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Inqovi Maintenance Therapy in Myeloid Neoplasms

Primary Purpose

Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, Stem Cell Leukemia

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Inqovi
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelodysplastic Syndromes focused on measuring Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, Stem Cell Leukemia

Eligibility Criteria

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

Inclusion Criteria:

  • Pathologically confirmed diagnosis of myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML).

    • Subjects should have less than 5% myeloblasts on a bone marrow biopsy within 42 days prior to the start of conditioning.
  • Age ≥ 18
  • Will undergo first allogeneic hematopoietic stem cell transplantation (HSCT) for their malignancy.
  • Transplantation will be performed with the use of reduced intensity conditioning (RIC).
  • HSCT Donor will be one of the following:

    • 5/6 or 6/6 (HLA-A, B, DR) matched related donor
    • 7/8 or 8/8 (HLA-A, B, DR, C) matched unrelated donor. Matching in the unrelated setting must be at the allele level.
    • Haploidentical related donor, defined as ≥ 3/6 (HLA-A, B, DR) matched
    • ≥ 4/6 (HLA-A, B, DR) umbilical cord blood (UCB). Matching in the UCB setting is at the antigen level. Recipients may receive either one or two UCB units. In the case of 2 UCB units, both units must have been at least 4/6 matched with the recipient.
  • ECOG performance status 0-2.
  • Participants must have normal organ and function as defined below:

    • AST (SGOT), ALT (SGPT) and Alkaline phosphatase < 3x institutional upper limit of normal (ULN)
    • Total bilirubin < 1.5 x ULN (with the exception of subjects with a history of Gilbert's syndrome)
    • Calculated creatinine clearance ≥ 30 mL/min (Cockcroft-Gault formula)
  • LVEF must be equal to or greater than 50%, as measured by MUGA scan or echocardiogram
  • Female patients of childbearing potential must have a negative pregnancy test, as measured by serum or urine testing
  • The effects of decitabine/cedazuridine on the developing human fetus are unknown. For this reason women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) during the entire study treatment period and through 6 months after the last dose of treatment
  • Ability to understand and the willingness to sign a written informed consent document.

Eligibility Criteria Prior to Treatment (Post HCT)

  • Maintenance therapy may begin at any time between day 30 and day 120 following hematopoietic cell transplantation. Participants must meet the following criteria to be eligible to treatment on this study:

    • Chimerism studies reveal that ≥ 70% of blood or bone marrow cells, or of the CD33 expressing fraction, are of donor origin.
    • There is no acute graft versus host disease (GVHD), requiring an escalation of corticosteroid dose or addition of other agent in the 4 weeks prior to Cycle 1 Day 1.
    • There is no morphological evidence of relapsed/recurrent/residual disease (as assessed by post HCT bone marrow biopsy and aspirate).
    • There is no systemic infection requiring IV antibiotic or antifungal or antiviral therapy within 7 days of starting decitabine/cedazuridine
    • ANC ≥ 1000/µL
    • Platelets ≥ 50,000/µL
    • AST (SGOT), ALT (SGPT) and Alkaline phosphatase < 3x institutional upper limit of normal (ULN)
    • Total bilirubin < 1.5 x ULN (with the exception of subjects with a history of Gilbert's syndrome)
    • Calculated creatinine clearance ≥ 30 mL/min (Cockcroft-Gault formula)

Exclusion Criteria:

  • Prior allogeneic hematopoietic stem cell transplants.
  • History of other malignancy(ies) unless

    • the participant has been disease-free for at least 12 months and is deemed by the investigator to be at low risk of recurrence of that malignancy, or
    • the only prior malignancy was cervical cancer in situ and/or basal cell or squamous cell carcinoma of the skin
  • Known diagnosis of active hepatitis B or hepatitis C
  • Current or history of congestive heart failure New York Heart Association (NHYA) class 3 or 4, or any history of documented diastolic or systolic dysfunction (LVEF < 50%, as measured by MUGA scan or echocardiogram)
  • Current or history of ventricular or life-threatening arrhythmias or diagnosis of long-QT syndrome
  • Systemic uncontrolled infection
  • Known dysphagia, short-gut syndrome, gastroparesis, or other condition(s) that limits the ingestion or gastrointestinal absorption of drugs administered orally
  • Uncontrolled hypertension (systolic blood pressure [BP] > 180 mmHg or diastolic BP > 100 mmHg)
  • QTc interval (i.e., Friderica's correction [QTcF]) ≥ 450 ms or other factors that increase the risk of QT prolongation or arrhythmic events (e.g., heart failure, hypokalemia, family history of long QT interval syndrome) at screening
  • Uncontrolled intercurrent illness that would limit compliance with study requirements.
  • Breastfeeding women

Sites / Locations

  • Massachusetts General HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Dose Escalation Inqovi

Recommended Phase 2 Dose Expansion (RP2S) Inqovi

Arm Description

Study will follow a standard '3+3' dose escalation design: Initial group of 3 participants will receive Inqovi (decitabine/cedazuridine) on days 1-3 of a 42 day cycle/dose-limiting toxicity (DLT) period. Additional enrollment, dosage and study cyles will be determined by number of dose-limiting toxicity (DLT) that occur in initial group

Once the Recommended Phase 2 Dose Expansion (RP2S) is established, 10 additional participants will be enrolled and receive Inqovi (decitabine/cedazuridine) on days 1-3 of a 28 day study cycle.

Outcomes

Primary Outcome Measures

Recommended Phase 2 Schedule Dose
Identify the recommended phase II schedule of oral decitabine/cedazuridine through standard 3+3 Dose escalation model.

Secondary Outcome Measures

Median number of days of Inqovi tolerated
Median number of day of Inqovi tolerated tabulated and reported descriptively.
Cumulative incidence of acute GVHD
Cumulative incidence of acute GVHD tabulated and reported descriptively.
Cumulative incidence of significant chronic GVHD
Cumulative incidence of significant chronic GVHD tabulated and reported descriptively.
Overall survival Rate
Assessed using Kaplan-Meier
Relapse-free survival Rate
Assessed using Kaplan-Meier
Proportion of subjects who successfully screen for study prior to transplantation but who do not reach the maintenance phase due to transplant related morbidity or mortality.
Proportion of subjects who successfully screen for study prior to transplantation but who do not reach the maintenance phase due to transplant related morbidity or mortality tabulated and reported descriptively.

Full Information

First Posted
July 18, 2021
Last Updated
September 29, 2021
Sponsor
Massachusetts General Hospital
Collaborators
Taiho Oncology, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04980404
Brief Title
Inqovi Maintenance Therapy in Myeloid Neoplasms
Official Title
A Phase Ib Study of Oral Decitabine/Cedazuridine as Maintenance Therapy Following Allogeneic Hematopoietic Cell Transplantation for Patients With Myeloid Neoplasms
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Recruiting
Study Start Date
September 17, 2021 (Actual)
Primary Completion Date
August 1, 2023 (Anticipated)
Study Completion Date
August 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
Taiho Oncology, Inc.

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 research is being done to see if the drug Inqov is effective in reducing the chance of myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML) relapsing after standard of care stem cell transplant. This research study involves the study drug Inqovi, which is a combination of the drugs decitabine and cedazuridine.
Detailed Description
This is a prospective, non-randomized, open-label, phase Ib study of oral Inqov-decitabine/cedazuridine, given as maintenance therapy following allogeneic hematopoietic cell transplantation for patients with myeloid neoplasms The U.S. Food and Drug Administration (FDA) has approved Inqovi for myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML) relapse but it has not been investigated in the post-transplant setting. Inqovi is made up of the two study drugs decitabine and cedazuridine. Decitabine is believed to work by stopping cancer cells from growing and spreading. Cedazuridine is believed to work by slowing down how quickly the body breaks down decitabine, which normally breaks down too quickly to be effective. The research study procedures include screening for eligibility and study treatment, including evaluations and follow up visits. As the study is looking for the highest dose of Inqovi that can be administered safely without severe or unmanageable side effects not everyone will receive the same dose of the study drug. Dosage will depend on the number of participants who have been enrolled in the study before and how well they have tolerated their doses. Participants will receive study treatment for up to 12 months and will be followed for up to 24 months after starting the study drug. It is expected that about 22 people will take part in this research study. Taiho Oncology, Inc., a pharmaceutical company, is supporting this research study by providing funding for the study, including the study drug.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, Stem Cell Leukemia
Keywords
Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, Stem Cell Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
22 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dose Escalation Inqovi
Arm Type
Experimental
Arm Description
Study will follow a standard '3+3' dose escalation design: Initial group of 3 participants will receive Inqovi (decitabine/cedazuridine) on days 1-3 of a 42 day cycle/dose-limiting toxicity (DLT) period. Additional enrollment, dosage and study cyles will be determined by number of dose-limiting toxicity (DLT) that occur in initial group
Arm Title
Recommended Phase 2 Dose Expansion (RP2S) Inqovi
Arm Type
Experimental
Arm Description
Once the Recommended Phase 2 Dose Expansion (RP2S) is established, 10 additional participants will be enrolled and receive Inqovi (decitabine/cedazuridine) on days 1-3 of a 28 day study cycle.
Intervention Type
Drug
Intervention Name(s)
Inqovi
Other Intervention Name(s)
decitabine, cedazuridine
Intervention Description
Tablet combination of drugs decitabine and cedazuridine, given orally.
Primary Outcome Measure Information:
Title
Recommended Phase 2 Schedule Dose
Description
Identify the recommended phase II schedule of oral decitabine/cedazuridine through standard 3+3 Dose escalation model.
Time Frame
42 Days
Secondary Outcome Measure Information:
Title
Median number of days of Inqovi tolerated
Description
Median number of day of Inqovi tolerated tabulated and reported descriptively.
Time Frame
Up to 2 years
Title
Cumulative incidence of acute GVHD
Description
Cumulative incidence of acute GVHD tabulated and reported descriptively.
Time Frame
Up to 2 years
Title
Cumulative incidence of significant chronic GVHD
Description
Cumulative incidence of significant chronic GVHD tabulated and reported descriptively.
Time Frame
Up to 2 years
Title
Overall survival Rate
Description
Assessed using Kaplan-Meier
Time Frame
The time from first dose of study drug to the date of death due to any cause up to 2 years
Title
Relapse-free survival Rate
Description
Assessed using Kaplan-Meier
Time Frame
The time from first dose of study drug to the earlier of relapse or death due to any cause up to 2 years
Title
Proportion of subjects who successfully screen for study prior to transplantation but who do not reach the maintenance phase due to transplant related morbidity or mortality.
Description
Proportion of subjects who successfully screen for study prior to transplantation but who do not reach the maintenance phase due to transplant related morbidity or mortality tabulated and reported descriptively.
Time Frame
