Sorafenib and Low Dose Cytarabine in Older Patients With Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome
Leukemia, Myelodysplastic Syndromes
About this trial
This is an interventional treatment trial for Leukemia focused on measuring adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), untreated adult acute myeloid leukemia, secondary acute myeloid leukemia, de novo myelodysplastic syndromes, secondary myelodysplastic syndromes
Eligibility Criteria
DISEASE CHARACTERISTICS:
Diagnosis of 1 of the following:
- Acute myeloid leukemia (AML) by FAB criteria (By morphology and routine histochemistry and confirmed, when possible, by flow cytometric analysis of surface immunophenotype; co-expression of lymphoid markers permitted)
- High-risk myelodysplastic syndromes defined as IPSS category of intermediate-2 or greater
- Must be considered unsuitable for intensive chemotherapy regimens
- No documented CNS involvement
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2
- AST and ALT ≤ 2 times upper limit of normal (ULN)
- Bilirubin normal
- Creatinine ≤ 1.2 times ULN OR creatinine clearance ≥ 50 mL/min
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No history of other malignancies, except adequately treated nonmelanoma skin cancer, curatively treated in situ carcinoma of the cervix, or other solid tumors curatively treated with no evidence of disease for ≥ 5 years
- No upper gastrointestinal or other conditions that would preclude compliance with or administration of oral medication
No serious illness or medical condition that would not permit the patient to be managed according to the protocol, including any of the following:
- History of significant neurologic or psychiatric disorder that would impair the ability to obtain consent
- Active, uncontrolled, serious infections
- Active peptic ulcer disease
- Evidence of bleeding diathesis
- No myocardial infarction within the past 6 months
- No congestive heart failure
- No unstable angina
- No active cardiomyopathy or unstable ventricular arrhythmia
- No poorly controlled hypertension (e.g., systolic BP ≥ 150 mm Hg or diastolic BP ≥ 95 mm Hg)
- No known hypersensitivity to the study drugs or their components
- No preexisting hypothyroidism prior to enrollment unless patient is euthyroid on medication
- No neuropathy ≥ grade 2
PRIOR CONCURRENT THERAPY:
- At least 2 days since prior hydroxyurea
- No other prior chemotherapy
No concurrent therapeutic doses (≥ 2 mg/day) of anticoagulants (e.g., warfarin)
- Doses of up to 2 mg/day given for prophylaxis of thrombosis are accepted provided INR is ≤ 1.5
- No other concurrent experimental drugs or anticancer therapy
Sites / Locations
- QEII Health Sciences Center
- Juravinski Cancer Centre at Hamilton Health Sciences
- Univ. Health Network-Princess Margaret Hospital
- McGill University - Dept. Oncology
Arms of the Study
Arm 1
Experimental
Sorafenib and Cytarabine
Cytarabine: subcutaneously twice daily from day 1 - 10. Sorafenib: Days 2-28; at the dose level assigned at registration. Sorafenib will be given orally twice daily.