This phase I trial is studying the side effects and best dose of vorinostat when given together with cytarabine and etoposide in treating patients with relapsed or refractory acute leukemia or myelodysplastic syndromes or myeloproliferative disorders. Vorinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cytarabine and etoposide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving vorinostat together with cytarabine and etoposide may kill more cancer cells.
OBJECTIVES: I. Determine the feasibility, tolerability, and toxicities, in terms of the maximum tolerated dose (MTD), of the sequential combination of vorinostat (SAHA) followed by cytarabine and etoposide in patients with relapsed and/or refractory acute leukemia or transforming myelodysplastic syndromes or myeloproliferative disorders. II. Determine whether the addition of SAHA to cytarabine and etoposide chemotherapy improves outcome, in terms of complete response rate, duration of response, and overall survival, in these patients. III. Determine the effects of SAHA on induction of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-death receptors DR4 and DR5 and other pro-apoptotic mediators in patient-derived cancer cells (leukemia blast cells) and somatic cells (buccal mucosa cells, using pre-SAHA and on SAHA treatment samples). IV. Determine the ability of SAHA to block leukemia blast cells in the G1 phase of the cell cycle (leukemia blast cells, using pre-SAHA and on SAHA treatment samples). V. Determine the effects of SAHA on the expression of P-glycoprotein/MDR1/ABCB1, and the breast cancer resistance protein (BCRP/ABCG2), using functional and mRNA/protein assays for these transporters (leukemia blast cells, using pre-SAHA and on SAHA treatment samples). OUTLINE: This is a dose-escalation study of vorinostat (SAHA). Patients receive oral SAHA two or three times daily on days 1-7 and cytarabine intravenously (IV) over 3 hours twice daily and etoposide IV over 1 hour once daily on days 11-14. Treatment repeats approximately every 6-7 weeks for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve complete response after 1 course of therapy may receive 1 or 2 more courses of therapy. Patients who achieve partial response after 1 course of therapy may receive 1 more course of therapy. Cohorts of 3-6 patients receive escalating doses of SAHA until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 1 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, an additional 10 patients are treated at that dose. Blood, buccal cells, and bone marrow samples are collected prior to and during treatment. Samples are used for pharmacokinetic and pharmacodynamic studies, protein expression studies, and gene expression profiling. After completion of study treatment, patients are followed within 30 days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Given orally
Given IV
Given IV
Correlative studies
Correlative studies
University of Maryland Greenebaum Cancer Center
Baltimore, Maryland, United States
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Maximum tolerated dose (MTD) of vorinostat (SAHA) in combination with cytarabine and etoposide
Based on the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
Time frame: Course 1
Response rate
Measured using a bone marrow aspirate and/or biopsy. 90% confidence interval will be calculated
Time frame: Baseline, day 4-7 of course 1, and after each course
Progression-free survival
Estimated using the Kaplan-Meir method.
Time frame: At 30 days after completion of study treatment and continued follow up visits
Disease-specific survival
Estimated using the Kaplan-Meir method.
Time frame: At 30 days after completion of study treatment and continued follow up visits
One-year survival
Estimated using the Kaplan-Meir method.
Time frame: At 1 year
Overall survival
Measured from time of enrollment onto this study to the time of death. Estimated using the Kaplan-Meir method.
Time frame: At 30 days after completion of study treatment and continued follow up visits
Degree of upregulation of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-death receptors and proteins associated with apoptosis
Performed by the Rnase protection assay.
Time frame: Baseline and days 4-7 of course 1
Alterations in cell cycle phase
Patient-derived bone marrow or peripheral blood mononuclear cells will be evaluated for cell cycle phase distribution, using the hypotonic propidium-iodide method and flow cytometry.
Time frame: Baseline and days 4-7 of course 1
Expression of MDR proteins at MTD of SAHA
Using quantitative, real-time polymerase chain reaction (PCR) methods with product detected using specific hybridization probes.
Time frame: Baseline and days 4-7 of course 1
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