This phase I/II trial studies the side effects and best dose of milademetan tosylate and to see how well it works with cytarabine with or without ventoclax in treating participants with acute myeloid leukemia that has come back (recurrent) or that does not respond to treatment (refractory). Milademetan tosylate and ventoclax may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known if giving milademetan tosylate and low-dose cytarabine with or without ventoclax will work better in treating participants with recurrent or refractory acute myeloid leukemia.
If you are found to be eligible to take part in this study, you will be assigned to a study group based on when you join this study. If you are enrolled in Phase 1, the dose of DS-3032b you receive will depend on when you join this study. If you are enrolled in Phase 2, you will receive DS-3032b at the highest dose that was tolerated in Phase 1. All participants will receive LDAC at a fixed dose (meaning the dose will not change). If you are assigned to receive it, your dose of venetoclax will not change either. However, if needed because you have side effects, your dose may be adjusted. Up to 58 participants will be enrolled in this study. All will take part at MD Anderson.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
16
M D Anderson Cancer Center
Houston, Texas, United States
Maximum Tolerated Dose (MTD) (Phase I)
As determined by dose limiting toxicity (DLT). MTD is defined the highest dose at which no more than one patient out of 6 patients experience DLTs in the first cycle. A 3+3 algorithm will be applied for dose escalation or dose de-escalation.
Time frame: Up to 28 days
Participants With a Response
Response is Complete Response (CR) + Complete Response with Incomplete Blood Count Recovery (CRi) + Partial Response (PR) + Morphologic Leukemia -Free State (MLFS: CR is Bone marrow blasts \< 5%; absence of circulating blasts and blasts with Auer rods; absence of extra-medullary disease; ANC \>/= 1.0 x 10\^9/L; platelet count \>/= 100 x 10\^9/L. CRi is CR except for ANC \< 1.0 x 10\^9 or platelet count , 100 x 10\^9/L. PR is decreased bone marrow blast % by at least 50% to a value of 5% to 25% and ANC \>/= 1.0 x 10\^9/L; platelet count \>/= 100 x 10\^9/L. MLFS is Bone marrow blasts \< 5%; abcence of blasts with Auer rods; absence of extra-medullary disease; no hematologic recovery required.
Time frame: Up to 3 years, 4 months
Overall Survival
Time from date of treatment start until date of death due to any cause or last Follow-up.
Time frame: Up to 3 years, 4 months
Event Free Survival (EFS)
Time from date of treatment start until the date of first objective documentation of disease-relapse.
Time frame: Up to 3 years, 4 months
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