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Panobinostat in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia or Acute Myeloid Leukemia

Primary Purpose

Leukemia

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
panobinostat
gene expression analysis
reverse transcriptase-polymerase chain reaction
laboratory biomarker analysis
Sponsored by
City of Hope Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring Philadelphia chromosome positive adult precursor acute lymphoblastic leukemia, recurrent adult acute lymphoblastic leukemia, recurrent adult acute myeloid leukemia

Eligibility Criteria

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

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed acute myeloid leukemia or acute lymphoblastic leukemia (ALL)

    • Relapsed or refractory disease
  • Patients with Philadelphia chromosome-positive (Ph+) ALL refractory to BCR/ABL inhibitors are eligible
  • Patients who have relapsed after prior autologous or allogenic stem cell transplant are eligible
  • No active CNS disease

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Serum albumin ≥ 3 g/dL
  • AST and ALT ≤ 2.5 times upper limit of normal (ULN) (5.0 times ULN if transaminase elevation is due to leukemic involvement)
  • Bilirubin ≤ 1.5 times ULN
  • Creatinine ≤ 1.5 times ULN or creatinine clearance ≥ 50 mL/min
  • Potassium ≥ lower limit of normal (LLN)
  • Phosphorous ≥ LLN
  • Serum total calcium (corrected for serum albumin) or serum ionized calcium ≥ LLN
  • Magnesium ≥ LLN
  • Thyroid stimulating hormone and free T4 normal (thyroid hormone replacement therapy allowed)
  • LVEF ≥ LLN by MUGA or ECHO
  • No impaired cardiac function, including any of the following:

    • QTc > 450 msec
    • Congenital long QT syndrome
    • History of sustained ventricular tachycardia
    • History of ventricular fibrillation or torsades de pointes
    • Bradycardia (i.e., heart rate < 50 beats per minute)

      • Pacemaker allowed provided heart rate ≥ 50 beats per minute
    • Myocardial infarction or unstable angina within the past 6 months
    • New York Heart Association class III-IV congestive heart failure
    • Right bundle branch block and left anterior hemiblock (bifascicular block)
  • No uncontrolled hypertension
  • No unresolved diarrhea > CTCAE grade 1
  • No impaired gastrointestinal (GI) function or GI disease that may significantly alter the absorption of oral panobinostat
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective double-barrier contraception during and for 3 months after completion of study treatment
  • No other primary malignancy within the past 5 years, other than curatively treated carcinoma in situ of the cervix or basal cell or squamous cell carcinoma of the skin
  • No HIV or hepatitis C positivity
  • No other concurrent severe and/or uncontrolled medical condition
  • No significant history of non-compliance to medical regimens or inability to give reliable informed consent

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from all prior therapy
  • More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) or radiotherapy
  • More than 4 weeks since prior valproic acid
  • No other prior treatment with a histone deacetylase inhibitor
  • No concurrent medication that may cause QTc prolongation or induce torsades de pointes
  • No concurrent CYP3A4 inhibitors
  • No concurrent grapefruit, grapefruit juice, or Seville (sour) oranges
  • No concurrent radiotherapy
  • No other concurrent anticancer therapy or investigational therapy

Sites / Locations

  • City of Hope Comprehensive Cancer Center
  • South Pasadena Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (panobinostat)

Arm Description

Patients receive oral panobinostat once on days 1, 3, and 5. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. panobinostat: 40 mg Monday, Wednesday and Friday of every week in a 28 day cycle

Outcomes

Primary Outcome Measures

Hematological Response Rate
Morphologic CR: morphologic leukemia-free state with absolute neutrophil count > 1000/uL and platelet count ≥ 100,000/uL and independent of blood transfusions. Cytogenic CR: morphologic CR along with reversion to a normal karyotype by cytogenetic analysis. Molecular CR: morphologic CR with no residual disease by molecular or flow cytometric detection methods. Morphologic CR with incomplete blood recovery (CRi): morphologic CR except for residual neutropenia (<1000/uL) and/or thrombocytopenia (<1000,000/uL). PR: same hematologic values for a CR but with a decrease of at least 50% in percentage of blasts to a post-treatment value of 5% to 25% in bone marrow aspirate. (If the pre-treatment blast percentage was 50-100% this must decrease to a value between 5-25%. If the pre-treatment blast percentage was 20-49% this must decrease by at least half to a value > 5%.) A value ≤ 5% is also considered a PR if Auer rods are present. Hematological response = morphologic CR+PR.

Secondary Outcome Measures

Full Information

First Posted
July 25, 2008
Last Updated
September 3, 2014
Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00723203
Brief Title
Panobinostat in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia or Acute Myeloid Leukemia
Official Title
A Phase II Study of LBH589, a Novel Histone Deacetylase Inhibitor, in Relapsed and Refractory Adult Patients With Acute Leukemia (AL) or in Newly Diagnosed Patients Over the Age of 60
Study Type
Interventional

