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Lestaurtinib, Cytarabine, and Idarubicin in Treating Younger Patients With Relapsed or Refractory Acute Myeloid Leukemia
This study has been suspended.
First Received: May 3, 2007   Last Updated: November 11, 2009   History of Changes
Sponsor: Children's Oncology Group
Collaborator: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00469859
  Purpose

RATIONALE: Lestaurtinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cytarabine and idarubicin, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving lestaurtinib together with cytarabine and idarubicin may kill more cancer cells.

PURPOSE: This phase I/II trial is studying the side effects and best dose of lestaurtinib when given together with cytarabine and idarubicin and to see how well they work in treating younger patients with relapsed or refractory acute myeloid leukemia.


Condition Intervention Phase
Leukemia
Drug: cytarabine
Drug: idarubicin
Drug: lestaurtinib
Phase I
Phase II

Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: A Pilot Study of Lestaurtinib (CEP-701) in Combination With Chemotherapy in Young Patients With Relapsed or Refractory FLT3-mutant Acute Myeloid Leukemia

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Tolerable and biologically active dose of lestaurtinib [ Designated as safety issue: No ]
  • Response to reinduction [ Designated as safety issue: No ]
  • Dose-limiting toxicity [ Designated as safety issue: Yes ]

Estimated Enrollment: 37
Study Start Date: June 2007
Estimated Primary Completion Date: December 2008 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine a safe, tolerable, and biologically active dose of lestaurtinib in combination with chemotherapy comprising cytarabine and idarubicin in younger patients with relapsed or refractory FLT3-mutant acute myeloid leukemia.

Secondary

  • Determine the overall response rate in patients treated with this regimen.
  • Optimize dosing of lestaurtinib based primarily on biologic activity rather than toxicity.
  • Correlate the clinical response to this regimen with the ability to achieve adequate FLT3 plasma inhibitory activity levels and the in vitro sensitivity of pretreatment leukemic cells to lestaurtinib in these patients.
  • Determine the mechanisms of resistance to lestaurtinib in these patients.
  • Assess the feasibility of using rapid central determination of FLT3 mutation status at study entry to determine induction therapy in future upfront protocols.

OUTLINE: This is a multicenter, dose-finding study of lestaurtinib followed by an efficacy study.

  • Dose-finding phase:

    • Course 1: Patients receive cytarabine IV over 2 hours twice daily on days 1-4, idarubicin IV over 15 minutes on days 2-4, and oral lestaurtinib twice daily on days 5-28. Patients achieving complete or partial response proceed to course 2.

Cohorts of 6 patients receive escalating doses of lestaurtinib until a tolerable and biologically active dose (TBAD) is determined. The TBAD is defined as the dose at which no more than 2 of 6 patients experience DLT and biologic activity is confirmed by plasma inhibitory activity (PIA) assay.

  • Course 2: Patients receive high-dose cytarabine IV over 3 hours twice daily on days 1-4 and oral lestaurtinib (at the dose determined in course 1) twice daily on days 5-28. Patients achieving complete or partial response proceed to continuation therapy.
  • Continuation therapy: Patients receive oral lestaurtinib twice daily on days 1-28. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

    • Efficacy phase: Once the TBAD is determined, subsequent patients receive treatment as in course 1 and 2 with lestaurtinib at the TBAD. Patients may also receive continuation therapy as in the dose-finding phase.

Blood samples are collected periodically during study treatment for pharmacokinetic and PIA assays.

After completion of study treatment, patients are followed periodically for up to 5 years.

PROJECTED ACCRUAL: A total of 37 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   1 Year to 30 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of acute myeloid leukemia (AML) according to FAB classification

    • At least 5% blasts in the bone marrow, with or without extramedullary disease
  • In first relapse after induction therapy OR refractory to induction therapy with ≤ 1 attempt at remission induction

    • Patients who are in a first relapse > 1 year from their initial diagnosis of AML are excluded from the dose-finding phase of the study, but are eligible for the efficacy phase
    • First relapse after hematopoietic stem cell transplantation (HSCT) allowed provided patient has no evidence of active graft-versus-host disease (GVHD) and is at least 4 months posttransplantation
  • Positive for a FLT3 activating mutation (internal tandem duplication or kinase domain point mutation) using standard polymerase chain reaction-based procedures at any time in the course of illness
  • Treatment-related AML allowed

PATIENT CHARACTERISTICS:

  • Karnofsky performance status (PS) 50-100% (> 16 years of age) OR Lansky PS 50-100% (≤ 16 years of age)
  • Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min OR serum creatinine based on age and gender as follows:

    • Creatinine no greater than 0.4 mg/dL (1 month to < 6 months of age)
    • Creatinine no greater than 0.5 mg/dL (6 months to < 1 year of age)
    • Creatinine no greater than 0.6 mg/dL (1 year to < 2 years of age)
    • Creatinine no greater than 0.8 mg/dL (2 years to < 6 years of age)
    • Creatinine no greater than 1 mg/dL (6 years to < 10 years of age)
    • Creatinine no greater than 1.2 mg/dL (10 years to < 13 years of age)
    • Creatinine no greater than 1.4 mg/dL (females) or 1.5 mg/dL (males) (13 years to < 16 years of age)
    • Creatinine no greater than 1.4 mg/dL (females) or 1.7 mg/dL (males) (16 years of age and over)
  • Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • ALT < 5 times ULN (unless it is related to leukemic involvement)
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Shortening fraction ≥ 27% by echocardiogram OR ejection fraction ≥ 50% by radionuclide angiogram

PRIOR CONCURRENT THERAPY:

  • Recovered from all prior therapy
  • No prior cumulative anthracycline doses exceeding 450 mg/m^2 daunorubicin equivalents

    • Patients who relapse after receiving treatment on protocol COG-AAML03P1 or COG-AAML0531 (300 mg/m^2 of daunorubicin hydrochloride and 48 mg/m^2 of mitoxantrone hydrochloride) allowed provided they have not received any additional anthracyclines
  • At least 14 days since prior cytotoxic therapy

    • Hydroxyurea allowed to decrease the WBC prior to starting protocol treatment
    • No concurrent hydroxyurea
  • At least 7 days since prior biologic agents
  • At least 14 days since prior monoclonal antibody therapy
  • Radiotherapy to chloromas allowed

    • Irradiated lesion may not be used to assess tumor response
  • No other concurrent chemotherapy, investigational therapy, immunomodulating agents, or steroids

    • Steroids used as an antiemetic allowed
    • Prophylactic intrathecal cytarabine allowed
  • No concurrent CYP3A4,5 inhibitors, including any of the following:

    • Azole antifungals (e.g., fluconazole or voriconazole)
    • Cyclosporine
    • Erythromycin
    • Clarithromycin
    • Troleandomycin
    • HIV protease inhibitors
    • Nefazodone
  • No concurrent CYP3A4,5 inducers, including any of the following:

    • Carbamazepine
    • Dexamethasone
    • Rifampin
    • Phenobarbital
    • Phenytoin
    • Hypericum perforatum (St. John's wort)
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00469859

  Hide Study Locations
Locations
United States, Alabama
Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
Birmingham, Alabama, United States, 35294
United States, California
Children's Hospital of Orange County
Orange, California, United States, 92868
United States, District of Columbia
Children's National Medical Center
Washington, District of Columbia, United States, 20010-2970
United States, Georgia
Winship Cancer Institute of Emory University
Atlanta, Georgia, United States, 30322
United States, Illinois
Children's Memorial Hospital - Chicago
Chicago, Illinois, United States, 60614
United States, Indiana
Indiana University Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, United States, 46202-5289
United States, Maryland
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231-2410
United States, Massachusetts
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
Boston, Massachusetts, United States, 02115
United States, Michigan
C.S. Mott Children's Hospital at University of Michigan Medical Center
Ann Arbor, Michigan, United States, 48109-0286
United States, Minnesota
Masonic Cancer Center at University of Minnesota
Minneapolis, Minnesota, United States, 55455
United States, Missouri
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
St. Louis, Missouri, United States, 63110
United States, New York
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
New York, New York, United States, 10032
United States, Ohio
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States, 45229-3039
United States, Oregon
Knight Cancer Institute at Oregon Health and Science University
Portland, Oregon, United States, 97239-3098
United States, Pennsylvania
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104-9786
Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15213
United States, Tennessee
St. Jude Children's Research Hospital
Memphis, Tennessee, United States, 38105
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee, United States, 37232-6838
United States, Texas
Baylor University Medical Center - Houston
Houston, Texas, United States, 77030-2399
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
Dallas, Texas, United States, 75390
United States, Washington
Children's Hospital and Regional Medical Center - Seattle
Seattle, Washington, United States, 98105
Sponsors and Collaborators
Children's Oncology Group
Investigators
Study Chair: Patrick A. Brown, MD Sidney Kimmel Comprehensive Cancer Center
Investigator: Donald Small, MD, PhD Sidney Kimmel Comprehensive Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Children's Oncology Group - Group Chair Office ( Gregory H. Reaman )
Study ID Numbers: CDR0000543398, COG-AAML06P1
Study First Received: May 3, 2007
Last Updated: November 11, 2009
ClinicalTrials.gov Identifier: NCT00469859     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by National Cancer Institute (NCI):
recurrent childhood acute myeloid leukemia
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
recurrent adult acute myeloid leukemia
secondary acute myeloid leukemia

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Neoplasms by Histologic Type
Antimetabolites, Antineoplastic
Immunologic Factors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Physiological Effects of Drugs
Leukemia, Myeloid
Antibiotics, Antineoplastic
Leukemia, Myeloid, Acute
Immunosuppressive Agents
Antiviral Agents
Pharmacologic Actions
Leukemia
Neoplasms
Idarubicin
Therapeutic Uses
Cytarabine

ClinicalTrials.gov processed this record on November 27, 2009