Phase III Study of CPX-351 Versus 7+3 in Patients 60-75 Years Old With Untreated High Risk (Secondary) Acute Myeloid Leukemia (301)
High Risk Acute Myeloid Leukemia
About this trial
This is an interventional treatment trial for High Risk Acute Myeloid Leukemia focused on measuring AML, Acute Myeloid Leukemia, high risk AML, secondary AML, AML in elderly
Eligibility Criteria
Inclusion Criteria:
- Ability to understand and voluntarily give informed consent
- Age 60-75 years at the time of diagnosis of AML
- Pathological diagnosis of AML according to WHO criteria (with at least 20% blasts in the peripheral blood or bone marrow)
Confirmation of:
- Therapy related AML: t-AML must have a documented history of prior cytotoxic therapy or ionizing radiotherapy for an unrelated disease
- AML with a history of myelodysplasia: MDSAML must have bone marrow documentation of prior MDS
- AML with a history of CMMoL: CMMoLAML must have bone marrow documentation of prior CMMoL
- De novo AML with karyotypic abnormalities characteristic of MDS: de novoAML must have cytogenetics with abnormalities per WHO.
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Able to adhere to the study visit schedule and other protocol requirements
Laboratory values fulfilling the following:
- Serum creatinine < 2.0 mg/dL
- Serum total bilirubin < 2.0 mg/dL, patients with Gilbert's Syndrome should contact the medical monitor
- Serum alanine aminotransferase or aspartate aminotransferase < 3 times the ULN Note: If elevated liver enzymes, above the ULN, are related to disease; contact medical monitor to discuss.
- Cardiac ejection fraction ≥ 50% by echocardiography or MUGA
- Patients with second malignancies in remission may be eligible if there is clinical evidence of disease stability for a period of greater than 6 months off cytotoxic chemotherapy, documented by imaging, tumor marker studies, etc., at screening. Patients maintained on long-term non-chemotherapy treatment, e.g., hormonal therapy, are eligible.
Exclusion Criteria:
- Except for CMMoL, patients with history of myeloproliferative neoplasms (MPN) (defined as a history of essential thrombocytosis or polycythemia vera, or idiopathic myelofibrosis prior to the diagnosis of AML) or combined MDS/MPN are not eligible.
- Acute promyelocytic leukemia [t(15;17)] or favorable cytogenetics, including t(8;21) or inv16 if known at the time of randomization.
- Clinical evidence of active CNS leukemia
- Patients with active (uncontrolled, metastatic) second malignancies are excluded.
- Prior treatment intended for induction therapy of AML; only hydroxyurea is permitted for control of blood counts. For example, a patient with MDS that changes HMA dose and schedule after the diagnosis of AML is excluded. AML-type therapy, such as cytarabine alone (>1g/m2/day) or cytarabine plus an anthracycline as well as prior HSCT are also excluded.
- Administration of any therapy for MDS (conventional or investigational) must be completed by 2 weeks prior to of the first dose of study drug; in the event of rapidly proliferative disease use of hydroxyurea is permitted until 24 hours before the start of study treatment. Toxicities associated with prior MDS therapy must have recovered to grade 1 or less prior to start of treatment.
- Any major surgery or radiation therapy within four weeks.
- Patients with prior cumulative anthracycline exposure of greater than 368 mg/m2 daunorubicin (or equivalent).
- Any serious medical condition, laboratory abnormality or psychiatric illness that would prevent obtaining informed consent
- Patients with myocardial impairment of any cause (e.g. cardiomyopathy, ischemic heart disease, significant valvular dysfunction, hypertensive heart disease, and congestive heart failure) resulting in heart failure by New York Heart Association Criteria (Class III or IV staging)
- Active or uncontrolled infection. Patients with an infection receiving treatment (antibiotic, antifungal or antiviral treatment) may be entered into the study but must be afebrile and hemodynamically stable for ≥72 hrs.
- Current evidence of invasive fungal infection (blood or tissue culture); patients with recent fungal infection must have a subsequent negative cultures to be eligible; known HIV (new testing not required) or evidence of active hepatitis B or C infection (with rising transaminase values)
- Hypersensitivity to cytarabine, daunorubicin or liposomal products
- History of Wilson's disease or other copper-metabolism disorder
Sites / Locations
- University of Alabama at Birmingham
- UCLA
- University of CA San Diego
- Stanford University
- Yale University
- University of Florida
- H. Lee Moffitt Cancer Center
- Northside Hospital
- Northwestern University
- Rush University Medical Center
- University of Chicago
- Franciscan St. Francis Health
- University of Kansas Medical Center
- Dana-Farber Cancer Institute
- University of Michigan
- University of Minnesota
- University of Missouri
- Washington University
- Dartmouth Hitchcock Medical Center
- Hackensack University Medical Center
- Montefiore Medical Center
- North Shore LIJ Health System
- Columbia University
- Cornell U, Weill Medical College
- New York Medical College
- University of North Carolina at Chapel Hill
- Duke University Medical Center
- Wake Forest University Health Services
- Providence Portland Medical Center
- Oregon Health and Science University
- Fox Chase Cancer Center
- UPMC
- Medical University of South Carolina
- Sarah Cannon Research Institute
- Vanderbilt University
- Baylor Research Insitute
- M.D. Anderson Cancer Center
- Fred Hutchinson Cancer Research Center
- Medical College of Wisconsin
- University of Alberta Hospital
- British Columbia Cancer Center
- Princess Margaret Hospital
- Hopital Maisonneuve-Rosemont
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Arm A (CPX-351)
Arm B (7+3)
Subjects are eligible to receive up to 2 inductions and up to 2 consolidations with CPX-351. The number of inductions and consolidations a subject received depended on response.
Subjects are eligible to receive up to 2 inductions and up to 2 consolidations with cytarabine and daunorubicin given as a 7 + 3, or 5 days of continuous infusion of cytarabine and 2 days of daunorubicin (5+2, second induction, consolidation courses) therapy. The number of inductions and consolidations a subject received depended on response.