Clinical trial NCT04742101: Phase I/II Trial of S65487 Plus Azacitidine in Acute Myeloid Leukemia
Official title: Phase I / II, Open Label, Dose Escalation Part (Phase I) Followed by Non-comparative Expansion Part (Phase II), Multi-centre Study, Evaluating Safety, Pharmacokinetics and Efficacy of S65487, a Bcl2 Inhibitor Combined With Azacitidine in Adult Patients With Previously Untreated Acute Myeloid Leukemia Not Eligible for Intensive Treatment
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE1
PHASE2
Conditions: Acute Myeloid Leukemia
Keywords: Acute Myeloid Leukemia
Dose escalation
Phase I/II
Azacitidine
Combination
Oncology
Lead sponsor: Servier
Sponsor class: INDUSTRY
Collaborators: name: ADIR, a Servier Group company
First posted: 2021-02-05
Enrollment: 57
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 purpose of this study is to assess the safety, tolerability and clinical activity of the combination S65487 with azacitidine in patients with acute myeloid leukaemia.

Detailed description: The study is designed in two parts: A dose escalation phase I part, and a dose expansion phase II part with an additional potential expansion cohort.

During dose escalation of S65487 in combination with azacitidine, only S65487 agent dose will escalate and a DDI (Drug-Drug interaction) assessment between S65487 and posaconazole (antifungal drug) will be performed. A ramp-up dose of S65487 will be administered on the first two days of cycle 1, then the full dose of S65487 will be administered for the remainder of cycle 1. Each treatment cycle is 28 days.

For the expansion phase, the dose will be the RP2D (Recommended Phase 2 Dose) determined during phase I part. An additional potential expansion cohort will be included if there is more than one promising dose/schedule candidate.

Eligibility criteria: Inclusion Criteria:

* Male or female participant aged ≥ 18 years old
* Participants with cytologically confirmed and documented treatment naïve, de novo or secondary AML defined by WHO 2016 classification (Arber, 2016). Secondary AML includes:

  * Previous myelodysplastic syndrome transformed
  * AML due to exposure to potentially leukemogenic therapies or agents (e.g. radiation therapy, alkylating agents, topoisomerase II inhibitors) with the primary malignancy in remission for at least 3 years
* Participants not eligible for standard induction chemotherapy

  * Aged ≥ 75 years old
  * Or Age ≥18 years with at least one of the following comorbidities:

    * Clinically significant heart or lung comorbidities, as reflected by at least one of:

      * Lung diffusing capacity for carbon monoxide (DLCO) ≤65% of expected
      * Forced expiratory volume in 1 second (FEV1) ≤65% of expected
    * Other contraindication(s) to anthracycline therapy (must be documented)
    * Other comorbidity that the Investigator judges as incompatible with intensive remission induction chemotherapy, which must be documented
* ECOG (Eastern Cooperative Oncology Group) performance status should be (criterion should be rechecked at inclusion visit) ECOG ≤ 2.
* Written informed consent obtained prior any study-specific procedure as described in section 13.3 of the protocol.
* Adequate renal and hepatic function
* Circulating White Blood Cell Count (WBC count) \< 25\*109 G/L (with or without use of hydroxycarbamide/leukapheresis)
* Serum potassium, serum calcium, serum phosphates, serum magnesium within normal limits with or without supplementation.

Exclusion Criteria:

* Major surgery within 3 weeks prior to the first IMP administration, or participants who have not recovered from side effects of the surgery
* Any radiotherapy within 3 weeks before the first IMP administration,
* Allogenic stem cell transplant within 3 months before the first IMP administration and/or participants with active Graft-versus-host disease within 3 months before the first IMP administration and/or participants who still receive immunosuppressive treatment within 3 months before the first IMP administration and/or participant who receive donor lymphocyte infusion (DLI) within 3 months before the first IMP administration
* Acute promyelocytic leukemia (APL, French-American-British M3 classification)
* Favorable risk cytogenetics such as t(8;21), inv(16) or t(16;16) or t(15;17) as per the National Comprehensive Cancer Network (NCCN) Guidelines Version 3, 2019 for Acute Myeloid Leukemia
* Treatment with hypomethylating agents (decitabine/azacitidine) or Venetoclax for AHD (antecedent hematologic disorders) in the 3 months prior to the first IMP intake

Primary outcomes:
measure: Dose Limiting Toxicity (DLT) (phase I part)
timeFrame: Through the end of first cycle (each cycle is 28 days)
measure: Adverse Event (phase I part)
timeFrame: Through study completion, an average of 3 years ans 5 months
measure: Complete Remission (CR) rate (phase II part)
timeFrame: Through study completion, up to 3 years and 5 months
Secondary outcomes:
measure: PharmacoKinetics - maximum Concentration at the End of the infusion (Cinf) (phase I and phase II parts)
timeFrame: Cycle 1 Day 1, Cycle 1 Day 8, Cycle 1 Day 15 (schedule 1, first two cohorts), Cycle 2 Day 8 (from Cohort 3), or Day 15 (first two cohorts)(each cycle is 28 days)
measure: PharmacoKinetics - Area Under the Curve (AUC) (phase I and phase II parts)
timeFrame: Cycle 1 Day 8 to Day 9, Cycle 2 Day 8 to Day 9 (from cohort 3), or Day 15 to Day 16 (first two cohorts)(each cycle is 28 days)
measure: Assessment of anti-leukemic activity of S65487 combined to azacitidine (phase I and phase II parts)
timeFrame: Through study completion, an average of 3 years and 5 months
measure: Assessment of anti-leukemic activity of S65487 combined to azacitidine (phase I and phase II parts)
timeFrame: Through study completion, an average of 3 years and 5 months
Other outcomes:
Locations:
city: Villejuif
country: France
facility: Institut Gustave Roussy
city: Budapest
country: Hungary
facility: Semmelweis Egyetem Belgyógyászati és Onkológiai Klinika Klinikai Farmakológiai Részleg
city: Seoul
country: Korea, Republic of
facility: Seoul National University Hospital - Department of Hematology-Oncology
city: Seoul
country: Korea, Republic of
facility: Samsung Medical Center - Division of Hematology-Oncology
city: Gliwice
country: Poland
facility: Narodowy Instytut Onkologii im. M. Sklodowskiej-Curie Klinika Transplantacji Szpiku i Onkohematologii pokoj 4.041 ul. Wybrzeze Armii Krajowej 15
city: Madrid
country: Spain
facility: Hospital 12 de Octubre Servicio de Hematología
city: Pamplona
country: Spain
facility: C. Universidad de Navarra Servicio de Hematologia
city: Valencia
country: Spain
facility: H. Universitario La Fe Servicio de Hematologia
city: Edinburgh
country: United Kingdom
facility: Western General Hospital
city: London
country: United Kingdom
facility: University College London - Hospitals NHS Foundation Trust
city: Manchester
country: United Kingdom
facility: The Christie NHS foundation Trust
Study officials:
References:
citation: Pierola AA, De Botton S, Jan JH, Campbell V, O'Nions J, Calbacho M, Ervin-Hayes AL, Keagle K, Maillard A, Beneton M, Romagnoli M, Broniscer A. Trial in Progress: An Open Label Phase I/II, Multicenter Study Evaluating Safety, Pharmacokinetics and Efficacy of S65487, a BCL-2 Inhibitor Combined with Azacitidine in Adults with Previously Untreated Acute Myeloid Leukemia Ineligible for Intensive Treatment. Blood. 2023 Nov 2;142(Supplement 1):1555. doi: https://doi.org/10.1182/blood-2023-180795