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CPX-351 Plus Enasidenib for Relapsed AML

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ClinicalTrials.gov Identifier: NCT03825796
Recruitment Status : Recruiting
First Posted : January 31, 2019
Last Update Posted : February 18, 2021
Sponsor:
Collaborator:
Jazz Pharmaceuticals
Information provided by (Responsible Party):
Jonsson Comprehensive Cancer Center

Brief Summary:
This trial evaluates how well CPX-351 and enasidenib work in treating patients with acute myeloid leukemia characterized by IHD2 mutation. Drugs used in chemotherapy, such as CPX-351, 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. Enasidenib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving CPX-351 and enasidenib may work better in treating patients with acute myeloid leukemia, compared to giving only one of these therapies alone.

Condition or disease Intervention/treatment Phase
Recurrent Acute Myeloid Leukemia Drug: Enasidenib Mesylate Drug: Liposome-encapsulated Daunorubicin-Cytarabine Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 18 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: CPX-351 Plus Enasidenib for Relapsed Acute Myelogenous Leukemia Characterized by the IDH2 Mutation
Actual Study Start Date : April 12, 2019
Estimated Primary Completion Date : September 1, 2021
Estimated Study Completion Date : January 1, 2022


Arm Intervention/treatment
Experimental: Treatment (CPX-351, enasidenib mesylate)
See detailed description
Drug: Enasidenib Mesylate
Given PO
Other Names:
  • 2-Methyl-1-[(4-[6-(trifluoromethyl)pyridin-2-yl]-6-{[2-(trifluoromethyl)pyridin-4-yl]amino}-1,3,5-triazin-2-yl)amino]propan-2-ol Methanesulfonate
  • 2-Propanol, 2-Methyl-1-((4-(6-(trifluoromethyl)-2-pyridinyl)-6-((2-(trifluoromethyl)-4-pyridinyl)amino)-1,3,5-triazin-2-yl)amino)-, Methanesulfonate (1:1)
  • AG-221 Mesylate
  • CC-90007
  • Enasidenib Methanesulfonate
  • Idhifa

Drug: Liposome-encapsulated Daunorubicin-Cytarabine
Given IV
Other Names:
  • CPX-351
  • Cytarabine-Daunorubicin Liposome for Injection
  • Liposomal AraC-Daunorubicin CPX-351
  • Liposomal Cytarabine-Daunorubicin
  • Liposome-encapsulated Combination of Daunorubicin and Cytarabine
  • Vyxeos




Primary Outcome Measures :
  1. Complete remission (CR)/CR with incomplete hematologic recovery (CRi) after induction therapy [ Time Frame: Up to day 60 ]

Secondary Outcome Measures :
  1. Proportion of patients with persistent grade 4 hematologic toxicity per Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 [ Time Frame: At day 60 ]
    The proportion along with the exact 95% confidence interval will reported.

  2. Proportion of patients who achieve CR/CRi during maintenance therapy [ Time Frame: Up to 2 years ]
    This is calculated only among patients who had stable disease after induction therapy and have received maintenance enasidenib monotherapy.

  3. Proportion of patients who achieve CR/complete remission with partial hematologic recovery (CRp) after induction therapy [ Time Frame: Up to 2 years ]
  4. Time to return of normal hematopoiesis [ Time Frame: From day 1 of induction assessed up to 2 years ]
    Defined as time from day 1 of induction to absolute neutrophil count (ANC) >= 1000/uL and platelet count >= 100,000/uL. The median time to return of normal hematopoiesis will be reported along with the corresponding range.

  5. Overall survival [ Time Frame: From day 1 of induction therapy, assessed at day 30 and 60 ]
    Will be estimated using Kaplan-Meier methods. The survival estimate at these two time points will be reported along with a 95% confidence interval.

  6. Proportion of patients who go on to receive allogeneic hematopoietic stem cell transplantation (HSCT) after achieving CR/CRi [ Time Frame: Up to 2 years ]
    Will be reported along with an exact 95% confidence interval.


Other Outcome Measures:
  1. Proportion of patients who have a particular co-occurring mutation with an allelic frequency >= 10% along with the IDH2 mutation, and have achieved CR/CRi [ Time Frame: Up to 2 years ]
    Will be reported along with an exact 95% confidence interval.

