Bortezomib, Daunorubicin, and Cytarabine in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia

National Cancer Institute (NCI)

Status and phase

Completed

Phase 2

Phase 1

Conditions

Adult Acute Megakaryoblastic Leukemia (M7)

Adult Erythroleukemia (M6a)

Untreated Adult Acute Myeloid Leukemia

Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities

Adult Acute Myeloid Leukemia With Inv(16)(p13;q22)

Adult Acute Myeloid Leukemia With t(8;21)(q22;q22)

Adult Pure Erythroid Leukemia (M6b)

Adult Acute Monoblastic Leukemia (M5a)

Adult Acute Myeloid Leukemia With t(16;16)(p13;q22)

Adult Acute Myelomonocytic Leukemia (M4)

Adult Acute Myeloblastic Leukemia With Maturation (M2)

Adult Acute Myeloblastic Leukemia Without Maturation (M1)

Adult Acute Minimally Differentiated Myeloid Leukemia (M0)

Adult Acute Monocytic Leukemia (M5b)

Acute Myeloid Leukemia

Treatments

Drug: daunorubicin hydrochloride

Drug: cytarabine

Drug: bortezomib

Study type

Interventional

Funder types

NIH

Identifiers

NCT00742625

CDR0000612758

U10CA031946 (U.S. NIH Grant/Contract)

CALGB 10502 (Other Identifier)

P30CA014236 (U.S. NIH Grant/Contract)

CALGB-10502 (Other Identifier)

NCI-2009-00443 (Registry Identifier)

Details and patient eligibility

About

This phase II trial studies the side effects and best dose of bortezomib when given together with daunorubicin and cytarabine and to see how well it works in treating older patients with previously untreated acute myeloid leukemia. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as daunorubicin and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving bortezomib together with combination chemotherapy may kill more cancer cells.

Full description

PRIMARY OBJECTIVES:

I. To define the remission induction response rate (complete response [CR] and CR with incomplete platelet recovery [CRp]) in older patients with previously untreated acute myeloid leukemia treated with induction therapy comprising bortezomib in combination with daunorubicin hydrochloride and cytarabine.

II. To define the maximum tolerated dose of bortezomib when administered in combination with intermediate-dose cytarabine after induction therapy.

SECONDARY OBJECTIVES:

I. To describe the disease-free survival of patients treated with this regimen. II. To describe the overall survival of patients treated with this regimen. III. To evaluate the treatment-related toxicities in these patients.

OUTLINE: This is a multicenter, dose-escalation study of bortezomib. Doses of bortezomib are escalated during remission consolidation therapy.

REMISSION INDUCTION THERAPY: Remission induction course 1: Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11; daunorubicin hydrochloride IV on days 1-3; and cytarabine IV continuously over 168 hours on days 1-7.

After completion of remission induction course 1, patients undergo bone marrow aspiration and biopsy for evaluation of response. Patients achieving a complete response (CR) or partial response (PR) proceed to remission consolidation therapy. Patients achieving a CR with incomplete platelet recovery (CRp) proceed to remission consolidation therapy after platelet counts recover. Patients with persistent leukemia (>= 20% bone marrow cellularity and >= 5% bone marrow myeloblasts) proceed to remission induction course 2.

REMISSION INDUCTION COURSE 2: Patients receive bortezomib IV over 3-5 seconds on days 1 and 4; daunorubicin hydrochloride IV on days 1 and 2; and cytarabine IV continuously over 120 hours on days 1-5.

After completion of remission induction course 2, patients undergo bone marrow aspiration and biopsy for evaluation of response. Patients achieving a CR or PR proceed to remission consolidation therapy. Patients achieving a CRp proceed to remission consolidation therapy after platelet counts recover. Patients with residual leukemia who do not meet the criteria for PR are removed from the study.

REMISSION CONSOLIDATION THERAPY: Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11 and intermediate-dose cytarabine IV over 3 hours on days 1-5. Patients then undergo bone marrow aspiration and biopsy for evaluation of response. Patients achieving a CR or who demonstrate continuing CR receive a second course of remission consolidation therapy beginning 2-4 weeks after blood counts recover.

After completion of study therapy, patients are followed every 2 months for 2 years, every 3 months for 2 years, and then annually for up to 10 years.

Enrollment

95 patients

Sex

All

Ages

60 to 75 years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria:

Unequivocally histologically confirmed acute myeloid leukemia (AML)
At least 20% blasts in the bone marrow based on WHO criteria
No acute promyelocytic leukemia (M3)
Antecedent hematologic disorder or myelodysplastic syndromes allowed provided the patient did not receive cytotoxic chemotherapy, including azacitidine and decitabine, for their pre-leukemic disorder
Concurrent enrollment on CALGB-8461 required
Not pregnant or nursing
Fertile patients must use effective contraception
No ataxia, cranial neuropathy, or peripheral neuropathy >= grade 2
LVEF >= 40% by ECHO or MUGA scan
No signs or symptoms of congestive heart failure
DLCO >= 50% (corrected for hemoglobin)
No prior therapy for leukemia or pre-leukemic disorders, except for the following:
- emergency leukapheresis;
- emergency treatment for hyperleukocytosis with hydroxyurea;
- cranial radiotherapy for CNS leukostasis (one dose only);
- growth factor/cytokine support
No other concurrent chemotherapy, except for the following:
- I) steroids administered for adrenal failure, hypersensitivity reactions, or septic shock;
- II) hormones administered for non-disease-related conditions (e.g., insulin for diabetes or estrogens or progestins for gynecologic indications)
No concurrent palliative radiotherapy