Clinical Trials /

Azacitidine or Decitabine With Venetoclax for Acute Myeloid Leukemia With Prior Hypomethylating Agent Failure

NCT04905810

Description:

This phase II trial evaluates the effect of azacitidine or decitabine and venetoclax in treating patients with acute myeloid leukemia that has not been treated before (treatment naive) or has come back (relapsed). Chemotherapy drugs, such as azacitidine, decitabine, and venetoclax, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.

Related Conditions:
  • Secondary Acute Myeloid Leukemia
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Azacitidine or Decitabine With Venetoclax for Acute Myeloid Leukemia With Prior Hypomethylating Agent Failure
  • Official Title: Phase II Study of Venetoclax With Alternative Hypomethylating Agent for Patients With Acute Myeloid Leukemia With Prior Hypomethylating Agent Failure: A University of California Hematologic Malignancies Consortium Protocol

Clinical Trial IDs

  • ORG STUDY ID: UCDCC#293
  • SECONDARY ID: NCI-2021-04009
  • SECONDARY ID: UCDCC#293
  • SECONDARY ID: P30CA093373
  • NCT ID: NCT04905810

Conditions

  • Acute Myeloid Leukemia
  • Recurrent Acute Myeloid Leukemia

Interventions

DrugSynonymsArms
Azacitidine5 AZC, 5-AC, 5-Azacytidine, 5-AZC, Azacytidine, Azacytidine, 5-, Ladakamycin, Mylosar, Onureg, U-18496, VidazaTreatment (azacitidine, decitabine, venetoclax)
Decitabine5-Aza-2''-deoxycytidine, Dacogen, Decitabine for Injection, Deoxyazacytidine, DezocitidineTreatment (azacitidine, decitabine, venetoclax)
VenetoclaxABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, VenclyxtoTreatment (azacitidine, decitabine, venetoclax)

Purpose

This phase II trial evaluates the effect of azacitidine or decitabine and venetoclax in treating patients with acute myeloid leukemia that has not been treated before (treatment naive) or has come back (relapsed). Chemotherapy drugs, such as azacitidine, decitabine, and venetoclax, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.

Detailed Description

      PRIMARY OBJECTIVE: I. To evaluate the efficacy of venetoclax plus alternative hypomethylating
      agent (HMA), as defined by the primary endpoint of overall response rate, for patients with
      treatment naive acute myeloid leukemia (AML) eligible for venetoclax plus HMA with prior HMA
      failure.

      SECONDARY OBJECTIVES:

      I. To further examine the efficacy of venetoclax plus alternative HMA for patients with
      treatment naive AML eligible for venetoclax plus HMA with prior HMA failure using additional
      efficacy endpoints.

      II. To further evaluate the safety of venetoclax plus alternative HMA for patients with
      treatment naive AML eligible for venetoclax plus HMA with prior HMA failure.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (azacitidine, decitabine, venetoclax)ExperimentalPatients receive azacitidine IV over 10-40 minutes or SC on days 1-7 (for patients with prior decitabine use), or decitabine IV on days 1-5 (for patients with prior azacitidine), and venetoclax PO daily on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Azacitidine
  • Decitabine
  • Venetoclax

Eligibility Criteria

        Inclusion Criteria:

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

          -  Diagnosis of AML by World Health Organization (WHO) 2016 criteria (Arber 2016)

          -  Age >= 18 years

          -  Treatment naïve and eligible for venetoclax plus HMA: * Age >= 75 OR * Age >= 18-74
             with at least one of the following co-morbidities: ** Eastern Cooperative Oncology
             Group (ECOG) performance status of 2 or 3 ** Cardiac history of chronic heart failure
             (CHF) requiring treatment or left ventricular ejection fraction (LVEF) =< 50% or
             chronic unstable angina ** Carbon monoxide diffusing capability (DLCO) =< 65% or
             forced expiratory volume in 1 second (FEV1) =< 65% ** Creatinine clearance >= 30
             mL/min to =< 45 mL/min ** Moderate hepatic impairment with total bilirubin > 1.5 to =<
             3 x upper limit of normal (ULN) ** Any other situation that the investigator judges to
             be incompatible with intensive chemotherapy must be reviewed with the study chair
             before study enrollment

          -  Patient experienced HMA failure for an antecedent hematologic disorder (e.g.
             myelodysplastic syndrome) prior to study entry (Santini 2019), defined as: * Disease
             progression or stable disease as best response to >= 4 cycles of HMA or >= 2 cycles of
             HMA combination therapy (primary resistance) OR * Relapse or progression after prior
             response to HMA (secondary resistance)

          -  Prior decitabine and/or azacitidine, including oral formulations, for antecedent
             hematologic disorder is required. The patient should be treatment naïve for the AML
             diagnosis

          -  Prior allogeneic hematopoietic transplant for antecedent hematologic disorder is
             allowed if done at least 3 months prior to enrollment and there is no evidence of
             active graft versus host disease (GVHD) or requirement for systemic immune suppression

          -  ECOG performance status of: * 0 to 2 for subjects >= 75 years of age OR * 0 to 3 for
             subjects >= 18-74 years of age

          -  Whole blood cell (WBC) >= 25,000/mm^3 at the start of study therapy (leukapheresis and
             hydroxyurea areallowed to meet this criteria)

          -  Total bilirubin =, 1.5 x institution's ULN unless related to AML or Gilbert's syndrome
             (subjects who are >= 18-74 may have a total bilirubin of =< 3 x institution's ULN)

          -  Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) and
             alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SPGT) =< 3 x
             institutional ULN unless related to AML

          -  Creatinine clearance >= 30 mL/min (calculated by the Cockcroft Gault formula or
             measured by 24-hours urine collection)

          -  Women of child-bearing potential and men with partners of child-bearing potential must
             agree to use adequate contraception (hormonal or barrier method of birth control;
             abstinence) prior to study entry, for the duration of study participation, and for 90
             days following completion of therapy. Should a woman become pregnant or suspect she is
             pregnant while participating in this study, she should inform her treating physician
             immediately. * A woman of child-bearing potential is any female (regardless of sexual
             orientation, having undergone a tubal ligation, or remaining celibate by choice) who
             meets the following criteria: ** Has not undergone a hysterectomy or bilateral
             oophorectomy; or ** Has not been naturally postmenopausal for at least 12 consecutive
             months (i.e., has had menses at any time in the preceding 12 consecutive months)

          -  Women of child-bearing potential has negative pregnancy test prior to initiating study
             drug dosing

          -  Able to swallow and retain oral medication

        Exclusion Criteria:

          -  Current or anticipated use of other investigational agents within 14 days or 5
             half-lives (whichever is shorter) prior to the first dose and throughout venetoclax
             administration

          -  Diagnosis of acute promyelocytic leukemia

          -  Active central nervous system involvement by AML

          -  Anticancer therapies, including investigational therapy, chemotherapy, targeted small
             molecule agents, or radiotherapy within 14 days or 5 half-lives (whichever is shorter)
             prior to the first dose and throughout venetoclax administration. Biologic agents
             (e.g. monoclonal antibodies) given for anti-neoplastic intent within 30 days prior to
             the first dose and throughout venetoclax administration

          -  Prior therapy with venetoclax

          -  Known diagnosis of human immunodeficiency virus (HIV) infection or known active
             hepatitis A, B or C infection with the exception of those with an undetectable viral
             load and CD4+ T-cell (CD4+) counts >= 350 cells/μL within 3 months of starting study
             treatment. Should have no titers within 28d of day 1. Patients with hepatitis C virus
             (HCV) infection should have completed curative antiviral treatment

          -  Known strong and/or moderate CYP3A inducers within 7 days prior to the initiation of
             study treatment

          -  Subject has consumed grapefruit, grapefruit products, Seville oranges or starfruit
             within 3 days prior to the initiation of study treatment

          -  Severe or uncontrolled medical disorder that would, in the investigator's opinion,
             impair ability to receive study treatment (i.e., uncontrolled diabetes, chronic renal
             disease, chronic pulmonary disease or active, uncontrolled infection, psychiatric
             illness/social situations that would limit compliance with study requirements)

          -  History of other malignancies, except for malignancy treated with curative intent with
             no known active disease present for >= 1 year; treated non-melanoma skin cancer; and
             localized, cured prostate and cervical cancer

          -  Evidence of uncontrolled active systemic infection requiring therapy (viral,
             bacterial, or fungal). Fever of unknown origin is not an exclusion criterion, as this
             may be disease related

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to agents used in study

          -  Subject has a malabsorption syndrome of other condition that precludes enteral route
             of administration

          -  Subjects with a cardiovascular disability status of New York Heart Association class
             greater than 2

          -  Pregnant or nursing. There is a potential for congenital abnormalities and for this
             regimen to harm nursing infants
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall response rate
Time Frame:Up to 1 year
Safety Issue:
Description:Will be defined as the rate of complete remission (CR) plus CR with incomplete count recovery (CRi).

Secondary Outcome Measures

Measure:Measurable/minimal residual disease (MRD) status
Time Frame:Up to 1 year
Safety Issue:
Description:Will be measured by multiparameter flow cytometry and/or molecular methods (e.g. real-time quantitative reverse transcription [qRT-PCR]). Will be assessed in patients achieving a CR, CRi or CR with partial hematologic recovery (CRh). Rates of MRD negative CR+CRi and CR+CRh will be calculated.
Measure:Rate of CR/CRh
Time Frame:Up to 1 year
Safety Issue:
Description:Will be defined as the rate of complete remission (CR) plus CR with partial hematologic recovery (CRh).
Measure:Rate of transfusion-independence
Time Frame:Up to 1 year
Safety Issue:
Description:Transfusion independence (TI) is defined as any period of >/= 56 days during treatment with no RBC or platelet transfusion.
Measure:Duration of CR/CRi (DoR)
Time Frame:From the date of CR/CRi until the date of relapse or death, assessed up to 1 year
Safety Issue:
Description:Time from the date of CR/CRi until the date of relapse or death
Measure:Relapse-free survival
Time Frame:From the date of CR/CRi until the date of relapse or death from any cause, assessed up to 1 year
Safety Issue:
Description:Time from the date of entry into study to the date of relapse or death from any cause
Measure:Event-free survival
Time Frame:From the date of entry into study to the date of treatment failure, relapse, or death from any cause, assessed up to 1 year
Safety Issue:
Description:Time from the date of entry into study to the date of treatment failure, relapse, or death from any cause
Measure:Overall survival
Time Frame:From the date of entry into study to the date of death from any cause, assessed up to 1 year
Safety Issue:
Description:Time from the date of entry into study to the date of death from any cause
Measure:Incidence of adverse events
Time Frame:Up to 1 year
Safety Issue:
Description:Will be captured and characterized by type, frequency, severity (as defined and graded by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 toxicity criteria), timing, seriousness, and relationship to treatment.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Brian Jonas

Last Updated

August 18, 2021