Vincristine Sulfate Liposome Injection (Marqibo®) in Combination With UK ALL R3 Induction Chemotherapy for Children, Adolescents, and Young Adults With Relapsed ALL

A Pilot Study of Vincristine Sulfate Liposome Injection (Marqibo®) in Combination With UK ALL R3 Induction Chemotherapy for Children, Adolescents, and Young Adults With Relapse of Acute Lymphoblastic Leukemia

This is a pilot study utilizing Marqibo® (vincristine sulfate liposome injection) combined with dexamethasone, mitoxantrone and asparaginase (UK ALL R3) for relapsed acute lymphoblastic leukemia (ALL).

Study Overview

• Status: Recruiting
• Conditions: Lymphoblastic Leukemia, Acute, Childhood; ALL, Childhood; Lymphoblastic Leukemia, Acute
• Intervention / Treatment: Drug: Marqibo

Detailed Description

This study will utilize Marqibo® as a replacement for standard vincristine in combination with chemotherapy for children with relapsed ALL. The hypothesis is that the incorporation of Marqibo® with combination chemotherapy will be safe and feasible. In the context of this pilot study, overall outcomes and efficacy will be a secondary objective. It is hypothesized that data from this combination may show improved efficacy including, complete remission (CR), minimal residual disease (MRD) negativity, and progression free survival (PFS) rates and safety (i.e., neurotoxicity) in comparison to outcomes in historical regimens, including the UK ALL R3 with standard vincristine.

• Study Type: Interventional
• Enrollment (Anticipated): 36
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Ellynore Florendo; Phone Number: (323) 361- 3022; Email: eflorendo@chla.usc.edu
• Study Contact Backup: Name: Lei-Lani Miller; Phone Number: (323) 361-5429; Email: llmiller@chla.usc.edu

Study Locations

• Australia
  • New South Wales
    • Randwick, New South Wales, Australia, 2031
      • Not yet recruiting
      • Sydney Children's Hospital
      • Principal Investigator: David Ziegler, MD
    • Westmead, New South Wales, Australia, 2145
      • Not yet recruiting
      • The Children's Hospital at Westmead
  • Queensland
    • South Brisbane, Queensland, Australia, 4101
      • Not yet recruiting
      • Lady Cilento Children's Hospital
  • Victoria
    • Parkville,, Victoria, Australia, 3052
      • Not yet recruiting
      • Royal Children's Hospital, Melbourne
      • Principal Investigator: Francoise Mechinaud, MD
• Canada
  • Montréal, Québec, Canada, H3T-1C5
    • Not yet recruiting
    • Sainte-Justine University Hospital Center
    • Principal Investigator: Henrique Bittencourt, MD
  • British Columbia
    • Vancouver, British Columbia, Canada, V6H 3V4
      • Not yet recruiting
      • British Columbia Children's Hospital
      • Principal Investigator: Kirk Schultz, MD
  • Ontario
    • Toronto, Ontario, Canada, M5G 1X8
      • Not yet recruiting
      • Hospital for Sick Children
      • Principal Investigator: Jim Whitlock, MD
• United States
  • California
    • Los Angeles, California, United States, 90027
      • Recruiting
      • Childrens Hospital Los Angeles
    • Orange, California, United States, 92868
      • Recruiting
      • Children's Hospital Orange County
    • San Francisco, California, United States, 94158
      • Recruiting
      • UCSF School of Medicine
  • Colorado
    • Aurora, Colorado, United States, 80045
      • Not yet recruiting
      • The Children's Hospital, University of Colorado
      • Principal Investigator: Lia Gore, MD
  • District of Columbia
    • Washington, District of Columbia, United States, 20010
      • Recruiting
      • Children's National Medical Center
  • Florida
    • Miami, Florida, United States, 33136
      • Not yet recruiting
      • University of Miami
      • Principal Investigator: Julio Barredo, MD
    • Saint Petersburg, Florida, United States, 33701
      • Not yet recruiting
      • All Children's Hospital
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Recruiting
      • Children's Healthcare of Atlanta at Egleston
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Not yet recruiting
      • Lurie Children's Hospital of Chicago
  • Maryland
    • Baltimore, Maryland, United States, 21231
      • Not yet recruiting
      • Sidney Kimmel Cancer Center at Johns Hopkins
      • Principal Investigator: Patrick Brown, MD
    • Bethesda, Maryland, United States, 20892
      • Recruiting
      • National Cancer Institute, Pediatric Oncology Branch
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Recruiting
      • Dana-Farber Cancer Institute
      • Principal Investigator: Lewis Silverman, MD
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • Recruiting
      • CS Mott Children's Hospital, Ann Arbor
      • Principal Investigator: Raymond J Hutchinson, MD
  • Minnesota
    • Minneapolis, Minnesota, United States, 55404
      • Recruiting
      • Children's Hospitals and Clinics of Minnesota
      • Principal Investigator: Yoav Messinger, MD
  • New York
    • New York, New York, United States, 10032
      • Not yet recruiting
      • Children's Hospital New York-Presbyterian
      • Principal Investigator: Maria Luisa Sulis, MD
  • North Carolina
    • Charlotte, North Carolina, United States, 28203
      • Not yet recruiting
      • Levine Children's Hospital
      • Principal Investigator: Joel Kaplan, DO
  • Ohio
    • Cincinnati, Ohio, United States, 45229
      • Recruiting
      • Cincinnati CHildren's Hospital
      • Principal Investigator: Maureen O'Brien, MD
    • Cleveland, Ohio, United States, 44106
      • Not yet recruiting
      • Rainbow Babies & Children's Hospital
      • Principal Investigator: Robin Norris, MD, MS, MPH
    • Columbus, Ohio, United States, 43205
      • Not yet recruiting
      • Nationwide Children's Hospital
      • Principal Investigator: Robyn Dennis, MD
  • Oregon
    • Portland, Oregon, United States, 97239
      • Recruiting
      • Oregon Health & Science University
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Not yet recruiting
      • Children's Hospital of Philadelphia
      • Principal Investigator: Susan Rheingold, MD
  • Tennessee
    • Nashville, Tennessee, United States, 37232
      • Not yet recruiting
      • Monroe Carell Jr. Children's Hospital at Vanderbilt
  • Texas
    • Dallas, Texas, United States, 75235
      • Recruiting
      • University of Texas Southwestern Medical Center
      • Principal Investigator: Ted Laetsch, MD
    • Fort Worth, Texas, United States, 76104
      • Recruiting
      • Cook Children's Medical Center
    • Houston, Texas, United States, 77030
      • Recruiting
      • Texas Children's Cancer Center, Baylor
      • Principal Investigator: Eric S Schafer, MD, MHS
  • Utah
    • Salt Lake City, Utah, United States, 84113
      • Recruiting
      • Primary Children's Hospital
      • Principal Investigator: Elizabeth Raetz, MD
  • Washington
    • Seattle, Washington, United States, 98105
      • Recruiting
      • Seattle Children's Hospital
      • Principal Investigator: Todd Cooper, MD
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53226
      • Recruiting
      • Medical College of Wisconsin
      • Principal Investigator: Mike Burke, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 year to 21 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria

Age

-Patients must be ≥ 1 and ≤ 21 years of age at the time of enrollment.

Diagnosis

• Cohort A: Patients must have a diagnosis of acute lymphoblastic leukemia (ALL) or mixed phenotypic acute leukemia with ≥ 5% blasts in the bone marrow (M2 or M3), with or without extramedullary disease) or a diagnosis of lymphoblastic lymphoma.
• Cohorts B & C: Patients must have a diagnosis of acute lymphoblastic leukemia (ALL), lymphoblastic lymphoma, or mixed phenotypic acute leukemia with any level of detectable disease (minimal residual disease level acceptable) with or without extramedullary disease

Performance Level -Karnofsky > 50% for patients > 16 years of age and Lansky > 50% for patients ≤ 16 years of age.

Prior Therapy

• Patients must have recovered from the acute toxic effects (≤ Grade 2 or baseline) of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study, unless otherwise specified. Subjects with disease related cytopenias will be eligible.
• Patients must have relapsed or refractory disease after attaining at least a first remission. They may be in first to third relapse..
• Patients with Philadelphia chromosome t(9;22) positive disease must have received at least two prior tyrosine kinase inhibitors.
• Patients who have experienced their relapse after a Hematopoietic stem cell transplantation (HSCT) are eligible, provided they have no evidence of graft-versus-host disease (GVHD) and are at least 100 days post-transplant at the time of enrollment.

• Prior anthracycline lifetime cumulative exposure: Patients must have less than 320 mg/m2 (or 400 mg/m2 if prior cardioprotection) lifetime exposure of anthracycline chemotherapy.

  1. Cohort A: Patients must have less than 320 mg/m2 (or 400 mg/m2 if prior cardioprotection) lifetime exposure of anthracycline chemotherapy (See Appendix 2 for anthracycline calculation worksheet).
  2. Cohorts B & C: There is no limit on prior anthracycline exposure.
• Hematopoietic growth factors: It must have been at least seven days since the completion of therapy with granulocyte colony-stimulating factor (GCSF) or other growth factors at the time of enrollment. It must have been at least 14 days since the completion of therapy with pegfilgrastim (Neulasta®).
• Biologic anti-neoplastic agents: At least seven days after the last dose of a biologic agent. For agents that have known adverse events occurring beyond seven days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair or vice chair.
• Monoclonal antibodies: At least three half-lives (or 30 days-whichever is longer) of the antibody must have elapsed after the last dose of monoclonal antibody. (e.g., Rituximab = 66 days, Epratuzumab = 69 days)
• Immunotherapy: At least 30 days after the completion of any type of immunotherapy, e.g. tumor vaccines, chimeric antigen receptor T-cells.
• Recent prior chemotherapy: At least 10 days after standard vincristine and the completion of any type of chemotherapy induction regimen. At least 3 weeks after radiation therapy. At least 30 days after the completion of any investigational neoplastic agent is also required. An investigational agent is defined as any drug that is not approved and licensed for sale by the FDA for institutions in the United States, by Health Canada for institutions in Canada and by The Therapeutic Goods Administration for institutions in Australia.

Exceptions:

• There is no time restriction in regard to prior intrathecal chemotherapy provided there is complete recovery from any acute toxic effects of such; it is allowable to enroll a patient that has received IT Cytarabine (ARA-C), IT Methotrexate (MTX) or triple IT therapy within 14 days of enrollment as part of their evaluation to diagnose disease relapse. The IT therapy given within 14 days of initiation of protocol specified chemotherapy, may substitute for the day 1 IT in cohorts A and B
• Subjects with rapidly progressive disease may receive hydroxyurea until they begin study therapy;
• Patients who relapse while on maintenance-type ALL therapy or are receiving maintenance therapy for disease stabilization will not require a wash-out period before entry into this study. However, there must be at least 10 days after any dose of standard vincristine.

Renal and Hepatic Function

• Renal function: Patient's serum creatinine must be ≤ 1.5 x institutional upper limit of normal (ULN) according to age. If the serum creatinine is greater than 1.5 times normal, the patient must have a calculated creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 70milliliter/min/1.73m2. Alternatively, a 24-hour creatinine clearance may also be used.
• Hepatic function: alanine aminotransferase (ALT) and aspartate aminotransferase (AST) must be < 5 x institutional upper limit of norm ULN. Total bilirubin must be ≤ 1.5 x ULN (except in the case of subjects with documented Gilbert's disease ≤ 5 × ULN).

Cardiac Function

-Patients must have a shortening fraction ≥ 27% or an ejection fraction ≥ 55% by echocardiogram, cardiac MRI or multigated acquisition scan (MUGA).

Reproductive Function

• Female patients must not be pregnant and those of childbearing potential must have a negative urine or serum pregnancy test confirmed within one week prior to enrollment.
• Female patients with infants must agree not to breastfeed their infants while on this study.
• Male and female patients of childbearing potential must agree to use an effective method of contraception during the study.

Exclusion Criteria

Patients will be excluded if they have isolated testicular disease.

Patients will be excluded if they have previously received Marqibo®.

Patients will be excluded if they have a known allergy to any of the drugs used in the study, with the exception that patients with an allergy to PEG-asparaginase who can receive Erwinia asparaginase are eligible. Patients unable to receive any formulation of asparaginase may only enroll on cohort C

Patients will be excluded if they have active, uncontrolled systemic fungal, bacterial, viral or other infection despite appropriate antibiotics or other treatment.

Patients who require azole antifungal agents will be excluded. Azoles must be discontinued at least one week prior to the start of Marqibo®.

Patients will be excluded if there is a plan to administer non-protocol chemotherapy, radiation therapy, another investigational agent or immunotherapy during the study period.

Patients with pre-existing, persistent grade 2 or greater sensory or motor neuropathy from any cause will be excluded.

