Description:
This phase Ib/II trial studies the side effects and best dose of venetoclax in combination
with quizartinib and how well they work in treating patients with acute myeloid leukemia that
has come back or does not respond to treatment, and who are FLT3-mutation positive.
Venetoclax and quizartinib may stop the growth of cancer cells by blocking some of the
enzymes needed for cell growth.
Title
- Brief Title: Venetoclax and Quizartinib in Treating Patients With FLT3-mutated Recurrent or Refractory Acute Myeloid Leukemia
- Official Title: A Phase Ib/II Study of Venetoclax in Combination With Quizartinib in FLT3-Mutated Acute Myelogenous Leukemia (AML)
Clinical Trial IDs
- ORG STUDY ID:
2018-0608
- SECONDARY ID:
NCI-2018-02396
- SECONDARY ID:
2018-0608
- SECONDARY ID:
P30CA016672
- NCT ID:
NCT03735875
Conditions
- Acute Myeloid Leukemia With FLT3/ITD Mutation
- Recurrent Acute Myeloid Leukemia
- Refractory Acute Leukemia
Interventions
Drug | Synonyms | Arms |
---|
Quizartinib | AC-220, AC010220, AC220 | Treatment (venetoclax, quizartinib) |
Venetoclax | ABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, Venclyxto | Treatment (venetoclax, quizartinib) |
Purpose
This phase Ib/II trial studies the side effects and best dose of venetoclax in combination
with quizartinib and how well they work in treating patients with acute myeloid leukemia that
has come back or does not respond to treatment, and who are FLT3-mutation positive.
Venetoclax and quizartinib 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 maximum tolerated dose (MTD) and the recommended phase 2 dose (RP2D) of
the combination of venetoclax with quizartinib in FLT3-internal tandem duplication (ITD)
mutated patients with relapsed/refractory acute myeloid leukemia (AML). (Phase Ib) II. To
determine the composite complete remission (CR) (CRc) rate including CR + CRp (complete
remission with incomplete platelet recovery) + CRi (complete remission with incomplete count
recovery) within 3 months of treatment initiation in FLT3-ITD mutated patients with
relapsed/refractory AML. (Phase II)
SECONDARY OBJECTIVES:
I. To determine the composite CRc rate including CR + CRp + CRi within 3 months of treatment
initiation in FLT3-ITD mutated patients with relapsed/ refractory AML. (Phase Ib) II. To
determine the overall response rate (ORR) including CRc + partial remission (PR) within 3
months of treatment initiation in FLT3-ITD mutated patients with relapsed/refractory AML.
(Phase Ib) III. To determine the duration of response (DOR), progression free survival,
event-free survival (EFS), overall survival (OS), and number of patients bridged to
hematopoietic stem cell transplant (HSCT) and median duration to HSCT from the initiation of
the combination in FLT3-ITD mutated patients with relapsed/ refractory AML. (Phase Ib) IV. To
characterize the pharmacokinetic (PK) profiles of combination therapy of venetoclax and
quizartinib in FLT3-ITD mutated patients with relapsed/refractory AML. (Phase Ib) V. To
determine the ORR within 3 months of treatment initiation in FLT3-ITD mutated patients with
relapsed/ refractory AML. (Phase II) VI. To determine the DOR, progression-free survival
(PFS), EFS, OS, and number of patients bridged to HSCT and median duration to HSCT from the
initiation of the combination in FLT3-ITD mutated patients with relapsed/refractory AML.
(Phase II) VII. To determine the safety and tolerability of the combination in FLT3-ITD
mutated patients with relapsed/refractory AML. (Phase II)
EXPLORATORY OBJECTIVES:
I. To investigate possible relationships between baseline next generation gene sequencing and
clinical response to the combination.
II. To investigate quantitative changes of FLT3-ITD allelic burden with time and the extent
of pharmacodynamics biomarker (such as phosphorylated [p]-FLT3, p-ribosomal protein S6 kinase
beta-1 [p70S6K], pERK, pSTAT) inhibition, and the induction of apoptosis in the bone marrow
and peripheral blasts in patients treated with the combination.
III. To investigate possible relationships between baseline gene expression signatures, Bcl-2
family messenger ribonucleic acid (mRNA) and protein levels of AML blasts and/or stem cell
sub-population, BH3 profiling of Bcl-2 family member dependency and ex vivo functional screen
and clinical response to the combination.
IV. To analyze immune modulation including alterations in total and percent of CD3+ T-cells,
total and percent of various T-cell subsets (CD4-effector, CD4-regs, CD8 cytotoxic T-cells),
and total and percent of T-cell/T-cell subsets expressing specific checkpoint
receptors/ligands with the combination.
V. To store and/or analyze surplus blood or tissue including bone marrow, if available, for
potential future exploratory research into molecular and immune factors that may influence
response to venetoclax and/or quizartinib (where response is defined broadly to include
efficacy, tolerability or safety).
OUTLINE: This is a phase Ib dose-escalation study of quizartinib, followed by a phase II
study.
