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Low-dose AZA, Pioglitazone, ATRA Versus Standard-dose AZA in Patients >=60 Years With Refractory AML (AML-ViVA)

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: NCT02942758
Recruitment Status : Recruiting
First Posted : October 24, 2016
Last Update Posted : October 11, 2018
Anticancer Fund, Belgium
Information provided by (Responsible Party):
Simone Thomas, University Hospital Regensburg

Brief Summary:

Diagnosis: Acute myeloid leukemia refractory to intensive induction chemotherapy; Age ≥ 60 years, no upper age limit; Study drug: low-dose azacitidine, pioglitazone, ATRA; Safety Run-In Phase; randomized Phase II, open-label

  • Safety Run-In Phase: Based on a 3 + 3 modified design, the tolerable dose of ATRA for the randomized phase II is defined.
  • Phase II: Experimental Arm: low-dose azacitidine, pioglitazone, ATRA; Standard Arm: standard-dose azacitidine; in both arms patients can receive further cycles (with no limit to the number given) as long as clinically appropriate

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia Drug: low-dose Azacitidine Drug: Pioglitazone Drug: ATRA Drug: standard-dose AZA Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 94 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized Phase II Trial With Safety run-in Phase Evaluating Low-dose AZA, ATRA and Pioglitazone Versus Standard Dose Azacitidine in Patients >=60 Years With AML Who Are Refractory to Standard Induction Chemotherapy
Actual Study Start Date : April 10, 2017
Estimated Primary Completion Date : February 2020
Estimated Study Completion Date : February 2020

Arm Intervention/treatment
Experimental: low-dose AZA / ATRA / Pioglitazone
low-dose azacitidine (75 mg/d), ATRA, pioglitazone
Drug: low-dose Azacitidine
Azacitidine 75 mg/d s.c. for 7 days, repeated 28-day treatment cycle
Other Name: Vidaza

Drug: Pioglitazone
Pioglitazone 45 mg p.o. continuously from day 1
Other Name: Actos

Drug: ATRA
ATRA *45 mg/m² p.o. from day 1 to 28, 15 mg/m² from day 29 continuously; *this regimen will be chosen for the first dose to be evaluated.
Other Name: All-trans-retinoic acid; Vesanoid

Active Comparator: standard-dose AZA
standard-dose azacitidine (75mg/m²/d)
Drug: standard-dose AZA
Azacitidine 75 mg/m²/d s.c. for 7 days, repeated 28-day treatment cycle
Other Name: Vidaza

Primary Outcome Measures :
  1. overall Survival [ Time Frame: 3 years ]

Secondary Outcome Measures :
  1. complete remission (CR) rate [ Time Frame: 3 years ]
  2. complete remission with incomplete blood count recovery (CRi) rate [ Time Frame: 3 years ]
  3. partial remission (PR) rate [ Time Frame: 3 years ]
  4. hematological improvement (HI) rate [ Time Frame: 3 years ]
  5. cumulative incidence of relapse (CIR) [ Time Frame: 3 years ]
  6. cumulative incidence of death (CID) [ Time Frame: 3 years ]
  7. cumulative incidence of relapse event free survival (EFS) [ Time Frame: 3 years ]
  8. event free survival (EFS) [ Time Frame: 3 years ]
  9. Quality of Life (QLQ-C30) [ Time Frame: 3 years ]
  10. Incidence and intensity of adverse events (AEs) [ Time Frame: 3 years ]

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

Inclusion Criteria:

  1. Patients with confirmed diagnosis of acute myeloid leukemia (AML) who are refractory* to induction therapy and not eligible for further intensive induction therapy based on documented medical reasons (e.g. disease characteristics or patient characteristics), or
  2. Patients with confirmed diagnosis of acute myeloid leukemia (AML) who are refractory* to induction therapy and not immediate candidates for allogeneic HSCT (bridge to transplant is allowed)

    *refractory to induction therapy is defined as no CR, no CRi and no PR (according to standard criteria, see Section 11.2.3) after at least one intensive induction therapy including at least 5 days of cytarabine 100-200 mg/m² continuously or an equivalent regimen with cytarabine with total dose not less than 500 mg/m² per cycle and at least 2 days of an anthracycline (e.g. daunorubicin, idarubicin).

  3. Age ≥ 60; no upper age limit
  4. ECOG performance status of ≤ 2 at screening
  5. To control hyperleukocytosis or extramedullary involvement, medication with hydroxyurea is allowed up to 24h before start of study treatment. In case of hyperleukocytosis hydroxyurea should be given and start of study treatment should be delayed until leukocyte counts are < 20 x 10^9/L.
  6. Female subjects of childbearing potential* may participate, providing they meet the following conditions:

    • Have a negative pregnancy test (serum or urine with a sensitivity of at least 25 mIU/mL; local laboratory) within 72 hours prior to starting study therapy. They must agree to ongoing pregnancy testing during the course of the study, and after end of study therapy. This applies even if the subject practices true abstinence** from heterosexual contact.
    • Agree to practice true abstinence** from heterosexual contact (which must be reviewed on a monthly basis) or agree to use, and be able to comply with two effective methods of contraception (e.g., oral, injectable, or implantable hormonal contraceptive; tubal ligation; intra-uterine device; barrier contraceptive with spermicide; or vasectomized partner) without interruption during the study therapy (including dose interruptions), and for 3 months after discontinuation of study drugs.

      • A female subject of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months).

        • True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence (eg, calendar, ovulation, symptothermal, postovulation methods) and withdrawal are not acceptable methods of contraception.
  7. Male patients with a female partner of childbearing potential must agree to abstain from sexual intercourse or to the use of at least two effective contraceptive methods (e.g., synthetic condoms with spermicide, etc) at screening and throughout the course of the study and should avoid fathering a child during the course of the study and for 3 months following the last study treatment.
  8. Signed written informed consent.

Exclusion Criteria:

  1. Known or suspected hypersensitivity to the study drugs and/or any excipients
  2. Patients with acute promyelocytic leukemia exhibiting t(15;17)(q22;q12); PML-RARA, or with variant translocations
  3. Acute myeloid leukemia (AML) with isocitratdehydrogenase (IDH) 1 or 2 mutations if results are available from the central AMLSG reference laboratories
  4. ECOG performance status > 2
  5. Inadequate cardiac, hepatic and/or renal function at Screening Visit defined as:

    1. heart failure NYHA II-IV
    2. unstable angina pectoris
    3. total bilirubin, ALT, AST > 2.5 x upper normal serum level
    4. Creatinine > 1.5 x upper normal serum level
  6. Active central nervous system involvement
  7. Uncontrolled infection
  8. Uncontrolled diabetes mellitus
  9. Patients with a "currently active" second malignancy requiring active therapy other than non-melanoma skin cancers (except for hormonal/antihormonal treatment, e.g. in prostate or breast cancer)
  10. Patients with "currently active" bladder cancer or bladder cancer in their history, patients with risk factors for bladder cancer (e.g. exposure to aromatic amines or heavy tobacco smoker), or macrohematuria of unknown origin
  11. Severe neurological or psychiatric disorder interfering with ability of giving an informed consent
  12. Known or suspected active alcohol or drug abuse
  13. Known positive for HIV, active HBV or HCV infection
  14. No consent for registration, storage and processing of the individual disease characteristics and course as well as information of the family physician and/or other physicians involved in the treatment of the patient about study participation.
  15. Treatment with any other clinical study drug within 14 days before the first administration of the investigational drugs or at any time during the study
  16. Breast feeding woman or women with a positive pregnancy test at Screening Visit
  17. Male patients with a female partner of childbearing potential not willing to abstain from sexual intercourse or to the use of at least two effective contraceptive methods (e.g., synthetic condoms with spermicide, etc) at screening and throughout the course of the study and for 3 months following the last study treatment.

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): NCT02942758

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Contact: Simone Thomas, PD Dr. +49-941-9440

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University Hospital Regensburg Recruiting
Regensburg, Germany, 93053
Sponsors and Collaborators
University Hospital Regensburg
Anticancer Fund, Belgium
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Principal Investigator: Simone Thomas, Dr. University Hospital Regensburg

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Simone Thomas, Dr. med., University Hospital Regensburg Identifier: NCT02942758    
Other Study ID Numbers: AMLSG26-16
First Posted: October 24, 2016    Key Record Dates
Last Update Posted: October 11, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors
Hypoglycemic Agents
Physiological Effects of Drugs