Clinical trial NCT01829503: Phase II Study of Decitabine and Cytarabine for Older Patients With Newly Diagnosed Acute Myeloid Leukemia (AML)
Official title: Phase II Study of Decitabine and Cytarabine for Older Patients With Newly Diagnosed AML
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Acute Myeloid Leukemia
Keywords: Phase II
decitabine
cytarabine
older patients
newly diagnosed
AML
Newly Diagnosed AML
Lead sponsor: University of Pittsburgh
Sponsor class: OTHER
First posted: 2013-04-11
Enrollment: 44
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Primary objective: To determine the efficacy of an induction regimen using decitabine as an epigenetic primer followed by cytarabine in the treatment of older patients with newly diagnosed Acute myeloid leukemia (AML).

Primary endpoint:

Complete remission rates

Secondary objective: To determine the safety of an induction regimen of decitabine followed by cytarabine in the treatment of older patients with newly diagnosed AML, evaluate survival and identify potential predictive factors for response to treatment

Secondary endpoints:

* Treatment related toxicities
* 4 and 8 week mortality
* Overall survival
* Relapse-free survival
* Predictive factors for response to treatment
* Quality of Life measures including self reported symptoms and assessment of sleep patterns

Treatment administration

Induction therapy Eligible patients will be treated with induction therapy (decitabine + cytarabine) at the University of Pittsburgh Cancer Center inpatient leukemia service at Shadyside Hospital. Patients will receive decitabine 20mg/m2 in 100mL normal saline (NS) intravenously (IV) over 1 hour daily for five days, followed by cytarabine 100mg/m2 in 1000 mL normal saline (NS) as a continuous IV infusion over 24 hours for 5 days. Treatment should be discontinued or delayed for any of the following during the treatment period: a rise in serum creatinine \> 2x patient baseline or upper limit of normal (whichever is higher) unless there is an identifiable reversible etiology, or ALT, AST or total bilirubin \> 5x upper limit of normal, and should be held until resolution below these parameters. There are no parameters for dose reduction.

Patients who have persistent disease on post-treatment bone marrow aspirate and biopsy, will undergo a repeat cycle of induction with decitabine followed by cytarabine as outlined above.

Supportive care including blood product transfusions, antiemetic medications antiviral and antifungal medications, or empiric antibiotics may be used at the clinical discretion of the provider.

Maintenance therapy Patients in complete response (CR) will proceed to decitabine maintenance therapy, where each treatment will be decitabine 20mg/m2 in 100mL normal saline (NS) intravenously (IV) over 1 hour daily for five days administered in the outpatient setting. Maintenance treatments will be continued until disease relapse. Maintenance treatments can be administered as an outpatient at the Hillman Cancer Center, or at a University of Pittsburgh Medical Center (UPMC) facility that is able to administer chemotherapy under the supervision of an Oncologist

Evaluations during maintenance Phase:

During maintenance therapy, complete blood count (CBC) w/ diff/platelets, CMP (Na, K, Cl, carbon dioxide (CO2), glucose, blood urea nitrogen (BUN), Cr, Ca, Total Protein, Albumin, AST, ALT, Alk Phos, Total Bilirubin) will be checked each cycle on day 14 \[+/- 4 days\].

Within 7 days of start of new cycle, study visits will include physical exam, adverse events assessment, CBC and comprehensive metabolic panel (CMP).

Maintenance cycles will be 28 days \[+/- 7 days\]. Cycles can be held up to 4 weeks \[28 days\]. For start of new cycle, any grade 3 or 4 non-hematologic toxicity possibly, probably or definitely related to decitabine therapy must resolve to grade 2 or baseline.

In addition the following lab parameters must be met to start a new cycle of maintenance:

Absolute Neutrophil Count (ANC) \> or = 1000/mm3 Platelets \>/= 50,000/mm3 AST or ALT \< 2 x Uppler Limit of Normal (ULN) Total billirubin \< 2 x ULN Serum creatinine \< 2x patient baseline or upper limit of normal (whichever is higher)

\[If lab parameters are not met for start of cycle, these labs will be checked a minimum of once per week\]. If start of new cycle is held for more than 4 weeks \[28 days\], the subject will be off treatment.

Other reasons for delay in treatment should be discussed with the Principal Investigator.


Eligibility criteria: Inclusion Criteria:

1. Age ≥ 70, or age ≥ 60 ineligible for treatment with standard induction chemotherapy (based on physician discretion or patient refusal), with a new diagnosis of AML based on World Health Organization Classification.
2. Eastern Cooperative Oncology Group Performance Status of 0-2
3. Cardiac ejection fraction ≥45%
4. Males are eligible to enter and participate in the study if they have either had a prior vasectomy or agree to avoid sexual activity or use adequate contraception from screening through two months post the last dose of decitabine

Exclusion Criteria:

1. Patients with acute promyelocytic leukemia
2. Life expectancy ≤3 months
3. Prior use of any hypomethylating agent or cytarabine
4. Uncontrolled, life-threatening infection that is not responding to antimicrobial therapy
5. Serum creatinine \> 2x upper limit of normal
6. Aspartate aminotransferase (AST),alanine aminotransferase (ALT), or total bilirubin \> 5x upper limit of normal
7. History of psychiatric disorder which may compromise compliance with the protocol or which does not allow for appropriate informed consent
8. Patient may not be receiving any other antineoplastic agents (hydroxyurea is allowed)
9. Concurrent malignancy. Exception: Subjects who have been disease-free for 5 years, or subjects with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible. Subjects with second malignancies that are indolent or definitively treated may be enrolled.
10. Evidence of severe or uncontrolled systemic diseases (e.g., unstable or uncompensated respiratory, hepatic, renal, or cardiac disease).

Primary outcomes:
measure: Number of Participants by Best Clinical Response Experienced
timeFrame: Up to 38 months
measure: Proportion of Participants With Clinical Response (CR)
timeFrame: Up to 38 months
Secondary outcomes:
measure: Numbers of Patients (Out of 44) Experiencing Adverse Events With CTCAE Grade ≥ 3 or Adverse Events Grade ≥ 4
timeFrame: Up to 38 months
measure: Proportion of Participants With Survival to Four and Eight Weeks and One Year
timeFrame: Up to one year (4 weeks, 8 weeks, and one year)
measure: Overall Survival (OS)
timeFrame: Up to 38 months (median follow-up = 25.4 months)
measure: Overall Survival (OS) in Participants Who Experienced Complete Response
timeFrame: Up to 38 months (median follow-up = 25.4 months)
measure: Overall Survival (OS) in Participants Who Experienced Complete Response or Complete Response With Incomplete Count Recovery
timeFrame: Up to 38 months (median follow-up = 25.4 months)
measure: Overall Survival (OS) in Participants Who Experienced Complete Response, Complete Response With Incomplete Count Recovery, or Partial Response
timeFrame: Up to 38 months (median follow-up = 25.4 months)
measure: Demographic Characteristics and Clinical Measures as Potential Predictors of Overall Survival (OS)
timeFrame: Up to 38 months (median follow-up = 25.4 months)
measure: Relapse-Free Survival in Participants With Complete Response or Complete Response With Incomplete Count Recovery.
timeFrame: Up to 38 months
measure: Relapse-Free Survival in Participants With Complete Response, Complete Response With Incomplete Count Recovery or Partial Response, and Received Maintenance Therapy
timeFrame: Up to 38 months
measure: Functional Assessment of Cancer Therapy: Health-related Quality of Life (HRQOL) Measure
timeFrame: Baseline to Post-treatment, up to 5 years
Other outcomes:
Locations:
city: Pittsburgh
country: United States
facility: University of PIttsburgh Cancer Institute
state: Pennsylvania
Study officials:
affiliation: UPCI
name: Annie Im, MD
role: PRINCIPAL_INVESTIGATOR
References: