Lenalidomide with epigenetic therapy in relapsed or refractory Acute Myeloid Leukaemia (AML)-Phase II
A Strategy of High-Dose Lenalidomide in Combination with Epigenetic Therapies for Relapsed or Refractory Acute Myeloid Leukaemia (AML)- Phase II
Australasian Leukaemia and Lymphoma Group
120 participants
Jun 1, 2018
Interventional
Conditions
Summary
The outcome in patients with Acute Myeloid Leukaemia (AML) who fail to respond to treatment or relapse after treatment is extremely poor. There is no standard treatment for these patients. This study aims to compare various chemtherapy combinations, comprising romidepsin and high dose lenalidomide, azacitidine and lenalidomide and high dose lnealiodmide alone in the treatment of advanced AML. The study plans to treat 120 patients in a number of sites throughout Australia and New Zealand. This stage of the study follows on from an initial study that aims to find the appropriate dose of romidepsin. The initial study can be found at http://www.anzctr.org.au/trial_view.aspx?ID=343451 Trial details In this study you will be allocated to receive either: the drug romidespin delivered intravenously (i.v) on days 1 and 15, and possibly 8, of a 6-week treatment cycle with 50mg oral lenalidomide on a daily basis on days 8-28; the drug azacitidine delivered subcutaneously on days 1-5 and 8-9 of a 6-week treatment cycle with 50mg oral lenalidomide on a daily basis on days 8-28; or 50mg oral lenalidomide on a daily basis on days 1-28. Your response to the treatment will be assessed after 2 cycles, and overall, your treatment should continue for at least 6-12 cycles. Beyond this time, the decision as to whether or not your treatment continues will be at the discretion of the study's Principal Investigator (PI). Who is it for? This study is open to male or female patients aged 18-80 with either a diagnosis of Acute Myeloid Leukaemia (AML) and failing previous therapy, either primary refractory or relapsed after no more than 3 previous lines of chemotherapy OR a diagnosis of Myelodysplasia transformed to AML after previous treatment. The full details of this study's inclusion and exclusion criteria can be found in the relevant sections within this record.
Eligibility
Inclusion Criteria14
- Male or female patients with one of the following diagnoses:
- a. AML failing previous therapy who are not eligible for transplant or who failed to be salvaged by standard therapy. Patients may be either primary refractory (failure to achieve greater than or equal to 50% blast reduction to 10-25% marrow blasts) or relapsed (greater than or equal to 50% increase in blasts to greater than or equal to 10% bone marrow blasts) after no more than 3 previous lines of chemotherapy, which may include hypomethylating agents
- OR
- b. Myelodysplasia (MDS) transformed to AML with greater than or equal to 20% bone marrow blasts after previous treatment, which may include previous treatment with hypomethylating agents
- Age 18-80 inclusive
- ECOG (Eastern Co-operative Oncology Group) Performance Status 0-2
- White Cell Count (WCC)<15 x 10^9/L (hydroxyurea or thioguanine may be used to reduce the WCC prior to study therapy with a washout period of 24hrs)
- Adequate hepatic function as defined by bilirubin less than or equal to 2 x the upper limit of normal (ULN) and Alanine transaminase (ALT) & aspartate aminotransferase (AST) less than or equal to 3 x ULN
- Adequate renal function as defined by serum creatinine less than or equal to 1.3 ULN
- All females of childbearing potential (FCBP) must agree to comply with the lenalidomide Pregnancy prevention risk management plan
- Females must agree to abstain from breastfeeding during study participation and for at least 28 days after study drug discontinuation
- All male participants must practice complete abstinence or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions and for at least 28 days following study drug discontinuation, even if he has undergone a successful vasectomy
- Subjects must agree not to donate blood, semen or sperm while on study treatment and for 28 days after treatment discontinuation
- Provision of written informed consent
Exclusion Criteria20
- History of major non-compliance to medication
- Post allogeneic-stem cell transplant patients on immunosuppression therapy greater than or equal to 5mg prednisolone/day or equivalent
- Evidence of central nervous system (CNS) leukaemia
- Impaired cardiac function or clinically significant cardiac disease as follows:
- a. left ventricular ejection fraction (LVEF) <45% as determined by Multi-gated Acquisition (MUGA) scan or echocardiogram (ECHO)
- b. Complete left bundle branch block or right bundle branch block + left anterior hemiblock (bifascicular block)
- c. Obligate use of a cardiac pacemaker
- d. Congenital long QT syndrome or QTc > 480 msec on the screening electrocardiogram (ECG)
- e. Clinically significant resting bradycardia (< 50 beats per minute)
- f. Angina pectoris or acute myocardial infarction (AMI) less than or equal to 3 months prior to starting study drug
- g. Unstable angina, congestive cardiac failure (CCF) or AMI within the last 6 months
- Patients taking any concurrent medications which have a known risk of prolonging the QTc interval or inducing Torsades de Pointes tachycardia
- Significant respiratory disease
- Uncontrolled active infection with known human immunodeficiency virus (HIV) or Hepatitis type B or C infection
- Currently active gastrointestinal disease (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhoea, malabsorption syndrome, or small bowel resection), or other disease, that prevents the patient from absorbing or taking oral medication
- Any other concurrent severe and/or uncontrolled medical conditions (eg. acute or chronic liver disease, infection, pulmonary disease) that in the opinion of the investigator could potentiate unacceptable safety risks or jeopardise compliance with the protocol
- Previous adverse reaction to the trial drug/s
- Has any other clinically important abnormalities as determined by the investigator that may interfere with his or her participation in or compliance with the study
- Female patients who are pregnant
- Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule. This condition must be discussed with the patient prior to signing consent and registration in the trial.
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Interventions
The Phase II follows on from a separate Phase I study that was designed to find the maximum tolerated dose (MTD) of intravenous (i.v) romidespin when delivered in conjunction with oral lenalidomide. The Phase I study can be found here http://www.anzctr.org.au/trial_view.aspx?ID=343451 The Phase II is a randomised study (1:1:1) comparing 50mg oral lenalidomide daily days 1-28 with either 50mg oral lenalidomide daily days 8-28 in combination with 75mg/m^2 subcutaneous (s.c) Azacitidine on days 1-5 and days 8-9; or 50mg oral lenalidomide daily days 8-28 in combination with maximum tolerated dose (MTD) from Phase I i.v romidepsin. Cycles are continuous 6 week cycles.
Locations(1)
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ACTRN12612000312842