Patients will be excluded if they have, significant concurrent disease, illness, psychiatric disorder or social issue that would compromise patient safety or adherence with the protocol treatment or procedures or interfere with consent, study participation, follow up, or interpretation of study results.Patients with Down syndrome will not be eligible for enrollment on Cohort A

Patients with a known history of human immunodeficiency virus (HIV) will will be excluded due to the increased risk of complications such as severe infection and unknown interaction of Marqibo® with antiretroviral drugs.

Active hepatitis B or C infection as defined by seropositive for hepatitis B (hepatitis B surface antigen (HBsAg)) or hepatitis C and elevated liver transaminases (defined as above the ULN per the institution normal ranges).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cohort A: Marqibo and UK ALL R3 backbone; Marqibo®: given by intravenous (IV) infusion on days 1, 8, 15 and 22.; Dexamethasone orally twice daily on days 1-5 and 15-19.; Mitoxantrone: given by intravenous (IV) infusion on days 1 and 2.; PEG-asparaginase: given as an injection into the muscle on says 3 and 17.; Methotrexate IT: given intrathecally (used to treat the brain and spinal cord and is given using a needle inserted into the spinal canal) on days 1 and 8.	Drug: Marqibo; The focus of the study design and statistical analysis is to determine whether Marqibo® can be substituted for standard vincristine and successfully administered to patients with relapsed ALL in three different treatment cohorts: (A) treatment with the UK ALL R3 regimen; (B) treatment with UK ALL R3 regimen without mitoxantrone, and (C) treatment with ALL maintenance therapy. Secondary objectives include estimating rates of serious toxicities and therapy delays in each of these cohorts.
Experimental: Cohort B: Marqibo and lower intensity UK ALL R3 backbone; Marqibo®: given by intravenous (IV) infusion on days 1, 8, 15 and 22.; Dexamethasone orally twice daily on days 1-5 and 15-19.; PEG-asparaginase: given as an injection into the muscle on days 3 and 17.; Methotrexate IT: given intrathecally (used to treat the brain and spinal cord and is given using a needle inserted into the spinal canal) on days 1 and 8.	Drug: Marqibo; The focus of the study design and statistical analysis is to determine whether Marqibo® can be substituted for standard vincristine and successfully administered to patients with relapsed ALL in three different treatment cohorts: (A) treatment with the UK ALL R3 regimen; (B) treatment with UK ALL R3 regimen without mitoxantrone, and (C) treatment with ALL maintenance therapy. Secondary objectives include estimating rates of serious toxicities and therapy delays in each of these cohorts.
Experimental: Cohort C: Marqibo and maintenance regimen; Marqibo®: given by intravenous (IV) infusion on day 1; Dexamethasone orally twice daily on days 1-5; Methotrexate: given orally on days 1 and 8; Mercaptopurine: given orally daily on days 1-13	Drug: Marqibo; The focus of the study design and statistical analysis is to determine whether Marqibo® can be substituted for standard vincristine and successfully administered to patients with relapsed ALL in three different treatment cohorts: (A) treatment with the UK ALL R3 regimen; (B) treatment with UK ALL R3 regimen without mitoxantrone, and (C) treatment with ALL maintenance therapy. Secondary objectives include estimating rates of serious toxicities and therapy delays in each of these cohorts.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants with Dose Limiting Toxicities as a Measure of Safety and Tolerability	The incidence of dose limiting toxicity (DLT) will be measured at different dose levels.	5 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The response rate after treatment.	The rate of remission will be assessed after 1 courses of therapy. A bone marrow aspirate/biopsy and CBC will be conducted to assess response.	Approx. 8 weeks

Collaborators and Investigators

• Sponsor: Therapeutic Advances in Childhood Leukemia Consortium
• Collaborators: Spectrum Pharmaceuticals, Inc

Study record dates

Study Major Dates

• Study Start (Actual): January 31, 2017
• Primary Completion (Anticipated): August 31, 2021
• Study Completion (Anticipated): December 31, 2022

Study Registration Dates

• First Submitted: August 16, 2016
• First Submitted That Met QC Criteria: August 25, 2016
• First Posted (Estimate): August 26, 2016

Study Record Updates

• Last Update Posted (Actual): April 17, 2020
• Last Update Submitted That Met QC Criteria: April 15, 2020
• Last Verified: April 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Disease Attributes; Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphoid; Acute Disease; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Antineoplastic Agents, Phytogenic; Vincristine
• Other Study ID Numbers: T2012-002

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No