An Open-Label, Phase I/II Study of Two Different Schedules of Dasatinib (Sprycel) and Decitabine (Dacogen) Used in Combination for Patients With Accelerated or Blastic Phase Chronic Myelogenous Leukemia (Protocol CA180357)
试验速览
- 阶段
- 1 期
- 状态
- 终止
- 入组人数
- 32
- 试验地点
- 1
- 主要终点
- Ph I Study: Maximum Tolerated Dose (MTD) Dasatinib
研究概览
简要总结
The goal of this clinical research study is to learn if combining Sprycel (dasatinib) and Dacogen (decitabine) can help to control Chronic Myeloid Leukemia (CML). The dose level of decitabine will also be studied.
Dasatinib is designed to block the protein that is responsible for chronic myeloid leukemia.
Decitabine is designed to affect the mechanism that cells use to control the expression of certain genes, some of which are important in the progression of CML.
This is an investigational study. Dasatinib is FDA approved and commercially available for the treatment of patients with certain types of CML.
Decitabine is FDA approved for the treatment of patients with myelodysplastic syndrome.
The combination of these drugs to treat CML is investigational.
Up to 84 patients will take part in this study. All will be enrolled at MD Anderson.
详细描述
Study Groups:
If you are found to be eligible to take part in this study, you will be assigned to a study group and dose level based on when you join this study and the side effects that are seen. Your doctor will discuss this with you in more detail.
There will be up to 5 doses of dasatinib tested in Phase 1. The first 3 participants will receive a lower dose of therapy. If no major side effects are seen in these participants, the next participants will receive a higher dose. Once a dose is identified that is well-tolerated for most participants, that dose will be used for all new participants. If you are in Phase 2, you will receive a dose level tested in Phase 1.
You will receive one of 2 doses of decitabine. What dose you receive is determined by chance (like a coin toss).
Study Administration:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients age 18 years of age or older with CML-AP, CML-BP or Philadelphia chromosome-positive acute myeloid leukemia defined as follows: CML-AP is defined by the presence of 15-29% blasts in peripheral blood (PB) or bone marrow (BM), >/= 20% basophils in PB or BM, >/= 30% blasts plus promyelocytes (with blasts <30%) in PB or BM, <100 x10(9)/L platelets unrelated to therapy, or by clonal cytogenetics evolution (i.e., the presence of cytogenetic abnormalities other than the Philadelphia chromosome); CML-BP is defined by the presence of >/= 30% blasts in the bone marrow and/or peripheral blood or the presence of extramedullary disease.
- •Patients are eligible whether they have received or not prior TKI therapy. For the phase I portion of the study, patients who had received prior therapy with dasatinib should have been able to tolerate the dose equivalent to the starting dose of dasatinib in the dose level at which the patient is being entered. Patients who previously received dasatinib but never at the dose being proposed are eligible provided they tolerated the maximum dose they were prescribed with no grade 3-4 toxicity not responding to optimal management.
- •Eastern Cooperative Oncology Group (ECOG) performance status 0-
- •Men and women of childbearing potential should practice 2 methods of contraception; 1 method must be highly effective and a second method must be either highly effective or less effective. Men and women of childbearing potential are defined as: a male that has not been surgically sterilized or a female that has not been amenorrheic for at least 12 consecutive months or that has not been surgically sterilized. Patients must use birth control during the study and for 3 months after the last dose of study drug if they are sexually active.
- •Women of childbearing potential must have a pregnancy test at screening.
- •Signed informed consent.
- •Patients must have been off all prior therapy for CML for 2 weeks prior to start of study therapy and recovered from the toxic effects of that therapy. Exceptions to these are hydroxyurea and Tyrosine kinase inhibitor (TKIs) (including but not limited to imatinib, nilotinib, and bosutinib) which should be discontinued >/= 24 hrs prior to the start of therapy. Patients who are receiving dasatinib prior to enrollment do not have to discontinue this agent prior to start of study therapy.
- •Adequate organ function: Serum creatinine </= 2.0 mg/dl or creatinine clearance >/=60 mL/min; Total bilirubin </= 1.5 x upper limit of normal (ULN) (unless considered due to Gilbert's syndrome or hemolysis); Alanine aminotransferase (ALT) </= 3 x ULN unless considered due to leukemic involvement.
排除标准
- •New York Heart Association (NYHA) cardiac class 3-4 heart disease.
- •Cardiac disease including: Uncontrolled angina within 3 months. Diagnosed or suspected congenital long QT syndrome; Any history of clinically significant ventricular arrhythmias (eg, ventricular tachycardia, ventricular fibrillation, or Torsades de pointes); Prolonged QTc interval on pre-entry electrocardiogram (> 470 msec) on the Fridericia's correction; Uncontrolled hypertension (defined for this protocol as sustained systolic BP >/=150 and diastolic >/=100); Patients currently taking drugs that are generally accepted to have a risk of causing Torsades de Pointes.
