This is a phase I study designed to assess the maximum tolerated dose (MTD) of pyrimethamine and provide the recommended Phase 2 dose (RP2D) for the treatment of intermediate/high-risk MDS that is refractory to or relapsed after treatment with azanucleosides.
Recruiting
Phase 1
| Drug | Synonyms | Arms |
|---|---|---|
| Pyrimethamine | Daraprim | Pyrimethamine Treatment (Intra-patient) |
The objective of this study is to determine the safety, dose tolerance, pharmacokinetics and
pharmacodynamics of pyrimethamine in intermediate / high-risk / relapsed or
azanucleoside-refractory MDS within the confines of a phase I study.
Pyrimethamine self-administered by participants orally once per day in morning with food.
Phase 1 study will start at dose of 50 mg once per day. (NOTE: For participants at dose level
of 50mg, the dose reduction, if needed is 25 mg.)
Intra-patient dose escalation is permitted (not beyond the highest dose allowed) if Complete
Remission/Response (CR) is not reached in week 1 of Cycle 3 and there is no significant
toxicity. (NOTE: In this study, the term "intra-patient" indicates within each participant
and not between different participants; i.e., dose escalation will be done within each
individual participant.) The decision to escalate intra-patient doses will be based on safety
and dose tolerance assessments made at the end of one treatment cycle (28 days of continuous
drug administration) for all 6 participants. Dose-limiting toxicity (DLT) is defined as the
occurrence of two consecutive grade 2 or 3 serious adverse events (SAEs) not recovered within
24 hours at a given dose. MTD will be defined as the dose where no DLT is observed among
three consecutive participants, or no more than one DLT among six participants. Participants
will be treated initially for one 28-day cycle followed by a toxicity evaluation - Toxicity
and adverse effect assessments will be made on Day 1 and Day 28 of every cycle of therapy.
| Name | Type | Description | Interventions |
|---|---|---|---|
| Pyrimethamine Treatment (Intra-patient) | Experimental | 50mg/100mg/150mg once daily on days 1-28 of each 28-day cycle. Administered using intra-patient dose escalation, starting at 50 mg and up to 150 mg. |
|
Inclusion Criteria:
- Participants at or above the age of 18 years
- Diagnosis of MDS confirmed within 6 months, by review of patient chart, prior to study
entry according to WHO (World Health Organization) criteria or FAB
(French-American-British) classification
- MDS classified as intermediate-1, intermediate-2 or high risk as per the International
Prognostic Scoring System-Revised (IPSS-R) score with a confirmed diagnosis of MDS
with cytogenetic abnormalities at diagnosis and bone marrow blast percentage between
10 and 30 percent (for patients with cytogenetic failure or dry tap)
- Potential participants must meet ONE of the following:
- Progression (according to 2006 International Working Group (IWG) criteria) at any
time after initiation of azacitidine or decitabine treatment during the past 3
years; OR
- Failure to achieve complete or partial response or hematological improvement
(according to 2006 IWG) after at least four cycles of azacitidine or decitabine
administered during the past 3 years OR
- Relapse after initial complete or partial response or hematological improvement
(according to 2006 IWG criteria) observed after at least four cycles of
azacitidine or decitabine administered during the past 3 years OR
- Intolerance to azacitidine or decitabine defined by drug-related more than or
equal to Grade 3 liver or renal toxicity leading to treatment discontinuation
during the past 3 years
- Off all other treatments for MDS for at least 3 weeks. Filgrastim (G-CSF) and
erythropoietin are allowed before and during the study as clinically indicated
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
- Willing to adhere to the prohibitions and restrictions specified in this protocol
- Patient (or patient's legally authorized representative) must signed an informed
consent document indicating that the patient understands the purpose of and procedures
required for the study and is willing to participate in the study
- Adequate organ and marrow function as defined in the protocol.
- Women of child-bearing potential and men with partners of child-bearing potential 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 90
days following completion of therapy.
Exclusion Criteria:
- Current or anticipated use of other investigational agents
- Participants who have had chemotherapy or radiotherapy within 3 weeks prior to
entering the study or those who have not recovered from clinically significant adverse
events due to agents administered more than 3 weeks earlier.
- History of allergic reactions or sensitivity to pyrimethamine
- Patients with a history of folic acid deficiency, currently on folic acid replacement
therapy or a previous history of megaloblastic anemia thought related to folic acid
deficiency
- Current use or anticipated need for treatment with any medications or substances that
are inhibitors or inducers of CYP2C9.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements
- Pregnant or nursing women
| Maximum Eligible Age: | N/A |
| Minimum Eligible Age: | 18 Years |
| Eligible Gender: | All |
| Healthy Volunteers: | No |
| Measure: | Dose-limiting toxicity (DLT) |
| Time Frame: | Day 28 |
| Safety Issue: | |
| Description: | Determination of DLT to be made at the completion of each cohort. |
| Phase: | Phase 1 |
| Primary Purpose: | Interventional |
| Overall Status: | Recruiting |
| Lead Sponsor: | Montefiore Medical Center |
August 23, 2021
