RecruitingPhase 1NCT05263284

8-Chloroadenosine in Combination With Venetoclax for the Treatment of Patients With Relapsed/Refractory Acute Myeloid Leukemia

A Phase 1 Trial of 8-Chloro-Adenosine in Combination With Venetoclax in Patients With Relapsed/Refractory Acute Myeloid Leukemia


Sponsor

City of Hope Medical Center

Enrollment

30 participants

Start Date

Dec 15, 2022

Study Type

INTERVENTIONAL

Conditions

Summary

This phase I trial tests the safety, side effects, and best dose of a new 8-chloroadenosine in combination with venetoclax in treating patients with acute myeloid leukemia that has come back (relapsed) or does not respond to treatment (refractory). 8-Chloroadenosine may help block the formation of growths that may become cancer. Venetoclax is in a class of medications called B-cell lymphoma-2 (BCL-2) inhibitors. It may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Giving 8-chloroadenosine in combination with venetoclax may help prevent the disease from coming back in patients with acute myeloid leukemia.


Eligibility

Min Age: 18 Years

Inclusion Criteria24

  • Documented informed consent of the participant and/or legally authorized representative.
  • Age: \>= 18 years.
  • Eastern Cooperative Oncology Group (ECOG) =\< 2.
  • Life expectancy \> 3 months.
  • Patients with histologically confirmed acute myeloid leukemia (AML), according to World Health Organization (WHO) criteria, with relapsed/refractory disease.
  • Patients must have any one of the following treatment history criteria:
  • Relapsed AML
  • Failed at least 1 line of salvage therapy or
  • Untreated relapse and are not candidates for allogeneic hematopoietic stem cell transplantation (alloHCT)
  • De novo AML
  • have not achieved complete response (CR) after 2 lines of therapy or
  • refractory to frontline therapy and not eligible for alloHCT
  • AML evolving from myelodysplastic syndrome (MDS) or myeloproliferative disorder who have failed hypomethylating agents (HMA) or induction chemotherapy
  • Patients who have relapsed after allo-HCT are eligible if they are at least 3 months after HCT, do not have active graft versus host disease (GVHD) and are off immunosuppression except for maintenance dose of steroids (prednisone 10 mg/day or less).
  • Male subjects must agree to not donate sperm while taking protocol therapy through at least 90 days after the last dose.
  • White blood cell (WBC) =\< 25 x 10\^9/L prior to initiation of venetoclax. Cytoreduction with hydroxyurea prior to treatment and/or during cycle 1 may be required.
  • Total bilirubin =\< 1.5 X upper limit of normal (ULN) (unless has Gilbert's disease).
  • Aspartate aminotransferase (AST) =\< 2.5 x ULN.
  • Alanine aminotransferase (ALT) =\< 2.5 x ULN.
  • Creatinine clearance of \>= 50 mL/min per 24 hour urine test or the Cockcroft-Gault formula.
  • QTc =\< 480 ms.
  • Women of childbearing potential (WOCBP): negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
  • Agreement by females and males of childbearing potential\* to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 6 months (females) and 3 months (males) after the last dose of protocol therapy.
  • Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for \> 1 year (women only).

Exclusion Criteria22

  • Current or planned use of other investigational agents, antineoplastic, biological, chemotherapy, or radiation therapy during the study treatment period, or within 2 weeks prior to day 1 of protocol therapy, with the following exception:
  • Hydroxyurea which may be continued through cycle 1.
  • Expected to undergo HCT within 120 days of enrollment.
  • Current or planned use of agents that prolong or suspected to prolong QTc.
  • Received strong or moderate CYP3A inducers or St. John's Wort within 7 days prior to day 1 of protocol therapy.
  • Received strong or moderate CYP3A inhibitors, or consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or Star fruit within 3 days prior to day 1 of protocol therapy.
  • P-glycoprotein (P-gp) inhibitors within 7 days prior to day 1 of protocol therapy.
  • Narrow therapeutic index P-gp substrates within 7 days prior to day 1 of protocol therapy.
  • Acute promyelocytic leukemia.
  • Active central nervous system (CNS) leukemia.
  • Active fungal infection or bacterial sepsis.
  • Class III/IV cardiovascular disability according to the New York Heart Association classification.
  • Participants with clinically significant arrhythmia or arrhythmias not stable on medical management within two weeks of enrollment. Subjects with controlled, asymptomatic atrial fibrillation can enroll.
  • History of acute cardiovascular ischemic event, i.e., myocardial infarction or unstable angina within 6 months of enrollment.
  • History of unexplained syncope, significant histories of CAD (requiring revascularization by percutaneous coronary intervention \[PCI\] or coronary artery bypass grafting \[CABG\]), cardiomyopathy (ejection fraction \[EF\] \< 50%).
  • Prior surgery or gastrointestinal dysfunction that may affect drug absorption (e.g., gastric bypass surgery, gastrectomy).
  • Unable to swallow capsules, has a partial or small bowel obstruction, or has a gastrointestinal condition resulting in a malabsorptive syndrome (e.g. small bowel resection with malabsorption).
  • Active peptic ulcer disease.
  • Other active malignancy except for localized skin cancer, bladder, prostate, breast or cervical carcinoma in situ.
  • Females only: Pregnant or breastfeeding.
  • Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures.
  • Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics).

Interventions

DRUG8-Chloroadenosine

Given IV

DRUGVenetoclax

Given PO


Locations(1)

City of Hope Medical Center

Duarte, California, United States

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NCT05263284


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