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Study to Evaluate the Safety and Efficacy of Magrolimab in Combination With Azacitidine Versus Physician's Choice of Venetoclax in Combination With Azacitidine or Intensive Chemotherapy in Previously Untreated Adults With TP53 Mutant Acute Myeloid Leukemia

NCT04778397

Description:

The primary objective of this study is to compare the efficacy of magrolimab + azacitidine versus venetoclax + azacitidine in adults with previously untreated TP53 mutant acute myeloid leukemia (AML) who are appropriate for non-intensive therapy as measured by overall survival (OS).

Related Conditions:
  • Acute Myeloid Leukemia
Recruiting Status:

Recruiting

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Study to Evaluate the Safety and Efficacy of Magrolimab in Combination With Azacitidine Versus Physician's Choice of Venetoclax in Combination With Azacitidine or Intensive Chemotherapy in Previously Untreated Adults With TP53 Mutant Acute Myeloid Leukemia
  • Official Title: A Phase 3, Randomized, Open-Label Study Evaluating the Safety and Efficacy of Magrolimab in Combination With Azacitidine Versus Physician's Choice of Venetoclax in Combination With Azacitidine or Intensive Chemotherapy in Previously Untreated Patients With TP53 Mutant Acute Myeloid Leukemia

Clinical Trial IDs

  • ORG STUDY ID: GS-US-546-5857
  • SECONDARY ID: 2020-003949-11
  • NCT ID: NCT04778397

Conditions

  • Acute Myeloid Leukemia

Interventions

DrugSynonymsArms
MagrolimabGS-4721Magrolimab + Azacitidine
VenetoclaxControl Arm: Venetoclax + Azacitidine
AzacitidineControl Arm: Venetoclax + Azacitidine
CytarabineControl Arm: 7+3 Chemotherapy
DaunorubicinControl Arm: 7+3 Chemotherapy
IdarubicinControl Arm: 7+3 Chemotherapy
Steroidal Eye DropsControl Arm: 7+3 Chemotherapy

Purpose

The primary objective of this study is to compare the efficacy of magrolimab + azacitidine versus venetoclax + azacitidine in adults with previously untreated TP53 mutant acute myeloid leukemia (AML) who are appropriate for non-intensive therapy as measured by overall survival (OS).

Trial Arms

NameTypeDescriptionInterventions
Magrolimab + AzacitidineExperimentalParticipants will receive an escalating dose of magrolimab and a fixed dose of azacitidine.
  • Magrolimab
  • Azacitidine
Control Arm: Venetoclax + AzacitidineActive ComparatorParticipants who are appropriate for non-intensive therapy will receive an escalating dose of venetoclax and a fixed dose of azacitidine.
  • Venetoclax
  • Azacitidine
Control Arm: 7+3 ChemotherapyActive ComparatorParticipants who are appropriate for intensive therapy will receive 7+3 chemotherapy: 7 day treatment with cytarabine and 3 day treatment with daunorubicin or idarubicin during induction and high-dose cytarabine and steroidal eye drops during consolidation.
  • Cytarabine
  • Daunorubicin
  • Idarubicin
  • Steroidal Eye Drops

Eligibility Criteria

        Key Inclusion Criteria:

          -  Individuals with histological confirmation of AML by World Health Organization
             criteria, previously untreated for AML, and who have presence of at least 1 TP53 gene
             mutation that is not benign or likely benign based on evaluation by central laboratory
             (individuals with biallelic 17p deletions, loss of both 17p alleles, are eligible
             based on locally evaluated cytogenetics/karyotype/fluorescence in situ hybridization
             (FISH) report)

          -  Individuals with white blood cell (WBC) count ≤ 20×10^3/microliter (μL) prior to
             randomization. If the individual's WBC is > 20×10^3/μL prior to randomization, the
             individual can be enrolled, assuming all other eligibility criteria are met. However,
             the WBC should be ≤ 20×10^3/μL prior to the first dose of study treatment and prior to
             each magrolimab dose for Cycle 1 (if the individual is randomized to the experimental
             arm) Note: Individuals can be treated with hydroxyurea throughout the study or prior
             to randomization to reduce the WBC to ≤ 20×10^3/μL to enable eligibility for study
             drug dosing. Oral etoposide (up to 200 mg orally per day) may be given as an
             alternative to hydroxyurea for individuals who are intolerant to hydroxyurea or cannot
             achieve sufficient WBC lowering on hydroxyurea.

          -  The hemoglobin must be ≥ 9.5 grams per deciliter (g/dL) prior to initial dose of study
             treatment for individuals with prior cardiac history (eg, ischemic heart disease, left
             ventricular ejection fraction (LVEF) ≤ 45%, symptomatic congestive heart failure, or
             other conditions that may be sensitive to demand ischemia). Transfusions are allowed
             to meet hemoglobin eligibility

          -  Individual has provided informed consent

          -  Individual is willing and able to comply with clinic visits and procedure outlined in
             the study protocol

          -  Individuals must have an Eastern Cooperative Oncology Group (ECOG) performance status
             of 0 to 2, except for individuals less than 75 years of age and appropriate for
             non-intensive treatment. For these individuals, the ECOG performance status score may
             be 0 to 3

          -  Individuals must have adequate renal function as demonstrated by a creatinine
             clearance ≥ 30 milliliters per minute per 1.73 square meter (mL/min/1.73m^2);
             calculated by the Cockcroft Gault formula or measured by 24 hours urine collection

          -  Adequate cardiac function as demonstrated by:

               -  Lack of symptomatic congestive heart failure and clinically significant cardiac
                  arrhythmias and ischemic heart disease

               -  LVEF > 50% for individuals appropriate for intensive therapy

          -  Adequate liver function as demonstrated by:

               -  Aspartate aminotransferase ≤ 3.0 × upper limit of normal (ULN)

               -  Alanine aminotransferase ≤ 3.0 × ULN

               -  Total bilirubin ≤ 1.5 × ULN, or primary unconjugated bilirubin ≤ 3.0 × ULN if
                  individual has a documented history of Gilbert's syndrome or genetic equivalent

          -  Pretreatment blood cross-match completed

          -  Males and females of childbearing potential who engage in heterosexual intercourse
             must agree to use protocol-specified method(s) of contraception

          -  Individuals must be willing to consent to mandatory pretreatment and on-treatment bone
             marrow biopsies (aspirate and trephines).

        Key Exclusion Criteria:

          -  Positive serum pregnancy test

          -  Breastfeeding female

          -  Known hypersensitivity to any of the study drugs, the metabolites, or formulation
             excipient

          -  Prior treatment with any of the following:

               -  Cluster of differentiation 47 (CD47) or signal regulatory protein alpha
                  (SIRPα)-targeting agents

               -  Antileukemic therapy for the treatment of AML (excluding hydroxyurea or oral
                  etoposide), hypomethylating agent (HMA), low dose cytarabine and/or venetoclax
                  Note: Individuals with prior myelodysplastic syndrome (MDS) who have not received
                  prior HMAs or chemotherapeutic agents for MDS are allowed on study. Other prior
                  MDS therapies including, but not limited to, lenalidomide, erythroid stimulating
                  agents, or similar RBC-direct therapies, are allowed. Localized non-central
                  nervous system (CNS) radiotherapy, erythroid and/or myeloid growth factors,
                  hormonal therapy with luteinizing hormone-releasing hormone agonists for prostate
                  cancer, hormonal therapy or maintenance for breast cancer, and treatment with
                  bisphosphonates and receptor activator of nuclear factor kappa-B ligand
                  inhibitors are also not criteria for exclusion.

          -  Current participation in another interventional clinical study

          -  Known inherited or acquired bleeding disorders

          -  Individuals appropriate for non-intensive therapy, who have received treatment with
             strong and/or moderate cytochrome P450 enzyme 3A (CYP3A) inducers within 7 days prior
             to the initiation of study treatments

          -  Individuals appropriate for non-intensive therapy who have consumed grapefruit,
             grapefruit products, Seville oranges (including marmalade containing Seville oranges)
             or starfruit within 3 days prior to the initiation of study treatment

          -  Individuals appropriate for non-intensive therapy who have malabsorption syndrome or
             other conditions that preclude enteral route of administration

          -  Clinical suspicion of active CNS involvement with AML

          -  Individuals who have acute promyelocytic leukemia

          -  Significant disease or medical conditions, as assessed by the Investigator and
             Sponsor, that would substantially increase the risk-benefit ratio of participating in
             the study. This includes, but is not limited to, acute myocardial infarction within
             the last 6 months, unstable angina, uncontrolled diabetes mellitus, significant active
             infections, and congestive heart failure New York Heart Association Class III-IV

          -  Second malignancy, except neoplasms such as MDS/myeloproliferative disorders that can
             transform to AML, or treated basal cell or localized squamous skin carcinomas,
             localized prostate cancer, or other malignancies for which individuals are not on
             active anti-cancer therapies and have had no evidence of active malignancy for at
             least ≥ 1 year Note: Individuals on maintenance therapy alone who have no evidence of
             active malignancy for at least ≥ 1 year are eligible.

          -  Known active or chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection
             or human immunodeficiency virus (HIV) infection in medical history

          -  Active HBV, and/or active HCV, and/or HIV following testing at screening:

               -  Individuals who test positive for hepatitis B surface antigen (HBsAg).
                  Individuals who test positive for hepatitis B core antibody (anti-HBc) will
                  require HBV deoxyribose nucleic acid (DNA) by quantitative polymerase chain
                  reaction (PCR) for confirmation of active disease

               -  Individuals who test positive for HCV antibody. These individuals will require
                  HCV ribose nucleic acid (RNA) quantitative PCR for confirmation of active disease

               -  Individuals who test positive for HIV antibody

               -  Individuals not currently receiving antiviral therapy and who have an
                  undetectable viral load in the prior 3 months may be eligible for the study.

        Note: Other protocol defined Inclusion/Exclusion criteria may apply.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall Survival (OS) in Participants Appropriate for Non-intensive Therapy
Time Frame:Randomization up to death or end of study (up to 27 months) whichever occurs first
Safety Issue:
Description:The OS is measured from the date of randomization to the date of death from any cause. Those whose deaths are not observed during the study will be censored at their last known alive date.

Secondary Outcome Measures

Measure:Overall Survival in All Participants
Time Frame:Randomization up to death or end of study (up to 27 months) whichever occurs first
Safety Issue:
Description:The OS is measured from the date of randomization to the date of death from any cause. Those whose deaths are not observed during the study will be censored at their last known alive date.
Measure:Event-Free Survival (EFS) in All Participants
Time Frame:Randomization up to end of study (up to 27 months)
Safety Issue:
Description:The EFS is defined as time from the date of randomization to the earliest date of documented relapse from complete remission (CR), treatment failure (defined as failure to achieve CR within 6 months of treatment with magrolimab + azacitidine or venetoclax + azacitidine, or up to 2 months of treatment with 7 + 3 chemotherapy), or death from any cause. Those who are not observed to have one of these events during the study will be censored at the date of their last response assessment with clear documentation of no relapse during the study. The date of randomization will be assigned as the event date for participants with treatment failure.
Measure:Red Blood Cell (RBC) Transfusion Independence Conversion Rate in All Participants
Time Frame:First dose date up to last dose date (Maximum: 24 months)
Safety Issue:
Description:The RBC transfusion independence conversion rate is the percentage of participants who have a 56-day or longer period with no RBC transfusions at any time between the date of first dose of study treatment and discontinuation of study treatment among all participants who are RBC transfusion dependent at baseline. The RBC transfusion dependence at baseline is defined as having received an RBC or whole blood transfusion within the 28 days prior to the first dose of study treatment.
Measure:Platelet Transfusion Independence Conversion Rate in All Participants
Time Frame:First dose date up to last dose date (Maximum: 24 months)
Safety Issue:
Description:The platelet transfusion independence conversion rate is the percentage of participants who have a 56 day or longer period with no platelet transfusions at any time between the date of first dose of study treatment and discontinuation of study treatment among all participants who are platelet transfusion dependent at baseline. Platelet transfusion dependence at baseline is defined as having received a platelet transfusion within the 28 days prior to the first dose of study treatment.
Measure:Rate of Complete Remission (CR) in All Participants
Time Frame:6 months for the Magrolimab + Azacitidine; Control Arm: Venetoclax + Azacitidine arm, and 2 months for Control Arm: 7+3 Chemotherapy
Safety Issue:
Description:The rate of CR is the percentage of participants who achieve a CR, including complete remission without minimal residual disease (CR MRD-) and complete remission with positive or unknown minimal residual disease (CR MRD+/unk) as defined by investigators based on European Leukemia Net 2017 recommendations for AML (ELN 2017 AML) with modifications, while on study prior to initiation of any new anti-AML therapy or stem cell transplant (SCT).
Measure:Rate of CR Without Minimal Residual Disease (CR MRD-) in All Participants
Time Frame:6 months for the Magrolimab + Azacitidine; Control Arm: Venetoclax + Azacitidine arm, and 2 months for Control Arm: 7+3 Chemotherapy
Safety Issue:
Description:The rate of CR MRD- is the percentage of participants who achieve a CR MRD- as defined by investigators based on ELN 2017 AML with modifications, while on study prior to initiation of any new anti-AML therapy or SCT.