Up to 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Pathologically confirmed diagnosis of myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML). Subjects should have less than 5% myeloblasts on a bone marrow biopsy within 42 days prior to the start of conditioning. Age ≥ 18 Will undergo first allogeneic hematopoietic stem cell transplantation (HSCT) for their malignancy. Transplantation will be performed with the use of reduced intensity conditioning (RIC). HSCT Donor will be one of the following: 5/6 or 6/6 (HLA-A, B, DR) matched related donor 7/8 or 8/8 (HLA-A, B, DR, C) matched unrelated donor. Matching in the unrelated setting must be at the allele level. Haploidentical related donor, defined as ≥ 3/6 (HLA-A, B, DR) matched ≥ 4/6 (HLA-A, B, DR) umbilical cord blood (UCB). Matching in the UCB setting is at the antigen level. Recipients may receive either one or two UCB units. In the case of 2 UCB units, both units must have been at least 4/6 matched with the recipient. ECOG performance status 0-2. Participants must have normal organ and function as defined below: AST (SGOT), ALT (SGPT) and Alkaline phosphatase < 3x institutional upper limit of normal (ULN) Total bilirubin < 1.5 x ULN (with the exception of subjects with a history of Gilbert's syndrome) Calculated creatinine clearance ≥ 30 mL/min (Cockcroft-Gault formula) LVEF must be equal to or greater than 50%, as measured by MUGA scan or echocardiogram Female patients of childbearing potential must have a negative pregnancy test, as measured by serum or urine testing The effects of decitabine/cedazuridine on the developing human fetus are unknown. For this reason women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) during the entire study treatment period and through 6 months after the last dose of treatment Ability to understand and the willingness to sign a written informed consent document. Eligibility Criteria Prior to Treatment (Post HCT) Maintenance therapy may begin at any time between day 30 and day 120 following hematopoietic cell transplantation. Participants must meet the following criteria to be eligible to treatment on this study: Chimerism studies reveal that ≥ 70% of blood or bone marrow cells, or of the CD33 expressing fraction, are of donor origin. There is no acute graft versus host disease (GVHD), requiring an escalation of corticosteroid dose or addition of other agent in the 4 weeks prior to Cycle 1 Day 1. There is no morphological evidence of relapsed/recurrent/residual disease (as assessed by post HCT bone marrow biopsy and aspirate). There is no systemic infection requiring IV antibiotic or antifungal or antiviral therapy within 7 days of starting decitabine/cedazuridine ANC ≥ 1000/µL Platelets ≥ 50,000/µL AST (SGOT), ALT (SGPT) and Alkaline phosphatase < 3x institutional upper limit of normal (ULN) Total bilirubin < 1.5 x ULN (with the exception of subjects with a history of Gilbert's syndrome) Calculated creatinine clearance ≥ 30 mL/min (Cockcroft-Gault formula) Exclusion Criteria: Prior allogeneic hematopoietic stem cell transplants. History of other malignancy(ies) unless the participant has been disease-free for at least 12 months and is deemed by the investigator to be at low risk of recurrence of that malignancy, or the only prior malignancy was cervical cancer in situ and/or basal cell or squamous cell carcinoma of the skin Known diagnosis of active hepatitis B or hepatitis C Current or history of congestive heart failure New York Heart Association (NHYA) class 3 or 4, or any history of documented diastolic or systolic dysfunction (LVEF < 50%, as measured by MUGA scan or echocardiogram) Current or history of ventricular or life-threatening arrhythmias or diagnosis of long-QT syndrome Systemic uncontrolled infection Known dysphagia, short-gut syndrome, gastroparesis, or other condition(s) that limits the ingestion or gastrointestinal absorption of drugs administered orally Uncontrolled hypertension (systolic blood pressure [BP] > 180 mmHg or diastolic BP > 100 mmHg) QTc interval (i.e., Friderica's correction [QTcF]) ≥ 450 ms or other factors that increase the risk of QT prolongation or arrhythmic events (e.g., heart failure, hypokalemia, family history of long QT interval syndrome) at screening Uncontrolled intercurrent illness that would limit compliance with study requirements. Breastfeeding women
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Zachariah DeFilipp, MD
Phone
617-643-3944
Email
zdefilipp@mgh.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Zachariah DeFilipp, MD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Zachariah DeFilipp, MD
Phone
617-643-3944
Email
zdefilipp@mgh.harvard.edu

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
IPD Sharing Time Frame
Data can be shared no earlier than 1 year following the date of publication
IPD Sharing Access Criteria
Contact the Partners Innovations team at http://www.partners.org/innovation

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Inqovi Maintenance Therapy in Myeloid Neoplasms

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