Myelodysplastic Syndrome
Conditions
Keywords
Myelodysplastic Syndrome, Dacogen, Oncology, Decitabine, Bone marrow disorders
Brief summary
The purpose of this study is to evaluate the effectiveness and safety of decitabine in the treatment of myelodysplastic syndrome (name of a group of conditions that occur when the blood-forming cells in the bone marrow are damaged) in Chinese patients.
Detailed description
This is a prospective (look forward using periodic observations collected predominantly following patient enrollment), open-label (all people involved in the study know the identity of the assigned drug), Phase IIIb study to evaluate the efficacy and safety of decitabine in the treatment of myelodysplastic syndrome (MDS). Patients are randomized (study drug assigned by chance) in 1:1 ratio to receive treatment with decitabine either 3-day or 5-day course of therapy. When a minimum of 30 patients are reached for 3-day course of therapy, the rest of the patients will all be enrolled into 5-day course of therapy. Each patient in the study treated for a minimum of 4 cycles; however, a complete or partial response may take longer than 4 cycles. The entire study duration for each patient will be approximately two years. Safety will be evaluated for each patient by monitoring of adverse events, physical examinations, vital signs measurements, electrocardiogram, hematology and clinical chemistry testing.
Interventions
DRUGDecitabine at 15 mg/m2
Decitabine will be given at a dose of 15 mg/m2 as a continuous intravenous infusion within a 3-hour intravenous infusion, repeated every 8 hours for 3 consecutive days.The total dose per day is 45 mg/m2; The total dose per course is 135 mg/m2. Cycles will be repeated every 6 weeks.
DRUGDecitabine at 20 mg/m2
Decitabine will be given at a dose of 20 mg/m2 as 1-hour IV infusion once daily on Days 1 through 5, of a 4-week treatment cycle.
Sponsors
Xian-Janssen Pharmaceutical Ltd.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Must have diagnosed with Myelodysplastic Syndrome (MDS) denovo (previously not present) or secondary as per the classification of French-American-British (FAB) and International Prognostic Scoring System (IPSS) greater than or eaul to 0.5 as determined by complete blood count (CBC), bone marrow assessment and bone marrow cytogenetics * Must have an Eastern Oncology Cooperative Group (ECOG) performance status of 0-2 * Must have adequate hepatic and renal function as measured by the aspartate transaminase (AST), alanine transaminase (ALT), total bilirubin and serum creatinine, respectively * Must have recovered from all toxic effects of prior therapy and not received any chemotherapy for a minimum of 4 weeks (6 weeks if the patient has been treated with a nitrosoureas) prior to the first dose of study drug - Woman must be postmenopausal, or surgically sterile, or abstinent, or, if sexually active, be practicing an effective method of birth control (eg, oral contraceptives, contraceptive injections, intrauterine device, double-barrier method, contraceptive patch, male partner sterilization)
Exclusion criteria
* Must not have a diagnosis of acute myeloid leukemia (greater than 30% bone marrow blasts) - Must not have received radiotherapy within 14 days before the first dose of study drug - Must not have any other prior cancer, other than superficial bladder cancer, basal cell skin and cervical cancer - Must not have associated autoimmune hemolytic anemia or immune thrombocytopenia and inaspirable bone marrow - Must not have a mental illness or any other condition (eg, uncontrolled cardiac or pulmonary disease, diabetes), that could prevent full cooperation with the study requirements.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate (ORR): Number of Participants Who Achieved Either Complete Remission (CR), Partial Remission (PR), or Marrow Complete Remission (mCR) - International Working Group (IWG) 2006 Response Criteria | From the date of first dose until 30 to 42 days after the last dose of the 2 years treatment period, or at time of discontinuation | IWG 2006 response criteria - CR: bone marrow evaluation shows less than or equal to (\<=) 5% blasts; normal maturation of all cells lines (mCR), peripheral blood evaluation shows hemoglobin \>= 11 gram per deciliter (g/dL), neutrophils \>= 1000/mL, platelets \>= 100,000/mL, 0% blasts; PR: Same as CR, except blasts decrease by \>=50%, still greater than 5% in bone marrow. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | From the date of first dose until 30 to 42 days after the last dose of the 2 years treatment period, or at time of discontinuation | As per IWG 2006 response criteria - Complete cytogenetic response: disappearance of the chromosomal abnormality without appearance of new ones; Partial cytogenetic response: At least 50% reduction of the chromosomal abnormality. Status of Clinical response - complete remission (CR); marrow CR (mCR); partial remission (PR). |
| Transfusion Independence: Number of Participants Who Were Transfusion Independent | Baseline; up to 2 years | A participant was considered to be transfusion independent, if the participant had no transfusions of Red Blood Cells (RBCs) or platelets for 8 consecutive weeks or more. |
| Hematological Improvement Rate: Number of Participants Who Achieved Complete Remission (CR), Partial Remission (PR) and Hematologic Improvement (HI) - International Working Group (IWG) 2006 Response Criteria | From the date of first dose until 30 to 42 days after the last dose of the 2 years treatment period, or at time of discontinuation | IWG 2006 response criteria - CR: bone marrow evaluation shows \<= 5% blasts; normal maturation of all cells lines (mCR), peripheral blood evaluation shows hemoglobin \>= 11 g/dL, neutrophils \>= 1000/mL, platelets \>= 100,000/mL, 0% blasts; PR: Same as CR, except blasts decrease by \>= 50%, still greater than 5% in bone marrow; HI: hemoglobin increase of \>= 1.5 g/dL, platelet increase of \>= 30,000/mL (starting with \> 20,000/mL), neutrophils increase of \>= 100% and \> 500/μL. |
| Overall Survival Rate: Percentage of Participants Who Survived During 6 Months and 12 Months of Treatment. | From the date of dosing until death or lost to follow-up for up to 2.5 years after last patient was enrolled | — |
| Mean Change From Baseline to End of Treatment in Scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ C-30) Physical Functioning Scale | Baseline to end of treatment (approximately up to 2 years) | EORTC QLQ-C30 is a questionnaire to assess quality of life of cancer patients. It is composed of 30 items, multi-item measure (28 items) and 2 single-item measures. For the multiple item measure, 4-point scale is used and the score for each item range from 1 = not at all to 4 = very much. Higher scores indicate worsening. The 2 single-item measure involves question about the overall health and overall quality of life which will be rated on a 7-point scale ranging from 1 = very poor to 7 = excellent. Lower scores indicate worsening. Scores are averaged, and transformed to 0-100 scale; higher score=better level of physical functioning. |
| Mean Percentage of Duration of Hospitalization (Relative to Days on Study Treatment) | Up to 2 years | Duration of hospitalization was calculated as, total number of days a participant stayed in hospital during study treatment divided by the study treatment duration |
Countries
China
Participant flow
Recruitment details
This study was conducted across 12 centers in China.
Participants by arm
| Arm | Count |
|---|---|
| 3-Day Posology Decitabine 15 milligram per meter\^2 (mg/m\^2) administered by continuous intravenous infusion over a 3-hour period, repeated every 8 hours for 3 consecutive days. Cycles repeated every 6 weeks. | 36 |
| 5-Day Posology Decitabine 20 mg/m\^2 administered by a 1-hour intravenous infusion once daily, on Days 1 through 5. Cycles repeated every 4 weeks. | 99 |
| Total | 135 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 8 | 15 |
| Overall Study | Completed treatment,dropped in follow-up | 4 | 8 |
| Overall Study | Death | 0 | 5 |
| Overall Study | Diease Progression | 4 | 18 |
| Overall Study | Other | 11 | 37 |
| Overall Study | Physician Decision | 4 | 7 |
| Overall Study | Poor Compliance | 0 | 5 |
| Overall Study | Protocol Violation | 0 | 2 |
| Overall Study | Randomized but not treated. | 2 | 1 |
| Overall Study | Withdrawal by Subject | 3 | 1 |
Baseline characteristics
| Characteristic | 3-Day Posology | 5-Day Posology | Total |
|---|---|---|---|
| Age, Continuous | 49.2 Years STANDARD_DEVIATION 16.04 | 51.6 Years STANDARD_DEVIATION 14.78 | 51.0 Years STANDARD_DEVIATION 15.11 |
| Age, Customized 18-60 Years (Y) (including 18 Y, excluding 60 Y) | 25 Participants | 69 Participants | 94 Participants |
| Age, Customized Greater than or equal to (>=) 60 Y | 11 Participants | 30 Participants | 41 Participants |
| Sex: Female, Male Female | 22 Participants | 34 Participants | 56 Participants |
| Sex: Female, Male Male | 14 Participants | 65 Participants | 79 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 33 / 34 | 97 / 98 |
| serious Total, serious adverse events | 8 / 34 | 26 / 98 |
Outcome results
Primary
Overall Response Rate (ORR): Number of Participants Who Achieved Either Complete Remission (CR), Partial Remission (PR), or Marrow Complete Remission (mCR) - International Working Group (IWG) 2006 Response Criteria
IWG 2006 response criteria - CR: bone marrow evaluation shows less than or equal to (\<=) 5% blasts; normal maturation of all cells lines (mCR), peripheral blood evaluation shows hemoglobin \>= 11 gram per deciliter (g/dL), neutrophils \>= 1000/mL, platelets \>= 100,000/mL, 0% blasts; PR: Same as CR, except blasts decrease by \>=50%, still greater than 5% in bone marrow.
Time frame: From the date of first dose until 30 to 42 days after the last dose of the 2 years treatment period, or at time of discontinuation
Population: Intent-to-treat (ITT) population: Participants who received at least one dose of study medication.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| 3-Day Posology | Overall Response Rate (ORR): Number of Participants Who Achieved Either Complete Remission (CR), Partial Remission (PR), or Marrow Complete Remission (mCR) - International Working Group (IWG) 2006 Response Criteria | 10 Participants |
| 5-Day Posology | Overall Response Rate (ORR): Number of Participants Who Achieved Either Complete Remission (CR), Partial Remission (PR), or Marrow Complete Remission (mCR) - International Working Group (IWG) 2006 Response Criteria | 25 Participants |
Comparison: Null Hypothesis: threshold for statistical significance = 10%p-value: 0.00395% CI: [15.1, 47.5]Exact binomial proportion test
Comparison: Null Hypothesis: threshold for statistical significance = 10%p-value: <0.00195% CI: [17.2, 35.3]Exact binomial proportion test
Secondary
Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria
As per IWG 2006 response criteria - Complete cytogenetic response: disappearance of the chromosomal abnormality without appearance of new ones; Partial cytogenetic response: At least 50% reduction of the chromosomal abnormality. Status of Clinical response - complete remission (CR); marrow CR (mCR); partial remission (PR).
Time frame: From the date of first dose until 30 to 42 days after the last dose of the 2 years treatment period, or at time of discontinuation
Population: Participants who had baseline cytogenetic abnormality and had at least one post baseline cytogenetic assessments during study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 3-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | mCR (n=1, 10) | 100.0 Percentage of Participants |
| 3-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | Overall (n=6, 24) | 66.7 Percentage of Participants |
| 3-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | CR+mCR+PR (n=3, 13) | 100.0 Percentage of Participants |
| 3-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | CR (n=2, 3) | 100.0 Percentage of Participants |
| 5-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | CR (n=2, 3) | 66.7 Percentage of Participants |
| 5-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | mCR (n=1, 10) | 90.0 Percentage of Participants |
| 5-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | CR+mCR+PR (n=3, 13) | 84.6 Percentage of Participants |
| 5-Day Posology | Cytogenetic Response Rate: Percentage of Participants Who Achieved Cytogenetic Response (Complete+Partial) by Status of Clinical Overall Response - International Working Group (IWG) 2006 Response Criteria | Overall (n=6, 24) | 66.7 Percentage of Participants |
Secondary
Hematological Improvement Rate: Number of Participants Who Achieved Complete Remission (CR), Partial Remission (PR) and Hematologic Improvement (HI) - International Working Group (IWG) 2006 Response Criteria
IWG 2006 response criteria - CR: bone marrow evaluation shows \<= 5% blasts; normal maturation of all cells lines (mCR), peripheral blood evaluation shows hemoglobin \>= 11 g/dL, neutrophils \>= 1000/mL, platelets \>= 100,000/mL, 0% blasts; PR: Same as CR, except blasts decrease by \>= 50%, still greater than 5% in bone marrow; HI: hemoglobin increase of \>= 1.5 g/dL, platelet increase of \>= 30,000/mL (starting with \> 20,000/mL), neutrophils increase of \>= 100% and \> 500/μL.
