Safety and Pharmacokinetics Study of SyB L-1101 in Patients With Recurrent/Relapsed or Refractory Myelodysplastic Syndrome (MDS)

Study Overview
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Brief Summary
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The purpose of this study is to investigate tolerability when SyB L-1101 is administered intravenously in patients with recurrent/relapsed or refractory myelodysplastic syndrome, to determine the dose-limiting toxicity and maximum tolerated dose, and to estimate the recommended dose for phase II studies. Pharmacokinetics and antitumor effects will also be investigated.

Official Title
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Phase I Clinical Trial of SyB L-1101 in Patients With Myelodysplastic Syndrome

Conditions
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Myelodysplastic Syndrome

Intervention / Treatment
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* Drug: SyB L-1101


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Patients must satisfy the following conditions listed below. Patients who have been histologically documented or cytologically confirmed with myelodysplastic syndrome (MDS), and who have been found to meet any of the following criteria on the basis of the World Health Organization (WHO) classification or French-American-British (FAB) classification. Refractory Anemia (RA) (< 5% myeloblasts, < 15% ringed sideroblasts) RA with Ring Sideroblasts (RARS) (< 5% myeloblasts, >= 15% ringed sideroblasts) RA with Excess of Blasts (RAEB)-1 (5% to 9% myeloblasts) RAEB-2 (10% to 19% myeloblasts) RAEB in transformation (RAEB-t) (20% to 29% myeloblasts or < 25,000/mm^3 peripheral leukocytes) Chronic myelomonocytic leukemia (CMML) (10% to 19% myeloblasts in marrow, >= 1,000/mm^3 peripheral monocytes, < 13,000/mm^3 leukocytes) However, RA patients must have score of Int-2 or higher in International prognostic scoring system (IPSS). Patients with a low value in at least one blood cell lineage (having at least one of the following cytopenias). Neutrophils : < 1,800/mm^3 Platelets : < 100,000/mm^3 Hemoglobin : < 10 g/dL Patients with a previous history of chemotherapy (including lenalidomide) for the target disease who meet any of the following criteria. Patients who have not achieved complete remission, partial remission, or hematologic improvement* Patients with recurrence/relapse after complete remission, partial remission, or hematologic improvement* Patients with intolerability that has led to discontinuation of treatment because of the development of liver dysfunction, kidney dysfunction, etc., after the start of treatment. * Proximate therapeutic efficacy judged under International Working Group (IWG) 2006 criteria Patients who have not been treated for four weeks or longer after the end of the previous therapy and who are judged to have no residual effects (antitumor effects) from the previous therapy. Patients who can be expected to survive at least three months or longer. Patients at least 20 years old (when informed consent is obtained). Patients who have score of 0 to 2 in Eastern Cooperative Oncology Group (ECOG) Performance Status (P.S.). Patients with adequate function in major organs (heart, lungs, liver, kidneys, etc.). Aspartate aminotransferase (AST) (Glutamic oxaloacetic transaminase, GOT) : no greater than 3.0 times the upper boundary of the reference range at each institution Alanine aminotransferase (ALT) (Glutamic pyruvic transaminase, GPT): no greater than 3.0 times the upper boundary of the reference range at each institution Total bilirubin: no more than 1.5 times the upper boundary of the reference range at each institution Serum creatinine: no more than 1.5 times the upper boundary of the reference range at each institution ECG: no abnormal findings requiring treatment Echocardiography: no abnormal findings requiring treatment Patients who personally signed an informed consent document for participation in this study. Exclusion Criteria: - Patients who satisfy any of the following conditions will not be enrolled in the study. Patients with anemia caused by factors other than MDS (hemolytic anemia, gastrointestinal (GI) bleeding, etc.). Patients who have undergone treatment for an active malignant tumor within the past year (except basal cell or squamous cell skin cancer or carcinoma in situ of the cervix or breast). Patients who have been administered a cytokine preparation such as granulocyte-colony stimulating factor (G-CSF), erythropoietin, etc. within 14 days of tests for enrollment of the study. Patients with obvious infectious diseases (including viral infections). Patients with serious complications (liver failure, renal failure, etc.). Patients with a complicating or previous history of serious heart disease (myocardial infarction, ischemic heart disease, etc.) within the past two years before enrollment, and with cardiac arrhythmia requiring treatment. Patients with a serious gastrointestinal condition (severe or significant nausea/vomiting, diarrhea, etc.). Patients who are positive for the Hepatitis B surface (HBs) antigen or HIV antibodies. Patients with serious bleeding tendencies (disseminated intravascular coagulation (DIC), internal hemorrhage, etc.). Ascites requiring active medical management including paracentesis, or hyponatremia (defined as serum sodium value of <130 mEq/L). Patients who have been administered a drug in a clinical trial or an unapproved drug within three months before enrollment. Patients with an addiction to a legal or illegal drug, or with alcohol dependency. Patients who are pregnant or may become pregnant. Patients who have not consented to the following contraceptive measures. Patients will avoid sexual intercourse with sexual partners or should use the following contraceptive methods in these time periods: for male patients during the administration period of the trial and for six months after the end of administration; female patients during the administration period of the trial, and until a second menstrual period is confirmed after the end of administration (or in the case of female patients with no menstrual period, for two months after the end of administration). •Male patients The patient will always use a condom. For effective contraception, it is recommended that the female partner also use the contraceptive methods for female patients. •Female patients Female patients who may become pregnant should use one or more types of the following contraceptive methods. In addition, the male partner will always use a condom. Oral contraceptive (birth control pills) Intrauterine device (IUD) Tubal ligation Other patients judged to be unsuitable by an investigator or sub-investigator.

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SyB L-1101<br>In Cohort 1, SyB L-1101 1200 mg/day group, Participants were administered 1200 mg/day of SyB L-1101 intravenously for 3 consecutive days, followed by 11-day observation period. In Cohort 2, SyB L-1101 1800 mg/day group, Participants were administered 1800 mg/day of SyB L-1101 intravenously for 3 consecutive days, followed by 11-day observation period. For both Cohorts, the treatment period of 14 days constitutes 1 cycle, and the treatment was allowed for up to 8 cycles. | Drug: SyB L-1101<br>* SyB L-1101（rigosertib sodium） will be administered to two cohorts at either 1200 mg/day or 1800 mg/day. The dose will be administered intravenously for 72 continuous hours (3 days), followed by 11-day observation period. The treatment period of 14 days (3 days of administration + 11 days of observation) constitutes 1 cycle. The study will involve treatment through the second cycle, but treatment can be continued for 3 or more cycles if conditions for continued administration are satisfied.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Who Experienced Dose-limiting Toxicities (DLTs) | A DLT was defined as adverse events for which a causal relationship with the investigational drug could not be ruled out and which met the following criteria that occurred by the final observation in Cycle 2. DLTs were also to be assessed in the Efficacy and Safety Assessment Committee. Criteria: Grade 3 or higher non-hematologic toxicity. However, nausea, vomiting, diarrhea, pyrexia, stomatitis, and esophagitis/dysphagia are excluded (Grade 3 nausea, vomiting, diarrhea, and pyrexia that cannot be controlled with antiemetic, antidiarrheal, or antifebrile agents are regarded as DLTs) Grade 3 or higher stomatitis, esophagitis, and dysphagia that persist for >= 4 days | Up to 60 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hematologic Remission Effect (IWG 2006 Criteria, Responses Must be Sustained at Least 4 Weeks) | Definition Complete remission (CR) Bone marrow: <= 5% myeloblasts; normal maturation of all cell lines Peripheral blood: Hemoglobin (Hgb) >= 11 g/dL, Platelets >= 100×10^9/L, Neutrophils >= 1.0×10^9/L, Blasts 0% Partial remission (PR) Same as CR criteria except bone marrow blasts decreased by >= 50% over pretreatment but still > 5% Marrow CR Bone marrow: <= 5% myeloblasts and decrease by >= 50% over pretreatment Peripheral blood: will be noted in addition to marrow CR Stable disease Failure to achieve at least PR, but no evidence of progression for > 8 wks Disease progression Patients with: Less than 5% blasts: >= 50% increase in blasts to > 5% blasts 5%-10% blasts: >= 50% increase to > 10% blasts 10%-20% blasts: >= 50% increase to > 20% blasts 20%-30% blasts: >= 50% increase to > 30% blasts Any of the following: At least 50% decrement from maximum remission/response in granulocytes or platelets Reduction in Hgb by >= 2 g/dL Transfusion dependence | Up to 60 weeks | 
| Hematologic Improvement Effect (IWG 2006 Criteria, Responses Must be Sustained at Least 8 Weeks) | Definition Hematologic Improvement Erythrocyte (HI-E): Hgb increase by >= 1.5 g/dL Relevant reduction of units of red blood cell (RBC) transfusions by an absolute number of at least 4 RBC transfusions/8 week compared with the pretreatment transfusion number in the previous 8 week. Only RBC transfusions given for a Hgb of <= 9.0 g/dL pretreatment will count in the RBC transfusion response evaluation Hematologic Improvement Platelet (HI-P): Absolute increase of >= 30×10^9/L for patients starting with > 20×10^9/L platelets Increase from < 20×10^9/L to > 20×10^9/L and by at least 100% Hematologic Improvement Neutrophil (HI-N): At least 100% increase and an absolute increase > 0.5×10^9/L Progressive disease / Relapse: At least 1 of the following: At least 50% decrement from maximum response levels in granulocytes or platelets Reduction in Hgb by >= 1.5 g/dL Transfusion dependence | Up to 60 weeks |