In this trial the investigators aim to evaluate safety and efficacy of combination Ivosidenib (AG-120) and nivolumab in the context of adult patients with Isocitrate dehydrogenase-1 (IDH1) mutated acute myeloid leukemias (AML) or Myelodysplastic syndromes (MDS).
Primary objectives: 1. To determine the overall response rate of (CR/CRi) of combination ivosidenib (AG-120) and nivolumab in patients with high risk MDS and relapsed/ refractory AML 2. To determine the duration of response of combination ivosidenib (AG-120) and nivolumab in patients with high risk MDS and relapsed/ refractory AML 2.2 Secondary Objectives 1\) To determine the progression free survival of patients treated with combination ivosidenib (AG- 120) and nivolumab. 2) To determine the overall survival of patients treated with combination ivosidenib (AG-120) and nivolumab. 3) To determine hematological response rate of patients treated with combination ivosidenib (AG- 120) and nivolumab. 4) To establish the duration of response to treatment of patients treated with combination ivosidenib (AG-120) and nivolumab. 5) To evaluate the safety and tolerability of combination ivosidenib (AG-120) and nivolumab. Exploratory objectives: 1. To assess the relationship between treatment response and correlative studies such as plasma and bone marrow 2-HG levels, and IDH variant allele frequency. 2. Genomic characterization by assaying specimens obtained from patients using an MDS/AML specific panel through the duration of therapy to longitudinally assess mutational burden before and during therapy, and correlating this mutational data with patient outcomes 3. Correlate exploratory biomarkers including PD-L1 expression, circulating myeloid-derived suppressor cells and interferon gamma signatures to response
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
The IDH1 inhibitor ivosidenib (AG-120) that will be administered orally on a continuous basis at the dose of 500 mg/day starting at day 1 of each cycle. A cycle will be defined as a 28-day period.
On Cycle 2 day 1 the patient will receive nivolumab 480mg once. This will be repeated on Day 1 of every subsequent cycle.
Yale Cancer Center
New Haven, Connecticut, United States
Overall response rate
1\) Overall response rate (ORR) of 60%, i.e., a 20% ORR improvement (historical control ORR = 40% with Ivosidenib\[AG-120\] monotherapy after 2 lines of therapy20) after 6 cycles of treatment based on MDS International Working Group 2006 criteria and AML MDS International Working group MDS/AML criteria33, 34Cumulative ORR will include complete remission (CR), morphologic complete remission with incomplete blood count recovery (CRi), CR with incomplete platelet recovery (CRp) and Partial response (PR).
Time frame: 168 days
Change in duration of response
2\) In the patients who respond, Improvement in duration of response to 12 months (compared to single agent ivosidenib \[AG-120\] 8.2 months with ivosidenib \[AG-120\] monotherapy)
Time frame: 12 months
Overall survival rate
Overall survival will be defined from the time of treatment initiation to the time of last follow up or death. Survival with censoring patients at the time of transplantation will also be evaluated.
Time frame: Up to 4 years
Progression free survival rate
Progression free survival will be defined from the time of documentation of response to the time of relapse or death or censored at the time of last follow-up. Survival with censoring patients at the time of transplantation will also be evaluated.
Time frame: Up to 4 years
Amount of Allogeneic hematopoietic stem cell transplant (HSCT) patients
Percentage of patients bridged to HSCT
Time frame: 2 years
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