Clinical trial NCT04657081: Pharmacokinetics, Safety, and Efficacy of ASTX727 in Combination With Venetoclax in Acute Myeloid Leukemia (AML)
Official title: A Single-Arm, Open-Label Pharmacokinetic, Safety, and Efficacy Study of ASTX727 in Combination With Venetoclax in Adult Patients With Acute Myeloid Leukemia
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE1
PHASE2
Conditions: Acute Myeloid Leukemia
Lead sponsor: Taiho Oncology, Inc.
Sponsor class: INDUSTRY
First posted: 2020-12-08
Enrollment: 101
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 Phase 1 portion of this study is a single-arm, open-label, multicenter, non-randomized interventional study to evaluate the pharmacokinetic (PK) interaction, safety, and efficacy of ASTX727 when given in combination with venetoclax for the treatment of newly diagnosed acute myeloid leukemia (AML) in adults who are age 75 years or older, or who have comorbidities that preclude use of intensive induction chemotherapy. The primary purpose of the study is to rule out drug-drug interactions between ASTX727 and venetoclax combination therapy by evaluating area under the curve (AUC) and maximum plasma concentration (Cmax) exposure. The Phase 2 portion of the study is to assess the efficacy of ASTX727 and venetoclax when given in combination and to evaluate potential PK interactions. Phase 2 will follow the same overall study design as Phase 1 and has two parts, Part A and Part B.


Eligibility criteria: Inclusion Criteria:

1. Participant must be 18 years of age or older.
2. Histological confirmation of newly diagnosed AML by World Health Organization (WHO) 2016 criteria.
3. Projected life expectancy of at least 3 months.
4. Participants must be considered ineligible for intensive induction chemotherapy defined by the following: a) Age 75 years or older, or b) Age 18 to 74 years with at least one of the following comorbidities: i) Severe cardiac disorder (eg, congestive heart failure requiring treatment, ejection fraction ≤50%, or chronic stable angina), ii) Severe pulmonary disorder (eg, diffusing lung capacity for carbon monoxide DLCO ≤65% or forced expiratory volume in 1 second \[FEV1\] ≤65%), iii) Creatinine clearance ≥30 mL/min to \<45 mL/min, iv) Moderate hepatic impairment with total bilirubin \>1.5 to ≤3.0 × upper limit of normal (ULN), v) Phase 1: Eastern Cooperative Oncology Group (ECOG) Performance Status of 2 (participants with ECOG ≥3 are not eligible); Phase 2, Parts A and B: ECOG Performance Status of 2 or 3 (participants with ECOG 4 are not eligible).
5. Phase 1: ECOG Performance Status of 0-2; Phase 2, Parts A and B: ECOG 0-3.
6. Women of child-bearing potential (according to recommendations of the Clinical Trial Facilitation Group \[CTFG\]) must not be pregnant or breastfeeding and must have a negative pregnancy test at screening.
7. Participants and their partners with reproductive potential must agree to use a highly effective contraceptive measure during the study and for 3 months after the last dose of study treatment, including refraining from sperm donation. Effective contraception includes methods such as oral contraceptives or double-barrier method (eg, use of a condom AND diaphragm, with spermicide).
8. Capable of giving legally effective informed consent, which includes compliance with the requirements and restrictions listed in the informed consent form and protocol, and willing to participate in the study.

Exclusion Criteria:

1. History of myeloproliferative neoplasm including myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia with or without BCR-ABL1 translocation and AML with BCR-ABL1 translocation.
2. The following karyotype abnormalities: t(8;21), inv(16) or t(15;17), or other acute promyelocytic leukemia variants that remain sensitive to all-trans retinoic acid (ATRA) therapy.
3. Known active central nervous system involvement from AML.
4. Known human immunodeficiency virus (HIV) infection (due to potential drug-drug interactions between antiretroviral medications and venetoclax). Human immunodeficiency virus testing will be performed at Screening, only if indicated per local guidelines or institutional standards.
5. Known active hepatitis B or C infection (detectable viral load). Hepatitis B or C testing will be performed at Screening, only if indicated per local guidelines or institutional standards.
6. Severe hepatic impairment defined as: bilirubin \>1.5×upper limit of normal (ULN) for participants ≥75 years or \>3×ULN for participants \<75 years; or aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) or alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SGPT) \>3×ULN (unless considered to be due to leukemic organ involvement).
7. Severe renal impairment defined as: calculated creatinine clearance or glomerular filtration rate \<30 mL/min.
8. A malabsorption syndrome or other condition that precludes enteral route of administration.
9. Cardiovascular disability status of New York Heart Association Class \>2. Class 2 is defined as cardiac disease in which patients are comfortable at rest but ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain.
10. Chronic respiratory disease that requires continuous oxygen, or significant history of renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, hepatic, cardiovascular disease, any other medical condition or known hypersensitivity to any of the study medications that in the opinion of the investigator would adversely affect his/her participating in this study.
11. Clinically significant uncontrolled systemic infection requiring therapy (viral, bacterial, or fungal).
12. History of other malignancies prior to study entry, with the exception of adequately treated in situ carcinoma of the breast or cervix uteri; localized basal cell carcinoma or squamous cell carcinoma of the skin; previous malignancy confined and surgically resected (or adequately treated and controlled with other modalities); and any early stage malignancy for which no definitive therapy is required.
13. White blood cell (WBC) count \>25,000/μL (Hydroxyurea treatment is permitted to meet this criterion).
14. Treatment with the following: a) A hypomethylating agent (azacitidine or decitabine), or venetoclax including prior treatment for myelodysplastic syndrome (MDS), b) Chimeric Antigen Receptor (CAR)-T cell therapy, c) Investigational therapies for MDS or AML.
15. Participants who cannot discontinue concomitant prophylactic antifungal therapy with CYP3A inhibitor activity or other concomitant medications with moderate or strong CYP3A inhibitor activity ≥7 days or 5 half-lives, whichever is greater, prior to cycle 1 day 1 (C1D1).
16. Participants who cannot discontinue concomitant drugs that are strong CYP3A or P-gp inhibitors ≥7 days or 5 half-lives, whichever is greater, prior to C1D1.
17. Participants who cannot avoid concomitant drugs known as moderate or strong CYP3A inducers.
18. Current participation in another research study requiring interventions such as drug therapy or study procedures.
19. Known or suspected hypersensitivity to decitabine, cedazuridine, venetoclax, or any of their excipients.
20. Known significant mental illness or other condition such as active alcohol or other substance abuse or addiction that, in the opinion of the investigator, predisposes the participant to high risk of noncompliance with the protocol.
21. Participants who consume grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or starfruit ≤7 days prior to C1D1.

Primary outcomes:
measure: Pharmacokinetic parameter: AUC0-24
timeFrame: On Days 5 and 15 in Cycle 2 (28 days per cycle)
measure: Pharmacokinetic parameter: Cmax
timeFrame: On Days 5 and 15 in Cycle 2 (28 days per cycle)
measure: Complete Response (CR)
timeFrame: Up to 36 months
Secondary outcomes:
measure: Pharmacokinetic parameter: AUC0-24
timeFrame: Cycle 1, 2 and 3 (28 days per cycle)
measure: Pharmacokinetic parameter: Cmax
timeFrame: Cycle 1, 2 and 3 (28 days per cycle)
measure: Pharmacokinetic parameter: AUC0-8
timeFrame: Cycle 1, 2 and 3 (28 days per cycle)
measure: Pharmacokinetic parameter: AUC0-inf
timeFrame: Cycle 1, 2 and 3 (28 days per cycle)
measure: Pharmacokinetic parameter: 5-day AUC
timeFrame: Cycle 2 (28 days per cycle)
measure: Safety: Participants with TEAEs
timeFrame: Up to 36 months
measure: Complete response (CR)
timeFrame: Up to 36 months
measure: Time to Response
timeFrame: Up to 36 months
measure: Duration of Response
timeFrame: Up to 36 months
measure: Overall Survival
timeFrame: Up to 36 months
measure: Pharmacokinetic parameter: Cmin
timeFrame: Cycle 1, 2 and 3 (28 days per cycle)
measure: Pharmacokinetic parameter: Tmax
timeFrame: Cycle 1, 2 and 3 (28 days per cycle)
measure: Pharmacokinetic Parameter: Apparent Elimination Half-life (T1/2)
timeFrame: Cycle 1, 2 and 3 (28 days per cycle)
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: USC Norris Comprehensive Cancer Center
state: California
city: Palo Alto
country: United States
facility: Stanford University
state: California
city: New Haven
country: United States
facility: Yale University
state: Connecticut
city: Jacksonville
country: United States
facility: Baptist MD Anderson Cancer Center
state: Florida
city: Plantation
country: United States
facility: Boca Raton Clinical Research
state: Florida
city: Chicago
country: United States
facility: The University of Chicago Medical Center
state: Illinois
city: Indianapolis
country: United States
facility: Indiana University Simon Cancer Center
state: Indiana
city: Boston
country: United States
facility: Tufts Medical Center
state: Massachusetts
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
city: Worcester
country: United States
facility: University of Massachusetts, Memorial Medical Center
state: Massachusetts
city: Kansas City
country: United States
facility: Health Midwest Ventures Group, Inc.
state: Missouri
city: Hackensack
country: United States
facility: Hackensack University of Medical Center
state: New Jersey
city: Buffalo
country: United States
facility: Roswell Park Comprehensive Cancer Center
state: New York
city: New York
country: United States
facility: Weill Cornell Medical College
state: New York
city: Rochester
country: United States
facility: University of Rochester
state: New York
city: Syracuse
country: United States
facility: The Research Foundation of the State University of New York (SUNY)
state: New York
city: Greenville
country: United States
facility: East Carolina University
state: North Carolina
city: Columbus
country: United States
facility: The Ohio State University
state: Ohio
city: Hershey
country: United States
facility: Penn State Milton S. Hershey Medical Center
state: Pennsylvania
city: Pittsburgh
country: United States
facility: UPMC Hillman Cancer Center
state: Pennsylvania
city: Nashville
country: United States
facility: Vanderbilt University Medical Center
state: Tennessee
city: Houston
country: United States
facility: MD Anderson Cancer Center
state: Texas
city: Temple
country: United States
facility: Baylor Scott & White Research Institute
state: Texas
city: Seattle
country: United States
facility: Seattle Cancer Care Alliance
state: Washington
city: Calgary
country: Canada
facility: University of Calgary - Health Sciences Centre
state: Alberta
city: Edmonton
country: Canada
facility: University of Alberta
state: Alberta
city: Ottawa
country: Canada
facility: The Ottawa Hospital, General Campus
state: Ontario
city: Montréal
country: Canada
facility: Jewish General Hospital
city: Oviedo
country: Spain
facility: Hospital Universitario Central de Asturias
state: Austrias
city: L'Hospitalet De Llobregat
country: Spain
facility: Institut Catala d'Oncologia-Hospital Duran i Reynals
state: Barcelona
city: Pamplona
country: Spain
facility: Clinica Universidad de Navarra, Pamplona
state: Navarra
city: Madrid
country: Spain
facility: Universitario Gregorio Marañon
city: Salamanca
country: Spain
facility: Hospital Universitario de Salamanca
city: Valencia
country: Spain
facility: Hospital Universitari i Politecnic La Fe
Study officials:
References: