LBH589 Plus Decitabine for Myelodysplastic Syndromes or Acute Myeloid Leukemia

Myelodysplastic Syndromes Clinical Trial

Official title:

A Phase I/II Study of LBH589 Plus Decitabine for Patients Age ≥ 60 Years With High Risk MDS or AML

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT00691938
• Other study ID #: 08-0172 / 201012979
• Status: Active, not recruiting
• Phase: Phase 1/Phase 2
• First received: June 4, 2008
• Last updated: March 18, 2015
• Start date: June 2008
• Est. completion date: September 2015

Study information

• Verified date: March 2015
• Source: Washington University School of Medicine
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

This study is designed to evaluate the combination of LBH589 and decitabine in patients age ≥ 60 years with high risk Myelodysplastic Syndrome (IPSS Int-2 or High) or Acute Myeloid Leukemia.

Description:

To address the need for less toxic, more effective treatments for older patients with advanced MDS and AML, the purpose of this Phase 1-2 single institution study is to evaluate the safety and efficacy of LBH 589 and decitabine administered in combination.

Decitabine is an epigenetic modifier of gene expression that has been shown to be well-tolerated in this population at the dose schedule proposed in this study, with reasonable efficacy. Although its precise mechanism of action is incompletely understood, it is postulated to work by reactivating the expression of key tumor suppressor genes silenced in tumor cells by reversing a pattern of hypermethylation of promotor elements.

LBH389 is likewise an epigenetic modifier that inhibits the deacetylation of both histones and non-histone proteins, including HSP90 and p53. Although clinical experience with LBH589 in AML is limited, aberrant histone deacetylase activity has been previously shown to play a significant role in the pathogenesis of AML. The addition of LBH589 to a decitabine regimen of previously established efficacy and tolerability will allow us to evaluate the hypothesis that two epigenetic modifiers that are believed to work through distinct mechanisms of action may act together to improve the responses of patients treated with decitabine alone, without significant additional toxicity.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 51
• Est. completion date: September 2015
• Est. primary completion date: July 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 60 Years and older

Eligibility

Inclusion Criteria:

• AML (except t(15;17), inv(16) or t(8;21) and variants) or high risk MDS (IPSS Int-2 or High) diagnosed according to WHO criteria (see Appendix 1)

• Age = 60 years old

• Not a candidate for allogeneic stem cell transplantation within next 12 weeks

• Ability to provide written informed consent, obtained prior to participation in the study and any related procedures being performed

• Patients must meet the following laboratory criteria:

• Serum albumin = 3 g/dL

• AST/SGOT and ALT/SGPT = 2.5 x upper limit of normal (ULN) ) or = 5.0 x ULN if the transaminase elevation is due to leukemic involvement

• Serum bilirubin = 1.5 x ULN

• Serum creatinine = 1.5 x ULN or 24-hour creatinine clearance = 50 ml/min

• Serum potassium = LLN

• Serum phosphorus = LLN

• Serum total calcium (corrected for serum albumin) or serum ionized calcium = LLN

• Serum magnesium = LLN, TSH and free T4 within normal limits (WNL) (patients may be on thyroid hormone replacement)

• Baseline MUGA or ECHO must demonstrate LVEF = the lower limit of the institutional normal.

• ECOG Performance Status of = 2

Exclusion Criteria:

• Prior treatment for MDS / AML with HDAC inhibitor or hypomethylating agent (e.g., Decitabine, azacitadine etc.)

• Active CNS involvement with MDS/AML

• Impaired cardiac function including any one of the following:

• Screening ECG with a QTc > 450 msec confirmed by central laboratory prior to enrollment to the study

• Patients with congenital long QT syndrome

• History of sustained ventricular tachycardia

• Any history of ventricular fibrillation or torsades de pointes

• Bradycardia defined as heart rate < 50 beats per minute. Patients with a pacemaker and heart rate = 50 beats per minute are eligible.

• Patients with a myocardial infarction or unstable angina within 6 months of study entry

• Congestive heart failure (NY Heart Association class III or IV)

• Right bundle branch block and left anterior hemiblock (bifasicular block)

• Uncontrolled hypertension

• Concomitant use of drugs with a risk of causing torsades de pointes (See Appendix 2-1)

• Patients with unresolved diarrhea > CTCAE grade 1

• Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of oral LBH589

• Other concurrent severe and/or uncontrolled medical conditions

• Patients who have received chemotherapy or any investigational drug < 2 weeks or hydroxyurea < 48 hours prior to starting study drug or who have not recovered from side effects of such therapy.

• Concomitant use of any anti-cancer therapy or radiation therapy

• Male patients whose sexual partners are WOCBP not using effective birth control

• Patients with known positivity for human immunodeficiency virus (HIV) or hepatitis C; baseline testing for HIV and hepatitis C is not required

• Patients with any significant history of non-compliance to medical regimens or with inability to grant a reliable informed consent

• Patients who will need valproic acid for any medical condition during the study or within 5 days prior to first LBH589 treatment

• Patients who have received targeted agents within 2 weeks or within 5 half-lives of the agent and active metabolites (whichever is longer) and who have not recovered from side effects of those therapies

• Patients who have undergone major surgery = 4 weeks prior to starting study drug or who have not recovered from side effects of such therapy.

Study Design

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

Related Conditions & MeSH terms

• Leukemia, Myeloid
• Leukemia, Myeloid, Acute
• Myelodysplastic Syndromes
• Preleukemia

Intervention

Drug:
• LBH589

• Decitabine

Locations

Country	Name	City	State
United States	Washington University	St. Louis	Missouri

Sponsors (1)

Lead Sponsor	Collaborator
Washington University School of Medicine

Country where clinical trial is conducted

United States, 

References & Publications (1)

Cashen, A., G. J. Schiller, et al. (2006). Phase II Study of Low-Dose Decitabine for the Front-Line Treatment of Older Patients with Acute Myeloid Leukemia (AML). ASH Annual Meeting Abstracts 108(11): 1984.

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Phase I: To determine the maximum tolerated dose and dose limiting toxicity of LBH589 when given in combination with decitabine in patients age = 60 years with high risk MDS or AML.		Approximately 3.5 years total for MTD and approximately 28 days for the DLT	Yes
Primary	Phase II: To determine the rate of morphologic complete remission (CR) of LBH589 plus decitabine in patients age = 60 years with high risk MDS or AML.		Approximately 12 months	No
Secondary	To determine the rates of cytogenetic complete remission (CRc) morphologic complete remission with incomplete count recovery (CRi), overall response rate (CR+ CRi) and hematologic improvement.		Approximately 12 months	No
Secondary	To measure changes in quality of life scores, the FACT-Leu and FACT-Leu Trial Outcome Index (TOI) in patients treated with LBH589 plus decitabine.		Up to approximately 1 year after start of treatment	No
Secondary	To determine the time to response, remission duration, progression-free survival, event-free survival and overall survival of patients treated with LBH589 plus decitabine.		Length of study	No
Secondary	To determine the frequency of adverse events by grade and attribution		Up to approximately 13 months after start of treatment	Yes

External Links

•   Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine