Vincristine Sulfate Liposome Injection (Marqibo®) in Combination With UK ALL R3 Induction Chemotherapy for Children, Adolescents, and Young Adults With Relapsed ALL

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02879643
Recruitment Status : Recruiting
First Posted : August 26, 2016
Last Update Posted : July 2, 2018
Spectrum Pharmaceuticals, Inc
Information provided by (Responsible Party):
Therapeutic Advances in Childhood Leukemia Consortium

Brief Summary:
This is a pilot study utilizing Marqibo® (vincristine sulfate liposome injection) combined with dexamethasone, mitoxantrone and asparaginase (UK ALL R3) for relapsed acute lymphoblastic leukemia (ALL).

Condition or disease Intervention/treatment Phase
ALL, Childhood Lymphoblastic Leukemia, Acute, Childhood Lymphoblastic Leukemia, Acute Drug: Marqibo in combination with UK ALL R3 Phase 1

Detailed Description:
This study will utilize Marqibo® as a replacement for standard vincristine in combination with UK ALL R3 induction for children with relapsed ALL. The hypothesis is that the incorporation of Marqibo® with combination chemotherapy will be safe and feasible. In the context of this pilot study, overall outcomes and efficacy will be a secondary objective. It is hypothesized that data from this combination may show improved efficacy including, complete remission (CR), minimal residual disease (MRD) negativity, and progression free survival (PFS) rates and safety (i.e., neurotoxicity) in comparison to outcomes in historical regimens, including the UK ALL R3 with standard vincristine.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Pilot Study of Vincristine Sulfate Liposome Injection (Marqibo®) in Combination With UK ALL R3 Induction Chemotherapy for Children, Adolescents, and Young Adults With Relapse of Acute Lymphoblastic Leukemia
Actual Study Start Date : January 31, 2017
Estimated Primary Completion Date : August 31, 2020
Estimated Study Completion Date : May 1, 2021

Arm Intervention/treatment
A multistage open label design
A multistage open label design over two Marqibo® dose levels will be used.
Drug: Marqibo in combination with UK ALL R3
The first six subjects treated on this protocol will be treated at Marqibo® Dose Level 1 (1.5 mg/m2/dose (no dose cap). Once safety is established at this dose, a dose escalation will be performed to Dose Level 2 (2.0 mg/m2/dose, no dose cap). There will be no intrapatient dose escalation or de-escalation. Only 1 course of treatment will be permitted.
Other Name: Marqibo in combination with UK ALL R3 Chemotherapy

Primary Outcome Measures :
  1. Number of Participants with Dose Limiting Toxicities as a Measure of Safety and Tolerability [ Time Frame: 5 weeks ]
    The incidence of dose limiting toxicity (DLT) will be measured at different dose levels.

Secondary Outcome Measures :
  1. The response rate after treatment. [ Time Frame: Approx. 8 weeks ]
    The rate of remission will be assessed after 1 courses of therapy. A bone marrow aspirate/biopsy and CBC will be conducted to assess response.

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Ages Eligible for Study:   1 Year to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Eligibility Criteria

Age Patients must be ≥ 1 and ≤ 21 years of age at the time of enrollment.

Diagnosis Patients must have a diagnosis of acute lymphoblastic leukemia (ALL) with ≥ 5% blasts in the bone marrow (M2 or M3), with or without extramedullary disease (excluding active Central Nervous System 3 involvement).

Subjects with first relapse must have an M3 marrow to be eligible.

Performance Level Karnofsky > 50% for patients > 16 years of age and Lansky > 50% for patients ≤ 16 years of age.

Prior Therapy

  1. Patients must have recovered from the acute toxic effects (≤ Grade 2 or baseline) of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study, unless otherwise specified. Subjects with disease related cytopenias will be eligible.
  2. Patients must have relapsed disease after attaining at least a first remission. They may be in first to third relapse.
  3. Patients with Philadelphia chromosome t(9;22) positive disease must have received at least two prior tyrosine kinase inhibitors.
  4. Patients who have experienced their relapse after a Hematopoietic stem cell transplantation (HSCT) are eligible, provided they have no evidence of graft-versus-host disease (GVHD) and are at least 100 days post-transplant at the time of enrollment.
  5. Prior anthracycline lifetime cumulative exposure: Patients must have less than 320 mg/m2 (or 400 mg/m2 if prior cardioprotection) lifetime exposure of anthracycline chemotherapy.
  6. Hematopoietic growth factors: It must have been at least seven days since the completion of therapy with granulocyte colony-stimulating factor (GCSF) or other growth factors at the time of enrollment. It must have been at least 14 days since the completion of therapy with pegfilgrastim (Neulasta®).
  7. Biologic anti-neoplastic agents: At least seven days after the last dose of a biologic agent. For agents that have known adverse events occurring beyond seven days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair or vice chair.
  8. Monoclonal antibodies: At least three half-lives (or 30 days—whichever is longer) of the antibody must have elapsed after the last dose of monoclonal antibody. (e.g., Rituximab = 66 days, Epratuzumab = 69 days)
  9. Immunotherapy: At least 30 days after the completion of any type of immunotherapy, e.g. tumor vaccines, chimeric antigen receptor T-cells.
  10. Recent prior chemotherapy: At least 14 days after standard vincristine and the completion of any type of chemotherapy induction regimen. At least 3 weeks after radiation therapy. At least 30 days after the completion of any investigational neoplastic agent is also required. An investigational agent is defined as any drug that is not approved and licensed for sale by the FDA for institutions in the United States, by Health Canada for institutions in Canada and by The Therapeutic Goods Administration for institutions in Australia.


  1. There is no time restriction in regard to prior intrathecal chemotherapy provided there is complete recovery from any acute toxic effects of such; it is allowable to enroll a patient that has received IT Cytarabine (ARA-C), IT Methotrexate (MTX) or triple IT therapy within 14 days of enrollment as part of their evaluation to diagnose disease relapse. The IT therapy given within 14 days of initiation of protocol specified chemotherapy, will substitute for the day 1 IT.
  2. Subjects with rapidly progressive disease may receive hydroxyurea until they begin study therapy;
  3. Patients who relapse while on maintenance-type ALL therapy or are receiving maintenance therapy for disease stabilization will not require a wash-out period before entry into this study. However, there must be at least 14 days after any dose of standard vincristine.

Renal and Hepatic Function

  1. Renal function: Patient's serum creatinine must be ≤ 1.5 x institutional upper limit of normal (ULN) according to age. If the serum creatinine is greater than 1.5 times normal, the patient must have a calculated creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 70milliliter/min/1.73m2. Alternatively, a 24-hour creatinine clearance may also be used.
  2. Hepatic function: alanine aminotransferase (ALT) and aspartate aminotransferase (AST) must be < 3 x institutional upper limit of norm ULN. Total bilirubin must be ≤ 1.5 x ULN (except in the case of subjects with documented Gilbert's disease ≤ 5 × ULN).

Cardiac Function Patients must have a shortening fraction ≥ 27% or an ejection fraction ≥ 55% by echocardiogram, cardiac MRI or multigated acquisition scan (MUGA).

Reproductive Function

  1. Female patients must not be pregnant and those of childbearing potential must have a negative urine or serum pregnancy test confirmed within one week prior to enrollment.
  2. Female patients with infants must agree not to breastfeed their infants while on this study.
  3. Male and female patients of childbearing potential must agree to use an effective method of contraception during the study.

Exclusion Eligibility Criteria

Patients will be excluded if they have active Central Nervous System (CNS) 3 status.

Patients will be excluded if they have isolated testicular disease.

Patients with biphenotypic leukemia will be excluded.

Patients will be excluded if they have refractory disease or fourth relapse and beyond, defined as any of the following:

  1. Patients with four or more prior induction attempts,
  2. Refractory disease after first or greater relapse and a re-induction attempt,
  3. Failing to go into remission from original diagnosis after two previous induction attempts.

Patients will be excluded if they have previously received Marqibo®.

Patients will be excluded if they have a known allergy to any of the drugs used in the study, with the exception that patients with an allergy to PEG-asparaginase who can receive Erwinia are eligible.

Patients will be excluded if they have active, uncontrolled systemic fungal, bacterial, viral or other infection despite appropriate antibiotics or other treatment.

Patients who require azole antifungal agents will be excluded. Azoles must be discontinued at least one week prior to the start of Marqibo®.

Patients will be excluded if there is a plan to administer non-protocol chemotherapy, radiation therapy, another investigational agent or immunotherapy during the study period.

Patients with pre-existing, persistent grade 2 or greater sensory or motor neuropathy from any cause will be excluded.

Patients will be excluded if they have Down syndrome, significant concurrent disease, illness, psychiatric disorder or social issue that would compromise patient safety or adherence with the protocol treatment or procedures or interfere with consent, study participation, follow up, or interpretation of study results.

Patients positive for human immunodeficiency virus (HIV) will be excluded due to the increased risk of complications such as severe infection and unknown interaction of Marqibo® with antiretroviral drugs.

Active hepatitis B or C infection as defined by seropositive for hepatitis B (hepatitis B surface antigen (HBsAg)) or hepatitis C and elevated liver transaminases (defined as above the ULN per the institution normal ranges).

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 identifier (NCT number): NCT02879643

Contact: Ellynore Florendo (323) 361- 3022
Contact: Lei-Lani Miller (323) 361-5429

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Sponsors and Collaborators
Therapeutic Advances in Childhood Leukemia Consortium
Spectrum Pharmaceuticals, Inc

Responsible Party: Therapeutic Advances in Childhood Leukemia Consortium Identifier: NCT02879643     History of Changes
Other Study ID Numbers: T2012-002
First Posted: August 26, 2016    Key Record Dates
Last Update Posted: July 2, 2018
Last Verified: June 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Acute Disease
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Disease Attributes
Pathologic Processes
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action