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Study of Vosaroxin or Placebo in Combination With Cytarabine in Patients With First Relapsed or Refractory AML

A Phase 3, Randomized, Controlled, Double-Blind, Multinational Clinical Study of the Efficacy and Safety of Vosaroxin and Cytarabine Versus Placebo and Cytarabine in Patients With First Relapsed or Refractory Acute Myeloid Leukemia (VALOR)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01191801
Acronym
VALOR
Enrollment
711
Registered
2010-08-31
Start date
2010-12-17
Completion date
2017-03-01
Last updated
2018-08-22

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Acute Myeloid Leukemia

Keywords

Leukemia, Acute Myeloid Leukemia, Hematologic, Hematologic diseases, Blood, Cancer, Malignancy, Vosaroxin, Cytarabine, First Relapsed AML, Refractory AML, VALOR, Sunesis, Voreloxin, SNS-595

Brief summary

This study compared treatment groups of patients treated with vosaroxin and cytarabine versus patients treated with placebo and cytarabine.

Detailed description

The study includes additional objectives to ones listed above as Outcome Measures. These additional objectives also compared treatment groups in the following: CR + CRp rate, defined as CR + CRp based on modified IWG response criteria. Combined CR rate (CR+CRp+CRi). Percentage of patients who have post-treatment (subsequent) transplantation. Percentage of patients who received subsequent non-protocol therapy (including transplantation). Safety and tolerability. In keeping with FDA guidance for adaptive trial designs, the study incorporated an independent DSMB (Drug Safety Monitoring Board) to address potential uncertainty concerning the true treatment affect between the treatment groups and to address a deterioration of power from a small difference. Sunesis remained blinded and had no involvement in the interim data analysis, interpretation, or adaptive design. Based on the results of the interim data analysis the DSMB recommended an increase in the target number of deaths from 375 in 450 patients to 562 in 675 patients which based on a 5% dropout rate increased enrollment from 475 to 712. The primary analysis was performed when the target number of deaths had been achieved based on a permuted block randomization procedure, stratified by disease status (refractory, first relapse with duration of first CR or CRp ≥ 90 days and \< 12 months, or first relapse with duration of first CR or CRp ≥ 12 months and ≤ 24 months), age (\< 60 years or ≥ 60 years), and geographic location (US or outside US). The study included periods of screening, treatment / hematologic recovery, post-treatment follow-up, and long-term follow-up for survival. Follow-up was monthly during the first year, every 2 months during the second year, and every 3 months thereafter until death, withdrawal of consent, or loss to follow-up, whichever occurred first. Long-term follow-up began for all patients when the required number of deaths for primary analysis had been met; thereafter, survival data were collected every 4 months until death, withdrawal of consent, or loss to follow-up, whichever occurred first. The long term follow-up for this study continues at this time and the September 2014 date reflects database lock for primary analyses reflected in the Results Section. During long term follow-up Sunesis is not collecting Adverse Events.

Interventions

DRUGvosaroxin + cytarabine

Vosaroxin days 1 and 4: 90 mg/m2 for induction 1; 70 mg/m2 for all other cycles Cytarabine 1 g/m2 daily on days 1-5 (IDAC)

DRUGplacebo + cytarabine

Placebo days 1 and 4: volume matched to vosaroxin Cytarabine 1 g/m2 daily on days 1-5 (IDAC)

Sponsors

Sunesis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Provided signed, written informed consent * At least 18 years of age * Had a diagnosis of AML according to World Health Organization (WHO) classification * First relapsed or refractory AML (refractory to initial induction therapy) with at least 5% blasts by bone marrow or aspirate or 1% blasts in peripheral blood with additional requirements for relapsed or refractory * Had an ECOG score of 0-2 * Had adequate liver and renal function as indicated by certain laboratory values * Had adequate cardiac function (left ventricular ejection fraction at least 40% by multiple gated acquisition scan or ECG) * Nonfertile or agreed to use an adequate method of contraception until 30 days after the last treatment * Had any clinically significant nonhematologic toxicity after prior chemotherapy recovered to Grade 1 per NCI-CTCAE

Exclusion criteria

* Had acute promyelocytic leukemia * Had more than 2 cycles of induction therapy for AML * Had completed a single cycle of treatment containing a total dose of 5 g/m2 or more of cytarabine within 90 days before randomization * Refractory to or relapsed within the previous 3 months after therapy with an IDAC- or HIDAC-containing regimen * Had received a hematopoietic stem cell transplant (HSCT) within the previous 90 days * Had received active immunosuppressive therapy for graft-versus-host disease (GVHD) within 2 weeks before study start * Had any other severe concurrent disease, or have a history of serious disease involving the heart, kidney, liver, or other organ system * Had evidence of central nervous system involvement of active AML * Had other active malignancies (including other hematologic malignancies) or been diagnosed with other malignancies within the last 12 months, except nonmelanoma skin cancer or cervical intraepithelial neoplasia * Had an active, uncontrolled infection * Had received any other investigational therapy within 14 days or not recovered from acute affects of the other investigational therapy * Had received prior or current hydroxyurea or medications to reduce blast count within 24 hours before randomization * Had received previous treatment with vosaroxin * Pregnant or lactating * Had any other medical, psychological, or social condition that may interfere with consent, study participation, or follow-up * Had known HIV seropositivity

Design outcomes

Primary

MeasureTime frameDescription
Overall SurvivalUp to 5 years or duration of studyVosaroxin + cytarabine patient survival versus placebo + cytarabine patient survival

Secondary

MeasureTime frameDescription
Complete Remission (CR) Rate Based on Modified International Working Group (IWG) Criteria.Up to 5 years or duration of studyGroup A (Vosaroxin + cytarabine) patient CR as compared to Group B (placebo + cytarabine) patient CR. Complete remission (CR) is typically defined using IWG criteria as bone marrow blast count of less than 5% with adequate recovery of peripheral blood counts.
All Cause Mortality30 DaysVosaroxin + cytarabine mortality versus placebo + cytarabine mortality

Other

MeasureTime frameDescription
Event Free Survival (EFS)Up to 5 years or duration of study
Overall Remission (OR) Rate Based on the IWG Response CriteriaUp to 5 years or the duration of the studyGroup A patient OR compared to Group B patient OR Overall Remission includes Complete Remission (CR), Complete Remission with incomplete platelet recovery (CRp), Complete Remission with incomplete blood count recovery (CRi), and Partial Remission (PR). Complete remission means bone marrow blast count of less than 5% with adequate recovery of peripheral blood counts as typically defined by the IWG. Both CRi and CRp refer complete remission but with incomplete blood count and platelet recovery, respectively. PR, or partial remission, refers to remission in which bone marrow contains blast counts between 5 and 25 percent.
Leukemia-Free Survival (LFS)Up to 5 years or the duration of the studyDurability of remission (CR) assessed by LFS

Countries

Australia, Austria, Belgium, Canada, Czechia, France, Germany, Hungary, Italy, New Zealand, Poland, South Korea, Spain, United Kingdom, United States

Participant flow

Recruitment details

320 patients enrolled in 30 US sites:391 patients enrolled at 71 sites outside of the US (Canada, Europe, Australia, New Zealand, and Republic of Korea)

Pre-assignment details

Six patients were randomized but never received treatment due to death prior to beginning treatment: 4 assigned to receive vosaroxin/cytarabine; 2 assigned to receive placebo/cytarabine.

Participants by arm

ArmCount
Group A (Vosaroxin/Cytarabine)
Vosaroxin on Days 1 and 4 (90 mg/m2 induction 1; 70 mg/m2 all other cycles); cytarabine 1 g/m2 daily on Days 1 through 5
356
Group B (Placebo/Cytarabine)
Placebo (volume matched to vosaroxin) on Days 1 and 4; cytarabine 1 g/m2 daily on Days 1 through 5
355
Total711

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event98
Overall StudyDeath3612
Overall StudyLack of Efficacy176258
Overall StudyNot Provided4527
Overall StudyPhysician Decision4724
Overall StudyProtocol Violation24
Overall StudyWithdrawal by Subject14

Baseline characteristics

CharacteristicGroup A (Vosaroxin/Cytarabine)Group B (Placebo/Cytarabine)Total
Age, Continuous61 years
STANDARD_DEVIATION 11.51
60.2 years
STANDARD_DEVIATION 12.49
60.6 years
STANDARD_DEVIATION 12.01
Region of Enrollment
Australia
25 participants20 participants45 participants
Region of Enrollment
Austria
4 participants4 participants8 participants
Region of Enrollment
Belgium
17 participants19 participants36 participants
Region of Enrollment
Canada
10 participants10 participants20 participants
Region of Enrollment
Czech Republic
5 participants6 participants11 participants
Region of Enrollment
France
38 participants50 participants88 participants
Region of Enrollment
Germany
27 participants31 participants58 participants
Region of Enrollment
Hungary
8 participants11 participants19 participants
Region of Enrollment
Italy
20 participants18 participants38 participants
Region of Enrollment
Korea, Republic of
10 participants5 participants15 participants
Region of Enrollment
New Zealand
4 participants3 participants7 participants
Region of Enrollment
Poland
3 participants1 participants4 participants
Region of Enrollment
Spain
9 participants8 participants17 participants
Region of Enrollment
United Kingdom
15 participants10 participants25 participants
Region of Enrollment
United States
161 participants159 participants320 participants
Sex: Female, Male
Female
154 Participants163 Participants317 Participants
Sex: Female, Male
Male
202 Participants192 Participants394 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
273 / 355288 / 350
other
Total, other adverse events
354 / 355349 / 350
serious
Total, serious adverse events
197 / 355125 / 350

Outcome results

Primary

Overall Survival

Vosaroxin + cytarabine patient survival versus placebo + cytarabine patient survival

Time frame: Up to 5 years or duration of study

Population: The intent-to-treat (ITT) population which consists of all patients enrolled (randomly assigned to treatment group).

ArmMeasureValue (MEDIAN)
Group A (Vosaroxin/Cytarabine)Overall Survival7.5 Months
Group B (Placebo/Cytarabine)Overall Survival6.1 Months
p-value: 0.0305Unstratified Log Rank
Secondary

All Cause Mortality

Vosaroxin + cytarabine mortality versus placebo + cytarabine mortality

Time frame: 30 Days

Population: Safety Population (705)

ArmMeasureValue (NUMBER)
Group A (Vosaroxin/Cytarabine)All Cause Mortality7.9 percentage of Participants in the Group
Group B (Placebo/Cytarabine)All Cause Mortality6.6 percentage of Participants in the Group
Secondary

All Cause Mortality

Vosaroxin + cytarabine mortality versus placebo + cytarabine mortality

Time frame: 60 Days

Population: Safety Population (705)

ArmMeasureValue (NUMBER)
Group A (Vosaroxin/Cytarabine)All Cause Mortality19.7 percentage of Participants
Group B (Placebo/Cytarabine)All Cause Mortality19.4 percentage of Participants
Secondary

Complete Remission (CR) Rate Based on Modified International Working Group (IWG) Criteria.

Group A (Vosaroxin + cytarabine) patient CR as compared to Group B (placebo + cytarabine) patient CR. Complete remission (CR) is typically defined using IWG criteria as bone marrow blast count of less than 5% with adequate recovery of peripheral blood counts.

Time frame: Up to 5 years or duration of study

Population: The percentage of patients who achieved CR was adjudicated by the CPARR (Central Pathology and Response Review) panel using modified IWG response criteria. The outcome measure reflects the Intent to Treat Population.

ArmMeasureValue (NUMBER)
Group A (Vosaroxin/Cytarabine)Complete Remission (CR) Rate Based on Modified International Working Group (IWG) Criteria.30.1 percentage of particpants
Group B (Placebo/Cytarabine)Complete Remission (CR) Rate Based on Modified International Working Group (IWG) Criteria.16.3 percentage of particpants
p-value: <0.0001Chi-squared
Other Pre-specified

Event Free Survival (EFS)

Time frame: Up to 5 years or duration of study

Population: Intent to Treat Population

ArmMeasureValue (MEDIAN)
Group A (Vosaroxin/Cytarabine)Event Free Survival (EFS)1.9 months
Group B (Placebo/Cytarabine)Event Free Survival (EFS)1.3 months
p-value: <0.0001Log Rank
Other Pre-specified

Leukemia-Free Survival (LFS)

Durability of remission (CR) assessed by LFS

Time frame: Up to 5 years or the duration of the study

Population: Subset of Intent to Treat patients that have a Measured CR

ArmMeasureValue (MEDIAN)
Group A (Vosaroxin/Cytarabine)Leukemia-Free Survival (LFS)11 Months
Group B (Placebo/Cytarabine)Leukemia-Free Survival (LFS)8.7 Months
p-value: 0.3134Log Rank
Other Pre-specified

Overall Remission (OR) Rate Based on the IWG Response Criteria

Group A patient OR compared to Group B patient OR Overall Remission includes Complete Remission (CR), Complete Remission with incomplete platelet recovery (CRp), Complete Remission with incomplete blood count recovery (CRi), and Partial Remission (PR). Complete remission means bone marrow blast count of less than 5% with adequate recovery of peripheral blood counts as typically defined by the IWG. Both CRi and CRp refer complete remission but with incomplete blood count and platelet recovery, respectively. PR, or partial remission, refers to remission in which bone marrow contains blast counts between 5 and 25 percent.

Time frame: Up to 5 years or the duration of the study

Population: Intent to Treat Population

ArmMeasureValue (NUMBER)
Group A (Vosaroxin/Cytarabine)Overall Remission (OR) Rate Based on the IWG Response Criteria37.9 percentage of participants
Group B (Placebo/Cytarabine)Overall Remission (OR) Rate Based on the IWG Response Criteria18.9 percentage of participants
p-value: <0.0001Chi-squared

Source: ClinicalTrials.gov · Data processed: Mar 15, 2026