Clinical trial NCT01411267: AC220 for Children With Relapsed/Refractory ALL or AML
Official title: A Phase I Study of AC220 for Children With Relapsed or Refractory ALL or AML
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Lymphoblastic Leukemia, Acute, Childhood
Myelogenous Leukemia, Acute, Childhood
Keywords: Relapse
Lymphoblastic
Leukemia
AC220
Refractory
Myelogenous
Acute
Childhood
Pediatric
ALL
AML
Lead sponsor: Therapeutic Advances in Childhood Leukemia Consortium
Sponsor class: OTHER
Collaborators: name: Ambit Biosciences Corporation
First posted: 2011-08-08
Enrollment: 24
Sex: ALL
Minimum age (years): 1
Maximum age (years): 21
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: TREATMENT

Brief summary: This is a phase I study of the investigational drug AC220 combined with cytarabine and etoposide in pediatric patients with relapsed acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML).

Detailed description: This is a study for pediatric patients with relapsed acute lymphoblastic leukemia (ALL) or acute myelogenous leukemia (AML). Some people diagnosed with leukemia have changes in a receptor located on the surface of white blood cells called FLT3. This is known as a FLT3 mutation. FLT3 plays an important role in the way cells grow and divide. In normal cells, the FLT3 receptor is switched off most of the time and only switches on when it gets a chemical signal from outside. But cells with the FLT3 mutation have the grow signal permanently switched on. This means leukemia cells with the FLT3 mutation are growing and dividing all the time. Doctors have found that people with leukemia cells that carry FLT3 mutations are less likely to go into remission with chemotherapy and have a higher risk of the leukemia coming back after treatment.

This is a study of an investigational drug called AC220. AC220 is considered investigational because it has not been approved in the United States by the Food and Drug Administration (FDA). AC220 is a drug which is able to "turn off" the FLT3 grow signal. AC220 will be given with cytarabine and etoposide to treat the relapsed leukemia. This is a phase I study, which means that the study is being done to find the highest dose of AC220 that can be given safely with the drugs cytarabine and etoposide to children and young adults.

Eligibility criteria: Inclusion Criteria:

* Patients must be greater than 1 month and ≤ 21 years of age at study entry.
* Patients must have a diagnosis of relapsed/refractory AML, ALL or acute leukemia of ambiguous lineage and meet the following criteria:

  1. Patients with AML or leukemia with ambiguous lineage must have greater than or equal to 5% blasts in the bone marrow.
  2. Patients with ALL must have an M3 marrow (marrow blasts \>25%).
  3. Patients with ALL must have MLL gene rearrangement or hyperdiploid \>50 chromosomes.
  4. Patients with treatment related AML (t-AML) are eligible, provided they meet all other eligibility criteria.
* Karnofsky \> 50% for patients \>16 years of age and Lansky \>50% for patients ≤16 years of age.
* Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study.

  * Myelosuppressive chemotherapy:

    * Patients with ALL who relapse during standard maintenance therapy are eligible at time of relapse.
    * For patients with ALL and AML who relapse while they are receiving cytotoxic therapy, at least 14 days must have elapsed since the completion of cytotoxic therapy.
    * Cytoreduction with hydroxyurea can be initiated and continued for up to 24 hours prior to the start of AC220.
    * Patients who have received other FLT3 inhibitors (ex. lestaurtinib, sorafenib) are eligible for this study.
  * Hematopoietic growth factors: At least 7 days since the completion of therapy with a growth factor.
  * Biologic (anti-neoplastic agent): At least 7 days since the completion of therapy with a biologic agent. For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair.
  * XRT: 2 wks must have elapsed since local palliative XRT for CNS chloromas; No washout period is necessary for other chloromas; at least 3 months must have elapsed if prior TBI, craniospinal XRT.
  * Hematopoetic Stem Cell Transplant: At least 90 days must have elapsed since hematopoietic stem cell transplant (HSCT) and patients must not have active GVHD.
* Patient must have adequate renal and hepatic functions as indicated by the following laboratory values:

  * Patients must have a calculated creatinine clearance or radioisotope GFR ≥70mL/min/1.73m2 or a normal serum creatinine based on age/gender.
  * Total bilirubin \<1.5 x ULN for age or normal conjugated bilirubin.
  * Alanine transaminase (ALT) \<5 × ULN (unless related to leukemic involvement).
* Patient must have a shortening fraction of ≥ 27% by echocardiogram, OR an ejection fraction of ≥ 50% by radionuclide angiogram.
* Reproductive Function

  * Female patients of childbearing potential must have a negative urine or serum pregnancy test confirmed within 2 weeks prior to enrollment.
  * Female patients with infants must agree not to breastfeed their infants while on this study.
  * Male and female patients of child-bearing potential must agree to use an effective method of contraception approved by the investigator during the study and for a minimum of 6 months after study treatment.

Exclusion Criteria:

* Patients will be excluded if they have CNS 3 disease.
* Patients will be excluded if they have uncontrolled or significant cardiovascular disease, including:

  * A myocardial infarction within 12 months.
  * Uncontrolled angina within 6 months.
  * Diagnosed or suspected congenital long QT syndrome or any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or torsades de pointes \[TdP\]); any history of arrhythmia will be discussed with the Sponsor's Medical Monitor prior to patient's entry into the study.
  * Prolonged QTcF interval on pre-entry ECG (≥450 ms).
  * Any history of second or third degree heart block (may be eligible if the patient currently has a pacemaker).
  * Heart rate \< 50/minute on pre-entry ECG.
  * Uncontrolled hypertension.
  * Complete left bundle branch block.
  * Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or TdP.
* Patients will be excluded if they have a systemic fungal, bacterial, viral or other infection that is exhibiting ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics or other treatment. The patient needs to be off pressors and have negative blood cultures for 48 hours.
* Patient is receiving or plans to receive concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol.
* Any significant concurrent disease, illness, psychiatric disorder or social issue that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results.
* Patients who are concurrently receiving CYP3A4 and 5 inhibitors and inducers

Primary outcomes:
measure: The Dose of AC220 That is Safe and Biologically Active When Given in Sequential Combination With Ara-C/Etoposide
timeFrame: 4 weeks from therapy start
Secondary outcomes:
measure: Disease Response
timeFrame: 10 weeks
measure: Count of Participants According to Inhibition of FLT3 Phosphorylation
timeFrame: 4 weeks from therapy start
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: Childrens Hospital Los Angeles
state: California
city: Madera
country: United States
facility: Children's Hospital Central California
state: California
city: San Francisco
country: United States
facility: UCSF School of Medicine
state: California
city: Aurora
country: United States
facility: The Children's Hospital, University of Colorado
state: Colorado
city: Atlanta
country: United States
facility: Children's Healthcare of Atlanta, Emory University
state: Georgia
city: Baltimore
country: United States
facility: Johns Hopkins University
state: Maryland
city: Boston
country: United States
facility: Dana Farber
state: Massachusetts
city: Kansas City
country: United States
facility: Children's Mercy Hospitals and Clinics
state: Missouri
city: Charlotte
country: United States
facility: Levine Children's Hospital at Carolinas Medical Center
state: North Carolina
city: Portland
country: United States
facility: Oregon Health and Science University
state: Oregon
city: Seattle
country: United States
facility: Seattle Children's Hospital
state: Washington
Study officials:
affiliation: Children's Healthcare of Atlanta, Emory University
name: Todd Cooper, MD
role: STUDY_CHAIR
References:
citation: Cooper TM, Cassar J, Eckroth E, Malvar J, Sposto R, Gaynon P, Chang BH, Gore L, August K, Pollard JA, DuBois SG, Silverman LB, Oesterheld J, Gammon G, Magoon D, Annesley C, Brown PA. A Phase I Study of Quizartinib Combined with Chemotherapy in Relapsed Childhood Leukemia: A Therapeutic Advances in Childhood Leukemia & Lymphoma (TACL) Study. Clin Cancer Res. 2016 Aug 15;22(16):4014-22. doi: 10.1158/1078-0432.CCR-15-1998. Epub 2016 Feb 26.