de Novo Myelodysplastic Syndromes, Previously Treated Myelodysplastic Syndromes, Secondary Myelodysplastic Syndromes
Conditions
Brief summary
This phase I/II trial studies how well giving azacitidine together with etanercept works in treating patients with myelodysplastic syndromes (MDS). Drugs used in chemotherapy, such as azacitidine, works in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemoprotective drugs, such as etanercept, may protect normal cells from the side effects of chemotherapy
Detailed description
PRIMARY OBJECTIVES: I. Determine the frequency of hematologic responses in patients with MDS to 5-aza (azacitidine) plus etanercept. II. Determine the efficacy of 5-aza combined with etanercept in patients with low or intermediate (int)-1 risk who fail to respond to anti-thymocyte globulin (ATG) plus etanercept and for the purpose of this trial are considered as having progressive or more advanced disease. III. Correlate results of ex vivo/in vitro studies on phenotypic, cytogenetic and functional disease characteristics with in vivo treatment responses, to identify parameters that are associated with a high probability of response. OUTLINE: Patients receive etanercept subcutaneously (SC) twice weekly during weeks 1 and 2 and azacitidine SC or intravenously (IV) over 10-40 minutes on days 1-7. Treatment repeats every 28 days for at least 3 courses. Treatment continues in the absence of disease progression or unacceptable toxicity.
Interventions
DRUGazacitidine
Given SC or IV
BIOLOGICALetanercept
Given SC
Sponsors
National Cancer Institute (NCI)
Fred Hutchinson Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Int-2 or high risk MDS patients * Patients with low-risk or int-1 risk MDS by International Prognostic Scoring System (IPSS) criteria with: * Single or multilineage cytopenia (absolute neutrophil count \[ANC\] \< 1500/μL, hemoglobin \[Hgb\],10g/dL, or platelet count \< 100,000/μL); or * Transfusion requirement of at least 2 units of packed red blood cells over an 8 week period * Serum creatinine =\< 1.5x ULN (upper limit of normal) * Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =\< 2x ULN * Performance status =\< 2 (Eastern Cooperative Oncology Group \[ECOG\] scale, 0-5)
Exclusion criteria
* Patients who have previously received hematopoietic stem cell transplants, specifically for MDS * Patients with a diagnosis of acute myeloid leukemia (AML) by World Health Organization (WHO) criteria (i.e \>= 20% blasts) at time of enrollment * Women of child bearing potential who are currently pregnant, lactating or who are not willing to use contraception during the entire duration of the study * Men who are unwilling to use contraception while receiving 5-aza * Patients with severe disease other than MDS which is expected to prevent compliance with the present protocol * Patients with severe infections (pneumonia, septicemia, etc) within the 2 weeks prior to the anticipated start of protocol treatment * Patients who are currently receiving or within the preceding 2 weeks have received cytotoxic therapy, hemopoietic growth factors, immunomodulatory therapy, or other experimental therapy for the treatment of MDS * Current evidence of uncontrolled cardiac arrhythmia or congestive heart failure * Platelet count =\< 10,000/mcl * Absolute neutrophil count =\< 250/mcl * Prior treatment with 5-aza * Known or suspected hypersensitivity to azacitidine or mannitol
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of Hematologic Responses, as Defined by International Working Group (IWG) Criteria | Up to 2 years | Count of participants with a hematologic improvement (erythroid, platelet, or neutrophil response), assessed at 3 months. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment (Chemotherapy, Chemoprotection) Patients receive etanercept SC twice weekly during weeks 1 and 2 and azacitidine SC or IV over 10-40 minutes on days 1-7. Treatment repeats every 28 days for at least 3 courses. Treatment continues in the absence of disease progression or unacceptable toxicity.
azacitidine: Given SC or IV
etanercept: Given SC | 32 |
| Total | 32 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Intracranial haemorrhage | 1 |
| Overall Study | Muscle pain | 1 |
Baseline characteristics
| Characteristic | Treatment (Chemotherapy, Chemoprotection) |
|---|---|
| Age, Continuous | 69 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 31 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 30 Participants |
| Sex: Female, Male Female | 11 Participants |
| Sex: Female, Male Male | 21 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 26 / 32 |
| serious Total, serious adverse events | 5 / 32 |
Outcome results
Primary
Frequency of Hematologic Responses, as Defined by International Working Group (IWG) Criteria
Count of participants with a hematologic improvement (erythroid, platelet, or neutrophil response), assessed at 3 months.
Time frame: Up to 2 years
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Treatment (Chemotherapy, Chemoprotection) | Frequency of Hematologic Responses, as Defined by International Working Group (IWG) Criteria | Erythroid response | 14 Participants |
| Treatment (Chemotherapy, Chemoprotection) | Frequency of Hematologic Responses, as Defined by International Working Group (IWG) Criteria | Platelet response | 8 Participants |
| Treatment (Chemotherapy, Chemoprotection) | Frequency of Hematologic Responses, as Defined by International Working Group (IWG) Criteria | Neutrophil response | 1 Participants |
| Treatment (Chemotherapy, Chemoprotection) | Frequency of Hematologic Responses, as Defined by International Working Group (IWG) Criteria | No response | 7 Participants |
| Treatment (Chemotherapy, Chemoprotection) | Frequency of Hematologic Responses, as Defined by International Working Group (IWG) Criteria | Withdrawn from study | 2 Participants |