Guadecitabine in Treating Patients With Higher-Risk Myelodysplastic Syndromes

Phase 2

Completed

Conditions: High Risk Myelodysplastic Syndrome

Interventions: Drug: Guadecitabine

Registration Number: NCT02131597

Lead Sponsor: M.D. Anderson Cancer Center

Brief Summary: This phase II trial studies how well guadecitabine works in treating patients with myelodysplastic syndromes that are at higher risk for becoming acute myeloid leukemia. Guadecitabine may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

Detailed Description: PRIMARY OBJECTIVES:

I. To evaluate the complete response (CR) rate with SGI-110 (guadecitabine) in patients with higher risk myelodysplastic syndrome (MDS).

SECONDARY OBJECTIVES:

I. Overall response rate, survival, transformation to acute myeloid leukemia (AML), transfusion independence.

II. Safety and toxicity.

OUTLINE:

Patients receive guadecitabine subcutaneously (SC) on days 1-5. Treatment repeats every 4-8 weeks for up to 24 courses in the absence of disease progression or unacceptable toxicity. Patients with stable disease after 3 courses are taken off therapy after 6 courses. Patients may continue to receive treatment after 24 courses if the investigator determines it is in the patient's best interest.

After completion of study treatment, patients are followed up at 30 days, and then every 2 months.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 100

Inclusion Criteria

Patients with higher risk MDS (International Prognostic Scoring System [IPSS] int-2 or high; or >= 10% blasts as defined by World Health Organization [WHO])
- No prior intensive chemotherapy or high-dose cytarabine (>= 1 g/m^2)
- Prior biologic therapies (=< 1 cycle of prior decitabine or azacitidine), targeted therapies, or single agent chemotherapy is allowed
- Off chemotherapy for 2 weeks prior to entering this study with no toxic effects of that therapy, unless there is evidence of rapidly progressive disease
- Hydroxyurea is permitted for control of counts prior to treatment
- Hematopoietic growth factors are allowed
Eastern Cooperative Oncology Group (ECOG) performance status =< 2
Serum creatinine =< 1.5 mg/dL
Serum bilirubin =< 1.5 x upper limit of normal (ULN)
Aspartate transaminase (AST) or alanine transaminase (ALT) =< 2.5 x ULN
Alkaline phosphatase =< 2.5 x ULN
Provide signed written informed consent
Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide valid informed consent
Female patients of childbearing potential must have a negative pregnancy test within 2 weeks prior to entering this study
Women who are able to become pregnant and men who can father a child must use birth control while on study and for at least 8 weeks after your last dose of study drug(s); acceptable birth control includes a condom or a diaphragm with spermicidal jelly; and birth control methods that are taken by mouth, injected, or implanted; if you are already using birth control, you must check with the study staff to make sure that it is considered one of the acceptable forms to use in this study

Exclusion Criteria

Current concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol
Use of investigational agents within 30 days or any anticancer therapy within 2 weeks prior to entering this study with the exception of hydroxyurea; the patient must have recovered from all acute toxicities from any previous therapy
Have any other severe concurrent disease, or have a history of serious organ dysfunction or disease involving the heart, kidney, liver, or other organ system that may place the patient at undue risk to undergo treatment
Patients with a systemic fungal, bacterial, viral, or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment)
Pregnant or lactating patients
Any significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results
Any concurrent malignancy
- Exceptions
  - Patients with treated non-melanoma skin cancer, in situ carcinoma, or cervical intraepithelial neoplasia, regardless of the disease-free duration, are eligible for this study if definitive treatment for the condition has been completed
  - Patients with organ-confined prostate cancer with no evidence of recurrent or progressive disease based on prostate-specific antigen (PSA) values are also eligible for this study if hormonal therapy has been initiated or a radical prostatectomy has been performed

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Treatment (guadecitabine)	Guadecitabine	Patients receive guadecitabine SC on days 1-5. Treatment repeats every 4-8 weeks for up to 24 courses in the absence of disease progression or unacceptable toxicity. Patients with stable disease after 3 courses are taken off therapy after 6 courses. Patients may continue to receive treatment after 24 courses if the investigator determines it is in the patient's best interest.

Primary Outcome Measures

Name	Time	Method
Number of Participants With a Complete Response (CR)	At cycle 3 and cycle 6, cycles are up every 4 to 8 weeks. Up to 9 years, 8 months and 15 days.	Complete Response is Normalization of the peripheral blood and bone marrow with \</= 5% bone marrow blasts, a peripheral blood granulocyte count \>/= 1.0 x 10\^9/L, and a platelet count \>/= 100 x 10\^9/L. Hemoglobin \>/= 11 g/dL at any point while on treatment after the first cycle of therapy.

Secondary Outcome Measures

Name	Time	Method
Overall Survival	Up to 9 years, 8 months and 15 days	Time from date of treatment start until date of death due to any cause or last Follow-up.
Time to Acute Myeloid Leukemia (AML) Transformation	Up to 9 years, 8 months and 15 days