Augmerosen Plus Fludarabine and Cytarabine in Treating Patients With Refractory or Relapsed Acute Myeloid Leukemia or Acute Lymphoblastic Leukemia

A Phase I Study of G3139 (NSC 683428) in Combination With Salvage Chemotherapy for Treatment of Refractory and Relapsed Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL)

Phase I trial to study the effectiveness of augmerosen plus fludarabine and cytarabine in treating patients who have refractory or relapsed acute myeloid leukemia or acute lymphoblastic leukemia. Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Gene therapy such as augmerosen may make cancer cells more sensitive to chemotherapy drugs. Combining more than one drug with augmerosen may kill more cancer cells.

Study Overview

• Status: Completed
• Conditions: Leukemia
• Intervention / Treatment: Drug: cytarabine; Drug: fludarabine phosphate; Biological: filgrastim; Biological: oblimersen sodium

Detailed Description

OBJECTIVES:

I. Determine the maximum tolerated dose of fludarabine and cytarabine when combined with augmerosen (G3139) in patients with refractory or relapsed acute myeloid leukemia or acute lymphoblastic leukemia and recommend a starting dose for phase II studies.

II. Determine the qualitative and quantitative toxic effects of this regimen in these patients with regard to organ specificity, time course, predictability, and reversibility.

III. Document the therapeutic response in patients treated with this regimen. IV. Measure bcl-2 and related antiapoptotic and proapoptotic proteins in circulating and/or marrow leukemia cells before, during, and after treatment with G3139.

V. Measure WT1 expression in leukemic blasts as a surrogate marker for minimal residual disease and correlate it with bcl-2 and related antiapoptotic and proapoptotic gene expression.

VI. Determine the time required for bcl-2 levels to recover after treatment with this regimen.

VII. Determine if TP53 mutations are present in leukemic blasts and how these mutations may affect expression of BAX, level of treatment induced apoptosis, and clinical endpoints.

VIII. Assess apoptosis in leukemic cells before, during, and after treatment with this regimen.

IX. Determine the pharmacokinetics of fludarabine and cytarabine in patients treated with this regimen.

X. Perform pharmacodynamic studies of fludarabine and cytarabine on the leukemic cells of patients prior to treatment.

OUTLINE: This is a dose-escalation study of fludarabine and cytarabine.

Patients receive augmerosen IV continuously on days 1-10 and filgrastim (G-CSF) subcutaneously beginning on day 5 and continuing until blood counts recover. Patients receive fludarabine IV over 30 minutes followed 3.5 hours later by cytarabine IV over 4 hours on days 6-10. Patients who achieve complete response (CR) receive a second course beginning 4 weeks after completion of the first course. Patients who achieve CR and have a matched sibling or unrelated bone marrow donor may undergo allogeneic bone marrow transplantation. Cohorts of 3-6 patients receive escalating doses of fludarabine and cytarabine until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Columbus, Ohio, United States, 43210-1240
      • Arthur G. James Cancer Hospital - Ohio State University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

DISEASE CHARACTERISTICS:

• Histologically proven refractory or relapsed acute myeloid leukemia or acute lymphoblastic leukemia
• Marrow cellularity must be at least 20%
• Must have diagnostic lumbar puncture and treatment with prophylactic intrathecal methotrexate within 1 week prior to entering study
• No active CNS involvement
• CNS involvement allowed if no residual leukemic cells are detected in CSF following intrathecal chemotherapy

PATIENT CHARACTERISTICS:

• Age: 16 and over
• Performance status: ECOG 0-2
• Life expectancy: At least 4 weeks

• Bilirubin no greater than 2 times upper limit of normal(ULN)

  • ALT and AST no greater than 2 times ULN
  • Alkaline phosphatase no greater than 2 times ULN*
  • Unless attributable to malignancy
• Creatinine no greater than 1.5 mg/dL unless attributable to malignancy
• No symptomatic congestive heart failure
• No unstable angina pectoris No or cardiac arrhythmia
• Resting cardiac ejection fraction no less than 45% unless attributable to malignancy
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception before and during study
• No history of allergy to study medications
• No uncontrolled concurrent illness
• No active infection
• No serious medical or psychiatric illness that would preclude informed consent or limit survival to less than 4 weeks

PRIOR CONCURRENT THERAPY:

• At least 2 weeks since prior chemotherapy except hydroxyurea
• No concurrent corticosteroids except for grade 4 toxicity unresponsive to all other agents
• At least 4 weeks since prior radiotherapy
• No other concurrent investigational or standard agents or therapies for leukemia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Arm I; Patients receive augmerosen IV continuously on days 1-10 and filgrastim (G-CSF) subcutaneously beginning on day 5 and continuing until blood counts recover. Patients receive fludarabine IV over 30 minutes followed 3.5 hours later by cytarabine IV over 4 hours on days 6-10. Patients who achieve complete response (CR) receive a second course beginning 4 weeks after completion of the first course. Patients who achieve CR and have a matched sibling or unrelated bone marrow donor may undergo allogeneic bone marrow transplantation. Cohorts of 3-6 patients receive escalating doses of fludarabine and cytarabine until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity.

Drug: cytarabine; Drug: fludarabine phosphate; Biological: filgrastim; Biological: oblimersen sodium

Collaborators and Investigators

• Sponsor: National Cancer Institute (NCI)
• Investigators: Study Chair: Guido Marcucci, MD, Ohio State University Comprehensive Cancer Center

Study record dates

Study Major Dates

• Study Start: October 1, 1999
• Primary Completion (Actual): December 1, 2001

Study Registration Dates

• First Submitted: March 7, 2000
• First Submitted That Met QC Criteria: January 28, 2004
• First Posted (Estimate): January 29, 2004

Study Record Updates

• Last Update Posted (Estimate): February 1, 2013
• Last Update Submitted That Met QC Criteria: January 31, 2013
• Last Verified: May 1, 2002

More Information

Terms related to this study

• Keywords: recurrent adult acute myeloid leukemia; recurrent adult acute lymphoblastic leukemia
• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphoid; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Fludarabine; Fludarabine phosphate; Cytarabine; Oblimersen
• Other Study ID Numbers: NCI-2012-01399; OSU-99H0257; OSU-9977; NCI-T99-0057; CDR0000067515 (Registry Identifier: PDQ (Physician Data Query))