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CPX-351 (Vyxeos™) for Transplant Eligible, Higher Risk Patients With Myelodysplastic Syndrome

Primary Purpose

Myelodysplastic Syndromes

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CPX-351
Research skin biopsy
Research blood draw
Research bone marrow aspirate
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelodysplastic Syndromes

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of myelodysplastic syndrome (MDS) with an IPSS-R score of Intermediate, High or Very High (see Appendix A) AND ≥ 5% myeloblasts in the bone marrow.
  • Age 18-70 years.
  • ECOG performance status ≤ 2 (see Appendix B)

Adequate renal and hepatic function as defined below:

*Total bilirubin ≤ 2.0 x IULN*

  • AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN
  • Serum creatinine ≤ 2.0 mg/dL
  • Note: If, in the opinition of the treatment physician, the bilirubin is elevated secondary to hemolysis or Gilbert's disease, the patient may be eligible after discussion with the Washington University PI.

    • Left ventricular cardiac ejection fraction ≥ 50% by echocardiography or MUGA.
    • Deemed by the treating physician to be a suitable candidate for cytotoxic induction therapy and an alloHCT candidate at the time of enrollment.
    • Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and continuing until 30 days after the last study treatment.
    • Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable).

Exclusion Criteria:

  • Prior treatment for MDS with disease-modifying therapy (conventional or investigational) (i.e. hypomethylator therapy, lenalidomide, or prior AML-like induction therapy intended for the therapy of MDS). Use of prior growth factor and ESA support is permitted.
  • Currently receiving any other investigational agents.
  • A history of allergic reactions attributed to compounds of similar chemical or biologic composition to CPX-351 or other agents used in the study.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.
  • History of Wilson's disease or other copper-metabolism disorder.
  • Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry.
  • Known active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients who are seropositive because of hepatitis B virus vaccine are eligible. Patients who are seropositive for HCV but have a negative viral load are also eligible provided that the patient has completed a course of therapy for HCV.

Sites / Locations

  • Moffitt Cancer Center
  • Washington University School of Medicine
  • Fred Hutchinson Cancer Research Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

CPX-351

Arm Description

CPX-351 will be given according to the assigned dose level over a minimum of a 90-minutes via IV infusion on Days 1, 3, and 5 of the first induction If the treating physician elects to perform a day 14 bone marrow biopsy then, a second induction may be considered for patients in the absence of a chemoablated, hypocellular marrow on the Day 14 bone marrow assessment, if the patient has failed to achieve a marrow CR, and it is deemed safe to administer by the treating physician. The second induction uses a modified schedule in which CPX-351 will be given according to the assigned dose level on Days 1 and 3 In the absence of disease progression or unacceptable toxicity, the patient may continue to consolidation at the discretion of the treating physician or the patient may proceed to alloHCT after induction at the discretion of the treating physician

Outcomes

Primary Outcome Measures

Safety and tolerability of a CPX-351 regimen in a transplant eligible, higher risk MDS population as measured by the proportion of participants who experience an adverse event by patient, type of event, and grade of event

Secondary Outcome Measures

Overall response rate in MDS patients treated with CPX-351
Overall response rate = complete remission + marrow complete remission + partial response + hematologic improvement Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Best overall response in MDS patients treated with CPX-351
-Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Remission duration in MDS patients treated with CPX-351
Defined as the interval from the date complete remission is documented to the date of recurrence. This is determined only for patients achieving a complete remission. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Relapse-free survival in MDS patients treated with CPX-351
-Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Progression-free survival in MDS patients treated with CPX-351
Defined as the interval from the date of first dose of study drug to disease progression or death from MDS. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Overall survival in MDS patients treated with CPX-351
-Defined as the date of first dose of study drug to the date of death from any cause.
Complete remission + marrow complete remission rates in patients treated with CPX-351
-Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Post-induction mortality in MDS patients treated with CPX-351
-Rate of death
Post-induction mortality in MDS patients treated with CPX-351
-Rate of death
Safety and feasibility of CPX-351 consolidation therapy in MDS patients as measured by the proportion of patients who experience an adverse event by patient, type of event, and grade of event
Proportion of MDS patients treated with CPX-351 proceeding to allogeneic hematopoietic cell transplant
Overall survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
-Defined as the date of first dose of study drug to the date of death from any cause.
Overall survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
-Defined as the date of first dose of study drug to the date of death from any cause.
Non-relapse mortality in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Non-relapse mortality in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Event-free survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Defined as the interval from the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Event-free survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Defined as the interval from the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS

Full Information

First Posted
June 18, 2018
Last Updated
April 4, 2023
Sponsor
Washington University School of Medicine
Collaborators
Jazz Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT03572764
Brief Title
CPX-351 (Vyxeos™) for Transplant Eligible, Higher Risk Patients With Myelodysplastic Syndrome
Official Title
A Pilot Study of CPX-351 (Vyxeos™) for Transplant Eligible, Higher Risk Patients With Myelodysplastic Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
December 14, 2018 (Actual)
Primary Completion Date
November 27, 2021 (Actual)
Study Completion Date
March 25, 2027 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a pilot and feasibility study of transplant eligible, higher risk myelodysplastic syndrome (MDS) patients to determine the safety and tolerability of a lower -dose and higher-dose CPX-351 regimen, with secondary objectives including complete remission (CR) rates and proportion of patients proceeding to transplant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelodysplastic Syndromes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CPX-351
Arm Type
Experimental
Arm Description
CPX-351 will be given according to the assigned dose level over a minimum of a 90-minutes via IV infusion on Days 1, 3, and 5 of the first induction If the treating physician elects to perform a day 14 bone marrow biopsy then, a second induction may be considered for patients in the absence of a chemoablated, hypocellular marrow on the Day 14 bone marrow assessment, if the patient has failed to achieve a marrow CR, and it is deemed safe to administer by the treating physician. The second induction uses a modified schedule in which CPX-351 will be given according to the assigned dose level on Days 1 and 3 In the absence of disease progression or unacceptable toxicity, the patient may continue to consolidation at the discretion of the treating physician or the patient may proceed to alloHCT after induction at the discretion of the treating physician
Intervention Type
Drug
Intervention Name(s)
CPX-351
Other Intervention Name(s)
Vyxeos™, Daunorubicin and cytarabine
Intervention Description
-CPX-351 will be provided by Jazz Pharmaceuticals
Intervention Type
Procedure
Intervention Name(s)
Research skin biopsy
Intervention Description
-And/or buccal swab Pre-treatment Post-induction (no earlier than Day 28 and no later than Day 56 from last induction)
Intervention Type
Procedure
Intervention Name(s)
Research blood draw
Intervention Description
Pre-treatment Post-induction (no earlier than Day 28 and no later than Day 56 from last induction) Post-consolidation 1 (if applicable) Post-consolidation 2 (if applicable) Post-transplant Day 30 (if applicable) Post-transplant Day 100 (if applicable)
Intervention Type
Procedure
Intervention Name(s)
Research bone marrow aspirate
Intervention Description
Pre-treatment Post-induction (no earlier than Day 28 and no later than Day 56 from last induction) Post-consolidation 1 (if applicable) Post-consolidation 2 (if applicable) Post-transplant Day 30 (if applicable) Post-transplant Day 100 (if applicable)
Primary Outcome Measure Information:
Title
Safety and tolerability of a CPX-351 regimen in a transplant eligible, higher risk MDS population as measured by the proportion of participants who experience an adverse event by patient, type of event, and grade of event
Time Frame
Through 56 days after the last dose
Secondary Outcome Measure Information:
Title
Overall response rate in MDS patients treated with CPX-351
Description
Overall response rate = complete remission + marrow complete remission + partial response + hematologic improvement Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
56 days after the last dose
Title
Best overall response in MDS patients treated with CPX-351
Description
-Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
56 days after the last dose
Title
Remission duration in MDS patients treated with CPX-351
Description
Defined as the interval from the date complete remission is documented to the date of recurrence. This is determined only for patients achieving a complete remission. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
Through 5 years
Title
Relapse-free survival in MDS patients treated with CPX-351
Description
-Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
Through 5 years
Title
Progression-free survival in MDS patients treated with CPX-351
Description
Defined as the interval from the date of first dose of study drug to disease progression or death from MDS. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
Through 5 years
Title
Overall survival in MDS patients treated with CPX-351
Description
-Defined as the date of first dose of study drug to the date of death from any cause.
Time Frame
Through 5 years
Title
Complete remission + marrow complete remission rates in patients treated with CPX-351
Description
-Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
56 days after the last dose
Title
Post-induction mortality in MDS patients treated with CPX-351
Description
-Rate of death
Time Frame
Day 30
Title
Post-induction mortality in MDS patients treated with CPX-351
Description
-Rate of death
Time Frame
Day 60
Title
Safety and feasibility of CPX-351 consolidation therapy in MDS patients as measured by the proportion of patients who experience an adverse event by patient, type of event, and grade of event
Time Frame
Through 56 days after the last dose
Title
Proportion of MDS patients treated with CPX-351 proceeding to allogeneic hematopoietic cell transplant
Time Frame
Through 56 days after the last dose
Title
Overall survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Description
-Defined as the date of first dose of study drug to the date of death from any cause.
Time Frame
Day 100
Title
Overall survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Description
-Defined as the date of first dose of study drug to the date of death from any cause.
Time Frame
1 year
Title
Non-relapse mortality in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Time Frame
Day 100
Title
Non-relapse mortality in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Time Frame
1 year
Title
Event-free survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Description
Defined as the interval from the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
Day 100
Title
Event-free survival in MDS patients treated with CPX-351 in patients undergoing allogeneic hematopoietic cell transplant
Description
Defined as the interval from the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause. Patients will be assessed for response according to modified International Working Group (IWG) criteria for MDS
Time Frame
1 year

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: Diagnosis of myelodysplastic syndrome (MDS) with an IPSS-R score of Intermediate, High or Very High (see Appendix A) AND ≥ 5% myeloblasts in the bone marrow. Age 18-70 years. ECOG performance status ≤ 2 (see Appendix B) Adequate renal and hepatic function as defined below: *Total bilirubin ≤ 2.0 x IULN* AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN Serum creatinine ≤ 2.0 mg/dL Note: If, in the opinition of the treatment physician, the bilirubin is elevated secondary to hemolysis or Gilbert's disease, the patient may be eligible after discussion with the Washington University PI. Left ventricular cardiac ejection fraction ≥ 50% by echocardiography or MUGA. Deemed by the treating physician to be a suitable candidate for cytotoxic induction therapy and an alloHCT candidate at the time of enrollment. Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and continuing until 30 days after the last study treatment. Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable). Exclusion Criteria: Prior treatment for MDS with disease-modifying therapy (conventional or investigational) (i.e. hypomethylator therapy, lenalidomide, or prior AML-like induction therapy intended for the therapy of MDS). Use of prior growth factor and ESA support is permitted. Currently receiving any other investigational agents. A history of allergic reactions attributed to compounds of similar chemical or biologic composition to CPX-351 or other agents used in the study. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia. History of Wilson's disease or other copper-metabolism disorder. Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry. Known active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients who are seropositive because of hepatitis B virus vaccine are eligible. Patients who are seropositive for HCV but have a negative viral load are also eligible provided that the patient has completed a course of therapy for HCV.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Meagan Jacoby, M.D., Ph.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Moffitt Cancer Center
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Fred Hutchinson Cancer Research Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Learn more about this trial

CPX-351 (Vyxeos™) for Transplant Eligible, Higher Risk Patients With Myelodysplastic Syndrome

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