Study of Magrolimab in Combination With Azacitidine Versus Physician's Choice of Venetoclax in Combination With Azacitidine or Intensive Chemotherapy in Patients With TP53 Mutant Acute Myeloid Leukemia That Have Not Been Treated (ENHANCE-2)
Acute Myeloid Leukemia
About this trial
This is an interventional treatment trial for Acute Myeloid Leukemia
Eligibility Criteria
Key Inclusion Criteria:
- Individuals with confirmation of AML by World Health Organization criteria, previously untreated for AML, and who have presence of at least 1 TP53 gene mutation that is not benign or likely benign based on evaluation by either central laboratory or an approved local laboratory (after central review of the bone marrow TP53 mitigation next-generation sequencing test results) (individuals with biallelic 17p deletions, loss of both 17p alleles, are eligible based on locally evaluated cytogenetics/karyotype/fluorescence in situ hybridization (FISH) report)
- Individuals with white blood cell (WBC) count ≤ 20×10^3/microliter (μL) prior to randomization. If the individual's WBC is > 20×10^3/μL prior to randomization, the individual can be enrolled, assuming all other eligibility criteria are met. However, the WBC should be ≤ 20×10^3/μL prior to the first dose of study treatment and prior to each magrolimab dose the first 4 weeks (if the individual is randomized to the experimental arm) Note: Individuals can be treated with hydroxyurea and/or leukapheresis throughout the study or prior to randomization to reduce the WBC to ≤ 20×10^3/μL to enable eligibility for study drug dosing.
- The hemoglobin must be ≥ 9 grams per deciliter (g/dL) prior to initial dose of study treatment Notes:Transfusions are allowed to meet hemoglobin eligibility
- Individual has provided informed consent
- Individual is willing and able to comply with clinic visits and procedure outlined in the study protocol
- Individuals must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2, except for individuals less than 75 years of age and appropriate for non-intensive treatment. For these individuals, the ECOG performance status score may be 0 to 3
- Individuals must have adequate renal function as demonstrated by a creatinine clearance ≥ 30 milliliters per minute calculated by the Cockcroft Gault formula
- Adequate cardiac function as demonstrated by:
- Lack of symptomatic congestive heart failure and clinically significant cardiac arrhythmias and ischemic heart disease
- LVEF > 50% for individuals appropriate for intensive therapy
- Adequate liver function as demonstrated by:
- Aspartate aminotransferase ≤ 3.0 × upper limit of normal (ULN)
- Alanine aminotransferase ≤ 3.0 × ULN
- Total bilirubin ≤ 1.5 × ULN, or primary unconjugated bilirubin ≤ 3.0 × ULN if individual has a documented history of Gilbert's syndrome or genetic equivalent
- Pretreatment blood cross-match completed
- Males and females of childbearing potential who engage in heterosexual intercourse must agree to use protocol-specified method(s) of contraception
- Individuals must be willing to consent to mandatory pretreatment and ontreatment bone marrow biopsies (aspirate and trephines).
Key Exclusion Criteria:
- Positive serum pregnancy test
- Breastfeeding female
- Known hypersensitivity to any of the study drugs, the metabolites, or formulation excipient
- 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 (excluding hydroxyurea), hypomethylating agent (HMA), low dose cytarabine and/or venetoclax Note: Individuals with prior myelodysplastic syndrome (MDS) who have not received prior HMAs or chemotherapeutic agents for MDS are allowed on study. Other prior MDS therapies including, but not limited to, lenalidomide, erythroid stimulating agents, or similar RBC-direct therapies, are allowed. Localized non-central nervous system (CNS) radiotherapy, erythroid and/or myeloid growth factors, hormonal therapy with luteinizing hormone-releasing hormone agonists for prostate cancer, hormonal therapy or maintenance for breast cancer, and treatment with bisphosphonates and receptor activator of nuclear factor kappa-B ligand inhibitors are also not criteria for exclusion.
- Individuals who are appropriate for intensive treatment but who have been previously treated with maximum cumulative doses of idarubicin and/or other anthracyclines and anthracenediones will be excluded.
- Individuals receiving any live vaccine within 4 weeks prior to initiation of study treatments.
- For individuals appropriate for intensive therapy, individuals treated with trastuzumab within 7 months prior to initiation of study treatments.
- Current participation in another interventional clinical study
- Known inherited or acquired bleeding disorders
- Individuals appropriate for non-intensive therapy, who have received treatment with strong and/or moderate cytochrome P450 enzyme 3A (CYP3A) inducers within 7 days prior to the initiation of study treatments
- Individuals appropriate for non-intensive therapy who have consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or starfruit within 3 days prior to the initiation of study treatment
- Individuals appropriate for non-intensive therapy who have malabsorption syndrome or other conditions that preclude enteral route of administration
- Clinical suspicion of active CNS involvement with AML
- Individuals who have acute promyelocytic leukemia
- Significant disease or medical conditions, as assessed by the Investigator and Sponsor, that would substantially increase the risk-benefit ratio of participating in the study. This includes, but is not limited to, acute myocardial infarction within the last 6 months, unstable angina, uncontrolled diabetes mellitus, significant active infections, and congestive heart failure New York Heart Association Class III-IV
- 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 anti-cancer therapies and have had no evidence of active malignancy for at least ≥ 1 year Note: Individuals on maintenance therapy alone who have no evidence of active malignancy for at least ≥ 1 year are eligible.
- Known active or chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection or human immunodeficiency virus (HIV) infection in medical history
- Active HBV, and/or active HCV, and/or HIV following testing at screening:
- Individuals who test positive for hepatitis B surface antigen (HBsAg). Individuals who test positive for hepatitis B core antibody (anti-HBc) will require HBV deoxyribose nucleic acid (DNA) by quantitative polymerase chain reaction (PCR) for confirmation of active disease
- Individuals who test positive for HCV antibody. These individuals will require HCV ribose nucleic acid (RNA) quantitative PCR for confirmation of active disease
- Individuals who test positive for HIV antibody
- Individuals not currently receiving antiviral therapy and who have an undetectable viral load in the prior 3 months may be eligible for the study.
Note: Other protocol defined Inclusion/Exclusion criteria may apply.
Sites / Locations
- University of Alabama at Birmingham
- City of Hope (City of Hope National Medical Center, City of Hope Medical Center)
- USC/ Norris Comprehensive Cancer Center
- Ronald Reagan UCLA Medical Center
- UC Irvine Health
- Colorado Blood Cancer Institute
- Mayo Clinic Florida
- Miami Cancer Institute
- AdventHealth Orlando
- Memorial Cancer Institute
- Moffitt Cancer Center
- Winship Cancer Institute
- Northwestern Memorial Hospital/Main Lab
- The University of Chicago Medical Centre
- University of Kansas Hospital
- University of Kentucky Medical Center
- Tulane Medical center
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Massachusetts General Hospital
- Dana-Farber Cancer Institute
- Mayo Clinic Cancer Center Outpatient Pharmacy
- MidAmerica Division, Inc., c/o Research Medical Center
- SSM Health Saint Louis University Hospital
- Roswell Park Cancer Institute
- Columbia University Medical Center - Herbert Irving Pavilion
- UNC Hospitals, The University of North Carolina at Chapel Hill
- Duke Blood Cancer Center
- The Ohio State University Wexner Medical Center/ James Cancer Hospital
- University of Oklahoma Health Sciences Center - OU Health Stephenson Cancer Center
- Thomas Jefferson University, Sidney Kimmel Cancer Center, Clinical Research Organization
- St. Francis Cancer Center
- Prisma Health Cancer Institute
- Baylor College of Medicine Medical Center
- The University of Texas MD Anderson Cancer Center
- Huntsman Cancer Institute ,The University of Utah
- Froedtert Hospital / Medical College of Wisconsin
- Canberra Hospital
- Calvary Master Newcastle
- Westmead Hospital / Department of Haematology and Bone Marrow Transplantation
- Princess Alexandra Hospital
- Royal Adelaide Hospital
- Andrew Love Cancer Centre, University Hospital Geelong
- The Alfred
- St Vincents Hospital Melbourne
- Fiona Stanley Hospital
- Royal Perth Hospital
- Univ. -Klinik für Hämatologie und Internistische Onkologie, Kepler Universitätskilkun GmbHMed
- Uniklinikum Salzburg, Universitatsklinik f. Innere Medizin III der PMU
- Algemeen Ziekenhuis Sint-Jan Brugge-Oostende AV
- Universitair Ziekenhuis Brussel
- Grand Hôpital De Charleroi - Notre Dame
- Universitaire Ziekenhuis Antwerpen
- Universitair Ziekenhuis Gent
- AZ Delta vzw
- Tom Baker Cancer Center
- Queen Elizabeth II Health Sciences Centre
- CIUSSS de L'Est-de-L'Ile-de- Montreal - Hopital Maisonneuve-Rosemont
- McGill University Health Centre
- Sunnybrook Research Institute
- Princess Margaret Cancer Centre
- Aalborg University Hospital
- Odense University Hospital
- CHU d'Angers
- CHU de Caen
- CHRU Lille - Hospital Claude Huriez
- CHU Limoges
- Central Hospital Lyon Sud
- Institut Paoli Calmettes
- CHU de Nantes, Hotel Dieu
- CHU Nice - Hopital Archet 1
- Gustave Roussy
- Hopital Haut-Leveque
- IUCT Oncopole
- Hopitaux de Brabois
- Uniklinik RWTH Aachen, Medizinische Klunuk IV - Klinik fur Hamatologie, Onkologie, Hamastaseologie und Srammzelltransplantation
- Dept. of Hematology, Oncology and Tumor Immunology, Charite- University Medicine Berlin, Campus Virchow Klinikum
- Department of Hematology and Oncology, Braunschweig Community Hospital
- Universitatsklinikum Carl Gustav Carus Dresden an der Technische Universitat Dresden, Medizinische Klinik und Poliklinik 1, Bereich Hamatologie
- Universitätsklinikum Düsseldorf -Klinik für Hämatologie, Onkologie und Klinische Immunologie
- Dept. of Medicine II, University Hospital Hamburg-Eppendorf
