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A Study to Investigate Fadraciclib (CYC065), in Subjects With Leukemia or Myelodysplastic Syndrome (MDS)

Primary Purpose

Leukemia, Myelodysplastic Syndrome(MDS)

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
fadraciclib
Sponsored by
Cyclacel Pharmaceuticals, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia

Eligibility Criteria

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

Inclusion Criteria:

  1. Males or females aged ≥ 18 years.
  2. a) AML/MDS with blasts > 10% in subjects who have had an inadequate response or progression to venetoclax combinations with either HMA or low dose Ara-C or similar venetoclax combinations. or b. CLL in subjects who have received at least 2 lines of therapy, including venetoclax and a BTK inhibitor, who require therapy as per iwCLL criteria.
  3. Any prior therapy must have been completed at least 2 weeks prior to enrollment on this protocol, and the participant must have recovered to eligibility levels from prior toxicity
  4. Hydroxyurea may be used for the first 14 days of Cycle 1 for peripheral blast control. Valproic acid not being used for seizure control should be stopped 72 hours before starting treatment with fadraciclib.
  5. Any prior therapy with decitabine or azacitidine must have been completed at least 3 weeks prior to enrollment on this protocol.
  6. Subjects who relapsed post-autologous or post-allogeneic transplant are eligible. Post-transplant subjects must be without active fungal disease or significant acute graft-versus-host disease.
  7. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  8. Women of childbearing potential (WOCBP) must have a negative pregnancy test (urine or serum) within 7 days prior to starting the study drug. Both males and females must agree to use effective birth control during the study (prior to receiving the first dose and for 6 months after the last dose) if conception is possible during this interval.
  9. Subjects must be able to swallow and retain orally administered medication and not have any clinically significant GI abnormalities that may alter the absorption, such as malabsorption syndrome or major resection of the stomach or bowels.
  10. Subjects must be able to agree to and sign the informed consent and to comply with the protocol.

Exclusion Criteria:

  1. Subjects with known active leptomeningeal involvement by AML.
  2. Subjects who have not received vaccines for SARS-COV-2 within the last 3 months and have suspected signs and symptoms of COVID-19 or a recent history (within 14 days) of contact with any COVID-19 positive subject/isolation/quarantine or subjects with confirmed COVID-19.
  3. Subjects with a history of another primary malignancy, other than:

    1. Carcinomas in situ, e.g., breast, cervix, and prostate
    2. Locally excised non-melanoma skin cancer
    3. No evidence of disease from another primary cancer for 2 or more years and has not taken any anticancer treatment in 2 years.
  4. Any other clinically significant acute or chronic medical or psychiatric condition or any laboratory abnormality that may increase the risk associated with study drug administration or may interfere with the interpretation of study results.
  5. Diseases that significantly affect GI absorption of fadraciclib.
  6. Subjects who have impaired cardiac function or clinically significant cardiac disease.
  7. Presence of active chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease) or GI perforation within 6 months of enrollment.
  8. Presence of an active infection requiring IV antibiotics.
  9. Presence of known history of human immunodeficiency virus-1/2 with uncontrolled viral load and on medications that may interfere with metabolism.
  10. Presence of active hepatitis B virus (HBV) or hepatitis C virus (HCV).
  11. Subject has received systemic anticancer therapy (including investigational therapy), radiotherapy, or immunotherapy < 14 days or 5 half-lives (whichever is shorter) prior to administration of Dose 1 of study drug on Day 1 or have not recovered from the side effects of such therapy.
  12. Major surgery/surgical therapy for any cause within 4 weeks of the first dose.

Sites / Locations

  • City of HopeRecruiting
  • MD Anderson Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Phase I Dose escalation

Phase 2

Arm Description

Phase 1 = fadraciclib administered orally in escalating doses starting at 50mg bid MWF for 3 weeks of a 4-week cycle. Subsequent cohorts will escalate in dose and schedule until optimized phase 2 dose and schedule is achieved.

Recommended fadraciclib phase 2 dose and schedule administered orally in 28-day cycles.

Outcomes

Primary Outcome Measures

Maximum tolerated dose
The incidence rate of dose-limiting toxicities (first cycle only) at each dose level
Overall Response Rate (ORR)
Assessment of response criteria according to iwCLL criteria for CLL/SLL and IWG criteria for AML and MDS.

Secondary Outcome Measures

Adverse events
Type, frequency, and severity of adverse drug reactions

Full Information

First Posted
December 9, 2021
Last Updated
April 1, 2022
Sponsor
Cyclacel Pharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05168904
Brief Title
A Study to Investigate Fadraciclib (CYC065), in Subjects With Leukemia or Myelodysplastic Syndrome (MDS)
Official Title
A Phase 1/2, Open Label, Multicenter Study to Investigate the Safety and Efficacy of Fadraciclib (CYC065), an Oral CDK 2/9 Inhibitor, in Subjects With Leukemias or Myelodysplastic Syndrome (MDS)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Recruiting
Study Start Date
October 22, 2021 (Actual)
Primary Completion Date
October 2024 (Anticipated)
Study Completion Date
December 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cyclacel Pharmaceuticals, 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 is a 2-part, phase 1/2, open-label, multicenter study designed to evaluate the safety and efficacy of fadraciclib (formerly CYC065) administered orally BID. This study consists of Phase 1 and Phase 2 components in subjects with Leukemia or Myelodysplastic syndrome (MDS) who have progressed despite having standard therapy or for which no standard therapy exists.
Detailed Description
Phase 1 part of the study will consist of a dose-escalation and a dose-finding component. Phase 2 will enroll subjects AML, CLL, or MDS, into 7 groups: Group 1: Subjects with AML or MDS having marrow blasts over > 10%, who have experienced an inadequate response or progression on venetoclax combinations with either HMAs or low dose Ara-C or similar venetoclax combinations Group 2: Fadraciclib: Subjects with AML or MDS relapsed/refractory having marrow blasts over > 10% with FLT3, KIT, MAPK pathway (N and K RAS, BRAF, PTPN11, NF1) mutations after at least 1 line of prior therapy. Group 3: Fadraciclib: Subjects with CLL who have progressed on 2 or more lines of therapy, including a Bruton's tyrosine kinase (BTK) inhibitor and venetoclax. Group 4: Fadraciclib plus azacitidine: Subjects with AML or MDS who have progressed after therapy with an HMA. Group 5: Fadraciclib plus venetoclax: Subjects with AML or MDS who have progressed after therapy with venetoclax. Group 6: Fadraciclib plus venetoclax: Subjects with CLL or small lymphocytic lymphoma (SLL) who have progressed after therapy with venetoclax. Group 7: Basket cohort: Leukemia types suspected to have a related mechanism of action such as MCL1, or MYC amplification/over-expression not included in previous groups

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Myelodysplastic Syndrome(MDS)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
210 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Phase I Dose escalation
Arm Type
Experimental
Arm Description
Phase 1 = fadraciclib administered orally in escalating doses starting at 50mg bid MWF for 3 weeks of a 4-week cycle. Subsequent cohorts will escalate in dose and schedule until optimized phase 2 dose and schedule is achieved.
Arm Title
Phase 2
Arm Type
Experimental
Arm Description
Recommended fadraciclib phase 2 dose and schedule administered orally in 28-day cycles.
Intervention Type
Drug
Intervention Name(s)
fadraciclib
Other Intervention Name(s)
CYC065
Intervention Description
Fadraciclib is a highly selective, orally- and intravenously- available, 2nd generation amino-purine inhibitor of CDK2 and CDK9.
Primary Outcome Measure Information:
Title
Maximum tolerated dose
Description
The incidence rate of dose-limiting toxicities (first cycle only) at each dose level
Time Frame
6 months
Title
Overall Response Rate (ORR)
Description
Assessment of response criteria according to iwCLL criteria for CLL/SLL and IWG criteria for AML and MDS.
Time Frame
18 months
Secondary Outcome Measure Information:
Title
Adverse events
Description
Type, frequency, and severity of adverse drug reactions
Time Frame
24 months
Other Pre-specified Outcome Measures:
Title
Pharmacodynamics
Description
To investigate CDK9-dependent transcription inhibition as assessed by differential target gene expression relative to baseline.
Time Frame
6 months
Title
Pharmacogenomics
Description
To investigate plasma cell-free DNA mutation and copy number variation profile of fadraciclib as determined by NGS.
Time Frame
24 months
Title
Correlative studies
Description
To investigate effect on epigenetics, immunomodulation and apoptotic pathway
Time Frame
24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males or females aged ≥ 18 years. a) AML/MDS with blasts > 10% in subjects who have had an inadequate response or progression to venetoclax combinations with either HMA or low dose Ara-C or similar venetoclax combinations. or b. CLL in subjects who have received at least 2 lines of therapy, including venetoclax and a BTK inhibitor, who require therapy as per iwCLL criteria. Any prior therapy must have been completed at least 2 weeks prior to enrollment on this protocol, and the participant must have recovered to eligibility levels from prior toxicity Hydroxyurea may be used for the first 14 days of Cycle 1 for peripheral blast control. Valproic acid not being used for seizure control should be stopped 72 hours before starting treatment with fadraciclib. Any prior therapy with decitabine or azacitidine must have been completed at least 3 weeks prior to enrollment on this protocol. Subjects who relapsed post-autologous or post-allogeneic transplant are eligible. Post-transplant subjects must be without active fungal disease or significant acute graft-versus-host disease. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Women of childbearing potential (WOCBP) must have a negative pregnancy test (urine or serum) within 7 days prior to starting the study drug. Both males and females must agree to use effective birth control during the study (prior to receiving the first dose and for 6 months after the last dose) if conception is possible during this interval. Subjects must be able to swallow and retain orally administered medication and not have any clinically significant GI abnormalities that may alter the absorption, such as malabsorption syndrome or major resection of the stomach or bowels. Subjects must be able to agree to and sign the informed consent and to comply with the protocol. Exclusion Criteria: Subjects with known active leptomeningeal involvement by AML. Subjects who have not received vaccines for SARS-COV-2 within the last 3 months and have suspected signs and symptoms of COVID-19 or a recent history (within 14 days) of contact with any COVID-19 positive subject/isolation/quarantine or subjects with confirmed COVID-19. Subjects with a history of another primary malignancy, other than: Carcinomas in situ, e.g., breast, cervix, and prostate Locally excised non-melanoma skin cancer No evidence of disease from another primary cancer for 2 or more years and has not taken any anticancer treatment in 2 years. Any other clinically significant acute or chronic medical or psychiatric condition or any laboratory abnormality that may increase the risk associated with study drug administration or may interfere with the interpretation of study results. Diseases that significantly affect GI absorption of fadraciclib. Subjects who have impaired cardiac function or clinically significant cardiac disease. Presence of active chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease) or GI perforation within 6 months of enrollment. Presence of an active infection requiring IV antibiotics. Presence of known history of human immunodeficiency virus-1/2 with uncontrolled viral load and on medications that may interfere with metabolism. Presence of active hepatitis B virus (HBV) or hepatitis C virus (HCV). Subject has received systemic anticancer therapy (including investigational therapy), radiotherapy, or immunotherapy < 14 days or 5 half-lives (whichever is shorter) prior to administration of Dose 1 of study drug on Day 1 or have not recovered from the side effects of such therapy. Major surgery/surgical therapy for any cause within 4 weeks of the first dose.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Mark H Kirschbaum, MD
Phone
626-316-3394
Email
mkirschbaum@cyclacel.com
First Name & Middle Initial & Last Name or Official Title & Degree
Julius Huang, PhD
Email
jhuang@cyclacel.com
Facility Information:
Facility Name
City of Hope
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Wirlen Elame
Email
welame@coh.org
Facility Name
MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gautam Borthakur
Email
gborthak@mdanderson.org
First Name & Middle Initial & Last Name & Degree
Gautam Borthakur, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Study to Investigate Fadraciclib (CYC065), in Subjects With Leukemia or Myelodysplastic Syndrome (MDS)

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