A Phase 1 Dose-escalation Study to Evaluate the Safety and Pharmacokinetics (PK) of Palifermin in Subjects With Acute Leukemias Undergoing HSCT

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Swedish Orphan Biovitrum
ClinicalTrials.gov Identifier:
NCT00460421
First received: April 12, 2007
Last updated: July 13, 2012
Last verified: July 2012
  Purpose

20010133 is an open-label, dose escalation study in pediatric patients with acute leukemias receiving myelotoxic therapy (high dose etoposide, cyclophosphamide and total body irradiation [TBI]) followed by hematopoietic stem cell transplant (HSCT). The study will evaluate the safety and pharmacokinetics of palifermin in pediatric patients. Three doses (40 μg/kg/day, 60 μg/kg/day, and 80 μg/kg/day) are to be evaluated in each age group (1 to 2, 3 to 11, and 12 to 16 years, respectively) using a conventional dose escalation design. Palifermin is administered for 3 consecutive days (Day -10 to Day -8, respectively) before the start of the conditioning regimen and for 3 consecutive days (Day 0 to Day +2) following HSCT. Patients will be enrolled simultaneously to each age group to identify a safe, well tolerated, efficacious dose in each age group. Patients will also be followed for secondary malignancies, progression-free survival (PFS) and overall survival (OS)


Condition Intervention Phase
Leukemia
Drug: Palifermin
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: A Phase 1 Dose-escalation Study to Evaluate the Safety and Pharmacokinetics (PK) of Palifermin in Pediatric Subjects With Acute Leukemias Undergoing Myeloablative Therapy and Allogeneic Hematopoietic Stem Cell Transplant (HSCT)

Resource links provided by NLM:


Further study details as provided by Swedish Orphan Biovitrum:

Primary Outcome Measures:
  • Incidence of Dose Limiting Toxicities (DLTs) [ Time Frame: Approximately 1 month duration (Day -10 through Day +16) ] [ Designated as safety issue: Yes ]

    A DLT is appearance of side effects during treatment severe enough to prevent further increase in dosage or strength of treatment agent, or to prevent continuation of treatment at any dosage level.

    A DLT was defined as: Grade 3 or 4 AE [based on Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events (CTCAE) v3.0] considered by the investigator to be related to palifermin with the exceptions: Grade 3 erythema, pruritus or rash that resolves within 7 days of the last dose of palifermin.

    The percentage of particiapnts with a DLT during the study was assessed.



Secondary Outcome Measures:
  • Incidence of Serum Palifermin Antibody Formation [ Time Frame: Approximately 4 month duration (Through Day + 100 (+/- 40 days)) ] [ Designated as safety issue: Yes ]
    The percentage of participants developing palifermin antibodies during the study was assessed.

  • Incidence of Severe Adverse Events (AEs) [ Time Frame: Approximately 1 1/2 months duration (Through Day +30/End of Treatment) ] [ Designated as safety issue: Yes ]
    The percentage of participants with a severe AE during the study was assessed.

  • Incidence of Laboratory Abnormalities [ Time Frame: Approximately 1 1/2 months duration (Through Day +30/End of Treatment) ] [ Designated as safety issue: Yes ]
    The percentage of participants with a laboratory value outside the normal ranges during the study.

  • Pharmacokinetics of Palifermin, Clearence (CL) After the 1st Intravenous (IV) Bolus Injection for Multiple Dose Levels [ Time Frame: Day -10 ] [ Designated as safety issue: No ]
    Clearence was estimated as dose divided by the area under serum concentration-time curve from time zero to infinity where the dose was given in amount palifermin actually administered.

  • Pharmacokinetics of Palifermin, Volume of Distribution at Steady State (Vss) After the 1st IV Bolus Injection for Multiple Dose Levels [ Time Frame: Day -10 ] [ Designated as safety issue: No ]
  • Pharmacokinetics of Palifermin, Terminal Half-life (t½,z) After the 1st IV Bolus Injection for Multiple Dose Levels [ Time Frame: Day -10 ] [ Designated as safety issue: No ]
    The terminal half-life was calculated as ln(2)/lambda,z where lambda,z was estimated using at least three quantifiable serum concentrations of the terminal log-linear phase.

  • Pharmacokinetics of Palifermin, t½,z After the 3rd IV Bolus Injection for Multiple Dose Levels [ Time Frame: Day -8 ] [ Designated as safety issue: No ]
    The terminal half-life was calculated as ln(2)/lambda,z where lambda,z was estimated using at least three quantifiable serum concentrations of the terminal log-linear phase.

  • Pharmacokinetics of Palifermin, Area Under the Concentration Time Curve From Zero to the End of the Dosing Interval (AUCtau) After the 1st IV Bolus Injection for Multiple Dose Levels [ Time Frame: Day -10 ] [ Designated as safety issue: No ]

    The AUC was estimated using the linear/log trapezoidal method for AUC0-tau from time zero to the end of the dosing interval (24 hours (hrs) post-dose)

    Data collected at time points: 0, 2 minutes (min), 15 min, 30 min, 60 min, 2 hrs, 4 hrs, 6, hrs, 10, hrs and 24 hrs post-dose.


  • Pharmacokinetics of Palifermin, AUCtau After the 3rd IV Bolus Injection for Multiple Dose Levels [ Time Frame: Day -8 ] [ Designated as safety issue: No ]

    The AUC was estimated using the linear/log trapezoidal method for AUC0-tau from time zero to the end of the dosing interval (24 hours (hrs) post-dose)

    Data collected at time points: 0, 2 minutes (min), 15 min, 30 min, 60 min, 2 hrs, 4 hrs, 6, hrs, 10, hrs and 24 hrs post-dose.


  • Long-Term Follow-Up: Incidence of Secondary Malignancies [ Time Frame: Up to 4 years duration (Assessments performed on months 6, 9, 12 (+/- 30 Days) for the first year and then annually) ] [ Designated as safety issue: Yes ]
  • Long-Term Follow-Up: Progression Free Survival [ Time Frame: Up to 4 years duration (Assessments performed on months 6, 9, 12 (+/- 30 Days) for the first year and then annually) ] [ Designated as safety issue: Yes ]
    Progression free survival (PFS) was defined as the number of days between the date of first investigational product administration and the date when physical or radiological evidence of disease progression is determined or death (regardless of cause)

  • Long-Term Follow-Up: Overall Survival [ Time Frame: Up to 4 years duration (Assessments performed on months 6, 9, 12 (+/- 30 Days) for the first year and then annually) ] [ Designated as safety issue: Yes ]
    Overall survival was defined as the number of days from the date of first investigational product administration to the date of death (regardless of cause)


Enrollment: 27
Study Start Date: August 2006
Study Completion Date: May 2011
Primary Completion Date: May 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
#1 Drug: Palifermin
Palifermin will be administered as an IV bolus injection once daily for 3 consecutive days before the start of conditioning regimen and after HCST (Day -10, -9, -8 and Day 0, +1, +2 respectively).

  Eligibility

Ages Eligible for Study:   1 Year to 16 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) requiring HSCT
  2. Age ≥ 1 and ≤ 16 years at screening
  3. Lansky performance status > 60%
  4. Candidate for allogeneic HSCT protocol:

    • Adequate kidney function: Serum creatinine: ≤ 1.5 mg/dL or creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 60 mL/min/1.73m2
    • Adequate liver function: Serum total bilirubin: ≤ 2.0 mg/dl; aspartate transaminase (AST)/alanine aminotransferase (ALT) ≤ 4.0 x institutional upper limits of normal (IULN); Albumin ≥ 2 g/dL
    • Adequate cardiac function: shortening fraction > 29% documented by echocardiogram, or ejection fraction ≥ 50% documented by multigated acquisition scan (MUGA).
    • Adequate pulmonary function documented by corrected lung diffusion capacity test (DLCO) > 50% or oxygen saturation of ≥ 92% on room air if unable to perform pulmonary function tests
    • Negative for human immunodeficiency virus (HIV), hepatitis C virus (HCV), human T cell lymphotropic virus (HTLV)
  5. Identification of an HLA-compatible donor per institutional standards
  6. Assent from a minor (if the child is capable of giving assent) per Department of Health and Human Services (DHHS) guidelines listed in 21CFR 50.55 and local Institutional Review Board (IRB) standards.
  7. Serum amylase and lipase: ≤ 1.2 x IULN
  8. Negative serum/urine pregnancy test for females with childbearing potential within 4 days before administration of the first palifermin dose
  9. Agreement by males and females of reproductive potential to use an effective means of contraception 30 days prior to enrollment through Day +30 (end of treatment)

Exclusion Criteria:

  1. Prior treatment with palifermin or other keratinocyte growth factors
  2. Received an investigational product or device, with the exception investigational stem cell separators, in another clinical trial within 30 days before enrollment.
  3. Known to have a life threatening infection not responding well to treatment
  4. Past history of veno-occlusive disease of the liver
  5. Known sensitivity to any Escherichia coli-derived products with grade 3 to 4 allergies to L-asparaginase [grade 1 to 2 allergies to L-asparaginase will be allowed].
  6. Receiving glutamine or any other medication to reduce the incidence of oral mucositis (OM) within 30 days before enrollment
  7. Previous or concurrent malignancy other than entry diagnostic criteria and/or solid organ transplantation and/or treatment of congenital immunodeficiency
  8. History of pancreatitis
  9. Breastfeeding (giving)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00460421

Locations
United States, Arizona
Arizona Cancer Center
Tucson, Arizona, United States
United States, California
Loma Linda University
Loma Linda, California, United States
Children´s Hospital
Los Angeles, California, United States
Regents of University of California
Los Angeles, California, United States
Children´s Hospital of Orange
Orange, California, United States
United States, Illinois
Children´s Memorial
Chicago, Illinois, United States
United States, Texas
University of Texas
Dallas, Texas, United States
Sponsors and Collaborators
Swedish Orphan Biovitrum
Investigators
Study Director: Maarten de Chateau, MD, PhD Swedish Orphan Biovitrum AB
  More Information

No publications provided

Responsible Party: Swedish Orphan Biovitrum
ClinicalTrials.gov Identifier: NCT00460421     History of Changes
Obsolete Identifiers: NCT00896506
Other Study ID Numbers: 20010133
Study First Received: April 12, 2007
Results First Received: May 30, 2012
Last Updated: July 13, 2012
Health Authority: United States: Food and Drug Administration
United States: Institutional Review Board

Keywords provided by Swedish Orphan Biovitrum:
Oral Mucositis
Acute Lymphoblastic Leukemia
Acute Myeloid Leukemia
Palifermin
Kepivance

Additional relevant MeSH terms:
Leukemia
Neoplasms by Histologic Type
Neoplasms

ClinicalTrials.gov processed this record on August 28, 2014