Patients receive quizartinib orally (PO) once daily (QD) on days 1-28 and venetoclax PO QD
beginning on day 8 of cycle 1. Treatment repeats every 28 days for up to 24 cycles in the
absence of disease progression or unacceptable toxicity. Patients may continue treatment
beyond 24 cycles at the discretion of the treating physician.
After completion of study treatment, patients are followed up at 30 days and then every 3-6
months for up to 5 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (venetoclax, quizartinib) | Experimental | Patients receive quizartinib PO QD on days 1-28 and venetoclax PO QD beginning on day 8 of cycle 1. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. Patients may continue treatment beyond 24 cycles at the discretion of the treating physician. | |
Eligibility Criteria
Inclusion Criteria:
- FLT3-ITD mutated patients with relapsed/refractory AML (up to four prior therapeutic
regimens for AML i.e. up to salvage 4 AML), including patients who may have been
previously exposed to prior FLT3-inhibitor/s other than quizartinib (stem cell
transplant [SCT] or stem cell therapy for patients who previously underwent SCT/stem
cell therapy in remission will not be considered a salvage regimen)
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2
- Potassium, magnesium, and calcium (normalized for albumin) levels should be within
institutional normal limits
- Serum direct bilirubin =< 1.5 x upper limit normal (ULN) (or =< 3.0 x ULN if deemed to
be elevated due to leukemia)
- Alanine aminotransferase and/or aspartate aminotransferase (aspartate transaminase) =<
2.5 x ULN (or =< 5.0 x ULN if deemed elevated due to leukemia)
- Subjects with documented Gilbert's Syndrome may have a total bilirubin > 1.5 x ULN
- Potassium levels should be within institutional normal limits
- Magnesium levels should be within institutional normal limits
- Calcium (normalized for albumin) levels should be within institutional normal limits
- Adequate renal function as demonstrated by a serum creatinine =< 1.8
- Patients must provide written informed consent
- With the exception of patients with rapidly proliferative disease, the interval from
prior treatment to time of initiation of venetoclax and quizartinib administration
will be at least 14 days or at least 5 half-lives (whichever is shorter) for
cytotoxic/noncytotoxic agents. The half-life for the therapy in question will be based
on published pharmacokinetic literature (abstracts, manuscripts, investigator
brochures, or drug-administration manuals) and will be documented in the protocol
eligibility document. The use of chemotherapeutic or anti-leukemic agents is not
permitted during the study with the following exceptions:
- Intrathecal (IT) therapy for patients with controlled central nervous system
(CNS) leukemia at the discretion of the principal investigator (PI). Controlled
CNS leukemia is defined by the absence of active clinical signs of CNS disease
and no evidence of CNS leukemia on the most recent 2 simultaneous cerebrospinal
fluid (CSF) evaluations
- Use of one dose of cytarabine (up to 2 g/m^2) or hydroxyurea for patients with
rapidly proliferative disease is allowed before the start of study therapy and on
therapy. These medications will be recorded in the case-report form
- Baseline ejection fraction by echocardiogram (ECHO) or multigated acquisition scan
(MUGA) must be >= 50%
- Women of non-childbearing potential are those who are postmenopausal greater than 1
year or who have had a bilateral tubal ligation or hysterectomy
- Women of childbearing potential must agree to have a negative serum or beta human
chorionic gonadotropin (beta-hCG) pregnancy test result within 7 days prior to the
first dose of study drugs and must agree to use an effective contraception method
during the study and for 90 days following the last dose of the study. Men who have
partners of childbearing potential must agree to use an effective contraceptive method
during the study and for 90 days following the last dose of study drug
Exclusion Criteria:
- Subject has t(8;21) or inv(16) karyotype abnormalities
- Subject has acute promyelocytic leukemia (French-American-British Class M3 AML)
- Prior exposure to quizartinib at any time in the past
- Serum potassium < 3.5 mEq/L despite supplementation, or > 5.5 mEq/L. Serum magnesium
above or below the institutional normal limit despite adequate management. Serum
calcium (corrected for albumin levels) above or below institutional normal limit
despite adequate management
- Patients with known allergy or hypersensitivity to quizartinib, venetoclax or any of
their components
- Subject with a known history of being human immunodeficiency virus (HIV) positive (due
to potential drug-drug interactions between antiretroviral medications and venetoclax,
as well as anticipated venetoclax mechanism-based lymphopenia that may potentially
increase the risk of opportunistic infections)
- Note: HIV testing is not required
- Subject has consumed grapefruit, grapefruit products, Seville oranges (including
marmalade containing Seville oranges) or star fruit within 3 days prior to the
initiation of study treatment
- Subject has a significant history of renal, neurologic, psychiatric, endocrinologic,
metabolic, immunologic, hepatic, cardiovascular disease, or any other medical
condition that in the opinion of the investigator and/or the PI would adversely affect
his/her participating in this study. Patients who have had any major surgical
procedure within 14 days of day 1
- Subject has a malabsorption syndrome or other condition that precludes enteral route
of administration
- Subject exhibits evidence of other clinically significant uncontrolled condition(s)
including, but not limited to: a. Uncontrolled systemic infection requiring
intravenous (IV) therapy (viral, bacterial or fungal). Infections controlled on
concurrent anti-microbial agents are acceptable, and anti-microbial prophylaxis per
institutional guidelines is acceptable. Patients with neutropenic fever considered
infection related should be afebrile for at least 72 hours prior to first dose
- Subject has a history of other malignancies within 1 year prior to study entry, with
the exception of:
- Adequately treated in situ carcinoma of the cervix uteri or carcinoma in situ of
breast
- Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin
- Previous malignancy confined and surgically resected (or treated with other
modalities) with curative intent
- Patients on active antineoplastic or radiation therapy for a concurrent
malignancy at the time of screening. Maintenance therapy, hormonal therapy, or
steroid therapy for well-controlled malignancy is allowed
- Patients with a known positive hepatitis B or C infection by serology, with the
exception of those with an undetectable viral load within 3 months (hepatitis B or C
testing is not required prior to study entry). Subjects with serologic evidence of
prior vaccination to hepatitis B virus (HBV) (i.e., hepatitis B surface antigen
negative [HBs Ag-], and hepatitis B surface antibody positive [anti-HBs+]) may
participate
- Female subjects who are pregnant or breastfeeding
- Impaired cardiac function including any of the following:
- Screening electrocardiogram (ECG) with a corrected QT (QTc) > 450 msec. The QTc
interval will be calculated by Fridericia's correction factor (QTcF) at screening
and on day 1 prior to the first dose of quizartinib. The QTcF will be derived
from the average QTcF in triplicate. If QTcF > 450 msec on day 1, quizartinib
will not be given.
- Patients with congenital long QT syndrome
- History or presence of sustained ventricular tachycardia requiring medical
intervention within 3 months prior to starting study drug
- Any history of clinically significant ventricular fibrillation or torsades de
pointes
- Known history of second or third degree heart block (may be eligible if the
patient currently has a pacemaker) within 3 months prior to starting study drug
- Sustained heart rate of < 50/minute on screening or day 1 ECG
- Right bundle branch block + left anterior hemiblock (i.e. bifascicular block)
- Isolated right bundle branch block (RBBB) will not be an exclusion criterion
- Complete left bundle branch block
- Patients with myocardial infarction or unstable angina within 6 months prior to
starting study drug
- Congestive heart failure (CHF) New York (NY) Heart Association class III or IV
within 3 months prior to starting study drug
- Atrial fibrillation documented within 2 weeks prior to first dose of study drug
- Patients who are actively taking CYP3A inducers. CYP3A4 inducers should be
stopped at least 3 days prior to the first dose of quizartinib and are prohibited
at any time on study. Moderate and strong CYP3A4 inhibitors should be stopped at
least 3 days prior to the first dose of quizartinib and are prohibited during
cycle 1. Moderate (but not strong) CYP3A4 inhibitors may be used with the below
dose reductions of venetoclax after cycle 1. Patients may receive weak CYP3A4
inhibitors at any time on study. The venetoclax and quizartinib doses do not need
to be adjusted for weak CYP3A4 inhibitors
- Patients who require treatment with concomitant drugs that prolong QT/QTc
interval. QT/QTc prolonging drugs should be stopped at least 3 days prior to the
first dose of quizartinib and are prohibited at any time on study
- Known family history of congenital long QT syndrome
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Maximum tolerated dose (MTD) as determined by dose limiting toxicity (Phase Ib) |
Time Frame: | Up to 28 days |
Safety Issue: | |
Description: | |
Secondary Outcome Measures
Measure: | Composite CRc rate including CR + CRp + CRi (Phase Ib) |
Time Frame: | Within 3 months of treatment initiation |
Safety Issue: | |
Description: | |
Measure: | Overall response rate (ORR) including CRc + partial remission (PR) (Phase Ib) |
Time Frame: | Within 3 months of treatment initiation |
Safety Issue: | |
Description: | |
Measure: | Duration of response (DOR) (Phase Ib) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Progression free survival (PFS) (Phase Ib) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Event-free survival (EFS) (Phase Ib) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Overall survival (OS) (Phase Ib) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Number of patients bridged to hematopoietic stem cell transplant (HSCT) (Phase Ib) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Median duration to HSCT (Phase Ib) |
Time Frame: | From the start of study treatment up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Characterization of pharmacokinetic profiles (Phase Ib) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | ORR (Phase II) |
Time Frame: | Within 3 months of treatment initiation |
Safety Issue: | |
Description: | |
Measure: | DOR (Phase II) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | PFS (Phase II) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | EFS (Phase II) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | OS (Phase II) |
Time Frame: | up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Number of patients bridged to hematopoietic stem cell transplant (HSCT) (Phase II) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Median duration to HSCT (Phase II) |
Time Frame: | From the start of study treatment up to 5 years |
Safety Issue: | |
Description: | |
Measure: | Incidence of adverse events (Phase II) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
May 15, 2020