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Tagraxofusp to Eradicate Measurable Residual Disease in Patients With Acute Myeloid Leukemia

Primary Purpose

Acute Myeloid Leukemia

Status
Not yet recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Azacitidine
Tagraxofusp-erzs
Sponsored by
Jonsson Comprehensive Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia

Eligibility Criteria

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

Inclusion Criteria: Age >= 18 years AML in first or second remission, including: Complete remission (CR), defined as bone marrow blasts < 5%, absence of circulating blasts, absence of extramedullary disease, absolute neutrophil count (ANC) >= 1,000/uL, platelet count > 100,000/uL Complete remission with incomplete hematologic recovery (CRi), defined as all CR criteria except for residual neutropenia (ANC < 1,000/uL) or residual thrombocytopenia (platelet count < 100,000/uL) Morphologic leukemia-free state with adequate marrow recovery, defined as bone marrow blasts < 5%, ANC >= 500/uL, and platelet count >= 20,000/uL Minimal residual disease positive >= 0.01% based on MPFC For participants in first remission, MRD positivity at any point from time of establishing first remission onward while still in first remission For participants in second remission, MRD positivity at any point from time of establishing second remission onward while still in second remission MRD must be repeated and remain positive if additional treatment is given prior to enrollment CD123 positivity on flow cytometry (partial, dim, or bright) from either: Conventional flow cytometry on marrow specimen from time of original diagnosis or first relapse High-sensitivity multiparametric flow cytometry on marrow specimen from time of MRD positivity Eastern Cooperative Oncology Group (ECOG) 0-2 Serum albumin level >= 3.2 g/dL in the absence of receiving albumin infusion Serum total bilirubin =< 1.5 mg/dL, unless considered due to Gilbert's disease or medication effect Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase =< 2.5 times the upper limit of normal, unless considered due to medication effect (eg, azole therapy) Creatinine clearance >= 60 mL/min based on Cockcroft-Gault glomerular filtration rate (GFR) and serum creatinine (Cr) =< 1.8 mg/dL Ability to give full informed consent Females of reproductive potential (postmenopausal for less than 24 consecutive months) must have a negative pregnancy test within 1 week of initiating treatment and may not be breastfeeding Exclusion Criteria: MRD negativity < 0.01% at screening Intensive AML therapy within the past 14 days, or non-intensive targeted therapy within the past 7 days Cord blood as donor source Second malignancy that would be expected to limit survival within less than 2 years Cardiovascular disease that would result in high risk for toxicity, including: Uncontrolled or New York Heart Association (NYHA) class III or VI congestive heart failure Recurrent or uncontrolled angina Unstable angina, myocardial infarction, or stroke in past 6 months Uncontrolled hypertension Arrhythmia not controlled by medication Left ventricular ejection fraction < 50% History of coronary stent placement that requires mandatory continuation of dual antiplatelet therapy Uncontrolled intercurrent illness that includes but is not limited to: uncontrolled infection, disseminated intravascular coagulation, psychiatric illness/compliance issues that would limit compliance with study protocol Any medical condition that in the opinion of the investigator places the participant at unacceptable risk for toxicity to investigational therapy

Sites / Locations

  • Habtemariam,Bruck
  • University of California San Francisco

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Cohort I (tagraxofusp-erzs)

Cohort II (azacitidine, tagraxofusp-erzs)

Arm Description

Patients receive tagraxofusp-erzs IV QD over 15 minutes on days 1-5. Treatment repeats every 28-42 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity.

Patients receive azacitidine SC daily on days 1-5 and tagraxofusp-erzs IV QD over 15 minutes on days 8-12. Treatment repeats every 28-42 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Dose-limiting toxicity
Grade >= 3 toxicity using Common Terminology Criteria for Adverse Events version 5.0 or severe persistent hematologic toxicity defined as absolute neutrophil count (ANC) < 500/uL OR platelet count < 10,000/uL in participants that have morphologic leukemia-free state (bone marrow blasts < 5%) are conditions for a dose limiting toxicity.

Secondary Outcome Measures

Measurable residual disease (MRD)
As measured by the University of Washington multiparametric flow cytometry (MPFC) assay with sensitivity of 0.01%
MRD
As measured by the University of Washington MPFC assay with sensitivity of 0.01%.
Number of days between investigational regimen day 28 and initiation of transplant conditioning regimen
Rate of sinusoidal obstruction syndrome
Relapse
As defined by International Working Group criteria: the relapse rate and median duration of remission following allogeneic hematopoietic cell transplantation (HCT) will be reported along with an exact 95% confidence interval.
MRD progression
Defined by presence of leukemia blasts >0.01% at any time after achieving MRD negativity (<0.01%).
Overall survival
Kaplan-Meier methods will estimate the overall survival at 1 year following allogeneic (allo)HCT. This analysis will be performed using the FAS. The 1-year survival estimate will be reported along with a 95% confidence interval.

Full Information

First Posted
January 11, 2023
Last Updated
April 10, 2023
Sponsor
Jonsson Comprehensive Cancer Center
Collaborators
Stemline Therapeutics, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05720988
Brief Title
Tagraxofusp to Eradicate Measurable Residual Disease in Patients With Acute Myeloid Leukemia
Official Title
Tagraxofusp-Based Therapy to Eradicate Measurable Residual Disease of Acute Myelogenous Leukemia Prior to Allogeneic Hematopoietic Cell Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
August 3, 2024 (Anticipated)
Primary Completion Date
August 3, 2025 (Anticipated)
Study Completion Date
August 3, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Jonsson Comprehensive Cancer Center
Collaborators
Stemline Therapeutics, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase Ib/II trial tests the safety of tagraxofusp when given with or without azacitidine in patients with acute myeloid leukemia in remission with measurable residual disease who will undergo allogeneic hematopoietic cell transplant. Tagraxofusp is a recombinant protein consisting of IL-3 conjugated to a truncated diptheria toxin. The IL-3 attaches to the cancer cells and the toxic substance kills them. Azacitidine may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Tagraxofusp and azacitidine may work better to kill cancer cells and eradicate measurable residual disease in patients with acute myeloid leukemia.
Detailed Description
PRIMARY OBJECTIVE: I. To determine the safety and tolerability of tagraxofusp-erzs (tagraxofusp) with or without azacitidine in participants with acute myeloid leukemia (AML) in remission who are planned to undergo allogeneic hematopoietic cell transplantation (alloHCT). SECONDARY OBJECTIVES: I. To estimate the rate of conversion from measurable residual disease (MRD) positive (>= 0.01% by multiparametric flow cytometry [MPFC]) pre-investigational therapy to MRD negative (=< 0.01% by MPFC) after 1 or 2 cycles of investigational therapy. II. To estimate the rate of conversion from MRD positive (>= 0.01% by MPFC) pre-investigational therapy to MRD negative (=< 0.01% by MPFC) post-investigational therapy within 30 days prior to initiation of transplant conditioning regimen and at day +100 following alloHCT. III. To evaluate if adverse effects of this investigational combination leads to delays in alloHCT. IV. To evaluate if this investigational therapy results in liver toxicities after alloHCT such as sinusoidal obstruction syndrome. V. To evaluate relapse rate following alloHCT in participants who receive investigational therapy. VI. To evaluate MRD progression following alloHCT in participants who receive investigational therapy. VII. To evaluate 1-year survival following alloHCT in participants who receive investigational therapy. EXPLORATORY OBJECTIVES: I. To estimate the rate of conversion from MRD positive to MRD negative by means of next generation sequencing. II. To describe the level of CD123 expression on leukemia blasts in the bone marrow specimen at diagnosis and/or time of relapse and the association with achievement of MRD negativity post-investigational therapy. III. To evaluate the number of days to full donor T-cell chimerism following alloHCT. OUTLINE: This is a dose-escalation study of tagraxofusp-erzs . Patients are assigned to 1 of 2 cohorts. COHORT I: Patients receive tagraxofusp-erzs intravenously (IV) once daily (QD) over 15 minutes on days 1-5. Treatment repeats every 28-42 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. COHORT II: Patients receive azacitidine subcutaneously (SC) daily on days 1-5 and tagraxofusp-erzs IV QD over 15 minutes on days 8-12. Treatment repeats every 28-42 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for 12 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
