International Trial of Selumetinib in Combination With Dexamethasone for the Treatment of Acute Lymphoblastic Leukaemia

  • STATUS
    Recruiting
  • End date
    May 29, 2022
  • participants needed
    42
  • sponsor
    University of Birmingham
Updated on 29 January 2021
graft versus host disease
dexamethasone

Summary

This trial is to investigate the combination of selumetinib and dexamethasone in the treatment of acute lymphoblastic leukaemia (ALL) in both adults and children. Phase I is to find the most suitable dose of selumetinib to safely give with dexamethasone. Phase II will use this dose to find out how well the combination works.

Description

Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer worldwide. The overall newly diagnosed ALL cure rate is approaching 90% however children with relapsed ALL often do not survive. The frequency of ALL in adults is significantly lower however more challenging to treat compared to childhood ALL. Adult ALL is more resistant to chemotherapy and patient have reduced treatment tolerance (particularly the elderly population) therefore overall survival rates are low. Therefore there is a need to develop more effective treatment which improves survival rates for this patient population.

Those eligible in the paediatric setting are in their second or further relapse, often after a previous allogeneic stem cell transplant (SCT), and usually in a palliative situation. Adult patients who are not suitable for more intensive therapy can enter the trial in first relapse. The trial offers an out-patient based treatment approach of this heavily pre-treated patient group. The trial includes patients with B-cell precursor and T-ALL irrespective of Central Nervous System (CNS) disease status.CNS positive patients and patients with T-ALL are usually excluded from other early phase clinical trials. If treatment is successful, patients could continue with other therapies/trials once complete remission achieved (e.g. Chimeric Antigen Receptor (CAR) T cell therapy).

Selumetinib is a small molecule inhibitor of MEK, a protein in the RAS-pathway. Mutations in genes in the RAS pathway have been found in a large proportion of patients with ALL. Selumetinib targets this over-activated pathway to arrest cancer cell growth. Dexamethasone is a steroid important in the treatment of leukaemia to stimulate the death of cancer cells. The SeluDex trial is for patients with relapsed or refractory RAS-pathway mutated ALL.

The primary objective of this trial in Phase I is to see what dose of selumetinib can safely be given in combination with dexamethasone in participants. During Phase II, the primary objective is to assess the preliminary information regarding the effectiveness of this combined treatment.

Details
Condition childhood ALL, Lymphocytic Leukemia, Acute, Acute Lymphoblastic Leukemia, Adult, Acute Lymphoblastic Leukemia, in Relapse, Acute Lymphoblastic Leukemia Recurrent, Acute Lymphoblastic Leukemia, Adult, Acute Lymphoblastic Leukemia, in Relapse, Acute Lymphoblastic Leukemia, Adult, Acute Lymphoblastic Leukemia, in Relapse, acute lymphoblastic leukemia, leukemia, acute lymphoblastic, acute lymphoid leukaemia, acute lymphocytic leukemia, acute lymphoblastic leukemia (all), Acute Lymphoblastic Leukemia, Adult, Acute Lymphoblastic Leukemia, in Relapse
Treatment Selumetinib, Dexamethasone
Clinical Study IdentifierNCT03705507
SponsorUniversity of Birmingham
Last Modified on29 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Morphologically proven relapsed/refractory (M2 or M3 marrow; 1st relapse for adults, 2nd relapse in paediatric group - see Protocol Appendix 5) or progressive B cell precursor or T-Acute Lymphoblastic Leukaemia (ALL) with demonstrated RAS pathway activating mutations (NRAS, KRAS, FLT3, PTPN11, cCBL) identified during the trial screening process
Group P (paediatric): <18 years of age; Group A (adult): 18 years of age
Adequate renal function
Group A: Serum creatinine <1.5 x upper limit of normal (ULN)
Group P as follows
years: Serum creatinine <0.8 mg/dL or 70 mol/L, > 5 years but 10 years: Serum creatinine <1 mg/dL or 88 mol/L, > 10 years but 15 years: Serum creatinine <1.2 mg/dL or 106 mol/L, > 15 years: Serum creatinine <1.5 mg/dL or 132 mol/L
Patient is able to swallow selumetinib capsules whole
Performance status (PS): Group A - Eastern Cooperative Oncology Group (ECOG) 2 (Protocol Appendix 6); Group P - Lansky play scale 60% (Protocol Appendix 7) or Karnofsky scale 60% (Appendix 8)
Women of childbearing potential (see protocol section 7.9.3 for definition) must have a negative pregnancy test
Patients who are women of childbearing potential and male patients with partners who are women of childbearing potential must agree to use appropriate contraception (see protocol section 7.9.3 for definition) whilst on trial
Written informed consent
Absence of any psychological, familial, sociological or geographical factors potentially hampering compliance with the trial protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
Patients who relapse or progress after Haematopoetic Stem Cell Transplant (HSCT) need to be at least at day +100, with no signs of Graft versus Host Disease and off immunosuppressive therapy for at least one week
Patients who relapse or progress after CAR T cell therapy should be at least 4 weeks after infusion of CAR T cells
Patients must have a body surface area (BSA) 0.55 m2

