Description:
The purpose of this study is to determine whether the combination of pevonedistat and
azacitidine improves event-free survival (EFS) when compared with single-agent azacitidine.
(An event is defined as death or transformation to AML in participants with MDS or CMML,
whichever occurs first, and is defined as death in participants with low-blast AML).
Title
- Brief Title: Pevonedistat Plus Azacitidine Versus Single-Agent Azacitidine as First-Line Treatment for Participants With Higher-Risk Myelodysplastic Syndromes (HR MDS), Chronic Myelomonocytic Leukemia (CMML), or Low-Blast Acute Myelogenous Leukemia (AML)
- Official Title: A Phase 3, Randomized, Controlled, Open-label, Clinical Study of Pevonedistat Plus Azacitidine Versus Single-Agent Azacitidine as First-Line Treatment for Patients With Higher-Risk Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, or Low-Blast Acute Myelogenous Leukemia
Clinical Trial IDs
- ORG STUDY ID:
Pevonedistat-3001
- SECONDARY ID:
2017-000318-40
- SECONDARY ID:
U1111-1189-8055
- SECONDARY ID:
MOH_2018-02-04_002154
- SECONDARY ID:
JapicCTI-183848
- SECONDARY ID:
NCI-2017-02059
- NCT ID:
NCT03268954
Conditions
- Myelodysplastic Syndrome
- Leukemia, Myelomonocytic, Chronic
- Leukemia, Myeloid, Acute
Interventions
Drug | Synonyms | Arms |
---|
Azacitidine | | Azacitidine |
Pevonedistat | | Azacitidine + Pevonedistat |
Purpose
The purpose of this study is to determine whether the combination of pevonedistat and
azacitidine improves event-free survival (EFS) when compared with single-agent azacitidine.
(An event is defined as death or transformation to AML in participants with MDS or CMML,
whichever occurs first, and is defined as death in participants with low-blast AML).
Detailed Description
The drug being tested in this study is called pevonedistat. Pevonedistat is being tested to
treat people with higher-risk myelodysplastic syndromes (HR MDS), chronic myelomonocytic
leukemia (CMML) and low-blast acute myelogenous leukemia (AML) as a combination treatment
with azacitidine. This study will look at the overall survival, event-free survival and
response to treatment in people who take pevonedistat and azacitidine when compared to people
who take single-agent azacitidine.
The study will enroll approximately 454 participants. Once enrolled, participants will be
randomly assigned in 1:1 ratio (by chance, like flipping a coin) to one of the two treatment
groups in 28-day treatment cycles:
- Pevonedistat 20 mg/m^2 and azacitidine 75 mg/m^2 combination
- Single-agent azacitidine 75 mg/m^2
All participants will receive azacitidine via intravenous or subcutaneous route. Participants
randomized to the combination arm will also receive pevonedistat intravenous infusion.
This multi-center trial will be conducted Spain, Belgium, Brazil, Canada, Czech Republic,
France, Germany, Israel, Italy, the United States, Australia, Greece, Japan, Mexico, Poland,
Russia, Korea, Turkey, China and United Kingdom. The overall time to participate in this
study is approximately 63 months. Participants will attend the end-of-treatment visit 30 days
after the last dose of study drug or before the start of subsequent anti-neoplastic therapy
if that occurs sooner.
Participants with HR MDS or CMML will have EFS follow-up study visits every month if their
disease has not transformed to AML and they have not started subsequent therapy. Participants
with low-blast AML will have response follow-up study visits every month until they relapse
from CR or meet the criteria for PD. All participants will enter OS follow-up (contacted
every 3 months) when they have confirmed transformation to AML (for participants with HR MDS
or CMML at enrollment) or experienced PD (for participants with low-blast AML at study
enrollment).
Trial Arms
Name | Type | Description | Interventions |
---|
Azacitidine + Pevonedistat | Experimental | Azacitidine 75 milligram per square meter (mg/m^2), intravenous or subcutaneous, on Days 1 to 5, Days 8 and 9 and pevonedistat 20 mg/m^2, 60-minute (+/-10) infusion, intravenous, on Days 1, 3, and 5 in 28-day treatment cycles until disease progression or unacceptable toxicity. | |
Azacitidine | Experimental | Azacitidine 75 mg/m^2, intravenous or subcutaneous, on Days 1 to 5, Days 8 and 9 in 28-day treatment cycles until disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
1. Has morphologically confirmed diagnosis of myelodysplastic syndromes (MDS) or CMML
(i.e., with white blood cell [WBC] <13,000/microliter [mcL]) or low-blast acute
myelogenous leukemia (AML).
2. Has MDS or CMML and must also have one of the following Prognostic Risk Categories,
based on the Revised International Prognostic Scoring System (IPSS-R):
- Very high (>6 points).
- High (>4.5-6 points).
- Intermediate (>3-4.5 points): a participant determined to be in the Intermediate
Prognostic Risk Category is only allowable in the setting of >=5% bone marrow
myeloblasts.
3. Eastern Cooperative Oncology Group (ECOG) status of 0, 1, or 2.
4. Participants with AML (20%-30% blasts) must have a treatment-related mortality (TRM)
score >=4 for intensive, induction chemotherapy as calculated using the simplified
model described by Walter and coworkers.
Calculation of TRM score:
- 0 for (age <61 years), +2 for (age 61-70 years), +4 for (age >=71 years).
- + 0 for (PS=0), +2 for (PS=1), +4 for (PS >1).
- + 0 for (platelets <50), +1 for (platelets >=50).
Exclusion Criteria:
1. Has previous treatment for HR MDS or CMML or low-blast AML with chemotherapy or other
antineoplastic agents including hypomethylating agent (HMAs) such as decitabine or
azacitidine. Previous treatment is permitted with hydroxyurea and with lenalidomide,
except that lenalidomide may not be given within 8 weeks before the first dose of
study drug.
2. Has acute promyelocytic leukemia as diagnosed by morphologic examination of bone
marrow, by fluorescent in situ hybridization or cytogenetics of peripheral blood or
bone marrow, or by other accepted analysis.
3. Participants with AML with a WBC count >50,000/mcL. Participants who are cytoreduced
with leukapheresis or with hydroxyurea may be enrolled if they meet the eligibility
criteria.
4. Is eligible for intensive chemotherapy and/or allogeneic stem cell transplantation.
The reason a participant is not eligible for intensive chemotherapy and/or allogeneic
stem cell transplantation may consist of one or more of the following factors:
- Age >75.
- Comorbidities.
- Inability to tolerate intensive chemotherapy (e.g., participants with AML with
20%-30% blasts and TRM >=4).
- Physician decision (e.g., lack of available stem cell donor).
- The reason a participant is not eligible should be documented in the electronic
case report form (eCRF).
5. Has either clinical evidence of or history of central nervous system involvement by
AML.
6. Has active uncontrolled infection or severe infectious disease, such as severe
pneumonia, meningitis, or septicemia.
7. Is diagnosed or treated for another malignancy within 2 years before randomization or
previously diagnosed with another malignancy and have any evidence of residual
disease.
8. Has nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they
have undergone resection.
9. Has prothrombin time (PT) or aPTT >1.5× upper limit of normal (ULN) or active
uncontrolled coagulopathy or bleeding disorder. Participants therapeutically
anticoagulated with warfarin, direct thrombin inhibitors, direct factor Xa inhibitors,
or heparin are excluded from enrollment.
10. Has known human immunodeficiency virus (HIV) seropositive.
11. Has known hepatitis B surface antigen seropositive, or known or suspected active
hepatitis C infection. Note: Participants who have isolated positive hepatitis B core
antibody (i.e., in the setting of negative hepatitis B surface antigen and negative
hepatitis B surface antibody) must have an undetectable hepatitis B viral load.
12. Has known hepatic cirrhosis or severe preexisting hepatic impairment.
13. Has known cardiopulmonary disease defined as unstable angina, clinically significant
arrhythmia, congestive heart failure (New York Heart Association Class III or IV),
and/or myocardial infarction within 6 months before first dose, or severe pulmonary
hypertension.
14. Has treatment with strong cytochrome P 3A (CYP3A) inducers within 14 days before the
first dose of pevonedistat.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Event-Free Survival (EFS) |
Time Frame: | From randomization until transformation to acute myeloid leukemia, or death due to any cause : up to 6 years |
Safety Issue: | |
Description: | EFS is defined as the time from randomization to the date of an EFS event. An EFS event is defined as death or transformation to AML (World Health Organization [WHO] classification as a participant having greater than (>) 20 percent (%) blasts in the blood or marrow and an increase of blast count by 50%), whichever event occurs first, in participants with MDS or CMML. An EFS event is defined as death in participants with low-blast AML. |
Secondary Outcome Measures
Measure: | Overall Survival (OS) |
Time Frame: | From randomization until death : up to 6 years |
Safety Issue: | |
Description: | OS is calculated as the time from date of randomization to the date of death due to any cause. Participants without documented death at the time of the analysis will be censored as of the date the participant was last known to be alive. |
Measure: | Six-Month Survival Rate |
Time Frame: | Month 6 |
Safety Issue: | |
Description: | Six-month survival rate is defined as Kaplan-Meier estimate of six-month survival rate. |
Measure: | One-Year Survival Rate |
Time Frame: | Month 12 |
Safety Issue: | |
Description: | One-year survival rate is defined as Kaplan-Meier estimate of one-year survival rate. |
Measure: | Thirty-Day Survival Rate |
Time Frame: | Day 30 |
Safety Issue: | |
Description: | Thirty-day survival rate is defined as Kaplan-Meier estimate of thirty-day survival rate. |
Measure: | Sixty-Day Survival Rate |
Time Frame: | Day 60 |
Safety Issue: | |
Description: | Sixty-day survival rate is defined as Kaplan-Meier estimate of sixty-day survival rate. |
Measure: | Time to AML Transformation in HR MDS and CMML Participants |
Time Frame: | From randomization until transformation to AML : up to 6 years |
Safety Issue: | |
Description: | Time to AML transformation in HR MDS and CMML participants is defined as time from randomization to documented AML transformation. Participants who died before progression to AML will be censored. Transformation to AML is defined, according to WHO classification, as a participant having 20% blasts in the blood or marrow and increase of blast count by 50%. |
Measure: | Percentage of Participants with complete remission (CR) and complete remission with incomplete blood count recovery (CRi) |
Time Frame: | From randomization until CR and CRi : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS or CMML or low-blast AML are based on the Modified IWG Response Criteria for MDS and for low-blast AML on the Revised International Working Group (IWG) Response Criteria for AML. CR for HR MDS or CMML is defined as less than or equal to (<=) 5% myeloblasts with normal maturation of all cell lines in the bone marrow, and greater than or equal to (>=)11 grams per deciliter (g/dL) Hemoglobin (Hgb), >=100*10^9 per liter (/L) platelets (pl), >=1.0*10^9/L neutrophils and 0% blasts in peripheral blood. CR for low-blast AML: morphologic leukemia-free state, neutrophils of >1.0*10^9/L and pl of >=1.0*10^9/L, transfusion independence, and no residual evidence of extramedullary leukemia. CRi for low-blast AML is based on the Modified IWG Response Criteria for low-blast AML. Patients fulfill all the criteria for CR except for less than (<)1.0*10^9 per liter (/L) neutrophils and less than (<)1.0*10^9/L platelets). |
