Description:
This phase Ib/II trials studies the side effects of decitabine/cedazuridine (ASTX727) and
venetoclax in combination with ivosidenib or enasidenib, and how well they work in treating
patients with acute myeloid leukemia that has come back (relapsed) or does not respond to
treatment (refractory). ASTX727 is the combination of a fixed dose of 2 drugs, cedazuridine
and decitabine. Cedazuridine may slow down how fast decitabine is broken down by the body,
and decitabine may block abnormal cells or cancer cells from growing. Venetoclax may stop the
growth of cancer cells by blocking BCL-2, a protein needed for cancer cell survival.
Enasidenib and ivosidenib may stop the growth of cancer cells by blocking some of the enzymes
needed for cell growth. Giving decitabine/cedazuridine and venetoclax in combination with
ivosidenib or enasidenib may help control acute myeloid leukemia.
Title
- Brief Title: Decitabine/Cedazuridine and Venetoclax in Combination With Ivosidenib or Enasidenib for the Treatment of Relapsed or Refractory Acute Myeloid Leukemia
- Official Title: Phase 1b/2 Study of Oral Decitabine/Cedazuridine (ASTX727) and Venetoclax in Combination With the Targeted Mutant IDH1 Inhibitor Ivosidenib or the Targeted Mutant IDH2 Inhibitor Enasidenib
Clinical Trial IDs
- ORG STUDY ID:
2020-1220
- SECONDARY ID:
NCI-2021-00893
- SECONDARY ID:
2020-1220
- NCT ID:
NCT04774393
Conditions
- Acute Myeloid Leukemia
- Recurrent Acute Myeloid Leukemia
- Refractory Acute Myeloid Leukemia
Interventions
Drug | Synonyms | Arms |
---|
Decitabine and Cedazuridine | ASTX727, CDA Inhibitor E7727/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Tablet, Inqovi | Arm A (decitabine/cedazuridine, venetoclax, ivosidenib) |
Enasidenib | AG-221, CC-90007 Free Base | Arm B (decitabine/cedazuridine, venetoclax, enasidenib) |
Ivosidenib | AG-120, Tibsovo | Arm A (decitabine/cedazuridine, venetoclax, ivosidenib) |
Venetoclax | ABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, Venclyxto | Arm A (decitabine/cedazuridine, venetoclax, ivosidenib) |
Purpose
This phase Ib/II trials studies the side effects of decitabine/cedazuridine (ASTX727) and
venetoclax in combination with ivosidenib or enasidenib, and how well they work in treating
patients with acute myeloid leukemia that has come back (relapsed) or does not respond to
treatment (refractory). ASTX727 is the combination of a fixed dose of 2 drugs, cedazuridine
and decitabine. Cedazuridine may slow down how fast decitabine is broken down by the body,
and decitabine may block abnormal cells or cancer cells from growing. Venetoclax may stop the
growth of cancer cells by blocking BCL-2, a protein needed for cancer cell survival.
Enasidenib and ivosidenib may stop the growth of cancer cells by blocking some of the enzymes
needed for cell growth. Giving decitabine/cedazuridine and venetoclax in combination with
ivosidenib or enasidenib may help control acute myeloid leukemia.
Detailed Description
PRIMARY OBJECTIVE:
I. To determine the safety and tolerability and recommended phase 2 dose (RP2D) of oral
decitabine/cedazuridine (ASTX727) and venetoclax in combination with either ivosidenib (Arm
A) or enasidenib (Arm B) for patients with acute myeloid leukemia. (Phase Ib) II. To
determine the overall response rate (complete response [CR], complete remission with
incomplete hematologic recovery [CRh], morphologic leukemia-free state [MLFS] and partial
response [PR)] of oral decitabine/cedazuridine (ASTX727) and venetoclax in combination with
either ivosidenib (Arm A) or enasidenib (Arm B) for patients with acute myeloid leukemia.
(Phase 2)
SECONDARY OBJECTIVES:
I. To determine duration of response (DOR), event-free survival (EFS), and overall survival
(OS).
II. To evaluate occurrence of minimal residual disease (MRD) negative status by
multiparameter flow cytometry and molecular evaluation.
EXPLORATORY OBJECTIVE:
I. To investigate global gene expression profiles, deoxyribonucleic acid (DNA) methylation
profiles, BH3 profiling and other potential prognostic markers to explore predictors of
antitumor activity and/or resistance to treatment.
OUTLINE: Patients are assigned to 1 of 2 arms.
ARM A: Patients receive decitabine/cedazuridine orally (PO) daily on days 1-5, venetoclax PO
daily on days 1-14, and ivosidenib PO daily on days 1-28. Treatment repeats every 28 days for
12 cycles in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive decitabine/cedazuridine PO daily on days 1-5, venetoclax PO daily on
days 1-14, and enasidenib PO daily on days 1-28. Treatment repeats every 28 days for 12
cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm A (decitabine/cedazuridine, venetoclax, ivosidenib) | Experimental | Patients receive decitabine/cedazuridine PO daily on days 1-5, venetoclax PO daily on days 1-14, and ivosidenib PO daily on days 1-28. Treatment repeats every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. | - Decitabine and Cedazuridine
- Ivosidenib
- Venetoclax
|
Arm B (decitabine/cedazuridine, venetoclax, enasidenib) | Experimental | Patients receive decitabine/cedazuridine PO daily on days 1-5, venetoclax PO daily on days 1-14, and enasidenib PO daily on days 1-28. Treatment repeats every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. | - Decitabine and Cedazuridine
- Enasidenib
- Venetoclax
|
Eligibility Criteria
Inclusion Criteria:
- Patients with a diagnosis of relapsed or refractory acute myeloid leukemia (AML)
(including biphenotypic or bilineage leukemia including a myeloid component or
isolated extramedullary AML); OR
- Patients (> 60 year old) with newly diagnosed AML not eligible for intensive
chemotherapy are also eligible
- Age >= 18 years
- Subjects must have documented IDH1 or IDH2 gene mutation
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2
- Adequate renal function including creatinine < 2 unless related to the disease
- Direct bilirubin < 2 x upper limit of normal (ULN) unless increase is due to Gilbert's
disease or leukemic involvement
- Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) < 3 x ULN
unless considered due to leukemic involvement, in which case direct bilirubin or AST
and/or ALT < 5 x ULN will be considered eligible)
- In the absence of rapidly proliferative disease, the interval from prior treatment to
time of initiation will be at least 7 days for cytotoxic or non-cytotoxic
(immunotherapy agent(s). Oral hydroxyurea and/or cytarabine (up to 2 g/m^2) for
patients with rapidly proliferative disease is allowed before the start of study
therapy, as needed, for clinical benefit and after discussion with the principle
investigator (PI). Concurrent therapy for central nervous system (CNS) prophylaxis or
continuation of therapy for controlled CNS disease is permitted
- Male subjects who are sexually active with a women of childbearing potential (WOCBP)
and who have not had vasectomies must be willing to use a barrier method of
contraception and refrain from sperm donation from initial study drug until 90 days
after last dose of study drug
- Willing and able to provide informed consent
Exclusion Criteria:
- Patients with t(15;17) karyotypic abnormality or acute promyelocytic leukemia
(French-American-British [FAB] class M3-AML)
- Patients with any concurrent uncontrolled clinically significant medical condition
including life-threatening severe infection, or psychiatric illness, which could place
the patient at unacceptable risk of study treatment
- Patients with active graft-versus-host-disease (GVHD) status post stem cell transplant
(patients without active GVHD on chronic suppressive immunosuppression and/or
phototherapy for chronic skin GVHD are permitted after discussion with the PI)
- Patients with any severe gastrointestinal or metabolic condition which could interfere
with the absorption of oral study medications
- Corrected QT (QTc) interval using Fridericia's formula (QTcF) >= 450 msec. Bundle
branch block and prolonged QTc interval are permitted after discussion with the PI
- Known active hepatitis B (HBV) or hepatitis C (HCV) infection or known human
immunodeficiency virus (HIV) infection
- Subject has a white blood cell count > 25 x 10^9/L. (Note: Hydroxyurea is permitted to
meet this criterion)
- Nursing women, women of childbearing potential (WOCBP) with positive urine pregnancy
test, or women of childbearing potential who are not willing to maintain adequate
contraception
- Appropriate highly effective method(s) of contraception include oral or
injectable hormonal birth control, intrauterine device (IUD), and double barrier
methods (for example a condom in combination with a spermicide)
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose limiting toxicity (Phase Ib) |
Time Frame: | Up to 1 cycle (1 cycle = 28 days) |
Safety Issue: | |
Description: | Will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5 by organ system. |
Secondary Outcome Measures
Measure: | Event-free survival (EFS) |
Time Frame: | Time interval between treatment start until disease progression, relapse/refractory, or death due to any cause, assessed 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: | Time interval between treatment start until death due to any cause, assessed 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: | Duration of response |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | The Kaplan-Meier method will be used to estimate the probabilities and log-rank tests will be used to compare among subgroups of patients. |
Measure: | Minimal residual disease negative status |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | Will be summarized graphically and with descriptive statistics. The association between molecular and cellular markers and overall response and/or resistance will be assessed through logistic regression analyses. Paired t-test or Wilcoxon signed rank test will be used to assess the marker change over time. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
July 6, 2021