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CPX-351 Therapy for MDS After Hypomethylating Agent Failure

Primary Purpose

Myelodysplastic Syndrome (MDS)

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
CPX-351
Sponsored by
Case Comprehensive Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelodysplastic Syndrome (MDS)

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must give voluntary written consent before performance of any study related procedures not part of standard medical care
  • Diagnosis of MDS or MDS/MPN according to 2016 WHO criteria12
  • Primary therapy failure with either hypomethylating agents (decitabine or azacitidine) defined as:
  • Progression (according to 2006 IWG criteria)13 after initiation of azacitidine or decitabine treatment; or
  • Failure to achieve complete or partial response or hematological improvement (according to 2006 IWG)13 after at least 4-6 cycles (4-weeks cycle) of azacitidine or decitabine; or
  • Relapse after initial complete or partial response or hematological improvement (according to 2006 IWG criteria)13 observed after at least 4 cycles of azacitidine or decitabine.
  • Eastern Cooperative Oncology Group (ECOG) Performance Status < 2
  • Subjects must have normal organ and marrow function defined as:
  • If total bilirubin < 2x upper limit of normal (</= 3 x ULN if considered to be due to leukemic involvement or Gilbert's syndrome) at the discretion of the treating physician following discussion with PI)
  • Calculated creatinine clearance value of > 30ml/min AND a serum creatinine < 1.5mg/dL
  • LVEF >/= 50%
  • Female patients who:
  • Are postmenopausal for at least 1 year before the screening visit, OR
  • Are surgically sterile, OR
  • Agree to practice true abstinence from heterosexual contact or agree to use effective contraception without interruption during the study therapy and 90 days after the last dose
  • Male patients who:
  • Are surgically sterile, OR
  • Agree to practice true abstinence from heterosexual contact or agree to use effective contraception without interruption during the study therapy and 90 days after the last dose

Exclusion Criteria:

  • Prior treatment with CPX-351, or known hypersensitivity to CPX-351 or its components.
  • Prior treatment with intensive chemotherapy.
  • Any serious medical condition, laboratory abnormality, or psychiatric illness that, in the view of the treating physician, would place the participant at an unacceptable risk if he or she were to participate in the study or would prevent that person from giving informed consent.
  • Any active malignancy (unrelated, non-hematological malignancy) diagnosed within the past 6 months of starting the study drug (other than curatively treated carcinoma-in-situ of the cervix or non-melanoma skin cancer).
  • Patients with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Known history of HIV or active hepatitis B or C.
  • Major surgery within 2 weeks prior to study enrollment.
  • Pregnant or lactating females
  • Male and female patients who are fertile who do not agree to use an effective barrier methods of birth control (i.e. abstinence or 2 forms of contraception) to avoid pregnancy while receiving study treatment.

Sites / Locations

  • Cleveland Clinic Taussig Cancer institute, Case Comprehensive Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

intravenous CPX-351 with potential maintenance therapy

Arm Description

Single agent CPX-351 administered at the standard FDA approved dose of 44 mg/m2 intravenously on days 1, 3, 5 of the induction cycle. If participants achieve complete remission (CR), complete remission with incomplete count recovery (CRi) or partial remission (PR), they will be eligible to continue on to maintenance therapy, which will consist of CPX351 at a dose of 15.4 mg/m2 every 28 days. Participants can receive up to 4 cycles of maintenance therapy.

Outcomes

Primary Outcome Measures

Efficacy of CPX-351 as measured by overall response rate (ORR)
Efficacy of CPX as measured by ORR as defined by IWG 2006 criteria for MDS participants at end of induction.

Secondary Outcome Measures

Time to response (TTR) associated with CPX-351
TTR associated with CPX-351 in participant with MDS at the end of induction. TTR defined by the time between starting the treatment and the time of achieving best response.
Duration of response (DOR) in participants achieving a response
DOR in participants achieving a response defined by the time between first response (day C1 D28 +/-7 days from induction) and the day of loss of response
Event-free survival (EFS)
EFS probability of all participants enrolled in this trial from start of treatment and up to 1 year after the end of treatment.
Overall survival (OS)
OS probability of all participants enrolled in this trial from start of treatment and up to 1 year after the end of treatment.

Full Information

First Posted
April 10, 2019
Last Updated
June 1, 2022
Sponsor
Case Comprehensive Cancer Center
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1. Study Identification

Unique Protocol Identification Number
NCT03957876
Brief Title
CPX-351 Therapy for MDS After Hypomethylating Agent Failure
Official Title
A Phase II Study of CPX-351 as a Novel Therapeutic Approach for Patients With Myelodysplastic Syndromes (MDS) After Hypomethylating Agent Failure
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Recruiting
Study Start Date
July 25, 2019 (Actual)
Primary Completion Date
August 2022 (Anticipated)
Study Completion Date
February 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Case Comprehensive Cancer Center

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
The purpose of this study is to evaluate the efficacy of treatment with CPX-351 (an FDA approved drug for the treatment of AML) in individuals with MDS while using a new stratification tool to predict outcomes of participants following HMA failure. This approach is intended to gain a better understanding and insight into identifying new opportunities for drug approvals in this setting.
Detailed Description
This study will evaluate efficacy of treatment with CPX-351in participants with MDS while using a new stratification tool to predict outcomes of patients following HMA failure in order to gain a better understanding and insight into identifying new opportunities for drug approvals in this setting. CPX-351is an investigational (experimental) drug for the indication of myelodysplastic syndrome that works by delivering two chemotherapy medications (daunorubicin and cytarabine) together which are then concentrated into the bone marrow (the part of the body that makes blood cells). CPX-351 is experimental because it is not approved by the Food and Drug Administration (FDA) for the indication of myelodysplastic syndrome. This drug is approved by theFDA for the indication of acute myeloid leukemia. One or more of the Investigators conducting this study serve as consultants for the company that makes products used in this study. These financial interests are within permissible limits established by the local institutional Conflict of Interest Policy. Prior to beginning treatment, all eligible participants will be grouped into low risk versus high risk based on a stratification tool used to determine their disease. Group 1 will be low risk participants and group 2 will be high risk participants. All study participants will get the same study drug, CPX-351. Participants will receive the CPX-351 on days 1, 3 and 5 of the first 28 day cycle. After participants finish the first round of treatment and based on their response they may be eligible for another 4 cycles of treatment. The participant's doctor will inform them if this is an available option when the time comes. Once participant have finished treatment, their doctor will continue observe for side effects and follow their condition for 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelodysplastic Syndrome (MDS)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
intravenous CPX-351 with potential maintenance therapy
Arm Type
Experimental
Arm Description
Single agent CPX-351 administered at the standard FDA approved dose of 44 mg/m2 intravenously on days 1, 3, 5 of the induction cycle. If participants achieve complete remission (CR), complete remission with incomplete count recovery (CRi) or partial remission (PR), they will be eligible to continue on to maintenance therapy, which will consist of CPX351 at a dose of 15.4 mg/m2 every 28 days. Participants can receive up to 4 cycles of maintenance therapy.
Intervention Type
Drug
Intervention Name(s)
CPX-351
Other Intervention Name(s)
(daunorubicin and cytarabine)
Intervention Description
CPX-351 is a liposomal formulation of a fixed combination of the antineoplastic drugs cytarabine and daunorubicin.
Primary Outcome Measure Information:
Title
Efficacy of CPX-351 as measured by overall response rate (ORR)
Description
Efficacy of CPX as measured by ORR as defined by IWG 2006 criteria for MDS participants at end of induction.
Time Frame
day 28 +/- 7 days of induction
Secondary Outcome Measure Information:
Title
Time to response (TTR) associated with CPX-351
Description
TTR associated with CPX-351 in participant with MDS at the end of induction. TTR defined by the time between starting the treatment and the time of achieving best response.
Time Frame
day 28 +/- 7 days of induction
Title
Duration of response (DOR) in participants achieving a response
Description
DOR in participants achieving a response defined by the time between first response (day C1 D28 +/-7 days from induction) and the day of loss of response
Time Frame
At the end of cycle 1 (each cycle is 28 days), up to 1 year after end of treatment
Title
Event-free survival (EFS)
Description
EFS probability of all participants enrolled in this trial from start of treatment and up to 1 year after the end of treatment.
Time Frame
up to 1 year after end of treatment
Title
Overall survival (OS)
Description
OS probability of all participants enrolled in this trial from start of treatment and up to 1 year after the end of treatment.
Time Frame
up to 1 year after end of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must give voluntary written consent before performance of any study related procedures not part of standard medical care Diagnosis of MDS or MDS/MPN according to 2016 WHO criteria12 Primary therapy failure with either hypomethylating agents (decitabine or azacitidine) defined as: Progression (according to 2006 IWG criteria)13 after initiation of azacitidine or decitabine treatment; or Failure to achieve complete or partial response or hematological improvement (according to 2006 IWG)13 after at least 4-6 cycles (4-weeks cycle) of azacitidine or decitabine; or Relapse after initial complete or partial response or hematological improvement (according to 2006 IWG criteria)13 observed after at least 4 cycles of azacitidine or decitabine. Eastern Cooperative Oncology Group (ECOG) Performance Status < 2 Subjects must have normal organ and marrow function defined as: If total bilirubin < 2x upper limit of normal (</= 3 x ULN if considered to be due to leukemic involvement or Gilbert's syndrome) at the discretion of the treating physician following discussion with PI) Calculated creatinine clearance value of > 30ml/min AND a serum creatinine < 1.5mg/dL LVEF >/= 50% Female patients who: Are postmenopausal for at least 1 year before the screening visit, OR Are surgically sterile, OR Agree to practice true abstinence from heterosexual contact or agree to use effective contraception without interruption during the study therapy and 90 days after the last dose Male patients who: Are surgically sterile, OR Agree to practice true abstinence from heterosexual contact or agree to use effective contraception without interruption during the study therapy and 90 days after the last dose Exclusion Criteria: Prior treatment with CPX-351, or known hypersensitivity to CPX-351 or its components. Prior treatment with intensive chemotherapy. Any serious medical condition, laboratory abnormality, or psychiatric illness that, in the view of the treating physician, would place the participant at an unacceptable risk if he or she were to participate in the study or would prevent that person from giving informed consent. Any active malignancy (unrelated, non-hematological malignancy) diagnosed within the past 6 months of starting the study drug (other than curatively treated carcinoma-in-situ of the cervix or non-melanoma skin cancer). Patients with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Known history of HIV or active hepatitis B or C. Major surgery within 2 weeks prior to study enrollment. Pregnant or lactating females Male and female patients who are fertile who do not agree to use an effective barrier methods of birth control (i.e. abstinence or 2 forms of contraception) to avoid pregnancy while receiving study treatment.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Sudipto Mukherjee, MD, PhD
Phone
866-223-8100
Email
TaussigResearch@ccf.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sudipto Mukherjee, MD, PhD
Organizational Affiliation
Cleveland Clinic Taussig Cancer institute, Case Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cleveland Clinic Taussig Cancer institute, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sudipto Mukherjee, MD
Phone
866-223-8100
Email
TaussigResearch@ccf.org

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
The study team does not plan to share IPD collected in this study

Learn more about this trial

CPX-351 Therapy for MDS After Hypomethylating Agent Failure

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