This phase II MyeloMATCH treatment trial compares ASTX727 with standard duration versus shorter duration of venetoclax for the treatment of newly diagnosed acute myeloid leukemia (AML). ASTX727 is a combination of decitabine and cedazuridine. Decitabine is in a class of medications called hypomethylation agents. It works by helping the bone marrow produce normal blood cells and by killing abnormal cells in the bone marrow. Cedazuridine is in a class of medications called cytidine deaminase inhibitors. It prevents the breakdown of decitabine, making it more available in the body so that decitabine will have a greater effect. Venetoclax is in a class of medications called B-cell lymphoma-2 (BCL-2) inhibitors. It may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Shorter duration venetoclax may be as effective as standard duration venetoclax when given with ASTX727 for the treatment of newly diagnosed AML.
PRIMARY OBJECTIVES: I. To compare whether the proportion of participants with a measurable residual disease (MRD) negative complete remission (CR) at 180 days (6 months) is not more than 12% worse between participants randomized to venetoclax for 14 days versus 28 days per cycle (non-inferiority assessment). II. If 14 days of venetoclax is found to be non-inferior to 28 days, to test whether the proportion of participants with an MRD-negative CR at 180 days (6 months) after randomization is significantly higher in the 14 days per cycle compared to the 28-days per cycle (superiority assessment). SECONDARY OBJECTIVES: I. In each arm, to estimate the frequency and severity of toxicities. II. In each arm, to estimate CR rates, CR with incomplete count recovery (CRi) (CRi, with and without MRD) rates, event-free survival (EFS), relapse-free survival (RFS), and overall survival (OS) for each of the regimens. III. In each arm, to use the disease characteristics from MATCHBox to describe mechanisms of resistance (and disease sensitivity) across the treatment arms. IV. In each arm, to tabulate the number of cycles competed, percent of cycles with at least one dose reduction, and percent of cycles with at least one treatment delay at 180 days (6 months) after randomization. BANKING OBJECTIVE: I. To bank specimens for future correlative studies. OUTLINE: Patients are randomized to 1 of 2 arms. ARM 1: Patients receive decitabine and cedazuridine (ASTX727) orally (PO) once daily (QD) on days 1-5 and venetoclax PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo bone marrow aspiration and blood sample collection throughout the study. ARM 2: Patients receive ASTX727 PO QD on days 1-5 and venetoclax PO QD on days 1-14 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo bone marrow aspiration and blood sample collection throughout the study. After completion of study treatment, patients are followed up periodically for up to 5 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
126
Undergo blood sample collection
Undergo bone marrow aspiration
Given PO
Given PO
Minimal residual disease (MRD) negative complete remission (CR)
Defined as from date of randomization the first of the following failure events: death from any cause, off protocol therapy without MRD negative CR, relapse from MRD negative CR, off protocol therapy without assessment of CR, off protocol therapy without assessment of MRD. Will be analyzed using intent-to-treat principles among eligible participants.
Time frame: At 180 days
Event free survival
Will be estimated using the Kaplan-Meier method. Response per 2022 European Leukemia Network (ELN) risk will be tabulated and exact 95% confidence intervals will be calculated.
Time frame: From randomization to first of: date off protocol therapy without complete remission (CR), CR with incomplete hematologic recovery (CRi) or CR with partial hematologic recovery (CRh), relapse from CR, CRi, or CRh, or death from any cause, up to 5 years
Relapse free survival
Defined only for participants achieving CR, CRi, or CRh. Will be estimated using the Kaplan-Meier method. Response per 2022 ELN risk will be tabulated and exact 95% confidence intervals will be calculated.
Time frame: From the date of achievement of a remission until the date of relapse or death from any cause, up to 5 years
Overall survival
Will be estimated using the Kaplan-Meier method. Response per 2022 ELN risk will be tabulated and exact 95% confidence intervals will be calculated.
Time frame: From day of randomization on study until death from any cause, up to 5 years
Incidence of adverse events
Time frame: Up to 5 years
Mechanisms of resistance
Will be described by treatment arm.
Time frame: Up to 5 years
Drug sensitivity
Will be described by treatment arm.
Time frame: Up to 5 years
Tolerability
Will be characterized by the number of cycles completed by 6 months along with dose reductions and delays.
Time frame: At 180 days
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