Description:
This phase II trial studies how well venetoclax and decitabine work in treating participants
with acute myeloid leukemia that has come back or does not respond to treatment, or with
high-risk myelodysplastic syndrome that has come back. Drugs used in chemotherapy, such as
venetoclax and decitabine, 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.
Title
- Brief Title: Venetoclax and Decitabine in Treating Participants With Relapsed/Refractory Acute Myeloid Leukemia or Relapsed High-Risk Myelodysplastic Syndrome
- Official Title: A Phase II Study of Venetoclax in Combination With 10-Day Decitabine in Newly Diagnosed Elderly or Relapsed/Refractory Acute Myeloid Leukemia and Relapsed High-Risk Myelodysplastic Syndrome and Blastic Plasmacytoid Dendritic Cell Neoplasm
Clinical Trial IDs
- ORG STUDY ID:
2017-0912
- SECONDARY ID:
NCI-2018-00752
- SECONDARY ID:
2017-0912
- NCT ID:
NCT03404193
Conditions
- Acute Myeloid Leukemia
- Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome
- Blastic Plasmacytoid Dendritic Cell Neoplasm
- Chronic Myelomonocytic Leukemia
- Mixed Phenotype Acute Leukemia
- Myelodysplastic Syndrome
- Recurrent Acute Biphenotypic Leukemia
- Recurrent Acute Myeloid Leukemia
- Recurrent Blastic Plasmacytoid Dendritic Cell Neoplasm
- Recurrent Chronic Myelomonocytic Leukemia
- Recurrent Mixed Phenotype Acute Leukemia
- Refractory Acute Myeloid Leukemia
- Refractory Blastic Plasmacytoid Dendritic Cell Neoplasm
- Refractory Chronic Myelomonocytic Leukemia
- Refractory Mixed Phenotype Acute Leukemia
Interventions
Drug | Synonyms | Arms |
---|
Decitabine | 5-Aza-2''-deoxycytidine, Dacogen, Decitabine for Injection, Deoxyazacytidine, Dezocitidine | Treatment (decitabine, venetoclax) |
Venetoclax | ABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, Venclyxto | Treatment (decitabine, venetoclax) |
Purpose
This phase II trial studies how well venetoclax and decitabine work in treating participants
with acute myeloid leukemia that has come back or does not respond to treatment, or with
high-risk myelodysplastic syndrome that has come back. Drugs used in chemotherapy, such as
venetoclax and decitabine, 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.
Detailed Description
PRIMARY OBJECTIVE:
I. To determine the overall response rate (ORR) of venetoclax in combination with 10-day
decitabine in patients with refractory/relapsed acute myeloid leukemia (AML); elderly (> 60
year old) patients with newly diagnosed AML not eligible for intensive chemotherapy; patients
with high-risk myelodysplastic syndrome (MDS) with bone marrow blasts between 10% and 20%,
relapsed or refractory to prior hypomethylating agent (HMA) therapy, or chronic
myelomonocytic leukemia (CMML) with bone marrow blasts >= 10% regardless of prior therapy;
AML patients with prior history of MDS or CMML who received therapy for the MDS or CMML and
progressed to AML, and younger patients with newly diagnosed AML with poor risk complex
karyotype and/or TP53 deletions/mutations and patients with blastic plasmacytoid dentritic
cell neoplasm (BPDCN).
SECONDARY OBJECTIVES:
I. To determine the duration of response, disease-free survival (DFS), and overall survival
(OS) of patients with refractory/relapsed AML treated with this combination.
II. To determine the number of patients who achieve a hematologic improvement (HI) in
platelets, hemoglobin, or absolute neutrophil count (ANC) and the number of patients who
achieve > 50% reduction in blasts on therapy with venetoclax/10-day decitabine.
III. To determine the safety of venetoclax in combination with 10-day decitabine in patients
with refractory/relapsed AML.
IV. To determine the number of patients who transition towards stem cell transplantation upon
achieving response with the combination venetoclax/10-day decitabine regimen.
V. To determine the incidence of infectious complications per cycle with venetoclax in
combination with 10-day decitabine.
EXPLORATORY OBJECTIVES:
I. To investigate possible relationships between baseline protein and gene expression
signatures/mutation profile and BH3 profiling in predicting clinical response to the
combination.
II. To characterize the pharmacokinetic (PK) profiles of venetoclax in combination with
decitabine and antifungals in plasma samples.
OUTLINE:
Participants receive decitabine intravenously (IV) over 1 hour on days 1-10 and may also
receive decitabine on days 1-5 after achieving complete remission/complete remission with
incomplete count recovery during consolidation/maintenance. Participants also receive
venetoclax orally (PO) daily on days 1-28 of cycle 1 and on days 1-21 of subsequent cycles.
Treatment repeat every 28 days for up to 24 cycles in the absence of disease progression or
unacceptable toxicity.
