This phase I trial studies the side effects and best dose of WEE1 inhibitor AZD1775 and belinostat when given together in treating patients with myeloid malignancies that have returned after a period of improvement or have not responded to previous treatment or patients with untreated acute myeloid leukemia. WEE1 inhibitor AZD1775 and belinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVES: I. To identify the maximum tolerated dose (MTD)/recommended phase 2 dose (RP2D) for a regimen combining WEE1 inhibitor AZD1775 (AZD1775) with belinostat in patients with refractory/relapsed acute myeloid leukemia (AML), chronic myeloid leukemia in blast crisis (CML-BC), or intermediate-2 or high-risk myelodysplastic syndrome (MDS), and selected previously untreated poor-prognosis patients with AML. SECONDARY OBJECTIVES: I. To describe the toxicities of this regimen. II. To observe and record anti-tumor activity. III. If responses are observed, to determine what relationship, if any, exists between such responses and tumor protein 53 (p53)/fms-related tyrosine kinase 3 (FLT3) mutational status. IV. To describe pharmacokinetic (PK) interactions, if any, between AZD1775 and belinostat. V. To test the feasibility of performing correlative studies involving leukemic blasts obtained pre-treatment and 24-hours post-treatment to determine if events associated with in vitro synergism (eg, down-regulation of phosphorylated \[p\]-Wee1 and p-checkpoint kinase 1 \[Chk1\]; dephosphorylation of cyclin-dependent kinase-like 1 \[cdc2\] at both tyrosine \[Tyr\]15 and threonine \[Thr\]14; increased expression of gamma H2A histone family, member X \[H2A.X\] and of p-histone H3 \[HH3\]) can be recapitulated following exposure to AZD1775 and belinostat in patients. OUTLINE: This is a dose-escalation study. Patients receive belinostat intravenously (IV) over 30-90 minutes once daily (QD) on days 1-5 and 8-12 and WEE1 inhibitor AZD1775 orally (PO) QD on days 1-5 and 8-12. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients achieving complete remission (CR), complete remission with incomplete blood count recovery (CRi), cytogenetic complete remission (CRc), or molecular complete remission (CRm) who do not go on to have stem cell transplant may only continue treatment for 3-4 additional courses after response. After completion of study treatment, all patients are followed up for 30 days and responding patients are followed up every 2 months for 1 year.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Moffitt Cancer Center
Tampa, Florida, United States
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, United States
Recommended phase 2 dose (RP2D) for the combination of WEE1 inhibitor AZD1775 and belinostat, defined as the dose in which =< 1 out of 6 patients at highest dose level below the maximally administered dose experience dose-limiting toxicities (DLTs)
Patients' treatment dosing level, dose modification, DLTs, and evaluability for DLTs will be listed and summarized by basic descriptive statistics (such as frequency and proportion). DLTs will be assessed according to the National Cancer (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 4.0.
Time frame: 21 days
Incidence of toxicity graded according to the National Cancer (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Adverse events (AEs) and serious AEs, dosing levels, treatment received, best clinical response, and demographics will be listed. Basic descriptive statistics will be used to summarize toxicities related to the study drugs by grade, and all toxicities, whether related or unrelated to the study drugs, and duration of response or stable disease to the combination therapy.
Time frame: Up to 30 days after completion of study treatment
Response rate (complete remission [CR] + CR with incomplete blood count recovery [CRi] + cytogenetic CR [CRc] + molecular CR [CRm]) according to International Working Group and European Leukemia Net criteria
The clinical best response rates will be calculated for each dose level, along with their corresponding 95% confidence intervals.
Time frame: Up to 2 years
Duration of response (in patients with (complete remission [CR] + CR with incomplete blood count recovery [CRi] + cytogenetic CR [CRc] + molecular CR [CRm])
Duration of response will be summarized by the first, second, and third quantiles and illustrated by a Kaplan-Meier plot.
Time frame: From documentation of tumor response to disease progression or death, whichever occurs first, assessed up to 2 years
Time to response
Time to response will be summarized by the first, second, and third quantiles and illustrated by a Kaplan-Meier plot.
Time frame: From registration to the time of documentation of tumor response, assessed up to 2 years
p53 and FLT3 mutation status
A Chi-square test and a Fisher exact test will be used to determine if there is a significant association between clinical responses and p53/FLT3 mutational status. An ordinal regression (where best clinical responses are considered as an ordinal outcome variable) and a logistic regression (where best responses are dichotomized as yes or no responses) will be used to test the association between responses and p53/FLT3 mutational status, with adjustment of potential factors (e.g., dose level, age, sex).
Time frame: Up to 24 hours after first dose of study treatment
Pharmacokinetic (PK) parameters (area under the curve [AUC], volume of distribution [Vd], peak concentration [Cmax], time to peak concentration [Tmax], and half-life [t1/2]) of belinostat
Will be calculated using standard non-compartmental methods and summarized as geometric mean and geometric coefficient of variation. Cmax and the times needed to reach these concentrations (tmax) will be assessed by inspection of the concentration versus time plots. The AUC will be calculated from time zero to infinity. Vd and t1/2 will also be calculated. To discover any potential PK interactions between the 2 agents, each PK parameter will be compared with each referenced PK parameter for those who receive single-agent at the same amount dose by a one-sample t-test.
Time frame: Day 1, course 1: pre-treatment, 5 minutes prior to the end of the belinostat infusion, 15 minutes (min), 30 min, 1 hour (hr), 2 hr, 4 hr, 6 hr, 8 hr, and 24 hr after the end of the belinostat infusion
PK parameters (area under the curve [AUC], volume of distribution [Vd], peak concentration [Cmax], time to peak concentration [Tmax], and half-life [t1/2]) of WEE1 inhibitor AZD1775
Will be calculated respectively using standard non-compartmental methods and summarized as geometric mean and geometric coefficient of variation. Cmax and the times needed to reach these concentrations (tmax) will be assessed by inspection of the concentration versus time plots. The AUC will be calculated from time zero to infinity. Vd and t1/2 will also be calculated. To discover any potential PK interactions between the 2 agents, each PK parameter will be compared with each referenced PK parameter for those who receive single-agent at the same amount dose by a one-sample t-test.
Time frame: Day 1, course 1: pre-treatment, and 30 min, 1 hr, 2 hr, 4 hr, 6 hr, 8 hr, and 24 hr after WEE1 inhibitor AZD1775 administration
Changes in candidate biomarker levels (including p-Wee1, p-cdc2 and gamma-H2A.X) in bone marrow and/or blood samples
Various paired t-tests will be used to determine if there is a significant change in each of the candidate biomarker between the pre- and 24-hour post-treatment assessments, in bone marrow samples and in blood samples. Various simple regression models will be used to check if there is an effect of potential factors (e.g., dose level, age, sex) on the change. The distribution of the change will be checked and if the data is highly skewed, then an appropriate data transformation will be conducted to satisfy the assumption of normality.
Time frame: Baseline to 24 hours after first dose of study treatment
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