CPX-351 for the Treatment of Secondary Acute Myeloid Leukemia in Patients Younger Than 60 Years Old

Overview

This phase II trial studies how well liposome-encapsulated daunorubicin-cytarabine (CPX-351) works in treating patients with secondary acute myeloid leukemia who are younger than 60 years old. Drugs used in chemotherapy, such as CPX-351, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.

Full Title of Study: “A Phase II Study of CPX-351 in Younger Patients < 60 Years Old With Secondary Acute Myeloid Leukemia”

Study Type

  • Study Type: Interventional
  • Study Design
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: September 5, 2022

Detailed Description

PRIMARY OBJECTIVE:

I. To determine the complete response rate including morphologic complete remission (CR) and morphologic complete remission with incomplete blood count recovery (CRi) as defined by the International Working Group Criteria.

SECONDARY OBJECTIVE:

I. To determine CR + CRi duration, event free survival (EFS), overall survival (OS), patients successfully proceeding to allogenic hematopoietic cell transplant, and adverse events (AE).

OUTLINE:

INDUCTION: Patients receive liposome-encapsulated daunorubicin-cytarabine intravenously (IV) over 90 minutes on days 1, 3, and 5 in the absence of disease progression or unacceptable toxicity.

RE-INDUCTION: Patients who do not achieve remission receive liposome-encapsulated daunorubicin-cytarabine IV over 90 minutes on days 1 and 3 in the absence of disease progression or unacceptable toxicity.

CONSOLIDATION: Beginning 5-8 weeks after the start of the last induction, patients who achieve CR receive liposome-encapsulated daunorubicin-cytarabine IV over 90 minutes on days 1 and 3. Treatment repeats every 45 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 30 days, and then every 3 months for up to 5 years.

Interventions

  • Drug: Liposome-encapsulated Daunorubicin-Cytarabine
    • Given IV

Arms, Groups and Cohorts

  • Experimental: Treatment (CPX-351)
    • INDUCTION: Patients receive liposome-encapsulated daunorubicin-cytarabine IV over 90 minutes on days 1, 3, and 5 in the absence of disease progression or unacceptable toxicity. RE-INDUCTION: Patients who do not achieve remission receive liposome-encapsulated daunorubicin-cytarabine IV over 90 minutes on days 1 and 3 in the absence of disease progression or unacceptable toxicity. CONSOLIDATION: Beginning 5-8 weeks after the start of the last induction, patients who achieve CR receive liposome-encapsulated daunorubicin-cytarabine IV over 90 minutes on days 1 and 3. Treatment repeats every 45 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity.

Clinical Trial Outcome Measures

Primary Measures

  • Complete response rate (morphological complete remission [CR] and incomplete blood count recovery [CRi])
    • Time Frame: At day 45
    • Defined by the International Working Group Criteria. Will be summarized using frequencies and relative frequencies.

Secondary Measures

  • CR + CRi duration
    • Time Frame: Time from CR or CRi until relapse or last follow-up, assessed up to 5 years
    • Will be summarized using standard Kaplan-Meier methods, where estimates of the median obtained with 90% confidence intervals.
  • Event free survival
    • Time Frame: Time from treating until disease progression/relapse, death due to disease, or last follow-up, assessed up to 5 years
    • Will be summarized using standard Kaplan-Meier methods, where estimates of the median obtained with 90% confidence intervals.
  • Overall survival
    • Time Frame: Time from treatment until death due to any cause or last follow-up, assessed up to 5 years
    • Will be summarized using standard Kaplan-Meier methods, where estimates of the median obtained with 90% confidence intervals.
  • Allogeneic hematopoietic cell transplant rate
    • Time Frame: Up to 5 years
    • Transplant rate estimated using a 90% confidence interval obtained using Jeffrey’s prior method.
  • Incidence of adverse events
    • Time Frame: Up to 5 years
    • Will be reported by grade using frequencies and relative frequencies.

Participating in This Clinical Trial

Inclusion Criteria

  • Newly diagnosed:
  • Therapy-related acute myeloid leukemia (AML)
  • AML with antecedent myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML)
  • AML with MDS-related changes (as per World Health Organization [WHO])
  • Have an Eastern Cooperative Oncology Group (ECOG) performance status of =< 2
  • Plasma creatinine =< 1.5 x upper limit of normal (ULN)
  • Total bilirubin < 2.0 mg/dL
  • Serum alanine aminotransferase and aspartate aminotransferase < 3 x ULN
  • Left ventricular ejection fraction by echocardiogram or multiple-gated acquisition >= 50%
  • Participants of child-bearing potential must agree to use adequate contraceptive methods (e.g., hormonal or barrier method of birth control; abstinence) prior to study entry. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately
  • Women of childbearing potential must have a negative serum or urine pregnancy test within 72 hours prior to enrollment and commit to two forms of birth control
  • Men must use a latex condom during any sexual contact with women of childbearing potential
  • Willing to adhere to protocol specific requirements
  • Participant or legal representative must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure

Exclusion Criteria

  • Prior treatment of AML
  • Known clinically active central nervous system (CNS) leukemia
  • Core-binding factor leukemia
  • Acute promyelocytic leukemia
  • Uncontrolled other malignancy
  • Prior anthracycline exposure > 368 mg/m^2 of daunorubicin or equivalent
  • Cardiovascular disease resulting in heart failure (New York Heart Association class III or IV), unstable angina (angina symptoms at rest), or new onset angina (began within the last 3 months) or myocardial infarction within the past 6 months
  • Hypersensitivity to cytarabine, daunorubicin, or liposomal drugs
  • Human immunodeficiency virus (HIV) infection
  • Pre-existing liver disease (e.g. cirrhosis, chronic hepatitis B or C, nonalcoholic steatohepatitis, sclerosing cholangitis)
  • Evidence of ongoing, uncontrolled systemic infection
  • Pregnant or breastfeeding women
  • Subject with concurrent severe and/or uncontrolled medical or psychiatric conditions that in the opinion of the investigator may impair the participation in the study or the evaluation of safety and/or efficacy
  • Received an investigational agent within 30 days prior to enrollment
  • History of Wilson disease or other copper-handling disorders
  • Any condition which in the investigator's opinion deems the participant an unsuitable candidate to receive study drug

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 59 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Roswell Park Cancer Institute
  • Collaborator
    • National Cancer Institute (NCI)
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Amanda C Przespolewski, Principal Investigator, Roswell Park Cancer Institute

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