MS-275 in Treating Patients With Hematologic Cancer

Johns Hopkins Medicine

Status and phase: Completed; Phase 1

Conditions: Multiple Myeloma and Plasma Cell Neoplasm; Leukemia; Myelodysplastic/Myeloproliferative Diseases; Myelodysplastic Syndromes

Treatments: Drug: entinostat

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00015925

P30CA006973 (U.S. NIH Grant/Contract)

NCI-2791

JHOC-J0253

U01CA069854 (U.S. NIH Grant/Contract)

CDR0000068574, J0253

MSGCC-0050

Details and patient eligibility

About

RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die.

PURPOSE: Phase I trial to study the effectiveness of MS-275 in treating patients who have hematologic cancer.

Full description

OBJECTIVES:

• Determine the toxic effects and pharmacokinetics of MS-275 in patients with poor-risk hematologic malignancy.
• Determine whether this drug induces changes in hematologic differentiation, in terms of changes in morphology, cell surface marker expression, and acetylation status, in these patients.
• Determine whether this drug induces clinical response in these patients.

OUTLINE: This is a dose-escalation study.

Patients receive oral MS-275 on days 1, 8, 15, and 22. Courses repeat every 6 weeks in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of MS-275 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

PROJECTED ACCRUAL: Approximately 25-30 patients will be accrued for this study.

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

• One of the following histologically confirmed diagnoses:

  • Acute myeloid leukemia (AML)

    • Newly diagnosed de novo AML in patients over 60 years old with the following poor-risk features:

      • Antecedent hematologic disorder
      • Complex karyotype or other adverse cytogenetics
      • Stem cell immunophenotype

    • AML arising from myelodysplastic syndromes (MDS)

    • Secondary AML

    • Relapsed or refractory AML, including primary induction failure

  • MDS

    • Poor-risk, defined as the following:

      • International Performance Score at least 1.5
      • More than 10% marrow blasts
      • Cytopenias in at least 2 lineages

    • Refractory anemia with excess blasts (RAEB)

    • RAEB in transformation

    • Chronic myelomonocytic leukemia

  • Acute lymphoblastic leukemia (ALL)

    • Newly diagnosed de novo ALL in patients over 60 years old with the following poor-risk features:

      • Complex karyotype or other adverse cytogenetics
      • Mixed lineage immunophenotype

    • Relapsed or refractory ALL, including primary induction failure

  • Chronic myelogenous leukemia (CML)

    • CML in accelerated phase or blast crisis
    • Interferon-refractory CML in chronic phase

  • Multiple myeloma (MM)

    • Relapsed or refractory, including prior autologous stem cell transplantation

  • Acute promyelocytic leukemia

    • Prior treatment with tretinoin

    • Ineligible for arsenic trioxide

    • No evidence of active coagulopathy

    • Low-risk for developing clinically significant coagulopathy during study

      • Low tumor burden by marrow aspiration at time of relapse
      • No prior coagulation-related sequelae (deep vein thrombosis, pulmonary embolism, or CNS thrombosis or bleed)

• Failure after primary induction therapy or relapse after complete remission allowed if patient received no more than 3 courses of prior induction/reinduction therapy

• Not eligible for curative stem cell transplantation

• No hyperleukocytosis with at least 50,000/mm^3 leukemic blasts

• No active CNS leukemia

• No plasma cell leukemia

• No amyloidosis resulting in major organ dysfunction

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• ECOG 0-2

Life expectancy:

• Not specified

Hematopoietic:

• See Disease Characteristics
• No disseminated intravascular coagulation
• No hyperviscosity

Hepatic:

• AST/ALT no greater than 2 times normal
• Alkaline phosphatase no greater than 2 times normal
• Bilirubin no greater than 1.5 times normal

Renal:

• Creatinine no greater than 1.5 times normal
• No uncorrected hypercalcemia

Cardiovascular:

• See Disease Characteristics

• LVEF at least 45% by MUGA or echocardiogram

• No intrinsic impaired cardiac function, including any of the following:

  • Myocardial infarction within the past 3 months
  • Prior severe coronary artery disease
  • Cardiomyopathy
  • Congestive heart failure

Other:

• No active uncontrolled infection
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• See Disease Characteristics
• At least 1 week since prior growth factors (epoetin alfa, filgrastim [G-CSF], sargramostim [GM-CSF], interleukin [IL]-3, or IL-11)
• At least 4 weeks since prior autologous stem cell transplantation
• No prior allogeneic stem cell transplantation
• No concurrent immunotherapy

Chemotherapy:

• See Disease Characteristics
• At least 3 weeks since prior chemotherapy and recovered
• At least 24 hours since prior hydroxyurea or mercaptopurine for prevention of leukostasis
• No concurrent chemotherapy

Endocrine therapy:

• Not specified

Radiotherapy:

• At least 2 weeks since prior emergency radiotherapy to large soft tissue or lytic bony lesions for MM
• No concurrent radiotherapy

Surgery:

• Not specified

Other:

• At least 24 hours since other prior noncytotoxic agents for prevention of leukostasis
• No other concurrent antitumor therapy