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Study of C6 Ceramide NanoLiposome (CNL) in Patients With Relapsed/Refractory Acute Myeloid Leukemia (KNAN2001)

Primary Purpose

Acute Myeloid Leukemia, in Relapse, Acute Myeloid Leukemia, Refractory

Status
Not yet recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ceramide NanoLiposome (Ceraxa)
Sponsored by
Keystone Nano, Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia, in Relapse focused on measuring Acute Myeloid Leukemia, Relapsed, Refractory, Ceramide, AML, NanoLiposome

Eligibility Criteria

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

Inclusion Criteria:

  1. Signed informed consent is obtained prior to conducting any study-specific screening procedures.
  2. Willing and able to understand the nature of this study and to comply with the study and follow-up procedures.
  3. Age and Disease: ≥ 18 years of age with refractory or relapsed AML

    Refractory AML: Patients who fail to achieve a complete remission (CR) after one line of AML directed therapy

    Relapsed AML: Patients who achieved a complete remission (CR) with one or more prior lines of AML directed therapy but then developed a relapse of AML.

    Note: Patients are eligible even if they have not received intensive induction chemotherapy but have been treated with other AML directed therapy like hypomethylating agents (azacitidine, decitabine).

  4. Eastern Cooperative Oncology Group (ECOG) performance status must be ≤2
  5. Peripheral white blood cell (WBC) count <30,000/µL. For cyto-reduction, hydroxyurea is allowed during screening and through Cycle 2, Day 3 to reduce WBC count to < 30,000 µL.
  6. Adequate organ function as evidenced by the following laboratory findings:

    • Total bilirubin ≤ 1.5 × upper limit of normal (ULN) or < 3 x ULN for patients with Gilbert-Meulengracht Syndrome
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × ULN
    • Creatinine clearance > 60 mL/min
  7. QT-interval corrected according to Fridericia's formula (QTcF) < 450 ms on one electrocardiogram (ECG) at screening

Exclusion Criteria:

Patients meeting any of the following criteria are ineligible for study entry:

  1. Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmias not well controlled with medication, myocardial infarction within the previous 6 months before registration, or psychiatric illness/social situations that would limit compliance with study requirements.
  2. Patients may not be receiving any other concurrent investigational agents, or have received any investigational agent within one week of registration.
  3. Since the teratogenic potential of this combination is currently unknown, females who are pregnant or lactating are excluded.
  4. History of any other malignancies within the preceding 12 months before registration with the exception of in-situ cancer, non-muscle invasive bladder cancer, prostate, basal or squamous cell skin cancer
  5. Life-threatening illnesses other than AML, uncontrolled medical conditions or organ system dysfunction that, in the Investigator's opinion, could compromise the patient's safety or put the study outcomes at risk
  6. Evidence of isolated extramedullary disease
  7. Acute Promyelocytic Leukemia or AML with active central nervous system (CNS) involvement
  8. Untreated severe (in the opinion of the treating investigator) infection
  9. Active and uncontrolled infection with HIV (viral load is detectable by PCR)
  10. Active infection with Hepatitis B virus (HbSAg positive or PCR with detectable viral load) or Hepatitis C virus (viral load detectable by PCR).
  11. Past Hematopoietic stem cell transplant (HSCT) with active graft vs host disease, immunosuppression other than low dose prednisone (5 mg), or calcineurin inhibitors within the 4 weeks before registration

Sites / Locations

  • Penn State University Hershey Medical Center
  • University of Virginia Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Open Label Administration of Ceramide NanoLiposome

Arm Description

Ceramide NanoLiposome will be administered by Intravenous Dosing twice per week in accordance with the protocol relative to dose escalation. There is no placebo group or arm of the study.

Outcomes

Primary Outcome Measures

Number of Patients with Dose Limiting Toxicities as defined in Protocol Section 13.5
Dose Limiting Toxicities within the first cycle of CNL monotherapy. See section 13.5 of Protocol for the complete list of Dose Limiting Toxicities
Number of Patients with Adverse Events
Number of Patients with Adverse Events
Severity of Adverse Events
Severity of Adverse Event As Described in Protocol
Duration of Adverse Events
Duration of Adverse Events, As Described in Protocol, measured in days
Duration of therapy
Duration of therapy provided as measured in days
Dose Levels achieved during study
Dose levels administered in milligrams per m2
Concentration Max (C Max)
Maximum Serum Concentration measured, in nanograms/milliliter
Time to Maximum Study Drug (T Max)
Time to maximum concentration measured, in minutes
Half Life of Study Drug
Time for drug to be reduced to half of the starting concentration (in minutes)
Study Drug Clearance
The Amount of Study Drug Cleared per unit time (Nanograms/Minute)
Ratio of C16/C24 Ceramides
Ratio of Ceramide 16 to Ceramide 24 (ng of C16/ng of C18) from bone marrow biopsy
Clinical Response - Complete Response
Complete Response
Clinical Response - Complete Response with Incomplete Hematologic Recovery (CRi)
Complete Response with Incomplete Hematological Recovery as defined by blasts in bone marrow
Clinical Response - Partial Remission
Partial Remission (as defined by blasts in bone marrow)

Secondary Outcome Measures

Number of Patients with Grade 3 or 4 Adverse Events
Grade 3 and 4 adverse events as defined by CTCAE v5.0
Overall Response
Overall response of CNL monotherapy in patients with RR-AML: Complete remission (CR) + Complete remission with incomplete count recovery (CRi) + partial response (PR). CR, CRi and PR as defined as European LeukemiaNet 2017 (ELN 2017) response criteria
Event Free Survival
Event-free survival (EFS): the time from registration until documented refractory disease, relapse after achieving CR/CRi, or death from any cause, whichever is observed first
Overall Survival
Overall survival (OS)
Quality of Life according to EORTC Quality of Life Questionnaire (QLQ) C30
Quality of life according to EORTC Quality of Life Questionnaire C30

Full Information

First Posted
November 30, 2020
Last Updated
October 1, 2023
Sponsor
Keystone Nano, Inc
Collaborators
University of Virginia, Milton S. Hershey Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT04716452
Brief Title
Study of C6 Ceramide NanoLiposome (CNL) in Patients With Relapsed/Refractory Acute Myeloid Leukemia
Acronym
KNAN2001
Official Title
Phase I Study of C6 Ceramide NanoLiposome (CNL) in Patients With Relapsed/Refractory Acute Myeloid Leukemia (RR-AML)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
June 1, 2024 (Anticipated)
Primary Completion Date
September 1, 2024 (Anticipated)
Study Completion Date
December 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Keystone Nano, Inc
Collaborators
University of Virginia, Milton S. Hershey Medical Center

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The study explores whether Ceramide NanoLiposome (CNL) combined with other conventional cancer-fighting drugs makes them work better.
Detailed Description
The research team has shown that C6 ceramide nanoliposome (CNL) has anti-cancer activity in laboratory models of AML and that when it is combined with other cancer-fighting drugs, it works better. The primary goal of this study is to evaluate the safety of CNL given without other cancer treatments in patients with AML where either their initial treatment didn't work or it stopped working and your AML came back (refractory or relapsed AML, or RR-AML). This study seeks to determine the right dose to start with in later studies when CNL is combined with other drugs. CNL is given by intravenous (IV) infusion and will be given twice a week in this study. Participants will receive study treatment as long as it is considered safe for them to continue, though their disease status will be checked regularly to make sure that their disease has not gotten worse. Blood samples will be collected at many time-points in order to see how their bodies are responding to the drug and how long it stays in the blood. The first patients in the study will start at one dose of the drug and, if that is shown to be safe, the next group will be treated at a slightly higher dose. Participants will be given CNL by intravenous (IV) infusion twice a week over about 2 hours and then they will be monitored for about 2 hours to make sure they don't have any bad side effects, but initially patients will be required to stay at the site for about 6 hours after the start of the infusion in order to get blood draws to see how long the drug stays active in their system. Participants will have a bone marrow biopsy before their second "cycle" of drug (after about 1 month) and then again before their third cycle of drug in order to see how their disease is responding. After that, bone marrow biopsies will be about every other cycle based on what the study doctor recommends. If the doctor doesn't think that CNL is helping their disease, of if their doctor decides that it is not safe for them to continue, they will be taken off study treatment. Participants will be followed for safety and disease status for up to 6 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, in Relapse, Acute Myeloid Leukemia, Refractory
Keywords
Acute Myeloid Leukemia, Relapsed, Refractory, Ceramide, AML, NanoLiposome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
Single group assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Open Label Administration of Ceramide NanoLiposome
Arm Type
Experimental
Arm Description
Ceramide NanoLiposome will be administered by Intravenous Dosing twice per week in accordance with the protocol relative to dose escalation. There is no placebo group or arm of the study.
Intervention Type
Drug
Intervention Name(s)
Ceramide NanoLiposome (Ceraxa)
Other Intervention Name(s)
Ceramide NanoLiposome
Intervention Description
Ceramide NanoLiposome will be given by IV twice a week. The dose, which is based on body size, will be increased for the next group of patients if the first group of patients tolerates that dose and it will decrease for the next group if they do not tolerate the dose.
Primary Outcome Measure Information:
Title
Number of Patients with Dose Limiting Toxicities as defined in Protocol Section 13.5
Description
Dose Limiting Toxicities within the first cycle of CNL monotherapy. See section 13.5 of Protocol for the complete list of Dose Limiting Toxicities
Time Frame
At the end of the the first cycle of administration (each cycle is 28 days)
Title
Number of Patients with Adverse Events
Description
Number of Patients with Adverse Events
Time Frame
Through study completion, an average of 24 weeks
Title
Severity of Adverse Events
Description
Severity of Adverse Event As Described in Protocol
Time Frame
Through study completion, an average of 24 weeks
Title
Duration of Adverse Events
Description
Duration of Adverse Events, As Described in Protocol, measured in days
Time Frame
Length of Adverse Events as measured in days, measured through study completion, an average of 24 weeks
Title
Duration of therapy
Description
Duration of therapy provided as measured in days
Time Frame
Through study completion, an average of 24 weeks
Title
Dose Levels achieved during study
Description
Dose levels administered in milligrams per m2
Time Frame
Through study completion, an average of 24 weeks
Title
Concentration Max (C Max)
Description
Maximum Serum Concentration measured, in nanograms/milliliter
Time Frame
Through cycle one, 28 days (each cycle is 28 days)
Title
Time to Maximum Study Drug (T Max)
Description
Time to maximum concentration measured, in minutes
Time Frame
Through cycle one, 28 days (each cycle is 28 days)
Title
Half Life of Study Drug
Description
Time for drug to be reduced to half of the starting concentration (in minutes)
Time Frame
Through cycle one, 28 days (each cycle is 28 days)
Title
Study Drug Clearance
Description
The Amount of Study Drug Cleared per unit time (Nanograms/Minute)
Time Frame
Through cycle one, 28 days (each cycle is 28 days)
Title
Ratio of C16/C24 Ceramides
Description
Ratio of Ceramide 16 to Ceramide 24 (ng of C16/ng of C18) from bone marrow biopsy
Time Frame
After one cycle of therapy (Day 28)
Title
Clinical Response - Complete Response
Description
Complete Response
Time Frame
After Cycle Two (56 days)
Title
Clinical Response - Complete Response with Incomplete Hematologic Recovery (CRi)
Description
Complete Response with Incomplete Hematological Recovery as defined by blasts in bone marrow
Time Frame
After Cycle Two (56 days)
Title
Clinical Response - Partial Remission
Description
Partial Remission (as defined by blasts in bone marrow)
Time Frame
After Cycle Two (56 days)
Secondary Outcome Measure Information:
Title
Number of Patients with Grade 3 or 4 Adverse Events
Description
Grade 3 and 4 adverse events as defined by CTCAE v5.0
Time Frame
Through study completion, an average of 24 weeks
Title
Overall Response
Description
Overall response of CNL monotherapy in patients with RR-AML: Complete remission (CR) + Complete remission with incomplete count recovery (CRi) + partial response (PR). CR, CRi and PR as defined as European LeukemiaNet 2017 (ELN 2017) response criteria
Time Frame
Through study completion, an average of 24 weeks, and up to 24 weeks afterwards (total of 48 weeks)
Title
Event Free Survival
Description
Event-free survival (EFS): the time from registration until documented refractory disease, relapse after achieving CR/CRi, or death from any cause, whichever is observed first
Time Frame
From registration to 24 weeks after completion of experimental drug treatment
Title
Overall Survival
Description
Overall survival (OS)
Time Frame
From registration to 24 weeks following drug administration
Title
Quality of Life according to EORTC Quality of Life Questionnaire (QLQ) C30
Description
Quality of life according to EORTC Quality of Life Questionnaire C30
Time Frame
Prior to starting study treatment, on day 1 of each cycle (each cycle is 28 days), and at end of treatment (which is expected to be 2 to 3 months (cycles) for most patients

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed informed consent is obtained prior to conducting any study-specific screening procedures. Willing and able to understand the nature of this study and to comply with the study and follow-up procedures. Age and Disease: ≥ 18 years of age with refractory or relapsed AML Refractory AML: Patients who fail to achieve a complete remission (CR) after one line of AML directed therapy Relapsed AML: Patients who achieved a complete remission (CR) with one or more prior lines of AML directed therapy but then developed a relapse of AML. Note: Patients are eligible even if they have not received intensive induction chemotherapy but have been treated with other AML directed therapy like hypomethylating agents (azacitidine, decitabine). Eastern Cooperative Oncology Group (ECOG) performance status must be ≤2 Peripheral white blood cell (WBC) count <30,000/µL. For cyto-reduction, hydroxyurea is allowed during screening and through Cycle 2, Day 3 to reduce WBC count to < 30,000 µL. Adequate organ function as evidenced by the following laboratory findings: Total bilirubin ≤ 1.5 × upper limit of normal (ULN) or < 3 x ULN for patients with Gilbert-Meulengracht Syndrome Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × ULN Creatinine clearance > 60 mL/min QT-interval corrected according to Fridericia's formula (QTcF) < 450 ms on one electrocardiogram (ECG) at screening Exclusion Criteria: Patients meeting any of the following criteria are ineligible for study entry: Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmias not well controlled with medication, myocardial infarction within the previous 6 months before registration, or psychiatric illness/social situations that would limit compliance with study requirements. Patients may not be receiving any other concurrent investigational agents, or have received any investigational agent within one week of registration. Since the teratogenic potential of this combination is currently unknown, females who are pregnant or lactating are excluded. History of any other malignancies within the preceding 12 months before registration with the exception of in-situ cancer, non-muscle invasive bladder cancer, prostate, basal or squamous cell skin cancer Life-threatening illnesses other than AML, uncontrolled medical conditions or organ system dysfunction that, in the Investigator's opinion, could compromise the patient's safety or put the study outcomes at risk Evidence of isolated extramedullary disease Acute Promyelocytic Leukemia or AML with active central nervous system (CNS) involvement Untreated severe (in the opinion of the treating investigator) infection Active and uncontrolled infection with HIV (viral load is detectable by PCR) Active infection with Hepatitis B virus (HbSAg positive or PCR with detectable viral load) or Hepatitis C virus (viral load detectable by PCR). Past Hematopoietic stem cell transplant (HSCT) with active graft vs host disease, immunosuppression other than low dose prednisone (5 mg), or calcineurin inhibitors within the 4 weeks before registration
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
James H Adair, Ph.D.
Phone
814-360-4654
Email
jadair@pendreabio.com
First Name & Middle Initial & Last Name or Official Title & Degree
Bernadette M Adair, BS
Email
ba8387@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel Vlock, MD
Organizational Affiliation
Keystone Nano, Inc
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Christopher Prior, Ph.D.
Organizational Affiliation
Keystone Nano
Official's Role
Study Chair
Facility Information:
Facility Name
Penn State University Hershey Medical Center
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Wanda Neidig
Email
wneidig@pennstatehealth.psu.edu
First Name & Middle Initial & Last Name & Degree
Racheal Griffith, RN
Email
rgriffith2@pennstatehealth.psu.edu
First Name & Middle Initial & Last Name & Degree
David Claxton, MD
Facility Name
University of Virginia Cancer Center
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22903
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cory Caldwell
Email
CJC2P@hscmail.mcc.virginia.edu
First Name & Middle Initial & Last Name & Degree
Jungeun Kim
Email
JK9TE@hscmail.mcc.virginia.edu
First Name & Middle Initial & Last Name & Degree
Michael Keng, MD

12. IPD Sharing Statement

Citations:
PubMed Identifier
31488436
Citation
Barth BM, Wang W, Toran PT, Fox TE, Annageldiyev C, Ondrasik RM, Keasey NR, Brown TJ, Devine VG, Sullivan EC, Cote AL, Papakotsi V, Tan SF, Shanmugavelandy SS, Deering TG, Needle DB, Stern ST, Zhu J, Liao J, Viny AD, Feith DJ, Levine RL, Wang HG, Loughran TP Jr, Sharma A, Kester M, Claxton DF. Sphingolipid metabolism determines the therapeutic efficacy of nanoliposomal ceramide in acute myeloid leukemia. Blood Adv. 2019 Sep 10;3(17):2598-2603. doi: 10.1182/bloodadvances.2018021295.
Results Reference
background
PubMed Identifier
31112736
Citation
Morad SAF, MacDougall MR, Abdelmageed N, Kao LP, Feith DJ, Tan SF, Kester M, Loughran TP Jr, Wang HG, Cabot MC. Pivotal role of mitophagy in response of acute myelogenous leukemia to a ceramide-tamoxifen-containing drug regimen. Exp Cell Res. 2019 Aug 15;381(2):256-264. doi: 10.1016/j.yexcr.2019.05.021. Epub 2019 May 18.
Results Reference
background
PubMed Identifier
25838296
Citation
Kester M, Bassler J, Fox TE, Carter CJ, Davidson JA, Parette MR. Preclinical development of a C6-ceramide NanoLiposome, a novel sphingolipid therapeutic. Biol Chem. 2015 Jun;396(6-7):737-47. doi: 10.1515/hsz-2015-0129.
Results Reference
background

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Study of C6 Ceramide NanoLiposome (CNL) in Patients With Relapsed/Refractory Acute Myeloid Leukemia

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