Crenolanib in Combination With Sorafenib in Patients With Refractory or Relapsed Hematologic Malignancies
Condition: Acute Myeloid Leukemia
MeSH terms: Hematologic Neoplasms
Study type: Interventional
Phase: Phase 1

Summary: 
      PRIMARY OBJECTIVE:

      This is a pilot study to characterize the toxicity profile, to determine the maximum
      tolerated dose of the combination of crenolanib and sorafenib, and to determine the
      feasibility of administering these drugs in patients with relapsed or refractory hematologic
      malignancies, including acute myeloid leukemia (AML), AML with prior myelodysplastic syndrome
      (MDS), and myeloperoxidase (MPO)-positive mixed phenotype acute leukemia with FLT3-internal
      tandem duplication (ITD) and tyrosine kinase domain (TKD) mutations.

      The study will include two phases:

        -  The dose-escalation phase will characterize the dose-limiting toxicities (DLTs) and
           determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of
           crenolanib when given in combination with sorafenib.

        -  The dose-expansion cohort will further assess the safety and explore the efficacy of
           this combination.
    

Detailed description: 
      Each course of therapy will be 28 days (±5 days), unless disease progression is seen while on
      the combination of crenolanib with sorafenib. Patients may receive subsequent courses (up to
      a total of 365 days) if there is no disease progression or unacceptable toxicity.

      In Day 1 of Course 1, crenolanib is given once in the morning followed by characterization of
      the pharmacokinetic profile over the following 24-hour period. Starting with day 2 of Course
      1, crenolanib will be given 3 times per day through day 28. On Days 8 to 28 of Course 1,
      sorafenib will be given once per day. Inter-patient dose escalation or de-escalation of
      crenolanib will be performed based on tolerability and toxicity.

      Response will be assessed on days 8 and at end of course. If disease progresses prior to day
      8, then sorafenib can be given before day 8.

      In subsequent courses (up to 365 days), crenolanib and sorafenib are given on days 1 through
      28. The treating physician may increase or decrease the sorafenib dose and frequency of
      administration per the trial's dosing table on the basis of effects and tolerability. If
      necessary, the crenolanib dose can be decreased per protocol.

      Maintenance therapy must start no sooner than 30 days and no later than 120 days after
      hematopoietic stem cell therapy (HSCT). Single agent crenolanib will start at the last dose
      tolerated prior to HSCT. Crenolanib maintenance can be given for up to 365 days and
      additional therapy can be provided after discussion after discussion with the PI, in patients
      who continue to benefit after 1 year.
    

Intervention name(s): Crenolanib; Sorafenib; methotrexate, hydrocortisone and cytarabine with leucovorin
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Day 1 of Course 1: once followed by pharmacokinetic analysis. Days 2-28 of cycle 1: 3 times per day Crenolanib dose will not be adjusted unless the participant experiences side effects.
All subsequent courses: 3 times per day on Days 1-28. At least 50% of participants in each dose level must be ≤ 18 years old.; Days 8-28 of course 1: given orally once each day.
All subsequent courses: given orally on days 1-28 once per day
This is a dose-finding study for the use of sorafenib in combination with crenolanib. Different doses will be given to several participants, with the first participants receiving a lower dose than typically used in children as a single agent. If the drug does not cause serious side effects, it will be given to other study participants at a higher dose. If side effects occur, the dose will be lowered.; Triple IT therapy includes methotrexate, hydrocortisone and cytarabine with leucovorin rescue given on day 8. All participants will receive one IT chemotherapy on Day 8 of the first cycle. If they do not have leukemia cells in their spinal fluid, they will receive only one IT chemotherapy per cycle. If leukemia cells are present in their spinal fluid, they will receive IT chemotherapy weekly during the course. Triple IT therapy will be repeated on Day 1 of Cycle 2 and with each subsequent cycle in all participants.
Other intervention name(s): CP-868,596; IND 112201; Sorafenib tosylate; BAY-43-9006; Nexavar®; Triple IT chemotherapy
Intervention MeSH terms: Leucovorin; Cytarabine; Hydrocortisone; Methotrexate; Sorafenib; Crenolanib
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment