Phase I study of oral clofarabine consolidation in adults aged 60 and older with acute myeloid leukemia

Abstract

Clofarabine has shown activity and tolerability in older patients with acute myeloid leukemia (AML). We investigated the safety and tolerability of an oral formulation of clofarabine for consolidation therapy of patients aged 60 and older with AML. In this phase I study, twenty-two patients older than 60 years with AML in first complete remission were treated once daily with oral clofarabine for 14 or 21 days of a 28-day cycle, for up to five cycles. Dose escalation from 1 mg to 6 mg daily using a 3 + 3 design was used to determine dose-limiting toxicities (DLT), the maximum tolerated dose (MTD), and tolerability of oral clofarabine. No DLTs or Grade 3-4 nonhematologic toxicities were observed. The primary toxicities were hematologic, including uncomplicated grade 3-4 neutropenia (50%) and thrombocytopenia (50%). Given that myelosuppression necessitating dose delays/reductions was observed more commonly at higher doses, the recommended phase II dose is 2 mg daily for 21 of 28 days. At doses equal to or greater than 2 mg, the median relapse-free survival was 28.35 months. Oral clofarabine was well-tolerated with encouraging activity in patients older than 60 years. Further investigation of oral clofarabine as a consolidation and/or maintenance therapy in AML for older individuals is warranted. (ClinicalTrials.gov:NCT00727766).

Copyright © 2014 Wiley Periodicals, Inc.

Figures

Figure 1

Kaplan Meier analysis of (A) relapse-free survival and (B) overall survival for patients receiving ≥ 2 mg of clofarabine. The median relapse-free survival was 28.4 months (95% CI [6.5 months, not reached]) and the median overall survival was not attained (95% CI [14.3 months, not reached]), with a median follow-up time of 13.3 months. (C) Kaplan Meier analysis of overall survival for patients who did not receive an allogeneic stem cell transplant (n=18). The median OS was 35.9 months (95% CI [9.7 months, not reached]). The dashed line represents the 95% confidence intervals.