Vorinostat and Azacitidine in Treating Patients With Myelodysplastic Syndromes or Acute Myeloid Leukemia
|Acute Erythroid Leukemia Acute Megakaryoblastic Leukemia Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome Chronic Myelomonocytic Leukemia Myelodysplastic Syndrome Myelodysplastic Syndrome With Excess Blasts Myelodysplastic Syndrome With Ring Sideroblasts Recurrent Adult Acute Myeloid Leukemia Refractory Anemia Refractory Anemia With Excess Blasts in Transformation||Drug: Azacitidine Other: Laboratory Biomarker Analysis Other: Pharmacological Study Drug: Vorinostat||Phase 1 Phase 2|
|Study Design:||Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:||A Phase 1/2 Study of Vorinostat [Suberoylanilide Hydroxamic Acid (SAHA)] in Combination With Azacitidine in Patients With the Myelodysplastic Syndrome (MDS)|
- Distribution of toxicities in the 12th treatment arm (Phase II) [ Time Frame: Up to 1 month post-treatment ]The frequency of subjects experiencing toxicities will be tabulated. Toxicities will be assessed and graded according to CTCAE v. 3.0 terminology. Exact 95% confidence intervals around the toxicity proportions will be calculated to assess the precision of the obtained estimates.
- Incidence of toxicities of vorinostat in combination with azacitidine graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version (v)3.0 (Phase I) [ Time Frame: Up to 1 month post-treatment ]Exact 95% confidence intervals around the toxicity proportions will be calculated to assess the precision of the obtained estimates.
- Objective overall response proportion (complete response [CR] + CR with incomplete blood count + partial response) (Phase II) [ Time Frame: Up to day 168 ]Ninety-five percent confidence intervals will be estimated for the response proportion in all three treatment groups via binomial proportions.
- Frequency of leukemic transformation [ Time Frame: Up to day 84 ]
- Overall survival [ Time Frame: Time from first treatment day until death, assessed up to 8 years ]Assessed by Kaplan-Meier survival analysis and 95% confidence intervals will be calculated using Greenwood's formulae.
- Progression-free survival [ Time Frame: Time from first treatment day until objective or symptomatic progression, assessed up to 8 years ]Assessed by Kaplan-Meier survival analysis and 95% confidence intervals will be calculated using Greenwood's formulae.
- Time to leukemic transformation [ Time Frame: Up to day 84 ]
- Time to response [ Time Frame: Up to day 84 ]
|Actual Study Start Date:||November 22, 2006|
|Estimated Primary Completion Date:||May 22, 2017 (Final data collection date for primary outcome measure)|
Experimental: Treatment (azacitidine, vorinostat)
Patients receive azacitidine SC QD on days 1-7 and vorinostat PO 2-3 times daily on days 3-5, 3-9, or 3-16. Treatment repeats every 28 days for at least 4 courses in the absence of disease progression or unacceptable toxicity.
Other Names:Other: Laboratory Biomarker Analysis
Correlative studiesOther: Pharmacological Study
Correlative studiesDrug: Vorinostat
I. To evaluate the safety and toxicity of vorinostat in combination with azacitidine in patients with myelodysplastic syndromes (MDS) and some select patients with acute myeloid leukemia (AML) (step 1).
II. To identify doses of both vorinostat and azacitidine for safe combination of the 2 agents that can be administered in repetitive cycles over time for use in phase II studies.
III. To determine the response rate of patients treated with the combination of suberoylanilide hydroxamic acid (SAHA) (vorinostat) and azacitidine at the doses established as safe and effective in Step 1 in an expanded cohort of patients with MDS.
IV. To obtain preliminary data on the effects of treatment with the combination of vorinostat and Aza C (azacitidine) in patients with MDS on a series of biologic surrogate markers including: deoxyribonucleic acid (DNA) methylation of specific genes (e.g. p15); histone acetylation; hematopoietic progenitor growth and differentiation; the fate of the MDS clone and changes in gene expression by array profiling.
I. Determine effect of treatment with the combination on time to response, time to leukemic transformation and frequency of transformation to leukemia in patients with MDS during the phase II segment of the study.
OUTLINE: This is a phase I, dose-escalation study followed by a phase II study.
Patients receive azacitidine subcutaneously (SC) once daily (QD) on days 1-7 and vorinostat orally (PO) 2-3 times daily on days 3-5, 3-9, or 3-16. Treatment repeats every 28 days for at least 4 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed monthly for 6 months and then every 2 months thereafter.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00392353
|United States, Illinois|
|University of Chicago Comprehensive Cancer Center|
|Chicago, Illinois, United States, 60637|
|United States, Maryland|
|University of Maryland/Greenebaum Cancer Center|
|Baltimore, Maryland, United States, 21201|
|United States, New York|
|North Shore University Hospital|
|Manhasset, New York, United States, 11030|
|Mount Sinai Hospital|
|New York, New York, United States, 10029|
|Weill Medical College of Cornell University|
|New York, New York, United States, 10065|
|Montefiore Medical Center-Weiler Hospital|
|The Bronx, New York, United States, 10461|
|Montefiore Medical Center - Moses Campus|
|The Bronx, New York, United States, 10467-2490|
|Principal Investigator:||Lewis Silverman||Montefiore Medical Center - Moses Campus|