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Belinostat and Azacitidine in Treating Patients With Advanced Hematologic Cancers or Other Diseases

Primary Purpose

Accelerated Phase of Disease, Adult Acute Myeloid Leukemia With Inv(16)(p13.1q22); CBFB-MYH11, Adult Acute Myeloid Leukemia With t(16;16)(p13.1;q22); CBFB-MYH11

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Belinostat
Azacitidine
Laboratory Biomarker Analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Accelerated Phase of Disease

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histologically confirmed diagnosis of 1 of the following: Relapsed or refractory acute myeloid leukemia (AML) Relapsed or refractory acute promyelocytic leukemia (must have failed both tretinoin and arsenic trioxide) Relapsed or refractory acute lymphoblastic leukemia Secondary AML, including AML arising from antecedent hematologic diseases, such as myelodysplastic syndromes (MDS) or myeloproliferative disorders, OR therapy-related AML Chronic myelogenous leukemia in accelerated or blast phase Advanced phases of Philadelphia chromosome-negative (Ph-) chronic myeloproliferative disorders, as defined by ≥ 1 of the following: Presence of anemia (hemoglobin < 10 g/dL and/or red blood cell transfusion dependent) Presence of palpable splenomegaly MDS, including chronic myelomonocytic leukemia Must have intermediate or high-risk International Prognostic Scoring System (IPSS) scores (≥ 0.5) Low-risk IPSS scores allowed provided ≥ 1 of the following criteria are met: Hemoglobin < 10 g/dL and/or red blood cell transfusion dependent Platelet count < 50,000/mm³ Absolute neutrophil count < 1,000/mm³ Refractory disease OR no standard therapy exists Evidence of AML associated with dysplasia on bone marrow histology for elderly patients (i.e., > 60 years old) who are previously untreated and not candidates for or unwilling to undergoing induction therapy No known active CNS involvement with disease CALGB performance status (PS) 0-2 OR Karnofsky PS 60-100% Bilirubin ≤ 2.0 mg/dL (unless due to Gilbert's syndrome) ALT ≤ 3 times upper limit of normal (unless due to disease) Creatinine ≤ 2 mg/dL Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No history of allergic reactions attributed to compounds of similar chemical or biologic composition to PXD101 or Azacitidine No history of allergic reactions to mannitol No history of dose-limiting toxicity during prior treatment with Azacitidine No concurrent uncontrolled illness including, but not limited to, the following: Ongoing or active infection Symptomatic congestive heart failure Unstable angina pectoris Cardiac arrhythmia Psychiatric illness or social situation that would preclude compliance with study requirements No marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a QTc interval > 500 msec) No long QT syndrome No uncontrolled cardiovascular disease, including the following: Severe uncontrolled hypertension Uncontrolled congestive heart failure related to primary cardiac disease Uncontrolled cardiac arrhythmia Uncontrolled ischemic or severe valvular heart disease Myocardial infarction within the past 6 months See Disease Characteristics Recovered from prior therapy At least 2 weeks since prior chemotherapy (6 weeks for mitomycin C or nitrosoureas) At least 2 weeks since prior radiotherapy At least 4 weeks since prior investigational agents At least 24 hours since prior hydroxyurea At least 2 weeks since prior valproic acid No concurrent combination antiretroviral therapy for HIV-positive patients No other concurrent investigational agents No concurrent medication that may cause torsade de pointes No other concurrent anticancer therapy, including chemotherapy, radiotherapy, or biological agents

Sites / Locations

  • University of Chicago Comprehensive Cancer Center
  • University of Wisconsin Hospital and Clinics
  • University Health Network-Princess Margaret Hospital
  • Princess Margaret Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm I (chemotherapy)

Arm II (chemotherapy, enzyme inhibitor therapy)

Arm Description

Patients receive azacitidine SC on days 1-5.

Patients receive azacitidine as in arm I and belinostat at the MTD IV over 30 minutes on days 1-5.

Outcomes

Primary Outcome Measures

Maximum tolerated dose of belinostat in combination with azacitidine
Graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 or 4.0.

Secondary Outcome Measures

Changes in pharmacodynamic variables (target gene expression, apoptosis)
Compared between the two groups using two-sample t tests.
Association of methylation status, categorized as positive or negative, with changes in target gene expression
Distinguished by sequence-specific polymerase chain reaction (PCR) primers. Compared using a two-sample t or Wilcoxon nonparametric test.
Clinical activity (complete remission, partial remission, stable disease, hematologic improvement)
Recorded and tabulated for both the MTD and randomized cohorts.

Full Information

First Posted
July 13, 2006
Last Updated
December 22, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00351975
Brief Title
Belinostat and Azacitidine in Treating Patients With Advanced Hematologic Cancers or Other Diseases
Official Title
A Phase I Study of PXD101 in Combination With Azacitidine (5-Aza) for Advanced Hematologic Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
October 2013
Overall Recruitment Status
Completed
Study Start Date
June 2006 (undefined)
Primary Completion Date
March 2013 (Actual)
Study Completion Date
March 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This phase I trial is studying the side effects and best dose of belinostat when given together with azacitidine in treating patients with advanced hematologic cancers or other diseases. Belinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the cancer. Drugs used in chemotherapy, such as azacitidine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving belinostat together with azacitidine may kill more cancer cells.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the maximum tolerated dose of PXD101 (belinostat) when given in combination with azacitidine (when azacitidine is utilized at a dose range where its effects on cellular differentiation are known to be predominant) in patients with advanced hematologic cancers or other diseases. SECONDARY OBJECTIVES: I. Identify any additive or synergistic effects of this regimen on pharmacodynamic parameters, including apoptosis and re-expression of specific target genes. II. Assess any evidence of clinical activity (complete remission, partial remission, hematologic improvement, stable disease) of this regimen in these patients. OUTLINE: This is a dose-escalation study of belinostat followed by a randomized study. Patients receive azacitidine subcutaneously (SC) and belinostat intravenously (IV) over 30 minutes on days 1-5. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of belinostat until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity. After the MTD is determined, additional patients with myelodysplastic syndromes (MDS) or acute myeloid leukemia (with trilineage dysplasia or arising from MDS) are randomized to 1 of 2 treatment arms. Arm I: Patients receive azacitidine SC on days 1-5. Arm II: Patients receive azacitidine as in arm I and belinostat at the MTD IV over 30 minutes on days 1-5. In both arms, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. After receiving one course, patients randomized to arm I may crossover to receive treatment on arm II. For patients enrolled in the randomized portion of the study, bone marrow aspirates are obtained at baseline, and after course 1 for correlative studies. Samples are examined by gene expression analysis of p15 and p21, DNA methylation of p15INK4B, and apoptosis by RT-PCR and flow cytometry. Pharmacodynamic assays are also performed. After completion of study treatment, patients are followed periodically for up to 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Accelerated Phase of Disease, Adult Acute Myeloid Leukemia With Inv(16)(p13.1q22); CBFB-MYH11, Adult Acute Myeloid Leukemia With t(16;16)(p13.1;q22); CBFB-MYH11, Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); RUNX1-RUNX1T1, Adult Acute Myeloid Leukemia With t(9;11)(p22;q23); MLLT3-MLL, Adult Acute Promyelocytic Leukemia With t(15;17)(q22;q12); PML-RARA, Atypical Chronic Myeloid Leukemia, BCR-ABL1 Negative, Blastic Phase, Chronic Myelogenous Leukemia, BCR-ABL1 Positive, Chronic Myelomonocytic Leukemia, de Novo Myelodysplastic Syndrome, Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable, Philadelphia Chromosome Negative, BCR-ABL1 Positive Chronic Myelogenous Leukemia, Previously Treated Myelodysplastic Syndrome, Primary Myelofibrosis, Recurrent Adult Acute Lymphoblastic Leukemia, Recurrent Adult Acute Myeloid Leukemia, Recurrent Disease, Secondary Acute Myeloid Leukemia, Secondary Myelodysplastic Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
56 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I (chemotherapy)
Arm Type
Experimental
Arm Description
Patients receive azacitidine SC on days 1-5.
Arm Title
Arm II (chemotherapy, enzyme inhibitor therapy)
Arm Type
Experimental
Arm Description
Patients receive azacitidine as in arm I and belinostat at the MTD IV over 30 minutes on days 1-5.
Intervention Type
Drug
Intervention Name(s)
Belinostat
Other Intervention Name(s)
Beleodaq, PXD 101, PXD101
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Azacitidine
Other Intervention Name(s)
5-AC, 5-AZC, U-18496
Intervention Description
Given SC
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Maximum tolerated dose of belinostat in combination with azacitidine
Description
Graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 or 4.0.
Time Frame
Course 1 (28 days)
