Description:
This will be an open-label, Phase 1B/2A, study to characterize the efficacy, safety,
pharmacokinetics, and pharmacodynamics of fosciclopirox administered alone and in combination
with cytarabine in patients with R/R AML with up to two cohorts studied to confirm the
efficacy (or futility) of fosciclopirox on the endpoint of disease response.
Initially, 14 evaluable patients will be enrolled in Cohort 1a. If disease response to
fosciclopirox alone IS observed in at least 4 of 14 patients, an additional 14 patients will
be enrolled in Cohort 1b. If disease response to fosciclopirox alone IS NOT observed in at
least 4 of 14 patients in Cohort 1a, based on a review of all available study data, the study
may be terminated OR a Cohort 2a may be initiated using the combination of fosciclopirox and
cytarabine. If disease response to fosciclopirox in combination with cytarabine IS observed
in at least 4 of 14 patients in Cohort 2a, an additional 14 patients will be enrolled in
Cohort 2b. If disease response to fosciclopirox in combination with cytarabine IS NOT
observed in at least 4 of 14 patients in the Cohort 2a, the study will be stopped for
futility.
Title
- Brief Title: Study of Fosciclopirox in Patients With Relapsed/Refractory Acute Myeloid Leukemia
- Official Title: A Phase 1B/2A, Open-label Study of the Safety, Pharmacokinetics, and Pharmacodynamics of Fosciclopirox Alone and In Combination With Cytarabine in Patients With Relapsed/Refractory Acute Myeloid Leukemia (AML)
Clinical Trial IDs
- ORG STUDY ID:
CPX-POM-003
- NCT ID:
NCT04956042
Conditions
- Refractory Acute Myeloid Leukemia
- Recurrent Acute Myeloid Leukemia
Interventions
Drug | Synonyms | Arms |
---|
Fosciclopirox | | Cohort 1 - Fosciclopirox only |
Fosciclopirox + Cytarabine | | Cohort 2 - Fosciclopirox + Cytarabine |
Purpose
This will be an open-label, Phase 1B/2A, study to characterize the efficacy, safety,
pharmacokinetics, and pharmacodynamics of fosciclopirox administered alone and in combination
with cytarabine in patients with R/R AML with up to two cohorts studied to confirm the
efficacy (or futility) of fosciclopirox on the endpoint of disease response.
Initially, 14 evaluable patients will be enrolled in Cohort 1a. If disease response to
fosciclopirox alone IS observed in at least 4 of 14 patients, an additional 14 patients will
be enrolled in Cohort 1b. If disease response to fosciclopirox alone IS NOT observed in at
least 4 of 14 patients in Cohort 1a, based on a review of all available study data, the study
may be terminated OR a Cohort 2a may be initiated using the combination of fosciclopirox and
cytarabine. If disease response to fosciclopirox in combination with cytarabine IS observed
in at least 4 of 14 patients in Cohort 2a, an additional 14 patients will be enrolled in
Cohort 2b. If disease response to fosciclopirox in combination with cytarabine IS NOT
observed in at least 4 of 14 patients in the Cohort 2a, the study will be stopped for
futility.
Detailed Description
This will be an open-label, Phase 1B/2A, study to characterize the efficacy, safety, PK, and
pharmacodynamics of fosciclopirox administered alone and in combination with cytarabine in
patients with R/R AML. There will be up to two cohorts used to confirm the efficacy (or
futility) of fosciclopirox on the endpoint of disease response.
Initially, 14 patients will be enrolled in Cohort 1a. If disease response to fosciclopirox
alone IS observed in at least 4 of 14 patients, an additional 14 patients will be enrolled in
Cohort 1b. If disease response to fosciclopirox alone IS NOT observed in at least 4 of 14
patients in the initial Cohort 1a, based on a review of all available data study data, the
study may be terminated OR a second cohort (Cohort 2a) may be initiated using the combination
of fosciclopirox and cytarabine. If disease response to fosciclopirox in combination with
cytarabine IS observed in at least 4 of 14 patients in Cohort 2a, an additional 14 patients
will be enrolled in Cohort 2b. If disease response to fosciclopirox in combination with
cytarabine IS NOT observed in at least 4 of 14 patients in Cohort 2a, the study will be
stopped for futility.
If both Cohorts 1a and 2a are initiated, the minimum patient number will be 28 (i.e.,
treatment with fosciclopirox alone and in combination with cytarabine are futile). The
maximum number of patients potentially evaluated is 42 (i.e., the first treatment is futile
based upon observations in 14 patients (Cohort 1a), but treatment in Cohort 2a evaluated is
positive [14 patients], and Cohort 2b [14 patients] is completed).
Patients in Cohort 1a will initially be treated with fosciclopirox as a single agent.
Patients who respond to this treatment, as defined below, may continue to receive treatment
cycles of fosciclopirox alone until evidence of disease progression. Patients who do not
respond to fosciclopirox alone, as defined below, may be switched to treatment with the
combination of fosciclopirox and cytarabine. Patients who respond to the combination
treatment may continue to receive treatment cycles of fosciclopirox in combination with
cytarabine until evidence of disease progression. Patients who do not respond to the
combination of fosciclopirox and cytarabine will be discontinued from the study.
Patients enrolled in Cohort 2a (if initiated) will initially be treated with fosciclopirox in
combination with cytarabine. The first patient to receive this combination will be observed
during Cycle 1 (21 days) and for a further 7 days (if they do not continue to Cycle 2) before
any further patients are accrued to the combination arm. As above, patients who respond to
the combination treatment may continue to receive treatment cycles until evidence of disease
progression, and patients who do not respond will be discontinued from the study.
