- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03383575
Azacitidine and Enasidenib in Treating Patients With IDH2-Mutant Myelodysplastic Syndrome
Targeted Therapy With the IDH2-Inhibitor Enasidenib (AG221) for High-Risk IDH2-Mutant Myelodysplastic Syndrome
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the safety and tolerability of enasidenib alone, and enasidenib in combination with azacitidine (AZA), for patients with isocitrate dehydrogenase 2 (IDH2) mutated myelodysplastic syndrome (MDS).
II. To assess the efficacy of the combination of enasidenib + azacitidine in hypomethylating agent (HMA) naive subjects with IDH2-mutated MDS, and to assess the efficacy of enasidenib single-agent in subjects with IDH2-mutated MDS who are relapsed/refractory to HMA therapy.
SECONDARY OBJECTIVES:
I. To evaluate molecular and cellular markers that may be predictive of antitumor activity and/or resistance including evaluation of IDH2 variant allele fraction (VAF) levels during treatment and presence of co-occurring mutations.
II. To assess overall survival, event-free survival and duration of response of enasidenib alone, and enasidenib in combination with azacitidine.
EXPLORATORY OBJECTIVES:
I. To assess changes in cellular differentiation and changes in deoxyribonucleic acid (DNA) methylation profiles in IDH2-mutated MDS treated with enasidenib alone and with enasidenib + azacitidine.
II. To evaluate quality of life (QOL) using an MDS-specific measure.
OUTLINE: Patients are assigned to 1 of 2 arms.
ARM I: Patients who are HMA-naive receive enasidenib orally (PO) once daily (QD) on days 1-28 and azacitidine intravenously (IV) oveer 30-60 minutes or subcutaneously (SC) on days 1-7. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM II: Patients relapsed and/or refractory to HMA therapy receive enasidenib PO QD on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for up to 3 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Courtney DiNardo, MD
- Phone Number: 713-794-1141
- Email: cdinardo@mdanderson.org
Study Locations
-
-
Maryland
-
Baltimore, Maryland, United States, 21287
- Active, not recruiting
- Johns Hopkins University/Sidney Kimmel Cancer Center
-
-
Ohio
-
Cleveland, Ohio, United States, 44195
- Active, not recruiting
- Cleveland Clinic Foundation
-
-
Texas
-
Houston, Texas, United States, 77030
- Recruiting
- M D Anderson Cancer Center
-
Principal Investigator:
- Courtney DiNardo
-
Contact:
- Courtney DiNardo
- Phone Number: 713-794-1141
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Signed, informed consent must be obtained prior to any study specific procedures
- Subjects with a histologically confirmed diagnosis of MDS, including both MDS and refractory anemia with excess blasts in transformation (RAEB-T) (acute myeloid leukemia [AML] with 20-30% blasts and multilineage dysplasia by French-American-British [FAB] criteria) by World Health Organization (WHO), and chronic myelomonocytic leukemia (CMML) are eligible
- Subjects must have an IDH2 gene mutation (IDH2-R140 or R172) as determined by local laboratory result
- (Arm A only): Subject must be hypomethylating agent naive (i.e. prior azacitidine, decitabine, SGI-110 is exclusionary). Receipt of other MDS-directed therapy such as lenalidomide is allowed
- (Arm A only): Subjects with high-risk MDS (i.e. International Prostate Symptom Score [IPSS] intermediate-2 or high-risk; or revised [R]-IPSS high or very-high risk). Patients with intermediate-1 risk by IPSS or intermediate risk by R-IPSS with high-risk molecular features including TP53, ASXL1, EZH2, and/or RUNX1 mutations are also eligible
- (Arm B only): Subject must be relapsed or refractory to prior hypomethylating agent therapy, defined as prior receipt of 6 cycles of HMA therapy with failure to attain a response, or relapse after prior response to HMA therapy
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Serum bilirubin =< 2 x the upper limit of normal (ULN) (except for patients with Gilbert's disease)
- Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) =< 3 x the laboratory ULN
- Serum creatinine =< 2 x the ULN
- Able to understand and voluntarily sign a written informed consent, and willing and able to comply with protocol requirements
- Resolution of all clinically significant treatment-related, non-hematological toxicities, except alopecia, from any previous cancer therapy to =< grade 1 prior to the first dose of study treatment
- Female patients of childbearing potential must have a negative serum or urine pregnancy test within 7 days of the first dose of study drug and agree to use dual methods of contraception during the study and for a minimum of 3 months following the last dose of study drug. Post-menopausal females (> 45 years old and without menses for > 1 year) and surgically sterilized females are exempt from these requirements. Male patients must use an effective barrier method of contraception during the study and for a minimum of 3 months following the last dose of study drug if sexually active with a female of childbearing potential
Exclusion Criteria:
- Any prior or coexisting medical condition that in the investigator's judgment will substantially increase the risk associated with the subject's participation in the study
- Subject has received a prior targeted IDH2 inhibitor
- Psychiatric disorders or altered mental status precluding understanding of the informed consent process and/or completion of the necessary study procedures
- Active uncontrolled infection at study enrollment including known diagnosis of human immunodeficiency virus or chronic active hepatitis B or C infection
- Clinically significant gastrointestinal conditions or disorders that may interfere with study drug absorption, including prior gastrectomy
- Patients with known active central nervous system (CNS) disease, including leptomeningeal involvement
- Impaired cardiac function, uncontrolled cardiac arrhythmia, or clinically significant cardiac disease including the following: a) New York Heart Association grade III or IV congestive heart failure, b) myocardial infarction within the last 6 months
- Subjects with a corrected QT (QTc) > 480 ms (QTc > 510 msec for subjects with a bundle branch block at baseline
- Nursing or pregnant women
- Subjects with known hypersensitivity to study drugs or their excipients
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Arm I (enasidenib, azacitidine)
Patients who are HMA-naive receive enasidenib PO QD on days 1-28 and azacitidine IV over 30-60 minutes or SC on days 1-7.
Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
|
Ancillary studies
Other Names:
Given IV or SC
Other Names:
Given PO
Other Names:
|
Experimental: Arm II (enasidenib)
Patients relapsed and/or refractory to HMA therapy receive enasidenib PO QD on days 1-28.
Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
|
Ancillary studies
Other Names:
Given PO
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of adverse events
Time Frame: Up to 3 years
|
Will use the Bayesian method by Thall, Simon and Estey for toxicity monitoring.
For purpose of toxicity monitoring, toxicity is defined as any grade 3 or higher treatment related-toxicities by Common Terminology Criteria for Adverse Events criteria.
|
Up to 3 years
|
Overall response rate
Time Frame: Up to 3 years
|
Defined as complete response (CR), partial response, and marrow CR assessed by International Working Group criteria.
Will be estimated along with the 90% credible interval.
|
Up to 3 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Event-free survival (EFS)
Time Frame: Up to 3 years
|
The Kaplan-Meier method will be used to estimate the probabilities of EFS.
Log-rank tests will be used to compare among subgroups of patients in terms of EFS.
|
Up to 3 years
|
Overall survival (OS)
Time Frame: Up to 3 years
|
The Kaplan-Meier method will be used to estimate the probabilities of OS.
Log-rank tests will be used to compare among subgroups of patients in terms of OS.
|
Up to 3 years
|
Anti-tumor activity
Time Frame: Up to 3 years
|
Will be summarized graphically and with descriptive statistics.
|
Up to 3 years
|
Pharmadynamics (PDn) markers
Time Frame: Up to 3 years
|
PDn markers will be summarized graphically and with descriptive statistics.
|
Up to 3 years
|
Drug exposure levels
Time Frame: Up to 3 years
|
Will be summarized graphically and with descriptive statistics.
|
Up to 3 years
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Biomarkers analysis
Time Frame: Up to 3 years
|
The association between molecular and cellular markers and overall response and/or resistance will be assessed through logistic regression analyses.
Paired t-test or Wilcoxon signed rank test will be used to assess the marker change over time.
|
Up to 3 years
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Courtney DiNardo, M.D. Anderson Cancer Center
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Neoplasms by Histologic Type
- Neoplasms
- Disease Attributes
- Disease
- Bone Marrow Diseases
- Hematologic Diseases
- Anemia
- Precancerous Conditions
- Myelodysplastic-Myeloproliferative Diseases
- Leukemia, Myeloid
- Anemia, Refractory
- Chronic Disease
- Syndrome
- Myelodysplastic Syndromes
- Leukemia
- Preleukemia
- Leukemia, Myelomonocytic, Chronic
- Leukemia, Myelomonocytic, Juvenile
- Anemia, Refractory, with Excess of Blasts
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Azacitidine
Other Study ID Numbers
- 2016-0981 (Other Identifier: M D Anderson Cancer Center)
- P30CA016672 (U.S. NIH Grant/Contract)
- NCI-2018-00987 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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