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Decitabine and Valproic Acid in Treating Patients With Refractory or Relapsed Acute Myeloid Leukemia or Previously Treated Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

27 september 2013 bijgewerkt door: National Cancer Institute (NCI)

A Phase I Study of Decitabine in Combination With Valproic Acid in Patients With Selected Hematologic Malignancies

This phase I trial is studying the side effects and best dose of decitabine and valproic acid in treating patients with refractory or relapsed acute myeloid leukemia or previously treated chronic lymphocytic leukemia or small lymphocytic leukemia. Drugs used in chemotherapy, such as decitabine, work in different ways to stop cancer cells from dividing so they stop growing or die. Valproic acid may stop the growth of cancer cells by blocking the enzymes necessary for their growth. Combining decitabine with valproic acid may kill more cancer cells.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

PRIMARY OBJECTIVES:

I. Determine the minimally effective pharmacological dose (MEPD) of decitabine in patients with refractory or relapsed acute myeloid leukemia or with previously treated chronic lymphocytic lymphoma or small lymphocytic lymphoma.

II. Determine the maximum tolerated dose (MTD) of valproic acid in combination with the MEPD of decitabine in these patients.

III. Determine the MEPD of valproic acid in combination with decitabine in these patients.

IV. Determine the qualitative and quantitative toxic effects of decitabine alone and in combination with valproic acid, in terms of organ specificity, time course, predictability, and reversibility in these patients.

SECONDARY OBJECTIVES:

I. Determine the therapeutic response in patients treated with decitabine alone and in combination with valproic acid.

II. Determine the pharmacokinetics of this regimen in these patients. III. Determine kinetics of methyltransferase activity and re-expression of select target genes in AML [p15, estrogen receptor (ER), WT-1, calcitonin, MYOD1] and in CLL/SLL [DERMO-1, DAPK, and ID4] known to be methylated in primary tumor cells.

IV. Correlate baseline and post-treatment changes in DNA methyltransferases (MT1, MT3a, and MT3b) expression with achievement of decitabine MEPD, toxicity, treatment resistance, and disease response in these patients.

V. Determine kinetics of HDAC enzyme inhibition and changes in the acetylation status of histones H3 or H4 following treatment with the combination. These parameters will be used to define the MEPD of the combination.

VI. Examine baseline and post-therapy changes in the "histone code' in both AML and CLL cells by assessment of the acetylation and methylation status of histones H3 and H4 lysine residues using both Western Blot and Mass Spectrometry techniques.

OUTLINE: This is a dose-escalation study. Patients are stratified according to disease (refractory or relapsed acute myeloid leukemia vs chronic lymphocytic leukemia or small lymphocytic lymphoma).

Patients receive decitabine IV over 1 hour on days 1-5 or 1-10. Treatment repeats every 28 days.

Cohorts of 6 patients receive escalating doses of decitabine until the minimally effective pharmacological dose (MEPD) is determined. The MEPD is defined as the dose at which at least 5 of 6 patients meet gene methylation criteria and no more than 1 of 6 patients experiences dose-limiting toxicity (DLT).

Once the MEPD is determined, patients receive decitabine at that dose level administered as above and oral valproic acid three times daily on days 5-21. Treatment repeats every 28 days.

Cohorts of 3-6 patients receive escalating doses of valproic acid until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience DLT. The MEPD of valproic acid is then determined using established gene methylation and toxicity criteria. Treatment continues for up to 24 months in the absence of disease progression or unacceptable toxicity.

Patients are followed for survival.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

84

Fase

  • Fase 1

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Verenigde Staten
    • Ohio
      • Columbus, Ohio, Verenigde Staten, 43210
        • Ohio State University Medical Center

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  • Patients with AML (Stratum I) or CLL/SLL (Stratum II) will be enrolled

  • Patients in stratum I will have one of the following:

    • Primary refractory or relapsed (in 1 year or less) disease and not a candidate for potentially curative therapy
    • Untreated AML patients who are not candidates for chemotherapy
    • Patients in stratum I must have a normal WBC (=< 10 x 10^9/L) or a WBC =< 40 x 10^9/L that is stable for 1 week (this may be sustained with hydroxyurea prior to starting therapy and during the first 4 days of therapy if clinically indicated)
  • Patients in stratum II will have received at least one prior therapy for CLL/SLL that has included a purine analog; patients in stratum II with a history of severe autoimmune disease or requiring therapy with chronic corticosteroids or who have any other specific relative contraindications to receive a purine analog and, therefore, have received another form of therapy that include alkylating agents will be eligible to participate
  • Performance status - ECOG 0-2
  • At least 12 weeks life expectancy

  • Stratum II:

    • No uncontrolled autoimmune hemolytic anemia
    • No idiopathic thrombocytopenia purpura
  • Bilirubin =< 1.5 mg/dL
  • ALT and AST =< 2 times upper limit of normal
  • Creatinine =< 2.0 mg/dL
  • No active infection requiring IV antibiotics
  • HIV negative
  • No other severe medical condition that would preclude study participation
  • No psychiatric condition that would preclude study compliance
  • No history of seizures
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • More than 14 days since prior chemotherapy (except hydroxyurea)
  • No prior FR901228 (depsipeptide) for step 2 of this study
  • No other concurrent chemotherapy
  • No concurrent corticosteroids for antiemetic therapy

  • No concurrent hormonal therapy except for the following:

    • Steroids for treatment of adrenal failure or septic shock
    • Insulin for diabetes
    • Tamoxifen or equivalent for breast cancer prevention or adjuvant therapy
    • Estrogens or progestins for gynecologic indications
  • More than 14 days since prior radiotherapy
  • No concurrent palliative radiotherapy
  • No concurrent anticonvulsant medication, including valproic acid

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: NVT
  • Interventioneel model: Opdracht voor een enkele groep
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Treatment (decitabine, valproic acid)

Patients receive decitabine IV over 1 hour on days 1-5 or 1-10. Treatment repeats every 28 days.

Cohorts of 6 patients receive escalating doses of decitabine until the MEPD is determined. The MEPD is defined as the dose at which at least 5 of 6 patients meet gene methylation criteria and no more than 1 of 6 patients experiences DLT.

Once the MEPD is determined, patients receive decitabine at that dose level administered as above and oral valproic acid three times daily on days 5-21. Treatment repeats every 28 days.

Cohorts of 3-6 patients receive escalating doses of valproic acid until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience DLT. The MEPD of valproic acid is then determined using established gene methylation and toxicity criteria. Treatment continues for up to 24 months in the absence of disease progression or unacceptable toxicity.
Ander: analyse van biomarkers in het laboratorium
Correlatieve studies
Ander: farmacologische studie
Correlatieve studies
Andere namen:
  • farmacologische studies
Geneesmiddel: decitabine
IV gegeven
Andere namen:
  • DAC
  • 5-aza-dCyd
  • 5AZA
Geneesmiddel: valproic acid
Given orally
Andere namen:
  • Depakeen
  • VA
  • Alti-Valproic
  • Novo-Valproic

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Tijdsspanne
MEPD of single agent decitabine
Tijdsspanne: 10 days
10 days
MTD of the combination of valproic acid with the MEPD of decitabine
Tijdsspanne: Up to 21 days
Up to 21 days
MEPD of valproic acid in combination with decitabine
Tijdsspanne: Up to 29 days
Up to 29 days
Qualitative and quantitative toxicities of single agent decitabine alone and in combination with valproic acid in regard to organ specificity, time course, predictability, and reversibility
Tijdsspanne: Up to 24 months
Up to 24 months

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

National Cancer Institute (NCI)

Onderzoekers

  • Hoofdonderzoeker: Kristie Blum, Ohio State University

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 februari 2004

Primaire voltooiing (Werkelijk)

1 mei 2011

Studieregistratiedata

Eerst ingediend

8 maart 2004

Eerst ingediend dat voldeed aan de QC-criteria

9 maart 2004

Eerst geplaatst (Schatting)

10 maart 2004

Updates van studierecords

Laatste update geplaatst (Schatting)

30 september 2013

Laatste update ingediend die voldeed aan QC-criteria

27 september 2013

Laatst geverifieerd

1 september 2013

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • NCI-2012-01447 (Register-ID: CTRP (Clinical Trial Reporting Program))
  • U01CA076576 (Subsidie/contract van de Amerikaanse NIH)
  • 6236 (CTEP)
  • NCI-6236
  • OSU-2003C0094
  • CDR0000355412
  • 0336 (Andere identificatie: Ohio State University Medical Center)
  • R21CA110496 (Subsidie/contract van de Amerikaanse NIH)

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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