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Safety Study of Thioridazine in Combination With Cytarabine to Treat Relapsed or Refractory Acute Myeloid Leukemia (THORIDAL)

Primary Purpose

Acute Myeloid Leukemia

Status
Completed
Phase
Phase 1
Locations
Canada
Study Type
Interventional
Intervention
Thioridazine
Sponsored by
Ontario Clinical Oncology Group (OCOG)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring Relapsed Acute Myeloid Leukemia, Refractory Acute Myeloid Leukemia, Thioridazine, Phase I, Clinical Trial

Eligibility Criteria

55 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Have a diagnosis of AML according to the WHO Classification1
  • AML is refractory or relapsed (requiring at least 5% leukemic blasts in the bone marrow, regardless of the presence of other features such as new or recurrent dysplastic changes or extra medullary disease) according to the following definitions:

    • Relapsed (defined as ≥ 5% leukemic blasts in the bone marrow) after three months from receiving up to three prior induction regimens.
    • Refractory (defined as ≥ 5% leukemic blasts in the bone marrow) to not more than one prior induction regimen (defined as failure to achieve a CR or CRi following induction therapy).
  • 55 years of age or older.

Exclusion Criteria:

  • Receiving any other systemic anti-leukemic therapy (standard or investigational).
  • Having received more than two prior chemotherapy lines for AML. Induction/consolidation therapy and bone marrow transplant are each considered a line of therapy.
  • Having received previous AML therapy within four weeks of the first dose of study drug, with the exception of hydroxyurea.
  • Clinical evidence suggestive of CNS involvement with leukemia unless a lumbar puncture confirms the absence of leukemic blasts in the CSF.
  • Acute promyelocytic leukemia.
  • An ECOG performance status of 3 or more.
  • Inadequate renal function (i.e., estimated GFR < 60 mL/min/1.73m2).
  • Inadequate hepatic function (i.e., serum bilirubin > 1.5×ULN; AST, ALT and alkaline phosphatase > 2.5×ULN).
  • Presence of acute or chronic GVHD.
  • Presence of a systemic fungal, bacterial, viral or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment).
  • Having any other severe concurrent disease, or have a history of serious organ dysfunction or disease involving the heart, kidney, liver or other organ system that may place the patient at undue risk to undergo induction therapy.
  • Diagnosed with a condition that can prolong the QT interval (e.g., long QT syndrome) or have a QTc interval ≥ 470ms if male, or ≥ 480ms if female.
  • Left ventricular ejection fraction less than 45%.
  • History of uncontrolled cardiac arrhythmia.
  • Known severe hypotensive or hypertensive heart disease.
  • Prior malignancy, unless the patient has been disease-free for at least five years following curative intent therapy, with the following exceptions: Patients with treated non-melanoma skin cancer, in situ carcinoma, or cervical intraepithelial neoplasia, regardless of the disease-free duration, if definitive treatment for the condition has been completed; or patients with organ-confined prostate cancer with no evidence of recurrent or progressive disease based on prostate-specific antigen (PSA) values if hormonal therapy has been initiated or a radical prostatectomy has been performed.
  • Known HIV positivity.
  • Known pregnancy or lactating female.
  • Presence of a psychiatric disorder that would interfere with consent, study participation, or follow-up.
  • Unable to provide informed consent.

Sites / Locations

  • Juravinski Hospital & Cancer Centre

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Thioridazine

Arm Description

Up to 3 dose levels of thioridazine will be assessed sequentially: 25 mg Q6H (Level I), 50 mg Q6H (Level II) and 100 mg Q6H (Level III). The duration of thioridazine therapy is for a total of 21 days (Days 1-22 on study). All patients will receive cytarabine 1 g/m2 administered as a 2 hour infusion for 5 consecutive days (Days 6-10 on study).

Outcomes

Primary Outcome Measures

Safety
Both acute and late toxicities will be determined according to NCI-CTCAE version 4.03

Secondary Outcome Measures

Assessment of Functional Leukemia Stem Cells
Bone marrow and peripheral blood samples obtained from patients treated with thioridazine and cytarabine will be analyzed in four separate assays.
Pharmacokinetic Analysis of Thioridazine Serum Trough Levels
Pharmacokinetic modeling will be performed to estimate values for individual C min levels.
Assessment of Objective Tumor Response
Tumor responses are categorized as either a complete remission, a complete remission with incomplete count recovery, a partial remission, a treatment failure, or as not evaluable
Pharmacogenetic Analysis of Thioridazine Serum Trough Levels
Cytochrome P450 2D6 genotype will be determined to examine genetic contribution to thioridazine Cmin levels.

Full Information

First Posted
March 20, 2014
Last Updated
December 6, 2016
Sponsor
Ontario Clinical Oncology Group (OCOG)
Collaborators
Hamilton Health Sciences Corporation, Juravinski Cancer Centre Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT02096289
Brief Title
Safety Study of Thioridazine in Combination With Cytarabine to Treat Relapsed or Refractory Acute Myeloid Leukemia
Acronym
THORIDAL
Official Title
A Phase I Trial Evaluating Oral Thioridazine in Combination With Intermediate Dose Cytarabine in Patients 55 Years and Older With Acute Myeloid Leukemia Who Have Relapsed or Have Refractory Disease
Study Type
Interventional

2. Study Status

Record Verification Date
December 2016
Overall Recruitment Status
Completed
Study Start Date
July 2014 (undefined)
Primary Completion Date
August 2016 (Actual)
Study Completion Date
September 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ontario Clinical Oncology Group (OCOG)
Collaborators
Hamilton Health Sciences Corporation, Juravinski Cancer Centre Foundation

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a Phase I trial investigating the safety of using thioridazine in addition to cytarabine in elderly patients with relapsed or refractory Acute Myeloid Leukemia.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia
Keywords
Relapsed Acute Myeloid Leukemia, Refractory Acute Myeloid Leukemia, Thioridazine, Phase I, Clinical Trial

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
13 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Thioridazine
Arm Type
Experimental
Arm Description
Up to 3 dose levels of thioridazine will be assessed sequentially: 25 mg Q6H (Level I), 50 mg Q6H (Level II) and 100 mg Q6H (Level III). The duration of thioridazine therapy is for a total of 21 days (Days 1-22 on study). All patients will receive cytarabine 1 g/m2 administered as a 2 hour infusion for 5 consecutive days (Days 6-10 on study).
Intervention Type
Drug
Intervention Name(s)
Thioridazine
Primary Outcome Measure Information:
Title
Safety
Description
Both acute and late toxicities will be determined according to NCI-CTCAE version 4.03
Time Frame
Up to 36 days
Secondary Outcome Measure Information:
Title
Assessment of Functional Leukemia Stem Cells
Description
Bone marrow and peripheral blood samples obtained from patients treated with thioridazine and cytarabine will be analyzed in four separate assays.
Time Frame
Up to 36 days
Title
Pharmacokinetic Analysis of Thioridazine Serum Trough Levels
Description
Pharmacokinetic modeling will be performed to estimate values for individual C min levels.
Time Frame
Up to 36 days
Title
Assessment of Objective Tumor Response
Description
Tumor responses are categorized as either a complete remission, a complete remission with incomplete count recovery, a partial remission, a treatment failure, or as not evaluable
Time Frame
Up to 36 days
Title
Pharmacogenetic Analysis of Thioridazine Serum Trough Levels
Description
Cytochrome P450 2D6 genotype will be determined to examine genetic contribution to thioridazine Cmin levels.
Time Frame
Up to 36 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
55 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have a diagnosis of AML according to the WHO Classification1 AML is refractory or relapsed (requiring at least 5% leukemic blasts in the bone marrow, regardless of the presence of other features such as new or recurrent dysplastic changes or extra medullary disease) according to the following definitions: Relapsed (defined as ≥ 5% leukemic blasts in the bone marrow) after three months from receiving up to three prior induction regimens. Refractory (defined as ≥ 5% leukemic blasts in the bone marrow) to not more than one prior induction regimen (defined as failure to achieve a CR or CRi following induction therapy). 55 years of age or older. Exclusion Criteria: Receiving any other systemic anti-leukemic therapy (standard or investigational). Having received more than two prior chemotherapy lines for AML. Induction/consolidation therapy and bone marrow transplant are each considered a line of therapy. Having received previous AML therapy within four weeks of the first dose of study drug, with the exception of hydroxyurea. Clinical evidence suggestive of CNS involvement with leukemia unless a lumbar puncture confirms the absence of leukemic blasts in the CSF. Acute promyelocytic leukemia. An ECOG performance status of 3 or more. Inadequate renal function (i.e., estimated GFR < 60 mL/min/1.73m2). Inadequate hepatic function (i.e., serum bilirubin > 1.5×ULN; AST, ALT and alkaline phosphatase > 2.5×ULN). Presence of acute or chronic GVHD. Presence of a systemic fungal, bacterial, viral or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment). Having any other severe concurrent disease, or have a history of serious organ dysfunction or disease involving the heart, kidney, liver or other organ system that may place the patient at undue risk to undergo induction therapy. Diagnosed with a condition that can prolong the QT interval (e.g., long QT syndrome) or have a QTc interval ≥ 470ms if male, or ≥ 480ms if female. Left ventricular ejection fraction less than 45%. History of uncontrolled cardiac arrhythmia. Known severe hypotensive or hypertensive heart disease. Prior malignancy, unless the patient has been disease-free for at least five years following curative intent therapy, with the following exceptions: Patients with treated non-melanoma skin cancer, in situ carcinoma, or cervical intraepithelial neoplasia, regardless of the disease-free duration, if definitive treatment for the condition has been completed; or patients with organ-confined prostate cancer with no evidence of recurrent or progressive disease based on prostate-specific antigen (PSA) values if hormonal therapy has been initiated or a radical prostatectomy has been performed. Known HIV positivity. Known pregnancy or lactating female. Presence of a psychiatric disorder that would interfere with consent, study participation, or follow-up. Unable to provide informed consent.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark N Levine, MD
Organizational Affiliation
Ontario Clinical Oncology Group, McMaster University
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Ronan Foley, MD
Organizational Affiliation
Hamilton Health Sciences, McMaster University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Juravinski Hospital & Cancer Centre
City
Hamilton
State/Province
Ontario
ZIP/Postal Code
L8V 1C3
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
30093531
Citation
Aslostovar L, Boyd AL, Almakadi M, Collins TJ, Leong DP, Tirona RG, Kim RB, Julian JA, Xenocostas A, Leber B, Levine MN, Foley R, Bhatia M. A phase 1 trial evaluating thioridazine in combination with cytarabine in patients with acute myeloid leukemia. Blood Adv. 2018 Aug 14;2(15):1935-1945. doi: 10.1182/bloodadvances.2018015677.
Results Reference
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Safety Study of Thioridazine in Combination With Cytarabine to Treat Relapsed or Refractory Acute Myeloid Leukemia

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