Clinical trial NCT01584531: Efficacy and Safety of Oral Rigosertib in Transfusion-dependent, Low or Int-1 or Trisomy 8 Int-2 Myelodysplastic Syndrome
Official title: A Phase II, Multicenter, Single-arm Study to Assess the Efficacy and Safety of Oral Rigosertib in Transfusion-dependent Low or Intermediate-1 (Any Cytogenetics) or Trisomy 8 Intermediate-2 Myelodysplastic Syndrome Patients Based on IPSS Classification
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Myelodysplastic Syndrome
MDS
Trisomy 8
Keywords: rigosertib sodium
rigosertib
ON 01910.Na
oral rigosertib
Lead sponsor: Traws Pharma, Inc.
Sponsor class: INDUSTRY
First posted: 2012-04-25
Enrollment: 82
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The primary objectives of this study are to determine if rigosertib sodium, given orally in the form of soft gel capsules, is safe and is associated with a reduction in the number of blood transfusion units that are needed in patients with myelodysplastic syndrome (MDS) classified as Low or Intermediate-1 (Int-1) (any cytogenetics) or trisomy 8 Intermediate 2 (Int-2) in the International Prognostic Scoring System (IPSS) who are transfusion-dependent. Rigosertib will be taken on days 1 to 21 of a 21-day cycle.

Detailed description: This will be a Phase II open-label, multicenter (up to 5 centers), single-arm study. Sixty transfusion-dependent patients with MDS classified as Low or Int-1 risk (any cytogenetics) or trisomy 8 Int-2 by International Prognostic Scoring System (IPSS) will be enrolled to receive rigosertib BID for 21 consecutive days of a 21-day cycle.

Patients will be stratified on prior treatment with azacitidine and/or decitabine and/or lenalidomide and/or erythropoietin.

Patients will remain treated on study until 2006 Internation Working Group (IWG) progression criteria are met or until death from any cause.

All study participants will be allowed, as medically justified, access to RBC and platelet transfusions, and to filgrastim \[G-CSF\]. Erythropoiesis-stimulating agents (ESAs) will not be allowed during the initial 3 cycles. Rigosertib dosing adjustment policies are described in Protocol.

Eligibility criteria: Inclusion Criteria:

* Diagnosis of MDS confirmed by bone marrow aspirate and/or biopsy within 6 weeks prior to first dose of study drug according to World Health Organization (WHO) or French-American-British (FAB) classification
* MDS classified as Low risk or Int-1 risk (any cytogenetics) or Trisomy 8 Int-2 risk, according to IPSS classification
* Transfusion dependency defined by at least 4 units of RBC administered within 8 weeks before baseline
* Off all other treatments for MDS (azacitidine, decitabine, lenalidomide, chemotherapy, immunosuppressive agents) for at least 4 weeks
* ECOG performance status of 0, 1 or 2

Exclusion Criteria:

* Ongoing clinically significant anemia due to factors such as iron, B12, or folate deficiencies, auto-immune or hereditary hemolysis, or gastrointestinal (GI) bleeding, unless stabilized for 1 week after RBC transfusion
* Serum ferritin \<50 ng/mL
* Hypoplastic MDS (cellularity \<10%)
* Any active malignancy within the past year, except basal cell or squamous cell skin cancer or carcinoma in situ of the cervix or breast
* Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia
* Active infection not adequately responding to appropriate therapy
* Total bilirubin ≥1.5 mg/dL not related to hemolysis or Gilbert's disease
* ALT/AST ≥2.5 x upper limit of normal (ULN)
* Serum creatinine ≥2.0 mg/dL
* Ascites requiring active medical management including paracentesis
* Hyponatremia (defined as serum sodium value of \<130 mEq/L)
* Female patients who are pregnant or lactating
* Patients who are unwilling to follow strict contraception requirements
* Female patients with reproductive potential who do not have a negative urine beta-human chorionic gonadotropin (bHCG) pregnancy test at Screening
* Major surgery without full recovery or major surgery within 3 weeks of rigosertib treatment start
* Uncontrolled hypertension (defined as a systolic pressure ≥160 mmHg and/or a diastolic pressure ≥110 mmHg)
* New onset seizures (within 3 months prior to the first dose of rigosertib) or poorly controlled seizures
* Any other concurrent investigational agent or chemotherapy, radiotherapy, or immunotherapy
* Chronic use (\>2 weeks) of corticosteroids (\>10 mg/24 hr equivalent prednisone) within 4 weeks of starting rigosertib
* Investigational therapy within 4 weeks of starting rigosertib
* Psychiatric illness or social situation that would limit the patient's ability to tolerate and/or comply with study requirements

Primary outcomes:
measure: Number of units of red blood cell transfusions
timeFrame: 8 weeks
Secondary outcomes:
measure: Number of Adverse Events (AEs)
timeFrame: From date of randomization until 30 days after last dose of study drug
measure: Bone marrow blasts
timeFrame: 4 weeks
measure: Complete blood count
timeFrame: 4 weeks
Other outcomes:
Locations:
city: Scottsdale
country: United States
facility: Mayo Clinic
state: Arizona
city: Atlanta
country: United States
facility: Winship Cancer Institute, Emory University
state: Georgia
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
city: New York
country: United States
facility: Columbia University Medical Center
state: New York
city: Greenville
country: United States
facility: Bon Secours St. Francis Hospital
state: South Carolina
Study officials:
affiliation: Traws Pharma, Inc.
name: Steven M. Fruchtman, MD
role: STUDY_DIRECTOR
References:
citation: Navada SC, Silverman LR. The safety and efficacy of rigosertib in the treatment of myelodysplastic syndromes. Expert Rev Anticancer Ther. 2016 Aug;16(8):805-10. doi: 10.1080/14737140.2016.1209413. Epub 2016 Jul 15.
citation: Garcia-Manero G, Fenaux P. Comprehensive Analysis of Safety: Rigosertib in 557 Patients with Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML). Blood Dec 2016, 128 (22) 2011; ASH 2016.