Measure: | Percentage of Participants with CR and Marrow CR |
Time Frame: | From randomization until CR or marrow CR : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS or CMML are based on the IWG Response Criteria for MDS and for low-blast AML on the Revised IWG Response Criteria for AML. CR for HR MDS or CMML is defined as <=5% myeloblasts with normal maturation of all cell lines in the bone marrow, and >=11 g/dL Hgb, >=100*10^9/L platelets (pl), >=1.0*10^9/L neutrophils and 0% blasts in peripheral blood. Marrow CR: Bone marrow: <=5% myeloblasts and decrease by >=50% over pretreatment. |
Measure: | Percentage of Participants with CR, partial remission (PR) and Hematologic Improvement (HI) |
Time Frame: | From randomization until, CR, PR or HI : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS/CMML based on Modified IWG Response Criteria for MDS. CR: <=5% myeloblasts with normal maturation of all bone marrow cell lines, >=11 g/dL Hgb, >=100*10^9/L pl, >=1.0*10^9/L neutrophils,0% blasts in peripheral blood. Marrow CR: Bone marrow: <=5% myeloblasts and decrease by >=50% over pretreatment. PR: all CR criteria met except bone marrow blasts >=50% decrease over pretreatment but still >5%. HI: Hgb increase (inc) >=1.5 g/dL if baseline less than (<)11 g/dL; pl inc >=30*10^9/L if baseline>20*10^9/L or inc from <20*10^9/L to >20*10^9/L and by at least 100%; neutrophil inc by 100% and absolute inc of >0.5*10^9/L if baseline <1.0*10^9/L. |
Measure: | Percentage of Participants with CR and Marrow CR and PR |
Time Frame: | From randomization until CR or Marrow CR and PR : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS/CMML based on Modified IWG Response Criteria for MDS. CR: <=5% myeloblasts with normal maturation of all bone marrow cell lines, >=11 g/dL Hgb, >=100*10^9/L pl, >=1.0*10^9/L neutrophils,0% blasts in peripheral blood. Marrow CR: Bone marrow: <=5% myeloblasts and decrease by >=50% over pretreatment. PR: all CR criteria met except bone marrow blasts >=50% decrease over pretreatment but still >5%. |
Measure: | Percentage of Participants with CR and Marrow CR, PR and Hematologic Improvement (HI) |
Time Frame: | From randomization until CR, marrow CR, PR or HI : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS/CMML based on Modified IWG Response Criteria for MDS. CR: <=5% myeloblasts with normal maturation of all bone marrow cell lines, >=11 g/dL Hgb, >=100*10^9/L pl, >=1.0*10^9/L neutrophils,0% blasts in peripheral blood. Marrow CR: Bone marrow: <=5% myeloblasts and decrease by >=50% over pretreatment. PR: all CR criteria met except bone marrow blasts >=50% decrease over pretreatment but still>5%. HI: Hgb increase (inc) >=1.5 g/dL if baseline <11 g/dL; pl inc >=30*10^9/L if baseline>20*10^9/L or inc from <20*10^9/L to >20*10^9/L and by at least 100%; neutrophil inc by 100% and absolute inc of >0.5*10^9/L if baseline <1.0*10^9/L. |
Measure: | Percentage of Participants with Overall Response (OR) |
Time Frame: | From randomization until CR and PR or CR, CRi and PR : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS/CMML based on Modified IWG Response Criteria for MDS; for low-blast AML on Revised IWG Response Criteria for AML. Overall response=CR or PR for HR MDS/CMML and CR + CRi + PR for low-blast AML. CR for HR MDS/CMML: <=5% myeloblasts with normal maturation of all bone marrow cell lines, >=11 g/dL Hgb, >=100*10^9/L pl, >=1.0*10^9/L neutrophils, 0% blasts in peripheral blood and PR: all CR criteria met except bone marrow blasts >=50% decrease over pretreatment but still>5%. For low-blast AML-CR:morphologic leukemia-free state>1.0*10^9 neutrophils, >=100*10^9/L pl, transfusion independence, no residual evidence of extramedullary leukemia; CR with incomplete blood count recovery (CRi): fulfill CR criteria except residual neutropenia <1.0*10^9/L or pl <100*10^9/L; PR: all CR hematological values but >=50% decrease in bone marrow aspirate. |
Measure: | Percentage of Participants with Overall Response 2 (OR2) |
Time Frame: | From randomization until, CR, PR or HI or CR, CRi or PR : up to 6 years |
Safety Issue: | |
Description: | Overall response 2=CR, PR or HI for HR MDS/CMML and CR, CRi or PR for low-blast AML. For HR MDS/CMML-CR: <=5% myeloblasts with normal maturation of all bone marrow cell lines, >=11 g/dL Hgb, >=100*10^9/L pl, >=1.0*10^9/L neutrophils, 0% blasts in peripheral blood; PR: all CR criteria met except bone marrow blasts >=50% decrease over pretreatment but still >5%;HI: Hgb increase (inc) >=1.5 g/dL if baseline <11 g/dL; pl inc >=30*10^9/L if baseline >20*10^9/L or inc from <20*10^9/L to >20*10^9/L and by 100%; and neutrophil inc by 100% and absolute inc of >0.5*10^9/L if baseline <100*10^9/L. For low-blast AML-CR: morphologic leukemia-free state >1.0*10^9 neutrophils, >=100*10^9/L pl, transfusion independence, no residual evidence of extramedullary leukemia; CR with incomplete blood count recovery: fulfill CR criteria except residual neutropenia <1.0*10^9/L or pl <100*10^9/L;PR: all CR hematological values but >=50% decrease in bone marrow aspirate. |
Measure: | Duration of CR |
Time Frame: | From CR until first documentation of PD or relapse from CR or relapse after CR or PR : up to 6 years |
Safety Issue: | |
Description: | Duration of CR is first documented CR to the first documentation of PD or relapse from CR (participants with low-blast AML)or relapse after CR or PR (participants with HR MDS/CMML). Disease responses for HR MDS or CMML are based on the Modified IWG Response Criteria for MDS and for low-blast AML on the Revised IWG Response Criteria for AML. CR for HR MDS or CMML is defined as <=5% myeloblasts with normal maturation of all cell lines in the bone marrow, and greater than or equal to >=11 g/dL hemoglobin (Hgb),>=100*10^9/liter (/L) platelets (pl),>=1.0*10^9/L neutrophils and 0% blasts in peripheral blood. CR for low-blast AML: morphologic leukemia-free state, neutrophils of more than 1.0*10^9/L and pl of >=100*10^9/L, transfusion independence, and no residual evidence of extramedullary leukemia. CR with incomplete blood count recovery (CRi) for low-blast AML: participants fulfill all of the criteria for CR except for residual neutropenia (<1.0*10^9/L) or thrombocytopenia (pl<100*10^9/L). |
Measure: | Duration of Overall Response (OR) |
Time Frame: | From CR or PR or CR, CRi or PR to the first documented PD or relapse from CR (in participants with low-blast AML) or relapse after CR or PR (in participants with HR MDS/CMML): up to 6 years |
Safety Issue: | |
Description: | Duration of OR: response to first documentation of PD or relapse from CR for low-blast AML or relapse after CR or PR for HR MDS/CMML. Disease responses for HR MDS/CMML based on Modified IWG Response Criteria for MDS; for low-blast AML on Revised IWG Response Criteria for AML. Overall response=CR+PR for HR MDS/CMML and CR+Cri+ PR for low-blast AML.CR for HR MDS/CMML:<=5% myeloblasts with normal maturation of all bone marrow cell lines,>=11 g/dL Hgb,>=100*10^9/L pl,>=1.0*10^9/L neutrophils,0% blasts in peripheral blood and PR:all CR criteria met except bone marrow blasts>=50% decrease over pretreatment but still >5%. For low-blast AML-CR: morphologic leukemia-free state >1.0*10^9 neutrophils,>=100*10^9/L pl, transfusion independence, no residual evidence of extramedullary leukemia; CR with CRi: fulfill CR criteria except residual neutropenia <1.0*10^9/L or pl <100*10^9/L; PR: all CR hematological values but >=50% decrease in % of blasts in bone marrow aspirate. |
