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PF-04449913 For Patients With Acute Myeloid Leukemia at High Risk of Relapse After Donor Stem Cell Transplant

Primary Purpose

Adult Acute Myeloid Leukemia in Remission, Recurrent Adult Acute Myeloid Leukemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
PF-04449913
Sponsored by
University of Colorado, Denver
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adult Acute Myeloid Leukemia in Remission focused on measuring Myeloid leukemia in remission, Recurrent myeloid leukemia

Eligibility Criteria

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

Inclusion Criteria:

  • WHO-confirmed AML
  • Age ≥18 years
  • Between days 28 and 50 post transplantation at the time of initiation of the study drug
  • ECOG performance status ≤ 2 (See Appendix A: ECOG Performance Status Scale)
  • Life expectancy > 2 months
  • Recipient of a myeloablative or non-myeloablative allogeneic HSCT

    • Conditioning regimen to be prescribed at investigator's discretion, but will be prospectively defined as myeloablative or non-myeloablative
  • Stable engraftment, as defined by absolute neutrophil count (ANC) ≥ 1000/mm3 and platelets ≥ 25,000/mm3
  • In morphologic remission (< 5% marrow blasts) based on BM biopsy performed +/- 5 days of day 28 post- transplantation
  • Without clinical signs of active central nervous system disease
  • For non-myeloablative transplants, ≥50% CD3 donor chimerism at screening
  • High risk of relapse after HSCT, defined as the presence of minimal residual disease as measured by flow cytometry in the absence of evidence of morphologic disease on a bone marrow biopsy prior to HSCT
  • Adequate organ function as indicated by the following laboratory values:

    • Aspartate aminotransferase (AST), alanine aminotransferase, (ALT) ≤ 3.0 x institutional upper limit of normal (ULN)
    • Total bilirubin ≤ 2.0 x institutional ULN, unless documented Gilbert's syndrome
    • Either creatinine <1.5 x institutional upper limit of normal (ULN) or creatinine clearance >60 mL/min as calculated by institution's standard formula
  • Serum/urine pregnancy test (for females of childbearing potential) that is negative within 72 hours prior to initiation of first dose of treatment (a patient is of childbearing potential if, in the opinion of the investigator, she is biologically capable of having children and is sexually active)
  • Female patients of childbearing potential and sexually active males and female partners of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 90 days after the last dose of assigned treatment.
  • Subject is able to comply with study procedures and follow-up examinations.

Exclusion Criteria:

  • Concomitant treatment with other anti-neoplastic agents, with the exception, when clinically indicated, of prophylaxis in the post-transplantation setting with intrathecal chemotherapy
  • Use of any other experimental drug or therapy within 28 days of baseline
  • Inability to swallow or absorb drug
  • Active uncontrolled acute fungal, bacterial, or other infection that is unresponsive to therapy at time of study drug dosing
  • Unstable angina pectoris
  • New York Heart Association Class III or IV heart failure
  • QTc interval (using Fridericia's correction formula, QTcF, if prolonged) >470 msec
  • Active cardiac arrhythmias with rapid ventricular response (defined as heart rate greater than 100 beats/minute)
  • Known HIV infection
  • Grade III/IV acute GVHD
  • Current use or anticipated need for food or drugs that are known moderate/strong CYP3A4 inducers (See Table 1 and section 5.9.2: Prohibited Concomitant Therapy), with the exception of azole antifungals, which are permitted.
  • Any medical, psychiatric, addictive or other kind of disorder which compromises the ability of the subject to give written informed consent and/or to comply with procedures.
  • Pregnant or lactating females

Sites / Locations

  • University of Colorado Cancer Center
  • Ohio State University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

PF-04449913

Arm Description

Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Relapse-free Survival in Days
Days after transplant until disease relapse or death as measured by Kaplan-Meier statistical method.

Secondary Outcome Measures

Remission Duration
Length of time before remission measured in days
Number of Patients With Adverse Events (AE) Related to Glasdegib
Subjects will be evaluated for AEs at each visit with the NCI-CTCAE version 4.03 used as a guide for the grading of severity.
Overall Survival of All Patients

Full Information

First Posted
April 23, 2013
Last Updated
December 30, 2021
Sponsor
University of Colorado, Denver
Collaborators
The Leukemia and Lymphoma Society
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1. Study Identification

Unique Protocol Identification Number
NCT01841333
Brief Title
PF-04449913 For Patients With Acute Myeloid Leukemia at High Risk of Relapse After Donor Stem Cell Transplant
Official Title
A Phase 2 Study of PF-04449913 for the Treatment of Acute Myeloid Leukemia Patients With High Risk of Post-Allogeneic Stem Cell Transplantation Relapse
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Completed
Study Start Date
April 29, 2013 (Actual)
Primary Completion Date
May 8, 2019 (Actual)
Study Completion Date
February 4, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Colorado, Denver
Collaborators
The Leukemia and Lymphoma Society

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase II trial will test whether the Hedgehog signaling pathway inhibitor PF-04449913 can decrease disease relapse in high-risk patients with acute myeloid leukemia after donor stem cell transplant.
Detailed Description
Disease relapse is the most common cause of death after allogeneic stem cell transplantation for acute myeloid leukemia. Patients at high risk for relapse may benefit from a novel, biologically rational therapeutic intervention to prevent this outcome. PF-04449913 is a small molecule inhibitor of the hedgehog (Hh) pathway that inhibits the protein Smoothened (SMO). Aberrant Hh signaling may contribute to the survival and expansion of the leukemia stem cell, and inhibiting the Hh pathway can eliminate these cells. Therefore, targeting Hh may be a logical intervention in the post-transplantation setting for those with high risk of relapse. The investigators propose a phase 2 study of PF-04449913 in patients with acute myeloid leukemia who have received an allogeneic stem cell transplantation and are at high risk of relapse. This is an open label, phase 2 study employing PF-04449913 in acute myeloid leukemia patients who received an allogeneic stem cell transplantation and are at high risk of relapse. Patients will receive consecutive 28-day cycles of PF-04449913 at 100 mg/day, beginning on post-transplantation day 80 +/- 10 days, after their routine post-transplant bone marrow biopsy. Treatment will continue for up to one year or until they experience toxicity or disease relapse. 50 patients will be required for a 90% power to detect a 20% difference in one-year relapse-free survival.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adult Acute Myeloid Leukemia in Remission, Recurrent Adult Acute Myeloid Leukemia
Keywords
Myeloid leukemia in remission, Recurrent myeloid leukemia

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
PF-04449913
Arm Type
Experimental
Arm Description
Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
PF-04449913
Other Intervention Name(s)
Hedgehog inhibitor
Intervention Description
100mg given orally
Primary Outcome Measure Information:
Title
Relapse-free Survival in Days
Description
Days after transplant until disease relapse or death as measured by Kaplan-Meier statistical method.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Remission Duration
Description
Length of time before remission measured in days
Time Frame
Up to 5 years
Title
Number of Patients With Adverse Events (AE) Related to Glasdegib
Description
Subjects will be evaluated for AEs at each visit with the NCI-CTCAE version 4.03 used as a guide for the grading of severity.
Time Frame
30 days
Title
Overall Survival of All Patients
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: WHO-confirmed AML Age ≥18 years Between days 28 and 50 post transplantation at the time of initiation of the study drug ECOG performance status ≤ 2 (See Appendix A: ECOG Performance Status Scale) Life expectancy > 2 months Recipient of a myeloablative or non-myeloablative allogeneic HSCT Conditioning regimen to be prescribed at investigator's discretion, but will be prospectively defined as myeloablative or non-myeloablative Stable engraftment, as defined by absolute neutrophil count (ANC) ≥ 1000/mm3 and platelets ≥ 25,000/mm3 In morphologic remission (< 5% marrow blasts) based on BM biopsy performed +/- 5 days of day 28 post- transplantation Without clinical signs of active central nervous system disease For non-myeloablative transplants, ≥50% CD3 donor chimerism at screening High risk of relapse after HSCT, defined as the presence of minimal residual disease as measured by flow cytometry in the absence of evidence of morphologic disease on a bone marrow biopsy prior to HSCT Adequate organ function as indicated by the following laboratory values: Aspartate aminotransferase (AST), alanine aminotransferase, (ALT) ≤ 3.0 x institutional upper limit of normal (ULN) Total bilirubin ≤ 2.0 x institutional ULN, unless documented Gilbert's syndrome Either creatinine <1.5 x institutional upper limit of normal (ULN) or creatinine clearance >60 mL/min as calculated by institution's standard formula Serum/urine pregnancy test (for females of childbearing potential) that is negative within 72 hours prior to initiation of first dose of treatment (a patient is of childbearing potential if, in the opinion of the investigator, she is biologically capable of having children and is sexually active) Female patients of childbearing potential and sexually active males and female partners of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 90 days after the last dose of assigned treatment. Subject is able to comply with study procedures and follow-up examinations. Exclusion Criteria: Concomitant treatment with other anti-neoplastic agents, with the exception, when clinically indicated, of prophylaxis in the post-transplantation setting with intrathecal chemotherapy Use of any other experimental drug or therapy within 28 days of baseline Inability to swallow or absorb drug Active uncontrolled acute fungal, bacterial, or other infection that is unresponsive to therapy at time of study drug dosing Unstable angina pectoris New York Heart Association Class III or IV heart failure QTc interval (using Fridericia's correction formula, QTcF, if prolonged) >470 msec Active cardiac arrhythmias with rapid ventricular response (defined as heart rate greater than 100 beats/minute) Known HIV infection Grade III/IV acute GVHD Current use or anticipated need for food or drugs that are known moderate/strong CYP3A4 inducers (See Table 1 and section 5.9.2: Prohibited Concomitant Therapy), with the exception of azole antifungals, which are permitted. Any medical, psychiatric, addictive or other kind of disorder which compromises the ability of the subject to give written informed consent and/or to comply with procedures. Pregnant or lactating females
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel A Pollyea, MD, MS
Organizational Affiliation
University of Colorado, Denver
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Colorado Cancer Center
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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PF-04449913 For Patients With Acute Myeloid Leukemia at High Risk of Relapse After Donor Stem Cell Transplant

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