of the following:

                    -  Symptomatic anemia with either hemoglobin < 10.0 g/dL or requiring red blood
                       cell (RBC) transfusion

                    -  Thrombocytopenia with a history of two or more platelet counts < 50,000/µL
                       or a significant hemorrhage requiring platelet transfusions

                    -  Neutropenia with two or more absolute neutrophil count (ANC) < 1,000/µL

               -  Non-M3 AML

          -  Prior treatment with ≥ 4 cycles of a hypomethylating agent (decitabine or azacitidine)
             without response OR documented disease progression on or after hypomethylating agent
             therapy

          -  Age ≥ 18 years old

          -  Adequate renal and hepatic function defined as all of the following:

               -  total bilirubin ≤ 1.5 x upper limit of normal (ULN), except in cases of Gilbert's
                  disease

               -  aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x ULN

               -  serum creatinine < 2.0 x ULN

          -  Peripheral blood blast count < 10,000/ µL.

          -  Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2

          -  Females must be surgically or biologically sterile or postmenopausal or, if of
             childbearing potential, must agree to use an adequate method of contraception during
             the study until 30 days after the last treatment. Males must be surgically or
             biologically sterile or agree to use an adequate method of contraception during the
             study until 30 days after the last treatment.

          -  Ability to understand and willingness to sign an IRB approved written informed consent
             document (or that of legally authorized representative, if applicable).

        Exclusion Criteria:

          -  Prior allogeneic stem cell transplant

          -  Central nervous system (CNS) leukemia

          -  Diagnosed with AML and eligible for standard induction chemotherapy or stem cell
             transplantation.

          -  At an increased risk of hemorrhage.

          -  Known allergies, hypersensitivity, or intolerance to any form of heparin or
             azacitidine

          -  Presence of significant active bleeding or condition requiring maintenance of a
             platelet count > 50,000/µL

          -  Presence of any condition requiring any form of anticoagulant therapy (heparin flushes
             for IV catheter are permitted)

          -  Receiving concomitant chemotherapy, radiation therapy, or immunotherapy during the
             duration of treatment on protocol, or within 21 days prior to enrollment

          -  Known seropositivity for or active viral infection with human immunodeficiency virus
             (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients who are
             seropositive because of hepatitis B virus vaccine are eligible.

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac
             arrhythmia

          -  Pregnant and/or breastfeeding. Women of childbearing potential must have a negative
             pregnancy test within 28 days of study entry.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall response rate (partial response or higher)
Time Frame:30 days following completion of treatment (estimated to be 28 weeks)
Safety Issue:
Description:Overall response rate = the percentage of patients obtaining partial response or higher Patients will be assessed for response according to modified International Working Group (IWG) criteria

Secondary Outcome Measures

Measure:Progression-free survival (PFS)
Time Frame:Up to 5 years
Safety Issue:
Description:The interval from the date of first dose of study drug to disease progression or death. Described by median time-to-event and a 95% confidence interval, if estimable, using Kaplan-Meier models
Measure:Disease-free survival (DFS)
Time Frame:Up to 5 years
Safety Issue:
Description:The interval from the date of first documentation of a CR to date of recurrence or death. This is determined only for patients achieving a CR Described by median time-to-event and a 95% confidence interval, if estimable, using Kaplan-Meier models
Measure:Overall survival (OS)
Time Frame:Up to 5 years
Safety Issue:
Description:The date of first dose of study drug to the date of death from any cause. Described by median time-to-event and a 95% confidence interval, if estimable, using Kaplan-Meier models
Measure:Safety and tolerability of regimen as measured by adverse events tabulated by patient
Time Frame:30 days following completion of therapy (estimated to be 28 weeks)
Safety Issue:
Description:-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 will be utilized for all toxicity reporting.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Washington University School of Medicine

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