Description:
This phase II trial studies the side effects and how well azacitidine and enasidenib work in
treating patients with IDH2-mutant myelodysplastic syndrome. Azacitidine and enasidenib may
stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
Title
- Brief Title: Azacitidine and Enasidenib in Treating Patients With IDH2-Mutant Myelodysplastic Syndrome
- Official Title: Targeted Therapy With the IDH2-Inhibitor Enasidenib (AG221) for High-Risk IDH2-Mutant Myelodysplastic Syndrome
Clinical Trial IDs
- ORG STUDY ID:
2016-0981
- SECONDARY ID:
NCI-2018-00987
- SECONDARY ID:
2016-0981
- SECONDARY ID:
P30CA016672
- NCT ID:
NCT03383575
Conditions
- Acute Myeloid Leukemia
- Blasts 20-30 Percent of Bone Marrow Nucleated Cells
- Chronic Myelomonocytic Leukemia
- IDH2 Gene Mutation
- Myelodysplastic Syndrome With Excess Blasts
- Recurrent High Risk Myelodysplastic Syndrome
- Refractory High Risk Myelodysplastic Syndrome
Interventions
Drug | Synonyms | Arms |
---|
Azacitidine | 5 AZC, 5-AC, 5-Azacytidine, 5-AZC, Azacytidine, Azacytidine, 5-, Ladakamycin, Mylosar, U-18496, Vidaza | Arm I (enasidenib, azacitidine) |
Enasidenib | AG-221, CC-90007 | Arm I (enasidenib, azacitidine) |
Purpose
This phase II trial studies the side effects and how well azacitidine and enasidenib work in
treating patients with IDH2-mutant myelodysplastic syndrome. Azacitidine and enasidenib may
stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the safety and tolerability of enasidenib alone, and enasidenib in
combination with azacitidine (AZA), for patients with isocitrate dehydrogenase 2 (IDH2)
mutated myelodysplastic syndrome (MDS).
II. To assess the efficacy of the combination of enasidenib + azacitidine in hypomethylating
agent (HMA) naive subjects with IDH2-mutated MDS, and to assess the efficacy of enasidenib
single-agent in subjects with IDH2-mutated MDS who are relapsed/refractory to HMA therapy.
SECONDARY OBJECTIVES:
I. To evaluate molecular and cellular markers that may be predictive of antitumor activity
and/or resistance including evaluation of IDH2 variant allele fraction (VAF) levels during
treatment and presence of co-occurring mutations.
II. To assess overall survival, event-free survival and duration of response of enasidenib
alone, and enasidenib in combination with azacitidine.
EXPLORATORY OBJECTIVES:
I. To assess changes in cellular differentiation and changes in deoxyribonucleic acid (DNA)
methylation profiles in IDH2-mutated MDS treated with enasidenib alone and with enasidenib +
azacitidine.
II. To evaluate quality of life (QOL) using an MDS-specific measure.
OUTLINE: Patients are assigned to 1 of 2 arms.
ARM I: Patients who are HMA-naive receive enasidenib orally (PO) once daily (QD) on days 1-28
and azacitidine intravenously (IV) oveer 30-60 minutes or subcutaneously (SC) on days 1-7.
Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM II: Patients relapsed and/or refractory to HMA therapy receive enasidenib PO QD on days
1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable
toxicity.
After completion of study treatment, patients are followed up every 3 months for up to 3
years.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm I (enasidenib, azacitidine) | Experimental | Patients who are HMA-naive receive enasidenib PO QD on days 1-28 and azacitidine IV over 30-60 minutes or SC on days 1-7. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. | |
Arm II (enasidenib) | Experimental | Patients relapsed and/or refractory to HMA therapy receive enasidenib PO QD on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
- Signed, informed consent must be obtained prior to any study specific procedures
- Subjects with a histologically confirmed diagnosis of MDS, including both MDS and
refractory anemia with excess blasts in transformation (RAEB-T) (acute myeloid
leukemia [AML] with 20-30% blasts and multilineage dysplasia by
French-American-British [FAB] criteria) by World Health Organization (WHO), and
chronic myelomonocytic leukemia (CMML) are eligible
- Subjects must have an IDH2 gene mutation (IDH2-R140 or R172) as determined by local
laboratory result
- (Arm A only): Subject must be hypomethylating agent naive (i.e. prior azacitidine,
decitabine, SGI-110 is exclusionary). Receipt of other MDS-directed therapy such as
lenalidomide is allowed
- (Arm A only): Subjects with high-risk MDS (i.e. International Prostate Symptom Score
[IPSS] intermediate-2 or high-risk; or revised [R]-IPSS high or very-high risk).
