This phase I trial studies the side effects and best dose of ivosidenib when given together with combination chemotherapy for the treatment of 1DH1 mutant acute myeloid leukemia that is newly diagnosed (previously untreated), has come back (relapsed), or does not respond to treatment (refractory). Ivosidenib may stop the growth of cancer cells by blocking the IDH1 mutation and some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as fludarabine phosphate, cytarabine, and filgrastim, 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. Giving ivosidenib with combination chemotherapy may work better in treating patients with acute myeloid leukemia compared to chemotherapy alone.
PRIMARY OBJECTIVE: I. To determine the maximum tolerated dose (MTD) of ivosidenib in combination with fludarabine, cytarabine, plus granulocyte-colony stimulating factor (G-CSF) (FLAG) ± Idarubicin chemotherapy. SECONDARY OBJECTIVES: I. To evaluate the safety profile of ivosidenib in combination with FLAG ± Idarubicin chemotherapy. II. To determine the rate of complete remission (CR + complete remission with incomplete hematological recovery \[CRi\] + complete remission with incomplete platelet recovery \[CRp\]) with ivosidenib in combination with FLAG ± Idarubicin chemotherapy. III. To evaluate the 1 year progression free survival. IV. To evaluate the 1 year overall survival. V. To assess the number of patients that receive allogeneic stem cell transplant after ivosidenib in combination with FLAG ± Idarubicin chemotherapy. EXPLORATORY OBJECTIVES: I. To assess for minimal residual disease negativity by polymerase chain reaction (PCR) for IDH1 mutations after treatment with ivosidenib in combination with FLAG ± Idarubicin chemotherapy. II. To assess for minimal residual disease negativity by PCR for IDH1 mutations after 3 cycles of maintenance therapy. OUTLINE: INDUCTION: Patients receive filgrastim subcutaneously (SC) once daily (QD) on days 0-6, fludarabine phosphate intravenously (IV) QD over 30 minutes on days 1-5, cytarabine IV QD over 4 hours on days 1-5, and ivosidenib orally (PO) QD on days 7-28. The addition of idarubicin to FLAG (FLAG ± IDA) will be per treating investigator and is to be to be administered at 8 mg/m2 by IV infusion over 30 minutes on days 4-6 of cycle 1, when given in combination with FLAG. Treatment continues for 28 days in the absence of disease progression or unacceptable toxicity. CONSOLIDATION: Patients that complete the induction cycle are eligible to receive consolidation therapy with 1 cycle of FLAG ± IDA and ivosidenib based on treating physician discretion. Eligible patients for consolidation therapy are those who have CR, CRi, CRp, or PR. Patients are not required to receive consolidation therapy. Patients receive filgrastim SC QD on days 0-5, fludarabine phosphate IV QD over 30 minutes on days 1-4, cytarabine IV QD over 4 hours on days 1-4, and ivosidenib PO QD on days 1-28. The addition of idarubicin to FLAG (FLAG ± IDA) will be per treating investigator and is to be to be administered at 8 mg/m2 by IV infusion over 30 minutes on days 4-6. Treatment continues for 28 days for 1 cycle in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients that have completed 1 cycle of induction with ivosidenib and FLAG ± IDA may start maintenance. Patients are not required to receive consolidation treatment in order to proceed to maintenance. Patients receive ivosidenib PO QD on days 1-28. Treatment repeats every 28 days for up to 26 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients complete follow up at 30 days and then every month for up to 1 year from start of study treatment to document survival and disease progression.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
2
Given IV
Given SC
Given IV
Given IV
Given PO
8 mg/m2 IV on days 4-6 of induction (cycle 1) and 8 g/m2 IV on days 4-6 of consolidation. Idarubicin will be administered per treating physician discretion. Idarubicin is a drug that belongs to a group of anti-cancer drugs called anthracyclines. These drugs were originally used as antibiotics, but it was subsequently found that they were effective anti-cancer drugs. Idarubicin hydrochloride is a DNA-intercalating analog of daunorubicin which has an inhibitory effect on nucleic acid synthesis and interacts with the enzyme topoisomerase II. The absence of a methoxy group at position 4 of the anthracycline structure gives the compound a high lipophilicity which results in an increased rate of cellular uptake compared with other anthracyclines.
Northwestern University
Chicago, Illinois, United States
Maximum tolerated dose of ivosidenib in combination with FLAG (± IDA) chemotherapy
Will be assessed for a DLT per the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Patients that complete the induction cycle will be eligible for assessment.
Time frame: Up to day 42 of the first treatment cycle
Review of adverse events of ivosidenib in combination with FLAG (± IDA) chemotherapy
Will be assessed by the CTCAE version 5.0. Toxicity profiles will be summarized for toxicities of any grade, with rates of \>= grade 3 toxicities also analyzed separately. Adverse events rates will be summarized and accompanied by 95% exact binomial confidence intervals.
Time frame: Up to 30 days after last dose
Rates of complete remission (CR + complete remission with incomplete hematological recovery [CRi] + complete remission with incomplete platelet recovery [CRp])
Patients that complete the induction cycle will be eligible for assessment. The rate of complete remission (CR + CRi + CRp) with ivosidenib in combination with FLAG (± IDA) chemotherapy will be assessed after induction or upon count recovery.
Time frame: After induction on day 28 or upon count recovery, up to 1 year
Progression free survival
Will be estimated using Kaplan-Meier curves.
Time frame: At 1 year
Overall survival
Will be estimated using Kaplan-Meier curves.
Time frame: At 1 year
Number of patients that receive hematopoietic stem cell transplant after induction treatment
Patients that complete the induction cycle will be eligible for assessment.
Time frame: Up to 1 year
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