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Mitoxantrone Hydrochloride Liposome Combined With Chemotherapy in Untreated de Novo Acute Myeloid Leukemia

Primary Purpose

Acute Myeloid Leukemia

Status
Not yet recruiting
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Mitoxantrone hydrochloride liposome injection
Cytarabine
Homoharringtonine
Venetoclax
Sponsored by
Institute of Hematology & Blood Diseases Hospital, China
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia

Eligibility Criteria

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

Inclusion Criteria: Able to understand the study and voluntarily sign informed consent. Age: 18~65 (including 18) years old, gender unlimited. Patients diagnosed with acute myeloid leukemia according to "The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia" who haven't been treated. Eastern Cooperative Oncology Group (ECOG) physical state score: 0-1. Fit for intensive chemotherapy. The function of main organs should meet the following standards before treatment: Kidney: Serum creatinine ≤ 1.5 × Upper limit of normal range (ULN) Liver: Total bilirubin ≤ 1.5 × ULN, AST and ALT ≤ 3× ULN Patients should agree to use contraception (such as intrauterine device [IUD], contraceptive pill or condom) during the study period and within 6 months after the end of the study; Female patients must have a negative serum pregnancy test within 7 days before enrollment. Exclusion Criteria: Any of the following cases:(1) diagnosed as acute promyelocytic leukemia (APL);(2) chronic myelogenous leukemia in blast crisis;(3) AML with central nervous system leukemia. AML arising from prior cytotoxic chemotherapy or radiotherapy for other tumours. Patient has been previously diagnosed with another malignancy in last 5 years (except for cured basal cell carcinoma of skin or cervical carcinoma in situ). Has been previously treated with doxorubicin or other anthracyclines and drugs for AML. Allergic history of mitoxantrone hydrochloride injection or any other drugs used in this study. Those on systemic anti-infective therapy with poorly controlled infection (signs of infection progression within 1 week prior to the first dose, or as determined by the investigator). Patient who is suffering from severe hemorrhagic diseases, such as haemophilia A, haemophilia B, von Willebrand disease and any other spontaneous bleeding require medical treatment. The estimated survival time is less than 3 months. Any of the following conditions occurs in cardiac function:(1) Long QTc syndrome or QTc interval > 480 ms;(2) Complete left bundle branch block or severe atrioventricular block disease (without a pacemaker);(3) Serious and uncontrolled arrhythmias and unstable angina pectoris requiring drug treatment;(4) History of chronic congestive heart failure, New York Heart Association (NYHA)≥grade 3;(5) The cardiac ejection fraction is less than 50% in Echocardiography;(6)Uncontrollable hypertension (defined as multiple measurements of systolic blood pressure > 150 mmHg or diastolic blood pressure > 90 mmHg under drug control);(7) History of myocardial infarction, unstable angina pectoris, viral myocarditis or severe pericardial disease, ECG evidence of acute ischemia or active conduction system abnormalities within 6 months before first dose. Patients have thromboembolic events within 6 months prior to first dose, such as cerebrovascular accidents (including transient ischemic attack) and pulmonary embolism. HBsAg/HBcAb positive with HBV-DNA higher than the lower limit of the detection value of the research center , hepatitis C antibody-positive with HCV-RNA higher than the lower limit of the detection value of the research center, or HIV antibody positive in the preliminary screening. Patients who have been treated with strong/moderate CYP3A inducers/inhibitors or P-gp inhibitors within 7 days prior to first dose (for treatment group 3 only). Patients who cannot take oral medications or have absorption disorder (for treatment group 3 only). Patient is suffering from any serious and /or non-controllable disease, or the investigator determines that the disease might affect the participation of patients in the study, including (but not limited to, uncontrolled diabetes, dialysis related kidney diseases, severe liver diseases, life-threatening autoimmune diseases and hemorrhagic diseases, drug abuse, neurological diseases, etc.). Pregnant or lactating female. Patients who are not suitable for this study as decided by the investigator due to other reasons.

Sites / Locations

  • Institute of Hematology & Blood Diseases Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Treatment group 1

Treatment group 2

Treatment group 3

Arm Description

Patients will receive mitoxantrone hydrochloride liposome injection combined with standard-dose of cytarabine.

Patients will receive mitoxantrone hydrochloride liposome injection combined with intermediate-dose of cytarabine and homoharringtonine.

Patients will receive mitoxantrone hydrochloride liposome injection combined with standard-dose of cytarabine and venetoclax.

