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Trial record 19 of 448 for:    "Juvenile myelomonocytic leukemia"

Guadecitabine and Atezolizumab in Treating Patients With Advanced Myelodysplastic Syndrome or Chronic Myelomonocytic Leukemia That Is Refractory or Relapsed

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ClinicalTrials.gov Identifier: NCT02935361
Recruitment Status : Recruiting
First Posted : October 17, 2016
Last Update Posted : July 3, 2018
Sponsor:
Collaborators:
National Cancer Institute (NCI)
Van Andel Research Institute
Information provided by (Responsible Party):
University of Southern California

Brief Summary:
This phase I/II trial studies the side effects and best dose of guadecitabine when given together with atezolizumab and to see how well they work in treating patients with myelodysplastic syndrome or chronic myelomonocytic leukemia that has spread to other places in the body and has come back or does not respond to treatment. Guadecitabine may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as atezolizumab, may interfere with the ability of cancer cells to grow and spread. Giving guadecitabine and atezolizumab may work better in treating patients with myelodysplastic syndrome or chronic myelomonocytic leukemia.

Condition or disease Intervention/treatment Phase
Chronic Myelomonocytic Leukemia Myelodysplastic Syndrome Recurrent Acute Myeloid Leukemia With Myelodysplasia-Related Changes Drug: Atezolizumab Drug: Guadecitabine Phase 1 Phase 2

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 72 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I/II Multicenter Study Combining Guadecitabine, a DNA Methyltransferase Inhibitor, With Atezolizumab, an Immune Checkpoint Inhibitor, in Patients With Intermediate or High-Risk Myelodysplastic Syndrome or Chronic Myelomonocytic Leukemia
Actual Study Start Date : November 2, 2016
Estimated Primary Completion Date : November 2, 2020
Estimated Study Completion Date : November 2, 2021


Arm Intervention/treatment
Experimental: Treatment (guadecitabine, atezolizumab)
Patients receive guadecitabine SC on days 1-5 and atezolizumab IV over 30-60 minutes on days 8 and 22. Courses repeat every 28 days for up to 24 months in the absence of disease progression or unacceptable toxicity.
Drug: Atezolizumab
Given IV
Other Names:
  • MPDL 3280A
  • MPDL 328OA
  • MPDL-3280A
  • MPDL3280A
  • MPDL328OA
  • RG7446
  • RO5541267
  • Tecentriq

Drug: Guadecitabine
Given SC
Other Names:
  • DNMT inhibitor SGI-110
  • S110
  • SGI-110




Primary Outcome Measures :
  1. Incidence of dose-limiting toxicities evaluated according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase I) [ Time Frame: Up to 56 days ]
    Descriptive summaries and analyses of CTCAE 4.0 toxicities that occur will be produced, both by patient and by cycle.

  2. Overall response (complete response [CR] + partial response + marrow CR + hematological improvement) (Phase II) [ Time Frame: Up to 168 days ]

Secondary Outcome Measures :
  1. Incidence of grade 3 or higher adverse events and grade 2 toxicities that do not resolve after 3 weeks assessed by CTCAE 4.0 [ Time Frame: Up to 8 weeks ]
    Descriptive summaries of toxicities that occur will be produced, both by patient and by course.

  2. Overall response rate (Phase II) [ Time Frame: Up to 4 years ]
  3. Overall survival [ Time Frame: From start of treatment to death from any cause, assessed up to 4 years ]
    Will be analyzed using survival analysis methods.

  4. Percentage of patients who were transfusion-dependent on study entry who become transfusion-independent [ Time Frame: Up to 4 years ]
  5. Progression free survival [ Time Frame: From start of treatment to the first disease progression or recurrence, assessed up to 4 years ]
    Will be analyzed using survival analysis methods.

  6. Time to best response [ Time Frame: Up to 4 years ]
    Will be analyzed using survival analysis methods.


Other Outcome Measures:
  1. Degree of PD-L1 expression assessed in bone marrow, T cells, and malignant cells by immunohistochemistry or flow cytometry [ Time Frame: Up to 4 years ]
  2. PD-1 expression by T cells and malignant cells [ Time Frame: Up to 4 years ]
    Relationship of PD-1/PD-L1 expression to efficacy endpoints will be explored.

  3. Percentage of T cells expressing PD-1/methylation levels [ Time Frame: Up to 4 years ]
  4. T-cell antigen recognition in MDS blood and bone marrow [ Time Frame: Up to 4 years ]
    Relationship of T-cell antigen recognition to efficacy endpoints will be explored.

  5. T-cell subset combinations in MDS blood and bone marrow [ Time Frame: Up to 4 years ]
    Relationship of T-cell subset combination to efficacy endpoints will be explored.

  6. Tumor antigen expression on MDS blasts [ Time Frame: Up to 4 years ]
    Relationship of tumor expression to efficacy endpoints will be explored.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Phase I: Adult subjects with advanced MDS requiring therapy who were previously treated with either azacitidine or decitabine for at least 4 cycles and deemed to have failed therapy due to progression of disease using International Working Group (IWG) criteria ("refractory") or losing their previously documented response to the therapy ("relapsed")
  • Phase II: Adult subjects with advanced MDS requiring therapy who were previously treated with either azacitidine or decitabine for at least 4 cycles and deemed to have failed therapy due to progression of disease using IWG criteria ("refractory") or losing their previously documented response to the therapy ("relapsed")
  • MDS should be classified as:

    • Intermediate 1-risk or higher risk according to the international prognostic scoring system (IPSS) or revised IPSS
    • Chronic myelomonocytic leukemia (CMML)
  • During the 8 weeks prior to inclusion in study, subjects must have a baseline bone marrow examination including all of the following:

    • Cytomorphology to confirm bone marrow blasts;
    • Cytogenetics; AND
    • Eastern Cooperative Oncology Group (ECOG) status 0-2
  • Subject is able to understand and willing to comply with protocol requirements and instructions
  • Subject has signed and dated informed consent
  • Total bilirubin (except for Gilbert's syndrome) =< 2.5 x upper limit of normal (ULN)
  • Aspartate aminotransferase (ALT) and alanine aminotransferase (AST) =< 3 x ULN
  • Creatinine =< 2.5 x ULN
  • For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 90 days after the last dose of atezolizumab

    • A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (>= 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus)
    • Examples of contraceptive methods with a failure rate of < 1% per year include bilateral tubal ligation, male sterilization, proper use of hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices
    • The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient; periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception
  • For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating sperm, as defined below:

    • With female partners of childbearing potential, men must remain abstinent or use a condom plus an additional contraceptive method that together result in a failure rate of < 1% per year during the treatment period and for at least 120 days after the last dose of guadecitabine; men must refrain from donating sperm during this same period
    • With pregnant female partners, men must remain abstinent or use a condom during the treatment period and for at least 30 days after the last dose of guadecitabine to avoid exposing the embryo
    • The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient; periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception
  • Women of childbearing potential (WOCBP) must have a negative serum test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) within 72 hours prior to the start of investigational product

Exclusion Criteria:

  • Any active history of a known autoimmune disease; subjects with vitiligo, type 1 diabetes mellitus, residual hypothyroidism requiring hormone replacement, or conditions not expected to recur in the absence of an external trigger are permitted to enroll
  • Subjects with a history of interstitial lung disease; patients requiring continuous supplemental oxygen are excluded to avoid possible complications from pneumonitis
  • History of idiopathic pulmonary fibrosis, organizing pneumonitis (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis
  • Patients who are actively receiving any other anticancer therapy
  • Patients with a history of allergic reactions attributed to compounds of similar chemical or biologic composition to HMAs
  • Patients with a diagnosis of acute myeloid leukemia (AML) not transformed from MDS or transformed from MDS with > 30% blasts in bone marrow or white blood cells (WBC) > 25 x 10^3/L
  • Patients with short life expectancy (less than 3 months) due to comorbidity other than MDS
  • Female subjects who are nursing or pregnant (positive serum or urine beta-human chorionic gonadotropin [B-hCG] pregnancy test)
  • Patients with current alcohol or drug abuse
  • Patients who have received treatment with an investigational drug within 30 days preceding the first dose of study medication
  • Patients with uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements

    • Patients with prior infections must be afebrile for >= 72 hours and completed any antibiotics prior to receiving study drug
    • In patients who received IV antibiotics for active infection, a washout period of 14 days is required prior to initiating study therapy (exception: patients with febrile neutropenia in whom no infectious etiology has been determined/documented)
    • Patients receiving chronic antimicrobial prophylaxis therapy (e.g. antifungal prophylaxis) may be included in the study provided there is no active infection
  • Patients infected with hepatitis B, C or human immunodeficiency virus (HIV), unless they are on stable and effective antiviral treatment

    • Serious infection requiring oral or IV antibiotics/antifungals/antivirals and/or hospitalization within 28 days prior to screening
    • Patients on prophylactic oral antibiotics, antifungals and antivirals due to prolonged neutropenia in the absence of documented infection are eligible
    • Patients who are treated with IV antibiotics for neutropenic fever, are eligible if no infectious etiology was determined and the last dose of antibiotics was >= 7 days from cycle 1, day 1
    • Patients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of randomization. Inhaled or topical steroids and adrenal replacement steroid doses > 10 mg daily prednisone equivalent, are permitted in the absence of uncontrolled autoimmune disease
  • Medication-related exclusion criteria
  • Prior treatment with anti−PD-1, or anti−PD-L1 therapeutic antibody or pathway-targeting agents
  • Prior treatment with anti−cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) therapeutic agents (e.g. ipilimumab)
  • Treatment with systemic immunostimulatory agents (including but not limited to interferon [IFN]-alpha or interleukin [IL]-2) within 6 weeks or five half-lives of the drug (whichever is shorter) prior to cycle 1, day 1
  • Treatment with any investigational agent within 4 weeks prior to cycle 1, day 1 (or within five half-lives of the investigational product, whichever is longer)
  • Treatment with systemic immunosuppressive medications (including but not limited to prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) within 2 weeks prior to cycle 1, day 1
  • Patients who have received acute, low-dose, systemic immunosuppressant medications may be enrolled
  • The use of inhaled corticosteroids and mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed
  • History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
  • Patients with prior allogeneic bone marrow transplantation or prior solid organ transplantation

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): NCT02935361


Contacts
Contact: Ibrahim Syed 323-865-3928 Ibrahim.Syed@med.usc.edu

Locations
United States, California
USC / Norris Comprehensive Cancer Center Recruiting
Los Angeles, California, United States, 90033
Contact: Casey L. O'Connell    323-865-3950    coconnel@usc.edu   
Principal Investigator: Casey L. O'Connell         
United States, Maryland
University of Maryland Medical Center Not yet recruiting
Baltimore, Maryland, United States, 21201
Contact: Maria R. Baer       MBaer@umm.edu   
Principal Investigator: Maria R. Baer         
United States, Pennsylvania
Fox Chase Cancer Center Recruiting
Philadelphia, Pennsylvania, United States, 19111
Contact: Patricia L. Kropf, MD    215-214-3119    Patricia.Kropf@tuhs.temple.edu   
Contact: Lilanee Chanyothi, RN    215-214-3035    Lilanee.Chanyothi@tuhs.temple.edu   
Principal Investigator: Patricia L. Kropf, MD         
Temple University Hospital Not yet recruiting
Philadelphia, Pennsylvania, United States, 19140
Contact: Patricia L. Kropf       Patricia.Kropf@tuhs.temple.edu   
Principal Investigator: Patricia L. Kropf         
Sponsors and Collaborators
University of Southern California
National Cancer Institute (NCI)
Van Andel Research Institute
Investigators
Principal Investigator: Casey O'Connell University of Southern California

Responsible Party: University of Southern California
ClinicalTrials.gov Identifier: NCT02935361     History of Changes
Other Study ID Numbers: 9L-16-3
NCI-2016-01233 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
9L-16-3 ( Other Identifier: USC / Norris Comprehensive Cancer Center )
P30CA014089 ( U.S. NIH Grant/Contract )
First Posted: October 17, 2016    Key Record Dates
Last Update Posted: July 3, 2018
Last Verified: June 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
Syndrome
Leukemia
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Preleukemia
Leukemia, Myelomonocytic, Acute
Leukemia, Myelomonocytic, Chronic
Leukemia, Myelomonocytic, Juvenile
Disease
Pathologic Processes
Neoplasms by Histologic Type
Neoplasms
Leukemia, Myeloid
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Myelodysplastic-Myeloproliferative Diseases
Atezolizumab
Azacitidine
Antibodies, Monoclonal
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Enzyme Inhibitors