Patient case: 58-year-old female with endometrial cancer; genetic feature: PIK3R1

Clinical trial: Lenalidomide Safety/Efficacy in Myelodysplastic Syndromes (MDS) Associated With a Deletion (Del)(5q) Cytogenetic Abnormality

Summary: This study is a multicenter, single-arm, open-label study of oral lenalidomide monotherapy administered to red blood cell (RBC) transfusion-dependent subjects with low- or intermediate-1-risk Myelodysplastic Syndromes (MDS) associated with a del (5q31-33) cytogenetic abnormality. Screening procedures will take place within 28 days of the first day of lenalidomide treatment. Subjects will receive lenalidomide in 28-day cycles for up to 6 cycles, or until bone marrow disease progression or progression/relapse following erythroid hematologic improvement is documented. Study visits will occur every cycle (every 28 days) and laboratory monitoring to assess hematological parameters will occur every 14 days. Safety and efficacy assessments to be performed during the study are outlined in the Schedule of Study Assessments.


Eligibility: Inclusion Criteria:
  -  Must understand and voluntarily sign an informed consent form
  -  Age 18 years or older at the time of signing the informed consent
  -  Must be able to adhere to the study visit schedule and other protocol requirements.
  -  Diagnosis of low or intermediate-1-risk International Prognostic Scoring System (IPSS) Myelodysplastic Syndromes (MDS) without an abnormality of chromosome 5 involving a deletion between bands q31 and q33.
  -  Red blood cell (RBC) transfusion-dependent anemia defined as having received greater than or equal to 2 units of RBCs within 8 weeks of the first day of study drug treatment.
  -  Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1 or 2.
  -  Women of childbearing potential (WCBP) must have a negative serum or urine pregnancy test within 7 days of starting study drug.
  -  Sexually active WCBP must agree to use adequate contraceptive methods (oral, injectable, or implantable hormonal contraceptive; tubal ligation; intra-uterine device; barrier contraceptive with spermicide; or vasectomized partner) while on study drug.
  -  WCBP must agree to have pregnancy tests every 4 weeks while on study drug.
  Exclusion Criteria:
  -  Pregnant or lactating females
  -  Prior therapy with lenalidomide.
  -  An abnormality of chromosome 5 involving a deletion between bands q31 and q33.
  -  Lab Abnormality: Absolute neutrophil count (ANC) <500 cell/mm^3 (0.5*10^9/L)
  -  Lab Abnormality: Platelet count <50,000/mm^3 (50*10^9/L)
  -  Lab Abnormality: Serum creatinine >2.5 mg/dL (221 mmol/L)
  -  Lab Abnormality: Serum total bilirubin >2.0 mg/dL (34 mmol/L)
  -  Prior greater than or equal to grade 3 National Cancer Institute (NCI) Common Toxicity Criteria (CTC) allergic reaction/hypersensitivity to thalidomide.
  -  Clinically significant anemia due to factors such as iron, B12 or folate deficiencies, autoimmune or hereditary hemolysis or gastrointestinal bleeding
  -  If a marrow aspirate is not evaluable for storage iron, transferrin saturation must be > 20% and serum ferritin not less than 50 ng/mL
  -  Use of hematopoietic growth factors within 7 days of the first day of study drug treatment.
  -  Prior greater than or equal to grade 3 NCI CTC rash or any desquamation (blistering) while taking thalidomide.
  -  Chronic use (>2 weeks) of greater than physiologic doses of a corticosteroid agent (dose equivalent to >10 mg/day of prednisone) within 28 days of the first day of study drug treatment.
  -  Use of experimental or standard drugs (i.e. chemotherapeutic, immunosuppressive, and cytoprotective agents) for the treatment of MDS within 28 days of the first day of study drug treatment.
  -  Prior history of malignancy other than MDS (except basal cell or squamous cell carcinoma or carcinoma in situ of the cervix or breast) unless the subject has been free of disease for greater than or equal to 3 years.
  -  Use of any other experimental therapy within 28 days of the first day of study drug treatment.

Relevance to patient case: not relevant