Description:
This phase I trial studies the side effects of using enasidenib as maintenance therapy in
treating patients with acute myeloid leukemia with IDH2 mutation following donor stem cell
transplant. Enasidenib may stop the growth of cancer cells by blocking some of the enzymes
needed for cell growth.
Title
- Brief Title: Enasidenib as Maintenance Therapy in Treating Patients With Acute Myeloid Leukemia With IDH2 Mutation After Donor Stem Cell Transplant
- Official Title: Pilot Trial of Enasidenib (AG-221) Maintenance Post Allogeneic Hematopoietic Cell Transplantation in Patients With IDH2 Mutation
Clinical Trial IDs
- ORG STUDY ID:
18117
- SECONDARY ID:
NCI-2018-02371
- SECONDARY ID:
18117
- NCT ID:
NCT03728335
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Enasidenib Mesylate | 2-Methyl-1-[(4-[6-(trifluoromethyl)pyridin-2-yl]-6-{[2-(trifluoromethyl)pyridin-4-yl]amino}-1,3,5-triazin-2-yl)amino]propan-2-ol Methanesulfonate, 2-Propanol, 2-Methyl-1-((4-(6-(trifluoromethyl)-2-pyridinyl)-6-((2-(trifluoromethyl)-4-pyridinyl)amino)-1,3,5-triazin-2-yl)amino)-, Methanesulfonate (1:1), AG-221 Mesylate, CC-90007, Enasidenib Methanesulfonate, Idhifa | Treatment (enasidenib mesylate) |
Purpose
This phase I trial studies the side effects of using enasidenib as maintenance therapy in
treating patients with acute myeloid leukemia with IDH2 mutation following donor stem cell
transplant. Enasidenib may stop the growth of cancer cells by blocking some of the enzymes
needed for cell growth.
Detailed Description
PRIMARY OBJECTIVES:
I. Evaluate the safety and tolerability of enasidenib mesylate as maintenance therapy in post
hematopoietic cell transplantation (HCT) patients.
SECONDARY OBJECTIVES:
I. Assess overall and leukemia free survival in patients post allogeneic HCT. II. Estimate
relapse incidence, non-relapse mortality, graft versus host disease (GVHD) and relapse free
survival (GRFS) in patients receiving enasidenib mesylate maintenance therapy.
EXPLORATORY OBJECTIVES:
I. Monitor disease status among subset of patients with minimal residual disease (MRD)
positive disease when starting to receive enasidenib mesylate by multiparameter flow
cytometry post allogeneic HCT on patients bone marrow (BM) on days +100 and +365.
II. Investigate clearance of IDH2 mutation post HCT by next generation sequencing-polymerase
chain reaction (NGS-PCR) testing on the bone marrow specimens on days +100 and +365 and in
peripheral blood every 3 months till 2 year follow up.
III. Investigate mIDH2 variant allele fraction (VAF) by droplet digital PCR (ddPCR) BEAMing
technology on bone marrow specimens on days +100 and +365.
OUTLINE:
Patients receive enasidenib orally (PO) once daily (QD) on days 1-28. Treatment repeats every
28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days and periodically
thereafter up to 2 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (enasidenib mesylate) | Experimental | Patients receive enasidenib PO QD on days 1-28. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
- Documented informed consent of the participant and/or legally authorized
representative
- Agreement to allow the use of archival tissue from diagnostic tumor biopsies
- If unavailable, exceptions may be granted with study principal investigator (PI)
approval
- Eastern Cooperative Oncology Group (ECOG) =< 2 or Karnofsky performance status (KPS)
>= 70
- Recipients of allogeneic HCT - all stem cell sources including sibling, unrelated,
mismatched related/unrelated, cord and haploidentical transplant patients will be
included
- Conditioning regimen: Investigator's choice based on center guidelines
- GvHD prophylaxis: sirolimus + tacrolimus or tacrolimus + methotrexate or investigator
choice
- Patients must have acute myeloid leukemia (AML) with IDH2 mutation at diagnosis. Day
30 marrow post HCT should show evidence of morphologic remission with < 5% bone marrow
blasts. Patients with MRD either by flow cytometry or IDH2 mutation testing will be
allowed
- Patients with previous therapy with IDH2 inhibitors will be included
- Absolute neutrophil count (ANC) > 1000 (performed within 28 days prior to day 1 of
protocol therapy unless otherwise stated)
- Hemoglobin >= 9.5 gm% (performed within 28 days prior to day 1 of protocol therapy
unless otherwise stated)
- Platelets > 50,000/mm^3 (performed within 28 days prior to day 1 of protocol therapy
unless otherwise stated)
- Platelets >= 20,000/mm^3 (performed within 28 days prior to day 1 of protocol therapy
unless otherwise stated)
- NOTE: Patients with lower counts can enroll if infection cytomegalovirus
(CMV)/human herpesvirus 6 (HHV6) etc. is being treated actively
- Total bilirubin =< 1.5 X upper limit of normal (ULN) (unless has Gilbert's disease)
(performed within 28 days prior to day 1 of protocol therapy unless otherwise stated)
- Total bilirubin < 2.0 mg/dl-exception permitted in patients with Gilbert's Syndrome
(performed within 28 days prior to day 1 of protocol therapy unless otherwise stated)
- Aspartate aminotransferases (AST) (serum glutamic-oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
=< 2 x ULN, patients with abnormal liver function tests (LFTs) in the context of
active GVHD will not be included (performed within 28 days prior to day 1 of protocol
therapy unless otherwise stated)
- Creatinine clearance of >= 40/min/1.73 m^2 for participants with creatinine levels
above institutional normal per 24 hour urine test or the Cockcroft-Gault formula
(performed within 28 days prior to day 1 of protocol therapy unless otherwise stated)
- Corrected QT (QTc) =< 480 ms
- Note: To be performed within 28 days prior to day 1 of protocol therapy
- Seronegative for human immunodeficiency virus (HIV) antigen/antibody (Ag/Ab) combo,
hepatitis C virus (HCV), active hepatitis B virus (HBV) (surface antigen negative),
and syphilis (rapid plasma reagin [RPR])
- If positive, hepatitis C ribonucleic acid (RNA) quantitation must be performed
- Women of childbearing potential (WOCBP): negative urine or serum pregnancy test
- If the urine test is positive or cannot be confirmed as negative, a serum
pregnancy test will be required
- Agreement by females and males of childbearing potential to use an effective method of
birth control or abstain from heterosexual activity for the course of the study
through at least 3 months after the last dose of protocol therapy
- Childbearing potential defined as not being surgically sterilized (men and women)
or have not been free from menses for > 1 year (women only)
Exclusion Criteria:
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to study agent
- Active diarrhea considered clinically significant and may impair oral drug
administration
- Clinically significant uncontrolled illness
- Active infection requiring antibiotics
- Active infection. Patients with treated viral, bacterial or fungal infections
that are controlled on therapy will be allowed to participate
- Known history of immunodeficiency virus (HIV) or hepatitis B or hepatitis C infection
- Diagnosis of Gilbert's disease
- Other active malignancy. Participants with history of prior malignancy treated with
curative intent who achieved complete response (CR) more than 2 years before study
entry are eligible. This exclusion rule does not apply to non-melanoma skin tumors and
in-situ cervical cancer
- Females only: Pregnant or breastfeeding
- Active grade II-IV acute GVHD and/or requiring systemic steroids with prednisone dose
equivalent of >= 0.25 mg/kg at end of 4 weeks
- Any other condition that would, in the investigator's judgment, contraindicate the
patient's participation in the clinical study due to safety concerns with clinical
study procedures
- Prospective participants, who, in the opinion of the investigator, may not be able to
comply with all study procedures (including compliance issues related to
feasibility/logistics)
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of adverse events (AEs) |
Time Frame: | Up to 30 days post treatment completion |
Safety Issue: | |
Description: | Toxicity will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). |
Secondary Outcome Measures
Measure: | Overall survival (OS) |
Time Frame: | From starting enasidenib to date of death, assessed up to 2 years |
Safety Issue: | |
Description: | Will be analyzed using the Kaplan-Meier curves. |
Measure: | Leukemia free survival (LFS) |
Time Frame: | From starting enasidenib to date of relapse or death, assessed up to 2 years |
Safety Issue: | |
Description: | Will be analyzed using the Kaplan-Meier curves. |
Measure: | Time to relapse |
Time Frame: | From starting enasidenib to date of relapse, assessed up to 2 years |
Safety Issue: | |
Description: | Time to relapse will be censored at the last disease assessment if patients are known to be alive and leukemia free. |
Measure: | Non-relapse mortality (NRM) |
Time Frame: | From starting enasidenib to date of death from other causes than relapse, assessed up to 2 years |
Safety Issue: | |
Description: | Will be analyzed using the curves of cumulative incidence. |
Measure: | Graft versus host disease (GvHD)-free relapse free survival (GRFS) |
Time Frame: | At 1 year mark of starting enasidenib |
Safety Issue: | |
Description: | Will be analyzed using the Kaplan-Meier curves. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | City of Hope Medical Center |
Last Updated
August 16, 2021