A Study of Gilteritinib (ASP2215) Combined With Chemotherapy in Children, Adolescents and Young Adults With FMS-like Tyrosine Kinase 3 (FLT3)/Internal Tandem Duplication (ITD) Positive Relapsed or Refractory Acute Myeloid Leukemia (AML)

March 27, 2024 updated by: Astellas Pharma Global Development, Inc.

A Phase 1/2, Multicenter, Open-Label, Single Arm, Dose Escalation and Expansion Study of Gilteritinib (ASP2215) Combined With Chemotherapy in Children, Adolescents and Young Adults With FMS-like Tyrosine Kinase 3 (FLT3)/Internal Tandem Duplication (ITD) Positive Relapsed or Refractory Acute Myeloid Leukemia (AML)

The purpose of the phase 1 portion (dose escalation) of the study will be to establish an optimally safe and biologically active recommended phase 2 dose (RP2D) and/or to determine maximum tolerated dose (MTD) for gilteritinib in sequential combination with fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG). The purpose of the phase 2 portion (dose expansion) is to determine complete remission (CR) rates and composite complete remission (CRc) rates after two cycles of therapy. The study will also assess safety, tolerability and toxicities of gilteritinib in combination with FLAG, evaluate FLT3 inhibition, assess pharmacokinetics (PK), perform serial measurements of minimal residual disease, obtain preliminary estimates of 1-year event free survival (EFS) and overall survival (OS) rate and assess the acceptability as well as palatability of the formulation.

One cycle is defined as 28 days of treatment. A participant completing 1 or 2 treatment cycles in phase 1 or 2 will have the option to participate in long term treatment (LTT) with gilteritinib (for up to 2 years).

Study Overview

Study Type

Interventional

Enrollment (Estimated)

97

Phase

  • Phase 2
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

    • Quebec
      • Montreal, Quebec, Canada, H3T 1C5
        • Recruiting
        • Site CA15001
      • Bordeaux, France
        • Recruiting
        • Site FR33003
      • Marseille cedex 05, France
        • Recruiting
        • Site FR33004
      • Paris, France
        • Recruiting
        • Site FR33005
      • Paris, France
        • Recruiting
        • Site FR33006
      • Vandoeuvre-Lès-Nancy, France
        • Recruiting
        • Site FR33002
    • Baden-Württemberg
      • Freiburg, Baden-Württemberg, Germany, 79106
        • Recruiting
        • Site DE49002
    • Bayern
      • Regensburg, Bayern, Germany, 93053
        • Recruiting
        • Site DE49003
    • Nordrhein-Westfalen
      • Essen, Nordrhein-Westfalen, Germany, 45147
        • Recruiting
        • Site DE49004
    • Sachsen-Anhalt
      • Halle (Saale), Sachsen-Anhalt, Germany, 06120
        • Recruiting
        • Site DE49001
      • Bologna, Italy, 40138
        • Recruiting
        • Site IT39003
      • Monza, Italy, 20900
        • Recruiting
        • Site IT39002
      • Roma, Italy, 165
        • Recruiting
        • Site IT39001
      • Barcelona, Spain, 08950
        • Recruiting
        • Site ES34001
      • Barcelona, Spain, 08950
        • Recruiting
        • Site ES34002
      • Sevilla, Spain, 41013
        • Recruiting
        • Site ES34003
      • Birmingham, United Kingdom, B4 6NH
        • Recruiting
        • Site GB44001
      • Bristol, United Kingdom, BS2 8BJ
        • Recruiting
        • Site GB44006
      • Cardiff, United Kingdom, CF14 4XW
        • Recruiting
        • Site GB44005
      • Glasgow, United Kingdom, G51 4TF
        • Recruiting
        • Site GB44003
      • Sutton, United Kingdom
        • Recruiting
        • Site UK44007
    • Ohio
      • Cincinnati, Ohio, United States, 45229
        • Recruiting
        • Cincinnati Children's Hospital Medical Center
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • Recruiting
        • The Children's Hospital of Philadelphia (CHOP)
    • Tennessee
      • Memphis, Tennessee, United States, 38105
        • Recruiting
        • St. Jude Children's Research Hospital
      • Nashville, Tennessee, United States, 37203
        • Recruiting
        • Sarah Cannon Research Institute

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

6 months to 21 years (Child, Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Subject is aged ≥ 6 months and < 21 years of age* at the time of signing informed consent and/or assent, as applicable.

    • *For phase 2: Enrollment of subjects from 6 months to less than 1 year and 1 year to less than 2 years will be dependent on the establishment of recommended phase 2 dose (RP2D) in the respective age groups during phase 1.
  • Subject has a diagnosis of acute myeloid leukemia (AML) according to The French-American-British (FAB) classification with ≥ 5% blasts in the bone marrow, with or without extramedullary disease (except subjects with active central nervous system [CNS] leukemia).

    • In the phase 1 portion of the study, subject must be in first or greater relapse or refractory to induction therapy with no more than 1 attempt at remission induction (up to 2 induction cycles).
    • For the phase 2 portion of the study, subject must be in refractory to or at the first hematologic relapse after first-line remission induction AML therapy (up to 2 induction cycles).
  • Subject has fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study.

    • Myelosuppressive chemotherapy:

      • For subject who relapses while receiving cytotoxic therapy, at least 21 days must have elapsed since the completion of cytotoxic therapy and prior to screening, unless the subject has recovered earlier than 21 days.
      • Cytoreduction with the following can be initiated and continued for up to 24 hours prior to the start of systemic protocol therapy (cycle 1 day -1).

        • hydroxyurea,
        • low dose cytarabine (100 mg/m^2 per dose once daily for 5 days) or
        • other low dose/maintenance therapies as per local site practice.
      • Subject who has received other FLT3 inhibitors (e.g., lestaurtinib, sorafenib, etc) is eligible for this study.
    • Hematopoietic growth factors: at least 7 days must have elapsed since the completion of therapy with a growth factor and prior to screening.
    • Biologic (anti-neoplastic agent): at least 7 days must have elapsed since the completion of therapy with a biologic agent and prior to screening. For agents that have known adverse events (AEs) occurring beyond 7 days after administration, this period must be extended beyond the time during which AEs are known to occur.
    • X-ray treatment (XRT):

      • 14 days must have elapsed for local palliative XRT for CNS chloromas and prior to screening; no washout period is necessary for other chloromas;
      • Prior to screening, 90 days must have elapsed if the subject had a prior traumatic brain injury or has received craniospinal XRT.
  • For subject undergoing hematopoietic stem cell transplant (HSCT), at least 90 days must have elapsed since HSCT and subject must not have active graft-versus-host disease (GVHD).
  • Subject has Karnofsky score ≥ 50 (if the subject is of ≥ 16 years of age) or Lansky score of ≥ 50 (if the subject is < 16 years of age). A score < 50 is acceptable if related to the subject's leukemia.
  • Subject must meet the following criteria as indicated on the clinical laboratory tests.

    • Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3.0 x upper limit normal (ULN) for age
    • Total serum bilirubin ≤ 1.5 x ULN for age
    • Estimated glomerular filtration rate of > 60 mL/min/1.73 m^2.
  • A female subject is eligible to participate if she is not pregnant and at least 1 of the following conditions applies:

    • Not a woman of childbearing potential (WOCBP) OR
    • WOCBP who agrees to follow the contraceptive guidance throughout the treatment period and for at least 180 days after the final study drug administration.
  • Female subject must agree not to breastfeed starting at Screening, and throughout the study period and for 60 days after the final study drug administration.
  • Female subject must not donate ova starting at Screening and throughout the study, and for 180 days after the final study drug administration.
  • A male subject with female partner(s) of childbearing potential must agree to use contraception during the treatment period and for at least 180 days after the final study drug administration.
  • A male subject must not donate sperm during the treatment period and for at least 120 days after the final study drug administration.
  • Male subject with a pregnant or breastfeeding partner(s) must agree to remain abstinent or use a condom for the duration of the pregnancy or time partner is breastfeeding throughout the study period and for 180 days after the final study drug administration.
  • Subject and subject's parent(s) or legal guardian agrees not to participate in another interventional study while on treatment.
  • Live Vaccines - At least 6 weeks must have elapsed since the administration of the last dose of a live vaccine and prior to the initiation of study treatment (cycle 1, day -1)
  • Phase 1: Subject is positive for FLT3 (ITD and/or tyrosine kinase domain [TKD]) mutation in bone marrow or blood as determined by the local institution.
  • Phase 2: Subject is positive for the FLT3 (ITD) mutation in bone marrow or blood as determined by the local institution.

Exclusion Criteria:

  • Subject has active CNS leukemia.
  • Subject has uncontrolled or significant cardiovascular disease, including:

    • Diagnosed or suspected congenital long QT syndrome or any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de Pointes (TdP)); any history of arrhythmia will be discussed with the sponsor prior to subject's entry into the study
    • Prolonged Fridericia's Correction Formula (QTcF) interval on pre-entry electrocardiogram (ECG) (≥ 450 ms)
    • Any history of second or third degree heart block (may be eligible if the subject currently has a pacemaker)
    • Heart rate < 50 beats/minute on pre-entry ECG
    • Uncontrolled hypertension
    • Complete left bundle branch block
  • Subject has systemic fungal, bacterial, viral or other infection that is exhibiting ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics or other treatment. The subject needs to be off pressors and have negative blood cultures for 48 hours.
  • Subject is receiving or plans to receive concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol.
  • Subject has active clinically significant GVHD or is on treatment with immunosuppressive drugs for treatment of active GVHD, with the exception of subjects being weaned from systemic corticosteroids where the subject is receiving ≤ 0.5 mg/kg of prednisone (or equivalent) daily dose for prior GVHD. Subject has received calcineurin inhibitors within 4 weeks prior to screening, unless used as GVHD prophylaxis.
  • Subject has active malignant tumors other than AML.
  • Subject has any significant concurrent disease, illness, psychiatric disorder or social issue that would compromise subject safety or compliance; interfere with consent, study participation, follow-up or interpretation of study results.
  • Subject has hypokalemia and/or hypomagnesemia at Screening (defined as values below institutional lower limit of normal [LLN]). Repletion of potassium and magnesium levels during the screening period is allowed.
  • Subject requires treatment with concomitant drugs that are strong inducers of cytochrome P450 (CYP)3A/P-glycoprotein (P-gp).
  • Subject is known to have human immunodeficiency virus infection.
  • Subject has active hepatitis B or C, or other active hepatic disorder.

    • Subjects with positive hepatitis B surface antigen (HBsAg) or detectable hepatitis B DNA are not eligible.
    • Subjects with negative HBsAg, positive hepatitis B core antibody and negative hepatitis B surface antibody will be eligible if hepatitis B DNA is undetectable.
    • Subjects with antibodies to hepatitis C virus will be eligible if hepatitis C RNA is undetectable.
  • Subject must wait for at least 5 half-lives after stopping therapy with any investigational agent and before starting gilteritinib.
  • Subject has a known or suspected hypersensitivity to gilteritinib, cytarabine, fludarabine, granulocyte colony-stimulating factor (G-CSF) or any components of the formulation used.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Dose Escalation - 2 years to less than 21 years of age
Participants will be administered fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG) chemotherapy on days -1 to 5 and gilteritinib will be administered once per day on days 8 to 21 at the assigned dose. Participants may receive prophylactic intrathecal cytarabine at the start of the cycle, as per institutional standards. A participant completing 2 cycles (cycle is defined as 28 days) will have the option to participate in long term treatment (LTT) with gilteritinib (for up to 2 years).
Administered orally.
Other Names:
  • ASP2215
Administered by intravenous (IV) infusion
Administered by intravenous (IV) infusion
Administered by subcutaneous injection
Experimental: Dose Escalation - 1 year to less than 2 years of age
Participants will be administered fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG) chemotherapy on days -1 to 5 and gilteritinib will be administered once per day on days 8 to 21 at the assigned dose. Participants may receive prophylactic intrathecal cytarabine at the start of the cycle, as per institutional standards. A participant completing 2 cycles (cycle is defined as 28 days) will have the option to participate in long term treatment (LTT) with gilteritinib (for up to 2 years).
Administered orally.
Other Names:
  • ASP2215
Administered by intravenous (IV) infusion
Administered by intravenous (IV) infusion
Administered by subcutaneous injection
Experimental: Dose Escalation - 6 months to less than 1 year of age
Participants will be administered fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG) chemotherapy on days -1 to 5 and gilteritinib will be administered once per day on days 8 to 21 at the assigned dose. Participants may receive prophylactic intrathecal cytarabine at the start of the cycle, as per institutional standards. A participant completing 2 cycles (cycle is defined as 28 days) will have the option to participate in long term treatment (LTT) with gilteritinib (for up to 2 years).
Administered orally.
Other Names:
  • ASP2215
Administered by intravenous (IV) infusion
Administered by intravenous (IV) infusion
Administered by subcutaneous injection
Experimental: Dose Expansion
Participants will be administered fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG) chemotherapy on days -1 to 5 and gilteritinib will be administered once per day on days 8 to 21 at the dose determined in dose escalation portion. Participants may receive prophylactic intrathecal cytarabine at the start of the cycle, as per institutional standards. A participant completing 2 cycles (cycle is defined as 28 days) will have the option to participate in long term treatment (LTT) with gilteritinib (for up to 2 years).
Administered orally.
Other Names:
  • ASP2215
Administered by intravenous (IV) infusion
Administered by intravenous (IV) infusion
Administered by subcutaneous injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants with dose limiting toxicity (DLT) (phase 1/dose escalation)
Time Frame: Up to 28 days
DLT is defined as any of the events meeting the DLT criteria that occur during DLT observation period & that is considered to be possibly or probably related to protocol therapy. Nonhematologic (NH) DLT will be defined as grade 3 NH toxicity at least possibly related to protocol therapy that persists for >48 hours without resolution to grade ≤ 2 or 4 NH toxicity, regardless of duration, at least possibly related to protocol therapy. Hy's law or treatment-related deaths will be considered as a DLT. Gilteritinib dosing will be interrupted if NH DLT occurs. Exceptions include toxicities commonly seen with intensive AML reinduction regimens. Hematologic DLT will be defined as failure to recover a peripheral absolute neutrophil count (ANC) >500/μL & non-transfusion dependent platelet count >20000/μL due to documented bone marrow aplasia/hypoplasia at day 42 from start of cycle 1 day 1. Failure to recover peripheral counts due to disease involvement of bone marrow will not be considered DLT
Up to 28 days
Complete Remission (CR) rate after 2 cycles of therapy (phase 2)
Time Frame: Up to 56 days
CR rate is defined as the number of participants who achieve the best response of CR divided by the number of participants in the analysis population. Complete remission is defined as having bone marrow regenerating normal hematopoietic cells and achieving a morphologic leukemia-free state and must have an absolute neutrophil count (ANC) ≥ 1 x 10^9/L and platelet count ≥ 100 x 10^9/L and normal marrow differential with < 5% blasts, and they will be red blood cell (RBC) and platelet transfusion independent (defined as 1 week without RBC transfusion and 1 week without platelet transfusion). There should be no evidence of extramedullary leukemia.
Up to 56 days
Composite complete remission (CRc) rate after 2 cycles of therapy (phase 2)
Time Frame: Up to 56 days
CRc rate is defined as the number of participants who achieve the best response of CRc (CR, CRp,or CRi) divided by the number of participants in the analysis population. Complete remission with incomplete platelet recovery (CRp) is defined as achieving CR except for incomplete platelet recovery (< 100 x 10^9/L) at a post baseline visit. Complete remission with incomplete hematologic recovery (CRi) is defined as achieving CR except for incomplete hematological recovery with residual neutropenia < 1 x 10^9/L with or without complete platelet recovery at a post baseline visit. Red blood cell (RBC) and platelet transfusion independence is not required.
Up to 56 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants with laboratory value abnormalities and/or adverse events (AEs)
Time Frame: Up to 2 years
Number of participants with potentially clinically significant laboratory values.
Up to 2 years
Number of participants with vital sign abnormalities and /or adverse events (AEs)
Time Frame: Up to 2 years
Number of participants with potentially clinically significant vital sign values.
Up to 2 years
Number of participants with Adverse Events (AEs)
Time Frame: Up to 2 years plus 28 day follow up
An AE is any untoward medical occurrence in a participant administered a study drug, and which does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a medicinal product whether or not considered related to the medicinal product.
Up to 2 years plus 28 day follow up
Number of participants with electrocardiogram (ECG) abnormalities and/or adverse events (AEs)
Time Frame: Up to 2 years
Number of participants with potentially clinically significant ECG values.
Up to 2 years
Percentage of inhibition of phosphorylated FLT3 in participants.
Time Frame: Up to 49 days
Inhibition of FLT3 phosphorylation after drug treatment will be determined relative to pre-treatment phosphorylated FLT3 levels in participants to assess the relationship with gilteritinib dose. Phosphorylated FLT3 will be measured by plasma inhibitory activity (PIA) assay.
Up to 49 days
Pharmacokinetics (PK) of gilteritinib: oral clearance (CL/F)
Time Frame: Up to 45 days
CL/F will be reported from the PK plasma samples collected.
Up to 45 days
PK of gilteritinib: apparent volume of distribution (Vd/F)
Time Frame: Up to 45 days
Vd/F will be reported from the PK plasma samples collected.
Up to 45 days
PK of gilteritinib: Maximum Concentration (Cmax)
Time Frame: Up to 45 days
Cmax will be reported from the PK plasma samples collected.
Up to 45 days
PK of gilteritinib: Time of Maximum Concentration (tmax)
Time Frame: Up to 45 days
tmax will be reported from the PK plasma samples collected.
Up to 45 days
PK of gilteritinib: Area Under the Concentration (AUC)
Time Frame: Up to 45 days
AUC will be reported from the PK plasma samples collected.
Up to 45 days
Duration of Event Free Survival (EFS)
Time Frame: Up to 2 years
EFS is defined as the time from the date of enrollment until the date of documented relapse (excluding relapse after PR), treatment failure or death, whichever occurs first. If a participant experiences relapse or death, the participant is defined as having EFS event related to either "relapse" or "death", and the event date is the date of relapse or death. If a participant fails to achieve any of the response of CR, CRp, CRi or PR during the treatment period, the participant is defined as having EFS event related to treatment failure, and the event date is the enrollment date. For a participant who is not known to have had a relapse or treatment failure or death event, EFS is censored at the date of last relapse-free disease assessment. Participant is not censored at hematopoietic stem cell transplant (HSCT).
Up to 2 years
Duration of Overall survival (OS)
Time Frame: Up to 4 years and 2 months
OS is defined as the time from the date of enrollment until the date of death from any cause. For a participant who is not known to have died by the end-of-study follow-up, OS is censored at the date of last contact.
Up to 4 years and 2 months
The number of participants with negative minimal residual disease (MRD) status
Time Frame: Up to 2 years
MRD negative status will be defined as FLT3-internal tandem duplication (ITD) signal ratio ≤ 10^-4.
Up to 2 years
Number of participants with MRD negative status in relation to CR rate
Time Frame: Up to 2 years
MRD negative status will be defined as FLT3-internal tandem duplication (ITD) signal ratio ≤ 10^-4.
Up to 2 years
Number of participants with MRD negative status in relation to CRc rate
Time Frame: Up to 2 years
MRD negative status will be defined as FLT3-internal tandem duplication (ITD) signal ratio ≤ 10^-4.
Up to 2 years
Number of participants with MRD negative status in relation to Overall survival (OS)
Time Frame: Up to 2 years
MRD negative status will be defined as FLT3-internal tandem duplication (ITD) signal ratio ≤ 10^-4.
Up to 2 years
Clinical Outcome Assessment of Taste
Time Frame: Up to 57 days
The acceptability and palatability of gilteritinib oral formulation as assessed by the participant using a single scale. The 5 point facial hedonic scale has high to low as: Liked it Very Much, Liked it a Little, Not sure, Disliked it a Little, Disliked it Very Much.
Up to 57 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Study Director: Medical Director, Astellas Pharma Global Development

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 4, 2020

Primary Completion (Estimated)

November 30, 2024

Study Completion (Estimated)

September 30, 2026

Study Registration Dates

First Submitted

January 21, 2020

First Submitted That Met QC Criteria

January 21, 2020

First Posted (Actual)

January 27, 2020

Study Record Updates

Last Update Posted (Actual)

March 28, 2024

Last Update Submitted That Met QC Criteria

March 27, 2024

Last Verified

March 1, 2024

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Access to anonymized individual participant level data collected during the study, in addition to study-related supporting documentation, is planned for studies conducted with approved product indications and formulations, as well as compounds terminated during development. Studies conducted with product indications or formulations that remain active in development are assessed after study completion to determine if Individual Participant Data can be shared. Conditions and exceptions are described under the Sponsor Specific Details for Astellas on www.clinicalstudydatarequest.com.

IPD Sharing Time Frame

Access to participant level data is offered to researchers after publication of the primary manuscript (if applicable) and is available as long as Astellas has legal authority to provide the data.

IPD Sharing Access Criteria

Researchers must submit a proposal to conduct a scientifically relevant analysis of the study data. The research proposal is reviewed by an Independent Research Panel. If the proposal is approved, access to the study data is provided in a secure data sharing environment after receipt of a signed Data Sharing Agreement.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

Yes

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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