The investigators hypothesize that CX-01 will disrupt the bone marrow microenvironment and increase the cytotoxic effects of azacitidine on myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) hematopoietic stem cells by disrupting the High-mobility group box protein 1 (HMGB1) interaction with toll-like receptor 4 (TLR4) and receptors for advanced glycation end products (RAGE), the CXC chemokine CXCL12/chemokine receptor 4 (CXCR4) axis, and by disrupting other leukocyte and vascular adhesion molecules. In addition, CX-01 may also help promote count recovery after treatment given its affinity for platelet factor-4 (PF4). The selection of CX-01 dose for study in relapsed or refractory MDS and AML has been based upon the dual requirements to have sufficient drug administered to have potential activity but without clinically significant anticoagulation. The study dose chosen (4 mg/kg bolus followed by 0.25 mg/kg/hour) fulfills both of these criteria. In addition, this dose is expected to result in serum levels of CX-01 which are significantly higher than the IC90 identified in preclinical studies for inhibition of HMGB1-RAGE, toll-like receptor 2 (TLR2) and TLR4 interaction. Therefore, the chosen dose represents a rational balance between effective dosing and safety in thrombocytopenic patients with MDS and AML. This dose was previously established to be safe and tolerable when combined with cytarabine and idarubicin in patients with AML.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
CX-01 at a dose of 4mg/kg on Day 1 of each 28-day cycle, followed by a continuous intravenous infusion at a dose of 0.25 mg/kg/hour for Days 1 through 7 of each cycle.
Azacitidine at a dose of 75mg/m\^2 on Days 1-7 of each 28-day cycle.
-Baseline, day 28 of even-numbered cycle through Cycle 6, and end of study
-Day 1 of each cycle, day 3 of each cycle, day 7 of each cycle, day 28 of every even-numbered cycle through Cycle 6, and end of study
Washington University School of Medicine
St Louis, Missouri, United States
Overall response rate (partial response or higher)
* Overall response rate = the percentage of patients obtaining partial response or higher * Patients will be assessed for response according to modified International Working Group (IWG) criteria
Time frame: 30 days following completion of treatment (estimated to be 28 weeks)
Progression-free survival (PFS)
* The interval from the date of first dose of study drug to disease progression or death. * Described by median time-to-event and a 95% confidence interval, if estimable, using Kaplan-Meier models
Time frame: Up to 5 years
Disease-free survival (DFS)
* The interval from the date of first documentation of a CR to date of recurrence or death. This is determined only for patients achieving a CR * Described by median time-to-event and a 95% confidence interval, if estimable, using Kaplan-Meier models
Time frame: Up to 5 years
Overall survival (OS)
* The date of first dose of study drug to the date of death from any cause. * Described by median time-to-event and a 95% confidence interval, if estimable, using Kaplan-Meier models
Time frame: Up to 5 years
Safety and tolerability of regimen as measured by adverse events tabulated by patient
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 will be utilized for all toxicity reporting.
Time frame: 30 days following completion of therapy (estimated to be 28 weeks)
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