- •Serious uncontrolled medical disorder or uncontrolled active systemic infection or current unstable or decompensated respiratory or cardiac conditions which makes it undesirable or unsafe for the patient to participate in the study.
- •Patients with known, clinically significant pericardial or pleural effusion.
- •History of significant bleeding disorder unrelated to cancer, including diagnosed congenital bleeding disorders (e.g., von Willebrand's disease), or diagnosed acquired bleeding disorders within one year (e.g., acquired anti-factor VIII antibodies).
- •Subject is receiving potent inhibitors of CYP3A4; for such medications, a wash-out period of >/= 7 days is required prior to starting dasatinib unless discontinuation or substitution of such an inhibitor is not in the best interest of the patient as determined by the investigator. These include the following medications: itraconazole, ketoconazole, miconazole, voriconazole; amprenavir, atazanavir, fosamprenavir, indinavir, nelfinavir, ritonavir; ciprofloxacin, clarithromycin, diclofenac, doxycycline, enoxacin, isoniazid, ketamine, nefazodone, nicardipine, propofol, quinidine, telithromycin. In instances where use of these agents is felt to be required for the best management of the patients, inclusion of such a patients should be discussed with PI and the rationale documented.
- •Females who are pregnant or are currently breastfeeding.
- •Patients that are eligible (including having available donor) and willing to receive an allogeneic stem cell transplant within 4 weeks.
研究组 & 干预措施
Phase I - Dasatinib 100 mg + Decitabine 10 mg/m2
Less Intensive, Schedule A1 Dasatinib 100 mg daily by mouth ; Decitabine 10 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Dasatinib (Drug)
Phase I - Dasatinib 140 mg + Decitabine 10 mg/m2
Less Intensive, Schedule B1 Dasatinib 140 mg daily by mouth ; Decitabine 10 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Decitabine (Drug)
Phase I - Dasatinib 100 mg + Decitabine 10 mg/m2
Less Intensive, Schedule A1 Dasatinib 100 mg daily by mouth ; Decitabine 10 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Decitabine (Drug)
Phase I - Dasatinib 100 mg + Decitabine 20 mg/m2
More Intensive, Schedule A2: Dasatinib 100 mg daily by mouth ; Decitabine ose 20 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Dasatinib (Drug)
Phase I - Dasatinib 100 mg + Decitabine 20 mg/m2
More Intensive, Schedule A2: Dasatinib 100 mg daily by mouth ; Decitabine ose 20 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Decitabine (Drug)
Phase I - Dasatinib 140 mg + Decitabine 10 mg/m2
Less Intensive, Schedule B1 Dasatinib 140 mg daily by mouth ; Decitabine 10 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Dasatinib (Drug)
Phase I - Dasatinib 140 mg + Decitabine 20 mg/m2
More Intensive, Schedule B2 Dasatinib 140 mg daily by mouth ; Decitabine 20 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Dasatinib (Drug)
Phase I - Dasatinib 140 mg + Decitabine 20 mg/m2
More Intensive, Schedule B2 Dasatinib 140 mg daily by mouth ; Decitabine 20 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Decitabine (Drug)
Phase II - Dasatinib 140 mg + Decitabine 10 mg/m2
Less Intensive, Schedule B1 Dasatinib 140 mg daily by mouth; Decitabine e 10 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Dasatinib (Drug)
Phase II - Dasatinib 140 mg + Decitabine 10 mg/m2
Less Intensive, Schedule B1 Dasatinib 140 mg daily by mouth; Decitabine e 10 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Decitabine (Drug)
Phase II - Dasatinib 140 mg + Decitabine 20 mg/m2
More Intensive, Schedule B2 Dasatinib140 mg daily by mouth; Decitabine 20 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Dasatinib (Drug)
Phase II - Dasatinib 140 mg + Decitabine 20 mg/m2
More Intensive, Schedule B2 Dasatinib140 mg daily by mouth; Decitabine 20 mg/m^2 by vein over 1 hour daily for 10 days; 28 day cycle.
干预措施: Decitabine (Drug)
结局指标
主要结局
Ph I Study: Maximum Tolerated Dose (MTD) Dasatinib
时间窗: End of first 28-day cycle
Maximum tolerated dose (MTD) defined as highest dose at which 0 of 3 or \</= 1/6 participant experience a first cycle dose limiting toxicity (DLT).
次要结局
- Number of Participants With Hematologic Responses During First 3 Months of Treatment(3 months)
- Overall Survival(Up to seven years)
- Duration of Response(up to seven years)