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Trial record 28 of 89 for:    "Acute Lymphoblastic Leukemia, Childhood" | "Antineoplastic Agents, Hormonal"

International Trial of Selumetinib in Combination With Dexamethasone for the Treatment of Acute Lymphoblastic Leukaemia (SeluDex)

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ClinicalTrials.gov Identifier: NCT03705507
Recruitment Status : Recruiting
First Posted : October 15, 2018
Last Update Posted : January 17, 2019
Sponsor:
Collaborators:
Cancer Research UK
AstraZeneca
Information provided by (Responsible Party):
University of Birmingham

Brief Summary:
This trial is to investigate the combination of selumetinib and dexamethasone in the treatment of acute lymphoblastic leukaemia (ALL) in both adults and children. Phase I is to find the most suitable dose of selumetinib to safely give with dexamethasone. Phase II will use this dose to find out how well the combination works.

Condition or disease Intervention/treatment Phase
Acute Lymphoblastic Leukemia Acute Lymphoblastic Leukemia, Adult Acute Lymphoblastic Leukemia, Pediatric Acute Lymphoblastic Leukemia, in Relapse Acute Lymphoblastic Leukemia Recurrent Drug: Selumetinib Drug: Dexamethasone Phase 1 Phase 2

Detailed Description:

Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer worldwide. The overall newly diagnosed ALL cure rate is approaching 90% however children with relapsed ALL often do not survive. The frequency of ALL in adults is significantly lower however more challenging to treat compared to childhood ALL. Adult ALL is more resistant to chemotherapy and patient have reduced treatment tolerance (particularly the elderly population) therefore overall survival rates are low. Therefore there is a need to develop more effective treatment which improves survival rates for this patient population.

Those eligible in the paediatric setting are in their second or further relapse, often after a previous allogeneic stem cell transplant (SCT), and usually in a palliative situation. Adult patients who are not suitable for more intensive therapy can enter the trial in first relapse. The trial offers an out-patient based treatment approach of this heavily pre-treated patient group. The trial includes patients with B-cell precursor and T-ALL irrespective of Central Nervous System (CNS) disease status.CNS positive patients and patients with T-ALL are usually excluded from other early phase clinical trials. If treatment is successful, patients could continue with other therapies/trials once complete remission achieved (e.g. Chimeric Antigen Receptor (CAR) T cell therapy).

Selumetinib is a small molecule inhibitor of MEK, a protein in the RAS-pathway. Mutations in genes in the RAS pathway have been found in a large proportion of patients with ALL. Selumetinib targets this over-activated pathway to arrest cancer cell growth. Dexamethasone is a steroid important in the treatment of leukaemia to stimulate the death of cancer cells. The SeluDex trial is for patients with relapsed or refractory RAS-pathway mutated ALL.

The primary objective of this trial in Phase I is to see what dose of selumetinib can safely be given in combination with dexamethasone in participants. During Phase II, the primary objective is to assess the preliminary information regarding the effectiveness of this combined treatment.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 42 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Group P will enrol all patients under 18 years of age and Group A will enrol all patients who are 18 years or older.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: International Phase I/II Expansion Trial of the MEK Inhibitor Selumetinib in Combination With Dexamethasone for the Treatment of Relapsed/Refractory RAS-pathway Mutated Paediatric and Adult Acute Lymphoblastic Leukaemia
Actual Study Start Date : April 17, 2018
Estimated Primary Completion Date : March 17, 2021
Estimated Study Completion Date : March 17, 2021


Arm Intervention/treatment
Experimental: Selumetinib + Dexamethasone - Group A (18 years and above)
Patients will receive the adult cohort specified dose of selumetinib by mouth, as a single dose on cycle 1 day 1, then twice daily continuously from cycle 1 day 4 onwards, combined with dexamethasone at 6mg/m2/day on days 2-14 then at 4mg/m2/day on days 15-28 divided into two doses (as per local practice) by mouth during cycle 1, then tapered dosing for the first week of cycle two, with full doses on days 1-5 during subsequent cycles.
Drug: Selumetinib
Selumetinib is a small molecule inhibitor of the MEK protein
Other Name: AZD6244

Drug: Dexamethasone
Steroid used for the treatment and management of a number of conditions including cancers and leukaemias.

Experimental: Selumetinib + Dexamethasone - Group P (under 18 years)
Patients will receive the paediatric cohort specified dose of selumetinib by mouth, as a single dose on cycle 1 day 1, then twice daily continuously from cycle 1 day 4 onwards, combined with dexamethasone 6mg/m2/day divided into two doses (as per local practice) by mouth from days 2-28 during cycle 1, then tapered dosing for the first week of cycle two, with full doses on days 1-5 during subsequent cycles.
Drug: Selumetinib
Selumetinib is a small molecule inhibitor of the MEK protein
Other Name: AZD6244

Drug: Dexamethasone
Steroid used for the treatment and management of a number of conditions including cancers and leukaemias.




Primary Outcome Measures :
  1. Phase I: The occurrence/non-occurrence of dose limiting toxicities (DLTs) in the trial defined assessment period [ Time Frame: During cycle 1 (each cycle is 28 days) ]
  2. Phase II: Response to treatment as measured by morphological response [ Time Frame: At the end of cycle 1 (each cycle is 28 days) ]
  3. Phase II: For patients with CNS involvement only response to treatment as measured by clearance of Cerebral Spinal Fluid (CSF) blasts [ Time Frame: At the end of cycle 1 (each cycle is 28 days) ]

Secondary Outcome Measures :
  1. Phase I & II: The occurrence of adverse events (AEs) as measured by Common Terminology Criteria for Adverse Events (CTCAE) version 4 [ Time Frame: From cycle 1 day 1 until 28 days after End of Treatment (6 cycles, each cycle is 28 days) ]
  2. Phase I & II: The occurrence of adverse events (AEs) as measured by causality assessment [ Time Frame: From cycle 1 day 1 until 28 days after the last treatment (6 cycles, each cycle is 28 days) ]
  3. Phase I & II: Pharmacokinetic variables of selumetinib in combination with dexamethasone from the concentration time profile measured by area under the plasma concentration versus time curve (AUC) [ Time Frame: At cycle 1 day 1, cycle 1 day 4 and cycle 2 day 1 (each cycle is 28 days) ]
  4. Phase I & II: Pharmacokinetic variables of selumetinib in combination with dexamethasone from the concentration time profile measured by the peak plasma concentration (Cmax) [ Time Frame: At cycle 1 day 1, cycle 1 day 4 and cycle 2 day 1 (each cycle is 28 days) ]
  5. Phase I & II: Pharmacokinetic variables of selumetinib in combination with dexamethasone from the concentration time profile measured by the time to reach peak plasma concentration (Tmax) [ Time Frame: At cycle 1 day 1, cycle 1 day 4 and cycle 2 day 1 (each cycle is 28 days) ]
  6. Phase I & II: Pharmacokinetic variables of selumetinib in combination with dexamethasone from the concentration time profile measured by the time required for the concentration of the drug to reach half of its original value (t1/2) [ Time Frame: At cycle 1 day 1, cycle 1 day 4 and cycle 2 day 1 (each cycle is 28 days) ]
  7. Phase I: Response to treatment assessed by complete remission rate as measured by morphological response in bone marrow (BM) [ Time Frame: At the end of cycle 1 (each cycle is 28 days) ]
  8. Phase I: Response to treatment assessed by complete remission rate as measured by minimal residual disease (MRD) response in BM [ Time Frame: At the end of cycle 1 (each cycle is 28 days) ]
  9. Phase I: For patients with CNS involvement only response to treatment assessed by complete remission rate as measured by clearance of CSF blasts [ Time Frame: At the end of cycle 1 (each cycle is 28 days) ]
  10. Phase I & II: Difference in pharmacokinetics of selumetinib (ΔAUC) when selumetinib is administered as single agent [ Time Frame: At cycle 1 day 1, cycle 1 day 4 and cycle 2 day 1 (each cycle is 28 days) ]
  11. Phase I & II: Difference in pharmacokinetics of selumetinib (ΔAUC) when selumetinib is administered in combination with dexamethasone [ Time Frame: At cycle 1 day 1, cycle 1 day 4 and cycle 2 day 1 (each cycle is 28 days) ]
  12. Phase II: The occurrence/non-occurrence of DLTs in the trial defined assessment period [ Time Frame: During cycle 1 (each cycle is 28 days) ]
  13. Phase II: MRD response in BM [ Time Frame: At the end of cycle 1 (each cycle is 28 days) ]

Other Outcome Measures:
  1. Exploratory pharmacodynamic biomarker studies including levels of phosphorylated Extracellular signal-regulated kinase (ERK) by flow cytometry as well as retrospective messenger ribonucleic acid (mRNA) profiling, including Bcl-2-like protein 11 (BIM) [ Time Frame: Cycle 1 day 1, cycle 1 day 4 and End of Treatment (6 cycles, each cycle is 28 days) ]


Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Morphologically proven relapsed/refractory (M2 or M3 marrow; ≥1st relapse for adults, ≥2nd relapse in paediatric group - see Protocol Appendix 5) or progressive B cell precursor or T-Acute Lymphoblastic Leukaemia (ALL) with demonstrated RAS pathway activating mutations (NRAS, KRAS, FLT3, PTPN11, cCBL) identified during the trial screening process
  • Group P (paediatric): <18 years of age; Group A (adult): ≥18 years of age
  • Adequate renal function:

    • Group A: Serum creatinine <1.5 x upper limit of normal (ULN)
    • Group P as follows:

      • 5 years: Serum creatinine <0.8 mg/dL or 70 μmol/L, > 5 years but ≤ 10 years: Serum creatinine <1 mg/dL or 88 μmol/L, > 10 years but ≤ 15 years: Serum creatinine <1.2 mg/dL or 106 μmol/L, > 15 years: Serum creatinine <1.5 mg/dL or 132 μmol/L
  • Patient is able to swallow selumetinib capsules whole
  • Performance status (PS): Group A - Eastern Cooperative Oncology Group (ECOG) ≤2 (Protocol Appendix 6); Group P - Lansky play scale ≥60% (Protocol Appendix 7) or Karnofsky scale ≥60% (Appendix 8)
  • Women of childbearing potential (see protocol section 7.9.1 for definition) must have a negative pregnancy test
  • Patients who are women of childbearing potential and male patients with partners who are women of childbearing potential must agree to use appropriate contraception (see protocol section 7.9.1 for definition) whilst on trial
  • Written informed consent
  • Absence of any psychological, familial, sociological or geographical factors potentially hampering compliance with the trial protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
  • Patients who relapse or progress after Haematopoetic Stem Cell Transplant (HSCT) need to be at least at day +100, with no signs of Graft versus Host Disease and off immunosuppressive therapy for at least one week.
  • Patients who relapse or progress after CAR T cell therapy should be at least 4 weeks after infusion of CAR T cells.
  • Patients must have a body surface area (BSA) ≥ 0.55 m2.

Exclusion Criteria:

  • ALL without presence of RAS-pathway activating mutations
  • Mature B-cell leukaemia and Philadelphia positive ALL
  • Prior exposure to MEK, RAS or RAF inhibitors
  • Any unresolved toxicity ≥ CTCAE Grade 2 from previous anti-cancer therapy, except for alopecia
  • Cardiac conditions as follows:

Group A and P

  • Prior or current cardiomyopathy including but not limited to the following:

    • Known hypertrophic cardiomyopathy
    • Known arrhythmogenic right ventricular cardiomyopathy
  • Even if full recovery has occurred, previous moderate or severe impairment of left ventricular systolic function (LVEF <45% on Echocardiogram (ECHO) in Group A; SF <29% in Group P but excluding transient impairments due to e.g. anaemia/sepsis or results not thought to represent a true reflection of cardiac function)
  • Severe valvular heart disease
  • Severe congenital heart disease
  • Uncontrolled hypertension:

    • Group A: BP ≥150/95 mmHg despite medical therapy
    • Group P: BP ≥95th percentile for age, height and gender (please refer to Blood Pressure by Age and Height Percentiles tables in Protocol Appendices 8 and 9) Group A
  • Baseline (LVEF) below the lower limit of normal (LLN) or <55% measured by ECHO
  • Acute coronary syndrome within 6 months prior to trial registration
  • Uncontrolled Angina - Canadian Cardiovascular Society grade II-IV despite medical therapy (Protocol Appendix 11)
  • Symptomatic heart failure New York Heart Association (NYHA) Class II-IV, prior or current cardiomyopathy, or severe valvular heart disease (Protocol Appendix 12)
  • Atrial fibrillation with a ventricular rate >100 bpm on Electrocardiogram (ECG) at rest
  • QTcF >450ms in male patients or ≥460ms in female patients, or other factors that increase the risk of QT prolongation Group P
  • Baseline SF <29%
  • Atrial fibrillation with a ventricular rate >130 bpm on Electrocardiogram (ECG) at rest
  • QTcF >450ms in patients <12 years or ≥460ms in patients ≥12 but <18 years
  • Ophthalmological conditions as follows:

    • Current or past history of retinal pigment epithelial detachment (RPED)/central serous retinopathy (CSR) or retinal vein occlusion
    • Intraocular pressure (IOP) > 21 mmHg or uncontrolled glaucoma (irrespective of IOP)
  • Pregnant and breast feeding females
  • Known severe hypersensitivity to selumetinib, dexamethasone or combination medications or any excipient of these medicinal products, or history of allergic reactions attributed to compounds of similar chemical or biologic composition to selumetinib
  • Have received or are receiving an Investigational Medicinal Product (IMP) or other systemic anti-cancer treatment (not including dexamethasone or hydroxycarbamide) within 4 weeks (6 weeks for nitrosoureas, mitomycin, and suramin) prior to trial registration, or within a period during which the IMP or systemic anticancer treatment has not been cleared from the body (e.g. a period of 5 'half-lives'), whichever is the most appropriate and as judged by the investigator
  • Have had recent major surgery within a minimum 4 weeks prior to trial registration, with the exception of surgical placement of vascular access
  • Have received radiation therapy within 4 weeks prior to trial registration, or limited field of radiation for palliation within 7 days of the first dose of trial treatment
  • Laboratory values as listed below (SI units):

    • Serum bilirubin >1.5 x ULN (unless due to Gilbert's syndrome)
  • Have evidence of any other significant clinical disorder or laboratory finding that, as judged by the investigator, makes it undesirable for the patient to participate in the trial
  • Have any evidence of a severe or uncontrolled systemic disease (e.g. unstable or uncompensated respiratory, cardiac, hepatic, or renal disease, active infection (including hepatitis B, hepatitis C, HIV), active bleeding diatheses, or renal transplant)
  • Have refractory nausea and vomiting, chronic gastrointestinal diseases (e.g., inflammatory bowel disease), or significant bowel resection that would adversely affect the absorption/bioavailability of the orally administered trial medication
  • Any other active malignancy which, in the opinion of the investigator would limit the ability of the patient to complete the study

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): NCT03705507


Contacts
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Contact: Sarah Johnson 01214146754 seludex@trials.bham.ac.uk

Locations
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United Kingdom
Queen Elizabeth Hospital Recruiting
Birmingham, United Kingdom, B15 2TH
Principal Investigator: Sridhar Chaganti         
Birmingham Children's Hospital Recruiting
Birmingham, United Kingdom, B4 6NH
Principal Investigator: Alice Norton         
Alder Hey Children's Hospital Recruiting
Liverpool, United Kingdom, L12 2AP
Principal Investigator: Mark Caswell         
Department of Paediatric Oncology, Royal Marsden Hospital, Sutton Recruiting
London Borough of Sutton, United Kingdom, SM2 5PT
Principal Investigator: Donna Lancaster         
Haemato-Oncology Adult Unit, Royal Marsden Hospital, Sutton Recruiting
London Borough of Sutton, United Kingdom, SM2 5PT
Sub-Investigator: David Taussig         
University College Hospital Recruiting
London, United Kingdom, NW1 2PG
Principal Investigator: Adele Fielding         
The Christie Hospital Recruiting
Manchester, United Kingdom, M20 4BX
Principal Investigator: Anna Castleton         
Great North Children's Hospital, Royal Victoria Infirmary Recruiting
Newcastle, United Kingdom, NE1 4LP
Principal Investigator: Geoff Shenton         
Freeman Hospital Recruiting
Newcastle, United Kingdom, NE7 7DN
Sub-Investigator: Tobias Menne         
Royal Hallamshire Hospital Recruiting
Sheffield, United Kingdom, S10 2JF
Principal Investigator: Nick Morley         
Sponsors and Collaborators
University of Birmingham
Cancer Research UK
AstraZeneca
Investigators
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Principal Investigator: Tobias Menne The Newcastle Hospitals NHS Foundation Trust

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Responsible Party: University of Birmingham
ClinicalTrials.gov Identifier: NCT03705507     History of Changes
Other Study ID Numbers: RG_16-186
2016-003904-29 ( EudraCT Number )
ISRCTN92323261 ( Registry Identifier: ISRCTN )
First Posted: October 15, 2018    Key Record Dates
Last Update Posted: January 17, 2019
Last Verified: January 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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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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Antineoplastic Agents, Hormonal
Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Dexamethasone
Dexamethasone acetate
BB 1101
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action