Back to results

A Phase 2 Study of Venetoclax in Combination With Low-dose HHT, G-CSF, and AZA as First-line Treatment for Newly Diagnosed Elderly AML Patients Unfit for Intensive Chemotherapy

Primary Purpose

Leukemia, Myeloid, Acute

Status

Not yet recruiting

Phase

Phase 2

Locations

Study Type

Interventional

Intervention

The combination of HHT, venetoclax, AZA, G-CSF

About this trial

This is an interventional treatment trial for Leukemia, Myeloid, Acute focused on measuring AML, venetoclax, combination therapy

Eligibility Criteria

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

Inclusion Criteria:

Participant must have confirmation of Acute Myeloid Leukemia (AML) by World Health Organization (WHO) criteria, previously untreated and unfit for intensive chemotherapy
Participant must be >= 60 years of age.
Participant must have a projected life expectancy of at least 12 weeks.
Participant must have adequate renal function as demonstrated by a creatinine >= 30 mL/min;determined via urine collection for 24-hour creatinine clearance or by the Cockcroft Gault formula
Participant must have adequate liver function as demonstrated by:
1. aspartate aminotransferase (AST) <= 3.0 x ULN*
2. alanine aminotransferase (ALT) <= 3.0 x ULN*
3. bilirubin <= 1.5 x ULN* * Unless considered to be due to leukemic organ involvement i. Subjects who are < 75 years of age may have a bilirubin of <= 3.0 x ULN

Exclusion Criteria:

Participant has history of myeloproliferative neoplasm (MPN) including myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia (CML) with or without BCR-ABL1 translocation and AML with BCR-ABL1 translocation
Participant has acute promyelocytic leukemia
Participant has known active central nervous system (CNS) involvement with AML
Participant is known to be positive for hepatitis B or C infection
Participant has received anticancer therapies including chemotherapy, radiotherapy or other investigational therapy, including targeted small molecule agents within 5 half-lives prior to first dose of study drug
Participant has received biologic agents (e.g. monoclonal antibodies) for anti-neoplastic intent within 30 days prior to first dose of study drug
Participant has received the following within 7 days prior to the first dose of the study drug:
1. Steroid therapy for anti-neoplastic intent;
2. Strong and Moderate CYP3A inhibitors (see Appendix A for examples)
3. Strong and Moderate CYP3A inducers (see Appendix A for examples)
Participant exhibits evidence of other clinically significant uncontrolled systemic infection requiring therapy
Participant has a serious cardiovascular, pulmonary or renal disability
Participant has a history of other malignancies within 2 years prior to study entry, with the exception of:
1. Adequately treated in situ carcinoma of the cervix uteri or carcinoma in situ of breast;
2. Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin;
3. Previous malignancy confined and surgically resected (or treated with other modalities) with curative intent; requires discussion with TA MD.

Sites / Locations

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

HVAG regimen

Arm Description

Outcomes

Primary Outcome Measures

Rate of complete remission (CR)

including Complete Remission with incomplete Platelet recovery (CRp) and Complete Remission with incomplete hematologic recovery (CRi)

Secondary Outcome Measures

Event-free survival (EFS)

EFS is defined as the time from the date of randomization until the date of documented relapse or discontinuation of the treatment, or initiation of other anti-leukemic treatment or death from any cause, whichever occurs first

Relapse-free survival

Relapse-free survival (RFS) will be measured from time of CR to either leukemia relapse or death, whichever comes first. Leukemia relapse will be defined as bone marrow (BM) blasts 5% or higher (not attributable to regenerating BM), any circulating blasts (not attributable to regenerating BM or growth factors), or any extra-medullary blast foci as per Revised International Working Group (R-IWG) criteria.

Overall survival(OS)

Safety and tolerability assessed by incidence and severity of adverse events

All grade ≥ 3 toxicities according to CTCAE (Common Terminology Criteria for Adverse Events) version 5 will be tabulated

Full Information

NCT ID

NCT04824924

First Posted

March 28, 2021

Last Updated

March 28, 2021

Sponsor

Shanghai Jiao Tong University School of Medicine

1. Study Identification

Unique Protocol Identification Number

NCT04824924

Brief Title

A Phase 2 Study of Venetoclax in Combination With Low-dose HHT, G-CSF, and AZA as First-line Treatment for Newly Diagnosed Elderly AML Patients Unfit for Intensive Chemotherapy

Official Title

A Phase 2 Study of Venetoclax in Combination With Low-dose HHT, G-CSF, and AZA as First-line Treatment for Newly Diagnosed Elderly AML Patients Unfit for Intensive Chemotherapy

Study Type

Interventional

2. Study Status

Record Verification Date

March 2021

Overall Recruitment Status

Not yet recruiting

Study Start Date

March 2021 (Anticipated)

Primary Completion Date

March 2024 (Anticipated)

Study Completion Date

March 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

Shanghai Jiao Tong University School of Medicine

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

Acute myeloid leukemia (AML) is a group of heterogeneous malignancies derived from hematopoietic precursors. Patients older than 65 years can hardly benefit from standard intensive chemotherapy while having a poor toxicity tolerance, leading to a dismal prognosis. Currently, there is no satisfactory treatment modality for this high-risk patient population, which is an unmet clinical need. Venetoclax (ABT-199/GDC-0199, VEN) is a highly selective, oral B-cell lymphoma 2 (BCL-2) inhibitor that has shown activity in BCL-2- dependent leukemia and lymphoma cell lines, and has recently exerted encouraging therapeutic effect with manageable toxicity profile in the field of treatment of AML. Promising results have emerged in the combination of venetoclax and hypomethylating agents (HMA), decitabine or azacitidin (AZA), producing complete remission (CR) plus CR with incomplete hematologic recovery (CRi) rates of 74% and 66.7%, respectively, in previously untreated elderly AML patients. Homoharringtonine (HHT) is an alkaloid and has been used in Chinese patients with acute and chronic myeloid leukemia for more than 30 years. The add of HHT to the combination of cytarabin and aclarubicin or daunorubicin has been proved to improve CR rate and prognosis of AML patients. Moreover, HHT combined with low-dose cytarabine and granulocyte colony-stimulating factor (G-CSF) has achieved durable efficacy in AML patients, either in the first-line or salvage setting. Interestingly, HHT has potent synergistic effects with VEN through reducing the expression of BCL-XL and MCL-1 in BCL-2 related pathways as previouly reported. This study aims at investigating the combination of HHT, VEN, AZA and G-CSF (HVAG) in the treatment of newly diagnosed elderly AML patients who are ineligible for intensive chemotherapy.

6. Conditions and Keywords

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

Leukemia, Myeloid, Acute

Keywords

AML, venetoclax, combination therapy

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Single Group Assignment

Masking

None (Open Label)

Allocation

N/A

Enrollment

100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title

HVAG regimen

Arm Type

Experimental

Intervention Type

Drug

Intervention Name(s)

The combination of HHT, venetoclax, AZA, G-CSF

Intervention Description

HVAG regimen in a 28-day cycle HHT: d1-d7 1mg/m2; VEN: d1 100mg, d2 200mg, d3-d28 400mg; AZA: d1-d7 75mg/m2; G-CSF: d1-d7 300mg

Primary Outcome Measure Information:

Title

Rate of complete remission (CR)

Description

including Complete Remission with incomplete Platelet recovery (CRp) and Complete Remission with incomplete hematologic recovery (CRi)

Time Frame

Up to 36 months

Secondary Outcome Measure Information:

Title

Event-free survival (EFS)

Description

Time Frame

Up to 36months

Title

Relapse-free survival

Description

Time Frame

36 months

Title

Overall survival(OS)

Time Frame

Up to 36 months

Title

Safety and tolerability assessed by incidence and severity of adverse events

Description

All grade ≥ 3 toxicities according to CTCAE (Common Terminology Criteria for Adverse Events) version 5 will be tabulated

Time Frame

36 months

10. Eligibility

Sex

All

Minimum Age & Unit of Time

60 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Participant must have confirmation of Acute Myeloid Leukemia (AML) by World Health Organization (WHO) criteria, previously untreated and unfit for intensive chemotherapy Participant must be >= 60 years of age. Participant must have a projected life expectancy of at least 12 weeks. Participant must have adequate renal function as demonstrated by a creatinine >= 30 mL/min;determined via urine collection for 24-hour creatinine clearance or by the Cockcroft Gault formula Participant must have adequate liver function as demonstrated by: aspartate aminotransferase (AST) <= 3.0 x ULN* alanine aminotransferase (ALT) <= 3.0 x ULN* bilirubin <= 1.5 x ULN* * Unless considered to be due to leukemic organ involvement i. Subjects who are < 75 years of age may have a bilirubin of <= 3.0 x ULN Exclusion Criteria: Participant has history of myeloproliferative neoplasm (MPN) including myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia (CML) with or without BCR-ABL1 translocation and AML with BCR-ABL1 translocation Participant has acute promyelocytic leukemia Participant has known active central nervous system (CNS) involvement with AML Participant is known to be positive for hepatitis B or C infection Participant has received anticancer therapies including chemotherapy, radiotherapy or other investigational therapy, including targeted small molecule agents within 5 half-lives prior to first dose of study drug Participant has received biologic agents (e.g. monoclonal antibodies) for anti-neoplastic intent within 30 days prior to first dose of study drug Participant has received the following within 7 days prior to the first dose of the study drug: Steroid therapy for anti-neoplastic intent; Strong and Moderate CYP3A inhibitors (see Appendix A for examples) Strong and Moderate CYP3A inducers (see Appendix A for examples) Participant exhibits evidence of other clinically significant uncontrolled systemic infection requiring therapy Participant has a serious cardiovascular, pulmonary or renal disability Participant has a history of other malignancies within 2 years prior to study entry, with the exception of: Adequately treated in situ carcinoma of the cervix uteri or carcinoma in situ of breast; Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin; Previous malignancy confined and surgically resected (or treated with other modalities) with curative intent; requires discussion with TA MD.

12. IPD Sharing Statement

Plan to Share IPD

Learn more about this trial

A Phase 2 Study of Venetoclax in Combination With Low-dose HHT, G-CSF, and AZA as First-line Treatment for Newly Diagnosed Elderly AML Patients Unfit for Intensive Chemotherapy

We'll reach out to this number within 24 hrs