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Dose Escalation Study of Minnelide in Relapsed or Refractory Acute Myeloid Leukemia

Primary Purpose

Acute Myeloid Leukemia

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Minnelide
Sponsored by
H. Lee Moffitt Cancer Center and Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring leukemia, myeloid leukemia

Eligibility Criteria

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

Inclusion Criteria:

  • Adults ages 18 years or older.
  • Participant must have relapsed or refractory acute myeloid leukemia (AML) (excluding acute promyelocytic leukemia).
  • Relapsed patients must have received at least 1 induction chemotherapy regimen or two cycles of a hypomethylating agent and achieved a Complete Response (CR), followed by relapse of disease.
  • Refractory patients must have received at least 1 induction chemotherapy regimen or two cycles of hypomethylating agent without achieving a CR.
  • Eastern Cooperative Oncology Group (ECOG) performance status <2.
  • Participants must have acceptable organ function.
  • Be able and willing to adhere to the study visit schedule and other protocol requirements.
  • Must be able to swallow capsules and have no evidence of GI tract abnormality that would alter the absorption of oral medications.
  • The effects of Minnelide on the developing human fetus are unknown. For this reason, women of child-bearing potential must have a negative serum or urine pregnancy test within 24 hours prior to beginning study treatment.
  • Participants of childbearing potential must practice contraception. Females of childbearing potential: Recommendation is for 2 effective contraceptive methods during the study. Male participants with female partners who are of childbearing potential: Recommendation is for male and partner to use at least 2 effective contraceptive methods, as described above, during the study. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with Minnelide, breastfeeding mothers must agree to discontinue nursing if the mother is treated with Minnelide.
  • Provision of signed and dated informed consent document
  • Patients with prior allogeneic stem cell transplant who experience relapse of AML are eligible if they are off of immunosuppressive therapy and without any evidence of graft-versus-host disease (GVHD)

Exclusion Criteria:

  • Participants may not have received any therapy with any investigational products, systemic anti-neoplastic therapy, or radiotherapy within 14 days prior to Cycle 1 Day 1. Patients actively receiving hydroxyurea are eligible and may continue to receive hydroxyurea during protocol treatment.
  • Candidates for standard and/or potentially curative treatments.
  • Major surgery within 28 days prior to Cycle 1 Day 1.
  • New York Heart Association Class III or IV heart failure, myocardial infarction within the past 6 months, unstable arrhythmia, or evidence of ischemia on an electrocardiogram (EKG)
  • Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy
  • Known, active HIV, Hepatitis A, B or C infection (prior Hepatitis C infection that has been treated and determined to be cured is allowed)
  • Symptomatic central nervous system (CNS) involvement with leukemia
  • A concurrent second active and non-stable malignancy with the exception of non-melanoma skin cancer or carcinoma in-situ.

Sites / Locations

  • H. Lee Moffitt Cancer Center and Research Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Minnelide Dose Escalation

Arm Description

A 3+3 design will be used. The first 3 patients will be treated at dose level 1. If none experience a Dose Limiting Toxicity (DLT), the next 3 patients will be treated at dose level 2. If a DLT is observed in 1 out of 3 patients at dose level 1, up to an 3 more patients will be enrolled and treated at that dose level. If 2 patients at dose level have DLTs, dosing will be lowered to dose level -1 (.5 mg daily, taken orally). If 2 or more of the up to 6 patients at any dose level have DLTs, the preceding dose will be declared the Maximum Tolerated Dose (MTD). If more than 1 DLT occurs at Dose Level -1, the investigators will consider stopping the study. Once the MTD has been established, an additional 10 patients will be enrolled at this level to better characterize safety and tolerability.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose (MTD) of Minnelide
MTD will be determined by testing increasing doses up to 1.25 mg daily. MTD reflects highest dose of drug that did not cause a Dose Limiting Toxicity (DLT).
Number of Participants Who Experience Dose Limiting Toxicities (DLTs)
A DLT is any Grade 3 or 4 drug-related non-hematologic toxicity, with some exceptions per protocol.

Secondary Outcome Measures

Complete Response (CR)
Participants who experience Complete Response (CR) and Complete Response with Incomplete Blood Count Recovery (CRi) rate as defined by 2003 International Working Group (IWG) for AML.
Overall Response Rate (ORR)
Overall Response Rate is defined as CR + CRi + partial response (PR) as defined by 2003 IWG criteria for AML.
Relapse Free Survival (RFS)
RFS is defined as time interval between achievement of CR to time of relapse.
Overall Survival (OS)
OS defined as time interval from time of enrollment onto the clinical trial to death from any cause.

Full Information

First Posted
November 27, 2018
Last Updated
October 18, 2023
Sponsor
H. Lee Moffitt Cancer Center and Research Institute
Collaborators
Minneamrita Therapeutics LLC
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1. Study Identification

Unique Protocol Identification Number
NCT03760523
Brief Title
Dose Escalation Study of Minnelide in Relapsed or Refractory Acute Myeloid Leukemia
Official Title
Phase 1/1b Dose Escalation Study of Minnelide in Relapsed or Refractory Acute Myeloid Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Terminated
Why Stopped
Toxicity -Two DLT events occurred
Study Start Date
April 18, 2019 (Actual)
Primary Completion Date
October 9, 2023 (Actual)
Study Completion Date
October 9, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
H. Lee Moffitt Cancer Center and Research Institute
Collaborators
Minneamrita Therapeutics LLC

4. Oversight

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

5. Study Description

Brief Summary
This study is to determine the safety and recommended dosing of Minnelide in Acute Myeloid Leukemia (AML)
Detailed Description
This phase 1 dose escalation clinical trial will establish the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of Minnelide as single-agent in relapsed/refractory (R/R) acute myeloid leukemia (AML) patients who are ineligible to receive intensive chemotherapy. The oral formulation of Minnelide will be used. Minnelide is a prodrug of triptolide (a potent heat shock protein (HSP) 70 inhibitor) with promising preclinical activity in AML.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia
Keywords
leukemia, 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
27 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Minnelide Dose Escalation
Arm Type
Experimental
Arm Description
A 3+3 design will be used. The first 3 patients will be treated at dose level 1. If none experience a Dose Limiting Toxicity (DLT), the next 3 patients will be treated at dose level 2. If a DLT is observed in 1 out of 3 patients at dose level 1, up to an 3 more patients will be enrolled and treated at that dose level. If 2 patients at dose level have DLTs, dosing will be lowered to dose level -1 (.5 mg daily, taken orally). If 2 or more of the up to 6 patients at any dose level have DLTs, the preceding dose will be declared the Maximum Tolerated Dose (MTD). If more than 1 DLT occurs at Dose Level -1, the investigators will consider stopping the study. Once the MTD has been established, an additional 10 patients will be enrolled at this level to better characterize safety and tolerability.
Intervention Type
Drug
Intervention Name(s)
Minnelide
Intervention Description
Patients will take Minnelide orally once daily on Days 1-21 of 28 day Cycle. Dose Escalation Schedule: Dose Level -1: .5 mg, Dose Level 1: .75 mg, Dose Level 2: 1 mg, Dose Level 3: 1.25 mg.
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose (MTD) of Minnelide
Description
MTD will be determined by testing increasing doses up to 1.25 mg daily. MTD reflects highest dose of drug that did not cause a Dose Limiting Toxicity (DLT).
Time Frame
Up to 28 days for each dosing cohort
Title
Number of Participants Who Experience Dose Limiting Toxicities (DLTs)
Description
A DLT is any Grade 3 or 4 drug-related non-hematologic toxicity, with some exceptions per protocol.
Time Frame
Up to 28 days for each dosing cohort
Secondary Outcome Measure Information:
Title
Complete Response (CR)
Description
Participants who experience Complete Response (CR) and Complete Response with Incomplete Blood Count Recovery (CRi) rate as defined by 2003 International Working Group (IWG) for AML.
Time Frame
Up to 12 months
Title
Overall Response Rate (ORR)
Description
Overall Response Rate is defined as CR + CRi + partial response (PR) as defined by 2003 IWG criteria for AML.
Time Frame
Up to 12 months
Title
Relapse Free Survival (RFS)
Description
RFS is defined as time interval between achievement of CR to time of relapse.
Time Frame
Up to 18 months
Title
Overall Survival (OS)
Description
OS defined as time interval from time of enrollment onto the clinical trial to death from any cause.
Time Frame
Up to 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adults ages 18 years or older. Participant must have relapsed or refractory acute myeloid leukemia (AML) (excluding acute promyelocytic leukemia). Relapsed patients must have received at least 1 induction chemotherapy regimen or two cycles of a hypomethylating agent and achieved a Complete Response (CR), followed by relapse of disease. Refractory patients must have received at least 1 induction chemotherapy regimen or two cycles of hypomethylating agent without achieving a CR. Eastern Cooperative Oncology Group (ECOG) performance status <2. Participants must have acceptable organ function. Be able and willing to adhere to the study visit schedule and other protocol requirements. Must be able to swallow capsules and have no evidence of GI tract abnormality that would alter the absorption of oral medications. The effects of Minnelide on the developing human fetus are unknown. For this reason, women of child-bearing potential must have a negative serum or urine pregnancy test within 24 hours prior to beginning study treatment. Participants of childbearing potential must practice contraception. Females of childbearing potential: Recommendation is for 2 effective contraceptive methods during the study. Male participants with female partners who are of childbearing potential: Recommendation is for male and partner to use at least 2 effective contraceptive methods, as described above, during the study. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with Minnelide, breastfeeding mothers must agree to discontinue nursing if the mother is treated with Minnelide. Provision of signed and dated informed consent document Patients with prior allogeneic stem cell transplant who experience relapse of AML are eligible if they are off of immunosuppressive therapy and without any evidence of graft-versus-host disease (GVHD) Exclusion Criteria: Participants may not have received any therapy with any investigational products, systemic anti-neoplastic therapy, or radiotherapy within 14 days prior to Cycle 1 Day 1. Patients actively receiving hydroxyurea are eligible and may continue to receive hydroxyurea during protocol treatment. Candidates for standard and/or potentially curative treatments. Major surgery within 28 days prior to Cycle 1 Day 1. New York Heart Association Class III or IV heart failure, myocardial infarction within the past 6 months, unstable arrhythmia, or evidence of ischemia on an electrocardiogram (EKG) Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy Known, active HIV, Hepatitis A, B or C infection (prior Hepatitis C infection that has been treated and determined to be cured is allowed) Symptomatic central nervous system (CNS) involvement with leukemia A concurrent second active and non-stable malignancy with the exception of non-melanoma skin cancer or carcinoma in-situ.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Zhuoer Xie, MD
Organizational Affiliation
H. Lee Moffitt Cancer Center and Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
H. Lee Moffitt Cancer Center and Research Institute
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States

12. IPD Sharing Statement

Links:
URL
http://moffitt.org/clinical-trials-research/clinical-trials/
Description
Moffitt Cancer Center Clinical Trials Website

Learn more about this trial

Dose Escalation Study of Minnelide in Relapsed or Refractory Acute Myeloid Leukemia

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