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Safety Study of CPX-351 in Children With Relapsed Leukemia or Lymphoma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01943682
Recruitment Status : Completed
First Posted : September 17, 2013
Last Update Posted : June 4, 2020
Sponsor:
Collaborator:
Jazz Pharmaceuticals
Information provided by (Responsible Party):
Children's Hospital Medical Center, Cincinnati

Brief Summary:

The purpose of this study is to test the safety of a study drug called CPX-351. This drug has been tested in adults but not yet in children and adolescents. This study tests different doses of the drug to see which dose is safer in children and adolescents.

Patients who have blood cancer are being asked to take part in this study . Blood cancers may include leukemia and lymphoma. Patients able to be in this study have already been treated with standard chemotherapy for their disease and the disease is still growing or has come back.

CPX-351 is a drug that is not yet approved by the United States Food and Drug Administration (FDA) and is only used in research studies like this one. CPX-351 is made up of two chemotherapy drugs that patients may have already received called cytarabine and daunorubicin that are now packaged together.

Another purpose of this study is to collect blood samples for special research studies. Researchers want to study how much of the CPX-351 is in the body over time. These studies are call pharmacokinetic studies or PK studies for short. PK studies require the collection of several blood samples before and after participants are given the study drug.


Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia Acute Lymphoblastic Leukemia Burkitt Lymphoma Diffuse Large Cell Lymphoma Gray Zone Lymphoma Lymphoblastic Lymphoma Anaplastic Large Cell Lymphoma Hodgkin Lymphoma Drug: CPX-351 Phase 1

Detailed Description:

Cytarabine in combination with an anthracycline is a frequently used chemotherapy platform for both newly diagnosed and relapsed/refractory acute myeloid leukemia (AML) and other hematologic malignancies. Synergistic antitumor activity has been demonstrated between cytarabine and daunorubicin that is dependent upon the ratio of the drugs with the best therapeutic effect observed with a cytarabine to daunorubicin ratio of 5:1 in in vitro and in vivo models. CPX-351 is a liposomal preparation of cytarabine and daunorubicin that maintains this therapeutic drug ratio 24 hours post infusion. The altered biodistribution from encapsulation may result in a greater therapeutic effect in patients with relapsed hematologic malignancies and demonstrate greater tolerability than non-liposomal cytarabine and daunorubicin.

This is a single institution phase-I pilot study that aims to assess the pharmacokinetics, toxicity and tolerability of CPX-351 in pediatric and young adults with relapsed/refractory hematologic malignancies. Subjects will receive a single course of CPX-351 administered on Days 1, 3, and 5. The study will first open to children in a dose exploration phase, and then be available to an expanded cohort, which will be open to children and young adults once a tolerable dose has been determined.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 27 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I/Pilot Study of CPX-351 for Children, Adolescents and Young Adults With Recurrent or Refractory Hematologic Malignancies
Study Start Date : September 2013
Actual Primary Completion Date : March 2019
Actual Study Completion Date : April 2019


Arm Intervention/treatment
Experimental: CPX-351
CPX-351 is made up of two chemotherapy drugs that patients may have already received called cytarabine and daunorubicin that are now packaged together. Subjects will receive a single course of CPX-351 administered on Days 1, 3, and 5.
Drug: CPX-351
Comparison of Different doses of drug




Primary Outcome Measures :
  1. Determine rate of dose limiting toxicities [ Time Frame: 56 days ]
    Any Grade 3 or greater adverse event that can be possible/probably/or definitely attributable to CPX-351 that occurs between Day 1 and Day 56.

  2. Number of participants with dose limiting toxicities to determine maximum tolerated dose. [ Time Frame: 56 Days ]
    If 2 or more participants have dose limiting toxicities at a given dose level, the maximum tolerated dose will have been exceeded.

  3. Pharmacokinetics: Serum concentration of CPX-351 components (cytarabine and daunorubicin) and metabolites. [ Time Frame: 10 Days ]
    Blood samples will be collected on Day 5 (prior to CPX-351 infusion, 45 minutes (mid infusion), 90 minutes (immediately post-infusion), 2 hr, 5 hr, 8 hr, 12 hrs, Day 6, Day 8, and Day 10. Serum will be analyzed for drug and metabolite concentrations.


Secondary Outcome Measures :
  1. Tumor measurement by bone marrow biopsy, blood counts, and/or PET/CT scan [ Time Frame: 28 days ]
    Tumor measurements will be used to assess disease response per standard response criteria for acute myeloid leukemia, acute lymphoid leukemia and lymphoma.

  2. Serum levels of biomarkers (troponin-1, troponin-T, and B-type natriuretic) of cardiac injury. [ Time Frame: 30 days ]


Information from the National Library of Medicine

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Ages Eligible for Study:   12 Months to 30 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age

    1. 12 months to 21 years at time of enrollment into dose exploration phase
    2. 12 months to 30 years at time of enrollment into expanded phase
  • Diagnosis: Patients must have a diagnosis of a hematologic malignancy (acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or aggressive lymphoma.
  • Disease Status

    1. Acute myeloid leukemia - patients with non-therapy related AML must be in first or greater relapse or have refractory disease to at least two courses of induction therapy.
    2. Acute lymphoid leukemia - patients with ALL must be in second or greater relapse or have relapsed disease refractory to re-induction therapy.
    3. Aggressive Lymphoma - patients must have relapsed or refractory disease for which there is no known curative therapy available. Patients must have measurable disease by CT scan.
  • Performance status: Karnofsky > or = to 50% or Lansky > or = to 50.
  • Prior therapy: Patients must have fully recovered from acute toxicities of prior therapy.

    1. Hematopoetic Stem cell transplant (HSCT): Patients who relapsed after HSCT, are eligible provided they have no evidence of active graft versus host disease (GVHD) and are at least 2 months post-transplant.
    2. Anthracycline exposure: Patients who have not previously had TBI (total body irradiation) must have a total previous cumulative anthracycline exposure ≤ 450 mg/m2 daunorubicin equivalents. Patients who have had prior TBI or radiation to the mediastinum must have a previous cumulative anthracycline exposure e ≤ 300 mg/m2 daunorubicin equivalents.
    3. Cytotoxic therapy:

      1. AML and Lymphoma: at least 14 days must have elapsed since the completion of systemic cytotoxic therapy, with the exception of hydroxyurea.
      2. ALL: patients who relapsed while receiving standard maintenance therapy do not have a waiting period. At least 14 days must have elapsed since receiving systemic cytarabine or an anthracycline/anthracenedione.
      3. Intrathecal cytotoxic therapy: no waiting period is required for patients receiving intrathecal cytarabine, methotrexate and/or hydrocortisone. At least 14 days must have elapsed since receiving liposomal cytarabine in intrathecal injection.
  • Organ function requirements

    1. Adequate bone marrow function - platelet count >/= 20,000/uL (may receive platelet transfusions; Hemoglobin >/= 8 g/dL (may receive red blood cell transfusions)
    2. Adequate Renal function - a maximum serum creatinine is based on age/gender. Subjects that do not meet eligibility criteria based upon serum creatinine may meet eligibility criteria based upon a 24 hour creatinine clearance or radioisotope determined GFR >/= 70 mL/min/1.73 m2.
    3. Adequate liver function - Direct bilirubin </= 1.5 x upper limit of normal (ULN) for age and SGPT (ALT) < 5.0 x upper limit of normal (ULN) for age and institution (unless elevation is related to leukemia involvement).
    4. Adequate cardiac function - Shortening fraction of >/= 27% by echocardiogram, or Ejection fraction of >/= 50% by gated radionuclide study or echocardiogram.
    5. Central Nervous system function - patients with seizure disorder may be enrolled if on anticonvulsants and well controlled and CNS toxicity </= Grade 2.

Exclusion Criteria:

  • Patients with the following diagnosis are not eligible: acute promyelocytic leukemia (APML), Down Syndrome, Fanconi Anemia, acute lymphoblastic leukemia with central nervous system leukemia (CNS status 3), Wilson's disease
  • Pregnant or breast-feeding women. Males and females of reproductive potential may not participate unless they have agreed to use an effective method of contraception.
  • Concomitant medications

    1. Growth factors- growth factors that support platelet or white cell number or function must not be administered within 7 days prior to enrollment.
    2. Investigational drugs - patients currently receiving another investigational drug are not eligible.
    3. Anti-cancer agents- patients who are currently receiving other anti-cancer agents are not eligible with the exception of intrathecal cytarabine and oral hydroxyurea. Hydroxyurea must be discontinued 24 hours prior to initiation of protocol therapy.
  • Infection: Patients who have an uncontrolled infection are not eligible.
  • Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study are not eligible.
  • History of Wilson's disease or other copper-metabolism disorder
  • Major surgery within 4 weeks of enrollment.
  • Greater than 13.6 Gy prior radiation to the mediastinum

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01943682


Locations
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United States, Ohio
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States, 45229
Sponsors and Collaborators
Children's Hospital Medical Center, Cincinnati
Jazz Pharmaceuticals
Investigators
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Principal Investigator: Michael Absalon, MD, PhD Children's Hospital Medical Center, Cincinnati
Additional Information:
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Responsible Party: Children's Hospital Medical Center, Cincinnati
ClinicalTrials.gov Identifier: NCT01943682    
Other Study ID Numbers: CPX-MA-1201
2013-4305 ( Other Identifier: CCHMC IRB )
First Posted: September 17, 2013    Key Record Dates
Last Update Posted: June 4, 2020
Last Verified: June 2020
Keywords provided by Children's Hospital Medical Center, Cincinnati:
Relapsed acute myeloid leukemia
non-therapy related acute myeloid leukemia
Refractory acute myeloid leukemia
Untreated acute myeloid leukemia
Lymphoma
Leukemia
Additional relevant MeSH terms:
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Burkitt Lymphoma
Lymphoma
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Lymphoma, Non-Hodgkin
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Lymphoma, Large B-Cell, Diffuse
Lymphoma, Large-Cell, Anaplastic
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Leukemia, Lymphoid
Lymphoma, B-Cell
Epstein-Barr Virus Infections
Herpesviridae Infections
DNA Virus Infections
Virus Diseases
Tumor Virus Infections
Lymphoma, T-Cell