Low Dose Cytarabine and Lintuzumab-Ac225 in Older Patients

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by M.D. Anderson Cancer Center
Sponsor:
Collaborator:
Actinium Pharmaceuticals
Information provided by (Responsible Party):
M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier:
NCT01756677
First received: December 20, 2012
Last updated: June 12, 2014
Last verified: June 2014
  Purpose

The goal of the Phase 1 part of this study is to find the highest tolerable dose of Lintuzumab-Ac225 that can be given with cytarabine to patients with AML.

The goal of the Phase 2 part of this study is to learn if Lintuzumab-Ac225 and cytarabine can control AML. The safety of this drug combination will also be studied.

Lintuzumab-Ac225 is designed to deliver radiation therapy directly inside leukemia cells without giving any radiation to the surrounding normal cells

Cytarabine is designed to insert itself into DNA (genetic material) of cancer cells and stop the DNA from repairing itself.


Condition Intervention Phase
Leukemia
Drug: Cytarabine
Biological: Lintuzumab-Ac225
Drug: Lasix
Drug: Spironolactone
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: A Phase I/II Study of Low Dose Cytarabine and Lintuzumab-Ac225 in Older Patients With Untreated Acute Myeloid Leukemia

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Maximum Tolerated Dose (MTD) of Lintuzumab-Ac225 [ Time Frame: Cycle 1, up to 52 days ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 24
Study Start Date: October 2012
Estimated Primary Completion Date: October 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cytarabine + Lintuzumab-Ac225
Cytarabine 20 mg subcutaneously every 12 hours Days 1 to 10 of every cycle. Starting dose level 1.0 μCi/Kg of Lintuzumab-Ac225 and 15 μg/Kg unlabeled HuM195 divided into 2 equal fractionated doses (0.5 μCi/Kg and 7.5 μg /Kg + 0.5 μCi/Kg and 7.5 μg /Kg) with the first fraction administered approximately 4 - 7 days after 1 cycle of low dose cytarabine and the second fraction administered 4-7 days after the first fraction, followed by up to 11 more cycles. Lasix 40 mg by mouth (po) daily one day prior to treatment with Lintuzumab-Ac225 and continuing for 10 days following administration of the 2nd divided dose. Spironolactone, 25 mg po daily, administered 11 days after second dose of 225Ac-HuM195 (the day after completion of furosemide) and continued for 12 months.
Drug: Cytarabine
Low dose cytarabine administered at 20 mg subcutaneously every 12 hours for the first 10 days (Days 1 to 10) of every cycle. Cycle 1 can last up to 52 days (depending on the schedule of study drug dosing) in order to allow for recovery from Lintuzumab-Ac225. Cycles 2-12 will last 28 days each.
Other Names:
  • Cytosar
  • Ara-C
  • DepoCyt
  • Cytosine arabinosine hydrochloride
  • Low dose Ara-C
  • LDAC
Biological: Lintuzumab-Ac225
Starting dose level 1.0 μCi/Kg of Lintuzumab-Ac225 and 15 μg/Kg unlabeled HuM195 divided into 2 equal fractionated doses (0.5 μCi/Kg and 7.5 μg /Kg + 0.5 μCi/Kg and 7.5 μg /Kg) with the first fraction administered approximately 4 - 7 days after 1 cycle of low dose cytarabine and the second fraction administered 4-7 days after the first fraction, followed by up to 11 more cycles.
Other Name: Lintuzumab
Drug: Lasix
40 mg by mouth daily one day prior to treatment with Lintuzumab-Ac225 and continuing for 10 days following administration of the 2nd divided dose.
Other Name: furosemide
Drug: Spironolactone
25 mg by mouth daily, administered 11 days after second dose of 225Ac-HuM195 (the day after completion of furosemide) and continued for 12 months.

  Hide Detailed Description

Detailed Description:

Study Groups:

If you are found to be eligible to take part in this study, you will be assigned to a study group based on when you join this study. Up to 4 groups of up to 6 participants will be enrolled in the Phase I portion of the study, and up to 53 participants will be enrolled in Phase II.

If you are enrolled in the Phase I portion, the dose of Lintuzumab-Ac225 you receive will depend on when you joined this study. The first group of participants will receive the lowest dose level of Lintuzumab-Ac225. Each new group will receive a higher dose of Lintuzumab-Ac225 than the group before it, if no intolerable side effects were seen. This will continue until the highest tolerable dose of Lintuzumab-Ac225 is found.

If you are enrolled in the Phase II portion, you will receive Lintuzumab-Ac225 at the highest dose that was tolerated in the Phase I portion.

All participants will receive the same dose level of cytarabine.

Study Drug Administration:

You will receive cytarabine as an injection under the skin. This is called a subcutaneous injection. During the first office visit, you or a caregiver will be taught to give these injections at home. You will get cytarabine injections 2 times each day during Days 1-10 of each study cycle. Cycle 1 may last up to 52 days and will depend on how you recover from the Lintuzumab-Ac225. All other cycles will be 28 days.

You will receive Lintuzumab-Ac225 by vein over 15-30 minutes at a time point about 4 to 7 days after your last dose of cytarabine in Cycle 1. You will receive it a second time about 4 to 7 days after that.

One (1) day before the second dose of Lintuzumab-Ac225, you will begin taking lasix (furosemide) by mouth every day for 10 days. Furosemide is taken to prevent possible damage to the kidneys.

One (1) day after your last dose of furosemide, you will begin taking spironolactone by mouth every day for up to 1 year. It is also taken to prevent possible kidney damage.

You will be given standard drugs to help decrease the risk of side effects. You may ask the study staff for information about how the drugs are given and their risks.

Study Visits:

During Cycle 1:

  • Every week, blood (6-10 teaspoons) will be drawn for routine tests.
  • Every other week, urine will be collected for routine tests.
  • About 1 week before Cycle 2, you will have a bone marrow aspirate and biopsy to check the status of the disease.

During Cycles 2-12:

  • Every week, blood (6-10 teaspoons) will be drawn for routine tests.
  • Blood (about 1-2 teaspoons) will be drawn to find out how Lintuzumab-Ac225 may affect your immune system (Cycles 3, 4, and 7 only).
  • Every month, urine will be collected for routine tests.
  • About 1 week before Cycles 3 and 5, you will have a bone marrow aspirate and biopsy to check the status of the disease.

Length of Study:

You will only receive Lintuzumab-Ac225 during the first cycle, but you may continue receiving cytarabine for up to 12 cycles. You will be taken off the study if the disease gets worse, if intolerable side effects occur, or if you are unable to follow study directions.

Your participation on the study will be over once you have completed the follow-up.

If you stop taking the study drugs before all 12 treatment cycles are finished, you may be contacted by telephone or be seen in the clinic every month for up to 1 year to check on any side effects you may be having.

This is an investigational study. Lintuzumab-Ac225 is not FDA approved or commercially available. It is currently being used for research purposes only. Cytarabine is FDA approved and commercially available for the treatment of AML. The use of these drugs in combination for AML is investigational.

Up to 72 participants will be enrolled in this multicenter study. Up to 24 will take part at MD Anderson.

  Eligibility

Ages Eligible for Study:   60 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Untreated AML, including patients with an antecedent hematologic disorder or secondary disease. Patients with prior MDS may have received therapy with immunomodulatory agents or hypomethylating agents for this diagnosis. patients with other prior cancer diagnoses are allowed as long as they ahve no measurable disease are not undergoing active therapy, and have a life expectancy of greater than or equal 4 months.
  2. Patients age greater than or equal to 60 years who: a. Are unwilling to receive intensive (e.g. 7+3) chemotherapy, or b. Have poor-risk prognostic factors defined as antecedent hematologic disorder, prior chemotherapy or XRT, abnormal karyotype other than t(8;21), inv16, or t(16;16), any karyotype with FLT3-ITD, or presenting WBC greater than 100K, or c. Have significant comorbidities, that in the judgment of the investigator makes the subject unsuitable for standard dose induction chemotherapy (e.g. anthracycline and infusional cytarabine given as 7+3); or d. Any patient age greater than or equal to 70 years.
  3. Blast count greater than or equal to 20 percent (WHO criteria)
  4. Greater than 25 percent of blasts must be CD33 positive.
  5. Creatinine less than 2.0 mg/dl
  6. Estimated creatinine clearance greater than or equal to 50ml/min.
  7. Bilirubin less than or equal to 2.0 mg/dl; AST and ALT less than or equal to 2.5 times the ULN.
  8. ECOG Performance status less than or equal to 3.

Exclusion Criteria:

  1. Patients with acute promyelocytic leukemia.
  2. Treatment with chemotherapy or biologic therapy within 3 weeks, except for hydroxyurea, which must be discontinued prior to treatment on study
  3. Treatment with radiation within 6 weeks
  4. Active serious infections uncontrolled by antibiotics
  5. Active malignancy within 2 years of entry, except previously treated non-melanoma skin cancer, carcinoma in situ or cervical intraepithelial neoplasia, and organ confined prostate cancer with no evidence of progressive disease based on PSA levels and are not on active therapy
  6. Clinically significant cardiac or pulmonary disease
  7. Active CNS leukemia. Patients with symptoms of CNS involvement, particularly those with M4 or M5 subtypes, should undergo lumbar puncture prior to treatment on study to exclude CNS disease. Symptoms include cranial neuropathies, other neurologic deficits, and headache.
  8. Psychiatric disorder that would preclude study participation.
  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: NCT01756677

Contacts
Contact: Farhad Ravandi-Kashani, MD 713-745-0394

Locations
United States, New York
Memorial Sloan Kettering Recruiting
New York, New York, United States, 10065
United States, Texas
UT MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Principal Investigator: Farhad Ravandi-Kashani, MD         
Sponsors and Collaborators
M.D. Anderson Cancer Center
Actinium Pharmaceuticals
Investigators
Study Chair: Farhad Ravandi-Kashani, MD UT MD Anderson Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT01756677     History of Changes
Other Study ID Numbers: 2012-0434, API-01
Study First Received: December 20, 2012
Last Updated: June 12, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by M.D. Anderson Cancer Center:
Cytarabine
Lintuzumab-Ac225
ACTINIUM-225
HUMANIZED ANTI-CD33 MONOCLONAL ANTIBODY HuM195
Alpha-Particle-Emitting Immunoconjugates

Additional relevant MeSH terms:
Leukemia
Neoplasms by Histologic Type
Neoplasms
Cytarabine
Antibodies, Monoclonal
Furosemide
Spironolactone
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antiviral Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Diuretics
Natriuretic Agents
Sodium Potassium Chloride Symporter Inhibitors
Membrane Transport Modulators
Cardiovascular Agents
Mineralocorticoid Receptor Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Diuretics, Potassium Sparing

ClinicalTrials.gov processed this record on September 18, 2014