29 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cohort I (tagraxofusp-erzs)
Arm Type
Active Comparator
Arm Description
Patients receive tagraxofusp-erzs IV QD over 15 minutes on days 1-5. Treatment repeats every 28-42 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity.
Arm Title
Cohort II (azacitidine, tagraxofusp-erzs)
Arm Type
Experimental
Arm Description
Patients receive azacitidine SC daily on days 1-5 and tagraxofusp-erzs IV QD over 15 minutes on days 8-12. Treatment repeats every 28-42 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Azacitidine
Other Intervention Name(s)
5 AZC, 5-AC, 5-Azacytidine, 5-AZC, Azacytidine, Azacytidine, 5-, Ladakamycin, Mylosar, U-18496, Vidaza
Intervention Description
Given SC
Intervention Type
Biological
Intervention Name(s)
Tagraxofusp-erzs
Other Intervention Name(s)
Diphtheria Toxin(388)-Interleukin-3 Fusion Protein, DT(388)-IL3 Fusion Protein, DT388IL3 fusion protein, Elzonris, IL3R-targeting Fusion Protein SL-401, SL-401, Tagraxofusp, Tagraxofusp ERZS
Intervention Description
Given IV
Primary Outcome Measure Information:
Title
Dose-limiting toxicity
Description
Grade >= 3 toxicity using Common Terminology Criteria for Adverse Events version 5.0 or severe persistent hematologic toxicity defined as absolute neutrophil count (ANC) < 500/uL OR platelet count < 10,000/uL in participants that have morphologic leukemia-free state (bone marrow blasts < 5%) are conditions for a dose limiting toxicity.
Time Frame
Up to 42 days
Secondary Outcome Measure Information:
Title
Measurable residual disease (MRD)
Description
As measured by the University of Washington multiparametric flow cytometry (MPFC) assay with sensitivity of 0.01%
Time Frame
At the end of cycle 1 and cycle 2 (each cycle is 28 days).
Title
MRD
Description
As measured by the University of Washington MPFC assay with sensitivity of 0.01%.
Time Frame
Within 30 days prior to initiation of transplant conditioning regimen and at day 100 after transplant
Title
Number of days between investigational regimen day 28 and initiation of transplant conditioning regimen
Time Frame
Between investigational regimen day 28 and initiation of transplant conditioning regimen, through study completion, an average of 1 year.
Title
Rate of sinusoidal obstruction syndrome
Time Frame
up to 1 year following investigational therapy
Title
Relapse
Description
As defined by International Working Group criteria: the relapse rate and median duration of remission following allogeneic hematopoietic cell transplantation (HCT) will be reported along with an exact 95% confidence interval.
Time Frame
Up to 1 year
Title
MRD progression
Description
Defined by presence of leukemia blasts >0.01% at any time after achieving MRD negativity (<0.01%).
Time Frame
Up to 1 year
Title
Overall survival
Description
Kaplan-Meier methods will estimate the overall survival at 1 year following allogeneic (allo)HCT. This analysis will be performed using the FAS. The 1-year survival estimate will be reported along with a 95% confidence interval.
Time Frame
1 year after transplant
Other Pre-specified Outcome Measures:
Title
CD123 expression via immunohistochemical stain on leukemia blasts in the bone marrow specimen
Description
CD123 expression, on the original bone marrow specimen at time of diagnosis or time of relapse and the bone marrow specimen at time of MRD negativity, will be described as bright, dim, partial, or negative; and summarized by mean, median, standard deviation, and interquartile range.
Time Frame
at time of diagnosis or relapse and following cycle 1 and cycle 2 (each cycle is 28 days).
Title
T-cell (CD3) chimerism via short tandem repeat assay
Description
Days to achieve full T-cell chimerism following alloHCT will be characterized by Kaplan-Meier methods along with 95% confidence interval.
Time Frame
30, 90, 180, and 365 days after transplant

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age >= 18 years AML in first or second remission, including: Complete remission (CR), defined as bone marrow blasts < 5%, absence of circulating blasts, absence of extramedullary disease, absolute neutrophil count (ANC) >= 1,000/uL, platelet count > 100,000/uL Complete remission with incomplete hematologic recovery (CRi), defined as all CR criteria except for residual neutropenia (ANC < 1,000/uL) or residual thrombocytopenia (platelet count < 100,000/uL) Morphologic leukemia-free state with adequate marrow recovery, defined as bone marrow blasts < 5%, ANC >= 500/uL, and platelet count >= 20,000/uL Minimal residual disease positive >= 0.01% based on MPFC For participants in first remission, MRD positivity at any point from time of establishing first remission onward while still in first remission For participants in second remission, MRD positivity at any point from time of establishing second remission onward while still in second remission MRD must be repeated and remain positive if additional treatment is given prior to enrollment CD123 positivity on flow cytometry (partial, dim, or bright) from either: Conventional flow cytometry on marrow specimen from time of original diagnosis or first relapse High-sensitivity multiparametric flow cytometry on marrow specimen from time of MRD positivity Eastern Cooperative Oncology Group (ECOG) 0-2 Serum albumin level >= 3.2 g/dL in the absence of receiving albumin infusion Serum total bilirubin =< 1.5 mg/dL, unless considered due to Gilbert's disease or medication effect Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase =< 2.5 times the upper limit of normal, unless considered due to medication effect (eg, azole therapy) Creatinine clearance >= 60 mL/min based on Cockcroft-Gault glomerular filtration rate (GFR) and serum creatinine (Cr) =< 1.8 mg/dL Ability to give full informed consent Females of reproductive potential (postmenopausal for less than 24 consecutive months) must have a negative pregnancy test within 1 week of initiating treatment and may not be breastfeeding Exclusion Criteria: MRD negativity < 0.01% at screening Intensive AML therapy within the past 14 days, or non-intensive targeted therapy within the past 7 days Cord blood as donor source Second malignancy that would be expected to limit survival within less than 2 years Cardiovascular disease that would result in high risk for toxicity, including: Uncontrolled or New York Heart Association (NYHA) class III or VI congestive heart failure Recurrent or uncontrolled angina Unstable angina, myocardial infarction, or stroke in past 6 months Uncontrolled hypertension Arrhythmia not controlled by medication Left ventricular ejection fraction < 50% History of coronary stent placement that requires mandatory continuation of dual antiplatelet therapy Uncontrolled intercurrent illness that includes but is not limited to: uncontrolled infection, disseminated intravascular coagulation, psychiatric illness/compliance issues that would limit compliance with study protocol Any medical condition that in the opinion of the investigator places the participant at unacceptable risk for toxicity to investigational therapy
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Bruck Habtemariam
Phone
3107940242
Email
bhabtemariam@mednet.ucla.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Caspian Oliai, MD
Organizational Affiliation
UCLA / Jonsson Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Habtemariam,Bruck
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Bruck Habtemariam
Phone
310-794-0242
Email
bhabtemariam@mednet.ucla.edu
First Name & Middle Initial & Last Name & Degree
Caspian Oliai, MD
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Aaron C. Logan
Phone
415-502-2110
Email
aaron.logan@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Aaron C. Logan

12. IPD Sharing Statement

Learn more about this trial

Tagraxofusp to Eradicate Measurable Residual Disease in Patients With Acute Myeloid Leukemia

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