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Bisantrene Combination for Resistant AML

Primary Purpose

Myelogenous Leukemia, Acute

Status
Recruiting
Phase
Phase 2
Locations
Israel
Study Type
Interventional
Intervention
Bisantrene
Fludarabine
Clofarabine
Sponsored by
Sheba Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelogenous Leukemia, Acute focused on measuring AML, Resistance relapsing ,Anti Leukemic effect , Bisantrene

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved written Informed Consent and privacy language as per national regulations.
  2. Age 18 -65 (inclusive) years
  3. Diagnosis of AML by World Health Organization (WHO) classification (WHO, 2016) and have received at least one line of therapy prior to enrollment into this study.
  4. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.0
  5. Life expectancy ≥ 3 months.
  6. Adequate organ function as evidenced by serum total bilirubin ≤ 2.0 mg/dL, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤4 × the upper limit of normal (ULN), serum albumin >2.8 g/dL, serum creatinine ≤2 mg/dL.
  7. Cardiac ejection fraction ≥50%, assessed by 2-Dimensional echocardiogram.
  8. Pulmonary function ≥50% assessed by diffusing capacity for carbon monoxide (DLCO), and any clinically significant decrease in DLCO must not be caused by infection.
  9. Negative for serum markers for HIV, Hepatitis -B, -C, and HTLV-1
  10. Clinically significant non-hematologic toxicity after prior chemotherapy has recovered to Grade 1 per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
  11. Females must be surgically or biologically sterile or postmenopausal (amenorrhoeic for at least 12 months) or if of childbearing potential, must have a negative urine or serum pregnancy test within 14 days before study entry, and must agree to use an adequate method of contraception, i.e. barrier method, during the study until 30 days after the last treatment. Males must be surgically or biologically sterile or agree to use an adequate method of contraception, i.e. barrier method, during the study until 30 days after the last treatment.

Exclusion Criteria:

  1. Acute promyelocytic leukemia (APML, APL) M3 subtype of AML.
  2. Other active malignancy (including other hematologic malignancies) or other malignancy within the last 12 months except non-melanoma skin cancer or cervical intraepithelial neoplasia.
  3. Prior or current therapy:

    1. Hydroxyurea or other oral medications to reduce blast count within 72 hours before the first dose of study drug
    2. Treatment with an investigational agent within 14 days before the first dose of study drug, or not recovered from all acute effects of previous investigational therapy
    3. Last treatment was with a drug of long elimination half-life (e.g. enasidenib), as such a wash out period 5x elimination half-life is necessary prior to enrollment
  4. For patients who have undergone hematopoietic stem cell transplantation (HSCT), procedure-related medications (e.g. immunosuppressive therapy) administered within 2 weeks prior to first dose of study drug.
  5. Any medical, psychological, or social condition that may interfere with study participation or compliance or may compromise the patient's safety in the opinion of the investigator.

Sites / Locations

  • Chaim Sheba Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bisantrene combined with Fludarabine and Clofarabine

Arm Description

Bisantrene 250 mg at final concentration of 0.5 mg/mL will be administrated by intravenous (IV) infusion, delivered by a controlled-rate programmable pump via a central line over 2 hours. Fludarabine (generic) and Clofarabine (generic) are commercially available as injection for intravenous infusion. The treatment regimen will comprise daily IV infusion of Fludarabine (Flu), Clofarabine (Clo) and Bisantrene (Xan) administered via central venous line and controlled-rate infusion pump with a 1-hour break between each agent infusion, amounting to a total of 6 hours for each daily FluCloXan treatment in the following sequence: First, infusion over 60 minutes of Fludarabine (Flu) at 10 mg/m2 Followed by infusion of Clofarabine (Clo) at 30 mg/m2 over 60 minutes Followed by infusion of Bisantrene (Xan) at 250 mg/m2 over 2 hours.

Outcomes

Primary Outcome Measures

The recommended Phase 2 dose (RP2D) , assessed by the number of treatment days of FluCloXan
The maximum tolerated dose (MTD) of Bisantre in mg per day
To evaluate safety and tolerability
The overall response rate (ORR)
Overall Response Rate (ORR) defined as the proportion of patients with complete remission (CR) and complete remission with incomplete blood count recovery (CRi) between Day 30 to Day 42.

Secondary Outcome Measures

Number of participants with treatment-related adverse events as assessed by CTCAE v4.0.
Confirm safety and tolerability of the combination regimen.
Time of respons in months
Number of months for each patient with no evidence of diseases.
Overall survival
Median surviving months for each patients.

Full Information

First Posted
July 7, 2021
Last Updated
October 30, 2022
Sponsor
Sheba Medical Center
Collaborators
Race Oncology Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT04989335
Brief Title
Bisantrene Combination for Resistant AML
Official Title
An Open-label, Phase II, Two-stage, Study of Bisantrene(Xantrene) in Combination With Fludarabine and Clofarabine as Salvage Therapy for Adult Patients With Relapsed or Refractory Acute Myeloid Leukemia (AML)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Recruiting
Study Start Date
August 2, 2021 (Actual)
Primary Completion Date
December 1, 2024 (Anticipated)
Study Completion Date
December 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Sheba Medical Center
Collaborators
Race Oncology Ltd

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
An Open-label, Phase II, Two-stage, Study of Xantrene® (Bisantrene) in combination with Fludarabine and Clofarabine as Salvage Therapy for Adult Patients with Relapsed or Refractory Acute Myeloid Leukemia (AML) Lead-in stage: up to 12 (up to 2 cohorts in a 3+3 dose escalation design) Efficacy stage: up to 17 (Simon 2-stage design 9+8) Study Objectives: Confirm safety and tolerability of the combination regimen Time to response with combination treatment Overall survival The treatment regimen will comprise daily IV infusion of Fludarabine (Flu), Clofarabine (Clo) and Bisantrene (Xan) administered via central venous line and controlled-rate infusion pump with a 1-hour break between each agent infusion, amounting to a total of 6 hours for each daily FluCloXan treatment in the following sequence: First, infusion over 60 minutes of Fludarabine (Flu) at 10 mg/m2 Followed by infusion of Clofarabine (Clo) at 30 mg/m2 over 60 minutes Followed by infusion of Bisantrene (Xan) at 250 mg/m2 over 2 hours. One cycle will comprise daily IV infusion of the combination treatment course for 4 or 5 consecutive days and rest period to between Day 30 and Day 42, based on patient performance and disease status.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelogenous Leukemia, Acute
Keywords
AML, Resistance relapsing ,Anti Leukemic effect , Bisantrene

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Bisantrene combined with Fludarabine and Clofarabine
Arm Type
Experimental
Arm Description
Bisantrene 250 mg at final concentration of 0.5 mg/mL will be administrated by intravenous (IV) infusion, delivered by a controlled-rate programmable pump via a central line over 2 hours. Fludarabine (generic) and Clofarabine (generic) are commercially available as injection for intravenous infusion. The treatment regimen will comprise daily IV infusion of Fludarabine (Flu), Clofarabine (Clo) and Bisantrene (Xan) administered via central venous line and controlled-rate infusion pump with a 1-hour break between each agent infusion, amounting to a total of 6 hours for each daily FluCloXan treatment in the following sequence: First, infusion over 60 minutes of Fludarabine (Flu) at 10 mg/m2 Followed by infusion of Clofarabine (Clo) at 30 mg/m2 over 60 minutes Followed by infusion of Bisantrene (Xan) at 250 mg/m2 over 2 hours.
Intervention Type
Drug
Intervention Name(s)
Bisantrene
Intervention Description
Combined escalated dose chemotherapy
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Intervention Description
Combined escalated dose chemotherapy
Intervention Type
Drug
Intervention Name(s)
Clofarabine
Intervention Description
Combined escalated dose chemotherapy
Primary Outcome Measure Information:
Title
The recommended Phase 2 dose (RP2D) , assessed by the number of treatment days of FluCloXan
Time Frame
12 months
Title
The maximum tolerated dose (MTD) of Bisantre in mg per day
Description
To evaluate safety and tolerability
Time Frame
12 months
Title
The overall response rate (ORR)
Description
Overall Response Rate (ORR) defined as the proportion of patients with complete remission (CR) and complete remission with incomplete blood count recovery (CRi) between Day 30 to Day 42.
Time Frame
between Day 30 to Day 42.
Secondary Outcome Measure Information:
Title
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0.
Description
Confirm safety and tolerability of the combination regimen.
Time Frame
12 months
Title
Time of respons in months
Description
Number of months for each patient with no evidence of diseases.
Time Frame
12 months
Title
Overall survival
Description
Median surviving months for each patients.
Time Frame
12 months
Other Pre-specified Outcome Measures:
Title
MRD status
Description
To determine the MRD status of patients post completion of FluCloXan. MRD will be asset in patients with defiant mutations by Polymerase Chain Techniques(PCR).
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved written Informed Consent and privacy language as per national regulations. Age 18 -65 (inclusive) years Diagnosis of AML by World Health Organization (WHO) classification (WHO, 2016) and have received at least one line of therapy prior to enrollment into this study. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.0 Life expectancy ≥ 3 months. Adequate organ function as evidenced by serum total bilirubin ≤ 2.0 mg/dL, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤4 × the upper limit of normal (ULN), serum albumin >2.8 g/dL, serum creatinine ≤2 mg/dL. Cardiac ejection fraction ≥50%, assessed by 2-Dimensional echocardiogram. Pulmonary function ≥50% assessed by diffusing capacity for carbon monoxide (DLCO), and any clinically significant decrease in DLCO must not be caused by infection. Negative for serum markers for HIV, Hepatitis -B, -C, and HTLV-1 Clinically significant non-hematologic toxicity after prior chemotherapy has recovered to Grade 1 per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Females must be surgically or biologically sterile or postmenopausal (amenorrhoeic for at least 12 months) or if of childbearing potential, must have a negative urine or serum pregnancy test within 14 days before study entry, and must agree to use an adequate method of contraception, i.e. barrier method, during the study until 30 days after the last treatment. Males must be surgically or biologically sterile or agree to use an adequate method of contraception, i.e. barrier method, during the study until 30 days after the last treatment. Exclusion Criteria: Acute promyelocytic leukemia (APML, APL) M3 subtype of AML. Other active malignancy (including other hematologic malignancies) or other malignancy within the last 12 months except non-melanoma skin cancer or cervical intraepithelial neoplasia. Prior or current therapy: Hydroxyurea or other oral medications to reduce blast count within 72 hours before the first dose of study drug Treatment with an investigational agent within 14 days before the first dose of study drug, or not recovered from all acute effects of previous investigational therapy Last treatment was with a drug of long elimination half-life (e.g. enasidenib), as such a wash out period 5x elimination half-life is necessary prior to enrollment For patients who have undergone hematopoietic stem cell transplantation (HSCT), procedure-related medications (e.g. immunosuppressive therapy) administered within 2 weeks prior to first dose of study drug. Any medical, psychological, or social condition that may interfere with study participation or compliance or may compromise the patient's safety in the opinion of the investigator.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Arnon Nagler, MD
Phone
972-3-530-58-30
Email
Arnon.Nagler@sheba.health.gov.il
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Arnon Nagler, MD
Organizational Affiliation
Sheba Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chaim Sheba Medical Center
City
Ramat Gan
ZIP/Postal Code
57261
Country
Israel
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Arnon Nagler, M.D.
Phone
+97235305830
Email
Arnon.Nagler@sheba.health.gov.il
First Name & Middle Initial & Last Name & Degree
M.D.

12. IPD Sharing Statement

Learn more about this trial

Bisantrene Combination for Resistant AML

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