After completion of study treatment, participants are followed up every 3 to 6 months for up
to 5 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (decitabine, venetoclax) | Experimental | Participants receive decitabine IV over 1 hour on days 1-10 and may also receive decitabine on days 1-5 after achieving complete remission/complete remission with incomplete count recovery during consolidation/maintenance. Participants also receive venetoclax PO daily on days 1-28 of cycle 1 and on days 1-21 of subsequent cycles. Treatment repeat every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
- Patients with AML, BPDCN, biphenotypic or bilineage leukemia (including a myeloid
component) or mixed phenotype acute leukemia (MPAL) who have failed prior therapy;
patients with AML should have failed prior therapy or have relapsed after prior
therapy; patients with isolated extramedullary AML are eligible
- Elderly (> 60 year old) patients with newly diagnosed AML, BPDCN, or mixed phenotype
acute leukemia (MPAL) not eligible for intensive chemotherapy
- Patients with newly diagnosed AML with poor risk complex karyotype and/or TP53
deletions/mutations equal or younger than 60 year old
- AML or BPDCN patients with prior history of MDS or CMML who received any therapy or no
therapy for the MDS or CMML and progressed to AML, are eligible at the time of
diagnosis of AML regardless of any prior therapy for MDS; the World Health
Organization (WHO) classification will be used for AML
- Patients with high-risk MDS with bone marrow blasts between 10% and 20%, relapsed or
refractory to prior hypomethylating agent (HMA) therapy, defined as prior receipt of 4
cycles of HMA therapy with failure to attain a response, or relapse after prior
response to HMA therapy; patients with high risk chronic myelomonocytic leukemia
(CMML) with bone marrow blasts >= 10% regardless of prior therapy
- Eastern Cooperative Oncology Group (ECOG) performance status =< 3
- White blood cell count =< 10,000
- Adequate renal function including creatinine < 2 unless related to the disease
- Adequate hepatic function including total bilirubin < 2 x upper limit of normal (ULN)
unless increase is due to Gilbert's disease or leukemic involvement
- Alanine aminotransferase (ALT) < 3 x ULN unless considered due to leukemic involvement
- Provision of written informed consent
- Oral hydroxyurea and/or one dose of cytarabine (up to 2 g/m^2) for patients with
rapidly proliferative disease is allowed before the start of study therapy and while
the patient is on active study treatment through cycle 1, as needed, for clinical
benefit and after discussion with the principal investigator (PI); concurrent therapy
for central nervous system (CNS) prophylaxis or continuation of therapy for controlled
CNS disease is permitted
- Females must be surgically or biologically sterile or postmenopausal (amenorrheic for
at least 12 months) or if of childbearing potential, must have a negative serum or
urine pregnancy test within 72 hours before the start of the treatment
- Women of childbearing potential must agree to use an adequate method of contraception
during the study and until 3 months after the last treatment; males must be surgically
or biologically sterile or agree to use an adequate method of contraception during the
study until 3 months after the last treatment
Exclusion Criteria:
- Patients having received any prior BCL2 inhibitor therapy
- Patients with t(15;17) karyotypic abnormality or acute promyelocytic leukemia
(French-American-British [FAB] class M3-AML)
- Patients with symptomatic CNS leukemia or patients with poorly controlled CNS leukemia
- Active and uncontrolled comorbidities including active uncontrolled infection,
uncontrolled hypertension despite adequate medical therapy, active and uncontrolled
congestive heart failure New York Heart Association (NYHA) class III/IV, clinically
significant and uncontrolled arrhythmia as judged by the treating physician
- Patients with known infection with human immunodeficiency virus (HIV) or active
hepatitis B or C
- Any other medical, psychological, or social condition that may interfere with study
participation or compliance, or compromise patient safety in the opinion of the
investigator
- Pregnant or breastfeeding
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall response rate (ORR) |
Time Frame: | Up to 4 cycles (112 days) |
Safety Issue: | |
Description: | Will be defined as the proportion of patients who had CR (complete remission), CRp (complete remission with incomplete platelet recovery), CRi (complete remission with incomplete count recovery), PR (partial response) or marrow clearance of blasts within 3 months of treatment initiation among adult patients with acute myeloid leukemia (AML); and complete remission (CR), partial remission (PR) or marrow CR (mCR) lasting at least 4 weeks for patients with myelodysplastic syndrome (MDS). Descriptive statistics including plots, mean, median and standard deviations will be used to summarize data. Will estimate the ORR for the combination treatment, along with the 95% confidence interval. The association between ORR and patient's clinical characteristics will be examined by Wilcoxon's rank sum test or Fisher's exact test, as appropriate. |
Secondary Outcome Measures
Measure: | Incidence of adverse events |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | Toxicity type, severity and attribution will be summarized for each patient using frequency tables. |
Measure: | Duration of response |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | Will be estimated using the method of Kaplan-Meier. Comparisons of time-to-event endpoints by important subgroups will be made using the log rank tests. |
Measure: | Disease free survival |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | Will be estimated using the method of Kaplan-Meier. Comparisons of time-to-event endpoints by important subgroups will be made using the log rank tests. |
Measure: | Overall survival |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | Will be estimated using the method of Kaplan-Meier. Comparisons of time-to-event endpoints by important subgroups will be made using the log rank tests. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
July 23, 2020