2. Study Status

Record Verification Date
September 2014
Overall Recruitment Status
Terminated
Why Stopped
Terminated early due to a lack of efficacy
Study Start Date
April 2008 (undefined)
Primary Completion Date
September 2010 (Actual)
Study Completion Date
September 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Panobinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. PURPOSE: This phase II trial is studying the side effects of panobinostat and to see how well it works in treating patients with relapsed or refractory acute lymphoblastic leukemia or acute myeloid leukemia.
Detailed Description
OBJECTIVES: Primary To determine the antitumor activity of panobinostat, in terms of objective response rate, time to progression, and survival, in patients with relapsed or refractory acute lymphoblastic leukemia or acute myeloid leukemia. To assess the toxicity of panobinostat in these patients. Secondary To perform correlative laboratory studies to assess changes in various proteins that may be altered by histone deacetylase inhibition therapy. OUTLINE: Patients receive oral panobinostat once on days 1, 3, and 5. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients undergo peripheral blood and bone marrow sample collection at baseline and on day 28 of course 1 for correlative laboratory studies. Samples are analyzed by RT-PCR for reactivation of FANCG, FOXO3A, GADD45A, GADD45B, GADD45G, H2AX, and TP73. After completion of study treatment, patients are followed for at least 4 weeks. PROJECTED ACCRUAL: A total of 74 patients (37 with acute myeloid leukemia and 37 with acute lymphoblastic leukemia) will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia
Keywords
Philadelphia chromosome positive adult precursor acute lymphoblastic leukemia, recurrent adult acute lymphoblastic leukemia, recurrent adult acute myeloid leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (panobinostat)
Arm Type
Experimental
Arm Description
Patients receive oral panobinostat once on days 1, 3, and 5. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. panobinostat: 40 mg Monday, Wednesday and Friday of every week in a 28 day cycle
Intervention Type
Drug
Intervention Name(s)
panobinostat
Intervention Description
40 mg Monday, Wednesday and Friday of every week in a 28 day cycle
Intervention Type
Genetic
Intervention Name(s)
gene expression analysis
Intervention Description
Day 1 and day 28 samples
Intervention Type
Genetic
Intervention Name(s)
reverse transcriptase-polymerase chain reaction
Intervention Description
Day 1 and day 28 samples
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Day 1 and day 28 samples
Primary Outcome Measure Information:
Title
Hematological Response Rate
Description
Morphologic CR: morphologic leukemia-free state with absolute neutrophil count > 1000/uL and platelet count ≥ 100,000/uL and independent of blood transfusions. Cytogenic CR: morphologic CR along with reversion to a normal karyotype by cytogenetic analysis. Molecular CR: morphologic CR with no residual disease by molecular or flow cytometric detection methods. Morphologic CR with incomplete blood recovery (CRi): morphologic CR except for residual neutropenia (<1000/uL) and/or thrombocytopenia (<1000,000/uL). PR: same hematologic values for a CR but with a decrease of at least 50% in percentage of blasts to a post-treatment value of 5% to 25% in bone marrow aspirate. (If the pre-treatment blast percentage was 50-100% this must decrease to a value between 5-25%. If the pre-treatment blast percentage was 20-49% this must decrease by at least half to a value > 5%.) A value ≤ 5% is also considered a PR if Auer rods are present. Hematological response = morphologic CR+PR.
Time Frame
Up to 6 cycles of treatment, up to 24 weeks.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically confirmed acute myeloid leukemia or acute lymphoblastic leukemia (ALL) Relapsed or refractory disease Patients with Philadelphia chromosome-positive (Ph+) ALL refractory to BCR/ABL inhibitors are eligible Patients who have relapsed after prior autologous or allogenic stem cell transplant are eligible No active CNS disease PATIENT CHARACTERISTICS: ECOG performance status 0-2 Serum albumin ≥ 3 g/dL AST and ALT ≤ 2.5 times upper limit of normal (ULN) (5.0 times ULN if transaminase elevation is due to leukemic involvement) Bilirubin ≤ 1.5 times ULN Creatinine ≤ 1.5 times ULN or creatinine clearance ≥ 50 mL/min Potassium ≥ lower limit of normal (LLN) Phosphorous ≥ LLN Serum total calcium (corrected for serum albumin) or serum ionized calcium ≥ LLN Magnesium ≥ LLN Thyroid stimulating hormone and free T4 normal (thyroid hormone replacement therapy allowed) LVEF ≥ LLN by MUGA or ECHO No impaired cardiac function, including any of the following: QTc > 450 msec Congenital long QT syndrome History of sustained ventricular tachycardia History of ventricular fibrillation or torsades de pointes Bradycardia (i.e., heart rate < 50 beats per minute) Pacemaker allowed provided heart rate ≥ 50 beats per minute Myocardial infarction or unstable angina within the past 6 months New York Heart Association class III-IV congestive heart failure Right bundle branch block and left anterior hemiblock (bifascicular block) No uncontrolled hypertension No unresolved diarrhea > CTCAE grade 1 No impaired gastrointestinal (GI) function or GI disease that may significantly alter the absorption of oral panobinostat Not pregnant or nursing Negative pregnancy test Fertile patients must use effective double-barrier contraception during and for 3 months after completion of study treatment No other primary malignancy within the past 5 years, other than curatively treated carcinoma in situ of the cervix or basal cell or squamous cell carcinoma of the skin No HIV or hepatitis C positivity No other concurrent severe and/or uncontrolled medical condition No significant history of non-compliance to medical regimens or inability to give reliable informed consent PRIOR CONCURRENT THERAPY: See Disease Characteristics Recovered from all prior therapy More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) or radiotherapy More than 4 weeks since prior valproic acid No other prior treatment with a histone deacetylase inhibitor No concurrent medication that may cause QTc prolongation or induce torsades de pointes No concurrent CYP3A4 inhibitors No concurrent grapefruit, grapefruit juice, or Seville (sour) oranges No concurrent radiotherapy No other concurrent anticancer therapy or investigational therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Leslie Popplewell, MD
Organizational Affiliation
City of Hope Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
City of Hope Comprehensive Cancer Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010-3000
Country
United States
Facility Name
South Pasadena Cancer Center
City
Pasadena
State/Province
California
ZIP/Postal Code
91030
Country
United States

12. IPD Sharing Statement

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Panobinostat in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia or Acute Myeloid Leukemia

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