Exclusion Criteria

ALL without presence of RAS-pathway activating mutations
Mature B-cell leukaemia and Philadelphia positive ALL
Prior exposure to MEK, RAS or RAF inhibitors
Any unresolved toxicity CTCAE Grade 2 from previous anti-cancer therapy, except for alopecia
Cardiac conditions as follows
Group A and P
Prior or current cardiomyopathy including but not limited to the following
Known hypertrophic cardiomyopathy
Known arrhythmogenic right ventricular cardiomyopathy
Even if full recovery has occurred, previous moderate or severe impairment of left ventricular systolic function (LVEF <45% on Echocardiogram (ECHO) in Group A; SF <29% in Group P but excluding transient impairments due to e.g. anaemia/sepsis or results not thought to represent a true reflection of cardiac function)
Severe valvular heart disease
Severe congenital heart disease
Uncontrolled hypertension
Group A: BP 150/95 mmHg despite medical therapy
Group P: BP 95th percentile for age, height and gender (please refer to Blood Pressure by Age and Height Percentiles tables in Protocol Appendices 8 and 9) Group A
Baseline (LVEF) below the lower limit of normal (LLN) or <55% measured by ECHO
Acute coronary syndrome within 6 months prior to trial registration
Uncontrolled Angina - Canadian Cardiovascular Society grade II-IV despite medical therapy (Protocol Appendix 11)
Symptomatic heart failure New York Heart Association (NYHA) Class II-IV, prior or current cardiomyopathy, or severe valvular heart disease (Protocol Appendix 12)
Atrial fibrillation with a ventricular rate >100 bpm on Electrocardiogram (ECG) at rest
QTcF >450ms in male patients or 460ms in female patients, or other factors that increase the risk of QT prolongation Group P
Baseline SF <29%
Atrial fibrillation with a ventricular rate >130 bpm on Electrocardiogram (ECG) at rest
QTcF >450ms in patients <12 years or 460ms in patients 12 but <18 years
Ophthalmological conditions as follows
Current or past history of retinal pigment epithelial detachment (RPED)/central serous retinopathy (CSR) or retinal vein occlusion
Intraocular pressure (IOP) > 21 mmHg or uncontrolled glaucoma (irrespective of IOP)
Pregnant and breast feeding females
Known severe hypersensitivity to selumetinib, dexamethasone or combination medications or any excipient of these medicinal products, or history of allergic reactions attributed to compounds of similar chemical or biologic composition to selumetinib
Have received or are receiving an Investigational Medicinal Product (IMP) or other systemic anti-cancer treatment (not including dexamethasone, prednisolone or hydroxycarbamide) within 4 weeks (6 weeks for nitrosoureas, mitomycin, and suramin) prior to trial registration, or within a period during which the IMP or systemic anticancer treatment has not been cleared from the body (e.g. a period of 5 'half-lives'), whichever is the most appropriate and as judged by the investigator
Have had recent major surgery within a minimum 4 weeks prior to trial registration, with the exception of surgical placement of vascular access
Have received radiation therapy within 4 weeks prior to trial registration, or limited field of radiation for palliation within 7 days of the first dose of trial treatment
Laboratory values as listed below (SI units)
Serum bilirubin >1.5 x ULN (unless due to Gilbert's syndrome)
Have evidence of any other significant clinical disorder or laboratory finding that, as judged by the investigator, makes it undesirable for the patient to participate in the trial
Have any evidence of a severe or uncontrolled systemic disease (e.g. unstable or uncompensated respiratory, cardiac, hepatic, or renal disease, active infection (including hepatitis B, hepatitis C, HIV), active bleeding diatheses, or renal transplant)
Have refractory nausea and vomiting, chronic gastrointestinal diseases (e.g., inflammatory bowel disease), or significant bowel resection that would adversely affect the absorption/bioavailability of the orally administered trial medication
Any other active malignancy which, in the opinion of the investigator would limit the ability of the patient to complete the study
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