Clinical Trials /

Venetoclax, Dasatinib, Prednisone, and Rituximab for the Treatment of Newly Diagnosed or Relapsed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia

NCT04872790

Description:

This phase I trial studies the effects of venetoclax in combination with dasatinib, prednisone, and rituximab in treating patients with Philadelphia chromosome positive acute lymphoblastic leukemia that is newly diagnosed or that has come back (relapsed). Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Dasatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Anti-inflammatory drugs, such as prednisone lower the body's immune response and are used with other drugs in the treatment of some types of cancer. Rituximab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Giving venetoclax in combination with dasatinib, prednisone, and rituximab may help treat patients with newly diagnosed or relapsed Philadelphia chromosome positive acute lymphoblastic leukemia.

Related Conditions:
  • B-Cell Acute Lymphoblastic Leukemia
Recruiting Status:

Not yet recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Venetoclax, Dasatinib, Prednisone, and Rituximab for the Treatment of Newly Diagnosed or Relapsed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia
  • Official Title: A Dose-Finding Phase I Study of the Oral BCL-2 Inhibitor Venetoclax (ABT-199) in Combination With Standard Induction Therapy, Dasatinib Prednisone, and Rituximab in Adult Patients With Newly Diagnosed and Relapsed Philadelphia Chromosome Positive ALL (Ph+ ALL)

Clinical Trial IDs

  • ORG STUDY ID: STUDY00022691
  • SECONDARY ID: NCI-2021-01791
  • SECONDARY ID: STUDY00022691
  • NCT ID: NCT04872790

Conditions

  • B Acute Lymphoblastic Leukemia
  • Recurrent B Acute Lymphoblastic Leukemia

Interventions

DrugSynonymsArms
DasatinibBMS-354825, Dasatinib Hydrate, Dasatinib Monohydrate, SprycelTreatment (prednisone, dasatinib, venetoclax, rituximab)
MethotrexateAbitrexate, Alpha-Methopterin, Amethopterin, Brimexate, CL 14377, CL-14377, Emtexate, Emthexat, Emthexate, Farmitrexat, Fauldexato, Folex, Folex PFS, Lantarel, Ledertrexate, Lumexon, Maxtrex, Medsatrexate, Metex, Methoblastin, Methotrexate LPF, Methotrexate Methylaminopterin, Methotrexatum, Metotrexato, Metrotex, Mexate, Mexate-AQ, MTX, Novatrex, Rheumatrex, Texate, Tremetex, Trexeron, Trixilem, WR-19039Treatment (prednisone, dasatinib, venetoclax, rituximab)
Prednisone.delta.1-Cortisone, 1, 2-Dehydrocortisone, Adasone, Cortancyl, Dacortin, DeCortin, Decortisyl, Decorton, Delta 1-Cortisone, Delta-Dome, Deltacortene, Deltacortisone, Deltadehydrocortisone, Deltasone, Deltison, Deltra, Econosone, Lisacort, Meprosona-F, Metacortandracin, Meticorten, Ofisolona, Orasone, Panafcort, Panasol-S, Paracort, Perrigo Prednisone, PRED, Predicor, Predicorten, Prednicen-M, Prednicort, Prednidib, Prednilonga, Predniment, Prednisone Intensol, Prednisonum, Prednitone, Promifen, Rayos, Servisone, SK-PrednisoneTreatment (prednisone, dasatinib, venetoclax, rituximab)
RituximabABP 798, BI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-102, IDEC-C2B8, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, PF-05280586, Rituxan, Rituximab ABBS, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar GB241, Rituximab Biosimilar IBI301, Rituximab Biosimilar JHL1101, Rituximab Biosimilar PF-05280586, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SAIT101, Rituximab Biosimilar SIBP-02, rituximab biosimilar TQB2303, rituximab-abbs, RTXM83, TruximaTreatment (prednisone, dasatinib, venetoclax, rituximab)
VenetoclaxABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, VenclyxtoTreatment (prednisone, dasatinib, venetoclax, rituximab)

Purpose

This phase I trial studies the effects of venetoclax in combination with dasatinib, prednisone, and rituximab in treating patients with Philadelphia chromosome positive acute lymphoblastic leukemia that is newly diagnosed or that has come back (relapsed). Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Dasatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Anti-inflammatory drugs, such as prednisone lower the body's immune response and are used with other drugs in the treatment of some types of cancer. Rituximab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Giving venetoclax in combination with dasatinib, prednisone, and rituximab may help treat patients with newly diagnosed or relapsed Philadelphia chromosome positive acute lymphoblastic leukemia.

Detailed Description

      PRIMARY OBJECTIVES:

      I. Determine the maximum tolerated dose (MTD) and/or a recommended phase II dose (RP2D) of
      venetoclax in combination with dasatinib.

      II. Evaluate the safety of venetoclax in combination with dasatinib by assessing the
      frequency, type, and severity of adverse events.

      SECONDARY OBJECTIVES:

      I. Assess preliminary response to venetoclax in combination with dasatinib based on minimal
      residual disease (MRD) negativity.

      II. Estimate progression-free and overall survival.

      EXPLORATORY OBJECTIVES:

      I. Evaluate the distribution of BCL-ABL fusion sub-types. II. Assess changes in BCL-family
      dependence. III. Presence of co-occurring leukemia specific mutations.

      OUTLINE: This is dose-escalation study of venetoclax.

      INDUCTION PHASE: Patients receive prednisone orally (PO) once daily (QD) on days -6 to 21 and
      taper off days 22-28, dasatinib PO QD days 1-28, venetoclax PO QD days 3-28 or days 3-21,
      rituximab intravenously (IV) on days 8 and 15, and methotrexate intrathecally (IT) once
      during week 1 and once during week 3 in the absence of disease progression or unacceptable
      toxicity.

      POST-INDUCTION PHASE: Patients receive dasatinib PO QD days 1-28, venetoclax PO QD on days
      1-28 or 1-21, rituximab IV on days 1 and 15, and methotrexate IT on days 1 and 15. Treatment
      repeat every 28 days for up to 2 cycles in the absence of disease progression or unacceptable
      toxicity. Patients with clinical benefit may continue to receive treatment for up to 12
      months per the discretion of the physician.

      After completion of study treatment, patients are followed up at 4 weeks and then every 12
      weeks for up to 1 year.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (prednisone, dasatinib, venetoclax, rituximab)ExperimentalINDUCTION PHASE: Patients receive prednisone PO QD on days -6 to 21 and taper off days 22-28, dasatinib PO QD days 1-28, venetoclax PO QD days 3-28 or days 3-21, rituximab IV on days 8 and 15, and methotrexate IT once during week 1 and once during week 3 in the absence of disease progression or unacceptable toxicity. POST-INDUCTION PHASE: Patients receive dasatinib PO QD days 1-28, venetoclax PO QD on days 1-28 or 1-21, rituximab IV on days 1 and 15, and methotrexate IT on days 1 and 15. Treatment repeat every 28 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. Patients with clinical benefit may continue to receive treatment for up to 12 months per the discretion of the physician.
  • Dasatinib
  • Methotrexate
  • Prednisone
  • Rituximab
  • Venetoclax

Eligibility Criteria

        Inclusion Criteria:

          -  Subjects must have histologically confirmed diagnosis of pre-B acute lymphoblastic
             leukemia harboring the t(9;22) translocation (Philadelphia chromosome positive acute
             lymphoblastic leukemia [Ph+ ALL]). All patients must have a bone marrow biopsy
             completed during the screening period. Patients with central nervous system (CNS)
             disease will be included

          -  Newly diagnosed subjects must have received no prior treatment for their ALL with the
             exception of steroids (prednisone, dexamethasone), hydrea or IT methotrexate. Patients
             may receive up to 6 days of pre-treatment with steroids prior to enrollment during the
             screening phase

          -  Patients with relapsed disease may not have had prior treatment with dasatinib

          -  Age >= 18 years. Both men and women and members of all races and ethnic groups will be
             included

          -  Eastern Cooperative Oncology Group (ECOG) status =< 2

          -  Must be able to take oral medication

          -  Aspartate aminotransferase (AST) < 2.5 x upper limit of normal (ULN)

               -  Unless considered due to leukemic organ involvement

          -  Alanine aminotransferase (ALT) < 2.5 x ULN

               -  Unless considered due to leukemic involvement

          -  Bilirubin < 1.5 x ULN

               -  Unless considered due to leukemic organ involvement

               -  Note: subjects with Gilbert's Syndrome may have a bilirubin > 1.5 x ULN per
                  discussion between the investigator and AbbVie medical monitor

          -  Subject must have adequate renal function as demonstrated by a calculated creatinine
             clearance >= 50 mL/min; determined via urine collection for 24-hour creatinine
             clearance or by the Cockcroft-Gault formula

               -  NOTE: For subjects that have body mass index (BMI) of > 25 kg/m^2, 24-hour
                  measured creatinine clearance is required

          -  Women of childbearing potential must have a negative serum or urine pregnancy test
             (sensitivity < 25 IU human chorionic gonadotropin [HCG]/L) within 72 hours prior to
             the start of the study drug

          -  Persons of reproductive potential must agree to use an adequate method of
             contraception throughout treatment and for at least 4 weeks after study drug is
             stopped. Women of childbearing potential and men with a sexual partner of childbearing
             potential must be advised of the importance of avoiding pregnancy during trial
             participation and the potential risk factors for an unintentional pregnancy

          -  Normal corrected QT (QTc) interval on screening electrocardiogram (EKG) (< 450 ms in
             men, < 470 ms in women)

          -  Ability to understand and the willingness to sign a written informed consent document

        Exclusion Criteria:

          -  For newly diagnosed subjects: who have received treatment with cytotoxic chemotherapy,
             radiotherapy or immunotherapy for their ALL, or prior dasatinib treatment. For
             relapsed subjects: prior dasatinib treatment

          -  Subjects who have received any investigational agents or subjects who are taking
             investigational or commercial agents or therapies with the intent to treat the
             subject's malignancy within seven days of enrollment

          -  Subjects with chronic myelogenous leukemia (CML) in myeloid blast crisis, Ph+ acute
             myeloid leukemia (AML) or acute leukemia of ambiguous lineage

          -  Subjects with clinically serious infections as determined by the provider requiring
             ongoing antibiotic therapy. This does not include antibiotic treatment for neutropenic
             fever

          -  Patients with a pleural or pericardial effusion of any grade

          -  Subjects with a history of allergic reactions attributed to compounds of similar
             chemical or biologic composition to dasatinib or other agents used in the study

          -  Subjects who have undergone prior allogeneic hematopoietic stem cell transplantation

          -  Subject has received the following within 7 days prior to the initiation of study
             treatment: Strong or moderate CYP3A inducers (such as rifampin, carbamazepine,
             phenytoin, and St. John's wort); warfarin or inhibitors (such as fluconazole,
             ketoconazole and clarithromycin

          -  Subjects with uncontrolled cardiac illness including but not limited to, symptomatic
             congestive heart failure, unstable angina pectoris, clinically significant ventricular
             arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de
             pointes), or pulmonary hypertension

          -  Subjects with diagnosed congenital prolonged QT syndrome

          -  Pregnant women are excluded from this study because dasatinib is a pregnancy category
             D agent with the potential for teratogenic or abortifacient effects. Because there is
             an unknown but potential risk for adverse events in nursing infants secondary to
             treatment of the mother with dasatinib, breastfeeding should be discontinued if the
             mother is treated with dasatinib. These potential risks may also apply to venetoclax
             for which the pregnancy category and risks to the fetus are unknown

          -  Participant is seropositive with human immunodeficiency virus (HIV) or has active
             infection with hepatitis B virus (HBV) or hepatitis C virus (HCV).

               -  HIV-infected patients on effective anti-retroviral therapy with undetectable
                  viral load within 6 months are eligible for this trial.

               -  For patients with evidence of chronic HBV infection, the HBV viral load must be
                  undetectable on suppressive therapy, if indicated.

               -  Individuals with a history of HCV infection must have been treated and cured. For
                  patients with HCV infection who are currently on treatment, they are eligible if
                  they have an undetectable HCV viral load

          -  Subjects with invasive malignancy over the previous year except treated early stage
             carcinomas of the skin, completely resected intraepithelial carcinoma of the cervix,
             completely resected papillary thyroid and follicular thyroid cancers, and localized
             prostate cancer treated with curative intent with surgery or radiation
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of dose-limiting toxicities
Time Frame:Up to 30 days after initiation of cycle 1 (1 cycle = 28 days)
Safety Issue:
Description:A dose-limiting toxicity (DLT) is defined as an adverse event or abnormal laboratory value assessed as unrelated to disease, disease progression, inter-current illness, or concomitant medications. In order to be declared a dose-limiting toxicity, an adverse experience must be determined related (definitely, probably, or possibly) to study drug. Point estimates and 95% exact confidence intervals will be reported

Secondary Outcome Measures

Measure:Rate of complete molecular response (uMRD)
Time Frame:Up to completion of cycle 3 (1 cycle = 28 days)
Safety Issue:
Description:
Measure:Duration of complete molecular response (CMR)
Time Frame:From date of CMR to date of molecular relapse, death or date of last follow-up, assessed up to 12 months after discontinuing study therapy
Safety Issue:
Description:The proportion of subjects with CMR as previously defined and its 95% exact confidence interval will be estimated using the efficacy analysis set. Will be estimated using the Kaplan-Meier method along with 95% exact confidence interval.
Measure:Progression-free survival
Time Frame:From first dose of dasatinib, to hematologic relapse of the disease or death in first complete response (CR) or complete response with incomplete bone marrow recovery (CRi), assessed up to 12 months after discontinuing study therapy
Safety Issue:
Description:Will be estimated using the Kaplan-Meier method along with 95% exact confidence interval.
Measure:Overall survival
Time Frame:From first dose of dasatinib to death from any cause, assessed up to 12 months after discontinuing study therapy
Safety Issue:
Description:Will be estimated using the Kaplan-Meier method along with 95% exact confidence interval.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:OHSU Knight Cancer Institute

Last Updated

May 11, 2021