Clinical trial NCT02692742: Efficacy and Safety Phase IIa Study of Myelo001 in Chemotherapy-Induced Neutropenia
Official title: A Randomised, Double-Blind, Placebo-Controlled, Parallel-Design, Multi-Center Study to Investigate the Efficacy To Reduce Chemotherapy-Induced Neutropenia (CIN), Effects on the Haematopoietic System, Safety and Pharmacokinetics of Myelo001 in Patients Receiving Adjuvant or Neoadjuvant Chemotherapy for the Treatment Of Breast Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Chemotherapy-Induced Neutropenia
Myelosuppression
Breast Cancer
Keywords: Chemotherapy
Chemotherapy-induced Neutropenia
Supportive Care
Myelosuppression
CIN
Lead sponsor: Myelo Therapeutics GmbH
Sponsor class: INDUSTRY
First posted: 2016-02-26
Enrollment: 137
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: Neutropenia is the most serious hematologic toxicity of cancer chemotherapy, often limiting the doses and density of chemotherapy that can be tolerated. The degree and duration of neutropenia determine the risk of infection. Myelo001, a small orally bioavailable molecule, has been shown in chemotherapy- or radiotherapy-induced myelosuppression to stimulate differentiation of peripheral white blood cells (WBC) and bone marrow cells of the leucocytic, lymphocytic, and erythrocytic lineage. The purpose of the MyeloConcept study is to determine the safety and effectiveness of Myelo001 in preventing or reducing chemotherapy-induced neutropenia and myelosuppression in patients receiving chemotherapy due to breast cancer.

Detailed description: Phase IIa study, 1:1 randomized, double-blind, placebo-controlled, parallel-design, multi-center study. Each breast cancer patient will be randomly assigned into one of two treatment arms receiving either Myelo001 or placebo as a tablet. Investigational medicinal product is taken as supportive care for 23 consecutive days during chemotherapy treatment. Hematologic and safety parameters as well as actual begin and doses of following chemotherapy cycles will be assessed. A single primary variable will be analyzed with test statistics based on frequent absolute neutrophil measurements. Additionally, in a subgroup of patients biomarkers and pharmacokinetics of Myelo001 will be investigated.

Eligibility criteria: Inclusion Criteria:

1. Female patient of any racial origin having fulfilled her 18th birthday on Visit 1 (Screening)
2. Histologically confirmed invasive breast cancer scheduled for neoadjuvant or adjuvant chemotherapy (patient with primary wound healing (\[R0\])
3. Already selected for neoadjuvant or adjuvant standard of care EC regimen (Epirubicin 90 mg/m2 BSA (body surface area) + Cyclophosphamide 600 mg/m2 BSA q21d (every 21 days)) (with or without treatment with taxanes afterwards)
4. Risk of chemotherapy-induced Febrile Neutropenia ≤20% according to ASCO Guidelines (2015)
5. More than 5 days remaining before the planned initiation of the 1st chemotherapy cycle
6. Performance status Grade 0-1 (ECOG)
7. Echocardiography: No contraindication for the scheduled chemotherapy
8. Haematologic, laboratory and chemistry thresholds at baseline:

   * Absolute neutrophil count (ANC) ≥2,000 cells/ mm3 (≥2.0 x 10/L)
   * Platelet count ≥100,000/mm3 (≥100 x 10exp9/L)
   * Haemoglobin ≥10 g/dL
   * Total bilirubin \<1.5 x, AST, ALT \<2.5 x upper limit of normal (ULN)
   * Serum creatinine \<2.0 mg/dL
9. Able to read, understand and willing to sign the informed consent form
10. Able to undergo the investigations and to follow the Visit schedule

Exclusion Criteria:

1. Suspected allergy to Myelo001 or its excipients
2. Prior chemotherapy
3. Prior or concomitant treatment with radiotherapy
4. Currently on or scheduled for other immunomodulatory or immunosuppressive therapies (e.g. TNF inhibitors) during the first chemotherapy cycle
5. Currently on or scheduled for other immunostimulatory or hematopoietic active therapies (e.g.G-CSF, GM-CSF)
6. Currently on or scheduled for primary prophylaxis with antibiotics in the first chemotherapy cycle
7. History of bone marrow transplantation or stem cell transplant
8. Administration of another investigational medicinal product / medical device within 30 days prior to screening. Participation in non-interventional, national or international cancer registries is allowed.
9. Already confirmed HIV, hepatitis B or C virus (HBV or HCV) infection
10. History of somatic disease/condition that may interfere with the objectives of the study
11. Any other medical disease or clinical laboratory parameter outside the normal range and of clinical significance according to the investigator
12. Serious uncontrolled comorbidities
13. Pregnant or breast-feeding subject
14. Woman considered to be of childbearing potential who do not use highly effective birth control methods during the study.

Primary outcomes:
measure: Threshold area over the curve (AOC1) of ANC: Area below the threshold line (ANC 2.0x10^9/L classified as grade 1 neutropenia) and above the individual ANC trajectory
timeFrame: visit 3 to visit 10 (22 days)
measure: Threshold area over the curve (AOC3) of ANC: Area below the threshold line (ANC 1.0x10^9/L classified as grade 3 neutropenia) and above the individual ANC trajectory
timeFrame: visit 3 to visit 10 (22 days)
measure: Duration of ANC < 1.0x10^9/L classified as grade 3 neutropenia
timeFrame: visit 3 to visit 10 (22 days)
Secondary outcomes:
measure: Treatment success rate: a) Neutropenia grade ≤2, b) No need for G-CSF rescue therapy, c) No early withdrawal (drop-out).
timeFrame: visit 3 to visit 10 (22 days)
measure: Threshold AOC of ANC (AOC4): Area below the threshold line (ANC 0.5x10^9/L classified as grade 4 neutropenia) and above the individual ANC trajectory
timeFrame: visit 3 to visit 10 (22 days)
measure: Change of Threshold Area over the Curve of lymphocytes
timeFrame: visit 3 to visit 10 (22 days)
measure: Change of Threshold Area over the Curve of leukocytes
timeFrame: visit 3 to visit 10 (22 days)
measure: Change of Threshold Area over the Curve of thrombocytes
timeFrame: visit 3 to visit 10 (22 days)
measure: Proportion of patients with neutropenia grade 1 and higher; 3 and higher, 4, and ANC ≤0.1x 10^9/L
timeFrame: visit 3 to visit 10 (22 days)
measure: Duration of neutropenia grade 1 and higher; 3 and higher, 4, and ANC ≤0.1x 10^9/L
timeFrame: visit 3 to visit 10 (22 days)
measure: ANC at nadir
timeFrame: visit 3 to visit 10 (22 days)
measure: Time to ANC nadir (from start of chemotherapy)
timeFrame: visit 3 to visit 10 (22 days)
measure: Time to ANC recovery from grade 3 neutropenia, i. e. time from onset to time of reaching neutropenia grade ≤2 (ANC ≥ 1.5x10^9/L)
timeFrame: visit 3 to visit 10 (22 days)
measure: Time to ANC recovery from grade 4 neutropenia, i. e. time from onset to time of reaching neutropenia grade ≤2 (ANC ≥ 1.5x10^9/L)
timeFrame: visit 3 to visit 10 (22 days)
measure: Time to ANC recovery from profound neutropenia (ANC ≥ 0.1x10^9/L), i. e. time from onset to time of reaching neutropenia grade ≤2 (ANC ≥1.5x10^9/L)
timeFrame: visit 3 to visit 10 (22 days)
measure: Proportion of patients with rescue therapy
timeFrame: visit 3 to visit 10 (22 days)
measure: Proportion of patients developing febrile neutropenia (body temperature ≥38.3°C by single tympanic or oral measurement) and ANC ≤0.5x 10^9/L (Grade 4)
timeFrame: visit 3 to visit 10 (22 days)
measure: Proportion of patients with CTX dose reduction and/or delay of CTX cycle 2
timeFrame: visit 10 to visit 11
Other outcomes:
Locations:
city: Aachen
country: Germany
facility: Site 20
city: Aurich
country: Germany
facility: Site 16
city: Dresden
country: Germany
facility: Site 21
city: Dresden
country: Germany
facility: Site 26
city: Erlangen
country: Germany
facility: Site 05
city: Esslingen
country: Germany
facility: Site 09
city: Frankfurt a.M.
country: Germany
facility: Site 02
city: Frankfurt a.M.
country: Germany
facility: Site 13
city: Friedrichshafen
country: Germany
facility: Site 01
city: Goslar
country: Germany
facility: Site 25
city: Hamburg
country: Germany
facility: Site 11
city: Hannover
country: Germany
facility: Site 10
city: Hannover
country: Germany
facility: Site 22
city: Konstanz
country: Germany
facility: Site 07
city: Lübeck
country: Germany
facility: Site 29
city: Mainz
country: Germany
facility: Site 03
city: Mainz
country: Germany
facility: Site 23
city: Offenbach
country: Germany
facility: Site 04
city: Oldenburg
country: Germany
facility: Site 19
city: Ravensburg
country: Germany
facility: Site 17
city: Rosenheim
country: Germany
facility: Site 24
city: Tübingen
country: Germany
facility: Site 28
city: Westerstede
country: Germany
facility: Site 12
Study officials:
affiliation: Myelo Therapeutics GmbH
name: Dirk Pleimes, MD
role: STUDY_DIRECTOR
References: