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A Randomized Placebo-controlled Phase 2 Study of Decitabine With or Without Eltrombopag in AML Patients (DELTA)

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ClinicalTrials.gov Identifier: NCT02446145
Recruitment Status : Unknown
Verified January 2016 by Technische Universität Dresden.
Recruitment status was:  Recruiting
First Posted : May 18, 2015
Last Update Posted : January 6, 2016
Sponsor:
Collaborator:
Novartis
Information provided by (Responsible Party):
Technische Universität Dresden

Brief Summary:
Acute myeloid leukemia (AML) is a disease with a poor prognosis including a 5-year overall survival (OS) of app. 20% for the entire population. In particular, the outcome of elderly patients with AML is dismal and the majority of patients die within the first year after diagnosis. This is also because treatment options for elderly patients with AML significantly differ from patients of younger age. In fact, comorbid conditions are common among the elderly such as heart disease, renal insufficiency and vascular disease thus influencing the ability to withstand intensive therapy. Elderly patients are also more likely than younger patients to develop severe, life threatening infections during the course of treatment. In addition to infectious complications, hemorrhages due to severe thrombocytopenia are responsible for morbidity and mortality in a considerable amount of patients. Compared with younger AML patients, elderly individuals with AML display a higher incidence of poor-prognosis karyotypes, of a preceding myelodysplastic syndrome (MDS), and greater expression of proteins involved in intrinsic resistance to chemotherapeutic agents. As a result conventional anthracycline based chemotherapy is only infrequently used in patients above the age of 65 years. Based on a recent randomized trial (Kantarjian et al. 2012) low-intensity epigenetic therapy with decitabine (DAC) has become the first-line standard of care in most European countries including Germany. Nevertheless, even with this treatment the 1-year OS is approximately 30 % only. Furthermore, severe thrombocytopenia is a main side effect of this therapy and can prevent adequate continuation of treatment being crucially for treatment success. Supportive care with platelet transfusions is effective primarily only over short periods and often requires hospitalization and therefore lowers the quality of life of these patients in their palliative situation. Therefore, patients could benefit from an approach aiming at an increase of platelet counts through combined use of DAC with an oral thrombopoietin receptor agonist like eltrombopag (EPAG). This could allow for a better adherence to DAC therapy by preventing dose delays due to prolonged thrombocytopenia. Additionally, the potential antileukemic effect of EPAG could also be beneficial for these AML patients.

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia Drug: Eltrombopag Drug: Placebo Phase 2

Detailed Description:

The DELTA-trial is designed as a two-arm, double-blind, multicenter randomized-controlled phase- II study of EPAG or placebo in combination with standard-dose DAC treatment as concomitant medication in subjects at least 65 years of age with AML not eligible for intensive chemotherapy and planned therapy with Decitabine (DAC). Patients will be randomized 1:1 into the experimental study arm and the control study arm. EPAG 200 mg (100 mg for East Asian patients) once daily has been selected as the starting dose for this study because this regimen has been investigated to be safe and potentially effective in increasing platelet counts in patients with AML. Concomitant medication with DAC will be according to the european label and the summary of product characteristics. There will be a dose adjustment of EPAG depending on the platelet counts obtained on day 1 of a planned DAC cycle.

Concomitant medication will be Decitabine (DAC) 20 mg/m2 i.v. over 30 minutes on days 1-5 of each cycle. One cycle lasts 28 days. Patients will receive medication as long as they benefit from treatment and in the absence of relevant adverse events indicating a treatment discontinuation; but for a maximum of 12 cycles. During Follow Up (up to 4 years) patient survival and first treatment change will be observed.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 238 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized Placebo-controlled Phase 2 Study of Decitabine With or Without Eltrombopag in AML Patients ≥65 Years of Age Not Eligible for Intensive Chemotherapy
Study Start Date : May 2015
Estimated Primary Completion Date : May 2019
Estimated Study Completion Date : May 2019


Arm Intervention/treatment
Experimental: Experimental intervention arm

Eltrombopag daily from day 1: 200 mg/day p.o. (100 mg for east asian patients) dose modification 100 mg up to 300 mg/d p.o. (50 - 150 mg for east asian patients)

  • concomitant medication: Decitabine days 1-5 of each cycle: 20 mg/qm i.v. over 30 minutes
  • one cycle lasts 28 days
Drug: Eltrombopag

Patients will receive EPAG in addition to their background standard treatment with Decitabine

- concomitant medication: Decitabine days 1-5 of each cycle: 20 mg/qm i.v. over 30 minutes

Other Name: Revolade

Placebo Comparator: Control intervention arm

Placebo daily from day 1: 200 mg/day p.o. (100 mg for east asian patients) dose modification 100 mg up to 300 mg/d p.o. (50 - 150 mg for east asian patients)

  • concomitant medication: Decitabine days 1-5 of each cycle: 20 mg/qm i.v. over 30 minutes
  • one cycle lasts 28 days
Drug: Placebo

Patients will receive Placebo in addition to their background standard treatment with Decitabine

- concomitant medication: Decitabine days 1-5 of each cycle: 20 mg/qm i.v. over 30 minutes





Primary Outcome Measures :
  1. treatment change-free survival [ Time Frame: up to 4 years ]
    time from randomization until day one of the new disease modifying treatment or death as the primary endpoint of this study


Secondary Outcome Measures :
  1. overall survival [ Time Frame: up to 4 years ]
  2. relapse free survival [ Time Frame: up to 4 years ]
  3. overall response rate [ Time Frame: up to 4 years ]
  4. number of bone marrow blasts after 5, 9, and 12 months [ Time Frame: screening, month 5, 9 and 12 ]
  5. quality of life questionnaire (QLQ-C30) [ Time Frame: screening, month 1, 3, 6, 9, 12 ]
  6. Short Form questionnaire 36 (SF-36) [ Time Frame: screening, month 1, 3, 6, 9, 12 ]
  7. median platelet counts [ Time Frame: month 1 - 12 ]
  8. number of platelet transfusions [ Time Frame: month 1 - 4 ]
  9. incidence of serious adverse events (SAE) [ Time Frame: up to 4 years ]
    incidence of SAE including death, incidence of bleeding events and hospitalization rate and duration



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   65 Years and older   (Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Newly diagnosed AML (including therapy-related or with antecedent MDS) other than acute promyelocytic leukemia (APL) according to WHO criteria, i.e. bone marrow aspirate / biopsy or peripheral blood must contain ≥20% blasts in AML defined by cytogenetic aberrations according to WHO the proportion of blasts may be <20%
  • Age ≥ 65 years
  • Eastern Cooperative Oncology Group performance status (ECOG) 0-3
  • patients not eligible for intensive induction therapy (according to investigator's decision)
  • planned therapy with DAC
  • platelet count <75 Gpt/L taken within 4 weeks prior to randomization
  • adequate liver function as assessed by the following laboratory requirements during screening (within 4 weeks prior to study inclusion):

    • Total bilirubin ≤ 3 times the upper limit of normal (except for Gilbert's Syndrome)
    • Alanine transaminase (ALAT) and Aspartate transaminase (ASAT) ≤ 3 times upper limit of normal
  • signed Informed Consent

Exclusion Criteria:

  • acute promyelocytic leukemia (APL)
  • history of higher-risk MDS or AML treatment with thrombopoietin receptor (TPO-R) agonists, hypomethylating agents or intensive chemotherapy
  • substance abuse, medical, psychological or social conditions that may interfere with the patient's participation in the study or evaluation of the study results
  • treatment with an investigational drug within 30 days or 5 half-lives (whichever is longer) preceding to first dose of study mediation
  • uncontrolled active infection
  • New York Heart Association (NYHA) stage ≥ 2 due to heart insufficiency
  • positive Human Immunodeficiency Virus (HIV) or Hepatitis B / C serology
  • patients unable to swallow medication
  • known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to EPAG or DAC or excipients that contraindicates their participation

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): NCT02446145


Contacts
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Contact: Julia Kalinka 0351 458 3089

Locations
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Germany
Uniklinik RWTH Aachen Recruiting
Aachen, Germany
Contact: Martina Crysandt, MD         
Charite Campus Benjamin Franklin Not yet recruiting
Berlin, Germany
Contact: Claudia Baldus, Prof.         
Klinikum Chemnitz GmbH Recruiting
Chemnitz, Germany
Contact: Mathias Hänel, MD         
Universitätsklinikum Dresden Recruiting
Dresden, Germany
Contact: Uwe Platzbecker, Prof.         
Marienhospital Düsseldorf GmbH Not yet recruiting
Düsseldorf, Germany
Contact: Aristoteles Giagounidis, MD         
Universitätsklinikum Essen Recruiting
Essen, Germany
Contact: Richard Noppeney, MD         
Universitätsklinikum Halle (Saale) Recruiting
Halle, Germany
Contact: Petra Tschanter, MD         
St. Marien-Hospital Hamm Not yet recruiting
Hamm, Germany
Contact: Heinz A Dürk, MD         
Klinikum rechts der Isar der TU München Not yet recruiting
München, Germany
Contact: Katharina Götze, MD         
Klinikum Nürnberg-Nord Recruiting
Nürnberg, Germany
Contact: Kerstin Schäfer-Eckart, MD         
Medizinisches Versorgungszentrum für Blut- und Krebserkrankungen Recruiting
Potsdam, Germany
Contact: Hartmut Linde, MD         
Wissenschaftskontor Nord GmbH & Co KG Not yet recruiting
Rostock, Germany
Contact: Andreas Lück, MD         
Diakonie-Klinikum Schwäbisch Hall gGmbH Recruiting
Schwäbisch Hall, Germany
Contact: Thomas Geer, MD         
Rems-Murr-Klinikum Winnenden Recruiting
Winnenden, Germany
Contact: Stefani Parmentier, MD         
Universitätsklinikum Würzburg Not yet recruiting
Würzburg, Germany
Contact: Volker Kunzmann, Prof.         
Sponsors and Collaborators
Technische Universität Dresden
Novartis
Investigators
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Principal Investigator: Uwe Platzbecker, Prof. Universitätsklinikum Dresden Medizinische Klinik und Poliklinik I

Additional Information:
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Responsible Party: Technische Universität Dresden
ClinicalTrials.gov Identifier: NCT02446145    
Other Study ID Numbers: TUD-DELTA1-063
2014-003150-13 ( EudraCT Number )
First Posted: May 18, 2015    Key Record Dates
Last Update Posted: January 6, 2016
Last Verified: January 2016
Additional relevant MeSH terms:
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Decitabine
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors