Clinical Trial Details

NCT ID: NCT02677922
Date Last Changed: September 28, 2017

Overview

Research Study Summary

A clinical research study of AG-120, Azacitidine and AG-221 for the treatment of Leukemia, Myeloid, Acute

Research Study Title

A Phase 1b/2 Open-label, Randomized Study of 2 Combinations of Isocitrate Dehydrogenase (IDH) Mutant Targeted Therapies Plus Azacitidine: Oral AG-120 Plus Subcutaneous Azacitidine and Oral AG-221 Plus SC Azacitidine in Subjects With Newly Diagnosed Acute Myeloid Leukemia Harboring an IDH1 or an IDH2 Mutation, Respectively, Who Are Not Candidates to Receive Intensive Induction Chemotherapy

Purpose

This Phase 1b/2 study is an open-label, randomized, multicenter trial to evaluate the safety and efficacy of oral AG-120 + Subcutaneous (SC) azacitidine and oral AG-221 + SC azacitidine in subjects with newly diagnosed AML with an IDH1 or an IDH2 mutation, respectively. The study population consists of subjects who are not candidates to receive intensive Inductive chemotherapy (IC). The study comprises a Phase 1b dose-finding and AG-120 expansion stage and a Phase 2 randomized stage.

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Recruitment Details

Phase
1/2
Gender
All
Age
18 and up
Overall Status
Recruiting
Lead Sponsor
Celgene
Duration
30 Months
Facility Type
N/A
Compensation

Eligibility

All ages 18 Years and up

Inclusion Criteria:

Subjects must satisfy the following criteria to be enrolled in the study:

  1. Subject is ≥ 18 years of age the time of signing the informed consent form (ICF).

  2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.

  3. Subject is willing and able to adhere to the study visit schedule and other protocol requirements.

  4. Subject has newly diagnosed, primary (ie, de novo) or secondary (progression of MDS or myeloproliferative neoplasms [MPN], or therapy-related) AML according to the WHO classification with ≥ 20% leukemic blasts in the bone marrow: -Have an Isocitrate dehydrogenase 1 (IDH1) or Isocitrate dehydrogenase 2 (IDH2) gene mutation (R132, R140, or R172)

  5. IDH mutational status will be assessed locally; for sites without local testing capabilities, a referral lab will be identified.

  6. By the investigator's assessment who are not candidates to receive intensive Inductive chemotherapy (IC).

  7. Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.

  8. Subject has adequate organ function defined as:

  9. Serum aspartate aminotransferase/serum glutamic oxaloacetic transaminase (AST/SGOT) and alanine aminotransferase (ALT/SGPT) ≤ 3 x ULN, unless considered due to leukemic organ involvement.

  10. Serum total bilirubin < 1.5 x ULN. Higher levels are acceptable if these can be attributed to ineffective erythropoiesis, 3 times the upper limit of normal for Gilbert's syndrome (eg, a gene mutation in UGT1A1), or leukemic organ involvement.

  11. Serum creatinine < 2 x ULN or creatinine clearance > 30 mL/min based on the Modification of Diet in Renal Disease (MDRD) glomerular filtration rate (GFR):

GFR (mL/min/1.73 m2) = 175 × (Scr)-1.154 × (Age)-0.203 × (0.742 if female) × (1.212 if African American)

  1. Agree to serial bone marrow aspirate/biopsies.

  2. Females of childbearing potential (FCBP)* may participate, providing they meet the following conditions:

  3. Agree to practice true abstinence ** from sexual intercourse or to use highly effective contraceptive methods (eg, combined [containing estrogen and progestogen] or progestogen only associated with inhibition of ovulation, oral, injectable, intravaginal, patch, or implantable hormonal contraceptive; bilateral tubal occlusion; intra-uterine device; intrauterine hormone-releasing system; or male partner sterilization [note that a vasectomized partner is a highly effective birth control method provided that partner is the sole sexual partner of the FCBP trial participant and that a vasectomized partner has received medical assessment of the surgical success]) at screening and throughout the study, and for at least 4 months following the last study treatment; and

  4. Have a negative serum β-subunit of human chorionic gonadotropin (β-hCG) pregnancy test (sensitivity of at least 25 mIU/mL) at screening; and

  5. Have a negative serum or urine (investigator's discretion under local regulations) β-hCG pregnancy test (sensitivity of at least 25 mIU/mL) within 72 hours prior to the start of study treatment in the Treatment Period (note that the screening serum pregnancy test can be used as the test prior to the start of study treatment in the Treatment Period if it is performed within the 72-hour timeframe).

  6. Male subjects must agree to practice true abstinence from sexual intercourse or agree to the use of highly effective contraceptive methods (as described above) with non-pregnant female partners of child bearing potential at screening and throughout the course of the study and should avoid conception with their partners during the course of the study and for at least 4 months following the last study treatment (6 months following last dose of azacitidine in Canada). Furthermore, the male subject must agree to use a condom while treated with azacitidine and for at least 4 months following the last azacitidine dose.

Exclusion Criteria:

  • The presence of any of the following will exclude a subject from enrollment:

  • Subject is suspected or proven to have acute promyelocytic leukemia based on morphology, immunophenotype, molecular assay, or karyotype.

  • Subject has AML secondary to chronic myelogenous leukemia (CML).

  • Subject has received a targeted agent against an Isocitrate dehydrogenase 1 (IDH1) or Isocitrate dehydrogenase 2 (IDH2) mutation.

  • Subject has received prior systemic anticancer therapy, HSCT, or radiotherapy for AML.

Note: Hydroxyurea is allowed prior to enrollment for the control of peripheral leukemic blasts in subjects with leukocytosis. (however, hydroxyurea should not be given within 72 hours prior to and after administration of azacitidine). For subjects with secondary AML (eg, MDS or MPN) treatment for prior cancer is not exclusionary; full treatment information will be collected within the CRF. The use of all trans retinoic acid (ATRA) for suspected APL is not exclusionary provided it is discontinued prior to initiation of treatment in the protocol.

  1. Subject has received more than 1 cycle of prior treatment with azacitidine, or subject has received any prior treatment with decitabine for Myelodysplastic syndromes (MDS).

  2. Clarification: Subjects with newly diagnosed Acute myeloid leukemia (AML) who are currently receiving their 1st cycle of azacitidine (7 days) can be screened for the study. On study, Cycle 1 must be started at 28 days (+/- 3 days) after initiation of the pre-study azacitidine.

  3. Subject has or is suspected of having central nervous system (CNS) leukemia. Evaluation of cerebrospinal fluid is only required if CNS involvement by leukemia is suspected during screening.

  4. Subject has immediate life-threatening, severe complications of leukemia such as uncontrolled bleeding, pneumonia with hypoxia or shock, and/or disseminated intravascular coagulation.

  5. Subject has significant active cardiac disease within 6 months prior to the start of study treatment, including New York Heart Association (NYHA) class III or IV congestive heart failure; acute coronary syndrome (ACS); and/or stroke; or left ventricular ejection fraction (LVEF) < 40% by echocardiogram (ECHO) or multi-gated acquisition (MUGA) scan obtained within 28 days prior to the start of study treatment.

  6. Subject has prior history of malignancy, other than MDS, Myeloproliferative neoplasm (MPN), or AML, unless the subject has been free of the disease for ≥ 1 year prior to the start of study treatment. However, subjects with the following history/concurrent conditions are allowed:

  7. Basal or squamous cell carcinoma of the skin

  8. Carcinoma in situ of the cervix

  9. Carcinoma in situ of the breast

  10. Incidental histologic finding of prostate cancer (T1a or T1b using the tumor, node, metastasis clinical staging system)

  11. Subject is known seropositive for or has active viral infection with human immunodeficiency virus (HIV), or active infection with hepatitis B virus (HBV) or hepatitis C virus (HCV)

  12. Subject is known to have dysphagia, short-gut syndrome, gastroparesis, or other conditions that limit the ingestion or gastrointestinal absorption of drugs administered orally

  13. Subject has uncontrolled hypertension (systolic blood pressure [BP] > 180 mmHg or diastolic BP > 100 mmHg)

  14. Subject is taking the following sensitive CYP substrate medications that have a narrow therapeutic range are excluded from the study unless the subject can be transferred to other medications at least 5 half-lives prior to the start of study treatment: phenytoin (CYP2C9), S-mephenytoin (CYP2C19), thioridazine (CYP2D6), theophylline, and tizanidine (CYP1A2).

  15. Subject is taking the breast cancer resistance protein (BCRP) transporter-sensitive substrate rosuvastatin; subject should be excluded from the study unless he/she can be transferred to other medications at least 5 half-lives prior to the start of study treatment.

  16. Subject has active uncontrolled systemic fungal, bacterial, or viral infection (defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics, antiviral therapy, and/or other treatment).

  17. Subject has known or suspected hypersensitivity to any of the components of study therapy.

  18. Subject is taking medications that are known to prolong the QT interval unless he/she can be transferred to other medications within ≥ 5 half-lives prior to the start of study treatment.

  19. Subject has Heart rate-corrected QT (QTc) interval (ie, Fridericia's correction [QTcF]) ≥ 450 ms or other factors that increase the risk of QT prolongation or arrhythmic events (eg, heart failure, hypokalemia, family history of long QT interval syndrome) at screening.

  20. Female subject who is pregnant or lactating.

  21. Subject has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study.

  22. Subject has any condition, including the presence of laboratory abnormalities that places the subject at unacceptable risk if he/she were to participate in the study.

  23. Subject has any condition that confounds the ability to interpret data from the study.

Site Locations (61)

Country State City Zip Facility and Contact
United States California Duarte 91010-301 City of Hope
United States Connecticut New Haven 06510 Yale Cancer Center
United States Illinois Chicago 60611 Northwestern University
United States Illinois Chicago 60637 University of Chicago
United States Massachusetts Boston 02114 Massachusetts General Hospital
United States Massachusetts Boston 02115 Beth Israel Deaconess Medical Center
United States Massachusetts Boston 02115 Dana Farber Cancer Institute
United States New York New York 10065 Memorial Sloan Kettering Cancer Center
United States Tennessee Nashville 37203 Sarah Cannon Research Inst
United States Texas Dallas 75390-85520 UT Southwestern Medical Center at Dallas
United States Texas Houston 77030 MD Anderson Cancer Center
Australia South Australia Adelaide SA 5000 Royal Adelaide Hospital
Australia Melbourne 3000 Parkville Cancer Clinical Trials Unit
Australia Melbourne 3141 The Alfred Hospital
Australia Perth 6000 Royal Perth Hospital
Canada Ontario Toronto M5G 2M9 Princess Margaret Hospital, Medical Oncology
France Lille 59037 CHRU de Lille-Hopital Claude Huriez Service des Maladies du Sang
France Marseille Cedex 9 13273 Institut Paoli Calmettes
France Paris Cedex 10 75475 Hopital Saint Louis
France Pessac 33604 Hospital haut leveque
France Pierre Benite 69495 Centre Hospitalier Lyon Sud
France Toulouse 31059 Institut Universitaire du Cancer Oncopole
France Villejuif Cedex 94805 Institut Gustave Roussy
Germany Berlin 12200 Medizinische Klinik III Klinikum der Universität München-Großhadern
Germany Dresden 01307 Universitaetsklinikum Carl Gustav Carus TU Dresden
Germany Düsseldorf 40225 Heinrich Heine Universitat Dusseldorf
Germany Frankfurt 60590 Universitatsklinikum Frankfurt
Germany Hannover 30625 Zentrum Innere Medizin Klinik fur Hamatologie
Germany Ulm 89081 Universitatsklinikum Ulm
Italy Bologna 40138 Azienda Ospedaliero-Universitaria di Bologna - Policlinico S.Orsola-Malpighi
Italy Firenze 50134 Azienda Ospedaliero-Universitaria Careggi
Italy Genova 16132 Azienda Ospedaliera Universitaria S. Martino di Genova
Italy Orbassano 10043 Azienda Ospedaliera San Luigi Gonzaga
Italy Padova 35128 Azienda Ospedaliera Di Padova
Italy Pesaro 31122 Azienda Ospedaliera Ospedali Riuniti Marche Nord AORMN
Italy Roma 00189 Azienda Ospedaliera S. Andrea - Università La Sapienza
Korea, Republic of Seoul 135-710 Samsung Medical Center
Korea, Republic of Seoul 137-701 The Catholic University of Korea Seoul - Saint Mary's Hospital
Korea, Republic of Seoul 138-736 Asan Medical Center
Netherlands Amsterdam VU University Medical Center
Netherlands Groningen 9713 GZ Universitair Medisch Centrum Groningen
Netherlands Rotterdam 3015 GJ Erasmus MC
Netherlands Utrecht 3584 CX University Medical Center Utrecht
Portugal Lisboa 1099-023 Instituto Portugues de Oncologia de Lisboa
Portugal Lisboa 1169-050 Centro Hospitalar de Lisboa Central - Hospital de Santo António dos Capuchos
Portugal Porto 4200-072 Instituto Portugues de Oncologia do Porto
Spain Barcelona 08036 H Clinic I Provincial
Spain Barcelona 08907 Hospital de Bellvitge
Spain Caceres 10005 Hospital San Pedro de Alcantara
Spain Madrid 28007 Hospital General Universitario Gregorio Maranon
Spain Malaga 29010 Hospital General Carlos Haya
Spain Valencia 46009 Hospital Universitario La Fe
Switzerland Basel 4031 UniversitatsSpital Basel
Switzerland Lausanne 1011 Centre Hospitalier Universitaire Vaudois CHUV BH-04
Switzerland Zurich Universitatsspital Zurich
United Kingdom Birmingham B15 2TH Queen Elizabeth Hospital UHB NHS Foundation Trust
United Kingdom Headington OX3 9DU John Radcliffe Hospital
United Kingdom Leeds LS7 4SA Leeds Teaching Hospitals Trust
United Kingdom London EC1M 6BQ Barts Cancer Institute, Queen Mary University of London, Charterhouse Square
United Kingdom London SE5 9RS King's College Hospital
United Kingdom Sidcup DA14 6LT Queen Marys NHS Trust

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