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Randomized Study of ON 01910.Na in Refractory Myelodysplastic Syndrome Patients With Excess Blasts (ONTIME)

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: NCT01241500
Recruitment Status : Active, not recruiting
First Posted : November 16, 2010
Last Update Posted : July 23, 2018
The Leukemia and Lymphoma Society
Information provided by (Responsible Party):
Onconova Therapeutics, Inc.

Brief Summary:
The primary objective of this study is to compare overall survival (OS) in patients receiving ON 01910.Na + best supportive care (BSC) to OS of patients receiving BSC in a population of patients with myelodysplastic syndrome (MDS) with excess blasts (5% to 30% bone marrow blasts) who have failed azacitidine or decitabine treatment. This patient population has no available therapy and a short life expectancy (approximately 4 months). The high level of bone marrow activity of ON 01910.Na documented in Phase 1 and 2 studies has the potential to delay substantially the transition of MDS to Acute Myeloid Leukemia(AML), a very significant and severe complication, which shortens survival of these MDS patients.

Condition or disease Intervention/treatment Phase
Myelodysplastic Syndromes MDS RAEB Chronic Myelomonocytic Leukemia Drug: ON 01910.Na Phase 3

Detailed Description:

This is a Phase III open-label, randomized, controlled, multicenter study (up to 50 centers). Approximately 270 patients with MDS classified as RAEB-1 and RAEB-2 using the WHO classification and as RAEB-t and chronic myelomonocytic leukemia (CMML) using the FAB classification who failed, became intolerant to, or progressed after treatment with 5-azacitidine or decitabine administered during the past 2 years, will be randomized in a 2:1 ratio into the following 2 treatment regimens:

  • Best Supportive Care (BSC) + ON 01910.Na 1800 mg/24 hr administered as a 72-hr continuous intravenous (CIV) infusion on Days 1, 2, and 3 of a 2-week cycle (N = approximately 180 patients)
  • BSC (N = approximately 90 patients).

Patients will be stratified at entry by bone marrow (BM) blasts (5% to 19% vs. 20% to 30%). After completing the first eight 2-week cycles (i.e., after 16 weeks of treatment), the frequency of further 72-hr CIV infusions will be decreased to an administration on Days 1, 2, and 3 of a 4-week cycle.

Patients will remain treated on study until 2006 International Working Group (IWG) progression criteria are met (i.e., 50% increase of BM blasts or worsening of cytopenias) or until death from any cause, whichever comes first.

Patients who progress to Acute Myeloid Leukemia (AML) while on study should be offered either standard treatment for AML or enrollment in an appropriate investigational study if they are eligible. These treatments with their start and end dates should be documented and patient survival time will be documented for all randomized patients.

Cross-over of BSC patients to ON 01910.Na after progression will not be allowed. However, patients in the BSC-only group will be allowed, as medically justified, access to low-dose cytarabine 20 mg/m2 subcutaneously (SC) once daily for the first consecutive 14 days of each 28-day cycle, up to 4 cycles, until progression or unacceptable toxicity develops. Low-dose cytarabine will be delayed as needed until recovery of blood counts. All study participants will be allowed, as medically justified, access to RBC and platelet transfusions and to growth factors (erythropoietin, Filgrastim [G-CSF]). Hydroxyurea will be allowed to manage blastic crisis with hyperleukocytosis when patients transition to leukemia.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 299 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase III MultiCenter Randomized Controlled Study to Assess Efficacy and Safety of ON 01910.Na 72-Hr Continuous IV Infusion in MDS Patients With Excess Blasts Relapsing After or Refractory to or Intolerant to Azacitidine or Decitabine
Study Start Date : November 2010
Estimated Primary Completion Date : September 2018
Estimated Study Completion Date : February 2019

Arm Intervention/treatment
Experimental: ON 01910.Na + best supportive care (BSC)
Patients will receive ON 01910.Na 1800 mg/24 hr as a continuous intravenous infusion for 72 hours every other week for the first 16 weeks then every 4 weeks afterwards and best supportive care (BSC).
Drug: ON 01910.Na
The dose of ON 01910.Na will be 1800 mg/24 hr as a continuous intravenous infusion for 72 hours every other week for the first 16 weeks then every 4 weeks afterwards. Infusion bags must be changed every 24 hours and a new infusion bag must be used for each of the subsequent 24 hours until completion of the total 72-hour infusion time.
Other Name: rigosertib

No Intervention: Best supportive care (BSC)
Patients will receive best supportive care (BSC).

Primary Outcome Measures :
  1. Overall survival [ Time Frame: Up to 18 months ]
    Overall survival (OS) is defined as the time from randomization to death from any cause. All patients will be followed until death or progression, even if they have discontinued treatment for whatever cause. Patients lost to follow-up will be censored at the time last known alive. The OS primary analysis will compare the active ON 01910.Na regimen to BSC once a total number of 223 deaths has been reached.

Secondary Outcome Measures :
  1. Overall response (complete and partial remission) according to 2006 IWG criteria [ Time Frame: Changes measured at Week 4 from Baseline and every 8 Weeks thereafter ]
    Compare the BSC + ON 01910.Na group to the BSC group with respect to changes in bone marrow myeloblasts, hemoglobin, peripheral neutrophils, platelets and blasts.

  2. Complete bone marrow response according to 2006 IWG criteria [ Time Frame: Changes measured at Week 4 from Baseline and every 8 Weeks thereafter ]
    Compare the BSC + ON 01910.Na group to the BSC group with respect to changes in bone marrow myeloblasts.

  3. Hematological improvements according to 2006 IWG criteria [ Time Frame: Weekly ]
    Compare the BSC + ON 01910.Na group to the BSC group with respect to in absolute neutrophil count (ANC), platelet count, and erythroid responses.

  4. Scores of Quality of Life Questionnaire [ Time Frame: Measured at Baseline and every 4 Weeks ]
    Compare the BSC + ON 01910.Na group to the BSC group with respect to scores of Quality-of-life (QOL)(using the European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire [QLQ]-C30 version 3.

  5. Adverse events [ Time Frame: Weekly ]
    Record adverse events according to CTCAE v4.

  6. Change in Aneuploidy [ Time Frame: Baseline and, only if abnormal at Baseline, Week 4 and every 8 Weeks thereafter ]
    Improvements of cytogenetics as evaluated by the change in aneuploidy in bone marrow according to 2006 IWG criteria.

  7. Transition time to AML [ Time Frame: Measured at Week 4 from date of randomization and every 8 Weeks thereafter ]
    Transition time to AML: Defined for RAEB-1 and RAEB-2 MDS and chronic myelomonocytic leukemia (CMML) patients (with BM blasts from 10% to 20% for CMML) by an increase of at least 50% BM blasts and more than 20% BM blasts; Defined for RAEB-t by an increase of at least 50% BM blasts.

  8. Incidence of infections and bleeding episodes. [ Time Frame: Every 4 Weeks ]
    Incidence of infections (treated with intravenous antimicrobials) and bleeding episodes.

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:

  • MDS diagnosis confirmed within 6 weeks prior to entry according to WHO or FAB classification
  • MDS classified as follows, according to WHO and FAB classification:

    • RAEB-1 (5% - 9% BM blasts)
    • RAEB-2 (10% - 19% BM blasts)
    • CMML (10% - 20% BM blasts) and WBC < 13,000/μL
    • RAEB-t (20% - 30% BM blasts), with following criteria:
    • o WBC < 25 x 10E9/L at entry
    • o Stable WBC at least 4 weeks prior to entry and not requiring intervention for WBC control with hydroxyurea, chemotherapy, or leukopheresis.
  • At least one cytopenia (ANC < 1800/µL or platelet count < 100,000/µL or hemoglobin <10 g/dL)
  • Progression according to 2006 International Working Group (IWG) criteria any time after start of azacitidine or decitabine during past 2 years; or failure to achieve complete or partial response or hematological improvement (according to 2006 IWG) after at least six 4-week cycles of azacitidine or four 6-week cycles of decitabine during past 2 years; or relapse after initial complete or partial response or hematological improvement (according to 2006 IWG criteria) observed after at least six 4-week cycles of azacitidine or four 6-week cycles of decitabine during past 2 years; or, intolerance to azacitidine or decitabine defined by drug-related ≥Grade 3 liver or renal toxicity leading to discontinuation during the past 2 years.
  • Did not respond to, relapsed after, not eligible for, or opted not to do bone marrow transplantation
  • Off other MDS treatments for at least 4 weeks; Filgrastim (G-CSF) and erythropoietin allowed before and during the study as clinically indicated.
  • No need for induction chemotherapy
  • ECOG status 0, 1 or 2
  • Willing to adhere to protocol prohibitions and restrictions
  • Patient (or a legally authorized representative) must sign informed consent form to indicate patient's understanding study's purpose and procedures and willingness to participate

Exclusion Criteria:

  • Anemia due to factors other than MDS (including hemolysis or gastrointestinal bleeding) unless stabilized for 1 week after RBC transfusion.
  • Any active malignancy within the past year, except basal cell or squamous cell skin cancer or carcinoma in situ of the cervix or breast
  • Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia
  • Active infection not adequately responding to appropriate therapy
  • Total bilirubin ≥1.5 mg/dL not related to hemolysis or Gilbert's disease.
  • Alanine transaminase (ALT)/aspartate transaminase (AST) ≥2.5 x upper limit of normal (ULN)
  • Serum creatinine ≥2.0 mg/dL
  • Ascites requiring active medical management including paracentesis, or hyponatremia (defined as serum sodium value of <130 mEq/L)
  • Pregnant or lactating females
  • Patients unwilling to follow strict contraception requirements (including condom use for males with sexual partners, and for females: prescription oral contraceptives [birth control pills], contraceptive injections, intrauterine device, double-barrier method [spermicidal jelly or foam with condoms or diaphragm], contraceptive patch, or surgical sterilization) before entry and throughout the study
  • Females with reproductive potential who do not have a negative urine beta-human chorionic gonadotropin pregnancy test at screening
  • Major surgery without full recovery or major surgery within 3 weeks of ON 01910.Na treatment start
  • Uncontrolled hypertension (defined as systolic pressure ≥160 mmHg and/or diastolic pressure ≥110 mmHg)
  • New onset seizures (within 3 months prior to first dose of ON 01910.Na) or poorly controlled seizures
  • Any other concurrent investigational agent or chemotherapy, radiotherapy, or immunotherapy
  • Prior treatment with low-dose cytarabine during past 2 years Investigational therapy within 4 weeks of starting ON 01910.Na
  • Psychiatric illness or social situation that limits the patient's ability to tolerate and/or comply with study requirements

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): NCT01241500

  Hide Study Locations
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United States, Arizona
Virginia G. Piper Cancer Center
Scottsdale, Arizona, United States, 85258
United States, California
University of California San Diego Moores Cancer Center
La Jolla, California, United States, 92093
Stanford Cancer Center
Stanford, California, United States, 94305
United States, Connecticut
Yale Cancer Center
New Haven, Connecticut, United States, 06520
United States, District of Columbia
Georgetown University Hospital
Washington, District of Columbia, United States, 20007
United States, Florida
Integrated Community Oncology Network
Jacksonville, Florida, United States, 32256
Mount Sinai Comprehensive Cancer Centers
Miami Beach, Florida, United States, 33140
Innovative Medical Research of South Florida, Inc.
Miami, Florida, United States, 33169
Woodlands Medical Specialists
Pensacola, Florida, United States, 32503
Martin Memorial Cancer Center
Stuart, Florida, United States, 34994
Cleveland Clinic Florida
Weston, Florida, United States, 33331
United States, Georgia
Emory University Winship Cancer Institute
Atlanta, Georgia, United States, 30322
United States, Illinois
Rush University Medical Center
Chicago, Illinois, United States, 60612
University of Chicago Medical Center
Chicago, Illinois, United States, 60637
North Shore Medical Center
Evanston, Illinois, United States, 60201
Cardinal Bernardin Cancer Center
Maywood, Illinois, United States, 60153
Edward H. Kaplan MD & Associates
Skokie, Illinois, United States, 60076
United States, Kansas
University of Kansas Medical Center
Westwood, Kansas, United States, 66205
United States, Louisiana
Mary Bird Perkins Cancer Center
Baton Rouge, Louisiana, United States, 70809
United States, Maryland
University of Maryland Greenebaum Cancer Center
Baltimore, Maryland, United States, 21201
Johns Hopkins Hospital
Baltimore, Maryland, United States, 21231
United States, Massachusetts
Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 02115
United States, Michigan
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, United States, 48109
Providence Cancer Center
Southfield, Michigan, United States, 48075
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
United States, New Jersey
Hackensack University Medical Center
Hackensack, New Jersey, United States, 07601
Overlook Hospital
Summit, New Jersey, United States, 07901
United States, New York
Albert Einstein College of Medicine
Bronx, New York, United States, 10461
North Shore - LIJ Health System
Lake Success, New York, United States, 11042
Weill Cornell Medical College
New York, New York, United States, 10021
Mount Sinai Medical Center
New York, New York, United States, 10029
United States, Ohio
Cleveland Clinic
Cleveland, Ohio, United States, 44195
United States, Oklahoma
University of Oklahoma Health Science Center
Oklahoma City, Oklahoma, United States, 73104
United States, Pennsylvania
University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States, 19104
United States, South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States, 29425
Bon Secours St. Francois Health System
Greenville, South Carolina, United States, 29601
United States, Texas
University of Texas Southwestern Medical Center at Dallas
Dallas, Texas, United States, 75390
University of Texas M. D. Anderson Cancer Center
Houston, Texas, United States, 77030
Cancer Care Centers of South Texas
San Antonio, Texas, United States, 78229
United States, Washington
Fred Hutchinson Cancer Research Center
Seattle, Washington, United States, 98109
United States, Wisconsin
Medical College of Wisconsin
Milwaukee, Wisconsin, United States, 53226
H. Hartziekenhuis Roeselare-Menen vzw
Roeselare, West-vlaanderen, Belgium, 8800
Ziekenhuis Netwerk Antwerpen
Antwerp, Belgium, 2060
Universitair Ziekenhuis Gent
Gent, Belgium, 9000
CHU de Mont-Godinne
Yvoir, Belgium, 5530
CHU Angers Service de Medecine D - Maladies du Sang
Angers, France, 49033
CHU Avignon Centre Hospitalier Henri Dufaut
Avignon, France, 84000
Hôpital Avicenne Hématologie Clinique
Bobigny, France, 93009
CHU Caen Hématologie Clinique
Caen, France, 14000
CHU Estaing Service d'hématologie
Clermont-Ferrand, France, 63000
CHU Lille Hôpital Claude Huriez
Lille, France, 59037
CHU Limoges Hopital Dupuytren
Limoges, France, 87042
Institute Paoli Calmettes
Marseille, France, 13009
Hôpital de L'archet I
Nice, France, 6202
Hôtel Dieu Sce Hématologie Clinique
Paris, France, 75004
Hôpital Saint-Antoine
Paris, France, 75571
CHU Perpignan Centre Hospitalier Hôpital Saint-Jean
Perpignan, France, 66046
CRLCC Henri Becquerel
Rouen, France, 76038
Chu-Strasbourg-Hopital Civil
Strasbourg, France, 67091
Hôpital Purpan
Toulouse, France, 31059
Universitätsklinikum Bonn
Bonn, Nordrhein-westfalen, Germany, 53127
Universitätsklinikum Dresden
Dresden, Germany, 01307
Heinrich-Heine-Universität Düsseldorf
Düsseldorf, Germany, 40225
Klinikum der Johann Wolfgang-Goethe-Universität
Frankfurt am Main, Germany, 60590
Universitätsklinikum Hamburg-Eppendorf
Hamburg, Germany, 20246
Universitätsklinikum zu Köln
Köln, Germany, 50924
Universitätsmedizin Mannheim
Mannheim, Germany, 68167
Johannes-Wesling-Klinikum Minden
Minden, Germany, 32429
Klinikum Rechts der Isar der Technischen Universität München
München, Germany, 81675
Universitätsklinikum Ulm
Ulm, Germany, 89081
Azienda Ospedaliera Universitaria Senese Policlinico Santa Maria alle Scotte
Siena, SI, Italy, 53100
Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo
Alessandria, Italy, 15100
Azienda Ospedaliero-Universitaria di Bologa Policlinico S. Orsola-Malpighi
Bologna, Italy, 40138
Azienda Ospedaliera-Universitairia Vittorio Emanuele-Ferrarotto-Santo Bambino
Catania, Italy, 95124
Azienda Ospedaliera Universitaria Careggi di Firenze
Firenze, Italy, 50134
Azienda Ospedaliera Universitaria San Martino
Genova, Italy, 16132
Azienda Osperdaliera Universitaria Maggiore della Carità
Novara, Italy, 28100
Università degli Studi La Sapienza
Roma, Italy, 00161
Azienda Ospedaliero Universitaria San Giovanni Battista di Torino
Torino, Italy, 10126
Hospital Universitario Central de Asturias
Oviedo, Asturias, Spain, 33006
Hospital Universitario La Princesa
Madrid, Spain, 28006
Hospital Universitario La Paz
Madrid, Spain, 28046
Hospital Clínico Universitario Virgen de la Victoria
Málaga, Spain, 29010
Hospital Universitario Son Espases
Palma de Mallorca, Spain, 07012
Hospital Clínico Universitario de Salamanca
Salamanca, Spain, 37007
Hospital Universitari i Politècnic La Fe
Valencia, Spain, 46009
Hospital Clínico Universitario de Valencia
Valencia, Spain, 46010
Sponsors and Collaborators
Onconova Therapeutics, Inc.
The Leukemia and Lymphoma Society
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Study Chair: Steven M. Fruchtman, MD Onconova Therapeutics, Inc.

Additional Information:
Publications of Results:
Al-Kali A. Relationship of bone marrow blast (BMBL) response to overall survival (OS) in a multicenter study of rigosertib (Rigo) in patients (pts) with myelodysplastic syndrome (MDS) with excess blasts progressing on or after treatment with a hypomethylating agent (HMA). Journal of Clinical Oncology 2017 35:15_suppl, 7056-7056 ASCO 2017
Garcia-Manero G, Fenaux P. Comprehensive Analysis of Safety: Rigosertib in 557 Patients with Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML). Blood Dec 2016, 128 (22) 2011; ASH 2016.

Other Publications:
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Responsible Party: Onconova Therapeutics, Inc. Identifier: NCT01241500     History of Changes
Other Study ID Numbers: 04-21
First Posted: November 16, 2010    Key Record Dates
Last Update Posted: July 23, 2018
Last Verified: July 2018
Keywords provided by Onconova Therapeutics, Inc.:
Myelodysplastic syndromes
Additional relevant MeSH terms:
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Leukemia, Myelomonocytic, Chronic
Leukemia, Myelomonocytic, Juvenile
Myelodysplastic Syndromes
Pathologic Processes
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Leukemia, Myeloid
Neoplasms by Histologic Type
Myelodysplastic-Myeloproliferative Diseases
ON 01910
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action