Lenalidomide Combined to Azacitidine in Intermediate-2 or High Risk MDS With Del 5q

Myelodysplastic Syndromes Clinical Trial

— GFM-AZA-REV-09  

Official title:

A Phase II Study of the Efficacy and Safety of Lenalidomide Combined to Azacitidine in Intermediate-2 or High Risk MDS With Del 5q

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01088373
• Other study ID #: AZA-REV-09
• Status: Completed
• Phase: Phase 2
• First received: March 16, 2010
• Last updated: December 14, 2017
• Start date: March 25, 2010
• Est. completion date: July 25, 2016

Study information

• Verified date: December 2017
• Source: Groupe Francophone des Myelodysplasies
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Higher risk MDS with del(5q) carry very poor prognosis, but show some response to azacitidine and Lenalidomide as single agents . The combination of Lenalidomide and Azacytidine is currently tested in non del 5q MDS patients. Preliminary results have been recently presented at ASH meeting (Sekeres et al, 2007).

Overall, the combination of Lenalidomide and Azacitidine is well-tolerated and early results suggest some efficacy in advanced MDS without del 5q.

In this trial, we will combine Lenalidomide to Azacytidine in higher risk MDS with del (5q).

Patients will receive azacitidine( 75mg/m2/day for 5 days every 28 days) combined to escalating doses of lenalidomide (starting at relatively low dose).

For patients in hematological CR, PR, HI or marrow CR after cycle 2 or 4, it is mandatory to continue on Azacitidine + Lenalidomide as long as there is no unacceptable toxicity or overt progression, with the schedule that yielded response.

In patient still responding after 52 weeks, the drug will continue to be supplied, and follow up until death will be continued in all patients.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 50
• Est. completion date: July 25, 2016
• Est. primary completion date: July 25, 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

1. age > ou = 18 years and < 75 years.

2. must understand and voluntarily sign an informed consent form.

3. patient considered ineligible for intensive chemotherapy due to age, cardiac contraindication to anthracyclines, comorbidities, previous failure of intensive chemotherapy, or patient willing to avoid intensive chemotherapy.

4. must be able to adhere to the study visit schedule and other protocol requirements.

5. prior thalidomide allowed.

6. documented diagnosis of MDS (according to FAB definition, ie. with marrow blasts up to 30%, or CMML with WBC < 13000/mm3 that meets IPSS criteria for intermediate-2 or high-risk disease.

7. with an associated del 5q[31](the deleted chromosomal region must include 5q[31]), with or without additional cytogenetic abnormalities.

8. female subjects of childbearing potential must:

• understand the study drug is expected to have a teratogenic risk.

• agree to have a medically supervised pregnancy test with a minimum sensitivity of 25mIU/ml on the day of the study visit or in the 3 days prior to the study visit once the subject has been on effective contraception for at least weeks. This requirement also applies to women of childbearing potential who practice complete and continued abstinence. the test should ensure the subject is not pregnant when she starts treatment.

• agree to have a medically supervised pregnancy test every 4 weeks including 4 weeks after the end of study treatment, except in the case of confirmed tubal sterilization. these pregnancy tests should be performed on the day of the study visit or in the 3 days prior to the study visit.

this requirement also applies to women of childbearing potential who practice complete and continued abstinence.

• agree to use, and to be able to comply with effective contraception without interruption, 4 weeks before starting study drug throughout the entire duration study drug therapy(including doses interruptions)and for 3 months after the end of the study drug therapy even if she has amenorrhea this applies unless the subject commits to absolute and continuous abstinence confirmed on a monthly basis, to avoid pregnancy for the duration of study.

the following are effective methods of contraception:

• implant

• levonorgestrel-releasing intrauterine system(IUS)

• Medroxyprogesterone acetate depot, tubal sterilization.

• sexual intercourse with a vasectomised male partner only(vasectomised must be confirmed by two negative semen analyses), ovulation inhibitory progesterone-only pills(i.e.desogestrel).

if not established on effective contraception, the female subject must be referred to an appropriately trained health care professional for contraceptive advice in order that contraception can be initiated.

Because of the increased risk of venous thromboembolism in patients with multiple myeloma taking lenalidomide and dexamethasone, combined oral contraceptive pills are not recommended. If a female subject is currently using combined oral contraception, the patient should switch to one of the effective methods listed above. The risk of venous thromboembolism continues for 4 to 6 weeks after discontinuing combined oral contraception. The efficacy of contraceptive steroids may be reduced during co-treatment with dexamethasone.

Implants and levonorgestrel-releasing intrauterine systems are associated with an increased risk of infection at the time of insertion and irregular vaginal bleeding. Prophylactic antibiotics should be considered particularly in patients with neutropenia .

Copper-releasing intrauterine devices are generally not recommended due to the potential risks of infection at the time of insertion and menstrual blood loss which may compromise patients with neutropenia or thrombocytopenia.

• Understand that even if she has amenorrhea, she must follow all the advice on effective contraception.

• She understands the potential consequences of pregnancy and the need to rapidly consult if there is a risk of pregnancy

9. Male patients must :

• Agree the need for the use of a condom if engaged in sexual activity with a woman of childbearing potential. during the entire period of treatment, even if disruption of treatment and during 3 months after end of treatment

• Agree not to conceive during treatment and study drug therapy (including doses interruptions) and for 3 months after the end of the study drug therapy

• Agree not to donate semen during study drug therapy and for one week after end of study drug therapy.

• Agree to learn about the procedures for preservation of sperm., before starting treatment

10. All subjects must :

• Agree to abstain from donating blood while taking study drug therapy and for one week following discontinuation of study drug therapy.

• Agree not to share study medication with another person and to return all unused study drug to the investigator.

11. Signed informed consent prior to start of any study-specific procedures,

12. Ability to participate to a clinical trial and adhere to study procedures.

• Criteria for women of non-childbearing potential :

A female patient or a female partner of a male patient is considered to have childbearing potential unless she meets at least one of the following criteria:

• Age = 50 years and naturally amenorrhoeic for = 1 year (amenorrhoea following cancer therapy does not rule out childbearing potential)

• Premature ovarian failure confirmed by a specialist gynaecologist

• Previous bilateral salpingo-oophorectomy, or hysterectomy

• XY genotype, Turner syndrome, uterine agenesis.

Related Conditions & MeSH terms

• Myelodysplastic Syndromes
• Preleukemia

Intervention

Drug:
• Azacitidine combined to Lenalidomide
Azacitidine: 75mg/m2/d for 5 days per cycle of 28 days. Lenalidomide: 5mg/day during 14 days for cohort 1. Lenalidomide: 5mg/day during 21 days for cohort 2. Lenalidomide: 10mg/day during 21 days for cohort 3.

Locations

Country	Name	City	State
France	CHU d'Amiens	Amiens
France	CHU Angers	Angers
France	Hôpital de la cote basque	Bayonne
France	Hôpital Avicenne	Bobigny
France	CHU Haut-Lévèque	Bordeaux
France	CH René Dubos	Cergy-pontoise
France	CHU de	Clermont Ferrand
France	Centre Hospitalier Sud-Francilien	Corbeil-Essonnes
France	CHU Henri Mondor	Creteil
France	CHU de Grenoble	Grenoble
France	Hôpital kremlin Bicêtre	Le Kremlin-Bicêtre	IDF
France	CH Le mans	Le mans
France	Centre Hospitalier de Lens	Lens
France	CHRU de Limoges	Limoges
France	Hôpital Edouard Heriot, dpt Hématologie Clinique	Lyon
France	Institut Paoli-Calmette, Département d'hématologie	Marseille
France	Centre Hospitalier de Meaux	Meaux
France	Chu Brabois	Nancy	Vandoeuvre
France	Hopital de l'Hotel Dieu, Hematology Dpt	Nantes
France	CHU Archet	Nice
France	CHR La Source orléans	Orléans
France	Hopital Cochin Service d'Hématologie	Paris
France	Hôpital la pitié-Salpétrière	Paris
France	Hôpital Saint Louis	Paris
France	Hôpital Saint-Antoine	Paris
France	Saint-Louis Hospital	Paris
France	Hôpital Maréchal Joffre	Perpignan
France	Hôpital Jean-Bernard	Poitiers
France	centre hospitalier Jacques Puel	Rodez
France	Hôpital Henri Becquerel	Rouen
France	Hôpital Purpan, médecine Interne	Toulouse
France	Hôpital PURPAN, Service d'Hématologie Clinique	Toulouse
France	CHU Bretonneau	Tours
France	Institut gustave Roussy	Villejuif

Sponsors (2)

Lead Sponsor	Collaborator
Groupe Francophone des Myelodysplasies	Celgene

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To identify the "safe most successful dose"(sMSD) that is the dose level where the probabilities of success is maximized across the dose levels and the toxicity rate is kept within acceptable boundaries.	Briefly, dose limiting toxicity would be defined by having greater than 30% occurrence of unexpected grade III-IV hematological or non hematological toxicity. Efficacy would be defined as a response rate of 40% after 2 cycles. Overall, 49 patients will be included.	2 and 4 months of treatment
Secondary	response rate and safety	response rate (according to IWG 2006 criteria) to the combination of lenalidomide and azacitidine in adult high and int 2 MDS with del 5q; safety (particularly hematological toxicity) of the combination of Lenalidomide and azacitidine in int-2 and high risk MDS with del 5q [31].; duration of response,; progression to AML,; and overall survival.	36 months

External Links

•   Website of the Groupe Francophone des Myélodysplasies (GFM)