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LBH589 Plus Decitabine for Myelodysplastic Syndromes (MDS) or Acute Myeloid Leukemia (AML)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Washington University School of Medicine
ClinicalTrials.gov Identifier:
NCT00691938
First received: June 4, 2008
Last updated: August 18, 2016
Last verified: August 2016
  Purpose
This study is designed to evaluate the combination of LBH589 and decitabine in patients age ≥ 60 years with high risk Myelodysplastic Syndrome (IPSS Int-2 or High) or Acute Myeloid Leukemia.

Condition Intervention Phase
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Drug: LBH589
Drug: Decitabine
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I/II Study of LBH589 Plus Decitabine for Patients Age ≥ 60 Years With High Risk MDS or AML

Resource links provided by NLM:


Further study details as provided by Washington University School of Medicine:

Primary Outcome Measures:
  • Phase I: Maximum Tolerated Dose (MTD) of LBH589 When Given in Combination With Decitabine [ Time Frame: Completion of Phase I enrollment for MTD (approximately 26 months) ] [ Designated as safety issue: Yes ]
  • Phase II: Overall Rate of Morphologic Complete Remission (CR) + Cytogenetic Complete Remission (CRc) + Morphologic Complete Remission With Incomplete Blood Count Recovery (CRi) [ Time Frame: Up to 12 months ] [ Designated as safety issue: No ]
    • Morphologic complete remission (CR). A CR designation requires that the patient achieve the morphologic leukemia-free state with less than 5% blasts in an aspirate sample with marrow spicules and with a count of at least 200 nucleated cells. There should be no blasts with Auer rods or persistence of extramedullary disease. Patients must also have an absolute neutrophil count of more than 1,000/μLand platelets of 100,000/μL.
    • Cytogenetic complete remission (CRc). A CRc will be defined by the achievement of a CR with reversion to a normal karyotype in a minimum of 20 metaphases analyzed by cytogenetics.
    • Morphologic complete remission with incomplete blood count recovery (CRi): Achievement of all of the criteria for CR except for residual neutropenia (< 1,000/μL) or thrombocytopenia (< 100,000/μL).


Secondary Outcome Measures:
  • Rate of Cytogenetic Complete Remission (CRc) [ Time Frame: Up to 12 months ] [ Designated as safety issue: No ]
    Cytogenetic complete remission (CRc). A CRc will be defined by the achievement of a CR with reversion to a normal karyotype in a minimum of 20 metaphases analyzed by cytogenetics.

  • Changes in Quality of Life Scores as Measured by the Function Assessment of Cancer Therapy-Leukemia (FACT-Leu) Version 4 [ Time Frame: Up to approximately 12 months after start of treatment ] [ Designated as safety issue: No ]
    -The FACT-Leu consists of a 27-item compilation of general questions divided into four primary quality of life domains: physical well-being, social/family well being, emotional well-being, and functional well-being along with a 17 item subscale developed specifically for patients with leukemia.

  • Time to Response [ Time Frame: Up to 12 months ] [ Designated as safety issue: No ]
    Time to response is defined as the date of the first dose of study drug to the date that all criteria for CR or CRi are fulfilled.

  • Safety and Tolerability of Regimen as Measured by the Rate of the Most Common Adverse Events Experienced [ Time Frame: Up to 13 months after start of treatment ] [ Designated as safety issue: Yes ]
    Adverse events will be assessed according to the Common Toxicity Criteria for Adverse Events (CTCAE) version 3.0.

  • Remission Duration [ Time Frame: Completion of follow-up (median follow-up was 58 months) ] [ Designated as safety issue: No ]
    Defined as the first date that all criteria for CR, CRi or HI are fulfilled to the date of treatment failure, relapse from CR, or death due to any cause.

  • Progression-free Survival [ Time Frame: Completion of follow-up (median follow-up was 58 months) ] [ Designated as safety issue: No ]
  • Event-free Survival [ Time Frame: Completion of follow-up (median follow-up was 58 months) ] [ Designated as safety issue: No ]
    Event-free survival is defined as the interval from the date of first dose of study drug to date of treatment failure, relapse from CR, or death due to any cause.

  • Overall Survival [ Time Frame: Completion of follow-up (median follow-up was 58 months) ] [ Designated as safety issue: No ]
    Overall survival is defined as the date of first dose of study drug to the date of death from any cause.

  • Rates of Morphologic Complete Remission With Incomplete Count Recovery (CRi) [ Time Frame: Up to 12 months ] [ Designated as safety issue: No ]
    Morphologic complete remission with incomplete blood count recovery (CRi): Achievement of all of the criteria for CR except for residual neutropenia (< 1,000/μL) or thrombocytopenia (< 100,000/μL).

  • Rate of Hematologic Improvement. [ Time Frame: Up to 12 months ] [ Designated as safety issue: No ]

    -Hematologic improvement (HI). Includes the following categories:

    • Erythroid response: Hemoglobin increase by ≥ 1.5 g/dL over baseline in which the pretreatment hemoglobin is < 11 g/dL or reduction of RBC transfusions of at least 4 RBC transfusions / 8 wk compared with the pretreatment transfusion number in the previous 8 weeks.
    • Platelet response. Absolute increase of > 30 x 10^9/L for patients starting with 20 x 10^9/L or increase from < 20 x 10^9/L to > 20 x 109/L and by at least 100%
    • Neutrophil response. At least 100% increase and an absolute increase > 0.5 x 109/L for patients with pretreatment neutrophils < 1.0 x 109/L)


Enrollment: 52
Study Start Date: June 2008
Study Completion Date: August 2014
Primary Completion Date: July 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Level 1

LBH589 10 mg/day three times a week on nonconsecutive days in a 28 day cycle.

Decitabine 20 mg/m^2 IV on days 1-5 in a 28 day cycle.

Drug: LBH589
Other Name: Panobinostat
Drug: Decitabine
Other Names:
  • Dacogen
  • 5-aza-2'-deoxycytidine
Experimental: Level 2

LBH589 15 mg/day three times a week on nonconsecutive days in a 28 day cycle.

Decitabine 20 mg/m^2 IV on days 1-5 in a 28 day cycle.

Drug: LBH589
Other Name: Panobinostat
Drug: Decitabine
Other Names:
  • Dacogen
  • 5-aza-2'-deoxycytidine
Experimental: Level 3

LBH589 20 mg/day three times a week on nonconsecutive days in a 28 day cycle.

Decitabine 20 mg/m^2 IV on days 1-5 in a 28 day cycle.

Drug: LBH589
Other Name: Panobinostat
Drug: Decitabine
Other Names:
  • Dacogen
  • 5-aza-2'-deoxycytidine
Experimental: Level 4

LBH589 30 mg/day three times a week on nonconsecutive days in a 28 day cycle.

Decitabine 20 mg/m^2 IV on days 1-5 in a 28 day cycle.

Drug: LBH589
Other Name: Panobinostat
Drug: Decitabine
Other Names:
  • Dacogen
  • 5-aza-2'-deoxycytidine
Experimental: Level 5

LBH589 40 mg/day three times a week on nonconsecutive days in a 28 day cycle.

Decitabine 20 mg/m^2 IV on days 1-5 in a 28 day cycle.

Drug: LBH589
Other Name: Panobinostat
Drug: Decitabine
Other Names:
  • Dacogen
  • 5-aza-2'-deoxycytidine
Experimental: Level 5B

LBH589 40 mg/day three times a week on nonconsecutive days for the first 2 weeks in a 28 day cycle.

Decitabine 20 mg/m^2 IV on days 1-5 in a 28 day cycle.

Drug: LBH589
Other Name: Panobinostat
Drug: Decitabine
Other Names:
  • Dacogen
  • 5-aza-2'-deoxycytidine
Experimental: Phase II

LBH589 will be given in the dose and in the schedule that was found to work in the Phase I portion which was Level 5B.

Decitabine 20 mg/m^2 IV on days 1-5 in a 28 day cycle.

Drug: LBH589
Other Name: Panobinostat
Drug: Decitabine
Other Names:
  • Dacogen
  • 5-aza-2'-deoxycytidine

Detailed Description:

To address the need for less toxic, more effective treatments for older patients with advanced MDS and AML, the purpose of this Phase 1-2 single institution study is to evaluate the safety and efficacy of LBH 589 and decitabine administered in combination.

Decitabine is an epigenetic modifier of gene expression that has been shown to be well-tolerated in this population at the dose schedule proposed in this study, with reasonable efficacy. Although its precise mechanism of action is incompletely understood, it is postulated to work by reactivating the expression of key tumor suppressor genes silenced in tumor cells by reversing a pattern of hypermethylation of promotor elements.

LBH389 is likewise an epigenetic modifier that inhibits the deacetylation of both histones and non-histone proteins, including HSP90 and p53. Although clinical experience with LBH589 in AML is limited, aberrant histone deacetylase activity has been previously shown to play a significant role in the pathogenesis of AML. The addition of LBH589 to a decitabine regimen of previously established efficacy and tolerability will allow us to evaluate the hypothesis that two epigenetic modifiers that are believed to work through distinct mechanisms of action may act together to improve the responses of patients treated with decitabine alone, without significant additional toxicity.

  Eligibility

Ages Eligible for Study:   60 Years and older   (Adult, Senior)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • AML (except t(15;17), inv(16) or t(8;21) and variants) or high risk MDS (IPSS Int-2 or High) diagnosed according to WHO criteria (see Appendix 1)
  • Age ≥ 60 years old
  • Not a candidate for allogeneic stem cell transplantation within next 12 weeks
  • Ability to provide written informed consent, obtained prior to participation in the study and any related procedures being performed
  • Patients must meet the following laboratory criteria:
  • Serum albumin ≥ 3 g/dL
  • Aspartate aminotransferase (AST)/SGOT and alanine aminotransferase (ALT)/SGPT ≤ 2.5 x upper limit of normal (ULN) ) or ≤ 5.0 x ULN if the transaminase elevation is due to leukemic involvement
  • Serum bilirubin ≤ 1.5 x ULN
  • Serum creatinine ≤ 1.5 x ULN or 24-hour creatinine clearance ≥ 50 ml/min
  • Serum potassium ≥ lower limit of normal (LLN)
  • Serum phosphorus ≥ LLN
  • Serum total calcium (corrected for serum albumin) or serum ionized calcium ≥ LLN
  • Serum magnesium ≥ LLN, thyroid stimulating hormone (TSH) and free thyroxine (T4) within normal limits (WNL) (patients may be on thyroid hormone replacement)
  • Baseline MUGA or ECHO must demonstrate left ventricular ejection fraction (LVEF) ≥ the lower limit of the institutional normal.
  • Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2

Exclusion Criteria:

  • Prior treatment for MDS / AML with Histone deacetylase (HDAC) inhibitor or hypomethylating agent (e.g., Decitabine, azacitidine etc.)
  • Active central nervous system (CNS) involvement with MDS/AML
  • Impaired cardiac function including any one of the following:
  • Screening electrocardiogram (ECG) with a QTc > 450 msec confirmed by central laboratory prior to enrollment to the study
  • Patients with congenital long QT syndrome
  • History of sustained ventricular tachycardia
  • Any history of ventricular fibrillation or torsades de pointes
  • Bradycardia defined as heart rate < 50 beats per minute. Patients with a pacemaker and heart rate ≥ 50 beats per minute are eligible.
  • Patients with a myocardial infarction or unstable angina within 6 months of study entry
  • Congestive heart failure (NY Heart Association class III or IV)
  • Right bundle branch block and left anterior hemiblock (bifasicular block)
  • Uncontrolled hypertension
  • Concomitant use of drugs with a risk of causing torsades de pointes
  • Patients with unresolved diarrhea > CTCAE grade 1
  • Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of oral LBH589
  • Other concurrent severe and/or uncontrolled medical conditions
  • Patients who have received chemotherapy or any investigational drug < 2 weeks or hydroxyurea < 48 hours prior to starting study drug or who have not recovered from side effects of such therapy.
  • Concomitant use of any anti-cancer therapy or radiation therapy
  • Male patients whose sexual partners are women of child bearing potential (WOCBP) not using effective birth control
  • Patients with known positivity for human immunodeficiency virus (HIV) or hepatitis C; baseline testing for HIV and hepatitis C is not required
  • Patients with any significant history of non-compliance to medical regimens or with inability to grant a reliable informed consent
  • Patients who will need valproic acid for any medical condition during the study or within 5 days prior to first LBH589 treatment
  • Patients who have received targeted agents within 2 weeks or within 5 half-lives of the agent and active metabolites (whichever is longer) and who have not recovered from side effects of those therapies
  • Patients who have undergone major surgery ≤ 4 weeks prior to starting study drug or who have not recovered from side effects of such therapy.
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00691938

Locations
United States, Missouri
Washington University
St. Louis, Missouri, United States, 63110
Sponsors and Collaborators
Washington University School of Medicine
Investigators
Principal Investigator: Geoffrey Uy, M.D. Washington Univerisity
  More Information

Additional Information:
Publications:
Cashen, A., G. J. Schiller, et al. (2006). Phase II Study of Low-Dose Decitabine for the Front-Line Treatment of Older Patients with Acute Myeloid Leukemia (AML). ASH Annual Meeting Abstracts 108(11): 1984.

Responsible Party: Washington University School of Medicine
ClinicalTrials.gov Identifier: NCT00691938     History of Changes
Other Study ID Numbers: 08-0172 / 201012979 
Study First Received: June 4, 2008
Results First Received: August 18, 2016
Last Updated: August 18, 2016
Health Authority: United States: Food and Drug Administration

Keywords provided by Washington University School of Medicine:
LBH589
Decitabine
panobinostat
histone deacetylase
methylation
hypomethylation

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

ClinicalTrials.gov processed this record on December 09, 2016