Measure: | Duration of Overall Response 2 (OR2) |
Time Frame: | From documented CR, PR or HI to the first documented PD or relapse from CR (in participants with low-blast AML) or relapse after CR or PR (in participants with HR MDS/CMML): up to 6 years |
Safety Issue: | |
Description: | Duration of OR2:response to first documented PD or relapse from CR for low-blast AML or relapse after CR or PR for HR MDS/CMML.OR2=CR,PR,HI for MDS/CMML and CR,CRi,PR for low-blast AML. For HR MDS/CMML-CR:<=5% myeloblasts with normal maturation of all bone marrow cell lines,>=11 g/dL Hgb, >=100*10^9/L pl,>=1.0*10^9/L neutrophils, 0% blasts in peripheral blood; PR: all CR criteria met except bone marrow blasts>=50% decrease over pretreatment, still >5%; HI: Hgb inc >=1.5 g/dL if baseline <11 g/dL; pl inc>=30*10^9/L if baseline>20*10^9/L or inc from<20*10^9/L to>20*10^9/L by at least 100%; neutrophil inc by 100% and absolute inc of >0.5*10^9/L if baseline <1.0*10^9/L.For low-blast AML-CR: morphologic leukemia-free state,>1.0*10^9 neutrophils,>=100*10^9/L pl, transfusion independence, no residual evidence of extramedullary leukemia;CRi: fulfill CR criteria except residual neutropenia<1.0*10^9/L or pl <100*10^9/L;PR:all CR hematological values but>=50% decrease in bone marrow aspirate |
Measure: | Percentage of Participants with Red Blood Cells (RBCs) and Platelet-transfusion Independence |
Time Frame: | 8 weeks before the first dose of study drug through 30 days after last dose of any study drug : up to 6 years |
Safety Issue: | |
Description: | A participant is defined as RBC or platelet-transfusion independent if he/she receives no RBC or platelet transfusions for a period of at least 8 weeks before the first dose of study drug through 30 days after the last dose of any study drug. Rate of transfusion independence is defined as number of participants who become transfusion independent divided by the number of participants who are transfusion dependent at Baseline. |
Measure: | Duration of Red Blood Cells (RBCs) and Platelet-transfusion Independence |
Time Frame: | 8 weeks before the first dose of study drug through 30 days after last dose of any study drug : up to 6 years |
Safety Issue: | |
Description: | Duration of RBC and Platelet transfusion independence is defined as the longest time between the last RBC and/or platelet transfusion before the start of the RBC and/or Platelet transfusion-independent period and the first RBC and/or Platelet transfusion after the start of the transfusion-independent period, which occurs>= 8 weeks later. |
Measure: | Time to First CR or PR |
Time Frame: | From randomization until CR or PR : up to 6 years |
Safety Issue: | |
Description: | Time to first CR or PR is defined as the time from randomization to first documented CR or PR, whichever occurs first. Disease responses for HR MDS or CMML or low-blast AML cycle 6 are based on Modified IWG Response Criteria for MDS and for low-blast AML on Revised IWG Response Criteria for AML. For HR MDS or CMML-CR:<=5% myeloblasts with normal maturation of all bone marrow cell lines,>=11 g/dL Hgb,>=100*10^9/L pl,>=1.0*10^9/L neutrophils, 0% blasts in peripheral blood; PR: all CR criteria met except bone marrow blasts>=50% decrease over pretreatment but still>5%; For low-blast AML-CR: morphologic leukemia-free state,>1.0*10^9/L neutrophils, pl>=100*10^9/L, transfusion independence, no residual evidence of extramedullary leukemia; CR with incomplete blood count recovery: fulfill CR criteria except residual neutropenia<1.0*10^9/L or pl <100*10^9/L; PR: all CR hematological values but with a decrease of at least 50% in the percentage of blasts to 5% to 25% in the bone marrow aspirate. |
Measure: | Percentage of Participants with Hematologic Improvement (HI) |
Time Frame: | From randomization until HI : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS/CMML based on Modified IWG Response Criteria for MDS. HI: Hgb increase (inc)>=1.5 g/dL if baseline <11 g/dL; pl inc >=30*10^9/L if baseline >20*10^9/L or inc from <20*10^9/L to >20*10^9/L by at least 100%; neutrophil inc by 100% and absolute inc of >0.5*10^9/L if baseline <1.0*10^9/L. |
Measure: | Percentage of Participants with at least 1 Inpatient Hospital Admissions Related to HR MDS, CMML or Low-blast AML |
Time Frame: | From randomization until transformation to AML or until initiation of subsequent therapy up to approximately up to 6 years |
Safety Issue: | |
Description: | Inpatient hospital admission data will be collected through transformation to AML (HR MDS/CMML participants) or disease progression (low-blast AML participants) or until initiation of subsequent therapy (all participants), whichever occurs first. Transformation to AML is defined, according to WHO Classification, as a participant having 20% blasts in the blood or marrow and increase of blast count by 50%. |
Measure: | Time to Progressive Disease (PD), Relapse after CR (Low-blast AML), Relapse After CR or PR (HR MDS/CMML), or Death |
Time Frame: | From randomization until PD, relapse after CR, or relapse after CR or PR, or death due to any cause, whichever occurs first (up to 6 years) |
Safety Issue: | |
Description: | Time to PD, relapse after CR(low-blast AML), relapse after CR or PR(HR MDS/CMML), or death,defined as time from date of randomization until date of first documentation of PD,relapse after CR(low-blast AML),relapse after CR or PR(HR MDS/CMML),or death due to any cause, whichever occurs first. In HR MDS/CMML,PD: Participants with<5% blasts:>=50% inc >5% blasts, with 5%-9% blasts:>=50% inc>10% blasts, with 10%-19% blasts:>=50% inc >20% blasts,with 20%-30% blasts, at least 50% decrement from maximum remission/response in granulocytes or pl or reduction in Hgb by>=2 g/dL/new transfusion dependence.Relapse after CR or PR: return to pretreatment bone marrow blast %/Decrement of >=50% from maximum remission/response levels in granulocytes/pl/reduction in Hgb conc.>=1.5 g/dL/transfusion dependence. In AML,PD:>50% inc in bone marrow blasts to >30% blasts,>50% inc in circulating blasts to>30% blasts in peripheral blood, Development of extramedullary disease/new sites of extramedullary leukemia. |
Measure: | Health-Related Quality of Life (HRQOL) using European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire- Core 30 |
Time Frame: | Baseline Up to 6 years |
Safety Issue: | |
Description: | The EORTC QLQ-C30 contains 30 items across 5 functional scales (physical, role, cognitive, emotional, and social), 9 symptom scales (fatigue, nausea and vomiting, pain, dyspnea, sleep disturbance, appetite loss, constipation, diarrhea, and financial difficulties) and a global health status/QOL scale. Most of the 30 items have 4 response levels (not at all, a little, quite a bit, and very much), with 2 questions relying on a 7-point numeric rating scale. Raw scores are converted into scale scores ranging from 0 to 100. For the functional scales and the global health status/QOL scale, higher scores represent better QOL; for the symptom scales, lower scores represent better QOL. |
Measure: | Plasma Concentration of Pevonedistat |
Time Frame: | Cycle 1 Day 1 predose and multiple time points (up to 4 hours) post dose; Cycle 1 Days 3 and 5 predose; Cycle 2 and 4 Day 1 at multiple time points (up to 3 hours) post dose; Cycle 4 Day 3 predose |
Safety Issue: | |
Description: | |
Measure: | Percentage of Participants with Overall Response in Participants who have TP53 Mutations, 17p Deletions, and/or are Determined to be in an Adverse Cytogenetic Risk Group |
Time Frame: | From randomization until CR, CRi and PR : up to 6 years |
Safety Issue: | |
Description: | Disease responses for HR MDS/CMML based on Modified IWG Response Criteria for MDS; for low-blast AML on Revised IWG Response Criteria for AML. Overall response=CR + PR for HR MDS/CMML and CR + CRi + PR for low-blast AML. CR for HR MDS/CMML: <=5% myeloblasts with normal maturation of all bone marrow cell lines, >=11 g/dL Hgb, >=100*10^9/L pl, >=1.0*10^9/L neutrophils,0% blasts in peripheral blood and PR: all CR criteria met except bone marrow blasts>=50% decrease over pretreatment but still>5%. For low-blast AML-CR: morphologic leukemia-free state, >1.0*10^9 neutrophils,>=100*10^9/L pl, transfusion independence, no residual evidence of extramedullary leukemia; CR with incomplete blood count recovery (CRi): fulfill CR criteria except residual neutropenia<1.0*10^9/L or pl<100*10^9/L; PR: all CR hematological values but>=50% decrease in the percentage of blasts to 5% to 25% in bone marrow aspirate. |
Measure: | Event-Free Survival in Participants who have TP53 Mutations, 17p Deletions, and/or are Determined to be in an Adverse Cytogenetic Risk Group |
Time Frame: | From randomization until transformation to AML if eligible or death : up to 6 years |
Safety Issue: | |
Description: | Event is defined as death or transformation to AML in participants with MDS or CMML, which ever occurs first. Transformation to AML is defined, according to world health organization (WHO) Classification as a participant having >20% blasts in the blood or marrow and increase of blast count by 50%. Event is defined as death in participants with low-blast AML. |
Measure: | Overall Survival in Participants who have TP53 Mutations, 17p Deletions, and/or are Determined to be in an Adverse Cytogenetic Risk Group |
Time Frame: | From randomization until death : up to 6 years |
Safety Issue: | |
Description: | OS is calculated from date of randomization to the date of death due to any cause. Participants without documented death at the time of the analysis will be censored as of the date the participant was last known to be alive. |
Measure: | Percentage of Participants with Overall Response by Cycle 6 |
Time Frame: | Up to Cycle 6 (up to approximately Day 168) |
Safety Issue: | |
Description: | Responses for HR MDS/CMML are based on Modified International Working Group (IWG) Response Criteria for MDS and for low-blast AML on Revised IWG Response Criteria for AML. Overall response=complete remission(CR)and partial remission(PR)for HR MDS/CMML and CR+CR with incomplete blood count recovery(CRi)+PR for low-blast AML. CR for HR MDS/CMML:<=5% myeloblasts with normal maturation of all bone marrow cell lines,>=11g/dL hemoglobin (Hgb),>=100*10^9/L platelet (pl),>=1.0*10^9/L neutrophils, 0% blasts in peripheral blood, and PR:all CR criteria met except bone marrow blasts >=50% decrease over pretreatment but still >5%. For low-blast AML-CR:morphologic leukemia-free state,>1.0*10^9 neutrophils, >=100*10^9/L pl, transfusion independence, no residual evidence of extramedullary leukemia;CRi:fulfill CR criteria except residual neutropenia <1.0*10^9/L/thrombocytopenia (pl<100*10^9/L); PR:all CR hematological values but>=50% decrease in percentage of blasts to 5%-25% in bone marrow aspirate. |
Details
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Millennium Pharmaceuticals, Inc. |
Trial Keywords
Last Updated
August 11, 2021