Bortezomib, Daunorubicin, and Cytarabine in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia
Condition: Acute Myeloid Leukemia; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Untreated Adult Acute Myeloid Leukemia
MeSH terms: Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukemia, Monocytic, Acute; Leukemia, Myelomonocytic, Acute; Leukemia, Megakaryoblastic, Acute; Leukemia, Erythroblastic, Acute
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      This phase II trial studies the side effects and best dose of bortezomib when given together
      with daunorubicin and cytarabine and to see how well it works in treating older patients with
      previously untreated acute myeloid leukemia. Bortezomib may stop the growth of cancer cells
      by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as
      daunorubicin and cytarabine, work in different ways to stop the growth of cancer cells,
      either by killing the cells or by stopping them from dividing. Giving bortezomib together
      with combination chemotherapy may kill more cancer cells.
    

Detailed description: 
      PRIMARY OBJECTIVES:

      I. To define the remission induction response rate (complete response [CR] and CR with
      incomplete platelet recovery [CRp]) in older patients with previously untreated acute myeloid
      leukemia treated with induction therapy comprising bortezomib in combination with
      daunorubicin hydrochloride and cytarabine.

      II. To define the maximum tolerated dose of bortezomib when administered in combination with
      intermediate-dose cytarabine after induction therapy.

      SECONDARY OBJECTIVES:

      I. To describe the disease-free survival of patients treated with this regimen. II. To
      describe the overall survival of patients treated with this regimen. III. To evaluate the
      treatment-related toxicities in these patients.

      OUTLINE: This is a multicenter, dose-escalation study of bortezomib. Doses of bortezomib are
      escalated during remission consolidation therapy.

      REMISSION INDUCTION THERAPY: Remission induction course 1: Patients receive bortezomib IV
      over 3-5 seconds on days 1, 4, 8, and 11; daunorubicin hydrochloride IV on days 1-3; and
      cytarabine IV continuously over 168 hours on days 1-7.

      After completion of remission induction course 1, patients undergo bone marrow aspiration and
      biopsy for evaluation of response. Patients achieving a complete response (CR) or partial
      response (PR) proceed to remission consolidation therapy. Patients achieving a CR with
      incomplete platelet recovery (CRp) proceed to remission consolidation therapy after platelet
      counts recover. Patients with persistent leukemia (>= 20% bone marrow cellularity and >= 5%
      bone marrow myeloblasts) proceed to remission induction course 2.

      REMISSION INDUCTION COURSE 2: Patients receive bortezomib IV over 3-5 seconds on days 1 and
      4; daunorubicin hydrochloride IV on days 1 and 2; and cytarabine IV continuously over 120
      hours on days 1-5.

      After completion of remission induction course 2, patients undergo bone marrow aspiration and
      biopsy for evaluation of response. Patients achieving a CR or PR proceed to remission
      consolidation therapy. Patients achieving a CRp proceed to remission consolidation therapy
      after platelet counts recover. Patients with residual leukemia who do not meet the criteria
      for PR are removed from the study.

      REMISSION CONSOLIDATION THERAPY: Patients receive bortezomib IV over 3-5 seconds on days 1,
      4, 8, and 11 and intermediate-dose cytarabine IV over 3 hours on days 1-5. Patients then
      undergo bone marrow aspiration and biopsy for evaluation of response. Patients achieving a CR
      or who demonstrate continuing CR receive a second course of remission consolidation therapy
      beginning 2-4 weeks after blood counts recover.

      After completion of study therapy, patients are followed every 2 months for 2 years, every 3
      months for 2 years, and then annually for up to 10 years.
    

Intervention name(s): daunorubicin hydrochloride; cytarabine; bortezomib
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Given IV; Given IV; Given IV
Other intervention name(s): Cerubidin; Cerubidine; daunomycin hydrochloride; daunorubicin; RP-13057; ARA-C; arabinofuranosylcytosine; arabinosylcytosine; Cytosar-U; cytosine arabinoside; LDP 341; MLN341; VELCADE
Intervention MeSH terms: Cytarabine; Bortezomib; Daunorubicin
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment