Clinical Trials /

Ibrutinib and Lenalidomide in Treating Patients With Myelodysplastic Syndrome

NCT03359460

Description:

This phase I trial studies the side effects and best dose of ibrutinib when giving together with lenalidomide in treating patients with myelodysplastic syndrome. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as lenalidomide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving ibrutinib and lenalidomide may work better in treating patients with myelodysplastic syndrome.

Related Conditions:
  • Myelodysplastic Syndromes
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Ibrutinib and Lenalidomide in Treating Patients With Myelodysplastic Syndrome
  • Official Title: Phase I Trial of the Combination of Ibrutinib and Lenalidomide for the Treatment of Patients With MDS Who Have Failed or Refuse Standard Therapy

Clinical Trial IDs

  • ORG STUDY ID: 1043625
  • SECONDARY ID: UCDCC#265
  • SECONDARY ID: UCDCC#265
  • SECONDARY ID: P30CA093373
  • SECONDARY ID: NCI-2017-01827
  • NCT ID: NCT03359460

Conditions

  • Myelodysplastic Syndrome
  • Previously Treated Myelodysplastic Syndrome
  • Refractory High Risk Myelodysplastic Syndrome
  • Secondary Myelodysplastic Syndrome
  • Therapy-Related Myelodysplastic Syndrome

Interventions

DrugSynonymsArms
IbrutinibBTK Inhibitor PCI-32765, CRA-032765, Imbruvica, PCI-32765Treatment (lenalidomide, ibrutinib)
LenalidomideCC-5013, CC5013, CDC 501, RevlimidTreatment (lenalidomide, ibrutinib)

Purpose

This phase I trial studies the side effects and best dose of ibrutinib when giving together with lenalidomide in treating patients with myelodysplastic syndrome. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as lenalidomide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving ibrutinib and lenalidomide may work better in treating patients with myelodysplastic syndrome.

Detailed Description

      PRIMARY OBJECTIVES:

      To determine the recommended Phase II dose (RP2D) for ibrutinib in combination with
      lenalidomide in patients with myelodysplastic syndrome (MDS).

      SECONDARY OBJECTIVES:

      To do an early assessment of the activity of the combination of ibrutinib and lenalidomide in
      patients with MDS.

      TERTIARY OBJECTIVES:

      To examine the pharmacodynamic and biological effects of the combination of ibrutinib and
      lenalidomide in MDS.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (lenalidomide, ibrutinib)ExperimentalPatients receive lenalidomide PO QD on days 1-21 and ibrutinib PO QD on days 1-28. Courses repeat every 28 days in the absence of disease progression or unaccepted toxicity.
  • Ibrutinib
  • Lenalidomide

Eligibility Criteria

        Inclusion Criteria:

          -  Pathologically confirmed diagnosis of MDS by World Health Organization (WHO) criteria
             (including secondary and therapy-related disease) who have failed standard therapy,
             who are intolerant of prior therapy, or who refuse standard therapy; any prior
             therapy, including ibrutinib and/or lenalidomide (unless intolerant of one or both of
             these medications), is permitted

               -  Hypomethylating agent failure is defined as disease progression or stable disease
                  as best response to an adequate course of treatment (at least four cycles) with
                  an injectable hypomethylating agent (azacitidine or decitabine)

          -  International Prognostic Scoring System (IPSS)-revised (R) intermediate, high or very
             high risk disease

          -  No specific hematologic parameters for study entry are required; transfusion-dependent
             patients are eligible and platelet counts should be maintained greater than
             10,000/mm^3

          -  Serum aspartate transaminase (AST) or alanine transaminase (ALT) less than or equal to
             3.0 x upper limit of normal (ULN)

          -  Estimated creatinine clearance greater than or equal to 60 ml/min (Cockcroft-Gault)

          -  Bilirubin less than or equal to 1.5 x ULN (unless bilirubin rise is due to Gilbert's
             syndrome or of non-hepatic origin)

          -  Prothrombin time (PT)/international normalized ratio (INR) less than or equal to 1.5 x
             ULN and partial thromboplastin time (PTT) (activated [a]PTT) less than or equal to 1.5
             x ULN

          -  Karnofsky performance status (KPS) performance status of 60% or greater

          -  Ability to understand and willingness to sign an informed consent form

          -  Ability to adhere to the study visit schedule and other protocol requirements

          -  Female subjects who are of non-reproductive potential (i.e., post-menopausal by
             history - no menses for >= 1 year; OR history of hysterectomy; OR history of bilateral
             tubal ligation; OR history of bilateral oophorectomy); or, female subjects of
             childbearing potential must have a negative serum pregnancy test upon study entry

          -  Male and female subjects who agree to use highly effective methods of birth control
             (e.g., condoms, implants, injectables, combined oral contraceptives, some intrauterine
             devices [IUDs], sexual abstinence, or sterilized partner) during the period of therapy
             and for 30 days after the last dose of study drug

          -  Females of reproductive potential must adhere to the scheduled pregnancy testing as
             required in the Revlimid Risk Evaluation and Mitigation Strategies (REMS) program

          -  All study participants must be registered into the mandatory Revlimid REMS program,
             and be willing and able to comply with the requirements of the REMS program

          -  Eligibility of patients receiving any medications or substances known to affect or
             with the potential to affect the activity or pharmacokinetics of ibrutinib or ability
             to adhere to the Revlimid REMS program will be determined following review of their
             case by the principal investigator

        Exclusion Criteria:

          -  Anticancer therapy including chemotherapy, immunotherapy, radiotherapy, hormonal or
             any investigational therapy within 14 days or 5 half-lives (whichever is shorter)
             prior to first dose of study drug; hydroxyurea is permitted up to the day before
             initiation of study treatment

          -  Prior allogeneic (allo)-hematopoietic cell transplantation (HCT) less than three
             months from the time of enrollment

          -  Acute graft versus host disease (GVHD) or active chronic GVHD greater than grade 1

          -  Concurrent systemic immunosuppressant therapy (e.g., cyclosporine A, tacrolimus, etc.,
             or chronic administration [> 14 days] of > 60 mg/day of prednisone or equivalent)
             within 28 days of the first dose of study drug

          -  History of allergy to or intolerance of ibrutinib or lenalidomide

          -  Vaccinated with live, attenuated vaccines within 4 weeks of first dose of study drug

          -  Recent culture-documented infection requiring systemic intravenous treatment that was
             completed =< 7 days before the first dose of study drug or any uncontrolled active
             systemic infection; fever of unknown origin is not an exclusion criterion, as this may
             be disease-related

          -  Unresolved toxicities from prior anti-cancer therapy, defined as having not resolved
             to Common Terminology Criteria for Adverse Event (CTCAE, version 4.03), grade 2 or
             less, or to the levels dictated in the inclusion/exclusion criteria with the exception
             of alopecia

          -  Known bleeding disorders (e.g., von Willebrand's disease) or hemophilia

          -  History of stroke or intracranial hemorrhage within 3 months prior to enrollment

          -  Active infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV) or
             hepatitis B virus (HBV); subjects who are positive for hepatitis B core antibody,
             hepatitis B surface antigen, or hepatitis C antibody must have a negative polymerase
             chain reaction (PCR) result before enrollment; those who are PCR positive will be
             excluded; subjects with HIV must have a CD4 count at or above the institutional lower
             limit of normal and not taking prohibited CYP3A strong inhibitors

          -  Major surgery within 4 weeks of first dose of study drug

          -  Any life-threatening illness, medical condition, or organ system dysfunction,
             including but not limited to, ongoing or active infection, symptomatic congestive
             heart failure, unstable angina pectoris, cardiac arrhythmia, active autoimmune
             disorder, or psychiatric illness/social situations that, in the investigator's
             opinion, could compromise the subject's safety or put the study outcomes at undue risk

          -  History of other malignancies, except for malignancy surgically resected (or treated
             with other modalities) with curative intent, adequately treated in situ carcinoma of
             the breast or cervix uteri, basal cell carcinoma of the skin or localized squamous
             cell carcinoma of the skin

          -  Concomitant use of warfarin or other vitamin K antagonists

          -  Subjects who received a strong cytochrome P 450 3A (CYP3A) inhibitor within 7 days
             prior to the first dose of ibrutinib or subjects who require continuous treatment with
             a strong CYP3A inhibitor

          -  Currently active, clinically significant hepatic impairment Child-Pugh class B or C
             according to the Child Pugh classification

          -  Lactating or pregnant patients or patients of reproductive potential not willing to
             use effective methods of contraception and adhere to the Revlimid REMS program

          -  Participation in clinical trials with other investigational agents not included in
             this trial throughout the duration of this trial

          -  Unwilling or unable to participate in all required study evaluations and procedures or
             unable to understand the purpose and risks of the study and to provide a signed and
             dated informed consent form (ICF) and authorization to use protected health
             information (in accordance with national and local subject privacy regulations)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum tolerated dose
Time Frame:Up to 28 days
Safety Issue:
Description:Data will be reported in tables with descriptive statistics used. Will be assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Effects (CTCAE) version 4.03. Tables will be created to summarize the toxicities and adverse effects by dose, course, organ and severity as well as the study demographics.

Secondary Outcome Measures

Measure:Disease free survival
Time Frame:From the time of first documented complete response until relapse or the date of death from any cause, assessed up to 6 months
Safety Issue:
Description:Will be summarized with Kaplan-Meier plots.
Measure:Disease response
Time Frame:Up to 6 months
Safety Issue:
Description:Will be assessed per modified International Working Group (IWG) 2006 response criteria. Response rates and the corresponding 95% confidence intervals will be obtained.
Measure:Hematologic normalization rate
Time Frame:Up to 6 months
Safety Issue:
Description:Will be assessed as complete remission + partial remission + hematologic improvement.
Measure:Overall survival
Time Frame:From the time of first study drug administration until the date of death from any cause, assessed up to 6 months
Safety Issue:
Description:Will be summarized with Kaplan-Meier plots.
Measure:Progression free survival
Time Frame:From the time of first study drug administration until the date of progression or death from any cause, assessed up to 6 months
Safety Issue:
Description:Will be summarized with Kaplan-Meier plots.
Measure:Time to response
Time Frame:From the time of first study drug administration to the date of complete remission, partial remission, or hematologic improvement, assessed up to 6 months
Safety Issue:
Description:Will be summarized with Kaplan-Meier plots.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Brian Jonas

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