Measure:Time Until Meaningful Definitive Deterioration (TUDD) on the EORTC QLQ-C30 GHS/QoL Scale in All Participants
Time Frame:Day 1 of each cycle (up to 24 months); Cycle=28 days
Safety Issue:
Description:TUDD on European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core Questionnaire (EORTC QLQ-C30) Global Health Status/Quality of Life (GHS/QoL) scale is defined as time from randomization date to earlier date that score is consistently at least 10 points worse than baseline score/death. Questionnaire includes 30 questions resulting in 5 functional scales (physical functioning, role functioning, emotional functioning, cognitive functioning, social functioning), 1 GHS/QoL scale, 3 symptom scales (fatigue, nausea and vomiting, pain), and 6 single items (dyspnea, insomnia, loss of appetite, constipation, diarrhea, financial difficulties). After linear transformation, all scales and single item measures range in score from 0-100. Higher score on GHS/QoL scale means better GHS/QoL. Those whose score does not reach meaningful definitive deterioration and whose deaths are not observed during study will be censored at their last GHS/QoL scale assessment.
Measure:TUDD on the EORTC QLQ-C30 Physical Functioning Scale in All Participants
Time Frame:Day 1 of each cycle (up to 24 months); Cycle=28 days
Safety Issue:
Description:TUDD on the EORTC QLQ C30 physical functioning scale is defined as time from the date of randomization to the earlier date that the score is consistently at least 10 points worse than the baseline score or death. Physical functioning scale is one of the five functional scales of the EORTC QLQ C30 questionnaire. After linear transformation, scale range in score from 0-100. A higher score on functional scales means better functioning and better quality of life. Those whose score does not reach meaningful definitive deterioration and whose deaths are not observed during the study will be censored at their last physical functioning scale assessment date.
Measure:Rate of CR and Complete Remission with Partial Hematologic Recovery (CR+CRh) in All Participants
Time Frame:6 months for the Magrolimab + Azacitidine; Control Arm: Venetoclax + Azacitidine arm, and 2 months for Control Arm: 7+3 Chemotherapy
Safety Issue:
Description:The CR+CRh rate is the percentage of participants who achieve a CR (including CR MRD- and CR MRD+/unk) or CRh as defined by CR with partial platelet and absolute neutrophil count (ANC) recovery while on study prior to initiation of any new anti-AML therapy or SCT.
Measure:Duration of Complete Remission (DCR)
Time Frame:First CR achieved within 6 months for the Magrolimab + Azacitidine; Control Arm: Venetoclax + Azacitidine arm, and 2 months for Control Arm: 7+3 Chemotherapy up to the end of study (up to 27 months)
Safety Issue:
Description:The DCR is measured from the time the assessment criteria are first met for CR (including CR MRD- and CR MRD+/unk) until the first date of AML relapse or death (including assessments post SCT). Those who are not observed to have relapsed disease or death while on study will be censored at the date of their last response assessment with no evidence of relapse.
Measure:Duration of CR+CRh
Time Frame:First CR or CRh achieved within 6 months for the Magrolimab + Azacitidine; Control Arm: Venetoclax + Azacitidine arm, and 2 months for Control Arm: 7+3 Chemotherapy up to the end of study (up to 27 months)
Safety Issue:
Description:The duration of CR+CRh is measured from the time the assessment criteria are first met for CR (including CR MRD- and CR MRD+/unk) or CRh until the first date of AML relapse or death (including assessments post SCT). Those who are not observed to have relapsed disease or death while on study will be censored at the date of their last response assessment with no evidence of relapse.
Measure:Percentage of Participants Experiencing Grade ≥ 3 Treatment-Emergent Adverse Events (TEAEs) According to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 5.0
Time Frame:First dose date up to last dose date (Maximum: 24 months) plus 70 days
Safety Issue:
Description:
Measure:Percentage of Participants Experiencing Grade ≥ 3 Treatment-Emergent Laboratory Abnormalities According to the NCI CTCAE Version 5.0
Time Frame:First dose date up to last dose date (Maximum: 24 months) plus 70 days
Safety Issue:
Description:
Measure:Serum Concentration of Magrolimab
Time Frame:Within 72 hours predose on Day 1 of Cycle 1, within 12 hours predose on Day 8 of Cycle 1 and Day 1 of Cycles 2, 3, 5, 7, 10, 13, and end of treatment (EOT) EOT=Maximum: 24 months (Cycle=28 days)
Safety Issue:
Description:
Measure:Rate of Anti-Magrolimab Antibody Incidence
Time Frame:Within 72 hours predose on Day 1 of Cycle 1, within 12 hours predose on Day 1 of Cycles 2, 3, 5, 7, 10, 13 and end of treatment (EOT) EOT=Maximum: 24 months (Cycle=28 days)
Safety Issue:
Description:Rate of anti-magrolimab antibody incidence is defined as the percentage of participants with anti-magrolimab antibodies.

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Gilead Sciences

Last Updated

August 25, 2021