Secondary Outcome Measure Information:
Title
Changes in pharmacodynamic variables (target gene expression, apoptosis)
Description
Compared between the two groups using two-sample t tests.
Time Frame
Course 1 (baseline to day 5)
Title
Association of methylation status, categorized as positive or negative, with changes in target gene expression
Description
Distinguished by sequence-specific polymerase chain reaction (PCR) primers. Compared using a two-sample t or Wilcoxon nonparametric test.
Time Frame
Baseline, days 4 or 5, and days 25-28
Title
Clinical activity (complete remission, partial remission, stable disease, hematologic improvement)
Description
Recorded and tabulated for both the MTD and randomized cohorts.
Time Frame
After 4, 8, and 16 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed diagnosis of 1 of the following: Relapsed or refractory acute myeloid leukemia (AML) Relapsed or refractory acute promyelocytic leukemia (must have failed both tretinoin and arsenic trioxide) Relapsed or refractory acute lymphoblastic leukemia Secondary AML, including AML arising from antecedent hematologic diseases, such as myelodysplastic syndromes (MDS) or myeloproliferative disorders, OR therapy-related AML Chronic myelogenous leukemia in accelerated or blast phase Advanced phases of Philadelphia chromosome-negative (Ph-) chronic myeloproliferative disorders, as defined by ≥ 1 of the following: Presence of anemia (hemoglobin < 10 g/dL and/or red blood cell transfusion dependent) Presence of palpable splenomegaly MDS, including chronic myelomonocytic leukemia Must have intermediate or high-risk International Prognostic Scoring System (IPSS) scores (≥ 0.5) Low-risk IPSS scores allowed provided ≥ 1 of the following criteria are met: Hemoglobin < 10 g/dL and/or red blood cell transfusion dependent Platelet count < 50,000/mm³ Absolute neutrophil count < 1,000/mm³ Refractory disease OR no standard therapy exists Evidence of AML associated with dysplasia on bone marrow histology for elderly patients (i.e., > 60 years old) who are previously untreated and not candidates for or unwilling to undergoing induction therapy No known active CNS involvement with disease CALGB performance status (PS) 0-2 OR Karnofsky PS 60-100% Bilirubin ≤ 2.0 mg/dL (unless due to Gilbert's syndrome) ALT ≤ 3 times upper limit of normal (unless due to disease) Creatinine ≤ 2 mg/dL Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No history of allergic reactions attributed to compounds of similar chemical or biologic composition to PXD101 or Azacitidine No history of allergic reactions to mannitol No history of dose-limiting toxicity during prior treatment with Azacitidine No concurrent uncontrolled illness including, but not limited to, the following: Ongoing or active infection Symptomatic congestive heart failure Unstable angina pectoris Cardiac arrhythmia Psychiatric illness or social situation that would preclude compliance with study requirements No marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a QTc interval > 500 msec) No long QT syndrome No uncontrolled cardiovascular disease, including the following: Severe uncontrolled hypertension Uncontrolled congestive heart failure related to primary cardiac disease Uncontrolled cardiac arrhythmia Uncontrolled ischemic or severe valvular heart disease Myocardial infarction within the past 6 months See Disease Characteristics Recovered from prior therapy At least 2 weeks since prior chemotherapy (6 weeks for mitomycin C or nitrosoureas) At least 2 weeks since prior radiotherapy At least 4 weeks since prior investigational agents At least 24 hours since prior hydroxyurea At least 2 weeks since prior valproic acid No concurrent combination antiretroviral therapy for HIV-positive patients No other concurrent investigational agents No concurrent medication that may cause torsade de pointes No other concurrent anticancer therapy, including chemotherapy, radiotherapy, or biological agents
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Olatoyosi Odenike
Organizational Affiliation
University of Chicago Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Chicago Comprehensive Cancer Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Facility Name
University of Wisconsin Hospital and Clinics
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53792
Country
United States
Facility Name
University Health Network-Princess Margaret Hospital
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2M9
Country
Canada
Facility Name
Princess Margaret Hospital
City
Cashmere
State/Province
Canterbury
ZIP/Postal Code
8022
Country
New Zealand

12. IPD Sharing Statement

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Belinostat and Azacitidine in Treating Patients With Advanced Hematologic Cancers or Other Diseases

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