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Carfilzomib in Patients With Relapsed Acute Myeloid or Acute Lymphoblastic Leukemia (AML ALL)

Primary Purpose

Leukemia

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Carfilzomib
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring carfilzomib, acute myeloid leukemia, acute lymphoblastic leukemia, phase I

Eligibility Criteria

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

Inclusion Criteria:

Disease Related

  • Relapsed acute myeloid leukemia or relapsed acute lymphoblastic leukemia. Patients with primary refractory AML or ALL (after standard induction chemotherapy) are also eligible if they have evidence of persistent disease documented by bone marrow biopsy done within 14 days of trial entry.
  • Subjects must have disease documented on bone marrow biopsy done within 14 days of starting cycle 1

Demographic

  • Males and females ≥ 18 years old.
  • Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2.

Laboratory

  • Peripheral blast count must be ≤ 30,000 on the first day of study drug administration. Leukopheresis and hydrea are acceptable measures of leuko-reduction prior to beginning the study drug.
  • Adequate hepatic function with ALT/SGPT ≤ 2.5 x upper limit of normal (ULN) or ≤ 5.0 x ULN if the transaminase elevation is due to leukemic involvement. Serum bilirubin ≤ 2.0 x ULN.
  • Adequate renal function with calculated creatinine clearance of ≥ 15 mL/min (calculated using the Cockcroft and Gault formula) or measured creatinine clearance ≥ 15 mL/min from 24 hour urine collection.
  • Uric acid, if elevated, must be corrected to within laboratory normal range prior to dosing.

Ethical / Other

  • Ability to provide written informed consent obtained prior to participation in the study and any related procedures being performed.
  • Women of childbearing age must have a negative serum pregnancy test within 7 days prior to initiating therapy and be willing to not become pregnant to by using effective contraception while undergoing treatment and for at least 3 months afterwards.
  • Men must be willing not to father a new child while receiving therapy. They must use an effective barrier method of contraception during the study and for 3 months following the last dose.

Exclusion Criteria:

Subjects meeting any of the following exclusion criteria are not eligible to enroll in this study.

Disease Related

  • Active CNS leukemia.
  • Receiving any other investigational agents within 14 days of first dose of study drug.
  • Had cytotoxic chemotherapy within 14 days of first dose of study drug. Leukopheresis and hydrea are allowed as specified per protocol
  • Had allogeneic stem cell transplantation within 100 days of first dose of study drug. Patients with a history of graft-versus-host disease on a stable dose of immunosuppression and who are otherwise medically fit are eligible for the trial. Patients with active graft-versus host disease are excluded.
  • Had radiotherapy within 14 days prior to study enrollment.
  • Subjects with pleural effusions requiring thoracentesis or ascites requiring paracentesis.

Concurrent Conditions

  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, congestive heart failure of NYHA class 3 or 4, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situation that would limit compliance with study requirements.
  • Major surgery within three weeks before Day 1.
  • Active hepatitis A, B, C infection.
  • Known or suspected HIV infection or subjects who are HIV seropositive.
  • Significant neuropathy (Grade 3, 4) at the time of study initiation.
  • Patients in whom oral and/or IV fluid hydration is contraindicated, e.g., due to pre-existing pulmonary, cardiac, or renal impairment, will not be eligible to participate in the clinical trial.

Ethical / Other

-Female subjects who are pregnant or lactating.

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Dose Level 0 (starting dose)

Dose Level +1

Dose Level +2

Arm Description

Carfilzomib - 20 mg/m2 days 1 and 2, 27 mg/m2 for days 8 and 9 of cycle 1 only and, if days 8 and 9 are tolerated, may be increased to 36 mg/m2 for all subsequent doses. If DLT occurs while receiving 36 mg/m2, the dose may be reduced to 27 mg/m2. Dosing schedule is days 1, 2, 8, 9, 15, 16, 22, and 23 with no rest period during the 28 day cycle. Dose will be given IV over 30 minutes. 2 cycles of treatment will be given. If the patient enters at leat a partial remission, then treatment may be extended up to 4 additional cycles.

Carfilzomib - 20 mg/m2 days 1 and 2, 36 mg/m2 for days 8 and 9 of cycle 1 only and, if days 8 and 9 are tolerated, may be increased to 45 mg/m2 for all subsequent doses. If DLT occurs while receiving 45 mg/m2, the dose may be reduced to 36 mg/m2. Dosing schedule is days 1, 2, 8, 9, 15, 16, 22, and 23 with no rest period during the 28 day cycle. Dose will be given IV over 30 minutes. 2 cycles of treatment will be given. If the patient enters at leat a partial remission, then treatment may be extended up to 4 additional cycles.

Carfilzomib - 20 mg/m2 days 1 and 2, 45 mg/m2 for days 8 and 9 of cycle 1 only and, if days 8 and 9 are tolerated, may be increased to 56 mg/m2 for all subsequent doses. If DLT occurs while receiving 56 mg/m2, the dose may be reduced to 45 mg/m2. Dosing schedule is days 1, 2, 8, 9, 15, 16, 22, and 23 with no rest period during the 28 day cycle. Dose will be given IV over 30 minutes. 2 cycles of treatment will be given. If the patient enters at leat a partial remission, then treatment may be extended up to 4 additional cycles.

Outcomes

Primary Outcome Measures

To determine the maximum tolerated dose (MTD) and dose limiting toxicity (DLT)
A hematologic adverse event will not be considered a dose-limiting toxicity. Tumor lysis syndrome is not a dose-limiting toxicity.

Secondary Outcome Measures

To determine the rate of morphologic complete remission (CR)
To determine the rates of cytogenetic complete remission (CRc) morphologic complete remission with incomplete count recovery (CRi), overall response rate (CR+ CRi), partial remission (PR), stable disease and hematologic improvement.
To determine the time to response, remission duration, progression-free survival, event-free survival and overall survival of patients treated with carfilzomib.
To determine the safety and tolerability of carfilzomib by evaluating the number of participants with adverse events as a measure of safety and tolerability.
To prospectively collect serum and bone marrow specimens to determine biomarkers of response and correlative ex vivo studies of the anti-leukemic activity of carfilzomib.

Full Information

First Posted
June 2, 2010
Last Updated
June 13, 2016
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT01137747
Brief Title
Carfilzomib in Patients With Relapsed Acute Myeloid or Acute Lymphoblastic Leukemia
Acronym
AML ALL
Official Title
A Phase I Trial of Carfilzomib in Adult Patients With Relapsed Acute Myeloid and Acute Lymphoblastic Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Completed
Study Start Date
October 2010 (undefined)
Primary Completion Date
August 2014 (Actual)
Study Completion Date
July 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is to test escalating doses of carfilzomib in patients with relapsed acute myeloid and acute lymphoblastic leukemia.
Detailed Description
Several published studies have demonstrated the in vitro anti-leukemic activity of carfilzomib in leukemia cell lines as well as in primary human acute myeloid and acute lymphoblastic leukemia cells. The anti-leukemic activity of carfilzomib was consistently more potent than that of bortezomib, particularly at doses ≥27mg/m2. Importantly, patients treated on the phase I and phase II carfilzomib trials have had low rates of treatment-associated neuropathy. Several large collaborative groups have current phase II clinical trials that incorporate bortezomib into the treatment regimens for acute myeloid or acute lymphoblastic leukemia. Thus, there is a strong rationale for a study of carfilzomib, a potentially more potent proteasome inhibitor with less toxicity, in patients with relapsed acute leukemias.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia
Keywords
carfilzomib, acute myeloid leukemia, acute lymphoblastic leukemia, phase I

