This is a phase Ib study with a 3 + 3 dose escalation design followed by a dose-expansion phase.
The study hypothesis is that the combination of pevonedistat, azacitidine, and venetoclax will be effective, safe, and well tolerated in patients with AML. The primary objective of this portion of the study is to determine a recommended phase 2 dose (RP2D) of pevonedistat, azacitidine, and venetoclax. The investigators will use a variation of the 3+3 design where both escalation and de-escalation are possible. A minimum of nine and a maximum of 24 subjects will be needed for the phase 1 part of the study (dose-escalation phase). The dose limiting toxicity (DLT) observation period for dose escalation will be during cycle 1. Prior to enrolling patients at the next applicable dose level, all patients must complete the DLT period of the current dose level. The Data Safety Monitoring Committee will review the results of each dose level before the next applicable dose level opens for enrollment. Dose Expansion Phase The primary objective of this portion of the study is to confirm the feasibility and tolerance of the combination of pevonedistat, azacitidine, and venetoclax in patients with AML. Given that the dose-escalation phase described above will be able to establish the RP2D, the dose-expansion phase will employ this dose. In addition to relapsed/refractory AML patients, newly diagnosed AML patients can also be included in this phase to assess the feasibility and tolerance of this combination regimen. A minimum of six patients will be enrolled in the dose-expansion phase, which could be expanded based on the safety and tolerability.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
16
75mg/m\^2 Days 1-7 given IV
100 mg on cycle 1 day 1, 200 mg daily on cycle 1 day 2, 400 mg on cycle 1 day 3 and thereafter from cycle 1. Venetoclax is given for a minimum of 21 days and a maximum of 28 days. Administered orally.
The doses for the 3 + 3 design (dose escalation phase) are listed in the arm description. The dose-expansion phase will use the maximum-tolerated dose.
Mayo Clinic
Rochester, Minnesota, United States
Froedtert Hospital and the Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Recommended phase 2 dose of pevonedistat when co-administered with azacitidine and venetoclax in patients with AML.
The maximum-tolerated dose is defined as the highest dose level at which none of the first three treated subjects, or no more than one of the first six treated subjects, experiences a dose-limiting toxicity.
Time frame: Up to 28 days (one cycle) for each dosing cohort.
The toxicity profile of pevonedistat, azacitidine, and venetoclax combination therapy.
The number of serious adverse events will be measured using NCI-CTCAE v5 criteria.
Time frame: Up to 30 days after last dose of study drugs.
Complete Remission Rate
The number of subjects who achieve complete remission. Complete remission is defined as follows: Bone marrow blasts \<5 percent; absence of blasts with Auer rods; absence of extramedullary disease; absolute neutrophil count \>1.0 x 10\^9/L (1000/μL); platelet count \>100 x 10\^9/L (100,000/μL); independence of red cell transfusions.
Time frame: Up to five years.
Complete Remission with Partial Hematological Recovery
The number of subjects who achieve complete remission with partial hematological recovery. Complete Remission with Partial Hematological Recovery is defined as: Complete remission with partial hematological recovery (CRh) defined as: * \<5% blasts in the bone marrow. * No evidence of disease. * Partial recovery of peripheral blood counts. * Platelets \>50,000/microliter and absolute neutrophil counts \>500/microliter.
Time frame: Up to five years.
Partial Remission Marrow
The number of subjects who achieve partial remission marrow. Partial Remission Marrow is defined as: Decrease of bone marrow blast percentage to 5 to 15%; and decrease of pretreatment bone marrow blast percentage by at least 50%.
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Time frame: Up to five years.
Morphologic Leukemia Free State
The number of patients who achieve morphologic leukemia free state. Morphologic Leukemia Free State is defined as: Bone marrow blasts \<5%; absence of blasts with Auer rods; absence of extramedullary disease; no hematologic recovery required.
Time frame: Up to five years.
Complete Remission without Minimal Residual Disease
The number of patients who achieve CR without minimal residual disease. Complete Remission without Minimal Residual Disease is defined as: CR with negativity for a genetic marker by reverse transcriptase polymerase chain reaction (RT-qPCR), or CR with negativity by MFC.
Time frame: Up to five years.