Outcomes

Primary Outcome Measures

Incidence of treatment-emergent adverse events (TEAEs)

Secondary Outcome Measures

Complete remission rate(CR)
Proportion of patients with complete remission
Complete remission or complete remission with partial hematologic recovery (CR/CRh)
Proportion of patients with complete remission or complete remission with partial hematologic recovery.
Composite remission rate (CRc)
Proportion of subjects with complete remission (CR) or complete remission with partial hematologic recovery (CRh) or complete remission with incomplete hematologic recovery (Cri).
Minimal Residual Disease (MRD)-negative composite remission rates
Among those who have achieved composite remission, proportion of patients who is MRD-negative.
Event-free survival (EFS)
It is defined as the time from the start of randomization to the occurrence of induction failure or disease progression or death from any cause (whichever occurs first).
Relapse-free Survival (RFS)
It is defined as the time from the start of achieving remission to disease progression, death from any cause or the last follow-up
Overall survival (OS)
It is defined as the time from the start of randomization to the death from any cause.
Blood concentrations of total and free mitoxantrone.

Full Information

First Posted
July 1, 2023
Last Updated
July 1, 2023
Sponsor
Institute of Hematology & Blood Diseases Hospital, China
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1. Study Identification

Unique Protocol Identification Number
NCT05941585
Brief Title
Mitoxantrone Hydrochloride Liposome Combined With Chemotherapy in Untreated de Novo Acute Myeloid Leukemia
Official Title
A Clinical Study to Evaluate the Safety, Efficacy and Pharmacokinetics of Mitoxantrone Hydrochloride Liposome Injection Combined With Chemotherapy in Previously Untreated de Novo Acute Myeloid Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
July 2023 (Anticipated)
Primary Completion Date
October 2026 (Anticipated)
Study Completion Date
December 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Institute of Hematology & Blood Diseases Hospital, China

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to determine the safety, efficacy and pharmacokinetics of mitoxantrone hydrochloride liposome injection combined with chemotherapy in previously untreated de novo acute myeloid leukemia.
Detailed Description
This is a prospective, multi-center, randomized, open-label, three-arm clinical study to explore the efficacy among three chemotherapy regimens combined with mitoxantrone hydrochloride liposome in previously untreated de novo acute myeloid leukemia. Patients will be randomized to different treatment group and be given different induction therapy in the first cycle. If patients do not achieve Morphologic Leukemia-free State (MLFS) after the first induction cycle, they will receive the second induction therapy with mitoxantrone hydrochloride liposome, cytarabine and venetoclax. Mitoxantrone hydrochloride liposome will be given on day 1 at the dose of 24 mg/m2 or 30 mg/m2 and be combined with cytarabine, venetoclax or homoharringtonine. A maximum of 2 cycles of induction therapy are planned.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment group 1
Arm Type
Experimental
Arm Description
Patients will receive mitoxantrone hydrochloride liposome injection combined with standard-dose of cytarabine.
Arm Title
Treatment group 2
Arm Type
Experimental
Arm Description
Patients will receive mitoxantrone hydrochloride liposome injection combined with intermediate-dose of cytarabine and homoharringtonine.
Arm Title
Treatment group 3
Arm Type
Experimental
Arm Description
Patients will receive mitoxantrone hydrochloride liposome injection combined with standard-dose of cytarabine and venetoclax.
Intervention Type
Drug
Intervention Name(s)
Mitoxantrone hydrochloride liposome injection
Intervention Description
intravenous infusion on day 1 in a 4-week treatment cycle.
Intervention Type
Drug
Intervention Name(s)
Cytarabine
Intervention Description
intravenous infusion
Intervention Type
Drug
Intervention Name(s)
Homoharringtonine
Intervention Description
intravenous infusion
Intervention Type
Drug
Intervention Name(s)
Venetoclax
Intervention Description
orally once a day
Primary Outcome Measure Information:
Title
Incidence of treatment-emergent adverse events (TEAEs)
Time Frame
Up to approximately one month
Secondary Outcome Measure Information:
Title
Complete remission rate(CR)
Description
Proportion of patients with complete remission
Time Frame
Up to approximately nine weeks
Title
Complete remission or complete remission with partial hematologic recovery (CR/CRh)
Description
Proportion of patients with complete remission or complete remission with partial hematologic recovery.
Time Frame
Up to approximately nine weeks
Title
Composite remission rate (CRc)
Description
Proportion of subjects with complete remission (CR) or complete remission with partial hematologic recovery (CRh) or complete remission with incomplete hematologic recovery (Cri).
Time Frame
Up to approximately nine weeks
Title
Minimal Residual Disease (MRD)-negative composite remission rates
Description
Among those who have achieved composite remission, proportion of patients who is MRD-negative.
Time Frame
Up to approximately nine weeks
Title
Event-free survival (EFS)
Description
It is defined as the time from the start of randomization to the occurrence of induction failure or disease progression or death from any cause (whichever occurs first).
Time Frame
Up to approximately 3 years.
Title
Relapse-free Survival (RFS)
Description
It is defined as the time from the start of achieving remission to disease progression, death from any cause or the last follow-up
Time Frame
Up to approximately 3 years.
Title
Overall survival (OS)
Description
It is defined as the time from the start of randomization to the death from any cause.
Time Frame
Up to approximately 3 years.
Title
Blood concentrations of total and free mitoxantrone.
Time Frame
30 minutes before administration and 5min, 6, 24, 72, 144, 288, 432, 648 hours after administration of Mitoxantrone hydrochloride liposome on day 1

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: Able to understand the study and voluntarily sign informed consent. Age: 18~65 (including 18) years old, gender unlimited. Patients diagnosed with acute myeloid leukemia according to "The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia" who haven't been treated. Eastern Cooperative Oncology Group (ECOG) physical state score: 0-1. Fit for intensive chemotherapy. The function of main organs should meet the following standards before treatment: Kidney: Serum creatinine ≤ 1.5 × Upper limit of normal range (ULN) Liver: Total bilirubin ≤ 1.5 × ULN, AST and ALT ≤ 3× ULN Patients should agree to use contraception (such as intrauterine device [IUD], contraceptive pill or condom) during the study period and within 6 months after the end of the study; Female patients must have a negative serum pregnancy test within 7 days before enrollment. Exclusion Criteria: Any of the following cases:(1) diagnosed as acute promyelocytic leukemia (APL);(2) chronic myelogenous leukemia in blast crisis;(3) AML with central nervous system leukemia. AML arising from prior cytotoxic chemotherapy or radiotherapy for other tumours. Patient has been previously diagnosed with another malignancy in last 5 years (except for cured basal cell carcinoma of skin or cervical carcinoma in situ). Has been previously treated with doxorubicin or other anthracyclines and drugs for AML. Allergic history of mitoxantrone hydrochloride injection or any other drugs used in this study. Those on systemic anti-infective therapy with poorly controlled infection (signs of infection progression within 1 week prior to the first dose, or as determined by the investigator). Patient who is suffering from severe hemorrhagic diseases, such as haemophilia A, haemophilia B, von Willebrand disease and any other spontaneous bleeding require medical treatment. The estimated survival time is less than 3 months. Any of the following conditions occurs in cardiac function:(1) Long QTc syndrome or QTc interval > 480 ms;(2) Complete left bundle branch block or severe atrioventricular block disease (without a pacemaker);(3) Serious and uncontrolled arrhythmias and unstable angina pectoris requiring drug treatment;(4) History of chronic congestive heart failure, New York Heart Association (NYHA)≥grade 3;(5) The cardiac ejection fraction is less than 50% in Echocardiography;(6)Uncontrollable hypertension (defined as multiple measurements of systolic blood pressure > 150 mmHg or diastolic blood pressure > 90 mmHg under drug control);(7) History of myocardial infarction, unstable angina pectoris, viral myocarditis or severe pericardial disease, ECG evidence of acute ischemia or active conduction system abnormalities within 6 months before first dose. Patients have thromboembolic events within 6 months prior to first dose, such as cerebrovascular accidents (including transient ischemic attack) and pulmonary embolism. HBsAg/HBcAb positive with HBV-DNA higher than the lower limit of the detection value of the research center , hepatitis C antibody-positive with HCV-RNA higher than the lower limit of the detection value of the research center, or HIV antibody positive in the preliminary screening. Patients who have been treated with strong/moderate CYP3A inducers/inhibitors or P-gp inhibitors within 7 days prior to first dose (for treatment group 3 only). Patients who cannot take oral medications or have absorption disorder (for treatment group 3 only). Patient is suffering from any serious and /or non-controllable disease, or the investigator determines that the disease might affect the participation of patients in the study, including (but not limited to, uncontrolled diabetes, dialysis related kidney diseases, severe liver diseases, life-threatening autoimmune diseases and hemorrhagic diseases, drug abuse, neurological diseases, etc.). Pregnant or lactating female. Patients who are not suitable for this study as decided by the investigator due to other reasons.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jianxiang Wang, MD
Phone
86-022-23909120
Email
wangjx@ihcams.an.cn
Facility Information:
Facility Name
Institute of Hematology & Blood Diseases Hospital
City
Tianjin
ZIP/Postal Code
300020
Country
China

12. IPD Sharing Statement

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Mitoxantrone Hydrochloride Liposome Combined With Chemotherapy in Untreated de Novo Acute Myeloid Leukemia

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