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dose Level 0 (starting dose)
Arm Type
Experimental
Arm Description
Carfilzomib - 20 mg/m2 days 1 and 2, 27 mg/m2 for days 8 and 9 of cycle 1 only and, if days 8 and 9 are tolerated, may be increased to 36 mg/m2 for all subsequent doses. If DLT occurs while receiving 36 mg/m2, the dose may be reduced to 27 mg/m2. Dosing schedule is days 1, 2, 8, 9, 15, 16, 22, and 23 with no rest period during the 28 day cycle. Dose will be given IV over 30 minutes. 2 cycles of treatment will be given. If the patient enters at leat a partial remission, then treatment may be extended up to 4 additional cycles.
Arm Title
Dose Level +1
Arm Type
Experimental
Arm Description
Carfilzomib - 20 mg/m2 days 1 and 2, 36 mg/m2 for days 8 and 9 of cycle 1 only and, if days 8 and 9 are tolerated, may be increased to 45 mg/m2 for all subsequent doses. If DLT occurs while receiving 45 mg/m2, the dose may be reduced to 36 mg/m2. Dosing schedule is days 1, 2, 8, 9, 15, 16, 22, and 23 with no rest period during the 28 day cycle. Dose will be given IV over 30 minutes. 2 cycles of treatment will be given. If the patient enters at leat a partial remission, then treatment may be extended up to 4 additional cycles.
Arm Title
Dose Level +2
Arm Type
Experimental
Arm Description
Carfilzomib - 20 mg/m2 days 1 and 2, 45 mg/m2 for days 8 and 9 of cycle 1 only and, if days 8 and 9 are tolerated, may be increased to 56 mg/m2 for all subsequent doses. If DLT occurs while receiving 56 mg/m2, the dose may be reduced to 45 mg/m2. Dosing schedule is days 1, 2, 8, 9, 15, 16, 22, and 23 with no rest period during the 28 day cycle. Dose will be given IV over 30 minutes. 2 cycles of treatment will be given. If the patient enters at leat a partial remission, then treatment may be extended up to 4 additional cycles.
Intervention Type
Drug
Intervention Name(s)
Carfilzomib
Other Intervention Name(s)
Kyprolis
Primary Outcome Measure Information:
Title
To determine the maximum tolerated dose (MTD) and dose limiting toxicity (DLT)
Description
A hematologic adverse event will not be considered a dose-limiting toxicity. Tumor lysis syndrome is not a dose-limiting toxicity.
Time Frame
End of cycle 1
Secondary Outcome Measure Information:
Title
To determine the rate of morphologic complete remission (CR)
Time Frame
Every 2 months for 2 years after first dose of study drug
Title
To determine the rates of cytogenetic complete remission (CRc) morphologic complete remission with incomplete count recovery (CRi), overall response rate (CR+ CRi), partial remission (PR), stable disease and hematologic improvement.
Time Frame
Every 2 months for 2 years after first dose of study drug
Title
To determine the time to response, remission duration, progression-free survival, event-free survival and overall survival of patients treated with carfilzomib.
Time Frame
Every 2 months for 2 years after first dose of study drug
Title
To determine the safety and tolerability of carfilzomib by evaluating the number of participants with adverse events as a measure of safety and tolerability.
Time Frame
30 days after end of treatment
Title
To prospectively collect serum and bone marrow specimens to determine biomarkers of response and correlative ex vivo studies of the anti-leukemic activity of carfilzomib.
Time Frame
Baseline, Day 28 of cycles 1, 2, 4, 6 & End of Study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Disease Related Relapsed acute myeloid leukemia or relapsed acute lymphoblastic leukemia. Patients with primary refractory AML or ALL (after standard induction chemotherapy) are also eligible if they have evidence of persistent disease documented by bone marrow biopsy done within 14 days of trial entry. Subjects must have disease documented on bone marrow biopsy done within 14 days of starting cycle 1 Demographic Males and females ≥ 18 years old. Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2. Laboratory Peripheral blast count must be ≤ 30,000 on the first day of study drug administration. Leukopheresis and hydrea are acceptable measures of leuko-reduction prior to beginning the study drug. Adequate hepatic function with ALT/SGPT ≤ 2.5 x upper limit of normal (ULN) or ≤ 5.0 x ULN if the transaminase elevation is due to leukemic involvement. Serum bilirubin ≤ 2.0 x ULN. Adequate renal function with calculated creatinine clearance of ≥ 15 mL/min (calculated using the Cockcroft and Gault formula) or measured creatinine clearance ≥ 15 mL/min from 24 hour urine collection. Uric acid, if elevated, must be corrected to within laboratory normal range prior to dosing. Ethical / Other Ability to provide written informed consent obtained prior to participation in the study and any related procedures being performed. Women of childbearing age must have a negative serum pregnancy test within 7 days prior to initiating therapy and be willing to not become pregnant to by using effective contraception while undergoing treatment and for at least 3 months afterwards. Men must be willing not to father a new child while receiving therapy. They must use an effective barrier method of contraception during the study and for 3 months following the last dose. Exclusion Criteria: Subjects meeting any of the following exclusion criteria are not eligible to enroll in this study. Disease Related Active CNS leukemia. Receiving any other investigational agents within 14 days of first dose of study drug. Had cytotoxic chemotherapy within 14 days of first dose of study drug. Leukopheresis and hydrea are allowed as specified per protocol Had allogeneic stem cell transplantation within 100 days of first dose of study drug. Patients with a history of graft-versus-host disease on a stable dose of immunosuppression and who are otherwise medically fit are eligible for the trial. Patients with active graft-versus host disease are excluded. Had radiotherapy within 14 days prior to study enrollment. Subjects with pleural effusions requiring thoracentesis or ascites requiring paracentesis. Concurrent Conditions Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, congestive heart failure of NYHA class 3 or 4, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situation that would limit compliance with study requirements. Major surgery within three weeks before Day 1. Active hepatitis A, B, C infection. Known or suspected HIV infection or subjects who are HIV seropositive. Significant neuropathy (Grade 3, 4) at the time of study initiation. Patients in whom oral and/or IV fluid hydration is contraindicated, e.g., due to pre-existing pulmonary, cardiac, or renal impairment, will not be eligible to participate in the clinical trial. Ethical / Other -Female subjects who are pregnant or lactating.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ravi Vij, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Carfilzomib in Patients With Relapsed Acute Myeloid or Acute Lymphoblastic Leukemia

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