Evaluating the Safety of Zileuton (Zyflo®) in Combination With Dasatinib (Sprycel®) in Chronic Myelogenous Leukemia
Primary Purpose
Chronic Myelogenous Leukemia
Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Zileuton (Zyflo®) Dasatinib (Sprycel®)
Dosing with Zileuton/Dasatinib in CML
Daily dosing of Zileuton/Dasatinib
Daily dosing with Zileuton/Dasatinib for CML
Sponsored by
About this trial
This is an interventional treatment trial for Chronic Myelogenous Leukemia focused on measuring Myelogenous Leukemia
Eligibility Criteria
Inclusion Criteria:
Target Population:
1. Patients with CML with known inadequate response (as appropriate for their CML status) to TKIs or known resistance will be considered for this study
- Patients who are resistant or not responding adequately to dasatinib as a first line therapy, but are not able or eligible to receive other effective second line treatment can be considered for participation in the study.
- Age > 18 years
- ECOG performance status ≤ 2
- Total bilirubin < 2.0 times the institutional Upper Limit of Normal (ULN)
- Hepatic enzymes (AST, ALT ) ≤ 1.5 times the institutional ULN
- Serum Na, K+, Mg2+, Phosphate and Ca2+>= Lower Limit of Normal (LLN)
- Serum Creatinine < 2.3 mg/dL
- PT, PTT all Grade 0-1 3) Ability to take oral medication 4) Concomitant Medications
- Patient agrees to discontinue St. Johns Wort while receiving dasatinib therapy 5) Age and Sex
- Women of childbearing potential and men of fathering potential must use an adequate method of contraception to avoid pregnancy throughout the study to minimize the risk of pregnancy
Exclusion Criteria:
Sex and Reproductive Status
- Women of childbearing potential and men of fathering potential unable or unwilling to use an adequate method of contraception to avoid pregnancy throughout the study to minimize the risk of pregnancy
Target Population
- Patients intolerant of dasatinib.
Medical History and Concurrent Diseases
- History of active malignancy during the past 5 years with the exception of nonmetastatic treated skin cancer (e.g. basal or squamous cell carcinoma ) or stage 0 cervical carcinoma
- Patients known to be HIV-positive
- Patients with active, uncontrolled infections
- Concurrent medical condition which may increase the risk of toxicity, including:
- Pleural or pericardial effusion of any grade
- Cardiac Conditions:
- Uncontrolled angina, congestive heart failure or MI within (6 months)
- Diagnosed congenital long QT syndrome
- Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de pointes)
- Prolonged QTc interval on pre-entry electrocardiogram (> 450 msec)
- Severe cardiac dysfunction (NYHA classification III-IV)
- Severe pulmonary disease
- History of significant bleeding disorder unrelated to cancer
Physical and Laboratory Test Findings
- Hepatic dysfunction (serum bilirubin ≥ 2 x ULN, and/or ALT ≥ 3 x ULN, and/or AST ≥ 3 x ULN)
- Renal dysfunction (creatinine ≥ 200 μmol/l or 2.3 mg/dl)
- Subjects with hypokalemia or hypomagnesemia that cannot be corrected prior to dasatinib administration
Allergies and Adverse Drug Reactions
- Patients with known allergic reaction or intolerance to either dasatinib or zileuton
Prohibited Treatments and/or Therapies
- Category I drugs that are generally accepted to have a risk of causing Torsades de Pointes including:
- quinidine, procainamide, disopyramide
- amiodarone, sotalol, ibutilide, dofetilide
- erythromycin, clarithromycin
- chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide
- cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone, halofantrine, levomethadyl, pentamidine, sparfloxacin, lidoflazine.
- Patients requiring anticoagulation with Coumadin
Other Exclusion Criteria
- Prisoners or subjects who are involuntarily incarcerated.
- Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g. infectious disease) illness.
Sites / Locations
- University of Massachusetts Medical School
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Zileuton/Dasatinib
Arm Description
zileuton/dasatinib: This is a traditional phase I design. Three dose levels of daily zileuton will be studied in conjunction with dasatinib to define the MTD
Outcomes
Primary Outcome Measures
To determine the maximal tolerated dose (MTD) of zileuton when added to dasatinib in patients with CML
Secondary Outcome Measures
To assess the efficacy of zileuton combined with dasatinib in terms of:
5-lipoxygenase (5-LO) blockade in patients
The rate of hematological response (where applicable)
The rate of complete cytogenetic response (where applicable)
The rate of major molecular response (where applicable)
Assessment of residual CML stem cells
Full Information
NCT ID
NCT02047149
First Posted
January 24, 2014
Last Updated
September 29, 2016
Sponsor
University of Massachusetts, Worcester
Collaborators
Bristol-Myers Squibb
1. Study Identification
Unique Protocol Identification Number
NCT02047149
Brief Title
Evaluating the Safety of Zileuton (Zyflo®) in Combination With Dasatinib (Sprycel®) in Chronic Myelogenous Leukemia
Official Title
Phase I Study to Evaluate the Safety of Zileuton (Zyflo®) in Combination With Dasatinib (Sprycel®) in Patients With Chronic Myelogenous Leukemia
Study Type
Interventional
2. Study Status
Record Verification Date
September 2016
Overall Recruitment Status
Terminated
Why Stopped
Low accrual
Study Start Date
January 2014 (undefined)
Primary Completion Date
June 2016 (Actual)
Study Completion Date
June 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Massachusetts, Worcester
Collaborators
Bristol-Myers Squibb
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Prospective nonrandomized phase I study
The purpose of this study is to determine safety and efficacy of zileuton when added to dasatinib in patients with chronic myelogenous leukemia (CML).
Detailed Description
The standard treatment for chronic myelogenous leukemia is therapy with tyrosine kinase inhibitors (TKIs). This treatment can diminish the amount of disease to very low levels that only very sensitive and specialized techniques can measure; it does not, however, provide a cure.
Dr. Shaoguang Li and colleagues at University of Massachusetts have published a unique discovery that the arachidonate 5-lipoxygenase (5-LO) gene (Alox5) is a critical regulator for LSCs in BCR-ABL-induced CML (Chen Y et al. Loss of the Alox5 gene impairs leukemia stem cells and prevents chronic myeloid leukemia. Nature Genetics 41:783-792, 2009). In the absence of Alox5, BCR-ABL failed to induce CML in preclinical studies. While deficiency in Alox5 had no effect on normal hematopoiesis, impairment of the LSCs function through differentiation and cell division of CML LSCs was observed. This defect led to a depletion of LSCs and a failure of CML development. Treatment with a 5-LO inhibitor (zileuton) also impaired the function of LSCs and prolonged survival. These results demonstrate that a specific target gene can be found in cancer stem cells and its inhibition can completely inhibit the function of these stem cells. These findings provide an exciting opportunity to develop the first anti-cancer stem cell therapy for treating CML.
Patients who did not respond or did not tolerate two TKIs will be considered for this study.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Myelogenous Leukemia
Keywords
Myelogenous Leukemia
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
2 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Zileuton/Dasatinib
Arm Type
Experimental
Arm Description
zileuton/dasatinib: This is a traditional phase I design. Three dose levels of daily zileuton will be studied in conjunction with dasatinib to define the MTD
Intervention Type
Drug
Intervention Name(s)
Zileuton (Zyflo®) Dasatinib (Sprycel®)
Intervention Description
To determine the maximum dose of zileuton/dasatinib in subjects with CML
Intervention Type
Drug
Intervention Name(s)
Dosing with Zileuton/Dasatinib in CML
Other Intervention Name(s)
Zyflo® + Sprycel®
Intervention Description
Three dose levels of daily zileuton will be studied in conjunction with dasatinib to define the MTD
Intervention Type
Drug
Intervention Name(s)
Daily dosing of Zileuton/Dasatinib
Other Intervention Name(s)
Zyflo® + Sprycel®
Intervention Description
Three dose levels of daily zileuton will be studied in conjunction with dasatinib to define the MTD
Intervention Type
Drug
Intervention Name(s)
Daily dosing with Zileuton/Dasatinib for CML
Other Intervention Name(s)
Zyflo®, Sprycel®
Intervention Description
Three dose levels of daily zileuton will be studied in conjunction with dasatinib to define the MTD
Primary Outcome Measure Information:
Title
To determine the maximal tolerated dose (MTD) of zileuton when added to dasatinib in patients with CML
Time Frame
36 mos
Secondary Outcome Measure Information:
Title
To assess the efficacy of zileuton combined with dasatinib in terms of:
Description
5-lipoxygenase (5-LO) blockade in patients
The rate of hematological response (where applicable)
The rate of complete cytogenetic response (where applicable)
The rate of major molecular response (where applicable)
Assessment of residual CML stem cells
Time Frame
36 mos
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Target Population:
1. Patients with CML with known inadequate response (as appropriate for their CML status) to TKIs or known resistance will be considered for this study
Patients who are resistant or not responding adequately to dasatinib as a first line therapy, but are not able or eligible to receive other effective second line treatment can be considered for participation in the study.
Age > 18 years
ECOG performance status ≤ 2
Total bilirubin < 2.0 times the institutional Upper Limit of Normal (ULN)
Hepatic enzymes (AST, ALT ) ≤ 1.5 times the institutional ULN
Serum Na, K+, Mg2+, Phosphate and Ca2+>= Lower Limit of Normal (LLN)
Serum Creatinine < 2.3 mg/dL
PT, PTT all Grade 0-1 3) Ability to take oral medication 4) Concomitant Medications
Patient agrees to discontinue St. Johns Wort while receiving dasatinib therapy 5) Age and Sex
Women of childbearing potential and men of fathering potential must use an adequate method of contraception to avoid pregnancy throughout the study to minimize the risk of pregnancy
Exclusion Criteria:
Sex and Reproductive Status
Women of childbearing potential and men of fathering potential unable or unwilling to use an adequate method of contraception to avoid pregnancy throughout the study to minimize the risk of pregnancy
Target Population
Patients intolerant of dasatinib.
Medical History and Concurrent Diseases
History of active malignancy during the past 5 years with the exception of nonmetastatic treated skin cancer (e.g. basal or squamous cell carcinoma ) or stage 0 cervical carcinoma
Patients known to be HIV-positive
Patients with active, uncontrolled infections
Concurrent medical condition which may increase the risk of toxicity, including:
Pleural or pericardial effusion of any grade
Cardiac Conditions:
Uncontrolled angina, congestive heart failure or MI within (6 months)
Diagnosed congenital long QT syndrome
Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de pointes)
Prolonged QTc interval on pre-entry electrocardiogram (> 450 msec)
Severe cardiac dysfunction (NYHA classification III-IV)
Severe pulmonary disease
History of significant bleeding disorder unrelated to cancer
Physical and Laboratory Test Findings
Hepatic dysfunction (serum bilirubin ≥ 2 x ULN, and/or ALT ≥ 3 x ULN, and/or AST ≥ 3 x ULN)
Renal dysfunction (creatinine ≥ 200 μmol/l or 2.3 mg/dl)
Subjects with hypokalemia or hypomagnesemia that cannot be corrected prior to dasatinib administration
Allergies and Adverse Drug Reactions
Patients with known allergic reaction or intolerance to either dasatinib or zileuton
Prohibited Treatments and/or Therapies
Category I drugs that are generally accepted to have a risk of causing Torsades de Pointes including:
quinidine, procainamide, disopyramide
amiodarone, sotalol, ibutilide, dofetilide
erythromycin, clarithromycin
chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide
cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone, halofantrine, levomethadyl, pentamidine, sparfloxacin, lidoflazine.
Patients requiring anticoagulation with Coumadin
Other Exclusion Criteria
Prisoners or subjects who are involuntarily incarcerated.
Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g. infectious disease) illness.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jan Cerny, MD, PhD
Organizational Affiliation
University of Massachusetts, Worcester
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Massachusetts Medical School
City
Worcester
State/Province
Massachusetts
ZIP/Postal Code
01655
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
19503090
Citation
Chen Y, Hu Y, Zhang H, Peng C, Li S. Loss of the Alox5 gene impairs leukemia stem cells and prevents chronic myeloid leukemia. Nat Genet. 2009 Jul;41(7):783-92. doi: 10.1038/ng.389. Epub 2009 Jun 7.
Results Reference
background
PubMed Identifier
18541900
Citation
Shah NP, Kantarjian HM, Kim DW, Rea D, Dorlhiac-Llacer PE, Milone JH, Vela-Ojeda J, Silver RT, Khoury HJ, Charbonnier A, Khoroshko N, Paquette RL, Deininger M, Collins RH, Otero I, Hughes T, Bleickardt E, Strauss L, Francis S, Hochhaus A. Intermittent target inhibition with dasatinib 100 mg once daily preserves efficacy and improves tolerability in imatinib-resistant and -intolerant chronic-phase chronic myeloid leukemia. J Clin Oncol. 2008 Jul 1;26(19):3204-12. doi: 10.1200/JCO.2007.14.9260. Epub 2008 Jun 9.
Results Reference
background
PubMed Identifier
2406902
Citation
Daley GQ, Van Etten RA, Baltimore D. Induction of chronic myelogenous leukemia in mice by the P210bcr/abl gene of the Philadelphia chromosome. Science. 1990 Feb 16;247(4944):824-30. doi: 10.1126/science.2406902.
Results Reference
background
Links:
URL
http://www.ncbi.nlm.nih.gov/pubmed/19823023
Description
The Alox5 gene is a novel therapeutic target in cancer stem cells of chronic myeloid leukemia
URL
http://www.eurekaselect.com/71277/article
Description
Novel Therapeutic Agents Against Cancer Stem Cells of Chronic Myeloid Leukemia
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Evaluating the Safety of Zileuton (Zyflo®) in Combination With Dasatinib (Sprycel®) in Chronic Myelogenous Leukemia
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