Patients with intermediate-1 risk by IPSS or intermediate risk by R-IPSS with
high-risk molecular features including TP53, ASXL1, EZH2, and/or RUNX1 mutations are
also eligible
- (Arm B only): Subject must be relapsed or refractory to prior hypomethylating agent
therapy, defined as prior receipt of 6 cycles of HMA therapy with failure to attain a
response, or relapse after prior response to HMA therapy
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Serum bilirubin =< 2 x the upper limit of normal (ULN) (except for patients with
Gilbert's disease)
- Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) =< 3 x the
laboratory ULN
- Serum creatinine =< 2 x the ULN
- Able to understand and voluntarily sign a written informed consent, and willing and
able to comply with protocol requirements
- Resolution of all clinically significant treatment-related, non-hematological
toxicities, except alopecia, from any previous cancer therapy to =< grade 1 prior to
the first dose of study treatment
- Female patients of childbearing potential must have a negative serum or urine
pregnancy test within 7 days of the first dose of study drug and agree to use dual
methods of contraception during the study and for a minimum of 3 months following the
last dose of study drug. Post-menopausal females (> 45 years old and without menses
for > 1 year) and surgically sterilized females are exempt from these requirements.
Male patients must use an effective barrier method of contraception during the study
and for a minimum of 3 months following the last dose of study drug if sexually active
with a female of childbearing potential
Exclusion Criteria:
- Any prior or coexisting medical condition that in the investigator's judgment will
substantially increase the risk associated with the subject's participation in the
study
- Subject has received a prior targeted IDH2 inhibitor
- Psychiatric disorders or altered mental status precluding understanding of the
informed consent process and/or completion of the necessary study procedures
- Active uncontrolled infection at study enrollment including known diagnosis of human
immunodeficiency virus or chronic active hepatitis B or C infection
- Clinically significant gastrointestinal conditions or disorders that may interfere
with study drug absorption, including prior gastrectomy
- Patients with known active central nervous system (CNS) disease, including
leptomeningeal involvement
- Impaired cardiac function, uncontrolled cardiac arrhythmia, or clinically significant
cardiac disease including the following: a) New York Heart Association grade III or IV
congestive heart failure, b) myocardial infarction within the last 6 months
- Subjects with a corrected QT (QTc) > 480 ms (QTc > 510 msec for subjects with a bundle
branch block at baseline
- Nursing or pregnant women
- Subjects with known hypersensitivity to study drugs or their excipients
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 12 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of adverse events |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | Will use the Bayesian method by Thall, Simon and Estey for toxicity monitoring. For purpose of toxicity monitoring, toxicity is defined as any grade 3 or higher treatment related-toxicities by Common Terminology Criteria for Adverse Events criteria. |
Secondary Outcome Measures
Measure: | Event-free survival (EFS) |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | The Kaplan-Meier method will be used to estimate the probabilities of EFS. Log-rank tests will be used to compare among subgroups of patients in terms of EFS. |
Measure: | Overall survival (OS) |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | The Kaplan-Meier method will be used to estimate the probabilities of OS. Log-rank tests will be used to compare among subgroups of patients in terms of OS. |
Measure: | Anti-tumor activity |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | Will be summarized graphically and with descriptive statistics. |
Measure: | Pharmadynamics (PDn) markers |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | PDn markers will be summarized graphically and with descriptive statistics. |
Measure: | Drug exposure levels |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | Will be summarized graphically and with descriptive statistics. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
January 25, 2021