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Fludarabine/Carboplatin/Topotecan w/Thalidomide for Relapsed/Refractory AML, CML and MDS

Primary Purpose

Leukemia, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
carboplatin
fludarabine phosphate
thalidomide
topotecan hydrochloride
Sponsored by
Case Comprehensive Cancer Center
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring adult acute promyelocytic leukemia (M3), refractory anemia with excess blasts in transformation, refractory anemia with excess blasts, de novo myelodysplastic syndromes, recurrent adult acute myeloid leukemia, secondary acute myeloid leukemia, untreated adult acute myeloid leukemia, blastic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, adult acute myeloid leukemia with t(8;21)(q22;q22), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with t(15;17)(q22;q12)

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Diagnosis of 1 of the following: Acute myeloid leukemia meeting 1 of the following criteria: Previously untreated and not a candidate for anthracycline-based chemotherapy In first or second relapse or refractory Secondary to chemotherapy or an antecedent hematologic disorder and treated with no more than 1 prior intensive induction regimen Chronic myelogenous leukemia in blast crisis at diagnosis or after prior imatinib mesylate Myelodysplastic syndromes (MDS) Refractory anemia with excess blasts (RAEB) or RAEB in transformation Must meet at least 1 of the following criteria: Absolute neutrophil count no greater than 500/mm^3 Platelet or red cell transfusion-dependent after no more than 1 prior intensive induction chemotherapy Acute promyelocytic leukemia t(15, 17) Failed prior treatment with tretinoin and arsenic Relapsed disease at least 3 months after prior autologous stem cell transplantation No active CNS leukemia PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-3 Life expectancy At least 8 weeks Hematopoietic See Disease Characteristics Hepatic Bilirubin no greater than 2.0 mg/dL AST and ALT less than 3 times upper limit of normal Renal Creatinine clearance at least 50 mL/min Cardiovascular Ejection fraction at least 40% No poorly controlled cardiac disease Pulmonary No poorly controlled pulmonary disease Other Not pregnant or nursing Negative pregnancy test Fertile female patients must use 1 highly effective and 1 additional method of contraception for 4 weeks before, during, and for at least 4 weeks after study Male patients must use effective contraception during and for 4 weeks after study Willing and able to comply with the System for Thalidomide Education and Prescribing Safety (STEPS) program HIV negative No poorly controlled infection No other active malignancy No severe peripheral neuropathy PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics Prior thalidomide allowed for MDS At least 5 days since prior hematopoietic growth factors At least 2 weeks since prior biologic therapy No prior allogeneic bone marrow transplantation Chemotherapy See Disease Characteristics At least 24 hours since prior hydroxyurea Endocrine therapy At least 24 hours since prior corticosteroids Radiotherapy Not specified Surgery Not specified Other At least 2 weeks since prior cytotoxic anticancer therapy Prior amifostine allowed for MDS

Sites / Locations

  • Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center

Outcomes

Primary Outcome Measures

Complete response rate

Secondary Outcome Measures

Full Information

First Posted
January 27, 2003
Last Updated
June 9, 2010
Sponsor
Case Comprehensive Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00053287
Brief Title
Fludarabine/Carboplatin/Topotecan w/Thalidomide for Relapsed/Refractory AML, CML and MDS
Official Title
Phase II Study of Fludarabine, Carboplatin, and Topotecan With Thalidomide for Patients With Relapsed/Refractory or High Risk Acute Myelogenous Leukemia, Chronic Myeloid Leukemia and Advanced Myelodysplastic Syndromes
Study Type
Interventional

2. Study Status

Record Verification Date
June 2010
Overall Recruitment Status
Completed
Study Start Date
September 2002 (undefined)
Primary Completion Date
January 2007 (Actual)
Study Completion Date
March 2007 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Case Comprehensive Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Thalidomide may stop the growth of cancer cells by stopping blood flow to the tumor. Combining chemotherapy with thalidomide may kill more cancer cells. PURPOSE: Phase II trial to study the effectiveness of combining fludarabine, carboplatin, and topotecan with thalidomide in treating patients who have relapsed or refractory acute myeloid leukemia, chronic myelogenous leukemia, or advanced myelodysplastic syndromes.
Detailed Description
OBJECTIVES: Determine the response rate of patients with relapsed/refractory or high-risk acute myeloid leukemia, chronic myelogenous leukemia, or advanced myelodysplastic syndromes treated with fludarabine, carboplatin, topotecan, and thalidomide. Determine the non-hematologic toxicity profile and time to hematopoietic recovery in patients treated with this regimen. Determine the effects of this regimen on changes in biologic parameters that may predict response in these patients. Correlate bone marrow microvascular density before and after treatment with response in these patients. Determine the prognostic value of pretreatment plasma and serum levels of vascular endothelial growth factor (VEGF) and/or the modulation of serum levels of VEGF during treatment in predicting response in these patients. OUTLINE: Patients are stratified according to diagnosis (previously untreated acute leukemia vs other). Patients receive fludarabine IV over 5-10 minutes and carboplatin IV over 24 hours on days 1-5 followed by topotecan IV continuously over 72 hours. Patients receive oral thalidomide daily beginning within days 1-3 and continuing in the absence of disease progression or unacceptable toxicity. Patients with residual disease on day 16-18 may receive a second course of chemotherapy as above. Patients who achieve remission may receive a third course of chemotherapy as above as consolidation beginning 4-8 weeks after completion of prior chemotherapy. Patients are followed monthly for 6 months. PROJECTED ACCRUAL: A total of 40 patients (20 per stratum) will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases
Keywords
adult acute promyelocytic leukemia (M3), refractory anemia with excess blasts in transformation, refractory anemia with excess blasts, de novo myelodysplastic syndromes, recurrent adult acute myeloid leukemia, secondary acute myeloid leukemia, untreated adult acute myeloid leukemia, blastic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, adult acute myeloid leukemia with t(8;21)(q22;q22), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with t(15;17)(q22;q12)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
42 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
carboplatin
Intervention Description
Carboplatin IV over 24 hours on days 1-5
Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate
Intervention Description
Fludarabine IV over 5-10 minutes on days 1-5.
Intervention Type
Drug
Intervention Name(s)
thalidomide
Intervention Description
Oral thalidomide daily beginning within days 1-3 and continuing in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
topotecan hydrochloride
Intervention Description
Topotecan IV continuously over 72 hours.
Primary Outcome Measure Information:
Title
Complete response rate
Time Frame
6 weeks after treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of 1 of the following: Acute myeloid leukemia meeting 1 of the following criteria: Previously untreated and not a candidate for anthracycline-based chemotherapy In first or second relapse or refractory Secondary to chemotherapy or an antecedent hematologic disorder and treated with no more than 1 prior intensive induction regimen Chronic myelogenous leukemia in blast crisis at diagnosis or after prior imatinib mesylate Myelodysplastic syndromes (MDS) Refractory anemia with excess blasts (RAEB) or RAEB in transformation Must meet at least 1 of the following criteria: Absolute neutrophil count no greater than 500/mm^3 Platelet or red cell transfusion-dependent after no more than 1 prior intensive induction chemotherapy Acute promyelocytic leukemia t(15, 17) Failed prior treatment with tretinoin and arsenic Relapsed disease at least 3 months after prior autologous stem cell transplantation No active CNS leukemia PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-3 Life expectancy At least 8 weeks Hematopoietic See Disease Characteristics Hepatic Bilirubin no greater than 2.0 mg/dL AST and ALT less than 3 times upper limit of normal Renal Creatinine clearance at least 50 mL/min Cardiovascular Ejection fraction at least 40% No poorly controlled cardiac disease Pulmonary No poorly controlled pulmonary disease Other Not pregnant or nursing Negative pregnancy test Fertile female patients must use 1 highly effective and 1 additional method of contraception for 4 weeks before, during, and for at least 4 weeks after study Male patients must use effective contraception during and for 4 weeks after study Willing and able to comply with the System for Thalidomide Education and Prescribing Safety (STEPS) program HIV negative No poorly controlled infection No other active malignancy No severe peripheral neuropathy PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics Prior thalidomide allowed for MDS At least 5 days since prior hematopoietic growth factors At least 2 weeks since prior biologic therapy No prior allogeneic bone marrow transplantation Chemotherapy See Disease Characteristics At least 24 hours since prior hydroxyurea Endocrine therapy At least 24 hours since prior corticosteroids Radiotherapy Not specified Surgery Not specified Other At least 2 weeks since prior cytotoxic anticancer therapy Prior amifostine allowed for MDS
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brenda W. Cooper, MD
Organizational Affiliation
Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center
Official's Role
Study Chair
Facility Information:
Facility Name
Ireland Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106-5065
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Fludarabine/Carboplatin/Topotecan w/Thalidomide for Relapsed/Refractory AML, CML and MDS

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