Acute Myeloid Leukemia
Conditions
Keywords
AML
Brief summary
The purpose of the study is to determine the maximum tolerated dose of ribavirin, when given in combination with low-dose ara-C and to determine if it is safe and well-tolerated in patients with acute myeloid leukemia.
Detailed description
Primary Objectives In the Phase I portion of this study, we will determine the maximum tolerated dose and recommended phase II dose (RP2D) of ribavirin and low-dose ara-C. The primary objective of the Phase II portion of the study is to determine the overall response rate, including the complete remission (CR), complete remission with incomplete blood count recovery (CRi), partial remission (PR) or blast response (BR), to therapy with ribavirin and low dose ara-C at the RP2D. STUDY DESIGN AND DURATION This is a multicentre, open-label, single arm Phase I/II study of oral ribavirin and low-dose ara-C for patients with AML M4/M5 or AML with high expression of eIF4E, who have relapsed or refractory disease, or who are not suitable candidates for induction chemotherapy. This study will determine the recommended phase II dose and will evaluate efficacy. Correlative studies will be included to assess relevant molecular targets.
Interventions
DRUGRibavirin
Dose level 1 = 1000 mg po BID/ Dose level 2 = 1400 mg po BID/ Dose level 3 = 1800 mg po BID
DRUGCytarabine arabinoside
Previous cohorts at 20 mg bid days 1 to 10 of every 28 day cycle. Dosage modified to 10 mg bid days 1 to 10 of every 28 day cycle for more recent cohorts.
Sponsors
The Leukemia and Lymphoma Society
Jewish General Hospital
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
* The following patients with acute myeloid leukemia (AML) are eligible: * De novo AML M4 or M5 FAB subtype or high eIF4E. * Secondary AML after a myelodysplastic syndrome (MDS) or a myeloproliferative disorder (not chronic myelogenous leukemia), if M4 or M5 FAB subtype or high eIF4E. * Therapy-related AML if M4 or M5 FAB subtype or high eIF4E. * CML blast crisis if they have failed imatinib and at least one other tyrosine kinase inhibitor. * All patients must have failed primary therapy (defined as two induction chemotherapies), have relapsed, or are not suitable candidates for intensive induction chemotherapy. * Patients who have a dry aspirate or extramedullary disease only are eligible for this study if they have a pre-treatment marrow or tissue biopsy demonstrating AML M4 or M5 subtype or high eIF4E expression. * ECOG performance status 0, 1, 2 or 3. * Life expectancy \> 4 weeks. * Age is \> 18 years. * Female patients of childbearing potential must have a negative serum (beta-HCG) pregnancy test within 14 days of starting protocol and must not be breastfeeding. Men and women of childbearing potential must agree to use an effective means of contraception throughout the study and for at least 30 days after completion of protocol. * Adequate renal and hepatic function: serum creatinine \< 1.5 x ULN; AST or ALT \< 2.5 x ULN (or \< 5 x ULN if liver involvement with leukemia); serum bilirubin \< 1.5 x ULN. * Provide written consent after the investigational nature, study design, risks and benefits of the study have been explained. * Accessible for treatment and follow up.
Exclusion criteria
* Uncontrolled central nervous system involvement by AML. * Active cardiovascular disease as defined by New York Heart Association (NYHA) class III-IV categorization. * Intercurrent illness or medical condition precluding safe administration of the planned protocol treatment or required follow-up. * Received any previous therapy for AML within 28 days prior to the study entry. Hydrea is permitted for the treatment of leukocytosis but must be stopped within 7 days of starting low dose ara-C and ribavirin. * Female patients who are pregnant or breastfeeding. * Concurrent treatment with other anti-cancer therapy. * Known infection with HIV. * History of other malignancy. Subjects who have been disease-free for 2 year or subjects with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible. * FAB AML M1, 2, 6, 7 will be excluded if they do not have high eIF4E expression. AML M3 is always excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recommended Phase II Dose (RP2D) of Ribavirin When Given in Combination With Low-dose Ara-C | 56 days | This 3+3 designed aimed to determine recommended phase II dose (RP2D) based on pharmacokinetics (PK) and maximum tolerated dose (MTD). For the dose to be selected, a target steady state level of ribavirin 20 uM was needed for all patients and no more than 1 of 6 patients could have had dose limiting toxicity at that dose. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate | 2-3 years | Overall response rate comprises complete response (\<5% blasts in the bone marrow, and in the peripheral blood Hgb more than or equal to 100 g/L, platelets more than or equal to 100x10-9/L, and neutrophils more than or equal to 1x10-9/L), partial response (5 to 25% blasts in the bone marrow and same peripheral blood parameters) and blast response (a greater than 50% decrease in bone marrow blast count and 2 log reduction in peripheral blood blast count, sustained for at least 28 days). |
| Complete Response Rate | 2-3 years | Defined as \<5% blasts in the bone marrow and a hgb 100 g/L, platelets 100,000/uL, neutrophils 1000/uL. |
| Partial Response | 2-3 years | Partial response was defined as 5 to 25% blasts in the bone marrow and Hgb \>100g/L, platelets \>100,000/ul and neutrophils \>1000/ul. |
| Blast Response | 2-3 years | Blast response was defined as a greater than 50% decrease in bone marrow blast count and 2 log reduction in peripheral blood blast count, sustained for at least 28 days. |
Countries
Canada
Participant flow
Recruitment details
Patients were enrolled in this dose escalation study according to a 3+3 design. Patients not completing 28 days of therapy were replaced as they were not evaluable for the pharmacokinetic endpoint of steady state level of ribavirin.
Participants by arm
| Arm | Count |
|---|---|
| Ribavirin and Cytarabine Dose level 1 = 1000 mg po BID/ Dose level 2 = 1400 mg po BID/ Dose level 3 = 1800 mg po BID Drug: Cytarabine arabinoside Previous cohorts at 20 mg bid days 1 to 10 of every 28 day cycle. Dosage modified to 10 mg bid days 1 to 10 of every 28 day cycle for more recent cohorts. | 29 |
| Total | 29 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 | FG006 |
|---|---|---|---|---|---|---|---|---|
| Overall Study | Death | 1 | 0 | 2 | 3 | 0 | 0 | 1 |
Baseline characteristics
| Characteristic | Ribavirin and Cytarabine |
|---|---|
| Age, Continuous | 65 years |
| FAB subtype FAB sutype M4/M5 | 22 Participants |
| FAB subtype Other FAB subtypes | 7 Participants |
| Sex: Female, Male Female | 14 Participants |
| Sex: Female, Male Male | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 29 / 29 |
| serious Total, serious adverse events | 7 / 29 |
Outcome results
Primary
Recommended Phase II Dose (RP2D) of Ribavirin When Given in Combination With Low-dose Ara-C
This 3+3 designed aimed to determine recommended phase II dose (RP2D) based on pharmacokinetics (PK) and maximum tolerated dose (MTD). For the dose to be selected, a target steady state level of ribavirin 20 uM was needed for all patients and no more than 1 of 6 patients could have had dose limiting toxicity at that dose.
Time frame: 56 days
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Ribavirin-Cytarabine | Recommended Phase II Dose (RP2D) of Ribavirin When Given in Combination With Low-dose Ara-C | Ribavirin po bid for 28 days | 1400 mg |
| Ribavirin-Cytarabine | Recommended Phase II Dose (RP2D) of Ribavirin When Given in Combination With Low-dose Ara-C | cytarabine arabinoside sc bid for 10 days | 10 mg |
Secondary
Blast Response
Blast response was defined as a greater than 50% decrease in bone marrow blast count and 2 log reduction in peripheral blood blast count, sustained for at least 28 days.
Time frame: 2-3 years
Population: Only patients treated for 28 days or more were evaluable for response.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ribavirin-Cytarabine | Blast Response | 2 Participants |
Secondary
Complete Response Rate
Defined as \<5% blasts in the bone marrow and a hgb 100 g/L, platelets 100,000/uL, neutrophils 1000/uL.
Time frame: 2-3 years
Population: Only patients treated for at least 28 days were evaluable for response.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ribavirin-Cytarabine | Complete Response Rate | 2 Participants |
Secondary
Overall Response Rate
Overall response rate comprises complete response (\<5% blasts in the bone marrow, and in the peripheral blood Hgb more than or equal to 100 g/L, platelets more than or equal to 100x10-9/L, and neutrophils more than or equal to 1x10-9/L), partial response (5 to 25% blasts in the bone marrow and same peripheral blood parameters) and blast response (a greater than 50% decrease in bone marrow blast count and 2 log reduction in peripheral blood blast count, sustained for at least 28 days).
Time frame: 2-3 years
Population: Only patients treated for 28 days or more were evaluable for response.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ribavirin-Cytarabine | Overall Response Rate | 5 Participants |
Secondary
Partial Response
Partial response was defined as 5 to 25% blasts in the bone marrow and Hgb \>100g/L, platelets \>100,000/ul and neutrophils \>1000/ul.
Time frame: 2-3 years
Population: Only patients treated for 28 days or more were assessed for response.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ribavirin-Cytarabine | Partial Response | 1 Participants |