A Phase II Trial of Fludarabine in Combination With Daunorubicin and Cytarabine Liposome for Adults With Newly-diagnosed Acute Myeloid Leukemia: University of California Hematologic Malignancies Consortium Protocol 1914
Overview
- Phase
- Phase 2
- Intervention
- Fludarabine
- Conditions
- Acute Myeloid Leukemia, Adult
- Sponsor
- University of California, San Diego
- Enrollment
- 2
- Locations
- 1
- Primary Endpoint
- Overall response rate after induction
- Status
- Terminated
- Last Updated
- 3 years ago
Overview
Brief Summary
This phase 2 clinical trial will evaluate the effectiveness and safety of fludarabine in combination with CPX-351 in patients with untreated AML. Patients will receive fludarabine and CPX-351 during Induction 1 and 2 as well as 2 cycles of consolidation therapy.
Detailed Description
This is a phase 2, open label single arm study to look at the effectives and safety of fludarabine in combination with CPX-351 in patients with untreated AML. The rationale for this combination stems from data which indicated that pre-treatment of the THP-1 cell line with fludarabine for 4 hours prior to CPX-351 administration (Flu-CPX) significantly potentiated intracellular ara-CTP accumulation compared to CPX-351 alone. This suggests that fludarabine combined with CPX-351 may have efficacy against leukemic clones that would be resistant to CPX-351 or standard chemotherapy in first induction. It has been demonstrated that treatment with CPX-351 produces superior clinical outcomes in secondary AML likely due to its novel formulation, which results in sustained exposure of the cytotoxic agents cytarabine and daunorubicin in a synergistic 5:1 ratio within the plasma and bone marrow. Fludarabine can potentially improve upon the outcomes observed with CPX-351 monotherapy and 7+3 by enhancing intracellular ara-CTP accumulation from CPX-351. Patients will received fludarabine and CPX-351 for up to 2 cycles of induction and 2 cycles of consolidation.
Investigators
James Mangan
Associate Clinical Professor of Medicine
University of California, San Diego
Eligibility Criteria
Inclusion Criteria
- •Histologically confirmed de novo or secondary AML as defined by WHO criteria
- •Intermediate- or poor-risk disease by ELN 2017 criteria
- •Adults 18 years of age or older
- •ECOG performance status of 0, 1, or 2
- •Able to give informed consent and follow study guidelines
- •Organ function requirements:
- •Adequate renal function defined as creatinine clearance greater than 60 ml/min
- •Adequate hepatic function defined by serum bilirubin less than or equal 2 mg/dL. If serum bilirubin greater than 2 mg/dl and direct bilirubin is less than 30 percent of total bilirubin contact study chair for eligibility exception for Gilbert's syndrome.
- •ALT/AST less than or equal to 3 times the upper limit of normal
- •LVEF 50 percent by echocardiogram or MUGA
Exclusion Criteria
- •Current or anticipated use of additional investigational agents.
- •Any prior treatment for AML with the exception of corticosteroids, hydroxyurea, and/or leukapheresis to prevent or treat early complications prior to starting study therapy. Permitted prior therapy must be stopped 24 hours prior to starting study therapy.
- •Prior use of hypomethylating agents is permitted for patients with history of antecedent MDS. Last dose of hypomethylating therapy must have been 15 or more days prior to starting study therapy. Toxicities associated with prior MDS therapy must have recovered to grade 1 or less prior to start of treatment.
- •Favorable risk cytogenetics as defined by 2017 ELN risk stratification including acute promyelocytic leukemia
- •Chronic myeloid leukemia in myeloid blast crisis
- •Except for CMML, patients with history of myeloproliferative neoplasms (MPN) (defined as a history of essential thrombocytosis or polycythemia vera, or idiopathic myelofibrosis prior to the diagnosis of AML) or combined MDS/MPN are not eligible
- •Clinical evidence of active CNS leukemia
- •Active or metastatic second malignancy
- •Any major surgery or radiation therapy within four weeks.
- •Patients with prior cumulative anthracycline exposure of greater than 368 mg/m2 daunorubicin (or equivalent).
Arms & Interventions
Fludarabine and CPX351
Induction 1: Fludarabine 30 mg/m2/day IV on days 1-5 for 5 doses Daunorubicin and cytarabine liposome (CPX-351) daunorubicin 44 mg/m2/day and cytarabine 100 mg/m2/day IV on days 1, 3, 5 (given 4 hours after fludarabine infusion) for 3 doses Induction 2 (residual leukemia after Induction 1): Fludarabine 30 mg/m2/day IV on days 1-3 for 3 doses Daunorubicin and cytarabine liposome (CPX-351) daunorubicin 44 mg/m2/day and cytarabine 100 mg/m2/day IV on days 1, 3 (given 4 hours after fludarabine infusion) for 2 doses Optional consolidation, up to 2 cycles: Daunorubicin and cytarabine liposome (CPX-351) daunorubicin 29 mg/m2/day and cytarabine 65 mg/m2/day IV on days 1, 3 for 2 doses
Intervention: Fludarabine
Fludarabine and CPX351
Induction 1: Fludarabine 30 mg/m2/day IV on days 1-5 for 5 doses Daunorubicin and cytarabine liposome (CPX-351) daunorubicin 44 mg/m2/day and cytarabine 100 mg/m2/day IV on days 1, 3, 5 (given 4 hours after fludarabine infusion) for 3 doses Induction 2 (residual leukemia after Induction 1): Fludarabine 30 mg/m2/day IV on days 1-3 for 3 doses Daunorubicin and cytarabine liposome (CPX-351) daunorubicin 44 mg/m2/day and cytarabine 100 mg/m2/day IV on days 1, 3 (given 4 hours after fludarabine infusion) for 2 doses Optional consolidation, up to 2 cycles: Daunorubicin and cytarabine liposome (CPX-351) daunorubicin 29 mg/m2/day and cytarabine 65 mg/m2/day IV on days 1, 3 for 2 doses
Intervention: Vyxeos
Outcomes
Primary Outcomes
Overall response rate after induction
Time Frame: 35 days
Overall response rate after induction, defined as the sum of complete response (CR) rate and complete response with incomplete count recovery (CRi) rate after 1-2 cycles of induction therapy, in accordance with 2017 ELN criteria.
Secondary Outcomes
- Incidence of Grade 3 Treatment Emergent Adverse Events [Safety and Tolerability](6 months)
- Platelet Recovery(60 days)
- Safety and Tolerability(6 months)
- Overall response rate(35 days)
- Overall survival(3 years)
- Incidence of Grade 4 Treatment Emergent Adverse Events [Safety and Tolerability](6 months)
- Incidence of Grade 5 Treatment Emergent Adverse Events [Safety and Tolerability](6 months)
- Leukemia-free survival(3 years)
- Event free survival(3 years)
- 30-day(30 days from start of study therapy)
- CR Rate(60 days)
- 60-day mortality(60 days from start of study therapy)