  2. Proportion of patients who achieved CR/CRi then achieve minimal residual disease negativity based on Invivoscribe assay [ Time Frame: Up to 2 years ]
  3. Proportion of abnormal troponin levels without concurrent elevated creatinine [ Time Frame: Up to 2 years ]
  4. Proportion of abnormal electrocardiogram (ECG) findings (new T-wave inversions or new ST segment abnormalities) [ Time Frame: Up to 2 years ]
  5. Proportion of echocardiogram findings with left ventricular ejection fraction reduction by >= 25% [ Time Frame: Up to 2 years ]


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

Inclusion Criteria:

  • Bone marrow blasts >= 5% that develops after CR/CRi in patient with prior history of AML, no restriction on prior number of relapses or regimens
  • AML characterized by the IDH2 gene mutation, without requirement for a particular allelic frequency
  • Patients previously treated with IDH2 inhibitor can be enrolled
  • At least a 3-month duration of CR/CRi prior to relapse
  • Relapses after allogeneic HSCT are included with a minimum of 3 from the date of allogeneic HSCT
  • Up to 1 cycle of hypomethylating agent monotherapy at time of relapse is allowed, must be discontinued at least 14 days prior to start of salvage induction
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  • Serum total bilirubin < 2.0 mg/dL, unless considered due to Gilbert's disease or leukemic involvement
  • Aspartate aminotransferase (AST), alanine aminotransferase (ALT) < 3 times the upper limit of normal, unless considered due to leukemic involvement
  • Alkaline phosphatase < 3 times the upper limit of normal, unless considered due to leukemic involvement
  • Serum creatinine =< 2.0 mg/dL, or creatinine clearance > 40 mL/min based on Cockcroft-Gault glomerular filtration rate (GFR)
  • Females of reproductive potential as well as fertile men and their partners who are female of reproductive potential must agree to abstain from sexual intercourse or to use two highly effective forms of contraception from the time of giving informed consent, during the study, and for four months (females and males) following the last dose of IDH inhibitor. A highly effective form of contraception is defined as hormonal oral contraceptives, injectables, patches, intrauterine devices, double-barrier method (eg, synthetic condoms, diaphragm or cervical cap with spermicidal foam, cream, or gel) or male partner sterilization

Exclusion Criteria:

  • Concurrent FLT3 mutation that the treating physician deems necessary to treat with FLT3-targeted therapy; whereas, patients with FLT3-mutated AML not treated with FLT3-targeted therapy can be enrolled
  • Acute promyelocytic leukemia
  • Inability to swallow medications or history of gastrointestinal (GI) malabsorptive disease
  • Active malignancy that would limit survival by less than two years
  • New York Heart Association class III or VI
  • Left ventricular ejection fraction < 40%
  • History of coronary stent placement that require mandatory continuation of dual-antiplatelet therapy
  • Baseline QT corrected interval based on Fridericia's formula (QTcF) interval > 450 ms
  • History of Wilson's disease or other copper handling disorders
  • Hypersensitivity to cytarabine, daunorubicin, or liposomal products
  • Active invasive fungal infection
  • Active bacterial or viral infection manifesting as fevers or hemodynamic instability within the past 72 hours
  • Lifetime cumulative daunorubicin-equivalent anthracycline dose > 368 mg/m^2
  • Pregnant or breast feeding

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): NCT03825796


Contacts
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Contact: Caspian Oliai, MD 310 206-8477 ext 30870 coliai@mednet.ucla.edu

Locations
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United States, California
UCLA / Jonsson Comprehensive Cancer Center Recruiting
Los Angeles, California, United States, 90095
Contact: Caspian Oliai, MD    310-206-8477 ext 30870    coliai@mednet.ucla.edu   
Principal Investigator: Caspian Oliai, MD         
University of California Davis Comprehensive Cancer Center Not yet recruiting
Sacramento, California, United States, 95817
Contact: Brian A. Jonas    916-734-3772    brian.jonas@ucdmc.ucdavis.edu   
Principal Investigator: Brian A. Jonas         
University of California San Diego Not yet recruiting
San Diego, California, United States, 92103
Contact: Matthew J. Wieduwilt    858-657-7000    mwieduwilt@ucsd.edu   
Principal Investigator: Matthew J. Wieduwilt         
University of California San Francisco Not yet recruiting
San Francisco, California, United States, 94143
Contact: Lloyd E. Damon    415-353-2737    damon@medicine.ucsf.edu   
Principal Investigator: Lloyd E. Damon         
Sponsors and Collaborators
Jonsson Comprehensive Cancer Center
Jazz Pharmaceuticals
Investigators
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Principal Investigator: Caspian Oliai, MD UCLA / Jonsson Comprehensive Cancer Center
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Responsible Party: Jonsson Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT03825796    
Other Study ID Numbers: 18-001416
NCI-2018-02998 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
18-001416 ( Other Identifier: UCLA / Jonsson Comprehensive Cancer Center )
First Posted: January 31, 2019    Key Record Dates
Last Update Posted: February 18, 2021
Last Verified: February 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Leukemia
Neoplasms by Histologic Type
Neoplasms
Cytarabine
Daunorubicin
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antibiotics, Antineoplastic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors