Low Dose Cytarabine and Lintuzumab-Ac225 in Older Patients
The goal of the Phase 1 part of this study is to find the highest tolerable dose of Lintuzumab-Ac225 that can be given with cytarabine to patients with AML.
The goal of the Phase 2 part of this study is to learn if Lintuzumab-Ac225 and cytarabine can control AML. The safety of this drug combination will also be studied.
Lintuzumab-Ac225 is designed to deliver radiation therapy directly inside leukemia cells without giving any radiation to the surrounding normal cells
Cytarabine is designed to insert itself into DNA (genetic material) of cancer cells and stop the DNA from repairing itself.
|Study Design:||Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Phase I/II Study of Low Dose Cytarabine and Lintuzumab-Ac225 in Older Patients With Untreated Acute Myeloid Leukemia|
- Maximum Tolerated Dose (MTD) of Lintuzumab-Ac225 [ Time Frame: Cycle 1, up to 52 days ] [ Designated as safety issue: Yes ]If two or more patients in a cohort experience dose limiting toxicity (DLT), then maximum tolerated dose (MTD) will have been exceeded, and no further dose escalation will occur. If only three patients were treated at a dose level under consideration as the MTD, then up to three additional patients will be accrued. If no more than one of the six patients at that dose level experiences DLT, then that dose level will be confirmed as the MTD.
- Response Rate [ Time Frame: After 4, 28 day cycles ] [ Designated as safety issue: No ]Response criteria defined by Cheson et al. used. Patients assessed for response at the end of Cycle 4 (just prior to Cycle 5 LDAC administration). The response rate, complete remission plus complete remission with incomplete platelet count recovery (CR + CRp), is primary efficacy endpoint.
|Study Start Date:||October 2012|
|Estimated Primary Completion Date:||October 2016 (Final data collection date for primary outcome measure)|
Experimental: Cytarabine + Lintuzumab-Ac225
Cytarabine 20 mg subcutaneously every 12 hours Days 1 to 10 of every cycle. Starting dose level 1.0 μCi/Kg of Lintuzumab-Ac225 and 15 μg/Kg unlabeled HuM195 divided into 2 equal fractionated doses (0.5 μCi/Kg and 7.5 μg /Kg + 0.5 μCi/Kg and 7.5 μg /Kg) with the first fraction administered approximately 4 - 7 days after 1 cycle of low dose cytarabine and the second fraction administered 4-7 days after the first fraction, followed by up to 11 more cycles. Lasix 40 mg by mouth (po) daily one day prior to treatment with Lintuzumab-Ac225 and continuing for 10 days following administration of the 2nd divided dose. Spironolactone, 25 mg po daily, administered 11 days after second dose of 225Ac-HuM195 (the day after completion of furosemide) and continued for 12 months.
Low dose cytarabine administered at 20 mg subcutaneously every 12 hours for the first 10 days (Days 1 to 10) of every cycle. Cycle 1 can last up to 52 days (depending on the schedule of study drug dosing) in order to allow for recovery from Lintuzumab-Ac225. Cycles 2-12 will last 28 days each.
Other Names:Biological: Lintuzumab-Ac225
Starting dose level 1.0 μCi/Kg of Lintuzumab-Ac225 and 15 μg/Kg unlabeled HuM195 divided into 2 equal fractionated doses (0.5 μCi/Kg and 7.5 μg /Kg + 0.5 μCi/Kg and 7.5 μg /Kg) with the first fraction administered approximately 4 - 7 days after 1 cycle of low dose cytarabine and the second fraction administered 4-7 days after the first fraction, followed by up to 11 more cycles.
Other Name: LintuzumabDrug: Lasix
40 mg by mouth daily one day prior to treatment with Lintuzumab-Ac225 and continuing for 10 days following administration of the 2nd divided dose.
Other Name: furosemideDrug: Spironolactone
25 mg by mouth daily, administered 11 days after second dose of 225Ac-HuM195 (the day after completion of furosemide) and continued for 12 months.
Hide Detailed Description
If you are found to be eligible to take part in this study, you will be assigned to a study group based on when you join this study. Up to 4 groups of up to 6 participants will be enrolled in the Phase I portion of the study, and up to 53 participants will be enrolled in Phase II.
If you are enrolled in the Phase I portion, the dose of Lintuzumab-Ac225 you receive will depend on when you joined this study. The first group of participants will receive the lowest dose level of Lintuzumab-Ac225. Each new group will receive a higher dose of Lintuzumab-Ac225 than the group before it, if no intolerable side effects were seen. This will continue until the highest tolerable dose of Lintuzumab-Ac225 is found.
If you are enrolled in the Phase II portion, you will receive Lintuzumab-Ac225 at the highest dose that was tolerated in the Phase I portion.
All participants will receive the same dose level of cytarabine.
Study Drug Administration:
You will receive cytarabine as an injection under the skin. This is called a subcutaneous injection. During the first office visit, you or a caregiver will be taught to give these injections at home. You will get cytarabine injections 2 times each day during Days 1-10 of each study cycle. Cycle 1 may last up to 52 days and will depend on how you recover from the Lintuzumab-Ac225. All other cycles will be 28 days.
You will receive Lintuzumab-Ac225 by vein over 15-30 minutes at a time point about 4 to 7 days after your last dose of cytarabine in Cycle 1. You will receive it a second time about 4 to 7 days after that.
One (1) day before the second dose of Lintuzumab-Ac225, you will begin taking lasix (furosemide) by mouth every day for 10 days. Furosemide is taken to prevent possible damage to the kidneys.
One (1) day after your last dose of furosemide, you will begin taking spironolactone by mouth every day for up to 1 year. It is also taken to prevent possible kidney damage.
You will be given standard drugs to help decrease the risk of side effects. You may ask the study staff for information about how the drugs are given and their risks.
During Cycle 1:
- Every week, blood (6-10 teaspoons) will be drawn for routine tests.
- Every other week, urine will be collected for routine tests.
- About 1 week before Cycle 2, you will have a bone marrow aspirate and biopsy to check the status of the disease.
During Cycles 2-12:
- Every week, blood (6-10 teaspoons) will be drawn for routine tests.
- Blood (about 1-2 teaspoons) will be drawn to find out how Lintuzumab-Ac225 may affect your immune system (Cycles 3, 4, and 7 only).
- Every month, urine will be collected for routine tests.
- About 1 week before Cycles 3 and 5, you will have a bone marrow aspirate and biopsy to check the status of the disease.
Length of Study:
You will only receive Lintuzumab-Ac225 during the first cycle, but you may continue receiving cytarabine for up to 12 cycles. You will be taken off the study if the disease gets worse, if intolerable side effects occur, or if you are unable to follow study directions.
Your participation on the study will be over once you have completed the follow-up.
If you stop taking the study drugs before all 12 treatment cycles are finished, you may be contacted by telephone or be seen in the clinic every month for up to 1 year to check on any side effects you may be having.
This is an investigational study. Lintuzumab-Ac225 is not FDA approved or commercially available. It is currently being used for research purposes only. Cytarabine is FDA approved and commercially available for the treatment of AML. The use of these drugs in combination for AML is investigational.
Up to 72 participants will be enrolled in this multicenter study. Up to 24 will take part at MD Anderson.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01756677
|United States, New York|
|Memorial Sloan Kettering|
|New York, New York, United States, 10065|
|United States, Texas|
|University of Texas MD Anderson Cancer Center|
|Houston, Texas, United States, 77030|
|Study Chair:||Farhad Ravandi-Kashani, MD||M.D. Anderson Cancer Center|