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AZA + Venetoclax as Maintenance Therapy in Patients With AML in Remission

Primary Purpose

Acute Myeloid Leukemia in Remission, FLT3 Gene Mutation, Hematologic and Lymphocytic Disorder

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Azacitidine
Venetoclax
Sponsored by
M.D. Anderson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia in Remission

Eligibility Criteria

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

Inclusion Criteria:

  1. Patients aged >/= 18 years AML who have achieved their FIRST CR or CRi and are not immediately candidates for allogeneic stem cell transplant.
  2. Patients who have received intensive therapy (defined as receiving standard or higher dose cytarabine-based therapy) to achieve remission (CR/CRi) should have received remission induction therapy and at least 1 consolidation cycle. These patients are eligible as long as they are not greater than 2 months from their last consolidation therapy and will be enrolled in COHORT 1.
  3. Patients who have received lower intensity therapy (defined as receiving low-dose cytarabine (LDAC) or hypomethylating agent (HMA)-based therapy) to achieve remission should have received at least 2 cycles of lower intensity therapy between the time they have achieved CR/CRi and enrollment on this protocol. They will be treated on COHORT 2.
  4. For either subgroup (lower or higher intensity), patients who have measurable residual disease may be enrolled on their respective cohort at any time without maximum 'time from consolidation' requirement.
  5. ECOG performance status of < or = 3
  6. Adequate organ function as follows:

    1. Serum total bilirubin < or = to 1.5 X the Upper Limit of Normal (ULN)
    2. Serum creatinine < or = to 2.5 x ULN
  7. Adequate BM reserve:

    1. Absolute neutrophil count (ANC) > 0.5 x k/uL
    2. Platelet count > or = 30 x k/uL
  8. For females of childbearing age, they may participate if they:

    1. Have a negative serum or urine pregnancy test within 10 to 14 days of enrolling
    2. Agree to either abstinence or 2 effective contraceptive methods (such as barrier methods or hormonal contraception) throughout the treatment period and up to 30 days after discontinuing treatment.
  9. For male patients with a female partner of childbearing age, they may participate if they agree to either abstinence or 2 effective contraceptive methods throughout the treatment period and up to 30 days after discontinuing treatment.
  10. Ability to understand and sign informed consent.

Exclusion Criteria:

  1. Diagnosis of acute promyelocytic leukemia (APL), AML - M3 by FAB classification based on morphology, immunophenotype, molecular, or cytogenetic s studies.
  2. Diagnosis of AML associated t(15;17) or APL variant. Patients with t(9;22) are also ineligible unless they are unable or unwilling to receive therapy with a tyrosine kinase inhibitor.
  3. Uncontrolled intercurrent illness including, but not limited to active uncontrolled infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  4. Patients with active CNS (central nervous system) disease.
  5. Patients with documented hypersensitivity to any components of the study program.
  6. Females who are pregnant or lactating or intending to become pregnant during the study.
  7. Patients with history of extramedullary AML, except for CNS involvement that is currently controlled, will not be eligible for enrollment.
  8. Patient should be removed from current trial if they wish to participate and get treatment on another trial.

Sites / Locations

  • M D Anderson Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (azacytidine, venetoclax)

Arm Description

Patients receive azacitidine SC or IV over 1 hour daily on days 1-5, and venetoclax PO daily on days 1-14. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Relapse-free survival (RFS)
The study will be continuously monitored for the primary endpoint, RFS, using the method of Thall, Wooten, and Tannir (2005). Will also summarize the posterior distribution of lambda-E (i.e., median RFS) assuming posterior mean and 95% credible interval.

Secondary Outcome Measures

Incidence of toxicity
Toxicities are defined as any treatment -related clinically significant grade 3 or 4 non-hematologic adverse events occurred during cycles 1-2 of the trial. Will continuously monitor treatment-related toxicities using the Bayesian approach of Thall, Simon, Estey (1995).
Modified RFS
Distribution assessed using Kaplan-Meier method.
Overall survival (OS)
Distribution assessed using Kaplan-Meier method.
Event free survival (EFS)
Distribution assessed using Kaplan-Meier method.
Complete remission duration (CRd)
Distribution assessed using Kaplan-Meier method.

Full Information

First Posted
August 16, 2019
Last Updated
October 13, 2023
Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI), Genentech, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04062266
Brief Title
AZA + Venetoclax as Maintenance Therapy in Patients With AML in Remission
Official Title
Phase II Study of 5-Azacytidine (AZA) + Venetoclax as Maintenance Therapy in Patients With AML in Remission
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 13, 2019 (Actual)
Primary Completion Date
October 31, 2030 (Anticipated)
Study Completion Date
October 31, 2030 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI), Genentech, Inc.

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 phase II trial studies how well azacitidine and venetoclax work in treating patients with acute myeloid leukemia that is in remission. Drugs used in chemotherapy, such as azacitidine and 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.
Detailed Description
PRIMARY OBJECTIVES: I. To assess relapse-free survival (RFS) of patients (pts) with acute myeloid leukemia (AML) treated with 5-azacytidine (azacitidine; AZA) combined with venetoclax (VEN) as maintenance therapy after achieving remission. SECONDARY OBJECTIVES: I. To assess modified RFS of pts with AML treated with 5-azacytidine combined with venetoclax as maintenance therapy. II. To assess overall survival (OS) of pts with AML treated with 5-azacytidine combined with venetoclax as maintenance therapy. III. To assess event-free survival (EFS) of pts with AML treated with 5-azacytidine combined with venetoclax as maintenance therapy. IV. To assess the duration of remission (CRd) of pts with AML treated 5-azacytidine combined with venetoclax as maintenance therapy. V. To assess toxicity and safety of 5-azacytidine combined with venetoclax as maintenance therapy in pts with AML. VI. To assess the effects of 5-azacytidine combined with venetoclax on dynamics of minimal residual disease (MRD) and their relationship to outcomes. OUTLINE: Patients receive azacitidine subcutaneously (SC) or intravenously (IV) over 1 hour daily on days 1-5, and venetoclax orally (PO) daily on days 1-14. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 days and then every 6-12 months thereafter.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia in Remission, FLT3 Gene Mutation, Hematologic and Lymphocytic Disorder, Acute Myeloid Leukemia, Minimal Residual Disease Persistence, Therapy-Related Acute Myeloid Leukemia

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment (azacytidine, venetoclax)
Arm Type
Experimental
Arm Description
Patients receive azacitidine SC or IV over 1 hour daily on days 1-5, and venetoclax PO daily on days 1-14. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Azacitidine
Other Intervention Name(s)
5 AZC, 5-AC, 5-Azacytidine, 5-AZC, Azacytidine, Azacytidine, 5-, Ladakamycin, Mylosar, U-18496, Vidaza
Intervention Description
Given SC or IV
Intervention Type
Drug
Intervention Name(s)
Venetoclax
Other Intervention Name(s)
ABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, Venclyxto
Intervention Description
Given PO
Primary Outcome Measure Information:
Title
Relapse-free survival (RFS)
Description
The study will be continuously monitored for the primary endpoint, RFS, using the method of Thall, Wooten, and Tannir (2005). Will also summarize the posterior distribution of lambda-E (i.e., median RFS) assuming posterior mean and 95% credible interval.
Time Frame
From date of complete remission (CR) or complete remission with incomplete count recovery (CRi), assessed for up to 10 years
Secondary Outcome Measure Information:
Title
Incidence of toxicity
Description
Toxicities are defined as any treatment -related clinically significant grade 3 or 4 non-hematologic adverse events occurred during cycles 1-2 of the trial. Will continuously monitor treatment-related toxicities using the Bayesian approach of Thall, Simon, Estey (1995).
Time Frame
Up to 10 years
Title
Modified RFS
Description
Distribution assessed using Kaplan-Meier method.
Time Frame
Time from enrollment on study until date of first objective documentation of relapse or death, assessed for up to 10 years
Title
Overall survival (OS)
Description
Distribution assessed using Kaplan-Meier method.
Time Frame
From the start of study treatment until date of death due to any cause, assessed for up to 10 years
Title
Event free survival (EFS)
Description
Distribution assessed using Kaplan-Meier method.
Time Frame
From the start of study treatment until date of first confirmed relapse, withdrawal from study due to adverse event, or death due to any cause, assessed for up to 10 years
Title
Complete remission duration (CRd)
Description
Distribution assessed using Kaplan-Meier method.
Time Frame
Time from CR or CRi until date of first objective documentation of confirmed relapse, assessed for up to 10 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients aged >/= 18 years AML who have achieved their FIRST CR or CRi and are not immediately candidates for allogeneic stem cell transplant. Patients who have received intensive therapy (defined as receiving standard or higher dose cytarabine-based therapy) to achieve remission (CR/CRi) should have received remission induction therapy and at least 1 consolidation cycle. These patients are eligible as long as they are not greater than 2 months from their last consolidation therapy and will be enrolled in COHORT 1. Patients who have received lower intensity therapy (defined as receiving low-dose cytarabine (LDAC) or hypomethylating agent (HMA)-based therapy) to achieve remission should have received at least 2 cycles of lower intensity therapy between the time they have achieved CR/CRi and enrollment on this protocol. They will be treated on COHORT 2. For either subgroup (lower or higher intensity), patients who have measurable residual disease may be enrolled on their respective cohort at any time without maximum 'time from consolidation' requirement. ECOG performance status of < or = 3 Adequate organ function as follows: Serum total bilirubin < or = to 1.5 X the Upper Limit of Normal (ULN) Serum creatinine < or = to 2.5 x ULN Adequate BM reserve: Absolute neutrophil count (ANC) > 0.5 x k/uL Platelet count > or = 30 x k/uL For females of childbearing age, they may participate if they: Have a negative serum or urine pregnancy test within 10 to 14 days of enrolling Agree to either abstinence or 2 effective contraceptive methods (such as barrier methods or hormonal contraception) throughout the treatment period and up to 30 days after discontinuing treatment. For male patients with a female partner of childbearing age, they may participate if they agree to either abstinence or 2 effective contraceptive methods throughout the treatment period and up to 30 days after discontinuing treatment. Ability to understand and sign informed consent. Exclusion Criteria: Diagnosis of acute promyelocytic leukemia (APL), AML - M3 by FAB classification based on morphology, immunophenotype, molecular, or cytogenetic s studies. Diagnosis of AML associated t(15;17) or APL variant. Patients with t(9;22) are also ineligible unless they are unable or unwilling to receive therapy with a tyrosine kinase inhibitor. Uncontrolled intercurrent illness including, but not limited to active uncontrolled infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Patients with active CNS (central nervous system) disease. Patients with documented hypersensitivity to any components of the study program. Females who are pregnant or lactating or intending to become pregnant during the study. Patients with history of extramedullary AML, except for CNS involvement that is currently controlled, will not be eligible for enrollment. Patient should be removed from current trial if they wish to participate and get treatment on another trial.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tapan M. Kadia
Phone
713-563-3534
Email
tkadia@mdanderson.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tapan M Kadia
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tapan M. Kadia
Phone
713-563-3534
First Name & Middle Initial & Last Name & Degree
Tapan M. Kadia

12. IPD Sharing Statement

Links:
URL
http://www.mdanderson.org
Description
University of Texas MD Anderson Cancer Center Website

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AZA + Venetoclax as Maintenance Therapy in Patients With AML in Remission

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