- Universitatsklinikum Heidelberg, Innere Medizin V, Hamatologie, Onkologie und Rheumatologie
- Universitatsklinikum Schleswig-Holstein
- Universitatsklinikum Koln
- Klinikum Ludwigshafen Medizinische Klinik A
- Klinikum rechts der Isar der Technischen Universitat Munchen, Klinik und Poliklinik fur Innere Medizin III
- LMU - Klinikum der Universitat Munchen, Medizinische Klinik und Poliklinik III, Campus Grosshadern
- Universitatsklinikum Ulm, Zentrum fur Innere Medizin, Innere Medizin III
- Prince of Wales Hospital, The Chinese University of Hong Kong
- Queen Mary Hospital
- Azienda Ospedaliero Universitaria delle Marche
- AOU Consorziale Policlinico Bari
- Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola-Malphigi U.O Ematologia
- Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRS - Oncologia Medica
- Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli U.O.S.C. di Ematologia con Trapianto di Midollo Osseo
- SC Ematologia, Azienda Ospedaliera di Perugia - Santa Maria della Misericordia
- AORM - AO Riuniti Marche Norde - Pesaro Presidio "San Salvatore" - Muraglia
- Fondazione PTV Policinico Tor Vergata
- SCDU Ematologia e Terrapie cellulari AO O Ordine Mauriziano Torino
- ASST Sette Laghi - Ospedale di Circolo e Fondazione Macchi
- Hyogo Prefectural Amagasaki General Medical Center
- Chiba Aoba Municipal Hospital
- University of Yamanashi Hospital
- Kyushu University Hospital
- Fukushima Medical University Hospital
- Aiiku Hospital
- Tokai University School of Medicine
- Kanazawa University Hospital
- National Cancer Center Hospital East
- Hospital of the University of Occupational and Environmental Health, Japan
- Kobe City Medical Center General Hospital
- Gunmaken Saiseikai Maebashi Hospital
- Ehime Prefectural Center Hospital
- Nagasaki University Hospital
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital
- Okayama University Hospital
- Osaka Metropolitan University Hospital
- Kindai University Hospital
- National University Corporation Tohoku University Tohoku University Hospital
- NTT Medical Center Tokyo
- Yamagata University Hospital
- University of Fukui Hospital
- Hospital General Universitario de Alicante
- Hospital del la Santa Creu i Sant Pau
- Hospital Universitari Vall d'Hebron
- Hospital Clinic de Barcelona
- Institut Catala d'Oncologia
- Complejo Asistencial Universitario de Burgos/H.U. de Burgos
- Hospital Universitario Reina Sofia
- Complejo Hospitalario San Pedro de Alcantara
- Hospital Universitario de Gran Canaria Doctor Negrin
- Hospital Universitario de La Princesa
- Hospital General Universitario Gregorio Maranon
- MD Anderson Cancer Center Madrid
- Hospital Regional Universitario de Malaga
- Hospital Universitario Central de Asturias
- Clinica Universidad de Navarra - Pamplona (Main Site)
- Complejo Asistencial Universitario de Salamanca - Hsopital Clinico
- Hospital U. Marques de Valdecilla
- Hospital Clinico Universitario de Valencia
- Hospital Universitari I Politècnic La Fe
- Universitetssjukhus, Hematologimottagnungen
- Universitatsspital Basel - Klinik fur Hamatrologie, Bereich Innere Medizin
- Inselspital, Universitatsspital Bern - Universitatsklinik fur Medizinisch Onkologie
- University Hospitals Birmingham NHS Foundation Trust
- United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Sibsey Road
- Cambridge University Hospital NHS Foundation Trust
- Cardiff and Vale University Health Board
- Barts Health NHS Trust
- NHS Tayside
- Beatson West of Scotland Cancer Centre
- University College London Hospitals NHS Foundation Trust
- King's College NHS Foundation Trust
- Oxford University Hospital NHS Foundation Trust
- The Royal Marsden NHS Foundation Trust
- The Christie NHS Foundation Trust
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Active Comparator
Active Comparator
Magrolimab + Azacitidine
Control Arm: Venetoclax + Azacitidine
Control Arm: 7+3 Chemotherapy
Participants will receive an escalating dose of magrolimab and a fixed dose of azacitidine.
Participants who are appropriate for non-intensive therapy will receive an escalating dose of venetoclax and a fixed dose of azacitidine.
Participants who are appropriate for intensive therapy will receive 7+3 chemotherapy: 7 day treatment with cytarabine and 3 day treatment with daunorubicin or idarubicin during induction and high-dose cytarabine and steroidal eye drops during consolidation.