Time frame: From the date of first dose until 30 to 42 days after the last dose of the 2 years treatment period, or at time of discontinuation
Population: Intent-to-treat (ITT) population- Participants who received at least one dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| 3-Day Posology | Hematological Improvement Rate: Number of Participants Who Achieved Complete Remission (CR), Partial Remission (PR) and Hematologic Improvement (HI) - International Working Group (IWG) 2006 Response Criteria | 16 Participants |
| 5-Day Posology | Hematological Improvement Rate: Number of Participants Who Achieved Complete Remission (CR), Partial Remission (PR) and Hematologic Improvement (HI) - International Working Group (IWG) 2006 Response Criteria | 47 Participants |
Secondary
Mean Change From Baseline to End of Treatment in Scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ C-30) Physical Functioning Scale
EORTC QLQ-C30 is a questionnaire to assess quality of life of cancer patients. It is composed of 30 items, multi-item measure (28 items) and 2 single-item measures. For the multiple item measure, 4-point scale is used and the score for each item range from 1 = not at all to 4 = very much. Higher scores indicate worsening. The 2 single-item measure involves question about the overall health and overall quality of life which will be rated on a 7-point scale ranging from 1 = very poor to 7 = excellent. Lower scores indicate worsening. Scores are averaged, and transformed to 0-100 scale; higher score=better level of physical functioning.
Time frame: Baseline to end of treatment (approximately up to 2 years)
Population: Intent-to-treat (ITT) population- Participants who received at least one dose of study drug. The missing data was imputed by the Last Observation Carried Forward (LOCF).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 3-Day Posology | Mean Change From Baseline to End of Treatment in Scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ C-30) Physical Functioning Scale | -5.5 Scores on a scale | Standard Deviation 29.48 |
| 5-Day Posology | Mean Change From Baseline to End of Treatment in Scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ C-30) Physical Functioning Scale | -9.1 Scores on a scale | Standard Deviation 26.34 |
Secondary
Mean Percentage of Duration of Hospitalization (Relative to Days on Study Treatment)
Duration of hospitalization was calculated as, total number of days a participant stayed in hospital during study treatment divided by the study treatment duration
Time frame: Up to 2 years
Population: Intent-to-treat (ITT) population: Participants who received at least one dose of study drug.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 3-Day Posology | Mean Percentage of Duration of Hospitalization (Relative to Days on Study Treatment) | 59.6 Percentage of total days | Standard Deviation 34.2 |
| 5-Day Posology | Mean Percentage of Duration of Hospitalization (Relative to Days on Study Treatment) | 59.2 Percentage of total days | Standard Deviation 34.17 |
Secondary
Overall Survival Rate: Percentage of Participants Who Survived During 6 Months and 12 Months of Treatment.
Time frame: From the date of dosing until death or lost to follow-up for up to 2.5 years after last patient was enrolled
Population: Intent-to-treat (ITT) population- Participants who received at least one dose of study drug.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 3-Day Posology | Overall Survival Rate: Percentage of Participants Who Survived During 6 Months and 12 Months of Treatment. | 6-month survival rate | 91.1 Percentage of participants |
| 3-Day Posology | Overall Survival Rate: Percentage of Participants Who Survived During 6 Months and 12 Months of Treatment. | 12-month survival rate | 75.9 Percentage of participants |
| 5-Day Posology | Overall Survival Rate: Percentage of Participants Who Survived During 6 Months and 12 Months of Treatment. | 6-month survival rate | 84.7 Percentage of participants |
| 5-Day Posology | Overall Survival Rate: Percentage of Participants Who Survived During 6 Months and 12 Months of Treatment. | 12-month survival rate | 65.9 Percentage of participants |
Secondary
Transfusion Independence: Number of Participants Who Were Transfusion Independent
A participant was considered to be transfusion independent, if the participant had no transfusions of Red Blood Cells (RBCs) or platelets for 8 consecutive weeks or more.
Time frame: Baseline; up to 2 years
Population: Intent-to-treat (ITT) population: Participants who received at least one dose of study drug. Here, 'n' is the number of participants analyzed at specified time point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 3-Day Posology | Transfusion Independence: Number of Participants Who Were Transfusion Independent | Treatment Phase (n=34, 97) | 18 Participants |
| 3-Day Posology | Transfusion Independence: Number of Participants Who Were Transfusion Independent | Baseline (Before First Dose) (n=34, 98) | 7 Participants |
| 5-Day Posology | Transfusion Independence: Number of Participants Who Were Transfusion Independent | Baseline (Before First Dose) (n=34, 98) | 37 Participants |
| 5-Day Posology | Transfusion Independence: Number of Participants Who Were Transfusion Independent | Treatment Phase (n=34, 97) | 47 Participants |