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A Phase 1b/2 Study of Alvocidib Plus Decitabine in Patients With MDS

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: NCT03593915
Recruitment Status : Recruiting
First Posted : July 20, 2018
Last Update Posted : July 12, 2019
Information provided by (Responsible Party):
Tolero Pharmaceuticals, Inc.

Brief Summary:

Alvocidib, a cyclin-dependent kinase 9 (CDK 9) inhibitor, in time-sequential therapy demonstrated significant clinical activity in secondary AML patients with prior MDS. Patients with IPSS-R intermediate and above MDS have an increased risk of developing AML and may be treated with the same chemotherapy regimens used in patients with AML. Eight Phase I or II clinical trials have been completed in patients with AML, totaling more than 400 patients with both relapsed/refractory or newly diagnosed AML.

Preclinical studies have demonstrated that decitabine exposure increased the expression of NOXA, which is a specific antagonist of the survival factor MCL 1. Pharmacologic downregulation of MCL-1 via CDK 9 inhibition, as well as upregulation of the MCL-1 antagonist, NOXA, following decitabine exposure may result in enhanced antileukemic activity in MCL-1-dependent malignancies.

Condition or disease Intervention/treatment Phase
Myelodysplastic Syndromes (MDS) Combination Product: Alvocidib Plus Decitabine Phase 1 Phase 2

Detailed Description:


Patients will be enrolled in cohorts of 3-6 patients. Escalation of the alvocidib dose will follow a standard 3+3 design with sequential cohorts of 3 patients treated with incrementally higher doses of alvocidib until a dose-limiting toxicity (DLT) is observed and the MTD is established.

Once the MTD or preliminary RP2D is identified, the study will progress to Phase 2.


Phase 2 design is based on the Simon 2-stage minimax design (Simon 1989).

  • Stage 1: Up to 15 evaluable patients will be enrolled and treated at the RP2D identified in the Phase 1b study.
  • Stage 2: Ten patients will be enrolled to bring the total enrollment in Phase 2 (including Stage-1 patients) to 25 evaluable patients. Stage-2 patients will also receive the RP2D dose identified in the Phase 1b study. If 6 or more responses are observed in 25 patients, the conclusion will be that the combination regimen is worthy of further investigation.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 49 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1b/2, Open-label Clinical Study to Determine Preliminary Safety and Efficacy of Alvocidib When Administered in Sequence After Decitabine in Patients With MDS
Actual Study Start Date : August 29, 2018
Estimated Primary Completion Date : February 2022
Estimated Study Completion Date : May 2022

Arm Intervention/treatment
Experimental: Ph 1b and 2: Pts w/ previously untreated MDS
  • Patients with previously untreated MDS
  • Patients with MDS who have received <6 cycles of HMAs
  • Patients with de novo (cause unknown) or secondary MDS (treatment-related) who are not eligible for intensive induction chemotherapy or stem cell transplant

    • All French-American-British (FAB) subtypes
    • Intermediate and above per IPSS-R groups
Combination Product: Alvocidib Plus Decitabine


Decitabine administered as a 1-hour intravenous (IV) infusion daily for 5 days at a dose of 20 mg/m2 followed on Day 8 by alvocidib as a loading dose over 30 minutes followed by a 4-hour IV infusion


The Phase 2 study will use the RP2D from the Phase 1b study and follow a Simon 2-stage minimax design

Primary Outcome Measures :
  1. PHASE 1b: Incidence of dose-limiting toxicities (DLTs) and treatment emergent adverse events. [ Time Frame: 28 days ]

    DLTs as observed in Cy 1. Must be at least possibly related to alvocidib. Any Gr 4 nonhematologic toxicity. Gr 3 nonhematologic toxicity that does not resolve to ≤Gr 2 in 48 hours. Gr 3 diarrhea, mucositis, nausea, or vomiting will be considered dose limiting only if resolution to ≤Gr 2 requires >7 days. ≥Grade 3 neurotoxicity of any duration

    ≥Grade 3 creatinine elevation of any duration Anorexia, fever, neutropenic fever, and infections of any grade Myelosuppression will not be considered in evaluating DLTs in patients except where bone marrow hypoplasia occurs for >50 days with bone marrow (BM) cellularity ≤5% and no evidence of MDS/leukemia.

  2. PHASE 2: Objective response rate using revised International Working Group (IWG) criteria (2006) [ Time Frame: 3 months ]
    Baseline disease assessment performed at screening and subsequent response assessments

Secondary Outcome Measures :
  1. PHASE 1b: Complete Response Rate (CRR: CRR: complete response [CR] / complete response with incomplete blood count recovery [CRi] / CRmarrow / partial response [PR] / hematologic improvement [HI]) [ Time Frame: 3 months ]
    Baseline disease assessment performed at screening and subsequent response assessments

  2. PHASE 1b and 2: Decitabine treatment effect on BH3 profiling results in peripheral blood to find the correlation between the rate of CR/CRi/CRmarrow/PR/HI and BH3 profiling by flow cytometry with an emphasis on MCL-1 dependence. [ Time Frame: 3 months ]
    Assessment of BH3 profiling in peripheral blood

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

Inclusion Criteria:

  1. Aged ≥18 years
  2. Phase 1b: Patients with previously untreated MDS and patients with MDS who received fewer than six (6) cycles of previous HMAs Phase 2: Untreated patients with de novo or secondary MDS
  3. Patients with an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) score ≤2 at enrollment
  4. Provide written informed consent prior to any study-related procedure. (In the event that the patient is re-screened for study participation or a protocol amendment alters the care of an ongoing patient, a new informed consent form must be signed.)
  5. Patients with a life expectancy of ≥3 months (90 days)
  6. Patients with adequate major organ functions meeting the following criteria on the basis of laboratory data within 4 weeks (28 days) before enrollment (if multiple data are available, most recent data during the period):

    1. Serum creatinine: ≤1.8× the upper limit of the normal (ULN) range
    2. Total bilirubin: ≤2× the ULN
    3. Aspartate transaminase (AST) and alanine transaminase (ALT): ≤3× the ULN
    4. Left ventricular ejection fraction (LVEF) >45% by echocardiogram or multigated acquisition (MUGA) scan
  7. Be able to comply with the requirements of the entire study.

Exclusion Criteria:

  1. Presence of concomitant severe cardiovascular disease:

    1. Patients who had myocardial infarction within 6 months (180 days) before enrollment
    2. Patients with significant diseases at enrollment that may affect study treatment, such as New York Heart Association (NYHA) Functional Class III or IV heart disease, National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0 grade ≥3 arrhythmia, angina pectoris, abnormal electrocardiogram findings, interstitial pneumonia or pulmonary fibrosis
  2. Presence of concomitant malignancy requiring chemotherapy or any malignancy (except basal and squamous cell carcinoma of the skin) for which the patient received chemotherapy within 6 months prior to enrollment. NOTE: Diagnosis of any previous or concomitant malignancy is thus not an exclusion criterion.
  3. Presence of uncontrolled or uncontrollable infection(s); or ≥Grade 3 infection according to NCI CTCAE v5.0
  4. Presence of any psychological, familial, sociological or geographical condition that, in the opinion of the investigator, could potentially hinder compliance with the study protocol and follow-up schedule
  5. Patients with a dry tap on bone marrow aspiration before enrollment
  6. Patients with concurrent autoimmune disease or a history of chronic or recurrent autoimmune disease, or patients who require long-term systemic steroid therapy greater than the equivalent of 20 mg of prednisone daily (excluding therapy given on an 'as needed' [PRN] basis)
  7. Patients with other documented malignancies within past year aside from synchronous or metachronous multiple cancers with a disease-free period of ≤5 years (excluding carcinoma in situ, mucosal carcinoma, or other such carcinomas curatively treated with local therapy)
  8. Patients with ≥Grade 2 hemorrhage according to NCI CTCAE v5.0
  9. Patients who have previously received alvocidib or another cyclin-dependent kinase 9 (CDK9) inhibitor
  10. Patients who are pregnant or breastfeeding
  11. Female patients of childbearing potential who are sexually active and unwilling to use a medically acceptable method of contraception associated with a low failure rate prior to study entry, for the duration of study participation and for at least 6 months after the last dose of study drug. (Patients will be considered to be of childbearing potential unless surgically sterilized by hysterectomy, or bilateral tubal ligation / salphingectomy, or postmenopausal for at least 2 years.)
  12. Male patients with partners of childbearing potential who are unwilling to use condoms in combination with a second effective method of contraception during the trial and for at least 3 months after the last administration of study treatment.
  13. Patients who are inappropriate for participation in the study for other reasons in the opinion of the investigator or sub-investigator(s)

