A Study of Venetoclax in Combination With Azacitidine Versus Azacitidine in Treatment Naïve Participants With Acute Myeloid Leukemia Who Are Ineligible for Standard Induction Therapy (Viale-a)
Acute Myeloid Leukemia (AML)
About this trial
This is an interventional treatment trial for Acute Myeloid Leukemia (AML) focused on measuring Acute Myeloid Leukemia, Venetoclax, Treatment Naïve, Azacitidine
Eligibility Criteria
Inclusion Criteria:
- Participant must have confirmation of Acute Myeloid Leukemia (AML) by World Health Organization (WHO) criteria, previously untreated and be ineligible for treatment with a standard cytarabine and anthracycline induction regimen due age or comorbidities.
- Participant must be >= 18 years of age.
- Participant must have a projected life expectancy of at least 12 weeks.
Participant must be considered ineligible for induction therapy defined by the following:
a. >= 75 years of age; or b. >= 18 to 74 years of age with at least one of the following comorbidities: i. Eastern Cooperative Oncology Group (ECOG) Performance Status of 2 or 3; ii. Cardiac history of Congestive Heart Failure (CHF) requiring treatment or Ejection Fraction <= 50% or chronic stable angina; iii. Diffusing capacity of the Lung for Carbon Monoxide (DLCO) <= 65% or Forced Expiratory Volume in 1 second (FEV1) <= 65%; iv. Creatinine clearance >= 30 mL/min to < 45 ml/min; v. Moderate hepatic impairment with total bilirubin > 1.5 to <= 3.0 × Upper Limit of Normal (ULN); vi. Any other comorbidity that the physician judges to be incompatible with intensive chemotherapy must be reviewed and approved by the AbbVie Therapeutic Medical Director during screening and before study enrollment.
Participant must have an ECOG Performance status:
- 0 to 2 for Participants >= 75 years of age or
- 0 to 3 for Participants >= 18 to 74 years of age.
- Participant must have adequate renal function as demonstrated by a creatinine >= 30 mL/min; calculated by the Cockcroft Gault formula or measured by 24 hours urine collection.
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
Female participants must be either postmenopausal defined as:
- Age > 55 years with no menses for 12 or more months without an alternative medical cause.
- Age ≤ 55 years with no menses for 12 or more months without an alternative medical cause AND an FSH level > 40 IU/L; or
- Permanently surgical sterile (bilateral oophorectomy, bilateral salpingectomy or hysterectomy); or
- Women of Childbearing Potential (WOCBP) practicing at least one protocol specified method of birth control, starting at Study Day 1 through at least 90 days after the last dose of study drug.
- Male Participants who are sexually active, must agree, from Study Day 1 through at least 90 days after the last dose of study drug, to practice the protocol specified contraception. Male subjects must agree to refrain from sperm donation from initial study drug administration through at least 90 days after the last dose of study drug.
Female participants of childbearing potential must have negative results for pregnancy test performed:
- At Screening with a serum sample obtained within 14 days prior to the first study drug administration, and
- Prior to dosing with urine sample obtained on Cycle 1 Day 1, if it has been > 7 days since obtaining the serum pregnancy test results.
- Participant must voluntarily sign and date an informed consent, approved by an Independent Ethics Committee (IEC)/Institutional Review Board (IRB), prior to the initiation of any screening or study-specific procedures.
Exclusion Criteria:
Participant has received treatment with the following:
- A hypomethylating agent, venetoclax and/or chemo therapeutic agent for Myelodysplastic syndrome (MDS).
- Chimeric Antigen Receptor (CAR)-T cell therapy.
- Experimental therapies for MDS or Acute Myeloid Leukemia (AML).
- Current participation in another research or observational study.
- 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 the following:
a. Favorable risk cytogenetics such as t(8;21), inv(16) or t(16;16) or t(15;17) as per the National Comprehensive Cancer Network (NCCN) Guidelines Version 2, 2016 for Acute Myeloid Leukemia.
- Participant has acute promyelocytic leukemia
- Participant has known active central nervous system (CNS) involvement with AML.
- Participant has known HIV infection (due to potential drug-drug interactions between antiretroviral medications and venetoclax) HIV testing will be performed at Screening, only if required per local guidelines or institutional standards.
- Participant is known to be positive for hepatitis B or C infection [HCV Ab indicative of a previous or current infection; and/or positive HBs Ag or detected sensitivity on HBV DNA PCR test for HBc Ab and/or HBs Ab positivity] with the exception of those with an undetectable viral load within 3 months screening. Hepatitis B or C testing is not required.
- Participant has received strong and/or moderate CYP3A inducers within 7 days prior to the initiation of study treatment; additional details as described in the protocol.
- Participant has consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or Starfruit within 3 days prior to the initiation of study treatment.
- Participant has a cardiovascular disability status of New York Heart Association Class > 2. Class 2 is defined as cardiac disease in which patients are comfortable at rest but ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain.
- Participant has chronic respiratory disease that requires continuous oxygen, or significant history of renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, hepatic, cardiovascular disease, any other medical condition or known hypersensitivity to any of the study medications including excipients of azacitidine that in the opinion of the investigator would adversely affect his/her participating in this study.
- Participant has a malabsorption syndrome or other condition that precludes enteral route of administration.
- Participant exhibits evidence of other clinically significant uncontrolled systemic infection requiring therapy (viral, bacterial or fungal).
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.
- Participant has a white blood cell count > 25 × 10^9/L. (Hydroxyurea or leukapheresis are permitted to meet this criterion.)
Sites / Locations
- City of Hope /ID# 154105
- University of California, Los Angeles /ID# 154107
- University of California, Davis Comprehensive Cancer Center /ID# 162725
- Emory Midtown Infectious Disease Clinic /ID# 162534
- Northwestern University Feinberg School of Medicine /ID# 201133
- University of Chicago Medicine /ID# 154108
- Fort Wayne Medical Oncology /ID# 157190
- Cotton-O'Neil Clinical Res Ctr /ID# 155136
- Norton Cancer Institute /ID# 154992
- EMMC Cancer Care /ID# 154991
- Johns Hopkins University /ID# 154104
- Massachusetts General Hospital /ID# 200752
- Beth Israel Deaconess Medical Center /ID# 201155
- Dana-Farber Cancer Institute /ID# 167009
- Sepctrum Health Medical Center /ID# 159522
- Columbia Univ Medical Center /ID# 154101
- Memorial Sloan Kettering Cancer Center-Koch Center /ID# 165077
- Duke Cancer Center /ID# 154106
- University of Pittsburgh MC /ID# 154102
- Tennessee Oncology-Nashville Centennial /ID# 200854
- University of Texas MD Anderson Cancer Center /ID# 154100
- Baylor Scott & White Medical Center- Temple /ID# 157191
- University of Utah /ID# 157192
- University Of Vermont Medical /ID# 157196
- Princess Alexandra Hospital /ID# 154272
- Royal Adelaide Hospital /ID# 154271
- Alfred Health /ID# 154275
- St Vincent's Hospital Melbourne /ID# 155094
- The Royal Melbourne Hospital /ID# 155095
- Sir Charles Gairdner Hospital /ID# 163924
- Royal Perth Hospital /ID# 154274
- Universitaetsklinikum St. Poelten /ID# 167436
- Ordensklinikum Linz GmbH Barmherzige Schwestern /ID# 154888
- Ordensklinikum Linz GmbH Elisabethinen /ID# 154885
- Medizinische Universitaet Graz /ID# 157882
- Duplicate_Landeskrankenhaus Salzburg /ID# 169719
- Hanusch Krankenhaus /ID# 155676
- UZ Brussel /ID# 153393
- UCL Saint-Luc /ID# 153391
- UZ Gent /ID# 153392
- AZ Sint-Jan Brugge /ID# 154041
- Hospital de Clinicas de Porto Alegre /ID# 157779
- Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto - USP /ID# 153099
- Instituto de Ensino e Pesquisa São Lucas /ID# 157778
- Instituto do Câncer do Estado de São Paulo - ICESP /ID# 153095
- Tom Baker Cancer Centre /ID# 159645
- St. Paul's Hospital /ID# 159644
- Juravinski Cancer Centre /ID# 153650
- Ottawa Hospital Research Institute /ID# 153541
- Princess Margaret Cancer Centre /ID# 153651
- Fujian Medical University Union Hospital /ID# 167314
- Nanfang Hospital of Southern Medical University /ID# 170148
- The Second Hospital of Hebei Medical University /ID# 167316
- Henan Cancer Hospital /ID# 167320
- Tongji Hospital Tongji Medical College Huazhong University of Science and Techno /ID# 167315
- Union Hospital Tongji Medical College Huazhong University of Science and Technol /ID# 167493
- Jiangsu Province Hospital /ID# 167489
- The First Hospital of Jilin University /ID# 167490
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine /ID# 167318
- West China Hospital, Sichuan University /ID# 167492
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sc /ID# 167487
- The First Affiliated Hospital, Zhejiang University School of Medicine /ID# 167317
- Qilu Hospital of Shandong University /ID# 167485
- Clinical Hospital Dubrava /ID# 153515
- Klinicki bolnicki centar Zagreb /ID# 153383
- Duplicate_Klinicki bolnicki centar Osijek /ID# 153623
- Fakultni Nemocnice Brno /ID# 154019
- Fakultni nemocnice Hradec Kralove /ID# 154021
- Fakultni nemocnice Ostrava /ID# 154017
- Fakultni nemocnice Plzen /ID# 154018
- Aalborg University Hospital /ID# 154047
- Tampere University Hospital /ID# 154963
- Helsinki University Hospital /ID# 155223
- Turku University Hospital /ID# 154964
- CHU Bordeaux - Hopital Haut Leveque /ID# 153789
- Chu Angers /Id# 153792
- AP-HP - Hopital Saint-Louis /ID# 153787
- IUCT Oncopole /ID# 153788
- Universitaetsklinikum Ulm /ID# 153054
- Universitaetsklinikum Frankfurt /ID# 153060
- Universitaetsklinikum Muenster /ID# 153059
- Universitaetsklinikum Halle (Saale) /ID# 153058
- Universitaetsklinikum Hamburg-Eppendorf (UKE) /ID# 153056
- Medizinische Hochschule Hannover /ID# 153055
- Szegedi Tudomanyegyetem Szent-Gyorgyi Albert Klinikai Kozpont /ID# 153812
- Debreceni Egyetem Klinikai Kozpont /ID# 153814
- Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktatokorhaz Josa Andras Okta /ID# 169854
- Somogy Megyei Kaposi Mor Oktato Korhaz /ID# 153813
- Semmelweis Egyetem /ID# 153816
- Duplicate_Semmelweis Egyetem /ID# 153815
- Del-pesti Centrumkorhaz Orszagos Hematologiai es Infektologiai Intezet /ID# 158990
- The Chaim Sheba Medical Center /ID# 154173
- Tel Aviv Sourasky Medical Center /ID# 154175
- Assaf Harofeh Medical Center /ID# 158063
- Rambam Health Care Campus /ID# 154174
- Hadassah /ID# 154172
- Rabin Medical Center /ID# 154176
- Presidio Ospedaliero Vito Fazzi /ID# 170837
- Fondazione PTV Policlinico Tor Vergata /ID# 152881
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona /ID# 171220
- Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII (Presidio Papa Giovanni /ID# 152875
- IRCCS Azienda Ospedaliero-Universitaria di Bologna /ID# 152883
- Ospedale Policlinico San Martino /ID# 158104
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico /ID# 152882
- Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli /ID# 152879
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli /ID# 152877
- Azienda Ospedaliero-Universitaria Sant'Andrea /ID# 152876
- Aichi Cancer Center Hospital /ID# 200824
- University of Fukui Hospital /ID# 167432
- National Hospital Organization Kyushu Cancer Center /ID# 201111
- Kyushu University Hospital /ID# 169095
- Gunmaken Saiseikai Maebashi Hospital /ID# 168316
- National Hospital Organization Mito Medical Center /ID# 168219
- Hitachi General Hospital /ID# 201109
- Duplicate_Kyoto Prefectural University of Medicine /ID# 167661
- Tohoku University Hospital /ID# 169259
- Nagasaki University Hospital /ID# 168632
- Okayama University Hospital /ID# 204124
- Duplicate_Kindai University Hospital /ID# 167662
- Osaka Metropolitan University Hospital /ID# 169055
- Saitama Medical University International Medical Center /ID# 167814
- Juntendo University Hospital /ID# 168309
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital /ID# 168639
- The Jikei University Daisan Hospital /ID# 168745
- NTT Medical Center Tokyo /ID# 167975
- Yamagata University Hospital /ID# 167634
- Duplicate_Konkuk University Medical Ctr /ID# 153973
- Seoul National University Hospital /ID# 153675
- Samsung Medical Center /ID# 153674
- Akershus universitetssykehus /ID# 154279
- Drammen Sykehus /ID# 154280
- Haukeland University Hospital /ID# 154281
- Sykehuset Ostfold Kalnes /ID# 157755
- Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego we Wrocławiu /ID# 153389
- Osrodek Badan Klinicznych przy Szpitalu Specjalistycznym im. Ludwika Rydygiera w /ID# 169846
- SP ZOZ Zespol Szpitali Miejskich w Chorzowie /ID# 153385
- Duplicate_Hospital de Braga /ID# 154797
- IPO Porto FG, EPE /ID# 154138
- VA Caribbean Healthcare System /ID# 160507
- Kuzbass Regional Clinical Hospital /ID# 157461
- Moscow State budget healthcare /ID# 155738
- Nizhny Novgorod Regional Clinical Hospital named N.A. Semashko /ID# 153268
- Duplicate_Regional Oncology Dispensary /ID# 153264
- State Institution of Health of the Ryazan Regional Clinical Hospital /ID# 157460
- Saratov State Medical University n.a. V.I. Razumovskiy /ID# 153267
- Federal State Budgetary Ins NRC for Hematology of MoH of Russian Federation /ID# 155740
- Samara State Medical University /ID# 157462
- University of Pretoria /ID# 153682
- Albert Alberts Stem Cell Transplant Centre /ID# 153684
- Hospital Universitario de Navarra /ID# 153254
- Hospital Clinic de Barcelona /ID# 153255
- Hospital Santa Creu i Sant Pau /ID# 153193
- Hospital Universitario de la Princesa /ID# 153256
- Hospital General Universitario Gregorio Maranon /ID# 153260
- Hospital Universitario 12 de Octubre /ID# 153258
- Hospital Universitario Virgen de la Victoria /ID# 153257
- Hospital Universitario y Politecnico La Fe /ID# 153259
- Akademiska Sjukhuset /ID# 153034
- Uddevalla sjukhus /ID# 156875
- Dup_VO Hematologi /ID# 153174
- Karolinska University Hospital /ID# 170003
- Changhua Christian Hospital /ID# 153899
- Kaohsiung Medical University Chung-Ho Memorial Hospital /ID# 153902
- China Medical University Hospital /ID# 153904
- National Taiwan University Hospital /ID# 153900
- Hacettepe University Faculty of Medicine /ID# 202073
- Ankara Universitesi Fakultesi /ID# 155200
- Ondokuz Mayis Universitesi Tip /ID# 155201
- Kyiv city clinical hospital #9 /ID# 153510
- Municipal Non-Profit Enterprise City Clinical Hospital 4 of Dnipro City Council /ID# 153511
- Kyiv Regional Onco Dispensary /ID# 153514
- Poltava Reg Clin Hosp Sklifoso /ID# 153513
Arms of the Study
Arm 1
Arm 2
Arm 3
Placebo Comparator
Active Comparator
Active Comparator
Group 1 and Group 2: Placebo + Azacitidine 75 mg/m^2
Group 1 and Group 2: Venetoclax 100 mg/200 mg/400 mg + Azacitidine 75 mg/m^2
Open Label China Cohort: Venetoclax 400 mg + Azacitidine 75 mg/m^2
Participants enrolled under original protocol and enrolled during or after protocol amendment 1 received venetoclax-matching placebo, orally, every day (QD), from Day 1 to Day 28 of each 28 day cycle along with azacitidine 75 mg/m^2, subcutaneously (SC) or intravenously (IV), QD for 7 days from Day 1 of each 28-day cycle until documented disease progression, unacceptable toxicity, withdrawal of consent, or other protocol criteria for discontinuation (whichever occurred first).
Participants enrolled under original protocol and enrolled during or after protocol amendment 1 received venetoclax 100 mg, once orally, on Day 1 of Cycle 1 followed by venetoclax 200 mg, once orally, on Day 2 of Cycle 1 and venetoclax 400 mg, orally, QD, on Day 3 to Day 28 of each 28 day cycle along with azacitidine 75 mg/m^2, SC or IV, QD for 7 days from Day 1 of each 28-day cycle until documented disease progression, unacceptable toxicity, withdrawal of consent, or other protocol criteria for discontinuation (whichever occurred first).
Participants received venetoclax 400 mg, orally, QD, from Day 1 to Day 28 of each 28 day cycle along with azacitidine 75 mg/m^2, SC, QD for 7 days from Day 1 of each 28-day cycle until documented disease progression, unacceptable toxicity, withdrawal of consent, or other protocol criteria for discontinuation (whichever occurred first).