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.
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
Drug | Synonyms | Arms |
---|
Dasatinib | BMS-354825, Dasatinib Hydrate, Dasatinib Monohydrate, Sprycel | Treatment (dasatinib, decitabine and cedazuridine) |
Decitabine and Cedazuridine | ASTX727, C-DEC, CDA Inhibitor E7727/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Combination Agent ASTX727, Cedazuridine/Decitabine Tablet, DEC-C, Inqovi | Treatment (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
Name | Type | Description | Interventions |
---|
Treatment (dasatinib, decitabine and cedazuridine) | Experimental | Patients 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