Fosciclopirox will be administered as 900 mg/m2 once daily as a 20-minute intravenous
infusion on Days 1 to 5 (D1-D5) of each 21-day treatment cycle (rest days D6-D21). When added
to fosciclopirox therapy, cytarabine will be administered as 1 gm/m2 once daily on D1 D5 of
each 21-day treatment cycle (rest days D6-D21).
Trial Arms
Name | Type | Description | Interventions |
---|
Cohort 1 - Fosciclopirox only | Experimental | An initial 14 study participants will be enrolled in Cohort 1a and will be treated with fosciclopirox. If there is a disease response, an additional 14 study participants will be enrolled into Cohort 1 (Cohort 1b). | |
Cohort 2 - Fosciclopirox + Cytarabine | Experimental | To be implemented if a disease response is not seen in Cohort 1a. Cohort 2a will have an initial 14 study participants treated with fosciclopirox and cytarabine. If a disease response is seen, an additional 14 study participants will be enrolled (Cohort 2b). | - Fosciclopirox + Cytarabine
|
Eligibility Criteria
Inclusion Criteria:
1. Patient is male or female aged ≥18 years.
2. Patient provided signed and dated informed consent prior to initiation of any study
procedures.
3. Patient has relapsed AML after complete remission of any duration as evidenced by
presence of neoplastic blasts in the bone marrow confirmed by flow cytometry OR has
refractory AML, defined as primary refractory to at least 2 cycles of induction
therapy.
4. No other therapy exists or patient has received all standard therapies that would be
potentially curative or might provide significant benefit.
5. Patient has an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0,
1, or 2.
6. Patient has a predicted life expectancy of ≥3 months.
7. Patient has a total white blood cell count of count ≤ 25.0 x 10^9/L at screening and
on C1D1. (Patient may have received hydroxyurea prior to the screening sample for
elevated WBC but must have discontinued the therapy at least 72 hours prior to
screening, and not be treated with hydroxyurea after the screening sample has been
taken).
8. Patient has adequate renal function (creatinine ≤2 × the upper limit of the normal
range (ULN) and an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73
m^2).
9. Patient has adequate hepatic function, as evidenced by a total bilirubin ≤2 × ULN,
aspartate aminotransferase (AST) ≤5 × ULN and /or alanine aminotransferase (ALT)
≤5 × ULN, unless due to leukemia involvement in the judgement of the Principal
Investigator in consultation with the Medical Monitor.
10. Patient has adequate cardiac function with an ejection fraction (EF) ≥45%, as assessed
by multi-gated acquisition (MUGA) or ultrasound/echocardiography (ECHO) and corrected
QT interval by Fridericia's correction formula (QTcF) <450 msec for males and <470
msec for females. The eligibility of patients with ventricular pacemakers for whom the
QT interval may not be accurately measurable will be determined on a case-by-case
basis by the Sponsor in consultation with the Medical Monitor.
11. Patient and his/her partner agree to use adequate contraception after providing
written informed consent through 3 months after the last dose of fosciclopirox, as
follows:
1. For women: Negative pregnancy test during Screening and at Day 1 of each
treatment cycle and compliant with a medically-approved contraceptive regimen
during, and for 3 months after, the Treatment period or documented to be
surgically sterile or postmenopausal.
2. For men: Compliant with a medically-approved contraceptive regimen during, and
for 3 months after, the Treatment period or documented to be surgically sterile.
Men whose sexual partners are of child-bearing potential must agree to use 2
methods of contraception prior to study entry, during the study, and for 3 months
after the Treatment period. Men must also agree not to donate sperm during the
Treatment period and for 3 months after the Treatment period.
12. Patient is willing and able to participate in the study and comply with all study
requirements.
13. Prior allogeneic stem cell transplant is allowed as long as patient is more than 100
days post-transplant and has no active graft versus host disease.
Exclusion Criteria:
Patients who meet any of the following exclusion criteria are not to be enrolled in this
study.
1. Patient has another active malignancy.
2. Patient has acute promyelocytic leukemia (APL) or Ph+ AML.
3. Patient has total white blood cell count >25.0 x 10^9/L at C1D1.
4. Patient has clinically significant cardiac disease.
5. Patient has known chronic active liver disease or evidence of acute or chronic
Hepatitis B Virus (HBV) or Hepatitis C (HCV).
6. Patient has known diagnosis of human immunodeficiency virus (HIV) infection. Testing
is not required in absence of clinical suspicion.
7. Patients has any serious and/or uncontrolled concurrent medical conditions (e.g.,
uncontrolled infection, uncontrolled diabetes) or psychiatric illness that could, in
the investigator's opinion, cause unacceptable safety risks or potentially interfere
with the completion of the treatment according to the protocol.
8. Patient has received any live viral vaccine used for prevention of infectious diseases
within 4 weeks prior to Baseline.
9. If female, patient is pregnant or breast-feeding.
10. Patient is taking warfarin.
11. Patient has known allergy or hypersensitivity to any component of fosciclopirox.
12. Patient is taking any iron replacement therapy administered IV, intramuscularly, or
orally due to the potential for loss of anticancer activity due to drug and/or
metabolites chelating iron.
13. Patient is taking Hydrea (hydroxyurea) within 72 hours prior to the screening visit.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Acute Myeloid Leukemia (AML) response |
Time Frame: | Screening through Day 42 |
Safety Issue: | |
Description: | Complete remission [CR], CR with incomplete hematologic recovery [CRi], partial remission [PR], or morphologic leukemia-free state [MLFS] at the conclusion of the first treatment cycle OR Nonprogression at the end of the first treatment cycle (defined as no increase in bone marrow or peripheral blood blast count) followed by CR, CRi, PR, or MLFS at the conclusion of the second treatment cycle |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Not yet recruiting |
Lead Sponsor: | CicloMed LLC |
Last Updated
August 9, 2021