Status and phase
Conditions
Treatments
Study type
Funder types
Identifiers
About
This phase I/II trial studies the best dose of venetoclax when given together with azacitidine and pevonedistat and to see how well it works in treating patients with newly diagnosed acute myeloid leukemia. Drugs used in chemotherapy, such as azacitidine, 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. Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Pevonedistat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving azacitidine, venetoclax, and pevonedistat may work better in treating patients with acute myeloid leukemia.
Full description
PRIMARY OBJECTIVES:
I. To determine the maximum-tolerated dose (MTD) of venetoclax in combination with azacitidine and pevonedistat in patients with previously untreated secondary acute myeloid leukemia (AML). (Phase I) II. To determine the efficacy of the combination regimen, as defined by the rate of complete response (CR) plus complete response with incomplete bone marrow recovery (CRi) within 6 cycles of treatment. (Phase II [AML]) III. To determine the efficacy of the combination regimen, as defined by the rate of CR within 6 cycles of treatment. (Phase II [myelodysplastic syndrome (MDS) Newly Diagnosed]) IV. To determine the overall response rate (defined as CR + marrow CR [mCR] + partial remission [PR] + hematological improvement [HI]) within 6 cycles of treatment. (Phase II [MDS/chronic myelomonocytic leukemia (CMML) post-hypomethylating agent (HMA) failure])
SECONDARY OBJECTIVES:
I. To determine efficacy outcomes, including CR rate, leukemia response rate (CR + CRi + partial response [PR] + morphologic leukemia free state [MLFS]), minimal residual disease (MRD) negativity by flow cytometry, duration of response, transformation to AML (in the MDS cohorts), relapse-free survival (RFS), event-free survival (EFS) and overall survival (OS).
II. To determine the safety of the combination regimen.
OUTLINE: This is a phase I, dose-escalation study of venetoclax followed by a phase II study.
Patients receive venetoclax orally (PO) once daily (QD) on days 1-28, azacitidine intravenously (IV) or subcutaneously (SC) on days 1-7, and pevonedistat IV over 60 minutes on days 1, 3, and 5. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 30 days, and then every 6 months thereafter.
Enrollment
Sex
Ages
Volunteers
Inclusion criteria
AML COHORT ONLY: Patients must have a new diagnosis (i.e., no prior therapy for AML) of AML per World Health Organization (WHO) 2016 criteria and any one of the following (i.e. therapy-related AML or AML with myelodysplastic-related changes per WHO):
NEWLY DIAGNOSED MDS/CMML COHORT ONLY: Diagnosis of MDS or CMML with intermediate-2 or high-risk disease by the International Prognostic Scoring System (IPSS)
MDS/CMML POST-HMA FAILURE COHORT ONLY: Diagnosis of MDS or CMML with intermediate-1, intermediate-2, or high-risk disease by the IPSS who have no responded, progressed, or relapsed after treatment with at least 4 cycles of azacitidine and/or decitabine
Eastern Cooperative Oncology Group (ECOG) performance status from 0-2
Total bilirubin =< 1.5 x upper limit of normal (ULN) except in patients with Gilbert's syndrome or if elevation is attributed to underlying leukemia. Patients with Gilbert's syndrome or with elevated bilirubin attributed to underlying leukemia may enroll if direct bilirubin =< 1.5 x ULN of the direct bilirubin (repeat if more than 3 days before the first dose)
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x ULN (repeat if more than 3 days before the first dose)
Creatinine clearance >= 30 mL/min (repeat if more than 3 days before the first dose)
White blood cell (WBC) count < 50,000/uL. Note: Hydroxyurea may be used to control leukocytosis for the first 28 days of study treatment (i.e., cycle 1). Use of hydroxyurea beyond this point may be permitted as clinically indicated, on a case-by-case basis and after discussion with the principal investigator (PI). (repeat if more than 3 days before the first dose)
Female patients who:
Are postmenopausal for at least 1 year before the screening visit, OR
Are surgically sterile, OR
If they are of childbearing potential:
Male patients, even if surgically sterilized (i.e., status postvasectomy), who:
Voluntary written consent must be given before performance of any study related procedure
Exclusion criteria
Treatment with any investigational anti-neoplastic drugs within 2 weeks before the first dose of any study drug (cycle 1 day 1 [C1D1])
AML COHORT ONLY: Patients who are suitable for and agreeable to receive intensive induction chemotherapy
NEWLY DIAGNOSED MDS/CMML COHORT ONLY: Prior treatment with hypomethylating agents
MDS/CMML POST-HMA FAILURE COHORT ONLY: Prior treatment with venetoclax or pevonedistat
Patients whose only site of disease is extramedullary
Acute promyelocytic leukemia as diagnosed by morphologic examination of bone marrow, by fluorescent in situ hybridization or cytogenetics of peripheral blood or bone marrow, or by other accepted analysis
Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of study procedures
Active uncontrolled infection or severe infectious disease, such as severe pneumonia, meningitis, or septicemia
Major surgery within 14 days before the first dose of any study drug
Patients with a prior or concurrent malignancy whose natural history or treatment is not anticipated to interfere with the safety or efficacy assessment of the investigational regimen may be included only after discussion with the PI
Life-threatening illness unrelated to cancer, leading to expected life expectancy (unrelated to leukemia) < 1 year
Patients with severe, uncontrolled coagulopathy or bleeding disorder not related to leukemia
Known human immunodeficiency virus (HIV) positive patients who meet the following criteria will be considered eligible:
Known hepatitis B surface antigen seropositive or known or suspected active hepatitis C infection
Known hepatic cirrhosis or severe pre-existing hepatic impairment
Known cardiopulmonary disease defined as:
Uncontrolled high blood pressure (i.e., systolic blood pressure > 180 mm Hg, diastolic blood pressure > 100 mm Hg documented on two consecutive blood pressure evaluations)
Prolonged rate corrected QT (QTc) interval >= 500 msec, calculated according to institutional guidelines
Left ventricular ejection fraction (LVEF) < 50% as assessed by echocardiogram or radionuclide angiography
Known severe chronic obstructive pulmonary disease, interstitial lung disease, and pulmonary fibrosis
Known central nervous system (CNS) involvement
Treatment with strong CYP3A4 inducers within 14 days (or 3 half-lives, whichever is shorter) before the first dose of the study drug. Strong CYP3A4 inducers are not permitted during this study
Systemic antineoplastic therapy or radiotherapy for other malignant conditions within 14 days (or 3 half-lives, whichever is shorter) before the first dose of any study drug, except for hydroxyurea or up to 2 total grams of intravenous cytarabine for cytoreduction. Prior hypomethylating agent (HMA) therapy is allowed, unless given for AML
Female patients who are either lactating and/or breastfeeding or have a positive serum pregnancy test during the screening period
Female patients who intend to donate eggs (ova) during the course of this study or 4 months after receiving their last dose of study drug(s)
Male patients who intend to donate sperm during the course of this study or 4 months after receiving their last dose of study drug(s)
Known hypersensitivity to azacitidine, mannitol or pevonedistat, any of their components, or compounds of similar chemical composition
Primary purpose
Allocation
Interventional model
Masking
40 participants in 1 patient group
Loading...
Data sourced from clinicaltrials.gov
Clinical trials
Research sites
Resources
Legal