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): NCT03593915

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Contact: Michelle Kaelin 832-474-6972
Contact: Susan Smith, MSN 210-414-7702

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United States, Iowa
University of Iowa Not yet recruiting
Iowa City, Iowa, United States, 52242
Contact: Karen Parrott    319-353-6347   
Principal Investigator: Carlos Vigil-Gonzalez, MD         
United States, Maryland
Johns Hopkins Recruiting
Baltimore, Maryland, United States, 21218
Contact: Joan McFadden Cain    410-502-0735   
Principal Investigator: Amy DeZern, MD         
United States, New York
Columbia University Recruiting
New York, New York, United States, 10032
Contact: Rebecca Martinez    212-304-5589   
Principal Investigator: Daniel Lee, MD         
United States, North Carolina
University of North Carolina Recruiting
Chapel Hill, North Carolina, United States, 27599
Contact: Jack Zhang    984-974-8251   
Principal Investigator: Joshua Zeidner, MD         
United States, Texas
US Oncology - Texas Oncology - Austin Midtown Recruiting
Austin, Texas, United States, 78705
Contact: Nic Baker    281-863-6690   
Principal Investigator: Jason Melear, MD         
US Oncology - Texas Oncology - Baylor University Medical Center Not yet recruiting
Dallas, Texas, United States, 75246
Contact: Nic Baker    281-863-6690   
Principal Investigator: Moshe Levy, MD         
US Oncology - Texas Oncology - Fort Worth Not yet recruiting
Fort Worth, Texas, United States, 76104
Contact: Nic Baker    281-863-6690   
Principal Investigator: Stephen Richey, MD, MPH, FACP         
US Oncology - Texas Oncology - San Antonio Medical Center Recruiting
San Antonio, Texas, United States, 78240
Contact: Nic Baker    281-863-6690   
Principal Investigator: Roger Lyons, MD         
US Oncology - Texas Oncology - Tyler Recruiting
Tyler, Texas, United States, 75702
Contact: Nic Baker    281-863-6690   
Principal Investigator: Habte Yimer, MD         
United States, Virginia
US Oncology - Virginia Cancer Specialists, PC Not yet recruiting
Fairfax, Virginia, United States, 22031
Contact: Nic Baker    281-863-6690   
Principal Investigator: Gregory Orloff, MD         
United States, Washington
US Oncology - Northwest Cancer Specialists, P.C. Recruiting
Vancouver, Washington, United States, 98684
Contact: Nic Baker    281-863-6690   
Principal Investigator: David Cosgrove, MD         
Sponsors and Collaborators
Tolero Pharmaceuticals, Inc.
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Study Director: Stephen Anthony, DO Tolero Pharmaceuticals

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Responsible Party: Tolero Pharmaceuticals, Inc. Identifier: NCT03593915     History of Changes
Other Study ID Numbers: TPI-ALV-102
First Posted: July 20, 2018    Key Record Dates
Last Update Posted: July 12, 2019
Last Verified: July 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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

Keywords provided by Tolero Pharmaceuticals, Inc.:
Previously untreated MDS
MDS who have received <6 cycles of treatment with hypomethylating agents (HMAs)
De novo or secondary MDS (treatment-related) who are not eligible for intensive induction chemotherapy or stem cell transplant
FAB subtypes: refractory anemia [RA], RA w/ ringed sideroblasts, RA w/ excess blasts, RA w/ excess blasts in transformation or chronic myelomonocytic leukemia
Intermediate and above per the Revised International Prognostic Scoring System (IPSS-R) groups
Phase 1b/2

Additional relevant MeSH terms:
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Myelodysplastic Syndromes
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors
Growth Inhibitors
Growth Substances
Physiological Effects of Drugs
Protein Kinase Inhibitors