Clinical Trials /

Decitabine/Cedazuridine and Venetoclax in Combination With Ivosidenib or Enasidenib for the Treatment of Relapsed or Refractory Acute Myeloid Leukemia

NCT04774393

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.

Related Conditions:
  • Acute Myeloid Leukemia
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

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

DrugSynonymsArms
Decitabine and CedazuridineASTX727, CDA Inhibitor E7727/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Tablet, InqoviArm A (decitabine/cedazuridine, venetoclax, ivosidenib)
EnasidenibAG-221, CC-90007 Free BaseArm B (decitabine/cedazuridine, venetoclax, enasidenib)
IvosidenibAG-120, TibsovoArm A (decitabine/cedazuridine, venetoclax, ivosidenib)
VenetoclaxABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, VenclyxtoArm 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

NameTypeDescriptionInterventions
Arm A (decitabine/cedazuridine, venetoclax, ivosidenib)ExperimentalPatients 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)ExperimentalPatients 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