- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04047641
Cladribine, Idarubicin, Cytarabine, and Quizartinib in Treating Patients With Newly Diagnosed, Relapsed, or Refractory Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome
A Combination of Cladribine, Idarubicin, Cytarabine (CLIA) and Quizartinib for the Treatment of Patients With Newly Diagnosed or Relapsed/Refractory Acute Myeloid Leukemia (AML) and High-Risk Myelodysplastic Syndrome (MDS))
Study Overview
Status
Conditions
- Acute Myeloid Leukemia
- Recurrent Acute Myeloid Leukemia
- Refractory Acute Myeloid Leukemia
- High Risk Myelodysplastic Syndrome
- Recurrent Acute Biphenotypic Leukemia
- Blasts 20 Percent or More of Bone Marrow Nucleated Cells
- Recurrent High Risk Myelodysplastic Syndrome
- Refractory High Risk Myelodysplastic Syndrome
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the efficacy of quizartinib (AC220) in combination with cladribine, idarubicin and cytarabine (ara-C) induction chemotherapy in newly diagnosed or relapsed/refractory patients with high-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).
II. To determine the safety of the combination.
SECONDARY OBJECTIVES:
I. To determine the overall survival and disease-free survival of patients treated with this combination.
II. To investigate correlations of response to this combination with a 81-gene panel of gene mutations both in patients with and without FLT3 mutations.
III. To identify individual treatment-resistant cell populations and their signaling state that may relate to clinical outcomes using CyTOF (cytometry by time of flight) and single cell sequencing.
OUTLINE:
INDUCTION: Patients receive idarubicin intravenously (IV) over 1 hour on days 1-3, cladribine IV over 1-2 hours on days 1-5, cytarabine IV over 2 hours on days 1-5 (or days 1-3 for patients over age 60), and quizartinib orally (PO) once daily (QD) on days 6-19. Treatment repeats every 28 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity.
CONSOLIDATION: Patients who achieve complete response (CR) or CR with incomplete platelet recovery (CRp) after Induction receive idarubicin IV over 1 hour on days 1-2, cladribine IV over 1-2 hours on days 1-3, cytarabine IV over 2 hours on days 1-3, and quizartinib PO QD on days 4-28. Treatment repeats every 28 days for up to 5 cycles in the absence of disease progression or unacceptable toxicity.
MAINTENANCE: Patients who achieve CR or CR with incomplete bone marrow recovery (CRi)/CR with partial hematologic recovery (CRh) after Consolidation receive quizartinib PO QD on days 1-28. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 6-12 months.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Contact
- Name: Musa Yilmaz
- Phone Number: 713-794-5783
- Email: myilmaz@mdanderson.org
Study Locations
-
-
Texas
-
Houston, Texas, United States, 77030
- Recruiting
- M D Anderson Cancer Center
-
Principal Investigator:
- Musa Yilmaz
-
Contact:
- Musa Yilmaz
- Phone Number: 713-794-5783
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Diagnosis of
- AML (World Health Organization [WHO] classification definition of >= 20% blasts, excluding Acute promyelocytic leukemia),
- Acute biphenotypic leukemia or
- High-risk MDS (> 10% bone marrow blasts)
- Frontline cohort: Patients aged 18 to 65 years
- Relapse cohort: Patients aged >=18 years old
Patients may be newly diagnosed (Frontline cohort) or with prior therapy (Relapsed cohort) as follows:
- For frontline cohort: Patients must be chemonaive, i.e., not have received any chemotherapy (except hydroxyurea [Hydrea] [no dose limit], tretinoin [atra] [no dose limit] or ara-C [one or two doses (max 2 gr/m^2 per dose)] for transient control of hyperleukocytosis) for AML or MDS. They may have received hypomethylating agents for prior MDS and transfusions, hematopoietic growth factors or vitamins. Temporary prior measures such as apheresis or Hydrea are allowed
- For relapsed cohort: Patients with previously treated, relapsed or refractory AML, acute biphenotypic leukemia or high-risk MDS (> 10% bone marrow blasts)
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2
- Creatinine < 1.5 mg/dl
- Total bilirubin < 1.5 mg/dL, unless increase is due to hemolysis or congenital disorder
- Transaminases (serum glutamate pyruvate transaminase [SGPT]) < 2.5 x upper limit of normal (ULN)
- Potassium, magnesium, and calcium (normalized for albumin) levels should be at least within institutional normal limits
- Ability to take oral medication
- Ability to understand and provide signed informed consent
- Baseline test of left ventricular ejection fraction >= 50%
- Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test within 7 days
- WOCBP must use appropriate method(s) of contraception such as oral contraceptive pills (OCP), birth control shots, intrauterine device (IUD) etc. WOCBP should use an adequate method to avoid pregnancy until 30 days after the last dose of investigational drug. Men must agree not to father a child and agree to use a condom if his partner is of child bearing potential. Women who are not of childbearing potential (ie, who are postmenopausal or surgically sterile) as well as men with known azoospermia do not require contraception
- Patients with isolated extramedullary myeloid neoplasm will be eligible
Exclusion Criteria:
- Any coexisting medical condition that in the judgment of the treating physician is likely to interfere with study procedures or results
- Breastfeeding women
- Patients with current active malignancies or any remission for < 6 months, except patients with carcinoma in situ or with non-melanoma skin cancer who may be in remission for less than 6 months or have active disease
- Active clinically serious and uncontrolled infection. Patients with recent infections must have no temperature of >= 101 degrees Fahrenheit (F) for at least 48 hours (hrs) (before first dose, day 1)
- Patients with known significant impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of quizartinib
- Documented active central nervous system leukemia (patients with history of central nervous system [CNS] leukemia without active disease are allowed)
- Patients with a known confirmed diagnosis of human immunodeficiency virus (HIV) infection or active viral hepatitis
- Patients who have had any major surgical procedure within 14 days of day 1
Impaired cardiac function including any of the following:
- Screening electrocardiography (ECG) with a corrected QT (QTc) > 450 msec. The QTc interval will be calculated by Fridericia's correction factor (QTcF). The QTcF will be derived from the average QTcF in triplicate. Patients are excluded if they have QTcF >= 450. Subjects with prolonged QTcF interval in the setting of RBBB (right bundle branch block) may participate upon review and approval by the medical monitor. RBBB for patients' triplicate electrocardiograms (EKGs) can show false QTc prolongation; therefore, the cardiology collaborator for this study will manually review to provide an accurate reading of the QTc
- Patients with congenital long QT syndrome
- Sustained ventricular tachycardia requiring medical intervention
- Any history of clinically significant ventricular fibrillation or torsades de pointes
- Known history of second or third degree heart block (may be eligible if the patient currently has a pacemaker)
- Heart rate of < 50/minute on pre-entry ECG
- Left bundle branch block
- Right bundle branch block + left anterior hemiblock (bifascicular block)
- Patients with myocardial infarction or unstable angina within 6 months prior to starting study drug
- Congestive heart failure (CHF) New York (NY) Heart Association class III or IV
- Atrial fibrillation documented within 2 weeks prior to first dose of study drug
- Known family history of congenital long QT syndrome
- Patients who are actively taking a strong CYP3A4 inducing medication
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment (idarubicin, cladribine, cytarabine, quizartinib)
INDUCTION: Patients receive idarubicin Intravenous over 1 hours on days 1-3, cladribine intravenous over 1-2 hours on days 1-5, cytarabine Intravenous over 3 hours on days 1-5 (or days 1-3 for patients over age 60), and quizartinib by mouth daily on days 6-19. Treatment repeats every 28 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. CONSOLIDATION: Patients who achieve CR or CRp after Induction receive idarubicin Intravenous over 1 hours on days 1-2, cladribine Intravenous over 1-2 hours on days 1-3, cytarabine Intravenous over 3 hours on days 1-3, and quizartinib by mouth daily on days 4-28. Treatment repeats every 28 days for up to 5 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients who achieve CR or CRi/CRh after Consolidation receive quizartinib by mouth daily on days 1-28. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. |
Given Intravenous
Other Names:
Given Intravenous
Other Names:
Given Intravenous
Other Names:
Given by mouth
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Event free survival (EFS)
Time Frame: From the date of start of treatment until event (resistance or relapse) or death, whichever occurred first, assessed up to 12 months
|
Will be estimate using the Kaplan-Meier method for each patient cohort.
In addition, efficacy EFS will be analyzed in the intent to treat (ITT) population per cohort.
|
From the date of start of treatment until event (resistance or relapse) or death, whichever occurred first, assessed up to 12 months
|
Incidence of adverse events
Time Frame: Up to 12 months
|
Defined as any clinically significant treatment-related grade 3 or greater non-hematologic toxicity.
Patient toxicity data will be summarized using frequency and percentages, by type, grade and relationship to the study drugs.
|
Up to 12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall survival (OS)
Time Frame: Up to 12 months
|
Will be estimate using the Kaplan-Meier method for each patient cohort.
In addition, efficacy OS will be analyzed in the ITT population per cohort.
|
Up to 12 months
|
Disease free survival (DFS)
Time Frame: Up to 12 months
|
Will be estimate using the Kaplan-Meier method for each patient cohort.
In addition, efficacy DFS will be analyzed in the ITT population per cohort.
|
Up to 12 months
|
Rate of response
Time Frame: Up to 12 months
|
The rate of response will be estimated for each 28-gene panel of gene mutations for each patient cohort.
|
Up to 12 months
|
Change of FLT3 ligand level
Time Frame: Baseline up to 12 months
|
Will also explore the change of FLT3 ligand level before and after treatment using summary statistics, by patient cohort and by other subgroups (i.e.
age).
|
Baseline up to 12 months
|
Change in the presence of other gene mutations
Time Frame: Baseline up to 12 months
|
Will also explore the change in the presence of other gene mutations before and after treatment using summary statistics, by patient cohort and by other subgroups (i.e.
age).
|
Baseline up to 12 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Musa Yilmaz, 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
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Lymphatic Diseases
- Immunoproliferative Disorders
- Disease Attributes
- Disease
- Bone Marrow Diseases
- Hematologic Diseases
- Precancerous Conditions
- Leukemia, Lymphoid
- Syndrome
- Myelodysplastic Syndromes
- Leukemia
- Leukemia, Myeloid
- Leukemia, Myeloid, Acute
- Recurrence
- Preleukemia
- Leukemia, Biphenotypic, Acute
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Antiviral Agents
- Enzyme Inhibitors
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Topoisomerase II Inhibitors
- Topoisomerase Inhibitors
- Antibiotics, Antineoplastic
- Cytarabine
- Idarubicin
- Cladribine
- 2-chloro-3'-deoxyadenosine
Other Study ID Numbers
- 2017-0153 (Other Identifier: M D Anderson Cancer Center)
- NCI-2019-04730 (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.
Clinical Trials on Acute Myeloid Leukemia
-
University of PennsylvaniaActive, not recruitingAcute Myeloid Leukemia, in Relapse | Acute Myeloid Leukemia, Refractory | Acute Myeloid Leukemia, PediatricUnited States
-
Terrence J Bradley, MDImago BioSciences, Inc., a subsidiary of Merck & Co., Inc., (Rahway, New...RecruitingAcute Myeloid Leukemia | Refractory Acute Myeloid Leukemia | Acute Myeloid Leukemia, in RelapseUnited States
-
Bhavana BhatnagarCTI BioPharmaCompletedRecurrent Adult Acute Myeloid Leukemia | Secondary Acute Myeloid Leukemia | Untreated Adult Acute Myeloid Leukemia | Therapy-Related Acute Myeloid LeukemiaUnited States
-
National Cancer Institute (NCI)RecruitingAcute Myeloid Leukemia | Secondary Acute Myeloid Leukemia | Recurrent Acute Myeloid Leukemia | Refractory Acute Myeloid LeukemiaUnited States
-
Washington University School of MedicineWithdrawnRefractory Acute Myeloid Leukemia | Relapsed Acute Myeloid LeukemiaUnited States
-
C. Babis AndreadisGateway for Cancer Research; AVEO Pharmaceuticals, Inc.TerminatedAcute Myeloid Leukemia | Refractory Acute Myeloid Leukemia | Relapsed Acute Myeloid LeukemiaUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)RecruitingAcute Myeloid Leukemia | Recurrent Adult Acute Myeloid Leukemia | Secondary Acute Myeloid Leukemia | Refractory Acute Myeloid LeukemiaUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)Active, not recruitingAcute Myeloid Leukemia | Secondary Acute Myeloid Leukemia | Untreated Adult Acute Myeloid Leukemia | Recurrent Acute Myeloid Leukemia | Refractory Acute Myeloid Leukemia | Therapy-Related Acute Myeloid LeukemiaUnited States
-
Kronos BioActive, not recruitingAcute Myeloid Leukemia | Refractory Acute Myeloid Leukemia | Relapsed Acute Myeloid LeukemiaUnited States, Spain
-
Massachusetts General HospitalExelixisCompletedRefractory Acute Myeloid Leukemia | Relapsed Acute Myeloid LeukemiaUnited States
Clinical Trials on Cladribine
-
Institute of Psychiatry and Neurology, WarsawPoznan University of Medical Sciences; Nalecz Institute of Biocybernetics and... and other collaboratorsRecruitingMultiple Sclerosis | Multiple Sclerosis, Secondary ProgressivePoland
-
EMD SeronoCompletedMultiple Sclerosis, Relapsing-Remitting
-
Alliance for Clinical Trials in OncologyNational Cancer Institute (NCI)Completed
-
National Center for Research Resources (NCRR)Scripps ClinicCompleted
-
Keith Edwards, M.D.EMD SeronoRecruitingMultiple SclerosisUnited States
-
National Cancer Institute (NCI)CompletedBrain and Central Nervous System TumorsUnited States
-
University Hospital, BonnUnknownLeukemia, Myelocytic, AcuteGermany
-
Hospital Virgen de la SaludUnknown
-
Queen Mary University of LondonBarts & The London NHS Trust; National Institute for Health Research, United... and other collaboratorsRecruitingProgressive Multiple Sclerosis | Advanced Multiple SclerosisUnited Kingdom
-
Pontificia Universidade Católica do Rio Grande...Merck S.A., Brazil, an affiliate of Merck KGaA, Darmstadt, GermanyActive, not recruitingMultiple Sclerosis, Relapsing-RemittingBrazil