Safety and Efficacy Study of Idarubicin Dose Intensification to Treat Acute Myeloid Leukemia (IDAML)

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2012 by Konkuk University Medical Center
Sponsor:
Collaborators:
Chung-Ang University
Seoul National University Hospital
Ewha Womans University
Samsung Medical Center
Chonbuk National University Hospital
Pusan National University Hospital
Hanyang University Seoul Hospital
Soon Chun Hyang University
Information provided by (Responsible Party):
Mark Lee, Konkuk University Medical Center
ClinicalTrials.gov Identifier:
NCT01518556
First received: January 21, 2012
Last updated: October 7, 2012
Last verified: October 2012
  Purpose

The purpose of this study is to determine whether idarubicin dose intensification is safe and effective as a remission induction therapy for acute myeloid leukemia.


Condition Intervention Phase
Leukemia, Myeloid, Acute
Drug: Idarubicin
Phase 1
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase I/II Clinical Study of Idarubicin Dose Intensification for Remission Induction Therapy in Acute Myeloid Leukemia Patients Age of 65 Years or Less

Resource links provided by NLM:


Further study details as provided by Konkuk University Medical Center:

Primary Outcome Measures:
  • Maximum tolerated dose of idarubicin in the phase I study. [ Time Frame: Within 2 months after induction therapy in the phase I study. ] [ Designated as safety issue: Yes ]
  • Complete remission rate in the phase II study. [ Time Frame: Within 2 months after induction therapy therappy in the phase II study. ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Dose-limiting toxicity in the phase I study. [ Time Frame: Within 2 months after induction therapy in the phase I study. ] [ Designated as safety issue: Yes ]
  • Event-free survival and overall survival in the phase II study. [ Time Frame: Within 5 years after induction therapy in the phase II study. ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 67
Study Start Date: July 2011
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: June 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Idarubicin
Idarubicin dose intensification for remission induction in acute myeloid leukemia
Drug: Idarubicin

In the phase I study, idarubicin dose is increased step by step as follows: 12 mg/m2/day for 3 days IV in the 1st step; 15 mg/m2/day for 3 days IV in the 2nd step; 18 mg/m2/day for 3 days IV in the 3rd step.

In the phase II study, idarubicin dose is the maximum tolerated dose that is determined from the phase I study or 18 mg/m2/day for 3 days .

Other Name: IDARU INJ

Detailed Description:

Up to nowadays, a standard induction therapy for acute myeloid leukemia(AML) has consisted of cytarabine 100-200 mg per square meter of body surface area(BSA) per day continuous infusion for 7 days with idarubicin 12 mg per square meter or daunorubicin 45 mg per square meter of BSA per day for 3 days. This standard therapy induces a complete remission(CR) in 50-75% of young adults and 40-50% of older adults. Recently two cooperative groups prospectively compared 45 mg per square meter of daunorubicin to 90 mg per square meter of BSA. They reported high-dose daunorubicin, as compared with a standard dose one, resulted in a significantly higher CR rate and improved overall survival(OS) up to age 65 without additional toxic effects.

Daunorubicin has been more commonly used anthracycline; however, idarubicin has a longer intracellular retention time and has shown more rapid clearance of marrow blasts. In the early 1990, three prospectively randomized studies showed that a combined regimen of idarubicin and cytarabine was superior to one of daunorubicin and cytarabine for the induction therapy of AML in adults. When they compared daunorubicin 45-50 mg per square meter with idarubicin 12-13 mg per square meter for induction therapy, there were no significant differences in hematologic and non-hematologic toxicities, including cardiac toxicity.

Phase I studies of idarubicin in patients with acute leukemia and chronic myelogenous leukemia in blast crisis reported the dose-limiting toxicities(DLT) were stomatitis and anorexia at the maximum tolerated dose(MTD) of 15 mg per square meter of BSA per day for 3 days. Based on the results of these studies, the investigators have generally administered idarubicin 12 mg per square meter per day for 3 days for the remission induction therapy of AML. Meanwhile Sanz et al. had administered idarubicin 12 mg per square meter per day for 4 days in patients with acute promyelocytic leukemia, and Tedeschi et al. had done a single high-dose idarubicin 40 mg per square meter combined with high-dose cytarabine 3 g per square meter per day for 5 days in patients with acute lymphoblastic leukemia, with no significant increase of severe toxicity. The MTD of idarubicin should be reevaluated in the treatment of acute leukemia, especially in the era of granulocyte colony-stimulating factor and better supportive care available.

In this phase I study, idarubicin 12 mg per square meter of BSA per day for 3 days will be given to three patients at the first stage and then the idarubicin dose will be increased by 3 mg per square meter of BSA each stage. The phase I study consists of 3 stages and the idarubicin dose will be increased up to 18 mg per square meter of BSA per day for 3 days unless DLTs do not develop in more than 33% of enrolled patients at each stage. In the subsequent phase II study, the MTD being determined from the phase I study or 18 mg per square meter of idarubicin will be given to the enrolled patients. There were three large studies which enrolled a total of 942 previously untreated adult patients with AML and in which idarubicin 12-13 mg per square meter of BSA per day for 3 days and cytarabine 100 mg per square meter daily for 7 days were administered intravenously. Therefore, the investigators can adopt them as historical control groups in terms of statistical assessment.

In conclusion, the investigators desire to determine the safety and effectiveness of the intensified dose of idarubicin in the treatment of acute myeloid leukemia through this phase I and II study.

  Eligibility

Ages Eligible for Study:   20 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient has been fully informed, has complete understanding fo this study, and has given voluntary written informed consent to comply with the protocol requirements.
  • previously untreated de novo or secondary acute myeloid leukemia, including biphenotypic leukemia
  • age between 20 and 65 years
  • adequate organ functions, unless these abnormalities are attributable to leukemia
  • left ventricular ejection fraction > 45%
  • serum creatinine < 1.5 x upper limit of normal
  • total bilirubin < 1.5 x upper limit of normal
  • alanine transferase and aspartate transferase < 2.5 x upper limit of normal if liver function abnormality is attributable to underlying leukemia, ALT and AST < 5 x upper limit of normal
  • Eastern Cooperative Oncology Group performance status score of 0 to 2

Exclusion Criteria:

  • hypersensitivity to the study drug
  • any other malignancies within 3 years, except for cured non-melanoma skin cancer and curatively treated in situ carcinoma of the cervix
  • New York Heart Association class III or IV heart failure, severe uncontrolled cardiac disease or myocardial infarction within the previous 6 months prior to the date of consent
  • incapable of giving voluntary written informed consent to comply with the protocol requirements, which results from drug or alcohol intoxication, or neurological or psychiatric disorders
  • pregnant or breastfeeding
  • recent chemotherapy within 4 weeks prior to this study treatment
  • acute promyelocytic leukemia
  • current or recent treatment with any other investigational medicinal product within 28 days prior to this study enrollment
  • unsuitable for this study, in the investigator's opinion
  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: NCT01518556

Contacts
Contact: Mark H Lee, M.D., Ph.D. +82-10-5035-7410 mlee@kuh.ac.kr
Contact: Mi-Ran Cho, R.N. +82-2-2030-6537 pro840214@naver.com

Locations
Korea, Republic of
Division of Hematology-Oncology, Konkuk University Medical Center Recruiting
Seoul, Korea, Republic of, 143-729
Contact: Mark H Lee, M.D., Ph.D.    +82-10-5035-7410    mlee@kuh.ac.kr   
Contact: Mi-Ran Cho, R.N.    +82-2-2030-6537    pro840214@naver.com   
Principal Investigator: Mark H Lee, M.D., Ph.D.         
Sponsors and Collaborators
Konkuk University Medical Center
Chung-Ang University
Seoul National University Hospital
Ewha Womans University
Samsung Medical Center
Chonbuk National University Hospital
Pusan National University Hospital
Hanyang University Seoul Hospital
Soon Chun Hyang University
Investigators
Principal Investigator: Mark H Lee, M.D., Ph.D. Konkuk University Medical Center
  More Information

No publications provided

Responsible Party: Mark Lee, Professor, Konkuk University Medical Center
ClinicalTrials.gov Identifier: NCT01518556     History of Changes
Other Study ID Numbers: AML-2011-01
Study First Received: January 21, 2012
Last Updated: October 7, 2012
Health Authority: South Korea: Korea Food and Drug Administration (KFDA)

Keywords provided by Konkuk University Medical Center:
Idarubicin
Remission Induction
Maximum Tolerated Dose
Survival

Additional relevant MeSH terms:
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Leukemia
Neoplasms by Histologic Type
Neoplasms
Idarubicin
Antibiotics, Antineoplastic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on September 16, 2014