Safety and Efficacy of RVU120 Combined With Venetoclax for Treatment of Relapsed/Refractory AML

Inclusion Criteria:

• Patients must have a diagnosis of AML (per 2022 WHO classification)

• Patients must have relapsed or refractory AML (per ELN 2022 criteria)

• Patients must have failed first-line treatment with venetoclax combined with ahypomethylating agent

• Patients must have no alternative therapeutic options likely to produce clinicalbenefit

• Patients must have ECOG performance status of 0 to 2

• Patients must have adequate end organ function defined as:

1. WBC < 25 x 10(9)/L on Day 1 prior to first dose of study drug

2. Platelet count > 10,000/mcL on Day 1 prior to first dose of study drug

3. AST (aspartate transaminase) and ALT (alanine transaminase) ≤ 3 x ULN (upperlimit of normal)

4. Total bilirubin ≤ 3 x ULN

5. Creatinine clearance (Cockcroft & Gault formula) ≥ 50 mL/min

6. LVEF (left ventricular ejection fraction) ≥ 40% by electrocardiography

• Subjects must have the ability to understand and the willingness to sign a writteninformed consent document and complete study related procedures

Exclusion Criteria:

• APL (acute promyelocytic leukemia), the M3 subtype of AML

• Active CNS (central nervous system) leukemia

• Previous treatment with CDK8 and/or CDK19-targeted therapy

• Major surgery within 28 days prior to the first dose of study drug

• Hematopoietic stem cell transplant within 120 days prior to the first dose of studydrug

• Currently pregnant or breast-feeding. Females of child bearing potential must have anegative serum pregnancy test within 72 hours prior to the first dose of study drug

• Uncontrolled intercurrent illness that could limit life expectancy or ability tocomplete study correlates. This includes but is not limited to:

1. Active, Grade ≥2 acute GVHD (graft versus host disease) or requirement forsystemic immunosuppressive medication for GVHD

2. Evidence of ongoing or uncontrolled systemic bacterial, fungal or viralinfection and acute inflammatory conditions (including pancreatitis)

3. Ongoing significant liver disease such as cirrhosis, drug-induced liver injury,active hepatitis, or chronic persistent hepatitis B and/or hepatitis C

4. Ongoing drug-induced pneumonitis

5. Significant cardiac dysfunction, defined as myocardial infarction within 12months prior to the first dose of study drug, NYHA (New York Heart Association)Class III or IV heart failure, uncontrolled dysrhythmias, poorly controlledangina

6. History of ventricular arrhythmia or QTc ≥ 470 ms (Bazett's formula)

7. Prior history of malignancies other than AML, unless disease-free for 5 yearsor more or prior basal cell carcinoma of the skin, non-metastatic squamous cellcarcinoma of the skin, carcinoma in situ of cervix, breast or bladder, andincidental histological finding of prostate cancer (TMN stage T1a or T1b)

• Impairment of gastrointestinal function or gastrointestinal disease that maysignificantly alter the absorption of RVU120 and/or venetoclax

• Taking any medications, herbal supplements, or other substances (including smoking(that are known to be strong inhibitors or moderate/strong inducers or sensitivesubstrates of CYP1A2

• Taking any medications, over-the-counter medications, foods or herbal supplementsthat are known to be strong or moderate inhibitors of CYP3A4 or P-gp (P-glycoprotein)

• Known allergy or hypersensitivity to any component of RVU120 or venetoclaxformulations