A phase I-II trial based on the combination of three drugs regimen LDAC or Azacitidine + Venetoclax + Quizartinib that in this population could be well tolerated by a sequential type administration. The first objective is to achieve rapid control of the disease, using two different schemes, one based in Azacitidine and the other in LDAC, by dose escalation in phase I of the trial. The second goal is to prevent relapse through a maintenance schedule. Phase II will study the efficacy and safety of the recommended dose for Phase II
The prognosis of AML in elderly patients remain very poor and without significant advances in last decades. AML is a heterogeneous disease in which many altered molecular pathways could contribute to the disease. Thus, curative approaches have been based on highly eradicating regimens using high-dose chemotherapy. However, the low rate of CRs and the high rate of deaths due to toxicity and relapses in elderly patients should stimulate the development of new regimens that overcome these therapeutic obstacles. In recent years, there are a series of new drugs under development that allow the design of sequential combination therapies in this vulnerable population. These drugs have an acceptable toxicity profile and are apparently effective in monotherapy or even in combination, being able to improve the CR rate in this population. The investigators hypothesize that the combination of two targeted drugs that have different mechanisms of action could be capable of breaking the viability of leukemic cells as well as their proliferative qualities, and therefore prolong survival. In this way, the combined action of a pro-apoptotic agent (Venetoclax) and an antiproliferative agent (Quizartinib) could produce a powerful antileukemic effect, preventing the adaptive escape mechanisms of leukemic cells. The investigators have designed a phase I-II trial based on the combination of three drugs regimen LDAC or Azacitidine + Venetoclax + Quizartinib that in this population could be well tolerated by a sequential type administration. The first objective is to achieve rapid control of the disease, using two different schemes, one based in Azacitidine and the other in LDAC, by dose escalation in phase I of the trial. The second goal is to prevent relapse through a maintenance schedule. Phase II will study the efficacy and safety of the recommended dose for Phase II.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
84
AZA 75 mg/m2/daily SC days 1 to 7 or on a 5-on/2-off \[weekend\]/2-on schedule in 28-day cycle
Venetoclax (ramp-up) 400 mg/daily oral days 1 to 28
Quizartinib 40 mg/daily oral, days, 8 to 28
Low-dose subcutaneous cytarabine (LDAC) 20 mg/m2/daily SC, days 1 to 10
Venetoclax (ramp-up) 600 mg/daily oral, days 1 to 28
Quizartinib 40 mg/daily oral, days 8 to 28
Hospital Universitario Príncipe de Asturias
Alcalá de Henares, Spain
NOT_YET_RECRUITINGHospital Clínic
Barcelona, Spain
RECRUITINGHospital San Pedro de Alcántara
Cáceres, Spain
RECRUITINGHospital Universitario de Jerez de La Frontera
Jerez de la Frontera, Spain
RECRUITINGHospital de León (Complejo Asistencial Universitario de León)
León, Spain
RECRUITINGHospital Universitari Arnau de Vilanova de Lleida
Lleida, Spain
RECRUITINGHospital Universitario Infanta Leonor
Madrid, Spain
NOT_YET_RECRUITINGHospital Universitario La Zarzuela
Madrid, Spain
RECRUITINGHospital Universitario Puerta de Hierro Majadahonda
Majadahonda, Spain
NOT_YET_RECRUITINGHospital de Sant Joan de Deu (Manresa)
Manresa, Spain
RECRUITING...and 5 more locations
Phase I: Recommended phase 2 dose (RP2D)
Recommended phase 2 dose (RP2D) of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules
Time frame: Approximately 6 months after first patient first visit (FPFV)
Phase II: CR/Cri rate of AZA based and LDAC based
CR/CRi rate of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules. Patients will receive 4 consecutive cycles of treatment (approximately every 28 days). After the first 4 cycles, depending on the response and tolerance to treatment, the patient will continue receiving treatment in maintenance cycles until one of these situations occurs: disease progression, lack of clinical benefit, hematological relapse, unacceptable toxicity.
Time frame: Aproximatey 3 years after FPFV
CR/CRi rate
To evaluate the CR/CRi rate after 1 and 4 cycles of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: After cycle 1 and after cycle 4, being each cycle of 28 days
Overall survival (OS)
Overall survival will be defined as the number of days from the start of treatment to the date of death. Subjects that have not died will be censored at the last known date to be alive. To estimate 1, 2 and 3 years event-free, disease-free, and relapse-free survival, as well as on the cumulative incidence of relapse.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
Overall hematologic and non-hematologic toxicity
To evaluate the safety and tolerability of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules (overall hematologic and non-hematologic toxicity).
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
Event-free survival (EFS)
EFS will be defined as the time from enrollment until the date of progressive disease, relapse from CR or CRi, failure to achieve CR or CRi at 6 months after initiation of treatment, or death from any cause. If a specified event does not occur, subjects will be censored at the date of last disease follow-up. Data for subjects without any disease assessments performed after enrollment will be censored at the date of enrollment.
Time frame: 1, 2 and 3 years.
Disease-free survival (DFS)
DFS will be defined as the time from achieving CR or CRi until the date of relapse or death from any cause, whichever occurs first.
Time frame: 1, 2 and 3 years.
Relapse-free survival (RFS)
RFS will be defined as the time from achieving CR or CRi until the date of relapse.
Time frame: 1, 2 and 3 years.
Cumulative incidence of relapse
Estimation of cumulative incidence of relapse
Time frame: 1, 2 and 3 years.
Impact on the quality of life assessed by EuroQoL Group EQ-5D-5L
The impact on the quality of life will be assessed using the EuroQoL Group EQ-5D-5L instrument.
Time frame: At the screening, after cycle 2, after cycle 6, and after cycle 12, being each cycle of 28 days; and through study completion, an average of 48 months.
Impact on the quality of life assessed by EORTC QLQ-C30
The impact on the quality of life will be assessed using the EORTC QLQ-C30 instrument.
Time frame: at the screening, after 6 cycles, after 12 cycles since start of therapy, being each cycle of 28 days; and through study completion, an average of 48 months
Use of medical resources during treatment phase
To evaluate the impact on the use of medical resources during treatment phase (ie, antibiotics, transfusions, duration of hospitalization, need of central venous line, use of strong or moderate CYP3A inhibitors and moderate CYP3A inducers).
Time frame: At the end of treatment phase: after cycle 4, being each cycle of 28 days.
Quality of CR
To evaluate the quality of CR (by study of minimal residual disease percentages in the bone marrow (BM) using multiparametric flow cytometry \[MPFC\] and NGS-MRD).
Time frame: After cycle 1, cycle 4 and then every 3 cycles during the first 2 years after start of the therapy (each cycle of 28 days).
CRh rate
To evaluate the CRh rate in AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
Early mortality
To evaluate early mortality rate in AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: First 30 and 60 days
CR/Cri rate of AZA based and LDAC based, in secondary AML subset
CR/CRi rate of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
CR/Cri rate of AZA based and LDAC based, in CBF subset
CR/CRi rate of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
CR/Cri rate of AZA based and LDAC based, in FLT3-ITD subset
CR/CRi rate of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
CR/Cri rate of AZA based and LDAC based, in NPM1 subset
CR/CRi rate of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
CR/Cri rate of AZA based and LDAC based, in P53 subset
CR/CRi rate of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
CR/Cri rate of AZA based and LDAC based, in IDH1/IDH2 subset
CR/CRi rate of AZA based and LDAC based triple combination with Quizartinib and Venetoclax schedules.
Time frame: Through study completion: 2 years after the last patient has been enrolled into the study, an average of 48 months.
MRD negativity rate in the BM
To evaluate the MRD negativity rate in the BM using MPFC and NGS-MRD, as part of analysis of biomarkers.
Time frame: After cycle 1, cycle 4 and then every 3 cycles, being each cycle of 28 days.
MRD negativity rate in PB
To evaluate the MRD negativity rate in PB using NGS-MRD, as part of analysis of biomarkers.
Time frame: After cycle 1, cycle 4 and then every 3 cycles, being each cycle of 28 days.
Natural Killer (NK) cell phenotypes and functions (immune recovery) analysis.
Natural Killer (NK) substudy to analyse NK cell phenotypes and functions, as part of biomarker analysis.
Time frame: At screening and after first and fourth cycles of treatment, being each cycle of 28 days.
Baseline and relapse molecular characterization by NGS.
Baseline and relapse molecular characterization by next generation sequencing (NGS), as part of biomarker analysis.
Time frame: At baseline and at through study completion due to relapse/resistance, an average of 48 months.
Carmen López-Carrero García
CONTACT
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