This is an open label study to assess the safety and efficacy of CPX-351 in combination with gemtuzumab ozogamicin (GO) as first intensive therapy in older (age \>55 years) subjects with newly diagnosed AML who are eligible for intensive induction chemotherapy, or AML subjects who previously failed low-intensity therapy but who would be eligible for high-intensity chemotherapy, with companion cognitive function testing to determine whether this contributes to outcome in these subjects. Subjects may have received prior AML treatment with non-intensive regimens, e.g. hypomethylating agents, low-dose cytarabine, or lenalidomide or a clinical trial drug in combination with hypomethylating agents or low-dose cytarabine, but may not have received intensive AML treatment with anthracyclines and/or infusional cytarabine prior to enrollment on this trial. Subjects may not have been treated with GO or other antibody targeting CD 33 prior to enrollment on this trial. The cohort will include 30 subjects treated with the combination of CPX-351 and GO and is designed to establish the safety and feasibility of the combination. These subjects will be assessed for efficacy and safety. Quality of life will be assessed using the FACT-LEU in all subjects. Cognitive function will be assessed using the Blessed Orientation-Memory-Concentration Test and the Montreal Cognitive Assessment.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
11
CPX-351 is a liposomal formulation of a fixed combination of the antineoplastic drugs cytarabine and daunorubicin. The two drugs are present inside the liposome in a 5:1 molar ratio. The liposome membrane is composed of distearoylphosphatidylcholine, distearoylphosphatidylglycerol and cholesterol in a 7:2:1 molar ratio.
Gemtuzumab ozogamicin is a CD-33 directed antibody drug conjugated to calicheamicin. CD 33 is expressed on myeloid leukemic blast cells and on normal hematopoietic cells. The drug is approved for the treatment of newly diagnosed CD 33 positive AML in adults and the treatment of relapsed and refractory CD 33 positive AML in adults. The drug is available for injection 4.5 mg as a lyophilized cake or powder in a single use vial for reconstitution and dilution.
Weill Cornell Medical College
New York, New York, United States
Feasible dose of Gemtuzumab Ozogamicin (GO) in combination with CPX-351 (cytarabine:daunorubicin) in older subjects with AML
The combination of CPX-351 + GO will be declared feasible if at least one dose of GO (day 1, 4, and 7) at 3 mg/m\^2 can be safely delivered to subjects.
Time frame: 5 years
Efficacy of the combination of CPX and GO as first intensive therapy in elderly (age ≥55 years) by response rate
The efficacy of the combination of CPX-351 and GO in this population will be assessed by treatment response rate, as determined by bone marrow analysis at Day 14 of each induction and consolidation, and as needed thereafter, up to 5 years.
Time frame: 5 years
Safety of the combination of CPX and GO in elderly (age ≥55 years) subjects with AML by evaluation of the frequency and severity of adverse events.
The safety of CPX-351 in this population will be assessed by evaluation of the frequency and severity of adverse events.
Time frame: 5 years
Assessment of Minimal Residual Disease (MRD) response in subjects treated with this combination using multiparameter flow cytometry and next generation sequencing.
MRD is defined as posttherapy persistence of leukemia cells at levels below morphologic detection, and is a prognostic marker of increased risk of relapse and shorter survival in this subject population.
Time frame: 5 years
Quality of Life Assessment using the Functional Assessment of Cancer Therapy-Leukemia (FACT-LEU).
Leukemia Subscale (LeuS): Range:0-68. To derive: Subtract the answers from "4" for each of the 17 questions, except #s 11 and 12 (these are added without modification). Add values, multiply by 17 and divide by # of questions answered. FACT-Leu total =PWB+SWB+EWB+FWB+LeuS. Range: 0-176.
Time frame: 5 years
Assessment of the relationship of cognitive function to outcome using the Blessed Orientation-Memory-Concentration Test
The relationship of cognitive function to outcome will be assessed using the Blessed Orientation-Memory-Concentration Test. The score for 6 items are multiplied to yield a "weighted" score. The higher the total weighted score, the more likely the patient has cognitive disability. Weight scores totaling greater than 10 are generally accepted as an indication of the presence of clinically meaningful cognitive impairment.
Time frame: 5 years
Assessment of the relationship of cognitive function to outcome using the Montreal Cognitive Assessment (MoCA).
The relationship of cognitive function to outcome will be assessed using the MoCA. The MoCA was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. The total possible score is 30 points; a score of 26 or above is considered normal.
Time frame: 5 years
CPX-351 as a post-remission (consolidation) therapy
The safety of CPX-351 as a post-remission (consolidation) therapy will be assessed by evaluation of the frequency and severity of adverse events.
Time frame: 5 years
Rate of morphologic leukemia-free state (MLFS)
The rate of morphologic leukemia-free state (MLFS) will be determined to supplement the efficacy assessment of CPX-351.
Time frame: 5 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.