ClinicalTrials.gov
ClinicalTrials.gov Menu

Recombinant EphB4-HSA Fusion Protein and Azacitidine or Decitabine for Relapsed or Refractory Myelodysplastic Syndrome, Chronic Myelomonocytic Leukemia, or Acute Myeloid Leukemia Patients Previously Treated With a Hypomethylating Agent

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT03146871
Recruitment Status : Recruiting
First Posted : May 10, 2017
Last Update Posted : August 24, 2018
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
University of Southern California

Brief Summary:
This trial studies the side effects of recombinant EphB4-HSA fusion protein when given together with azacitidine or decitabine in treating patients with myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia that has come back or has not responded to previous treatment with a hypomethylating agent. Recombinant EphB4-HSA fusion protein may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Hypomethylating agents, such as azacitidine and decitabine, slow down genes that promote cell growth and can kill cells that are dividing rapidly. Giving recombinant EphB4-HSA fusion protein together with azacitidine or decitabine may work better in treating patients with myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia.

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome Chronic Myelomonocytic Leukemia Previously Treated Myelodysplastic Syndrome Recurrent Acute Myeloid Leukemia With Myelodysplasia-Related Changes Recurrent Adult Acute Myeloid Leukemia Drug: Azacitidine Drug: Decitabine Other: Laboratory Biomarker Analysis Other: Pharmacological Study Biological: Recombinant EphB4-HSA Fusion Protein Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To describe the toxicities and assess the tolerability of recombinant EphB4-HSA fusion protein (sEphB4-HSA) in combination with an approved hypomethylating agent (HMA) among patients with myelodysplastic syndrome (MDS) who are refractory to or have lost their response to one or more HMAs and among patients with relapsed/refractory acute myeloid leukemia (AML) previously treated with a HMA.

SECONDARY OBJECTIVES:

I. To measure the expression of EphB4 among marrow and peripheral blood blasts in patients with MDS & AML at baseline and over the course of treatment.

II. To measure the expression of immune check-point activating ligands (such as PD-L1, PD-L2) on marrow and peripheral blood blasts in patients treated with HMA and sEphB4-HSA in combination.

III. To profile immune subsets (activated and exhausted T cells, natural killer [NK] cells, T regulatory cells, and myeloid derived suppressor cells) in the peripheral blood and marrow in patients treated with HMA and sEphB4-HSA in combination.

IV. To assess efficacy of sEphB4-HSA in combination with an HMA as manifest by International Working Group (IWG) response criteria, as well as time to development of acute myeloid leukemia (AML) in patients with MDS and time to progression.

OUTLINE:

Patients receive recombinant EphB4-HSA fusion protein intravenously (IV) over 60 minutes on days 1 and 15. Patients also receive azacitidine IV or subcutaneously (SC) on days 1-7 or days 1-5 and 8-9, or decitabine IV on days 1-5. Administration of recombinant EphB4-HSA fusion protein occurs before or after the HMA (not concurrently). Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 6 months.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 12 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Pilot/Safety Study of sEphB4-HSA in Combination With a Hypomethylating Agent (HMA) for Patients With Relapsed or Refractory Myelodysplastic Syndrome (MDS) and AML Previously Treated With a Hypomethylating Agent
Actual Study Start Date : April 20, 2017
Estimated Primary Completion Date : April 20, 2020
Estimated Study Completion Date : April 20, 2021


Arm Intervention/treatment
Experimental: Treatment (sEphB4-HSA, azacitidine, decitabine)
Patients receive recombinant EphB4-HSA fusion protein intravenously (IV) over 60 minutes on days 1 and 15. Patients also receive azacitidine IV or subcutaneously (SC) on days 1-7 or days 1-5 and 8-9, or decitabine IV on days 1-5. Administration of recombinant EphB4-HSA fusion protein occurs before or after the HMA (not concurrently). Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Drug: Azacitidine
Given IV or SC
Other Names:
  • 5 AZC
  • 5-AC
  • 5-Azacytidine
  • 5-AZC
  • Azacytidine
  • Azacytidine, 5-
  • Ladakamycin
  • Mylosar
  • U-18496
  • Vidaza

Drug: Decitabine
Given IV
Other Names:
  • 5-Aza-2'-deoxycytidine
  • Dacogen
  • Decitabine for Injection
  • Deoxyazacytidine
  • Dezocitidine

Other: Laboratory Biomarker Analysis
Correlative studies

Other: Pharmacological Study
Correlative studies

Biological: Recombinant EphB4-HSA Fusion Protein
Given IV
Other Name: sEphB4-HSA




Primary Outcome Measures :
  1. Incidence of adverse events graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v)4.0 [ Time Frame: Up to 30 days of the last dose of protocol treatment ]
    Will be tabulated and reported according to grade, type, cycle, and attribution.

  2. Overall response defined as the occurrence of complete response, marrow complete response, partial response, or hematological improvement assessed by the IWG Working Group Criteria for MDS and AML [ Time Frame: Up to 56 days (2 courses of protocol treatment) ]
    Will be calculated based on all patients who began treatment; exact 95% confidence intervals will be constructed.

  3. Time to death from any cause [ Time Frame: From start of treatment to death from any cause, assessed for up to 3 years ]
    Will be displayed with Kaplan-Meier plots.

  4. Time to disease progression [ Time Frame: From the start of treatment to the first disease progression or recurrence, assessed for up to 3 years ]
    Will be displayed with Kaplan-Meier plots.

  5. Tolerability defined as the ability to complete two courses of treatment without the occurrence of dose limiting toxicity and the ability to begin course 3 within 4 weeks and graded according to the NCI CTCAE v4.0 [ Time Frame: Up to 4 weeks following completion of course 2 ]
    Will be tabulated and reported according to grade, type, cycle, and attribution.


Other Outcome Measures:
  1. Change in the percent of bone marrow and peripheral blood blasts expressing EphB4 assessed by flow cytometry [ Time Frame: Baseline up to 3 years ]
  2. T-cell subset profile assessed by flow cytometry [ Time Frame: Baseline up to 3 years ]


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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

Inclusion Criteria:

  • Adult subjects with advanced MDS requiring treatment with HMA and either refractory to at least 4 cycles or progressing after previously documented response

    • Patient must be treated within 6 months of the last HMA treatment and must be willing to be treated with the same agent they last received on this study
    • Prior treatment with novel HMA analog of decitabine on clinical trial is allowed; in such cases, decitabine will be used as the standard of care agent
  • MDS classified as intermediate 1-risk or high risk according to the international prognostic scoring system (IPSS) or revised-IPSS
  • Chronic myelomonocytic leukemia (CMML)
  • Acute myeloblastic leukemia (AML) that was previously treated with HMA and is unfit for intensive chemotherapy

    • Patient must be within 6 months of prior treatment with HMA and must be willing to be treated with the same agent on this study
  • During the 8 weeks prior to inclusion in study, subjects must have a baseline bone marrow examination including all of the following:

    • Cytomorphology to confirm bone marrow blasts
    • Cytogenetics
  • Eastern Cooperative Oncology Group (ECOG) status 0-2
  • Subject is able to understand and willing to comply with protocol requirements and instructions
  • Subject has signed and dated informed consent
  • Total bilirubin (except for Gilbert's syndrome) =< 2.5 x upper limit of normal (ULN)
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x ULN
  • Creatinine =< 2.5 x ULN
  • Women of childbearing potential (WOCBP) and male patients with WOCBP as partners must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 12 weeks after the last dose of the investigational agent; subject is practicing an acceptable method of contraception (documented in case report form [CRF]); WOCBP include any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not postmenopausal; post menopause is defined as:

    • Amenorrhea >= 12 consecutive months without another cause or
  • For women with irregular menstrual periods and on hormone replacement therapy (HRT), a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL
  • Women who are using oral contraceptives, other hormonal contraceptives (vagina products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy, or are practicing abstinence or where their partner is sterile (e.g., vasectomy) should be considered to be of childbearing potential
  • WOCBP must have a negative serum test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) within 72 hours prior to the start of investigational product
  • Patients with uncontrolled hypertension

Exclusion Criteria:

  • Patients with AML whose white blood cell count exceeds 25,000
  • Corrected QT (QTc) (Fridericia Correction Formula) > 480 on electrocardiogram (ECG)
  • Patients whose electrolytes (sodium, potassium, calcium, magnesium) are abnormal or cannot be normalized with standard intervention on the day of treatment with study drug
  • Patients who are actively receiving any other anticancer therapy
  • Patients with a history of allergic reactions attributed to compounds of similar chemical or biologic composition to HMAs
  • Patients with a diagnosis of acute promyelocytic leukemia
  • Patients with short life expectancy (less than 3 months) due to comorbidity other than MDS
  • Female subjects who are nursing or pregnant (positive serum or urine Beta-human chorionic gonadotropin [B-hCG] pregnancy test)
  • Patients with current alcohol or drug abuse
  • Patients who have received treatment with an investigational drug within 30 days preceding the first dose of study medication
  • Patients with uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Patients infected with hepatitis B, C or human immunodeficiency virus (HIV), unless they are on stable and effective antiviral treatment
  • Patients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of randomization; inhaled or topical steroids and adrenal replacement steroid doses > 10mg daily prednisone equivalent, are permitted in the absence of uncontrolled autoimmune disease
  • MEDICATION-RELATED EXCLUSION CRITERIA
  • Patients with uncontrolled hypertension (HTN) (> 160/90) will not be admitted onto 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): NCT03146871


Contacts
Contact: Ibrahim Syed 323-409-4375 Syed_I@med.usc.edu
Contact: Christine Duran 323-865-0371 Duran_C@med.usc.edu

Locations
United States, California
USC / Norris Comprehensive Cancer Center Recruiting
Los Angeles, California, United States, 90033
Contact: Ibrahim L. Syed    323-865-3928    Ibrahim.Syed@med.usc.edu   
Principal Investigator: Casey L. O'Connell, MD         
Sponsors and Collaborators
University of Southern California
National Cancer Institute (NCI)
Investigators
Principal Investigator: Casey O'Connell, MD University of Southern California

Responsible Party: University of Southern California
ClinicalTrials.gov Identifier: NCT03146871     History of Changes
Other Study ID Numbers: 9L-16-6
NCI-2017-00623 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
9L-16-6 ( Other Identifier: USC / Norris Comprehensive Cancer Center )
P30CA014089 ( U.S. NIH Grant/Contract )
First Posted: May 10, 2017    Key Record Dates
Last Update Posted: August 24, 2018
Last Verified: August 2018

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Syndrome
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Preleukemia
Leukemia, Myelomonocytic, Acute
Leukemia, Myelomonocytic, Chronic
Leukemia, Myelomonocytic, Juvenile
Disease
Pathologic Processes
Neoplasms by Histologic Type
Neoplasms
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Myelodysplastic-Myeloproliferative Diseases
Azacitidine
Decitabine
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors