Tipifarnib and Bortezomib in Treating Patients With Acute Leukemia or Chronic Myelogenous Leukemia in Blast Phase

Phase 1

Completed

• Conditions: Adult Acute Eosinophilic Leukemia; Adult Acute Myeloid Leukemia With t(9;11)(p22;q23); MLLT3-MLL; Adult Pure Erythroid Leukemia; Recurrent Adult Acute Myeloid Leukemia; Adult Acute Megakaryoblastic Leukemia; Adult Acute Myelomonocytic Leukemia; Recurrent Disease; Adult Acute Myeloid Leukemia With Inv(16)(p13.1q22); CBFB-MYH11; Adult Acute Myeloid Leukemia With Maturation; Adult Acute Myeloid Leukemia With Minimal Differentiation
• Interventions: Drug: Bortezomib; Other: Laboratory Biomarker Analysis; Drug: Tipifarnib

• Registration Number: NCT00383474
• Lead Sponsor: National Cancer Institute (NCI)

Brief Summary

This phase I trial is studying the side effects and best dose of tipifarnib and bortezomib in treating patients with acute leukemia or chronic myelogenous leukemia in blast phase. Tipifarnib and bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving tipifarnib together with bortezomib may kill more cancer cells.

Detailed Description

PRIMARY OBJECTIVE:

I. Determine the dose-limiting toxicity and maximum tolerated dose of tipifarnib and bortezomib in patients with relapsed or refractory acute myeloid leukemia, acute lymphoblastic leukemia, or chronic myeloid leukemia in blast phase.

SECONDARY OBJECTIVES:

I. Determine the effect of this regimen on farnesyltransferase and proteasome inhibition in peripheral blood mononuclear cells in these patients.

II. Determine the clinical efficacy of this regimen in these patients.

OUTLINE: This is a dose-escalation study.

Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11 and oral tipifarnib twice daily on days 1-14. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients with partial response or stable disease may continue therapy beyond 6 courses at the discretion of the investigator.

Cohorts of 3-6 patients receive escalating doses of bortezomib and tipifarnib 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 dose-limiting toxicity.

Blood is collected periodically for protein expression studies. Bone marrow aspirates obtained at baseline are examined by immunohistochemistry for Ki-67 activity.

Study Timeline

• Study Start: 2006-08
• Study First Submitted: 2006-09-29
• Study First Submitted QC: 2006-09-29
• Study First Posted: 2006-10-03
• Primary Completion: 2012-06
• Study Completion: 2012-06
• Status Verified: 2013-04
• Last Update Submitted: 2015-04-14
• Last Update Posted: 2015-04-15

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 35

Inclusion Criteria

• Meets 1 of the following disease-specific criteria:

  • Relapsed disease after =< 2 prior chemotherapy regimens (consolidation therapy excluded)
  • Primary-induction failure
  • Previously untreated and deemed unfit for or refusing cytotoxic chemotherapy

• No hyperleukocytosis (leukemic blasts >= 30,000/mm^3)

• No acute promyelocytic leukemia (M3)

• No active CNS leukemia

• SGOT and SGPT =< 2 times upper limit of normal (ULN)

• Bilirubin normal

• Creatinine =< 1.5 times ULN

• No uncontrolled hypertension, congestive heart failure, angina pectoris, or ventricular dysrhythmias

• Not pregnant or nursing

• Negative pregnancy test

• No uncontrolled disseminated intravascular coagulation

• Fertile patients must use effective contraception

  • Hormonal contraception must have been initiated ≥ 1 month prior to study entry

• No active graft-vs-host disease

• No active uncontrolled infection

• No intrinsic impaired organ function

• No known allergy to imidazole drugs

• No neuropathy >= grade 1

• No known hypersensitivity to bortezomib, tipifarnib, boron, or mannitol

• No physical or psychiatric conditions that would preclude study participation, including poorly controlled psychosis

• At least 48 hours since prior hydroxyurea

• No prior tipifarnib, bortezomib, or investigational proteasomal inhibitors

• No concurrent radiotherapy, chemotherapy, or immunotherapy

• No concurrent enzyme-inducing antiepileptic medications (e.g., phenytoin, phenobarbital, or carbamazepine)

• ECOG performance status 0-2

• LVEF >= 40%

• Pathologically confirmed diagnosis of 1 of the following:

  • Acute myeloid leukemia
  • Acute lymphoblastic leukemia
  • Chronic myelogenous leukemia in blast phase

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Arm I	Laboratory Biomarker Analysis	Patients will receive an infusion of bortezomib twice a week for 2 weeks. They will also receive tipifarnib by mouth twice a day for 2 weeks.
Arm I	Tipifarnib	Patients will receive an infusion of bortezomib twice a week for 2 weeks. They will also receive tipifarnib by mouth twice a day for 2 weeks.
Arm I	Bortezomib	Patients will receive an infusion of bortezomib twice a week for 2 weeks. They will also receive tipifarnib by mouth twice a day for 2 weeks.

Primary Outcome Measures

Name	Time	Method
Dose-limiting toxicity and maximum tolerated dose of tipifarnib and bortezomib	21 days

Secondary Outcome Measures

Name	Time	Method
Clinical efficacy (response rate) evaluated using the revised International Working Group Criteria (IWG) for AML	Up to 3 years
Farnesytransferase and proteasome inhibition in peripheral blood mononuclear cells	Day 15
Changes in apoptotic protein expression (Bim, Bax, AKT)	Baseline and day 8

Trial Locations

Locations (1)

Moffitt Cancer Center; 🇺🇸 Tampa, Florida, United States