Study of Magrolimab Versus Placebo in Combination With Venetoclax and Azacitidine in Participants With Acute Myeloid Leukemia (ENHANCE-3)
Acute Myeloid Leukemia
About this trial
This is an interventional treatment trial for Acute Myeloid Leukemia
Eligibility Criteria
Key Inclusion Criteria:
Previously untreated individuals with histological confirmation of acute myeloid leukemia (AML) by World Health Organization (WHO) criteria who are ineligible for treatment with a standard cytarabine and anthracycline induction regimen due to age, or comorbidity. Individuals must be considered ineligible for intensive chemotherapy, defined by the following:
- ≥ 75 years of age; Or
≥ 18 to 74 years of age with at least 1 of the following comorbidities:
- Eastern Cooperative Oncology Group (ECOG) performance status of 2 or 3
- Diffusing capacity of the lung of carbon monoxide ≤ 65% or forced expiratory volume in 1 second ≤ 65%
- Left ventricular ejection fraction ≤ 50%
- Baseline creatinine clearance ≥ 30 mL/min to < 45 mL/min calculated by the Cockcroft Gault formula or measured by 24-hour urine collection
- Hepatic disorder with total bilirubin > 1.5 x upper limit of normal (ULN)
- Any other comorbidity that the investigator judges to be incompatible with intensive chemotherapy
ECOG performance status:
- Of 0 to 2 for individuals ≥ 75 years of age Or
- Of 0 to 3 for individuals ≥ 18 to 74 years of age
Individuals with white blood cell (WBC) count ≤ 20 x 10^3/μL prior to randomization. If the individual's WBC is > 20 x10^3/μL prior to randomization, the individual can be enrolled, assuming all other eligibility criteria are met. However, the WBC should be ≤ 20 x 10^3/μL prior to the first dose of study treatment and prior to each magrolimab/placebo dose during Cycle 1.
- Note: Individuals can be treated with hydroxyurea and/or leukapheresis prior to randomization and throughout the study to reduce the WBC to ≤ 20 x 10^3/μL to enable eligibility for study drug dosing
Hemoglobin must be ≥ 9 g/dL prior to initial dose of study treatment
- Note: Transfusions are allowed to meet hemoglobin eligibility
- Pretreatment blood cross-match completed
Key Exclusion Criteria:
Prior treatment with any of the following:
- cluster of differentiation 47 (CD47) or signal regulatory protein alpha (SIRPα)-targeting agents
Antileukemic therapy for the treatment of AML (eg, hypomethylating agents (HMAs), low-dose cytarabine, and/or venetoclax), excluding hydroxyurea
- Note: Individuals with prior MDS who have not received prior HMAs or venetoclax or chemotherapeutic agents for MDS may be enrolled in the study. Prior treatment with myelodysplastic syndrome (MDS) therapies including, but not limited to lenalidomide, erythroid-stimulating agents, or similar red blood cell negative (RBC-), white blood cell negative (WBC-), or platelet-direct therapies or growth factors is allowed for these individuals.
- Clinical suspicion of or documented active central nervous system (CNS) involvement with AML
- Individuals who have acute promyelocytic leukemia
- Second malignancy, except MDS, treated basal cell or localized squamous skin carcinomas, localized prostate cancer, or other malignancies for which individuals are not on active anticancer therapies and have had no evidence of active malignancy for at least 1 year
Note: Other protocol defined Inclusion/Exclusion criteria may apply.
