Study of Elacytarabine Versus Investigator's Choice in Patients With Late Stage Acute Myeloid Leukaemia (AML) (CLAVELA)

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. Read our disclaimer for details. Identifier: NCT01147939
Recruitment Status : Completed
First Posted : June 22, 2010
Last Update Posted : September 27, 2013
Information provided by (Responsible Party):
Clavis Pharma

Brief Summary:
The purpose of the study is to assess the efficacy and safety of elacytarabine versus investigator's choice treatment in patients with relapsed or refractory acute myeloid leukemia (AML).

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia (AML) Drug: Elacytarabine Drug: Investigator's Choice Phase 3

Detailed Description:

The study investigates the new nucleoside analogue derivative, elacytarabine, as treatment for patients with relapsed or refractory Acute Myeloid Leukemia (AML). To be included in the study, patients must have failed to respond to two or three different therapies for AML, or have obtained remission but then relapsed within a relatively short period of time. Patients of age ≥ 65 with adverse cytogenetics can be included in the study after having received one and up to three previous induction/re-induction therapies.

Elacytarabine is an investigational drug which is not commercially available. It is the elaidic acid ester derivative of cytarabine. Cytarabine is routinely used in the treatment of patients with AML. A substantial portion of AML patients have a deficient uptake of cytarabine, often explained by lack of a transport protein (hENT1) in the leukemic cell membrane. Due to the elaidic acid (a naturally occurring fatty acid), cellular uptake of elacytarabine is independent of this transport protein.

Patients included in the study will be randomized to elacytarabine or control treatment. Since there is no standard therapy for relapsed or refractory AML, there is a list of 7 control treatments and the investigator has to choose one that is locked before randomization.

Elacytarabine is given as a continuous infusion over five days, followed by a rest period of minimum two weeks. Investigator's choice treatment is given according to the specific routine.

After each course response evaluation and a decision on further treatment will be made.

Repeated courses of elacytarabine and control treatment might be needed to attain and/or maintain complete remission or clinical benefit.

After the end of study treatment, all patients will be followed for relapse and survival.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 381 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomised Phase III Study of Elacytarabine vs. Investigator's Choice in Patients With Late Stage Acute Myeloid Leukaemia
Study Start Date : June 2010
Actual Primary Completion Date : February 2013
Actual Study Completion Date : June 2013

Arm Intervention/treatment
Experimental: Elacytarabine Drug: Elacytarabine
Elacytarabine 2000 mg/m2/d administered as a continuous intravenous infusion (CIV) in a d 1-5 q3w cycle.

Active Comparator: Investigator's Choice Drug: Investigator's Choice
E.g. cytarabine single agent/combinations, hypomethylating agents, best supportive care (BSC)

Primary Outcome Measures :
  1. Overall survival [ Time Frame: Until 300 events occur ]
    Time from date of randomisation until the date of death

Secondary Outcome Measures :
  1. Remission rate [ Time Frame: Until 300 events occur ]
    • Remission rate measured by overall response rate (ORR) (i.e. complete remission (CR) and complete remission with incomplete bone marrow recovery (CRi))
    • Remission rate measured by CR
    • Remission duration analysed using cumulative incidence of relapse (CIR) measured from date of CR or CRi

  2. Compare number of patients with adverse events (AEs) per study arm as a measure of safety and tolerability [ Time Frame: From first dose of study treatment, until 30 days after the last dose (for each patient) ]
    Summaries will include rates of occurrence of any AEs, rates of AEs by system organ classification (SOC),rates of discontinuation of study treatment due to AEs.

  3. Characterize exposure-response relationships for measures of effectiveness and toxicity [ Time Frame: During the first course of elacytarabine ]

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:

  • 18 years of age or older
  • Confirmed diagnosis of AML according to WHO classification (excluding acute promyelocytic leukaemia) who have received two or three previous induction/re-induction regimens or patients of age ≥ 65 with adverse cytogenetics who have received 1-3 previous induction/re-induction regimens. One of the (re-)induction regimens could be stem cell transplantation (SCT) for achievement of remission. Maintenance and consolidation (including SCT) may have been given, but are not counted as previous regimens.
  • Bone marrow aspirates and/or biopsies must contain > 5 % leukaemic blast cells or patient must have biopsy-proven extramedullary AML, or patient's peripheral blood shows occurrence of leukaemic blast cells
  • Patients must

    • have never attained CR or CRi (primary refractory), or
    • have failed initial induction therapy, and have attained CR or CRi after salvage therapy(ies), and then relapsed within < 6 months, or
    • have attained CR or CRi after initial induction therapy and relapsed within <12 months, and failed to respond to salvage therapy(ies), or
    • have relapsed after the latest CR or CRi within < 6 months
  • Patients younger than 65 years should have received previous treatment with cytarabine
  • Patients must have recovered from previous bone marrow and/or stem cell transplantation to a stage that the patient can tolerate the study treatment. There is no restriction on number of regimens or type of treatment administered for maintenance or consolidation during previous stages of the disease
  • ECOG performance status (PS) of 0 - 2
  • Women of child-bearing potential must have a negative serum or urine pregnancy test within 2 weeks prior to treatment start
  • Male and female patients must use acceptable contraceptive methods for the duration of time on study, and males also for 3 months after the last elacytarabine dose
  • Capable of understanding and complying with protocol requirements, and must be able and willing to sign a written informed consent form

Exclusion Criteria:

  • A history of allergic reactions to egg. A history of allergic reactions of CTCAE grade 3 or 4 to cytarabine
  • Persistent clinically significant toxicities from previous chemotherapy
  • A cancer history that, according to the investigator, might confound the assessment of the study endpoints
  • Known positive status for human immunodeficiency virus (HIV)
  • Pregnant and nursing patients
  • Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, or psychiatric illness/social situations that would limit compliance with study requirements
  • Impairment of hepatic or renal function to such an extent that the patient, in the opinion of the investigator, will be exposed to an excessive risk if entered into this clinical study
  • Active heart disease including myocardial infarction within previous 3 months, symptomatic coronary artery disease, arrhythmias not controlled by medication, or uncontrolled congestive heart failure. Any New York Heart Association (NYHA) functional classification grade 3 or 4
  • Applicable only for patients for whom an anthracycline is part of the selected control treatment: Left ventricular ejection fraction (LVEF) must be ≥ 45 % as measured by MUGA scan or 2D ECHO within 14 days prior to start of therapy. Either method is acceptable for measuring LVEF
  • Applicable only for patients for whom an anthracycline is part of the selected control treatment: The patient should tolerate minimum one course of combination therapy
  • Any anti-leukaemic agents within the last 3 weeks. Hydroxyurea,however, is allowed for up to 12 hours prior to study treatment
  • Any investigational treatment within the last 14 days
  • Any medical condition which in the opinion of the investigator places the patient at an unacceptably high risk for toxicities

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): NCT01147939

  Hide Study Locations
United States, California
Scripps Cancer Center Clinical Research
La Jolla, California, United States, 90095
USC/Norris Comprehensive Cancer Center and Hospital
Los Angeles, California, United States, 90033
UCLA School of Medicine, Division of Hematology/Oncology
Los Angeles, California, United States, 90095
United States, Colorado
Rocky Mountain Blood and Bone Marrow Transplant Program
Denver, Colorado, United States, 80218
United States, Florida
Shands at the University of Florida
Gainesville, Florida, United States, 32610
United States, Georgia
Winship Cancer Institute at Emory
Atlanta, Georgia, United States, 30322
The Blood and Marrow Transplant Group of GA
Atlanta, Georgia, United States, 30342
United States, Illinois
Northwestern University
Chicago, Illinois, United States, 60611
Rush University Medical Center
Chicago, Illinois, United States, 60612
United States, Indiana
St. Francis Hospital and Health Center
Indianapolis, Indiana, United States, 46107
United States, Iowa
University of Iowa Hopsitals
Iowa City, Iowa, United States, 52242
United States, Louisiana
LSU Health Sciences Center,
Shreveport, Louisiana, United States, 71103
United States, New Jersey
Northern New Jersey Cancer Associates
Hackensack, New Jersey, United States, 07601
United States, New York
New York Presbyterian Hospital, Weill-Cornell Medical College
New York, New York, United States, 10021
Memorial Sloan-Kettering
New York, New York, United States, 10065
New York Medical College
Valhalla, New York, United States, 10595
United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710
Wake Forest University, Health Sciences Section on Hematology and Oncology
Winston-Salem, North Carolina, United States, 27157-1082
United States, Ohio
The Jewish Hospital
Cincinnati, Ohio, United States, 45236
United States, Pennsylvania
Western Pennsylvania Hospital
Pittsburgh, Pennsylvania, United States, 15224
United States, South Carolina
St. Francis Hospital
Greenville, South Carolina, United States, 29601
United States, Tennessee
Sarah Cannon Research Institute
Nashville, Tennessee, United States, 37203
United States, Wisconsin
Froedtert Hospital, Medical College of Wisconsin
Milwaukee, Wisconsin, United States, 53226
Australia, New South Wales
Royal North Shore Hopsital
Sydney, New South Wales, Australia, 2065
Australia, Victoria
Alfred Hospital
Melbourne, Victoria, Australia, 3004
Box Hill Hospital
Melbourne, Victoria, Australia, 3128
Australia, Western Australia
Sir Charles Gairdner Hospital
Perth, Western Australia, Australia, 6009
Algemeen Ziekenhuis Sint-Jan
Brugge, Belgium, 8000
UZ Brussel
Brussels, Belgium, 1090
Institut Jules Bordet
Bruxelles, Belgium, 1000
University Hospital Antwerp
Edegem, Belgium, 2650
CHU Liège
Liège, Belgium, 4000
UCL Mont-Godinne
Yvoir, Belgium, 5530
Canada, Ontario
Princess Margaret Hospital
Toronto, Ontario, Canada, M5G2M9
CHU Limoges - Hôpital Dupuytren
Limoges, France, 87042
Hopital Edouard Herriot
Lyon, France, 69437
Institut J. Paoli and I. Calmettes
Marseilles, France, 13723
Centre Antoine Lacassagne
Nice, France, 06189
Hopital Saint Antoine
Paris, France, 75271
CHU de Bordeaux - Hopital Haut-Leveque
Pessac, France, 33604
CHU de Toulouse - Hôpital Purpan
Toulouse, France, 31053
Charité-Campus B. Franklin Med. Klinik Haematology
Berlin, Germany, 12200
Evangelische Kliniken Johanniter- und Waldkrankenhaus Bonn GmbH
Bonn, Germany
Heinrich-Heine Universität Düsseldorf, Klinik für Hämatologie/Onkolog. und Klin. Immunologie
Düsseldorf, Germany, 40225
III. Medizinische Klinik und Poliklinik;Hämatologie, Onkologie und Pneumologie
Mainz, Germany, 55131
Universitätsklinikum Münster, Medisinische Klinik & Poliklinik A
Münster, Germany, 48149
Universitätsklinikum Rostock
Rostock, Germany, 18057
Robert-Bosch-Krankenhaus, Abt.Hämatologie,Onkologie u.Palliativmedizin
Stuttgart, Germany, 70736
Universitätsklinikum Ulm, Klinik für Innere Medizin III, Comprehensive Cancer Center Ulm (CCCU)
Ulm, Germany, 89081
St James's Hospital Dublin
Dublin, Ireland
University Hospital Galway
Galway, Ireland
A.O.U Careggi
Firenze, Italy, 50134
A.O San Martino
Genova, Italy, 16132
Fondazione San Raffaele del Monte Tabor
Milano, Italy, 20132
A.O. Cardarelli
Napoli, Italy, 80131
Hospital S. Maria delle Croci
Ravenna, Italy, 48121
Fondazion Policlin T Vergata
Roma, Italy, 00133
Haukeland Universitetssykehus
Bergen, Norway, 5021
Oslo University Hospital
Oslo, Norway, 0027
St Olavs Hospital
Trondheim, Norway, 7006
Samodzielny Publiczny Szpital Kliniczny Nr 1 we Wroclawiu
Wroclaw, Poland, 50-367
Fundeni Clinical Institute "Stefan Berceanu" Center for Hematology and Bone Marrow Transplant
Bucharest, Romania, 022328
Oncology Institute ,,Ion Chiricuta" Cluj Napoca , Hematology dept.
Cluj Napoca, Romania, 400124
St. Spiridon" University Hospital, Hematology Department
Iasi, Romania, 700111
Hospital Germans Trias i Pujol
Badalona, Spain, 08916
Hospital Universitario La Princesa
Madrid, Spain, 28006
Hospital Universitari Son Dureta
Palma de Mallorca, Spain, 07014
Hospital de Navarra
Pamplona, Spain, 31008
Hospital Universitario de Salamanca
Salamanca, Spain, 37007
Hospital Universitario La Fé, Servicio de Hematología
Valencia, Spain, 46009
United Kingdom
Gartnavel General Hospital: Beatson WOS Cancer Centre
Glasgow, Scotland, United Kingdom, G12 0YN
Bristol Haematology and Oncology Centre
Bristol, United Kingdom, BS2 8ED
Christie Hospital, Haematology and Transplant Day Unit
Manchester, United Kingdom, M20 4BX
Sponsors and Collaborators
Clavis Pharma
Principal Investigator: David Rizzieri, MD Duke University Medical Center, Durham, NC, USA
Study Chair: Francis J Giles, MD, PhD Cancer Therapy & Reseach Center at the University of Texas Health Science Center San Antonio, TX, USA

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Clavis Pharma Identifier: NCT01147939     History of Changes
Other Study ID Numbers: CP4055-306
First Posted: June 22, 2010    Key Record Dates
Last Update Posted: September 27, 2013
Last Verified: September 2013

Keywords provided by Clavis Pharma:
Acute Myeloid Leukaemia
Investigator's Choice
Refractory or relapsed AML
Phase III

Additional relevant MeSH terms:
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Neoplasms by Histologic Type
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs