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Oral Clofarabine for Acute Myeloid Leukemia

Primary Purpose

Leukemia, Myeloid, Acute

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Clofarabine
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia, Myeloid, Acute focused on measuring Clofarabine, Clolar, AML, Consolidation

Eligibility Criteria

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

Inclusion Criteria:

  • Diagnosis of Acute Myeloid Leukemia according to WHO criteria
  • Age ≥ 60 years at enrollment
  • Patients must be in complete remission by bone marrow examination, within 30 days of enrollment, following treatment with a cytotoxic induction chemotherapy regimen (such as 7+3)

    • Complete remission must be confirmed by bone marrow biopsy
    • If one cycle of consolidation was administered, then patient may be within 60 days of the confirmation of complete remission by bone marrow biopsy
    • Minimum platelet count of 100,000
  • Patients may have received "low-intensity" therapy (i.e. decitabine, lenalidomide, etc) prior to traditional induction chemotherapy.
  • Patients may have received 1 cycle of cytarabine-based consolidation therapy.
  • Patients must have an ECOG performance status of 0-2 at the beginning of consolidation therapy.
  • Have adequate renal and hepatic functions as indicated by the following laboratory values:

    • Serum creatinine ≤ 1.0 mg/dL; if serum creatinine >1.0 mg/dL, then the estimated glomerular filtration rate (GFR) must be >60 mL/min/1.73 m2 as calculated by the Modification of Diet in Renal Disease equation where Predicted GFR (ml/min/1.73 m2) = 186 x (Serum Creatinine)-1.154 x (age in years)-0.023 x (0.742 if patient is female) x (1.212 if patient is black)
    • Serum total bilirubin ≤ 1.5 mg/dL × upper limit of normal (ULN) except for unconjugated hyperbilirubinemia secondary Gilbert's syndrome
    • Aspartate transaminase (AST)/alanine transaminase (ALT) ≤ 2.5 × ULN
    • Alkaline phosphatase ≤ 2.5 × ULN
  • Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide signed valid written informed consent or when appropriate, have an appointed legally authorized representative who is capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide signed valid written informed consent for the benefit of the patient.
  • Male and female patients who are of child bearing potential must use an effective contraceptive method during the study and for a minimum of 6 months after study treatment.
  • Patients MAY have received prior therapy with purine analogs (such as fludarabine and cladribine).

Exclusion Criteria:

  • Current concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol.
  • The diagnosis of AML-M3 (acute promyelocytic leukemia) characterized by translocations involving the retinoic acid receptor-alpha (RAR-alpha) gene.
  • Use of investigational agents within 2 weeks or any anticancer therapy within 2 weeks before study entry. The patient must have recovered from all acute toxicities from any previous therapy.
  • Have any other severe concurrent disease, or have a history of serious organ dysfunction or disease involving the heart, kidney, liver, or other organ system that may place the patient at undue risk to undergo treatment.
  • Patients with a systemic fungal, bacterial, viral, or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment).
  • Have currently active gastrointestinal disease, or prior surgery that may affect the ability of the patient to absorb oral clofarabine.

Sites / Locations

  • Washington University

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Cohort 1

Cohort 2

Cohort 3

Cohort 4

Cohort 5

Cohort 6

Arm Description

Clofarabine 1 mg for 14 days followed by 14 days of rest. Each cycle is 28 days long.

Clofarabine 2 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.

Clofarabine 3 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.

Clofarabine 4 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.

Clofarabine 5 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.

Clofarabine 6 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.

Outcomes

Primary Outcome Measures

Maximum tolerated dose (MTD) and dose limiting toxicity (DLT)

Secondary Outcome Measures

Adverse events by grade and attribution
Disease-free survival
Overall survival

Full Information

First Posted
July 30, 2008
Last Updated
November 10, 2014
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT00727766
Brief Title
Oral Clofarabine for Acute Myeloid Leukemia
Official Title
Phase I Study of Oral Clofarabine Consolidation in Adults Aged 60 and Older With Acute Myeloid Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
November 2014
Overall Recruitment Status
Completed
Study Start Date
January 2009 (undefined)
Primary Completion Date
September 2012 (Actual)
Study Completion Date
November 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase I study designed to test the safety of oral clofarabine when given as consolidation therapy to older patients with AML in remission.
Detailed Description
The prognosis of acute myeloid leukemia (AML) in patients 60 and older is dismal with traditional therapy. Several factors contribute to the poor prognosis of older individuals, including the increased incidence of the multidrug resistance efflux pump, comorbidities and unfavorable cytogenetics. The recently reported AML-13 and ALFA trials suggest that less intense consolidation in this population is at least equivalent to more intense, induction style efforts. Clofarabine is a next generation nucleoside analogue that was designed to optimize the favorable attributes of fludarabine and cladribine, while minimizing toxicity. The intravenous formulation has shown considerable activity in older patients with AML who have been considered either unfit for or unlikely to benefit from conventional therapy. Additionally, clofarabine has an oral formulation that patients may find more acceptable for consolidation therapy rather than multiple courses of intravenous medications, administered over several days. This study is designed as a traditional 3x3 phase I trial with the intention of defining the maximum tolerated dose of oral clofarabine consolidation for older patients with AML in remission.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Myeloid, Acute
Keywords
Clofarabine, Clolar, AML, Consolidation

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Cohort 1
Arm Type
Experimental
Arm Description
Clofarabine 1 mg for 14 days followed by 14 days of rest. Each cycle is 28 days long.
Arm Title
Cohort 2
Arm Type
Experimental
Arm Description
Clofarabine 2 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.
Arm Title
Cohort 3
Arm Type
Experimental
Arm Description
Clofarabine 3 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.
Arm Title
Cohort 4
Arm Type
Experimental
Arm Description
Clofarabine 4 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.
Arm Title
Cohort 5
Arm Type
Experimental
Arm Description
Clofarabine 5 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.
Arm Title
Cohort 6
Arm Type
Experimental
Arm Description
Clofarabine 6 mg for 21 days followed by 7 days of rest. Each cycle is 28 days long.
Intervention Type
Drug
Intervention Name(s)
Clofarabine
Other Intervention Name(s)
Clolar
Primary Outcome Measure Information:
Title
Maximum tolerated dose (MTD) and dose limiting toxicity (DLT)
Time Frame
DLT - 1st cycle (28 days), MTD - completion of 1st cycle by all patients in all cohorts
Secondary Outcome Measure Information:
Title
Adverse events by grade and attribution
Time Frame
Start of treatment through 30 days post-last dose
Title
Disease-free survival
Time Frame
Every 6 months for 3 years
Title
Overall survival
Time Frame
Every 6 months for 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of Acute Myeloid Leukemia according to WHO criteria Age ≥ 60 years at enrollment Patients must be in complete remission by bone marrow examination, within 30 days of enrollment, following treatment with a cytotoxic induction chemotherapy regimen (such as 7+3) Complete remission must be confirmed by bone marrow biopsy If one cycle of consolidation was administered, then patient may be within 60 days of the confirmation of complete remission by bone marrow biopsy Minimum platelet count of 100,000 Patients may have received "low-intensity" therapy (i.e. decitabine, lenalidomide, etc) prior to traditional induction chemotherapy. Patients may have received 1 cycle of cytarabine-based consolidation therapy. Patients must have an ECOG performance status of 0-2 at the beginning of consolidation therapy. Have adequate renal and hepatic functions as indicated by the following laboratory values: Serum creatinine ≤ 1.0 mg/dL; if serum creatinine >1.0 mg/dL, then the estimated glomerular filtration rate (GFR) must be >60 mL/min/1.73 m2 as calculated by the Modification of Diet in Renal Disease equation where Predicted GFR (ml/min/1.73 m2) = 186 x (Serum Creatinine)-1.154 x (age in years)-0.023 x (0.742 if patient is female) x (1.212 if patient is black) Serum total bilirubin ≤ 1.5 mg/dL × upper limit of normal (ULN) except for unconjugated hyperbilirubinemia secondary Gilbert's syndrome Aspartate transaminase (AST)/alanine transaminase (ALT) ≤ 2.5 × ULN Alkaline phosphatase ≤ 2.5 × ULN Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide signed valid written informed consent or when appropriate, have an appointed legally authorized representative who is capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide signed valid written informed consent for the benefit of the patient. Male and female patients who are of child bearing potential must use an effective contraceptive method during the study and for a minimum of 6 months after study treatment. Patients MAY have received prior therapy with purine analogs (such as fludarabine and cladribine). Exclusion Criteria: Current concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol. The diagnosis of AML-M3 (acute promyelocytic leukemia) characterized by translocations involving the retinoic acid receptor-alpha (RAR-alpha) gene. Use of investigational agents within 2 weeks or any anticancer therapy within 2 weeks before study entry. The patient must have recovered from all acute toxicities from any previous therapy. Have any other severe concurrent disease, or have a history of serious organ dysfunction or disease involving the heart, kidney, liver, or other organ system that may place the patient at undue risk to undergo treatment. Patients with a systemic fungal, bacterial, viral, or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment). Have currently active gastrointestinal disease, or prior surgery that may affect the ability of the patient to absorb oral clofarabine.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Camille N. Abboud, M.D.
Organizational Affiliation
Washington Univerisity
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
24415560
Citation
Jacoby MA, Martin MG, Uy GL, Westervelt P, Dipersio JF, Cashen A, Stockerl-Goldstein K, Vij R, Luo J, Reineck T, Bernabe N, Abboud CN. Phase I study of oral clofarabine consolidation in adults aged 60 and older with acute myeloid leukemia. Am J Hematol. 2014 May;89(5):487-92. doi: 10.1002/ajh.23663. Epub 2014 Mar 3.
Results Reference
derived
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Oral Clofarabine for Acute Myeloid Leukemia

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