Clinical Trials /

ASTX727 and Dasatinib for the Treatment of Newly Diagnosed Philadelphia Chromosome or BCR-ABL Positive Chronic Myeloid Leukemia in Chronic Phase

NCT05007873

Description:

This phase II trial studies the effect of ASTX727 and dasatinib in treating patients with newly diagnosed Philadelphia chromosome or BCR-ABL positive chronic myeloid leukemia in chronic phase. Philadelphia chromosome positive and BCR-ABL positive are types of genetic mutations (changes). Chemotherapy drugs, such as ASTX727, 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. Dasatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. ASTX727 and dasatinib may help to control Philadelphia chromosome-positive chronic myeloid leukemia or BCR-ABL positive chronic myeloid leukemia in chronic phase.

Related Conditions:
  • Chronic Myeloid Leukemia
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: ASTX727 and Dasatinib for the Treatment of Newly Diagnosed Philadelphia Chromosome or BCR-ABL Positive Chronic Myeloid Leukemia in Chronic Phase
  • Official Title: Phase II Study Assessing Safety and Clinical Activity of the Combination of ASTX727 With Dasatinib in Patients With Newly Diagnosed Chronic Myeloid Leukemia in Chronic Phase (CML-CP)

Clinical Trial IDs

  • ORG STUDY ID: 2021-0271
  • SECONDARY ID: NCI-2021-08486
  • SECONDARY ID: 2021-0271
  • NCT ID: NCT05007873

Conditions

  • Chronic Phase Chronic Myelogenous Leukemia
  • Philadelphia Chromosome Positive
  • BCR-ABL1 Positive Chronic Myelogenous Leukemia
  • BCR-ABL1 Positive

Interventions

DrugSynonymsArms
DasatinibBMS-354825, Dasatinib Hydrate, Dasatinib Monohydrate, SprycelTreatment (dasatinib, decitabine and cedazuridine)
Decitabine and CedazuridineASTX727, C-DEC, CDA Inhibitor E7727/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Tablet, DEC-C, InqoviTreatment (dasatinib, decitabine and cedazuridine)

Purpose

This phase II trial studies the effect of ASTX727 and dasatinib in treating patients with newly diagnosed Philadelphia chromosome or BCR-ABL positive chronic myeloid leukemia in chronic phase. Philadelphia chromosome positive and BCR-ABL positive are types of genetic mutations (changes). Chemotherapy drugs, such as ASTX727, 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. Dasatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. ASTX727 and dasatinib may help to control Philadelphia chromosome-positive chronic myeloid leukemia or BCR-ABL positive chronic myeloid leukemia in chronic phase.

Detailed Description

      PRIMARY OBJECTIVE:

      I. To estimate the proportion of patients with previously-untreated chronic phase chronic
      myeloid leukemia (CML) who achieve molecular response 4 (MR4) after 6-months of the
      combination of decitabine and cedazuridine (ASTX727) and dasatinib 50 mg daily.

      SECONDARY OBJECTIVES:

      I. To estimate the proportion of patients with previously-untreated chronic phase CML who
      achieve MR4 after both the 3-months of the combination of ASTX727 and dasatinib 50 mg daily.

      II. To estimate cumulative overall rate of molecular response 4.5 (MR4.5). III. To estimate
      the 12-months major molecular response (MMR) rate. IV. To estimate the proportion of patients
      with MR4.5 at 6-, 12-, 18-, 24-, and 36-months of therapy.

      V. To estimate the proportion of patients with sustained MR4.5 of 3 years and more.

      VI. To estimate the treatment-free remission rate (TFR), time to progression, and overall
      survival.

      VII. To assess the safety of this combination.

      OUTLINE:

      Patients receive dasatinib orally (PO) once daily (QD) on days 1-28. Beginning cycle 4,
      patients also receive decitabine and cedazuridine PO QD on days 1-3. Cycles repeat every 28
      days for up to 3 years in the absence of disease progression or unacceptable toxicity.

      MAINTENANCE: Patients receive dasatinib PO QD on days 1-28. Cycles repeat every 28 days for
      up to 12 years in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up at 30 days and then every 6
      months thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (dasatinib, decitabine and cedazuridine)ExperimentalPatients receive dasatinib PO QD on days 1-28. Beginning cycle 4, patients also receive decitabine and cedazuridine PO QD on days 1-3. Cycles repeat every 28 days for up to 3 years in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients receive dasatinib PO QD on days 1-28. Cycles repeat every 28 days for up to 12 years in the absence of disease progression or unacceptable toxicity.
  • Dasatinib
  • Decitabine and Cedazuridine

Eligibility Criteria

        Inclusion Criteria:

          -  Diagnosis of Philadelphia chromosome (Ph)-positive or BCR-ABL positive CML in early
             chronic phase CML (i.e., time from diagnosis =< 12 months). Except for hydroxyurea
             and/or 1 to 2 doses of cytarabine patients must have received no or minimal prior
             therapy, defined as < 1 month (30 days) of prior Food and Drug Administration (FDA)
             approved tyrosine kinase inhibitor (TKI)

               -  Clonal evolution defined as the presence of additional chromosomal abnormalities
                  other than the Ph chromosome has historically been included as a criterion for
                  accelerated phase. However, patients with clonal evolution as the only criterion
                  of accelerated phase have a significantly better prognosis, and when present at
                  diagnosis may not impact the prognosis at all. Thus, patients with clonal
                  evolution and no other criteria for accelerated phase will be eligible for this
                  study

          -  Eastern Cooperative Oncology Group (ECOG) performance of 0-2

          -  Total bilirubin < 1.5 x upper limit of normal (ULN) (unless secondary to Gilbert's
             disease, in which case should be < 2.5 x ULN)

          -  Serum glutamic pyruvic transaminase (SGPT) < 3 x ULN

          -  Creatinine < 1.5 x ULN

          -  Patients must sign an informed consent indicating they are aware of the
             investigational nature of this study, in keeping with the policies of the hospital

        Exclusion Criteria:

          -  New York Heart Association (NYHA) cardiac class 3-4 heart disease

          -  Cardiac Symptoms: Patients meeting the following criteria are not eligible unless
             cleared by Cardiology:

               -  Uncontrolled angina within 3 months

               -  Diagnosed or suspected congenital long QT syndrome

               -  Any history of clinically significant ventricular arrhythmias (such as
                  ventricular tachycardia, ventricular fibrillation, or Torsades de pointes).

               -  Prolonged corrected QT (QTc) interval on pre-entry electrocardiogram (> 460 msec)

               -  History of significant bleeding disorder unrelated to cancer, including:

                    -  Diagnosed congenital bleeding disorders (e.g., von Willebrand's disease)

                    -  Diagnosed acquired bleeding disorder within one year (e.g., acquired
                       anti-factor VIII antibodies)

          -  Patients with active, uncontrolled psychiatric disorders include: psychosis, major
             depression, and bipolar disorders

          -  Subject is known to be positive for human immunodeficiency virus (HIV) (HIV testing is
             not required)

          -  Evidence of other clinically significant uncontrolled condition(s) including, but not
             limited to:

               -  Uncontrolled and/or active systemic infection (viral, bacterial or fungal)

               -  Chronic hepatitis B virus (HBV) or hepatitis C (HCV) requiring treatment. Note:
                  subjects with serologic evidence of prior vaccination to HBV (i.e. hepatitis B
                  surface [HBs] antigen negative-, anti-HBs antibody positive and anti-hepatitis B
                  core [HBc] antibody negative) or positive anti-HBc antibody from intravenous
                  immunoglobulins (IVIG) may participate

          -  Women of pregnancy potential must practice an effective method of birth control during
             the course of the study, in a manner such that risk of failure is minimized. Prior to
             study enrollment, women of childbearing potential (WOCBP) must be advised of the
             importance of avoiding pregnancy during trial participation and the potential risk
             factors for an unintentional pregnancy. Postmenopausal women must be amenorrheic for
             at least 12 months to be considered of non-childbearing potential. Women must continue
             birth control for the duration of the trial and at least 3 months after the last dose
             of study drug. Pregnant or breast-feeding women are excluded. All WOCBP must have a
             negative pregnancy test prior to first receiving investigational product. If the
             pregnancy test is positive, the patient must not receive study drug and must not be
             enrolled in the study

          -  Patients in late chronic phase (i.e., time from diagnosis to treatment > 12 months),
             accelerated (except as noted in inclusion criteria) or blast phase are excluded. The
             definitions of CML phases are as follows:

               -  Early chronic phase: time from diagnosis to therapy =< 12 months

               -  Late chronic phase: time from diagnosis to therapy > 12 months

               -  Blastic phase: presence of 30% blasts or more in the peripheral blood or bone
                  marrow

               -  Accelerated phase CML: presence of any of the following features:

                    -  Peripheral or marrow blasts 15% or more

                    -  Peripheral or marrow basophils 20% or more

                    -  Thrombocytopenia < 100 x 10^9/L unrelated to therapy

                    -  Documented extramedullary blastic disease outside liver or spleen
      
Maximum Eligible Age:N/A
Minimum Eligible Age:N/A
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Rate of molecular response 4 (MR4)
Time Frame:At 6 months
Safety Issue:
Description:Will be estimated with 95% credible intervals. The association between molecular responses and demographic/ clinical characteristics will be examined by Wilcoxon's rank sum test or Fisher's exact test.

Secondary Outcome Measures

Measure:Rate of MR4.5
Time Frame:At 12 months
Safety Issue:
Description:Will be presented with 95% confidence intervals. The association between molecular responses and demographic/ clinical characteristics will be examined by Wilcoxon's rank sum test or Fisher's exact test.
Measure:Major molecular response rate
Time Frame:At 12 months
Safety Issue:
Description:Will be presented with 95% confidence intervals. The association between molecular responses and demographic/ clinical characteristics will be examined by Wilcoxon's rank sum test or Fisher's exact test.
Measure:Treatment-free remission rate
Time Frame:Up to 15 years
Safety Issue:
Description:Will be presented with 95% confidence intervals. The association between molecular responses and demographic/ clinical characteristics will be examined by Wilcoxon's rank sum test or Fisher's exact test.
Measure:Time to progression
Time Frame:Up to 15 years
Safety Issue:
Description:Survival time will be estimated using the Kaplan-Meier method. Patients who drop out of the study will be included in the time to event data as "censored data". The two-sided log-rank test will be used to assess the differences of time to events between groups.
Measure:Overall survival
Time Frame:Up to 15 years
Safety Issue:
Description:Survival time will be estimated using the Kaplan-Meier method. Patients who drop out of the study will be included in the time to event data as "censored data". The two-sided log-rank test will be used to assess the differences of time to events between groups.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

August 17, 2021