Sites / Locations
- University of Arkansas for Medical Sciences
- City of Hope (City of Hope National Medical Center, City of Hope Medical Center)
- Community Cancer Institute
- UC Irvine Health- Chao Family Comprehensive Cancer Center
- Baptist MD Anderson Cancer Center
- Moffitt Cancer Center
- Loyola University Medical Center
- Parkview Research Center
- Indiana Blood and Marrow Transplantation - Clinic
- The University of Iowa Hospitals and Clinics
- University of Maryland, Greenebaum Comprehensive Cancer Center
- University of Massachusetts Worcester
- MidAmerica Division, Inc., c/o Research Medical Center
- SSM Health Saint Louis University Hospital
- John Theurer Cancer Center at Hackensack University Medical Center
- Rutgers Cancer Institute of New Jersey
- New York-Presbyterian/Weill Cornell Medical Center
- Icahn School of Medicine at Mount Sinai and The Mount Sinai Hospital
- University of Rochester Medical Center
- UNC Hospitals, The University of North Carolina at Chapel Hill
- Novant Health Cancer Institute Hematology- Charlotte
- Novant Health Cancer Institute Hematology - Forsyth
- Wake Forest Baptist Health
- University Hospitals Cleveland Medical Center
- Cleveland Clinic Foundation
- OU Health Stephenson Cancer Center
- Providence Cancer Institute Franz Clinic
- Penn State Hershey Medical Center
- Fox Chase Cancer Center
- West Penn Hospital
- Rhode Island Hospital
- Baylor University Medical Center
- Brooke Army Medical Center
- Houston Methodist Hospital Cancer Center
- MD Anderson Cancer Center
- Intermountain Health - LDS Hospital
- Virginia Mason Franciscan Health
- Fred Hutchinson Cancer Center
- Froedtert Hospital and the Medical College of Wisconsin
- Canberra Hospital
- Border Medical Oncology Research Unit
- Concord Repatriation General Hospital
- Liverpool Hospital
- St George Hospital, Clinical Research Unit Haemotology, Division of Cancer Services
- Gold Coast University Hospital
- Monash University, Eastern Health-Box Hill Hospital
- Northern Health
- Peter MacCallum Cancer Centre
- Ordensklinikum Linz GmbH Elisabethinen
- Hanusch Krankenhaus
- Wiener Gesundheitsverbund, Klinik Hietzing
- Ziekenhuis Netwerk Antwerp (ZNA) - Stuivenberg
- Cliniques Universitaires Saint-Luc
- University Hospital Gent
- Hopital de Jolimont
- University Hospital Leuven (UZ Leuven) - Campus Gasthuisberg
- Centre Hospitalier Universitaire de Liege
- Queen Elizabeth II (QEII) Health Sciences Centre
- Centre Integre Universitaire de Sante et de Services Sociaux(CIUSSS) de l'Est-de-L'Ile-de- Montreal - Hopital Maisonneuve-Rosemont
- Princess Margaret Cancer Centre - University Health Network
- CancerCare Manitoba
- Fakultni nemocnice Brno, Interni hematologicka a onkologicka klinika FN Brno a LF MU
- Fakultni nemocine Olomouc, Hemato-onkologicka klinika
- Fakultni nemocnice Ostrava, Klinika hematoonkologie
- Fakulti nemocnice Kralovske Vinohrady, Internf hematologicka klinika FNKV a 3. LF UK
- Vseobecna fakultni nemocnice v Praze, Fakultni poliklinika, Hematologicka ambulance
- CHU Amiens Picardie
- CHU d'Angers
- Hopital Avicenne
- Hopitaux Universitaires Henri Mondor
- Centre Hospitalier Universitaire Grenoble Alpes
- Centre Hospitalier de Versailles
- Hôpital Claude Huriez (CHRU de Lillle)
- Centre Leon Berard
- Centre Hospitalier Universitaire Nantes - Hotel Dieu
- Hopital Saint-Louis
- Centre Hospitalier Lyon-Sud (CHLS)
- Institut de Cancérologie Strasbourg Europe (ICANS)
- Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole
- CHU de Nancy - Hopitaux de Brabois
- Charite - Universitatsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Hamatologie, Onkologie und Tumorimmunologie
- Universitätsklinikum Bonn
- Städtisches Klinikum Braunschweig GmbH Medizinische Klinik III/Hämatologie und Onkologie
- Universitatsklinikum Dusseldorf, Klink fur Hamatologie, Onkologie und Klinische Immunologie
- Marien Hospital Dusseldorf GmbH, Klinik Fur Onkologie, Hamatologie Und Palliativmedizin
- Malteser Krankenhaus St. Franziskus Hospital,Med.Klinik I
- Universitatsklinikum Frankfurt Goethe Universitat Med. Klink II
- Asklepios Klink St.Georg
- Medizinische Hochschule Hannover, Hamatologie, Hamostaseologie, Onkologie und Stammzelltrandsplantation
- Universitätsklinikum Magdeburg
- Johannes Wesling Klinikum Minden Universitätsklinik fur Hämatologie, Onkologie, Hämostaseologie und Pastativrndezin, Universitatsklinik der Ruhr-Unive
- Klinikum rechts der Isar Technischen Universitat Munchen
- Klinikum Oldenburg, Rahel-Straus-Straße 10
- Universitatsklinikum Regensburg, Klink fur Innere Medizin III
- Universitatsklinikum Ulm, Zentrum fur Innere Medizin, Klinik fur Innere Medizin III
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital
- Princess Margaret Hospital
- Queen Mary Hospital
- Tuen Mun Hospital
- Semmelweis Egyetem Belgyogyaszati es Hematologiai Klinika
- Petz Aladár Egyetemi Oktató Kórház II. Belgyógyaszat - Haematológia
- Debreceni Egyetem Klinikai Központ Belgyogyaszati Klinika B epulet Hematologia
- Szegedi Tudomanyegyetem Szent-Gyorgyi Albert Kozpont
- Rambam Health Care Campus
- Shaare Zedek Medical Center
- Hadassah University Hospital Ein Kerem
- Rabin Medical Center
- The Chaim Sheba Medical Center
- Azienda Ospedaliero Universitaria delle Marche - SOD Clinica di Ematologia
- ASST Papa Giovanni XXIII
- Azienda Ospedaliero Universitaria di Bologna Policlinico Sant'Orsola-Malpighi
- IRCCS Istituto Clinico Humanitas
- ASST Monza-Ospedale San Gerardo
- Azienda Ospedaliera di Perugia - Santa Maria della Misericordia
- Azienda Sanitaria Territoriale Pesaro e Urbino - "Stabilimento Ospedaliero San Salvatore - Muraglia" - U.O. Ematologia e Centro Trapianti
- Seoul National University Hospital
- Samsung Medical Center
- Severance Hospital
- Asan Medical Center
- The Catholic University of Korea Seoul Saint Mary's Hospital
- Jeroen Bosch Ziekenhuis
- Meander Medisch Centrum
- Amsterdam Universitair Medische Centra-Locatie Vrije Universiteit Medisch Centrum
- Amphia Hospital, department Oncologie, Route 43
- HagaZiekenhuis
- Medisch Spectrum Twente - Enschede Koningsplein
- Universitair Medisch Centrum Groningen
- Medisch Centrum Leeuwarden
- Masstricht Universitair Medisch Centrum
- St. Antonius Ziekenhuis, Nieuwegein
- Canisius Wilhelmina Ziekenhuis
- Erasmus Medisch Centrum
- Oslo University Hospital, Department of Hematology
- Centrum Onkologii Ziemi Lubelskiej im. Sw. Jana z Dukli, Oddzial Hematologiczny
- Szpital Wojewodozki w Opolu Sp. z 0.0. Oddzial Klinixzny Hematologii, Onkologii Hematologicznej i Chorob Wemnetrznych
- Wojewódzkie Wielospecjalistyczne Centrum Onkologii i Traumatologii im. M.Kopernika w Lodzi, Oddzial Hematologii Ogolnej
- Hospital Universitario Araba
- Hospital Clinic de Barcelona
- Hospital Universitario Reina Sofia
- Hospital General Universitario Gregorio Maranon
- Hospital Universitario 12 de Octubre
- Hospital Universitario La Paz
- Hospital Universitario Quironsalud Madrid
- Hospital Universitario Ramon y Cajal
- Hospital Regional Universitario de Malaga
- Complejo Asistencial Universitario de Salamanca - Hospital Clinico
- Complejo Hospitalario Universitario de Santiago de Compostela
- Hospital Universitari I Politecnic La Fe
- Inselspital Universitätsspital Bern
- Kaohsiung Chang Gung Memorial Hospital
- China Medical University Hospital
- National Taiwan University Hospital
- National Cheng Kung University Hospital
- Blackpool Teaching Hospitals NHS Foundation Trust
- University Hospitals Bristol and Weston NHS Foundation Trust
- Leeds Teaching Hospitals NHS Trust
- Clatterbridge Cancer Centre NHS Foundation Trust
- Barts Health NHS Trust
- King's College Hospital
- The Christie NHS Foundation Trust
- Newcastle upon Tyne Hospitals Foundation Trust
- Oxford University Hospitals NHS Foundation Trust, Churchill Hospital
- South Warwickshire University NHS Foundation Trust
- The Royal Wolverhampton NHS Trust
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Magrolimab + Venetoclax + Azacitidine
Magrolimab Placebo + Venetoclax + Azacitidine
Participants will receive magrolimab: 1 mg/kg priming dose on Days 1 and 4; 15 mg/kg on Day 8; and 30 mg/kg on Days 11, 15, and then every week for 5 doses and every 2 weeks thereafter venetoclax: 100 mg on Cycle 1 Day 1, 200 mg on Cycle 1 Day 2, 400 mg on Cycle 1 Day 3 and daily thereafter azacitidine: 75 mg/m^2 on Days 1-7 or Days 1-5 and 8-9 of each cycle Each cycle is 28 days.
Participants will receive magrolimab placebo: Days 1, 4, 8, 11, and 15, then every week for 5 doses and every 2 weeks thereafter venetoclax: 100 mg on Cycle 1 Day 1, 200 mg on Cycle 1 Day 2, 400 mg on Cycle 1 Day 3 and daily thereafter azacitidine: 75 mg/m^2 on Days 1-7 or Days 1-5 and 8-9 of each cycle Each cycle is 28 days.