Description:
A Phase 1b/2a multi-center, open-label, non-randomized study to assess the safety,
tolerability and efficacy of dose-adjusted brequinar in adult subjects with acute myeloid
leukemia (AML). Ribavirin BID may be added to brequinar twice weekly in eligible subjects.
Title
- Brief Title: A Study of Brequinar in Subjects With Relapsed/Refractory Acute Myeloid Leukemia
- Official Title: A Phase 1b/2a Open-label, Multi-center Study to Assess the Safety, Efficacy and Pharmacokinetics of Intrapatient Dose-adjusted Brequinar and Inhibition of Dihydroorotate Dehydrogenase (DHODH) in Adult Subjects With AML
Clinical Trial IDs
- ORG STUDY ID:
CCB-01
- NCT ID:
NCT03760666
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Brequinar | | Brequinar |
Brequinar + Ribavirin | | Brequinar + Ribavirin |
Purpose
A Phase 1b/2a multi-center, open-label, non-randomized study to assess the safety,
tolerability and efficacy of dose-adjusted brequinar in adult subjects with acute myeloid
leukemia (AML). Ribavirin BID may be added to brequinar twice weekly in eligible subjects.
Detailed Description
Up to 27 subjects will be entered in this Phase 1b/2a multi-center, open-label,
non-randomized study to assess the safety, tolerability and efficacy of dose-adjusted
brequinar in adult subjects with acute myeloid leukemia (AML). Active Cohort 2 subjects on
brequinar alone twice weekly may roll over into brequinar twice weekly + ribavirin BID.
Cohort 3 subjects will begin treatment with brequinar alone twice weekly then move to
brequinar twice weekly + ribavirin BID as tolerated. Both the brequinar and ribavirin doses
may be adjusted based on safety, tolerability, and enzyme inhibition levels.
Trial Arms
Name | Type | Description | Interventions |
---|
Brequinar | Experimental | Brequinar dosed orally. Multiple doses. | |
Brequinar + Ribavirin | Other | Subjects in Cohort 2 may roll over to add ribavirin dosing; subjects in Cohort 3 will start with brequinar alone then add ribavirin dosing. | |
Eligibility Criteria
Inclusion Criteria:
1. 1. Willing and able to provide written informed consent for the trial.
2. Patients 18 years of age or older, with relapsed/refractory AML by World Health
Organization classification, T-cell leukemia (T-ALL), bi-lineal leukemia (BLL), or
mixed phenotypic acute leukemia (MPAL) and who have exhausted available therapy.
3. ECOG Performance Status 0 to 2.
4. 12-lead ECG with no clinically unacceptable findings; adequate cardiac function/NYHA
Class 0 to 2.
5. Adequate hepatic function (unless deemed to be related to underlying leukemia).
1. Direct bilirubin ≤ 2 x ULN
2. ALT ≤ 3 x ULN
3. AST ≤ 3 x ULN
6. Adequate renal function as documented by creatinine clearance ≥ 50 mL/min based on the
Cockcroft-Gault equation.
7. In the absence of rapidly proliferative disease, the interval from prior
leukemia-directed therapy to first dose of study drug will be at least 7 days for
cytotoxic or non-cytotoxic (immunotherapy) agents. Use of supportive care measures per
institution's standard of care is permitted at any time.
8. The effects of brequinar on the developing human fetus are unknown. For this reason,
women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry and for
the duration of study participation. Should a woman become pregnant or suspect she is
pregnant while she or her partner is participating in this study, she should inform
her treating physician immediately. Men treated or enrolled on this protocol must also
agree to use adequate contraception prior to the study, for the duration of study
participation, and for 90 days after completion of brequinar administration.
9. Male subjects must agree to refrain from sperm donation from initial study drug
administration until 90 days after the last dose of study drug.
Exclusion Criteria:
1. Patients in need of immediate leukapheresis.
2. Any concurrent uncontrolled clinically significant medical condition, laboratory
abnormality, or psychiatric illness that could place the participant at unacceptable
risk of study treatment.
3. QTc interval using Fridericia's formula (QTcF) ≥ 470 msec. Participants with a bundle
branch block and prolonged QTc interval may be eligible after discussion with the
medical monitor.
4. Pre-existing liver disease.
5. The use of other chemotherapeutic agents or anti-leukemic agents is not permitted
during study with the following exceptions:
a. Intrathecal chemotherapy for prophylactic use or maintenance of controlled CNS
leukemia.
6. Presence of graft versus host disease (GVHD) which requires an equivalent dose of ≥
0.5 mg/kg/day of prednisone or therapy beyond systemic corticosteroids (e.g.
cyclosporine or other calcineurin inhibitors or other immunosuppressive agents used
for GVHD).
7. Active cerebrospinal involvement of AML, T-cell leukemia (T-ALL), bi-lineal leukemia
(BLL), or mixed phenotypic acute leukemia (MPAL).
8. Diagnosis of acute promyelocytic leukemia (APL)
9. Clinically active hepatitis B (HBV) or hepatitis C (HCV) infection.
10. Severe gastrointestinal or metabolic condition that could interfere with the
absorption of oral study medication.
11. Prior malignancy, unless it has not been active or has remained stable for at least 2
years. Participants with treated non-melanoma skin cancer, in situ carcinoma or
cervical intraepithelial neoplasia, regardless of the disease-free duration, are
eligible if definitive treatment for the condition has been completed. Participants
with organ-confined prostate cancer with no evidence of recurrent or progressive
disease are eligible if at the active surveillance stage, hormonal therapy has been
initiated, or the malignancy has been surgically removed or treated with definitive
radiotherapy.
12. Nursing women or women of childbearing potential (WOCBP) with a positive pregnancy
test.
13. Documented hemoglobinopathy.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of Participants with Treatment-Related Adverse Events |
Time Frame: | 12 months |
Safety Issue: | |
Description: | The number of subjects with treatment-related adverse events as assessed by CTCAE v. 4.03. |
Secondary Outcome Measures
Measure: | Overall Response Rate (ORR) |
Time Frame: | 12 months |
Safety Issue: | |
Description: | The number of participants in the Efficacy Analysis Set with best overall response of one of the responses of CR, CRi, CRh, PR, of MLFS. |
Measure: | Complete Remission (CR) rate |
Time Frame: | Up to approximately 12 months |
Safety Issue: | |
Description: | The proportion of subjects in the Efficacy Analysis Set with best overall response of CR |
Measure: | Complete Remission with Incomplete Hematologic Recovery (CRi) rate |
Time Frame: | Up to approximately 12 months |
Safety Issue: | |
Description: | The proportion of subjects in the Efficacy Analysis Set with a best overall response of CRi |
Measure: | Complete Remission with Partial Hematological Recovery (CRh) rate |
Time Frame: | Up to approximately 12 months |
Safety Issue: | |
Description: | The proportion of subjects in the Efficacy Analysis Set with a best overall response of CRh |
Measure: | Morphologic Leukemia Free State (MLFS) rate |
Time Frame: | Up to approximately 12 months |
Safety Issue: | |
Description: | The proportion of subjects in the Efficacy Analysis Set with a best overall response of MLFS |
Measure: | Partial Remission (PR) rate |
Time Frame: | Up to approximately 12 months |
Safety Issue: | |
Description: | The proportion of subjects in the Efficacy Analysis Set with a best overall response of PR |
Measure: | Event free survival (EFS) rate |
Time Frame: | Up to approximately 12 months |
Safety Issue: | |
Description: | Interval between first dose and relapse (>=5% bone marrow blasts, reappearance of blasts in blood, or development of extramedullary disease), disease progression, or both |
Measure: | Duration of response |
Time Frame: | Up to approximately 12 months |
Safety Issue: | |
Description: | The duration of response is defined as the number of days from the time response criteria are initially met for CR, CRi, CRh, PR, or MLFS (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented, or death due to any cause. Participants without events reported are censored at the last disease evaluation. |
Measure: | Brequinar Pharmacokinetics - Elimination Half-Life (T 1/2) |
Time Frame: | Up to 14 days after first dose. |
Safety Issue: | |
Description: | The period of time required for the concentration of drug in plasma to be reduced by one-half. |
Measure: | Brequinar Pharmacokinetics - AUC |
Time Frame: | Up to 14 days after first dose. |
Safety Issue: | |
Description: | The plot of drug concentration in blood plasma vs. time. |
Measure: | DHO Plasma Level |
Time Frame: | Up to 14 days after first dose. Pre-dose at the beginning of each cycle (every 2 weeks for 3 months then every 4 weeks). |
Safety Issue: | |
Description: | Plasma level of DHO |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Clear Creek Bio, Inc. |
Trial Keywords
- DHODH
- Brequinar
- Differentiation
- IMPDH Inhibition
Last Updated
August 3, 2021