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STAT Inhibitor OPB-111077, Decitabine and Venetoclax in Treating Patients With Acute Myeloid Leukemia That Is Refractory, Relapsed or Newly Diagnosed and Ineligible for Intensive Chemotherapy

Primary Purpose

Acute Myeloid Leukemia, Recurrent Acute Myeloid Leukemia, Refractory Acute Myeloid Leukemia

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
STAT Inhibitor OPB-111077
Decitabine
Venetoclax
Laboratory Biomarker Analysis
Sponsored by
Sidney Kimmel Cancer Center at Thomas Jefferson University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must have histologic evidence of high risk acute myeloid leukemia defined as one of the following:

    • Non-M3 AML refractory to standard primary induction therapy
    • Non-M3 AML relapsed after (i) any standard induction therapy (ii) any number of standard or experimental salvage therapies
    • Newly diagnosed non-M3 AML not eligible for intensive induction chemotherapy
  • Subjects must have an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less
  • Subjects must have a life expectancy of at least 4 weeks
  • Subjects must be able to consume oral medication
  • Subjects must have recovered from the toxic effects of any prior chemotherapy to= < grade 1 (except alopecia)
  • Creatinine clearance (CrCL) >= 45
  • Total bilirubin =< 2 x upper limit of normal (ULN)
  • Serum glutamate pyruvate transaminase (SGPT) alanine aminotransferase (ALT) =< 2 x ULN
  • Negative pregnancy test for women with child-bearing potential
  • Patients must be able to sign consent and be willing and able to comply with scheduled visits, treatment plan and laboratory testing

Exclusion Criteria:

  • Subjects with FAB M3 (t(15;17)(q22;q21)[PML-RARalpha]) are not eligible
  • Subjects must not be receiving any chemotherapy agents (except hydroxyurea); intrathecal methotrexate and cytarabine are permissible
  • Subjects must not be receiving growth factors, except for erythropoietin
  • Subjects with a "currently active" second malignancy, other than non-melanoma skin cancer, carcinoma in situ of the cervix, resected incidental prostate cancer (staged pT2 with Gleason score =< 6 and postoperative prostate-specific antigen [PSA] < 0.5 ng/mL), or other adequately treated carcinoma-in-situ are ineligible; patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for >= 1 year
  • Subjects with uncontrolled high blood pressure, unstable angina, symptomatic congestive heart failure (New York Heart Association [NYHA] class 3), myocardial infarction within the past 6 months or serious uncontrolled cardiac arrhythmia are not eligible
  • Subjects with other severe concurrent disease which in the judgment of the investigator would make the patient inappropriate for entry into this study are ineligible
  • Subjects must not have evidence of active leukemia in the central nervous system (CNS)
  • Subjects must not have received any investigational agents within 14 days or 5 half-lives (whichever is longer) of study entry
  • Subjects must not be pregnant or breastfeeding; pregnancy tests must be obtained for all females of child-bearing potential; pregnant or lactating patients are ineligible for this study; males or women of childbearing potential may not participate unless they have agreed to use an effective contraceptive method (defined as hormonal contraceptives, intrauterine devices, surgical contraceptives, or condoms)
  • Subjects who have uncontrolled infection are not eligible; patients must have any active infections under control; fungal disease must be stable for at least 2 weeks before study entry
  • Subjects with bacteremia must have documented negative blood cultures prior to study entry
  • Subjects who are suitable for and willing to receive standard intensive induction therapy
  • Subjects who are candidates for allogeneic transplantation, have a suitable donor, and are willing to undergo transplantation

Sites / Locations

  • Sidney Kimmel Cancer Center at Thomas Jefferson University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (STAT inhibitor OPB-111077, venetoclax, decitabine)

Arm Description

INDUCTION CYCLE 1: Patients receive STAT inhibitor OPB-111077 PO QD on days 1-28, and venetoclax PO QD on days 4-28 of cycle 1. Patients also receive decitabine IV over approximately 1 hour on days 4-8 of cycle 1. Patients who achieve complete remission (CR) after 1 cycle move on to Maintenance, and patients who do not achieve a CR move on to Cycle 2. INDUCTION CYCLE 2: Patients receive STAT inhibitor OPB-111077, venetoclax, and decitabine as in Induction Cycle 1. Patients who achieve CR, CRi, PR, or stable disease (or clinically significant hematologic improvement as determined by the investigator) move on to Maintenance. MAINTENANCE: Patients receive STAT inhibitor OPB-111077, venetoclax, and decitabine as in Induction Cycle 1. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Incidence of grade 4, non-hematologic dose limiting toxicities assessed by National Cancer Institute Common Toxicity Criteria for Adverse Events version 5.0
Data analysis will be descriptive. All estimates of dose-specific rates (e.g., response and toxicity) will be presented with corresponding confidence intervals using the exact method. The method of Atkinson and Brown will be used for any rate related to definition of dose limiting toxicity, due to two-stage sampling. The method of Conover will be used otherwise.

Secondary Outcome Measures

Metabolomics as determined by bone marrow biopsy
Data analysis will be descriptive.
Adenosine triphosphate (ATP) generation as determined by bone marrow biopsy
Data analysis will be descriptive.
Apoptotic rate in blood and bone marrow assessed by apoptosis assays
Data analysis will be descriptive.
Cellular proliferation in blood and bone marrow assessed by proliferation assays
Data analysis will be descriptive.
Complete response as determined by bone marrow biopsy
Data analysis will be descriptive
Complete response in the absence of total platelet recovery determined by bone marrow biopsy
Data analysis will be descriptive

Full Information

First Posted
February 21, 2017
Last Updated
June 1, 2023
Sponsor
Sidney Kimmel Cancer Center at Thomas Jefferson University
Collaborators
Otsuka America Pharmaceutical
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1. Study Identification

Unique Protocol Identification Number
NCT03063944
Brief Title
STAT Inhibitor OPB-111077, Decitabine and Venetoclax in Treating Patients With Acute Myeloid Leukemia That Is Refractory, Relapsed or Newly Diagnosed and Ineligible for Intensive Chemotherapy
Official Title
Phase I Trial of OPB-111077 in Combination With Decitabine and Venetoclax for the Treatment of AML Refractory to or Ineligible for Intensive Chemotherapy
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 17, 2017 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Cancer Center at Thomas Jefferson University
Collaborators
Otsuka America Pharmaceutical

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase I trial studies the side effects and best dose of STAT inhibitor OPB-111077 when given together with decitabine and venetoclax in treating patients with acute myeloid leukemia that does not respond to treatment (refractory), has come back (relapsed), or is newly diagnosed and ineligible for intensive chemotherapy. STAT inhibitor OPB-111077 and decitabine may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as venetoclax, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving STAT inhibitor OPB-111077, decitabine, and venetoclax may work better in treating patients with acute myeloid leukemia compared to decitabine alone.
Detailed Description
PRIMARY OBJECTIVE: I. To determine the safety and tolerability of STAT inhibitor OPB-111077 (OPB-111077) in combination with decitabine and venetoclax. SECONDARY OBJECTIVES: I. To describe any preliminary efficacy of OPB-111077 in combination with decitabine and venetoclax in patients with acute myeloid leukemia (AML). II. To measure adenosine triphosphate (ATP) generation and perform metabolomics in patients with AML who are receiving OPB-111077, decitabine, and venetoclax. III. To assess apoptosis and proliferation assays in patients with AML who are receiving OPB-111077, decitabine, and venetoclax. OUTLINE: This is a dose escalation study of STAT inhibitor OPB-111077. INDUCTION CYCLE 1: Patients receive STAT inhibitor OPB-111077 orally (PO) once daily (QD) on days 1-28, and venetoclax PO QD on days 4-28 of cycle 1. Patients also receive decitabine intravenously (IV) over approximately 1 hour on days 4-8 of cycle 1. Patients who achieve complete remission (CR) after 1 cycle move on to Maintenance, and patients who do not achieve a CR move on to Cycle 2. INDUCTION CYCLE 2: Patients receive STAT inhibitor OPB-111077, venetoclax, and decitabine as in Induction Cycle 1. Patients who achieve CR, complete remission with incomplete hematologic recovery (CRi), partial remission (PR), or stable disease (or clinically significant hematologic improvement as determined by the investigator) move on to Maintenance. MAINTENANCE: Patients receive STAT inhibitor OPB-111077, venetoclax, and decitabine as in Induction Cycle 1. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, Recurrent Acute Myeloid Leukemia, Refractory Acute Myeloid 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
37 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (STAT inhibitor OPB-111077, venetoclax, decitabine)
Arm Type
Experimental
Arm Description
INDUCTION CYCLE 1: Patients receive STAT inhibitor OPB-111077 PO QD on days 1-28, and venetoclax PO QD on days 4-28 of cycle 1. Patients also receive decitabine IV over approximately 1 hour on days 4-8 of cycle 1. Patients who achieve complete remission (CR) after 1 cycle move on to Maintenance, and patients who do not achieve a CR move on to Cycle 2. INDUCTION CYCLE 2: Patients receive STAT inhibitor OPB-111077, venetoclax, and decitabine as in Induction Cycle 1. Patients who achieve CR, CRi, PR, or stable disease (or clinically significant hematologic improvement as determined by the investigator) move on to Maintenance. MAINTENANCE: Patients receive STAT inhibitor OPB-111077, venetoclax, and decitabine as in Induction Cycle 1. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
STAT Inhibitor OPB-111077
Other Intervention Name(s)
OPB-111077
Intervention Description
Given PO
Intervention Type
Drug
Intervention Name(s)
Decitabine
Other Intervention Name(s)
2'-Deoxy-5-azacytidine, 4-Amino-1-(2-deoxy-beta-D-erythro-pentofuranosyl)-1,3,5-triazin-2(1H)-one, 2353-33-5, 5-Aza-2'-deoxycytidine, 5-Aza-2'deoxycytidine, 5-Aza-2-deoxycytidine, 5-Azadeoxycytidine, Dacogen, Decitabine for Injection, Deoxyazacytidine, Dezocitidine
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Venetoclax
Other Intervention Name(s)
1257044-40-8, 4-(4-((2-(4-Chlorophenyl)-4, 4-dimethylcyclohex-1-en-1-yl)methyl)piperazin-1-yl)-N-((3-nitro-4-((tetrahydro-2H-pyran-4-ylmethyl)amino)phenyl)sulfonyl)-2-(1H-pyrrolo(2,3-b)pyridin-5-yloxy)benzamide, ABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, Venclyxto
Intervention Description
Given PO
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Incidence of grade 4, non-hematologic dose limiting toxicities assessed by National Cancer Institute Common Toxicity Criteria for Adverse Events version 5.0
Description
Data analysis will be descriptive. All estimates of dose-specific rates (e.g., response and toxicity) will be presented with corresponding confidence intervals using the exact method. The method of Atkinson and Brown will be used for any rate related to definition of dose limiting toxicity, due to two-stage sampling. The method of Conover will be used otherwise.
Time Frame
Up to 2 years
Secondary Outcome Measure Information:
Title
Metabolomics as determined by bone marrow biopsy
Description
Data analysis will be descriptive.
Time Frame
At the end of Cycle 1 (each cycle is 28 days)
Title
Adenosine triphosphate (ATP) generation as determined by bone marrow biopsy
Description
Data analysis will be descriptive.
Time Frame
At the end of Cycle 1 (each cycle is 28 days)
Title
Apoptotic rate in blood and bone marrow assessed by apoptosis assays
Description
Data analysis will be descriptive.
Time Frame
At the end of Cycle 1 (each cycle is 28 days)
Title
Cellular proliferation in blood and bone marrow assessed by proliferation assays
Description
Data analysis will be descriptive.
Time Frame
At the end of Cycle 1 (each cycle is 28 days)
Title
Complete response as determined by bone marrow biopsy
Description
Data analysis will be descriptive
Time Frame
At the end of Cycle 1 (each cycle is 28 days)
Title
Complete response in the absence of total platelet recovery determined by bone marrow biopsy
Description
Data analysis will be descriptive
Time Frame
At the end of Cycle 1 (each cycle is 28 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have histologic evidence of high risk acute myeloid leukemia defined as one of the following: Non-M3 AML refractory to standard primary induction therapy Non-M3 AML relapsed after (i) any standard induction therapy (ii) any number of standard or experimental salvage therapies Newly diagnosed non-M3 AML not eligible for intensive induction chemotherapy Subjects must have an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less Subjects must have a life expectancy of at least 4 weeks Subjects must be able to consume oral medication Subjects must have recovered from the toxic effects of any prior chemotherapy to= < grade 1 (except alopecia) Creatinine clearance (CrCL) >= 45 Total bilirubin =< 2 x upper limit of normal (ULN) Serum glutamate pyruvate transaminase (SGPT) alanine aminotransferase (ALT) =< 2 x ULN Negative pregnancy test for women with child-bearing potential Patients must be able to sign consent and be willing and able to comply with scheduled visits, treatment plan and laboratory testing Exclusion Criteria: Subjects with FAB M3 (t(15;17)(q22;q21)[PML-RARalpha]) are not eligible Subjects must not be receiving any chemotherapy agents (except hydroxyurea); intrathecal methotrexate and cytarabine are permissible Subjects must not be receiving growth factors, except for erythropoietin Subjects with a "currently active" second malignancy, other than non-melanoma skin cancer, carcinoma in situ of the cervix, resected incidental prostate cancer (staged pT2 with Gleason score =< 6 and postoperative prostate-specific antigen [PSA] < 0.5 ng/mL), or other adequately treated carcinoma-in-situ are ineligible; patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for >= 1 year Subjects with uncontrolled high blood pressure, unstable angina, symptomatic congestive heart failure (New York Heart Association [NYHA] class 3), myocardial infarction within the past 6 months or serious uncontrolled cardiac arrhythmia are not eligible Subjects with other severe concurrent disease which in the judgment of the investigator would make the patient inappropriate for entry into this study are ineligible Subjects must not have evidence of active leukemia in the central nervous system (CNS) Subjects must not have received any investigational agents within 14 days or 5 half-lives (whichever is longer) of study entry Subjects must not be pregnant or breastfeeding; pregnancy tests must be obtained for all females of child-bearing potential; pregnant or lactating patients are ineligible for this study; males or women of childbearing potential may not participate unless they have agreed to use an effective contraceptive method (defined as hormonal contraceptives, intrauterine devices, surgical contraceptives, or condoms) Subjects who have uncontrolled infection are not eligible; patients must have any active infections under control; fungal disease must be stable for at least 2 weeks before study entry Subjects with bacteremia must have documented negative blood cultures prior to study entry Subjects who are suitable for and willing to receive standard intensive induction therapy Subjects who are candidates for allogeneic transplantation, have a suitable donor, and are willing to undergo transplantation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Margaret Kasner, MD
Organizational Affiliation
Sidney Kimmel Cancer Center at Thomas Jefferson University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sidney Kimmel Cancer Center at Thomas Jefferson University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19171
Country
United States

12. IPD Sharing Statement

Links:
URL
http://hospitals.jefferson.edu/
Description
Thomas Jefferson University Hospital

Learn more about this trial

STAT Inhibitor OPB-111077, Decitabine and Venetoclax in Treating Patients With Acute Myeloid Leukemia That Is Refractory, Relapsed or Newly Diagnosed and Ineligible for Intensive Chemotherapy

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