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Vosaroxin and Azacitidine in Treating Patients With Myelodysplastic Syndromes

Primary Purpose

Myelodysplastic Syndromes

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
vosaroxin
Azacitidine
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelodysplastic Syndromes

Eligibility Criteria

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

Inclusion Criteria:

  • Diagnosis of myelodysplastic syndrome and one of the following:

    • Cytopenias requiring red blood cell and/or platelet transfusions or neutropenia (ANC <1 X109/L)
    • IPSS score of INT-1 or higher at screening
    • MDS with excess blasts in transformation as defined by FAB criteria (20-29% bone marrow blasts) or
    • Chronic myelomonocytic leukemia
  • Age ≥18 years old
  • Adequate renal and hepatic function defined as all of the following:

    • total bilirubin ≤ 2.0 mg/dl, except in cases of Gilbert's disease;
    • AST and ALT ≤2.5 institutional ULN;
    • serum creatinine within normal institutional limits or estimated creatinine clearance ≥60 mL/min/1.73 m2 by the Cockcroft-Gault equation
  • ECOG performance status ≤2
  • Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable).
  • Females must be surgically or biologically sterile or postmenopausal or if of childbearing potential, must agree to use an adequate method of contraception during the study until 30 days after the last treatment. Males must be surgically or biologically sterile or agree to use an adequate method of contraception during the study until 30 days after the last treatment. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.
  • Patients may have received up to 3 prior cycles of hypomethylator therapy (i.e. decitabine or azacitidine) prior to enrollment and may have received supportive care measures (growth factors, erythropoietin stimulating agents, transfusion, etc.
  • Either enrolled in HRPO# 201011766 ("Tissue Acquisition for Analysis of Genetic Progression Factors in Hematologic Diseases"), which facilitates collection of blood, bone marrow, and skin for correlative studies, or consents to collection of blood, bone marrow, and skin as part of this protocol.

Exclusion Criteria:

  • Prior treatment with four or more cycles of hypomethylator therapy.
  • Receiving concomitant chemotherapy, radiation therapy, or immunotherapy during the duration of treatment on protocol.
  • Known seropositivity for or active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients who are seropositive because of hepatitis B virus vaccine are eligible. Patients who are seropositive for HCV, but have a negative viral load are also eligible. Documentation that the patients have completed a course of therapy for HCV is required and will be obtained.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Pregnant and/or breastfeeding.

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (vosaroxin, azacitidine)

Arm Description

Patients receive vosaroxin IV over 10 minutes on days 1 and 4 and azacitidine SC or IV over 15 minutes on days 1-7. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

MTD of vosaroxin in combination with azacitidine
Defined as the highest dose of vosaroxin that results in a DLT in =< 1 of 6 patients graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) 4.0

Secondary Outcome Measures

Best response (including hematologic improvement)
According to the modified IWG criteria. Summarized as proportion with 95% confidence intervals.
Best overall response
According to the modified IWG criteria. Summarized as proportion with 95% confidence intervals
Incidence of adverse events
Graded according to NCI CTCAE v. 4.0. summarized by grade, type and patient.
Time to response
According to the modified IWG criteria. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Event-free survival
From the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Progression-free survival (PFS)
From the date of first dose of study drug to disease progression or death from MDS. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Disease-free survival (DFS)
From the date of first documentation of a complete remission (CR) to date of relapse. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Overall survival (OS)
Date of first dose of study drug to the date of death from any cause. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Biomarkers of response to vosaroxin and azacitidine therapy
Serial estimate of biomarker expression will be plotted and summarized over time using means and standard deviations, possibly on a log scale

Full Information

First Posted
July 30, 2013
Last Updated
March 28, 2023
Sponsor
Washington University School of Medicine
Collaborators
Sunesis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01913951
Brief Title
Vosaroxin and Azacitidine in Treating Patients With Myelodysplastic Syndromes
Official Title
A Phase I Study of Vosaroxin Plus Azacitidine for Patients With Myelodysplastic Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
November 22, 2013 (Actual)
Primary Completion Date
December 5, 2016 (Actual)
Study Completion Date
April 29, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
Sunesis Pharmaceuticals

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
This phase I trial studies the side effects and the best dose of vosaroxin when given together with azacitidine in treating patients with myelodysplastic syndromes. Drugs used in chemotherapy, such as vosaroxin and azacitidine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelodysplastic Syndromes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
35 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (vosaroxin, azacitidine)
Arm Type
Experimental
Arm Description
Patients receive vosaroxin IV over 10 minutes on days 1 and 4 and azacitidine SC or IV over 15 minutes on days 1-7. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
vosaroxin
Other Intervention Name(s)
voreloxin
Intervention Description
Given IV over 10 minutes on Day 1 and 4
Intervention Type
Drug
Intervention Name(s)
Azacitidine
Other Intervention Name(s)
Vidaza, Ladakamycin
Intervention Description
Given SC or IV over 15 minutes on days 1-7
Primary Outcome Measure Information:
Title
MTD of vosaroxin in combination with azacitidine
Description
Defined as the highest dose of vosaroxin that results in a DLT in =< 1 of 6 patients graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) 4.0
Time Frame
28 days
Secondary Outcome Measure Information:
Title
Best response (including hematologic improvement)
Description
According to the modified IWG criteria. Summarized as proportion with 95% confidence intervals.
Time Frame
At 3 cycles
Title
Best overall response
Description
According to the modified IWG criteria. Summarized as proportion with 95% confidence intervals
Time Frame
Up to 7 months
Title
Incidence of adverse events
Description
Graded according to NCI CTCAE v. 4.0. summarized by grade, type and patient.
Time Frame
Up to 7 months
Title
Time to response
Description
According to the modified IWG criteria. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Time Frame
Up to 7 months
Title
Event-free survival
Description
From the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Time Frame
up to 5 years
Title
Progression-free survival (PFS)
Description
From the date of first dose of study drug to disease progression or death from MDS. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Time Frame
up to 5 years
Title
Disease-free survival (DFS)
Description
From the date of first documentation of a complete remission (CR) to date of relapse. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Time Frame
up to 5 years
Title
Overall survival (OS)
Description
Date of first dose of study drug to the date of death from any cause. Described using Kaplan-Meier models to plot these endpoints and estimate median times with a 95% confidence interval.
Time Frame
up to 5 years
Title
Biomarkers of response to vosaroxin and azacitidine therapy
Description
Serial estimate of biomarker expression will be plotted and summarized over time using means and standard deviations, possibly on a log scale
Time Frame
Up to 5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of myelodysplastic syndrome and one of the following: Cytopenias requiring red blood cell and/or platelet transfusions or neutropenia (ANC <1 X109/L) IPSS score of INT-1 or higher at screening MDS with excess blasts in transformation as defined by FAB criteria (20-29% bone marrow blasts) or Chronic myelomonocytic leukemia Age ≥18 years old Adequate renal and hepatic function defined as all of the following: total bilirubin ≤ 2.0 mg/dl, except in cases of Gilbert's disease; AST and ALT ≤2.5 institutional ULN; serum creatinine within normal institutional limits or estimated creatinine clearance ≥60 mL/min/1.73 m2 by the Cockcroft-Gault equation ECOG performance status ≤2 Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable). Females must be surgically or biologically sterile or postmenopausal or if of childbearing potential, must agree to use an adequate method of contraception during the study until 30 days after the last treatment. Males must be surgically or biologically sterile or agree to use an adequate method of contraception during the study until 30 days after the last treatment. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Patients may have received up to 3 prior cycles of hypomethylator therapy (i.e. decitabine or azacitidine) prior to enrollment and may have received supportive care measures (growth factors, erythropoietin stimulating agents, transfusion, etc. Either enrolled in HRPO# 201011766 ("Tissue Acquisition for Analysis of Genetic Progression Factors in Hematologic Diseases"), which facilitates collection of blood, bone marrow, and skin for correlative studies, or consents to collection of blood, bone marrow, and skin as part of this protocol. Exclusion Criteria: Prior treatment with four or more cycles of hypomethylator therapy. Receiving concomitant chemotherapy, radiation therapy, or immunotherapy during the duration of treatment on protocol. Known seropositivity for or active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients who are seropositive because of hepatitis B virus vaccine are eligible. Patients who are seropositive for HCV, but have a negative viral load are also eligible. Documentation that the patients have completed a course of therapy for HCV is required and will be obtained. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Pregnant and/or breastfeeding.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Meagan Jacoby, M.D., Ph.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
21760592
Citation
Lancet JE, Ravandi F, Ricklis RM, Cripe LD, Kantarjian HM, Giles FJ, List AF, Chen T, Allen RS, Fox JA, Michelson GC, Karp JE. A phase Ib study of vosaroxin, an anticancer quinolone derivative, in patients with relapsed or refractory acute leukemia. Leukemia. 2011 Dec;25(12):1808-14. doi: 10.1038/leu.2011.157. Epub 2011 Jul 15.
Results Reference
background
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Learn more about this trial

Vosaroxin and Azacitidine in Treating Patients With Myelodysplastic Syndromes

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