Clinical trial NCT04522895: IDH2-Post-Allo-Trial for Patients with IDH2-mut Myeloid Neoplasms After Allo-SCT
Official title: IDH2-Post-Allo-Trial: Enasidenib As Consolidation or Salvage Therapy for Patients with IDH2 Mutated AML or MDS Following Allogeneic Blood Stem Cell Transplantation
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Chronic Myelomonocytic Leukemia
IDH2 Gene Mutation
IDH2 R172
IDH2 R140
Keywords: IDH2 Gene Mutation
MDS
CMML
AML
allogeneic blood stem cell transplantation
maintenance
consolidation
Lead sponsor: Heinrich-Heine University, Duesseldorf
Sponsor class: OTHER
Collaborators: name: Celgene Corporation
name: Koordinierungszentrum für Klinische Studien Düsseldorf
First posted: 2020-08-21
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: single arm
Primary purpose: TREATMENT

Brief summary: This is a prospective, open label, single arm, multi-centre phase II trial aiming to evaluate the safety and efficacy of Enasidenib (investigational product) as prophylactic consolidation in patients with IDH2-mutated MDS, CMML and AML in remission after allo-SCT.

Detailed description: This is a prospective, open label, single arm, multi-centre phase II trial aiming to evaluate the safety and efficacy of Enasidenib (investigational product) as prophylactic consolidation in patients with IDH2-mutated MDS, CMML and AML in remission after allo-SCT.

Study Design:

* interventional
* prospective, open-label, single arm, multicenter phase-II trial
* total patients sample size: 50 patients
* number of trial sites: 11 all located in Germany and members of the EBMT

Patients with AML, MDS and CMML, in whom an IDH2 mutation has been detected at diagnosis prior allo-SCT, are eligible for consolidation therapy, if they are in complete hematological remission after first allo-SCT. IDH2 mutation might be absent at this time (CRMRDnegative), or might be detectable at submicroscopical levels (CRMRDpositive) given the high sensitivity of detection methods nowadays available. Remission will be evaluated within a screening period between day +25 and day +35. Evaluation of remission will be performed locally with IDH2 mutation analysis performed at an experienced local laboratory of the respective center. The report about IDH2 mutation testing at diagnosis has to be sent to the principle investigator for review at screening to include the patient; a BM sample will be stored for central retesting, which will be performed in batch during the course of the study. Having a documented hematological CR, patients will enter the treatment phase within 30 days after this BM evaluation (latest time point day +65) and start treatment with Enasidenib. They are envisaged to receive Enasidenib (100 mg per day, day 1-28) for up to 12 cycles (=12 months). Patients will go off protocol prematurely in case of relapse, intolerability of study treatment and in case of withdrawal of consent. In those patients who relapse during study treatment subsequent therapy for relapse will be performed according to the choice of the individual treating physician. Patients who finish study as planned or prematurely will be regularly followed for one year, lost to follow up, death or withdrawal of consent.

Eligibility criteria: Inclusion Criteria:

* Patients with myeloid malignancy (AML, MDS and CMML) and known IDH2 mutation (IDH2 R172 or R140 mutation) at diagnosis prior to first allo-SCT
* hematological CR after allo-SCT determined during screening period between day +25 and day +35 (the hematological remission will be confirmed locally by cytomorphological/histological evaluation)
* Hematopoietic recovery after transplantation indicated by an absolute neutrophil count of at least 1.000/µl and platelet count of at least 50.000/µl
* no previous therapy with Enasidenib or any other IDH2 inhibitor
* ECOG performance status ≤ 2 at study entry (s. Appendix)
* no active, steroid refractory GvHD treated with additional systemic immunosuppression within 4 weeks before inclusion
* no uncontrolled infection at inclusion
* Understand and voluntarily sign an informed consent form.
* Age ≥18 years at the time of signing the informed consent form.
* Able to adhere to the study visit schedule and other protocol requirements.
* Female of childbearing potential (FCBP) must:

Understand that Enasidenib can cause embryo-fetal harm when administered to a pregnant woman Agree to have a medically supervised pregnancy test within 72 hours prior study start and at day 1 of every treatment cycle Use effective contraception during treatment with Enasidenib and for at least 2 months after the last dose Coadministration of Enasidenib may increase or decrease the concentrations of combined hormonal contraceptives Avoid becoming pregnant while receiving Enasidenib Notify her study doctor immediately if there is a risk of pregnancy Agree to abstain from breastfeeding during study participation and for at least 30 days after study drug discontinuation Understand that Enasidenib may impair fertility in females of reproductive potential and this effect may be not reversible

- Males must: Understand that Enasidenib can cause embryo-fetal harm Use effective contraception during treatment with Enasidenib and for at least 2 months after the last dose of Enasidenib if engaged in sexual activity with a pregnant female or a female with childbearing potential Agree to notify the investigator immediately, if pregnancy or a positive pregnancy test occurs in his partner during study participation Understand that Enasidenib may impair fertility in males of reproductive potential and this effect may be not reversible

Exclusion Criteria:

* Any evidence of hematological relapse of the underlying IDH2-mutated myeloid malignancy (AML, MDS and CMML) determined during screening period until start of treatment
* Any previous prophylactic therapy given within the interval between allo-SCT and screening period
* Patients with myeloid malignancy (AML, MDS and CMML) and known IDH2 mutation (IDH2 R172 or R140 mutation) after second allo-SCT
* Active, steroid refractory GvHD treated with additional systemic immunosuppression within the last 4 weeks
* Uncontrolled infection
* Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
* Pregnant or lactating females
* Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study
* Impaired renal function (GFR \< 30 ml/min)
* Impaired hepatic function, as follows:

Aspartate aminotransferase (19) ≥3 x ULN or Alanine aminotransferase (ALT) ≥3 x ULN or Total bilirubin ≥3 x ULN or Alkaline Phosphatase ≥3 x ULN

* Known hypersensitivity to Enasidenib or any other component of the treatment
* Prior history of malignancy other than AML, MDS or CMML (except basal and squamous cell carcinoma or carcinoma in situ of the cervix or breast) unless the subject has been free of disease for ≥3 years
* Concurrent use of other anti-cancer agents or treatments
* Known positive for HIV or active infectious hepatitis, type A, B or C
* Participation in another study with ongoing use of unlicensed investigational product from 28 days before study enrollment until the end of the study (in cases where the investigational product has an unusually long half-life (e.g. antibodies), the interval until study enrollment must be at least five times the plasma half-life of the investigational product)

Primary outcomes:
measure: Type, incidence and severity of adverse events specifying seriousness and expectedness (AE, SAE, SUSAR)
timeFrame: through study completion, an average of 2 years
Secondary outcomes:
measure: Number of participants who maintain remission (molecular/hematological) after allo-SCT
timeFrame: through study completion, an average of 2 years
measure: Overall Survival
timeFrame: through study completion, an average of 2 years
measure: Relapse-free Survival
timeFrame: through study completion, an average of 2 years
measure: Non-relapse mortality
timeFrame: through study completion, an average of 2 years
measure: Relapse incidence
timeFrame: through study completion, an average of 2 years
measure: Numbers of Participants Meeting Criteria of Treatment Failure
timeFrame: through study completion, an average of 2 years
measure: Correlation of cytogenetics/molecular alterations and relapse-free survival
timeFrame: through study completion, an average of 2 years
measure: Incidence, course and severity of aGvHD and cGvHD
timeFrame: through study completion, an average of 2 years
measure: Number of hospitalizations
timeFrame: through treatment completion, an average of 1 year
measure: Number of participants who require dose reductions for toxicity reasons
timeFrame: through treatment completion, an average of 1 year
measure: Number of participants who have to stop consolidation therapy due to toxicity (Consolidation Arm)
timeFrame: through treatment completion, an average of 1 year
measure: Number of participants who can receive all 12 cycles of consolidation therapy(Consolidation Arm)
timeFrame: through treatment completion, an average of 1 year
measure: Number of screened participants that can start consolidation therapy within the envisaged time frame (Consolidation Arm)
timeFrame: up to 65 days
Other outcomes:
Locations:
city: Duesseldorf
country: Germany
facility: University Hospital Duesseldorf Dept. of Hematology, Oncology and Clinical Immunology
state: NRW
city: Aachen
country: Germany
facility: Uniklinik RWTH Aachen Klinik für Hämatologie, Onkologie, Hämostaseologie und Stammzelltransplantation (Med. Klinik IV)
city: Dresden
country: Germany
facility: Universitätsklinikum Carl Gustav Carus Medizinische Klinik und Poliklinik I
city: Essen
country: Germany
facility: Universitätsklinikum Essen Klinik für Hämatologie und Stammzelltransplantation
city: Frankfurt
country: Germany
facility: Universitätsklinikum Frankfurt Med. Klinik II
city: Hamburg
country: Germany
facility: Universitätsklinikum Hamburg-Eppendorf Interdisziplinäre Klinik für Stammzelltransplantation
city: Heidelberg
country: Germany
facility: Universitätsklinikum Heidelberg Innere Medizin V: Hämatologie, Onkologie und Rheumatologie
city: Köln
country: Germany
facility: Universitätsklinikum Köln Klinik I für Innere Medizin
city: Leipzig
country: Germany
facility: Universitätsklinikum Leipzig Medizinische Klinik und Poliklinik I, Hämatologie und Zelltherapie
city: München
country: Germany
facility: Klinikum rechts der Isar der TU München Klinik und Poliklinik für Innere Medizin III, Hämatologie und Onkologie
city: Münster
country: Germany
facility: Universitätsklinikum Münster Medizinische Klinik A / KMT Zentrum
Study officials:
affiliation: University Hospital Duesseldorf Dept. of Hematology, Oncology and Clinical Immunology
name: Thomas Schroeder, PD Dr.
role: PRINCIPAL_INVESTIGATOR
References: