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Trial for Relapsed or Refractory AML Patients Combining Cytarabine and Mitoxantrone With Venetoclax (RELAX) (RELAX)

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ClinicalTrials.gov Identifier: NCT04330820
Recruitment Status : Recruiting
First Posted : April 2, 2020
Last Update Posted : August 6, 2020
Sponsor:
Collaborator:
AbbVie
Information provided by (Responsible Party):
Technische Universität Dresden

Brief Summary:
This is an open-label Phase I dose-escalation study of oral venetoclax in combination with increasing cytarabine doses plus mitoxantrone to define the safety profile and MTD of cytarabine in subjects with a histologically or cytologically confirmed acute myeloid leukemia who are refractory or suffered a relapse. This study will be conducted at multiple centers in Germany.

Condition or disease Intervention/treatment Phase
Relapsed Adult AML Drug: Venetoclax Oral Tablet Phase 1 Phase 2

Detailed Description:
  • To determine safety, tolerability, maximum tolerated dose, and recommended phase II dose of venetoclax in combination with increasing cytarabine doses plus fixed dose mitoxantrone in subjects with a relapsed or refractory AML considered fit for intensive salvage therapy.
  • To assess the preliminary efficacy of venetoclax in combination with increasing cytarabine doses plus fixed dose mitoxantrone in subjects with a relapsed or refractory AML considered fit for intensive salvage therapy.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Intervention Model: Sequential Assignment
Intervention Model Description:

The phase I part will be conducted according to the enhanced algorithms of a 3+3H design (Ji et al. J Clin Oncol 2013).

The phase II part will be performed as single stage study adopting the A'Hern design (A'Hern Stat Med 2001).

Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase-I/II Trial for Relapsed or Refractory AML Patients Combining Cytarabine and Mitoxantrone With Venetoclax (RELAX)
Actual Study Start Date : April 6, 2020
Estimated Primary Completion Date : June 2022
Estimated Study Completion Date : April 2024

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Venetoclax+Cytarabin+ Mitoxantron
The treatment plan combines a fixed dose of venetoclax and mitoxantrone with increasing doses of cytarabine (V-MAC).
Drug: Venetoclax Oral Tablet
This study will investigate the combination of a fixed maximum venetoclax dose with increasing cytarabine doses plus mitoxantrone in a fixed dose. The venetoclax dose of 400 mg will be reached by a ramp up over 4 days. Parallel chemotherapy with cytarabine will start on day 4.
Other Name: Cytarabin




Primary Outcome Measures :
  1. Maximum tolerated dose (= recommended phase II dose) of cytarabine in combination with venetoclax plus mitoxantrone [ Time Frame: appr. 9 months ]
    number of dose limiting toxicities related to venetoclax per cohort

  2. CR/CRi rate [ Time Frame: appr. 12 months ]
    preliminary efficacy of venetoclax in combination with increasing cytarabine doses plus fixed dose mitoxantrone


Secondary Outcome Measures :
  1. remission [ Time Frame: appr. 48 months ]
    Duration of Remission and Depth of remission (MRD)

  2. Relapse [ Time Frame: appr. 48 months ]
    Cumulative incidence of relapse

  3. Relapse-free survival [ Time Frame: appr. 48 months ]
    number of participants alive without relapse

  4. Mortality [ Time Frame: appr. 48 months ]
    Early mortality (within 14 and 30 days)

  5. Proportion of allogeneic stem cell transplantation [ Time Frame: appr. 48 months ]
    number of allogeneic stem cell transplantation following response

  6. incidence and severity of adverse Events [safety and tolerability] [ Time Frame: appr. 48 months ]
    number and grade of Adverse Events assessed by CTCAE v5.0

  7. Overall survival [ Time Frame: appr. 48 months ]
    number of patients alive


Other Outcome Measures:
  1. Identification of biomarkers predicting CR/CRi achievement [ Time Frame: appr. 48 months ]
    Baseline samples from all patients with be sequenced for genes which have been associated with response to venetoclax treatment. The panel will include TP53, WT1, PDGFRB, ASXL1, and EZH2. Testing for additional markers may be added triggered by new scientific evidence.

  2. clonal architecture of hematopoiesis [ Time Frame: appr. 48 months ]
    We will test for changes of the clonal architecture of hematopoiesis during therapy and maintenance treatment. This will be done by NGS using a gene panel including TP53, DNMT3A, ASXL1, TET2, JAK2, RUNX1, SF3B1, and EZH2.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria for both escalation and expansion phase:

  • Ability to understand and the willingness to sign a written informed consent. A signed informed consent must be obtained before screening.
  • AML according to WHO-2016 criteria, excluding acute promyelocytic leukemia
  • Relapsed from first or second CR after 1-2 cycles of standard induction chemotherapy (which must have included cytarabine with an anthracycline or anthracenedione), including relapse after allogeneic stem cell transplantation (dose escalation and expansion part)
  • Age 18-75 years
  • Fit for intensive chemotherapy, defined by

    • ECOG 0-2, life expectancy > 3months
    • Adequate hepatic function: ALAT/ASAT/Bilirubin ≤2.5 x ULN*

      • unless considered due to leukemic organ involvement Note: Subjects with Gilbert's Syndrome may have a bilirubin > 2.5 × ULN per discussion between the investigator and Coordinating investigator.
    • Adequate renal function assessed by serum creatinine ≤ 1.5x ULN OR creatinine clearance (by Cockcroft Gault formula) ≥ 50 mL/min
  • Patient is afebrile and hemodynamically stable for at least 72 hours at the time of study medication initiation.
  • Male subjects must agree to refrain from unprotected sex and sperm donation from time point of signing the informed consent until 30 days after the last dose of study drug.
  • Women must fulfill at least one of the following criteria in order to be eligible for trial inclusion:

    • Post-menopausal (12 months of natural amenorrhea or 6 months of amenorrhea with Serum FSH > 40 U/ml)
    • Postoperative (i.e. 6 weeks) after bilateral ovariectomy with or without hysterectomy
    • Women of childbearing potential must have a negative serum pregnancy test performed within 7 days before the first dose of study drug.
    • Continuous and correct application of a contraception method with a Pearl Index of <1% (e.g. implants, depots, oral contraceptives, intrauterine device - IUD) from time point of signing the informed consent until 30 days after the last dose of study drug.

Note: At present, it is not known whether the effectiveness of hormonal contraceptives is reduced by venetoclax. For this reason, women should use a barrier method in addition to hormonal contraceptive methods.

  • Sexual abstinence
  • Vasectomy of the sexual partner

Inclusion criteria applying for expansion phase (Phase II) only:

• Primary refractory after 1-2 cycles of standard induction chemotherapy (100 to 200 mg/m2 cytarabine over 7-10 days plus anthracycline or mitoxantrone over 3 days) or relapsed from first or second CR after 1-2 cycles of standard induction chemotherapy (which must have included cytarabine with an anthracycline or anthracenedione), including relapse after allogeneic stem cell transplantation

Exclusion Criteria:

  • Acute promyelocytic leukemia (AML M3)
  • CNS involvement or subjects with extramedullary disease only
  • Known hypersensitivity to excipients of the preparation or any agent given in association with this study including cytarabine or mitoxantrone
  • Intended hematopoietic stem cell transplantation planned as early conditioning from aplasia without previous blood count recovery
  • Cumulative previous exposure to anthracyclines of >410 mg/m2 doxorubicin equivalents
  • Acute GVHD ≥ grade 2, extensive chronic GVHD or requiring systemic immunosuppressive therapy within 2 weeks prior to start of study treatment
  • HIV infection (due to potential drug-drug interactions between antiretroviral medications and venetoclax, as well as anticipated venetoclax mechanism-based lymphopenia that may potentially increase the risk of opportunistic infections).
  • Inability to swallow oral medications
  • Any malabsorption condition
  • Treatment with strong and moderate CYP3A inhibitors (see Appendix 1) during screening
  • Cardiovascular disability status of New York Heart Association (NYHA) Class ≥ 2.

Class 2 is defined as cardiac disease in which patients are comfortable at rest but ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain.

  • Chronic respiratory disease that requires continuous oxygen use.
  • White blood cell count > 25 × 109/L. Note: Hydroxyurea is permitted to meet this criterion.
  • AML relapse treatment with any investigational or commercial drug within 14 days before enrolment. Hydroxyurea is allowed until enrolment to control peripheral WBC counts. Toxic effects of previous investigational drug treatment have to recover to Grade <2.
  • Substance abuse, medical, psychological, or social conditions that may interfere with the subject's cooperation with the requirements of the trial or evaluation of the study results
  • Pregnant or breastfeeding women. Breastfeeding has to be discontinued before onset of and during treatment and should be discontinued for at least 3 months after end of treatment.
  • History of active or chronic infectious hepatitis unless serology demonstrates clearance of infection (Occult or prior hepatitis B virus (HBV) infection (defined as negative hepatitis B surface antigen and positive total hepatitis B core antibody) may be included if HBV DNA is undetectable, provided that they are willing to undergo monthly DNA testing. Patients who have protective titers of hepatitis B surface antibody after vaccination or prior but cured hepatitis B are eligible. Patients positive for hepatitis C virus antibody are eligible provided PCR is negative for HCV RNA.)
  • History of clinically significant liver cirrhosis (e.g., Child-Pugh class B and C).
  • Live-virus vaccines given within 28 days prior to the initiation of study treatment

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): NCT04330820


Contacts
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Contact: Christoph Röllig, Prof. (MD) +49 351 458 3775 christoph.roellig@ukdd.de
Contact: Martin Wermke, MD +49 351 7566 martin.wermke@uniklinikum-dresden.de

Locations
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Germany
Universitätsklinikum Dresden Recruiting
Dresden, Germany, 01307
Contact: Christoph Röllig, Prof.         
Universitätsklinikum Frankfurt am Main Recruiting
Frankfurt am Main, Germany, 60590
Contact: Björn Steffen, MD         
Universitätsklinikum Würzburg Recruiting
Würzburg, Germany, 97080
Contact: Sabrina Kraus, MD         
Sponsors and Collaborators
Technische Universität Dresden
AbbVie
Investigators
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Principal Investigator: Christoph Röllig, Prof. (MD) Technische Universität Dresden (TUD)
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Responsible Party: Technische Universität Dresden
ClinicalTrials.gov Identifier: NCT04330820    
Other Study ID Numbers: TUD-RELAX1-070
First Posted: April 2, 2020    Key Record Dates
Last Update Posted: August 6, 2020
Last Verified: August 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Venetoclax
Antineoplastic Agents