Safety, Efficacy, & Pharmacokinetic Study of Tamibarotene to Treat Patients With Relapsed or Refractory APL

Acute Promyelocytic Leukemia Clinical Trial

— STAR-1  

Official title:

A Phase II Study of Oral Tamibarotene in Acute Promyelocytic Leukemia Patients Who Have Received Prior Therapy With ATRA and Arsenic Trioxide (STAR-1)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00520208
• Other study ID #: INNO-507-P2
• Status: Completed
• Phase: Phase 2
• First received: August 21, 2007
• Last updated: February 11, 2013
• Start date: September 2007
• Est. completion date: January 2013

Study information

• Verified date: February 2013
• Source: CytRx
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

This is a Phase II, open-label, non-randomized study to evaluate the safety, efficacy, and pharmacokinetics of tamibarotene in adult patients with relapsed or refractory acute promyelocytic leukemia (APL) following treatment with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO). Patients must have received and failed therapy with ATRA and ATO. Treatment may have been administered either as combination therapy or sequentially as single agents. Patients who are intolerant to either drug are eligible for this study.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 15
• Est. completion date: January 2013
• Est. primary completion date: December 2012
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Patients must meet all of the following criteria for admission into the study:

1. Have a diagnosis of either relapsed and/or refractory APL:

• Refractory disease is defined as a confirmed diagnosis of APL and a myeloblast plus promyelocyte count of > 10% in the bone marrow in patients who have failed to respond to induction therapy in the first or second line setting. Induction therapy must have included ATRA- and ATO-based therapy given either sequentially or in combination.

• Relapsed disease is defined as a confirmed diagnosis of APL and a myeloblast plus promyelocyte count of > 10% in the bone marrow following a documented complete remission or positive RT-PCR assay for PML/RAR-a in two consecutive tests separated by at least one month, after treatment with ATRA- and ATO-based therapy given either sequentially or in combination.

2. Confirmation of diagnosis and relapsed/refractory APL must be obtained in blood or bone marrow mononuclear cells by at least one of the following methods:

• Conventional cytogenetics showing the translocation t(15:17),

• Positive RT-PCR assay for PML/RAR-a, or

• Fluorescence in situ hybridization (FISH) analysis showing evidence of the PML/RAR-a translocation.

3. Patients must have received and failed therapy with ATRA and ATO either within the same or separate induction/consolidation schedule(s). Treatment must have been administered for a minimum of 28 days for each agent. Treatment may have been administered either as combination therapy or sequentially as single agents. Patients who failed to complete a course of induction/consolidation therapy, as specified, due to drug intolerance are eligible for the study.

4. Patients in whom ATO is contraindicated (for example due to congenital long QT syndrome) are eligible for inclusion on study if they have received and failed ATRA therapy as defined in (3).

5. Be able to provide written informed consent prior to enrollment into the study.

6. Be = 18 years old.

7. Have an Eastern Cooperative Oncology Group (ECOG) Performance Status of = 2.

8. Have an estimated life expectancy of = 12 weeks.

9. Be male or a non-pregnant, non-lactating female. Fertile patients must agree to use an effective barrier method of contraception (e.g., latex condom, diaphragm, or cervical cap) to avoid pregnancy while on therapy and for 90 days following the discontinuation of the study drug. [In countries where double barrier contraception is required by Regulatory Authorities, patients who are fertile must agree to use 2 forms of barrier method contraception (e.g., latex condom AND a diaphragm or cervical cap) while on therapy and for 90 days following the discontinuation of the study drug.]

A non-fertile female is defined as:

• Postmenopausal (amenorrheic for = 12 months)

• Undergone a complete oophorectomy or hysterectomy.

10. Have a negative serum or urine pregnancy test within 10 days prior to the first dose of study drug (if patient is a female of childbearing potential).

11. Have adequate organ function.

Patients who meet any of the following criteria will be excluded from study admission:

1. Extramedullary leukemia.

2. Patients on a vitamin A preparation or patients with hypervitaminosis A.

3. Have received cytotoxic therapy = 2 weeks from the start of therapy. If the patient needs these agents due to urgent medical care within 2 weeks prior to starting tamibarotene, a waiver may be granted by the INNOVIVE Medical Monitor.

4. Have a history of myelodysplastic syndromes (MDS).

5. Have impaired cardiac function or clinically significant heart disease including:

• Myocardial infarction within 3 months, unstable angina pectoris, congenital long QT syndrome and clinically significant resting bradycardia (< 50 beats per minute), uncontrolled congestive heart failure, uncontrolled hypertension, history of labile hypertension, or history of poor compliance with antihypertensive medication.

6. Have an active, uncontrolled systemic infection considered opportunistic, life-threatening, or clinically significant at the time of treatment.

7. Have clinically significant acute or chronic liver or renal disease considered unrelated to leukemia.

8. Have uncontrolled hyperlipidemia.

9. Have uncontrolled or poorly controlled diabetes mellitus.

10. Have impaired gastrointestinal function that may significantly alter drug absorption (e.g., uncontrolled vomiting, ulcerative colitis, malabsorption, or small bowel resection).

11. Are pregnant or lactating.

12. Have psychiatric disorder(s) that would interfere with consent, study participation, or follow-up.

13. Have not recovered from acute toxicities of all previous therapy prior to enrollment.

14. Have any other severe concurrent disease and/or uncontrolled medical conditions, which, in the judgment of the investigator, could predispose patients to unacceptable safety risks or compromise compliance with the protocol.

15. Have a history of another primary malignancy that has been actively treated in the last 24 months.

16. Are unwilling or unable to comply with the protocol.

Study Design

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Acute Promyelocytic Leukemia
• Leukemia, Promyelocytic, Acute

Intervention

Drug:
• Tamibarotene
For induction therapy, tamibarotene will be self-administered via tablets on an outpatient basis at a dose of 6 mg/m2 per day, taken orally, in two divided doses approximately one hour after breakfast and dinner. Induction therapy will continue for a maximum of 56 days until either a morphologic leukemia-free state or complete response (CR) has been achieved. For patients who achieve a CR with induction therapy, consolidation therapy will commence 4 to 8 weeks after the end of induction therapy. For patients who have a morphologic leukemia-free state after induction therapy but who fail to achieve a CR, consolidation therapy will commence 8 weeks after the end of induction therapy.

Locations

Country	Name	City	State
United States	Northwestern University	Chicago	Illinois
United States	UT MD Anderson Cancer Center	Houston	Texas

Sponsors (1)

Lead Sponsor	Collaborator
CytRx

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To determine the rate of durable complete response for tamibarotene therapy when administered as a single agent to adult patients with relapsed or refractory APL.		Minimum 28 days	No
Secondary	(1) To determine the rates of morphologic leukemia-free state, partial response, cytogenetic complete response, and molecular complete response for tamibarotene therapy in the indicated patient population.		Minimum 28 days	No
Secondary	(2) To determine the safety profile and tolerability of tamibarotene in the indicated patient population.		Up to 32 weeks	Yes
Secondary	(3) To determine the pharmacokinetic (PK) profile of tamibarotene when administered in the indicated patient population.		One year	No