This study is a multicenter, open-label, nonrandomized, sequential group, dose-escalation
study to assess safety, tolerability, pharmacokinetics and preliminary anti-tumor activity of
ascending doses of AZD5991 in subjects with relapsed or refractory hematologic malignancies.
Part 1 of the study is monotherapy dose escalation. Part 2 of the study is monotherapy
expansion groups for relapsed/refractory chronic lymphocytic leukaemia (CLL), AML/
myelodysplastic syndromes (MDS), and multiple myeloma (MM) Part 3 is a sequential,
dose-escalation study of the combination of AZD5991 and venetoclax in subjects with
- Provision of signed and dated, written informed consent prior to any study-specific
procedures, sampling and analyses.
- Men and women 18 to 85 years of age, inclusive.
- Diagnosis of any of the following hematologic malignancies:
- non-Hodgkin lymphoma
- Richter syndrome
- Chronic lymphocytic leukemia/small lymphocytic lymphoma (SLL)
- T-cell lymphoma
- multiple myeloma (MM)
- Acute Myeloid Leukemia (AML)
- Acute Lymphocytic Leukemia (ALL)
- Myelodysplastic Syndrome (MDS)
- Eastern Cooperative Oncology Group (ECOG) performance status of ≤2.
- Must have received at least 2 prior lines of therapy for the treatment of current
histology; there are no treatment options available known to provide clinical benefit.
Refer to National Comprehensive Cancer Network (NCCN) guidelines of each respective
histology for guidance.
- Women should be using adequate contraceptive measures, should not be breast feeding
and must have a negative pregnancy test before start of dosing if of child-bearing
potential or must have evidence of nonchildbearing potential.
- Men should be willing to use barrier contraception (ie, condoms) and refrain from
sperm donation during and after the conduct of the trial.
Inclusion criteria for expansion cohorts in CLL and MM (Part 2 only):
- To be eligible for the CLL expansion cohort, subjects must have received at least 2
prior lines of therapy for CLL including a Bruton tyrosine kinase (BTK) inhibitor and
- To be eligible for the MM expansion cohort, subjects must have received at least 2
prior lines of therapy for MM including an immunomodulatory agent (eg, lenalidamide),
a proteasome inhibitor and daratumumab.
Inclusion for AZD5991+venetoclax:
- Must have received at least 2 prior lines of therapy for the treatment of AML or MDS;
there are no treatment options available known to provide clinical benefit. Refer to
National Comprehensive Cancer Network (NCCN) guidelines.
- Documented active disease requiring treatment per respective NCCN guideline that is
relapsed or refractory defined as:
- Recurrence of disease after response to prior line(s) of therapy.
- Or progressive disease after completion of the treatment regimen preceding entry into
- WBC ≤25,000 cells/mm3 (25 x 109/L); use of leukapheresis or hydroxyurea before study
drug initiation is allowed to achieve this entry criterion.
- Adequate hepatic and renal function at screening defined as:
- Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤3.0 x upper
limit of normal (ULN).
- Bilirubin ≤1.5 x ULN (unless bilirubin rise is due to Gilbert's syndrome or of
- Serum creatinine ≤1.5 times ULN and creatinine clearance ≥50 mL/min (measured or
calculated by Cockcroft and Gault equation [(140-Age) • Mass (kg)/(72 • creatinine
mg/dL) • multiply by 0.85 if female]).
- Lipase ≤1.5 x ULN and serum amylase ≤1.5 x ULN and no history of pancreatitis.
- Treatment with any of the following:
- Any investigational agents from a previous clinical study within 4 half-lives of
said prior investigational agent(s) with regard to the first dose of study
treatment on this protocol. Washout period not required in subjects with
aggressive disease who require treatment sooner.
- Any other chemotherapy, immunotherapy or anticancer agents within 2 weeks of the
first dose of study treatment. Washout period not required in subjects with
aggressive disease who require treatment sooner.
- Any hematopoietic growth factors (eg, filgrastim [granulocyte colony-stimulating
factor; G-CSF], sargramostin [granulocyte-macrophage colony-stimulating factor;
GM-CSF]) within 7 days of the first dose of study drug or pegylated G-CSF
(pegfilgrastim) or darbepoetin within 14 days of the first dose of study drug.
- Major surgery (excluding placement of vascular access) within 4 weeks of the first
dose of study treatment.
- Except for alopecia, any unresolved toxicities from prior therapy greater than CTCAE
Grade 1 at the time of starting study treatment.
- Presence of, or history of, central nervous system (CNS) lymphoma, leptomeningeal
disease or spinal cord compression.
- As judged by the Investigator, any evidence of severe or uncontrolled systemic disease
(eg, severe hepatic impairment, interstitial lung disease [bilateral, diffuse,
parenchymal lung disease]), or current unstable or uncompensated respiratory or
cardiac conditions, or uncontrolled hypertension, history of, or active, bleeding
diatheses (eg, hemophilia or von Willebrand disease) or uncontrolled active systemic
fungal, bacterial, viral, or other infection (defined as exhibiting ongoing
signs/symptoms related to the infection and without improvement, despite appropriate
antibiotics or other treatment), or intravenous anti-infective treatment within 2
weeks before first dose of study drug.
Exclusion AZD5991 + venetoclax
- AML with known active central nervous system involvement.
- Malabsorption syndrome or other condition that precludes enteral route of
- Chronic respiratory disease that requires continuous oxygen use.
- Known diagnosis of a hypercoagulable disorder other than malignancy
- High risk of developing renal impairment, per investigator discretion.
- Hyperuricemia (defined as uric acid above laboratory normal range) present at
screening or hyperphosphatemia (defined as phosphate/phosphorus levels above
laboratory normal range) present at screening.
- Any of the following cardiac criteria:
- Mean resting corrected QT interval (QTcF) ≥ 450 msec obtained from 3
- Any clinically important abnormalities in rhythm, conduction or morphology of
resting ECG eg, complete left bundle branch block, third degree heart block
- Any factors that increase the risk of QTc prolongation or risk of arrhythmic
events such as heart failure, hypokalaemia, congenital long QT syndrome, family
history of long QT syndrome or unexplained sudden death under 40 years of age.
Concomitant medications known to prolong QTc should be used with caution and
cannot be used starting with the first dose of study drug and through the DLT
- Abnormal echocardiogram (ECHO) or multi-gated acquisition scan (MUGA) at baseline
(left ventricular ejection fraction [LVEF] <40%). Appropriate correction to be
used, if a MUGA is performed.
- History of severe allergic or anaphylactic reactions to BH3 mimetics or history of
hypersensitivity to active or inactive excipients of AZD5991.
- Received the following within 7 days before initiation of venetoclax:
- Strong or moderate cytochrome P450 3A (CYP3A) inducers
- Strong or moderate CYP3A inhibitors
- Pg-P inhibitors
- Consumed grapefruit, grapefruit products, Seville oranges (including marmalade
containing Seville oranges) or star fruit within 3 days before the initiation of