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Quizartinib and Decitabine in Treating Participants With Untreated or Relapsed FLT3-ITD Mutated Acute Myeloid Leukemia or Myelodysplastic Syndrome

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: NCT03661307
Recruitment Status : Recruiting
First Posted : September 7, 2018
Last Update Posted : May 2, 2019
National Cancer Institute (NCI)
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Brief Summary:
This phase I/II trial studies how well quizartinib and decitabine work in treating participants with FLT3-ITD mutated acute myeloid leukemia or myelodysplastic syndrome that is untreated or has come back. Quizartinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as decitabine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving quizartinib and decitabine may work better at treating acute myeloid leukemia and myelodysplastic syndrome.

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia With FLT3/ITD Mutation Blasts More Than 10 Percent of Bone Marrow Nucleated Cells Blasts More Than 10 Percent of Peripheral Blood White Cells Myelodysplastic Syndrome Recurrent Acute Myeloid Leukemia Recurrent Myelodysplastic Syndrome Drug: Decitabine Drug: Quizartinib Phase 1 Phase 2

Detailed Description:


I. To determine the overall response rate (ORR) including CR (complete remission) + CRp (complete remission with incomplete platelet recovery) + CRi (complete remission with incomplete count recovery) + partial remission (PR) within 3 months of treatment initiation of quizartinib and decitabine combination in patients with newly diagnosed or relapsed FLT3-ITD mutated acute myeloid leukemia (AML) or high risk myelodysplastic syndrome (MDS) (> 10% blasts).

II. To determine the safety and maximum tolerable dose (MTD) of this combination.


I. To determine CR and CR+CRh rates within 3 months of treatment initiation of quizartinib and decitabine combination in patients with newly diagnosed or relapsed AML or or high risk MDS (> 10% blast).

II. To determine the duration of response (DOR), event-free survival (EFS), overall survival (OS), and number of patients bridged to hematopoietic stem cell transplant (HSCT) and median duration to HSCT from the initiation of the combination.

II. To investigate correlations of response to this combination with a pre-therapy, on-therapy, and progression 81-gene panel of gene mutations in AML.


I. To investigate possible relationships between response and non-response to the combination with pretherapy, on-therapy, and progression gene expression signatures.

II. To store and/or analyze surplus blood or tissue including bone marrow, if available, for potential future exploratory research into factors that may influence development of AML and/or response to the combination (where response is defined broadly to include efficacy, tolerability or safety).

OUTLINE: This is a phase I, dose escalation study followed by a phase I study.

Participants receive decitabine intravenously (IV) over 1 hour on days 1-10 and quizartinib orally (PO) every day beginning on day 5 of course 1. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, participants are followed up every 3-6 months for up to 5 years.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 52 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I/II Study of Quizartinib in Combination With Decitabine for the Treatment of Patients With Acute Myeloid Leukemia (AML)
Actual Study Start Date : October 31, 2018
Estimated Primary Completion Date : January 1, 2020
Estimated Study Completion Date : January 1, 2020

Arm Intervention/treatment
Experimental: Treatment (decitabine, quizartinib)
Participants receive decitabine IV over 1 hour on days 1-10 and quizartinib PO every day beginning on day 5 of course 1. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: Decitabine
Given IV
Other Names:
  • 5-Aza-2'-deoxycytidine
  • Aza-TdC
  • Dacogen
  • Decitabine for Injection
  • Deoxyazacytidine
  • Dezocitidine

Drug: Quizartinib
Given PO
Other Names:
  • AC-220
  • AC010220
  • AC220

Primary Outcome Measures :
  1. Maximum tolerated dose of the combination drugs (Phase I) [ Time Frame: Up to 28 days ]
  2. Incidence of adverse events (Phase II) [ Time Frame: Within 3 months ]
  3. Overall response rate (ORR) including CR (complete remission) + CRp (complete remission with incomplete platelet recovery) + CRi (complete remission with incomplete count recovery) + partial remission (PR) (Phase II) [ Time Frame: Within 3 months ]

Information from the National Library of Medicine

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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:

  • Diagnosis of 1) AML (World Health Organization [WHO] classification definition of >= 20% blasts) excluding acute promyelocytic leukemia (APL) or 2) MDS with > 10% blasts (defined by the International Prognostic Scoring System [IPSS] classification).
  • For frontline Cohort: Patients aged >= 60 years old who are not candidates for intensive induction therapy and agree to receive the proposed combination therapy will be enrolled.
  • For relapsed cohort: Patients aged >= 18 years old. (Patients who are candidates for relapse cohort will be enrolled into the study regardless of their fitness for intensive chemotherapy).
  • For frontline cohort: Patients must be chemonaive, i.e. not have received any chemotherapy (except hydrea or 1-2 doses of ara-C for transient control of hyperleukocytosis) for AML or MDS. They may have received transfusions, hematopoietic growth factors or vitamins for an antecedent hematological disorder (AHD) or for AML. Temporary prior measures such as apheresis, all-trans-retinoic acid (ATRA), steroids or hydrea while diagnostic work-up is being performed are allowed and not counted as a prior salvage. Supportive care therapy for MDS (growth factors, transfusions) will not be considered as prior therapy for MDS/AML and these patients will be enrolled to the frontline cohort of the study if they are otherwise eligible.
  • For relapsed cohort: Patients who have received at least one prior therapy for AML or for MDS with > 10% blasts will be eligible. Patients may have received up to 4 prior salvages for AML and/or MDS (defined by the IPSS classification). Prior therapy for AML or MDS will be counted as a prior salvage. Patients who receive MDS directed therapies considered not purely supportive such as HMAs, lenalidomide, investigational therapies, will be enrolled to the salvage cohort if they are otherwise eligible.
  • In the absence of rapidly progressing disease, the interval from prior treatment to time of initiation of protocol therapy will be at least 2 weeks for cytotoxic agents or at least 5 half-lives for cytotoxic/noncytotoxic agents. The half-life for the therapy in question will be based on published pharmacokinetic literature and will be documented in the protocol eligibility document.
  • The use of chemotherapeutic or anti-leukemic agents is not permitted during the study with the following exceptions: (1) intrathecal (IT) therapy for patients with controlled central nervous system (CNS) leukemia at the discretion of the principal investigator (PI) a (2) Use of one dose of cytarabine (up to 2 g/m^2) or hydroxyurea for patients with rapidly proliferative disease is allowed before the start of study therapy and for the first four weeks on therapy. These medications will be recorded in the case-report form.
  • Eastern Cooperative Oncology Group (ECOG) performance status =< 2.
  • Serum biochemical values with the following limits unless considered due to leukemia, hemolysis or congenital disorder (creatinine < 1.8 mg/dl, total bilirubin < 1.8 mg/dL, [serum glutamate pyruvate transaminase (SGPT)] < 2.5 x upper limit of normal).
  • Ability to take oral medication.
  • Ability to understand and provide signed informed consent.
  • Baseline left ventricular ejection fraction by echocardiogram (ECHO) or multigated acquisition (MUGA) >= 50%.
  • Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test within 7 days. Men must agree not to father a child and agree to use a condom if his partner is of child bearing potential.
  • WOCBP must use appropriate method(s) of contraception. WOCBP should use an adequate method to avoid pregnancy until at least 3 months after the last dose of investigational drug. Women who are not of childbearing potential (ie, who are postmenopausal or surgically sterile) as well as men with azoospermia do not require contraception.
  • Negative urine or serum pregnancy test.

Exclusion Criteria:

  • Patients with known allergy or hypersensitivity to quizartinib, mannitol, decitabine or any of their components.
  • Prior quizartinib use.
  • Patients with known uncontrolled CNS leukemia.
  • Only for frontline cohort: patients who are fit for intensive chemotherapy.
  • Patients with electrolyte abnormalities at study entry defined as follows: Serum potassium < 3.5 mEq/L despite supplementation, or > 5.5 mEq/L Serum magnesium above or below the institutional normal limit despite adequate management. Serum calcium (corrected for albumin levels) above or below institutional normal limit despite adequate management.
  • Patients with known significant impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of quizartinib.
  • Patients with any other known concurrent severe and/or uncontrolled medical condition including but not limited to diabetes, cardiovascular disease including hypertension, renal disease, or active uncontrolled infection, which could compromise participation in the study. Patients on active antineoplastic or radiation therapy for a concurrent malignancy at the time of screening. Maintenance therapy, hormonal therapy, or steroid therapy for well-controlled malignancy is allowed.
  • Patients with a known human immunodeficiency virus (HIV) infection.
  • Patients with known positive hepatitis B or C infection by serology, with the exception of those with an undetectable viral load within 3 months. (Hepatitis B or C testing is not required prior to study entry). Subjects with serologic evidence of prior vaccination to HBV [i.e., hepatitis B surface antigen [HBs Ag]-, and anti-HBs+] may participate.
  • Patients who have consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or Starfruit within 3 days prior to the initiation of study treatment.
  • Patients who have had any major surgical procedure within 14 days of day 1.
  • Impaired cardiac function including any of the following: Screening electrocardiography (ECG) with a QTc > 450 msec. The QTc interval will be calculated by Fridericia's correction factor (QTcF) at screening and on day 5 prior to the first dose of AC220. The QTcF will be derived from the average QTcF in triplicate. If QTcF > 450 msec on day 5, AC220 will not be given. Patients with congenital long QT syndrome. History or presence of sustained ventricular tachycardia requiring medical intervention. Any history of clinically significant ventricular fibrillation or torsades de pointes. Known history of second or third degree heart block (may be eligible if the patient currently has a pacemaker). Sustained heart rate of < 50/minute on pre-entry ECG. Right bundle branch block + left anterior hemiblock (bifascicular block). complete left bundle branch block. Patients with myocardial infarction or unstable angina within 6 months prior to starting study drug. Congestive heart failure (CHF) New York (NY) Heart Association class III or IV. Atrial fibrillation documented within 2 weeks prior to first dose of study drug. Patients who are actively taking a strong CYP3A4 inducing medication.
  • (cont) Atrial fibrillation documented within 2 weeks prior to first dose of study drug. Patients who are actively taking a strong CYP3A4 inducing medication [see appendix]
  • Patients who require treatment with concomitant drugs that prolong QT/QTc interval or strong CYP3A4 inhibitors with the exception of antibiotics, antifungals, and antivirals that are used as standard of care to prevent or treat infections and other such drugs that are considered absolutely essential for the care of the subject or if the Investigator believes that beginning therapy with a potentially QTc-prolonging medication (such as anti-emetic) is vital to an individual subject's care while on study.
  • Known family history of congenital long QT syndrome.

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): NCT03661307

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Contact: Musa Yilmaz 713-745-9945

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United States, Texas
M D Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Musa Yilmaz    713-745-9945      
Principal Investigator: Musa Yilmaz         
Sponsors and Collaborators
M.D. Anderson Cancer Center
National Cancer Institute (NCI)
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Principal Investigator: Musa Yilmaz M.D. Anderson Cancer Center

Additional Information:
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Responsible Party: M.D. Anderson Cancer Center Identifier: NCT03661307     History of Changes
Other Study ID Numbers: 2018-0394
NCI-2018-01789 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
2018-0394 ( Other Identifier: M D Anderson Cancer Center )
P30CA016672 ( U.S. NIH Grant/Contract )
First Posted: September 7, 2018    Key Record Dates
Last Update Posted: May 2, 2019
Last Verified: April 2019

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

Additional relevant MeSH terms:
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Leukemia, Myeloid
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Pathologic Processes
Neoplasms by Histologic Type
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors