A Study Evaluating the Safety and Efficacy of Idasanutlin in Combination With Cytarabine and Daunorubicin in Patients Newly Diagnosed With Acute Myeloid Leukemia (AML) and the Safety and Efficacy of Idasanutlin in the Maintenance of First AML Complete Remission

Roche

Status and phase: Terminated; Phase 2; Phase 1

Conditions: Acute Myeloid Leukemia

Treatments: Drug: Idasanutlin; Procedure: Allogeneic Hematopoietic Stem Cell Transplant (Allo-HSCT); Drug: Cytarabine; Drug: Daunorubicin

Study type: Interventional

Funder types: Industry

Identifiers

NCT03850535

2018-002964-25 (EudraCT Number)

GO40800

Details and patient eligibility

About

This Phase Ib/II, open-label, multicenter, non-randomized study will evaluate the safety, efficacy, and pharmacokinetics of idasanutlin when it is given in combination with cytarabine and daunorubicin in induction, in combination with cytarabine in consolidation, and as a single agent in maintenance for treating participants with acute myeloid leukemia (AML).

Enrollment: 24 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Inclusion Criteria for All Study Phases:

• Eastern Cooperative Oncology Group (ECOG) performance status ≤2
• Adequate hepatic and renal function
• For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating eggs with a failure rate of <1% per year during the treatment period and for at least 6 months after the final dose of idasanutlin, cytarabine, or daunorubicin. Women must refrain from donating eggs during this same period.
• For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive, measures, and agreement to refrain from donating sperm that together result in a failure rate of <1% per year during the treatment period and for 6 months after the final dose of idasanutlin, cytarabine, or daunorubicin. Men must refrain from donating sperm during this same period.

Inclusion Criteria for Patients in the Dose-Escalation and Expansion Phases:

• Documented/confirmed newly diagnosed acute myeloid leukemia (AML) not previously treated according to World Health Organization (WHO)

Inclusion Criteria for Patients in the Post-Consolidation Phase:

• Documented/confirmed AML according to WHO in remission after induction, within 21 days of end of last chemotherapy consolidation cycle, and were minimum residual disease (MRD) positive at the end of induction as per local laboratory assessment

Exclusion criteria

Exclusion Criteria for All Study Phases:

• Clinical evidence of central nervous system (CNS) leukemia
• Any Grade ≥2 non-hematologic toxicities prior to starting therapy
• Current treatment with any other investigational or commercial agents or therapies administered with the intention to treat their malignancy with the exception of hydroxyurea (HU) or 6-mercaptopurine (6-MP)
• Treatment-related AML
• Acute promyelocytic leukemia
• History of other malignancy that could affect compliance with the protocol or interpretation of results
• Any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study, impair the ability of the investigator to evaluate the patient, or impair the patient's ability to complete the study
• Echocardiogram (ECHO) or multiple-gated acquisition (MUGA) scan showing ejection fraction ≤40%
• Non-malignant medical illnesses that are uncontrolled or whose control may be jeopardized by this study treatment, such as hereditary coagulation disorders, insulin-dependent diabetes mellitus not optimally controlled with medical management (e.g., presence of ketoacidosis), or active GI conditions affecting absorption
• Infection considered by the investigator to be clinically uncontrolled or of unacceptable risk to the patient upon the induction of neutropenia, that is, patients who are or should be on antimicrobial agents for the treatment of active infection
• Febrile patients within 72 hours of study treatment initiation
• Patients with a history of active or chronic infectious hepatitis unless serology demonstrates clearance of infection
• Patients who are unable to interrupt treatment with moderate to strong CYP2C8 inducers and inhibitors
• Patients who are unable to temporarily interrupt treatment with oral or parenteral anticoagulants/anti-platelet agents during treatment phase
• Patients who have a history of clinically significant liver cirrhosis
• Patients with extramedullary AML with no evidence of systemic involvement
• Pregnant or breastfeeding patients
• Known history of HIV-positive status
• Patients who might refuse to receive blood products and/or have a hypersensitivity to blood products
• Prior treatment with an MDM2 antagonist
• Patients with clinically relevant QTc prolongation, a family history of long QT syndrome

Exclusion Criteria for Patients in the Phase Ib Dose-Escalation Phase:

• Adverse risk patients as per European LeukemiaNet (ELN) 2017 criteria

Exclusion Criteria for Patients in Phase Ib Post-Consolidation Phase:

• Any ongoing Grade ≥2 hematologic adverse events prior to starting therapy
• Previous hematopoietic stem cell transplant (HSCT)

Exclusion Criteria for Patients in the Dose-Escalation Phase and Patients in the Favorable/Intermediate-Risk Cohort of the Expansion Phase:

• Secondary AML, defined as AML evolving from antecedent hematologic disorder (AHD)

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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24 participants in 4 patient groups

Dose-Escalation Phase

Experimental group

Description:

Participants with newly diagnosed, previously untreated, favorable or intermediate risk AML (according to European LeukemiaNet \[ELN\] 2017 criteria) will undergo the treatment sequence of induction, consolidation, and maintenance. For induction, participants will be treated with idasanutlin plus cytarabine and daunorubicin. At the investigator's discretion for consolidation, either participants will be treated with idasanutlin and cytarabine or they will undergo Allo-HSCT. For maintenance, participants will be treated with single-agent idasanutlin.

Treatment:

Drug: Daunorubicin

Drug: Cytarabine

Procedure: Allogeneic Hematopoietic Stem Cell Transplant (Allo-HSCT)

Drug: Idasanutlin

Post-Consolidation Phase

Experimental group

Description:

Participants who are idasanutlin treatment-naive, had received induction and chemotherapy consolidation for AML outside of the study, and were in minimal residual disease (MRD)-positive remission after induction will be enrolled in this cohort to receive maintenance treatment with single-agent idasanutlin.

Treatment:

Drug: Idasanutlin

Expansion Phase: Favorable/Intermediate-Risk AML

Experimental group

Description:

Participants with newly diagnosed, previously untreated, favorable or intermediate risk AML (according to ELN 2017 criteria) will undergo the treatment sequence of induction, consolidation, and maintenance. For induction, participants will be treated with idasanutlin (at the recommended Phase 2 dose) plus cytarabine and daunorubicin. At the investigator's discretion for consolidation, either participants will be treated with idasanutlin and cytarabine or they will undergo Allo-HSCT. For maintenance, participants will be treated with single-agent idasanutlin.

Treatment:

Drug: Daunorubicin

Drug: Cytarabine

Procedure: Allogeneic Hematopoietic Stem Cell Transplant (Allo-HSCT)

Drug: Idasanutlin

Expansion Phase: High-Risk AML

Experimental group

Description:

Participants with newly diagnosed, previously untreated, high-risk AML (defined as adverse risk according to ELN 2017 criteria, and secondary AML) will undergo the treatment sequence of induction, consolidation, and maintenance. For induction, participants will be treated with idasanutlin (at the recommended Phase 2 dose) plus cytarabine and daunorubicin. At the investigator's discretion for consolidation, either participants will be treated with idasanutlin and cytarabine or they will undergo Allo-HSCT. For maintenance, participants will be treated with single-agent idasanutlin.

Treatment:

Drug: Daunorubicin

Drug: Cytarabine

Procedure: Allogeneic Hematopoietic Stem Cell Transplant (Allo-HSCT)

Drug: Idasanutlin