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Pembrolizumab and Decitabine for Refractory or Relapsed Acute Myeloid Leukemia

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ClinicalTrials.gov Identifier: NCT02996474
Recruitment Status : Active, not recruiting
First Posted : December 19, 2016
Last Update Posted : November 22, 2018
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Heart, Lung, and Blood Institute (NHLBI) )

Brief Summary:

Background:

Acute myeloid leukemia (AML) is a cancer of the white blood cells. It is fatal if not treated. Treatment for AML that has not responded to treatment (refractory) or has returned after treatment (relapsed) often do not work. Researchers want to see if an immunotherapy drug, combined with a less intense chemotherapy, may be able to help.

Objective:

To test if pembrolizumab, in combination with decitabine, is a possible treatment for people with relapsed or refractory AML.

Eligibility:

Adults 18 years of age and older with refractory AML or relapsed AML.

Design:

Participants will be first screened for eligibility.

The study is counted in 21-day cycles. The initial phase of the study consists of 8 cycles. Participants may be in the study for up to 2 years if they are responding to the treatment.

The first 3 weeks of treatment is usually done in the hospital. The rest may be done as an outpatient.

Participants will get pembrolizumab at the beginning of each cycle through an IV.

Participants will usually get decitabine by IV on days 8 12 and days 15 19 of every other cycle.

Participants will give blood samples.

Participants will have bone marrow exams. A needle will be inserted into the hip to extract cells from the bone marrow.

Some participants may give a sample of saliva from the inside of their cheek.

Some participants may give a small skin sample. The top layer of the skin is removed.

Some patients may require leukapheresis before starting treatment. This is a procedure to remove leukemia cells in the blood stream.


Condition or disease Intervention/treatment Phase
Relapsed Acute Myeloid Leukemia Drug: Pembrolizumab Drug: Decitabine Phase 1 Phase 2

Detailed Description:
This is a pilot study to determine the feasibility of a novel combination of Pembrolizumab and Decitabine in relapsed/refractory adult AML patients. While both Pembrolizumab and Decitabine are FDA approved agents, this study will explore giving these drugs in combination for this population of patients.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 10 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pembrolizumab and Decitabine for Refractory or Relapsed Acute Myeloid Leukemia
Study Start Date : December 16, 2016
Estimated Primary Completion Date : July 1, 2019
Estimated Study Completion Date : July 1, 2019


Arm Intervention/treatment
Experimental: Single
Up to eight cycles of pembrolizumab will be given during the initial induction phase. Each cycle is 21 days.Decitabine will ordinarily be given on days 8 through 12 and 15 through 19 on alternative cycles (ie: cycles 1, 3, 5 and 7).
Drug: Pembrolizumab
200 mg will be administered as a 30 minute IV infusion every 3 weeks. Every effort should be made to target infusion timing to be as close to 30 minutes as possible. However, given the variability of infusion pumps, a window of -5 minutes and +10 minutes is permitted (i.e., infusion time is 30 minutes: -5 min/+10 min).

Drug: Decitabine
Will be administered at a dose of 20 mg/m2 by continuous intravenous infusion over 1 hour repeated daily ordinarily on days 8 through 12 and 15 through 19 of alternative cycles (ie: cycles 1, 3, 5, 7). Decitabine should be repeated every 6 weeks.




Primary Outcome Measures :
  1. Feasibility [ Time Frame: 8 cycles ]
    The primary aim is to assess the feasibility of this novel pembrolizumab and decitabine combination in this patient population.


Secondary Outcome Measures :
  1. Efficacy [ Time Frame: 8 cycles plus 30 days after last dose ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 99 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Unequivocal diagnosis of relapsed or refractory acute myeloid leukemia (AML) confirmed by an NIH attending pathologist within 30 days of study enrollment (includes residual AML as confirmed by institutional standards by NIH pathologists
  • Received at least one prior AML therapy before study enrollment.
  • Ability to comprehend the investigational nature of the study and provide informed consent.
  • Be at least 18 years of age on day of signing informed consent.
  • Availability of a physician willing to assume clinical care after completion of the study.
  • Be willing to provide blood and bone marrow for research as described in the study.
  • Have a performance status of less than or equal to 1 on the ECOG Performance Scale
  • Demonstrate adequate organ function as defined below, all screening labs should be performed within 14 days of treatment initiation.
  • Female subjects of childbearing potential must be willing to use an adequate method of contraception; Contraception, for the course of the study through 120 days after the last dose of study medication. Note: Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the subject.
  • Male subjects of childbearing potential must agree to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy. Note: Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the subject.
  • Adequate Organ Function Laboratory Values: System Laboratory - Value

    • Renal

      ---Serum Creatinine - Less than or equal to 1.5 X upper limit of normal (ULN)

    • Hepatic

      • Serum total bilirubin Less than or equal to 1.5 X ULN OR
      • Direct bilirubin less than or equal to ULN for subjects with total bilirubin levels greater than 1.5 ULN
      • AST (SGOT) and ALT(SGPT) Less than or equal to 3 X ULN

EXCLUSION CRITERIA:

The subject must be excluded from participating in the trial if the subject:

  • Has a diagnosis of acute promyelocytic leukemia (APL)
  • Has previously received an allogeneic hematopoietic stem cell transplant.
  • Has received AML treatment with an investigational therapy or device within 4 weeks of the first dose of treatment.
  • Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
  • Has a known history of active TB (Bacillus Tuberculosis)
  • Has hypersensitivity to pembrolizumab or any of its excipients.
  • Has hypersensitivity to decitabine or any of its excipients.
  • Has received more than two prior cycles of decitabine.
  • Has had a prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study Day 1.
  • Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1.

    --Note: Subjects who have received cytoreductive therapy with hydroxyurea at any time prior to study Day 1 are an exception to this criterion.

  • Has not recovered (i.e., less than or equal to Grade 1 or at baseline) from adverse events due to previously administered AML therapy agents.

    • Note: Subjects with less than or equal to Grade 2 neuropathy are an exception and may qualify for the study.
    • Note: If subject received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy.
  • Has a known additional malignancy that is progressing or requires active treatment. Patients with basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer would not be excluded.
  • Has known malignant central nervous system (CNS) involvement.
  • Has active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
  • Has history of (non-infectious) pneumonitis that required steroids, evidence of interstitial lung disease or active, non-infectious pneumonitis.
  • Has an active infection requiring intravenous systemic therapy.
  • Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject s participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
  • Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  • Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 120 days after the last dose of trial treatment.
  • Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent.
  • Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
  • Has known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected).
  • Has received a live vaccine within 30 days of planned start of study therapy. Note: Seasonal influenza vaccines for injection are generally inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g., Flu-Mist ) are live attenuated vaccines, and are not allowed.

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): NCT02996474


Locations
United States, Maryland
National Institutes of Health Clinical Center
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
Investigators
Principal Investigator: Christopher S Hourigan, M.D. National Heart, Lung, and Blood Institute (NHLBI)

Additional Information:
Responsible Party: National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier: NCT02996474     History of Changes
Other Study ID Numbers: 170026
17-H-0026
First Posted: December 19, 2016    Key Record Dates
Last Update Posted: November 22, 2018
Last Verified: November 15, 2018

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

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Heart, Lung, and Blood Institute (NHLBI) ):
Pembrolizumab
Decitabine
AML (Acute Myelogenous Leukemia)

Additional relevant MeSH terms:
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Neoplasms by Histologic Type
Neoplasms
Pembrolizumab
Decitabine
Azacitidine
Antineoplastic Agents
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Enzyme Inhibitors