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Acute Myelogenous Leukemia (AML)
January 19, 2015
Celator Pharmaceuticals issued results
of a phase II study of CPX-351 in adult
patients with first-relapse acute myeloid
leukemia (AML). The randomized, controlled
phase II study enrolled 125 patients, ages
18 to 65, from 35 centers in the U.S., Canada
and Europe diagnosed with AML in first
relapse after an initial complete remission
lasting for one month or longer. Patients
were randomized 2:1 to receive CPX-351
(100 u/m(2) days one, three and five by
90-minute infusion) or investigators’ choice
of first salvage chemotherapy. Control
salvage treatment was usually based on
cytarabine and an anthracycline, often with
one or more additional agents. The primary
endpoint for the study was survival at one
year post treatment. Patients were stratified
per the European Prognostic Index (EPI)
into favorable, intermediate and poor-risk
groups based on duration of first complete
remission, cytogenetics, age and transplant
history, and were well-balanced between
the control and the treatment arms. Results
showed improved efficacy following CPX-
351 and the protocol-defined EPI-poor-risk
subset demonstrated statistically significant
improvement in overall survival (HR, 0.55;
P=0.02), improvement in event-free survival
(HR, 0.63; P=0.08) and higher response
rate (39.3% v. 27.6%). Additionally, 60-day
mortality was lower in the CPX-351 study
arm for poor-risk patients (16.1% v. 24.1%).
CPX-351 currently is in phase III trials.
July 21, 2014
Boehringer Ingelheim released results of a phase II trial of volasertib for older patients with acute myeloid leukemia (AML). The open-
label study enrolled 87 adult patients (median age 75) with AML not considered suitable for intensive induction therapy. Patients were randomly assigned to receive either volasertib in combination with LDAC (n=42) or LDAC (n=45). Patients were randomized in a 1:1 ratio to receive the combination of LDAC plus volasertib 350mg intravenously over one hour on days one and 15 versus LDAC 20mg twice daily subcutaneously on days one to 10 alone. Cycles were scheduled every four weeks until progression, relapse, intolerance or patient/
investigator requested discontinuation. The study’s primary endpoint showed the objective response rate (complete remission or complete remission with incomplete blood count recovery) was more than doubled for patients receiving volasertib and LDAC versus LDAC alone (31% v. 13.3%, p=0.052). The trial showed patients treated with volasertib combined with LDAC had a median overall survival of eight months versus 5.2 months in patients treated with LDAC (p=0.047). Median event-free survival was prolonged in patients receiving volasertib and LDAC versus LDAC (5.6 months v. 2.3 months; p=0.021). Relapse-
free survival for volasertib and LDAC versus LDAC was 18.5 months versus 10 months. There is an ongoing phase III study initiated for volasertib.
June 23, 2014
Ambit Biosciences released results of a
phase II study of quizartinib (AC220) for
FLT3-ITD (+) relapsed or refractory acute
myeloid leukemia. A total of 76 subjects
were enrolled. Dosing was 30mg/day and
60mg/day. The CRc rate remained at 47%
(5% CR+CRp, 42% CRi). The rate of hematopoietic
stem cell transplantation (HSCT)
after quizartinib use remained at 34%. The
median overall survival was 20.9 weeks for
patients initially treated at 30mg/day and
25.4 weeks for patients at 60mg/day, with
24/38 patients censored as they remained
alive in follow-up at the time of the analysis.
In addition, the further follow-up now
shows 24 subjects were alive at >24 weeks
with four subjects alive >12 months. Overall,
the additional follow up continued to show
that both the 30mg and the 60mg doses of
quizartinib showed substantial activity in
terms of overall CRc rate and bridge to HSCT
with impact on improved median OS. The
safety profile is similar at both doses and
QTcF prolongation did not worsen with additional
duration of treatment and/or follow
up. There is a currently ongoing phase III
study of quizartinib (AC220).
December 13, 2010
Celator issued positive results from a phase II trial of CPX-351 for the treatment of acute myeloid leukemia (AML).This North-America-based, randomized, open-label enrolled 126 subjects with newly diagnosed AML. The subjects received CPX- 351 or the conventional cytarabine and daunorubicin regimen. At 12 months, CPX-351 resulted in the following improvements over the conventional regimen: a higher aplasia rate (87.7% vs. 71.1%), a higher remission rate (complete remissions and complete remissions with incomplete neutrophil/platelet recovery; 66.7% vs. 51.2%), lower induction mortality (4.7% vs. 14.6%), improved median event-free survival (5.4 vs. 2 months) and improved median overall survival (14.7 vs. 12.9 months). Greater improvements over the conventional regimen were also observed in a subset of high-risk subjects and those with secondary AML. Adverse events were comparable between the treatment arms.
March 29, 2010
BioSante issued positive results from a phase II trial of GVAX, a potential vaccine for the treatment of acute myelogenous leukemia (AML). This open-label trial enrolled 54 subjects who received either immunotherapy-primed lymphocytes following autologous stem cell transplantation, with or without GVAX. Of the 54 subjects enrolled, 28 (52%) received a pre-transplantation GVAX AML dose. A total of 46 (85%) subjects achieved complete remission during the treatment period. For all subjects who achieved complete remission, the 3-year relapse-free survival rate was 47.4% compared to 61.8% in the GVAX-treated group. While the overall survival rate in all subjects was 57.4%, it was 73.4% in the GVAX-treated group.
December 14, 2009
Sunesis reported positive results from a phase II trial of voreloxin for the treatment of acute myeloid leukemia. This open label study, dubbed REVEAL-1 (Response Evaluation of Voreloxin in Elderly AML), enrolled l 13 previously untreated, elderly subjects who were unlikely to benefit from standard induction chemotherapy. The trial included three dosing schedules: Schedule A, once weekly for three weeks, Schedule B, once weekly for two weeks and Schedule C, on days one and four at either 72 mg/m2 or 90 mg/m2. Median survival was 8.7 months in Schedule A; 5.8 months in Schedule B; and 7.3 months in Schedule C (72 mg/m2 on days one and four). Median duration of remission was 10.7 months and one year survival was 38% for Schedule A. For the other schedules, median duration of remission has not been reached and one year survival is too early to evaluate. Subjects aged 75 or older (n≡49) with at least 1 additional risk factor at diagnosis experienced a CR rate of 30% and a 30-day all-cause mortality of 5%. Survival in these patients was too early to evaluate. For Schedule C, response rates were 38% and 30- and 60-day all-cause mortality were 7% and 17%, with improved tolerability over Schedule A. Based on trial results, Schedule C was determined to be the optimal regimen for future studies.
February 4, 2008
Bayer and Onyx released positive results from an ongoing phase I/II trial of sorafenib for the treatment of acute myeloid leukemia (AML). This trial enrolled newly relapsed subjects and those newly diagnosed with high-risk disease. The subjects received sorafenib in combination with the standard of care chemotherapy combination for AML, idarubicin and cytosine arabinoside. Results showed that sorafenib targeted the FLT3-ITD mutation, a genetic mutation active in about one third of the subjects with AML. In sixteen evaluable subjects with this mutation, sorafenib reduced the median percentage of leukemia cells circulating in the blood from 81% to 7.5% and in the bone marrow from 75.5% to 34%. In addition, two subjects had circulating leukemia cells, or blasts, drop to zero. Treatment was well tolerated to date and the maximum tolerated dose has not been reached. Based on the results the trial will continue as planned.
Wilex released positive results from a phase I trial of WX-UK1 for the treatment of solid tumors. This dose escalation study enrolled twenty five subjects who received once weekly infusions of WX-UK1 for three weeks at various fixed doses and daily capecitabine (Xeloda) concomitantly for two weeks. This three-week cycle was repeated until disease progression or toxicity, or for a maximum of fifteen treatment cycles. Treatment was safe and well tolerated, with no increase in adverse events and no reported serious adverse events. Pharmacokinetic analysis showed no significant reciprocal drug-drug interactions. WX-UK1 showed dose-linear pharmacokinetic profile over the dose range tested. Preliminary efficacy data revealed prolonged stable disease and partial response in several of the subjects. Based on the results, Wilex plans to continue the development of WX-UK1.
June 3, 2002
Further analysis of phase III trial results indicate that Zamyl was well tolerated but did not achieve a statistically significant overall response in subjects with relapsed or refractory acute myeloid leukemia. With all evaluable subjects analyzed on an intent-to-treat basis, the overall response rate from Zamyl in combination with chemotherapy was 36%, compared to 28% for subjects who received chemotherapy alone. Twenty-nine percent of subjects receiving Zamyl plus chemotherapy achieved a complete response, compared to 23% treated with only chemotherapy. Based on these results, Protein Design Labs does not plan to file a Biologic License Application (BLA) for Zamyl at this time.