Acute Biphenotypic Leukemia, Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome, Recurrent Acute Myeloid Leukemia, Refractory Acute Myeloid Leukemia
Conditions
Brief summary
This phase II trial studies the side effects lirilumab and azacitidine and to see how well they work in treating patients with acute myeloid leukemia that has not responded to treatment or has returned after a period of improvement. Monoclonal antibodies, such as lirilumab, may interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as azacitidine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving lirilumab with azacitidine may be an effective treatment for relapsed or refractory acute myeloid leukemia.
Detailed description
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) and dose limiting toxicity (DLT) of lirilumab in combination with 5-azacytidine (azacitidine) in patients with refractory/relapsed acute myeloid leukemia (AML). (Part A, Lead-In Phase) II. To determine the overall response rate (ORR) of lirilumab in combination with 5-azacytidine in patients with refractory/relapsed AML. (Part B, Phase II) SECONDARY OBJECTIVES: I. To determine the duration of response, disease-free survival (DFS), and overall survival (OS) of patients with refractory/relapsed AML treated with this combination. II. To determine the safety of lirilumab in combination with 5-azacytidine in patients with refractory/relapsed AML. OUTLINE: Patients receive azacitidine subcutaneously (SC) or intravenously (IV) over 1 hour as determined by the treating physician on days 1-7 and lirilumab IV over 60 minutes on day 8. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 days and up to 90 days.
Interventions
DRUGAzacitidine
Given SC or IV
BIOLOGICALLirilumab
Given IV
Sponsors
National Cancer Institute (NCI)
M.D. Anderson Cancer Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Phase IB, lead-in/II to determine MTD
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with AML or biphenotypic or bilineage leukemia who have failed at least one prior therapy; patients with AML should have failed prior therapy or have relapsed after prior therapy * Patients should not be eligible or able to receive approved therapy of confirmed clinical benefit in this patient population * Patients with myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML) who received therapy for the MDS or CMML and progress to AML are eligible at the time of diagnosis of AML regardless any prior therapy for AML; the World Health Organization (WHO) classification will be used for AML * Prior therapy with hydroxyurea, chemotherapy, biological or targeted therapy (e.g. FLT3 inhibitors, other kinase inhibitors), or hematopoietic growth factors is allowed * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 * Total bilirubin =\< 2 times upper limit of normal (x ULN) (=\< 3 x ULN if considered to be due to leukemic involvement or Gilbert's syndrome) * Aspartate aminotransferase or alanine aminotransferase =\< 2.5 x ULN (=\< 5.0 x ULN if considered to be due to leukemic involvement) * Serum creatinine =\< 2 x ULN or glomerular filtration rate (GFR) \>= 50 * Patients must provide written informed consent * In the absence of rapidly progressing disease, the interval from prior treatment to time of initiation of 5-azacytidine and lirilumab will be at least 2 weeks OR at least 5 half-lives for cytotoxic/noncytotoxic agents; use of one dose of cytarabine (up to 2 g/m\^2) is allowed prior to the start of study therapy or hydroxyurea for patients with rapidly proliferative disease is allowed before the start of study therapy and while the patient is on active study treatment, as needed, for clinical benefit and after discussion with the principal investigator (PI); concurrent therapy for central nervous system (CNS) prophylaxis or continuation of therapy for controlled CNS disease is permitted * Females must be surgically or biologically sterile or postmenopausal (amenorrheic for at least 12 months) or if of childbearing potential, must have a negative serum or urine pregnancy test within 72 hours before the start of the treatment * Women of childbearing potential must agree to use an adequate method of contraception during the study and until 30 days after the last treatment; males must be surgically or biologically sterile or agree to use an adequate method of contraception during the study until 30 days after the last treatment; women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks ago; in the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential
Exclusion criteria
* Patients with known allergy or hypersensitivity to lirilumab, 5-azacytidine, or any of their components; patients who have previously been treated with lirilumab in combination with 5-azacytidine will be excluded * Patients with a known history of severe interstitial lung disease or severe pneumonitis or active pneumonitis that is uncontrolled in the opinion of the treating physician * Patients with a known history of any of the following autoimmune diseases are excluded: (a) patients with a history of inflammatory bowel disease (including Crohn's disease and ulcerative colitis) (b) patients with a history of rheumatoid arthritis, systemic progressive sclerosis \[scleroderma\], systemic lupus erythematosus, autoimmune vasculitis \[e.g., Wegener's granulomatosis\]) * Patients with organ allografts (such as renal transplant) are excluded * Patients with allogeneic stem cell transplantation within the last 6 months or patients with active graft-versus-host disease (GVHD) will be excluded * Ongoing immunosuppressive therapy, including cyclosporine and tacrolimus; patients who are on high dose steroid; Note: Subjects may be using systemic corticosteroids (daily doses =\< 10 mg of prednisone or equivalent) or topical or inhaled corticosteroids * Patients with symptomatic CNS leukemia or patients with poorly controlled CNS leukemia * Active and uncontrolled disease/(active uncontrolled infection, uncontrolled hypertension despite adequate medical therapy, active and uncontrolled congestive heart failure New York Heart Association \[NYHA\] class III/IV, clinically significant and uncontrolled arrhythmia) as judged by the treating physician * Patients with active and uncontrolled human immunodeficiency virus (HIV) infection will be excluded; however, patients with well controlled HIV infection will be considered * Patients known to be positive for hepatitis B by surface antigen expression; known to have active hepatitis C infection (positive by polymerase chain reaction or on antiviral therapy for hepatitis C within the last 6 months) * Any other medical, psychological, or social condition that may interfere with study participation or compliance, or compromise patient safety in the opinion of the investigator * Patients unwilling or unable to comply with the protocol * Pregnant or breastfeeding * Acute promyelocytic leukemia (APL)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum Tolerated Dose of Iirilumab in Combination With 5-azacitidine | Up to 28 days | To identify the dose at which \<2/6 participants experience Dose Limiting Toxicities (DLT). The dose level at which 0-1/6 participants experience a DLT in the first 28 days of treatment will be the maximum tolerated dose (MTD) and would be used to treat an additional 34 participants in the phase II potion of the study. (Part A, Lead-In Phase) |
| Participants With an Objective Response | Up to 3 months | Objective Response Rate (ORR) will be monitored using the Bayesian approach of Thall, Simon, Estey and the extension by Thall and Sung. Overall response rate (ORR), defined as complete remission (CR) + CR with incomplete platelet recovery (CRp) + CR with incomplete count recovery (CRi) + partial response (PR) + marrow clearance of blasts + hematological improvement within 3 months of treatment initiation among adult patients with refractory/relapsed Acute Myelogenous Leukemia (AML) (Phase II) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response | Up to 2.5 years | The date of Objective Response to the date of loss of response or last follow-up. |
| Overall Survival | Up to 2 years | Overall Survival (OS) is defined: Time of presentation to date of death or censored at last follow-up date. |
| Disease Free Survival | Up to 2.5 years | Disease Free Survival (DFS) is defined: Time from date of treatment start until the date of first objective documentation of disease-relapse |
Countries
United States
Participant flow
Recruitment details
Recruitment Period: May 2015 - June 2017
Participants by arm
| Arm | Count |
|---|---|
| Phase 1b Lead-in Cohort 1 Patients receive azacitidine SC or IV over 1 hour as determined by the treating physician on days 1-7 and lirilumab IV over 60 minutes on day 8. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
5-Azacitidine 75mg/m\^2 Lirilumab 1.0 mg/kg
Azacitidine: Given SC or IV
Lirilumab: Given IV | 6 |
| Phase 1b Lead-in Cohort 2 Patients receive azacitidine SC or IV over 1 hour as determined by the treating physician on days 1-7 and lirilumab IV over 60 minutes on day 8. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
5-Azacitidine 75mg/m\^2 Lirilumab 3.0 mg/kg
Azacitidine: Given SC or IV
Lirilumab: Given IV | 6 |
| Phase 2 Patients receive azacitidine SC or IV over 1 hour as determined by the treating physician on days 1-7 and lirilumab IV over 60 minutes on day 8. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
5-Azacitidine 75mg/m\^2 Lirilumab 3.0 mg/kg
Azacitidine: Given SC or IV
Lirilumab: Given IV | 24 |
| Total | 36 |
Baseline characteristics
| Characteristic | Phase 1b Lead-in Cohort 2 | Phase 2 | Total | Phase 1b Lead-in Cohort 1 |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 3 Participants | 11 Participants | 16 Participants | 2 Participants |
| Age, Categorical Between 18 and 65 years | 3 Participants | 13 Participants | 20 Participants | 4 Participants |
| Age, Continuous | 68.5 years | 65 years | 64 years | 59.5 years |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 4 Participants | 5 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) White | 6 Participants | 19 Participants | 30 Participants | 5 Participants |
| Region of Enrollment United States | 6 participants | 24 participants | 36 participants | 6 participants |
| Sex: Female, Male Female | 3 Participants | 14 Participants | 18 Participants | 1 Participants |
| Sex: Female, Male Male | 3 Participants | 10 Participants | 18 Participants | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 4 / 6 | 2 / 6 | 9 / 24 |
| other Total, other adverse events | 6 / 6 | 6 / 6 | 22 / 24 |
| serious Total, serious adverse events | 6 / 6 | 6 / 6 | 20 / 24 |
Outcome results
Primary
Maximum Tolerated Dose of Iirilumab in Combination With 5-azacitidine
To identify the dose at which \<2/6 participants experience Dose Limiting Toxicities (DLT). The dose level at which 0-1/6 participants experience a DLT in the first 28 days of treatment will be the maximum tolerated dose (MTD) and would be used to treat an additional 34 participants in the phase II potion of the study. (Part A, Lead-In Phase)
Time frame: Up to 28 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Phase 1 Participants | Maximum Tolerated Dose of Iirilumab in Combination With 5-azacitidine | 3.0 mg/kg |
Primary
Participants With an Objective Response
Objective Response Rate (ORR) will be monitored using the Bayesian approach of Thall, Simon, Estey and the extension by Thall and Sung. Overall response rate (ORR), defined as complete remission (CR) + CR with incomplete platelet recovery (CRp) + CR with incomplete count recovery (CRi) + partial response (PR) + marrow clearance of blasts + hematological improvement within 3 months of treatment initiation among adult patients with refractory/relapsed Acute Myelogenous Leukemia (AML) (Phase II)
Time frame: Up to 3 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| All Phase 1 Participants | Participants With an Objective Response | 2 Participants |
| Phase 1b Lead-in Cohort 2 | Participants With an Objective Response | 1 Participants |
| Phase 2 | Participants With an Objective Response | 2 Participants |
Secondary
Disease Free Survival
Disease Free Survival (DFS) is defined: Time from date of treatment start until the date of first objective documentation of disease-relapse
Time frame: Up to 2.5 years
Population: The outcome for the secondary response, disease free survival was only done on the Phase II portion of this study.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Phase 2 | Disease Free Survival | 7.7 Months |
Secondary
Duration of Response
The date of Objective Response to the date of loss of response or last follow-up.
Time frame: Up to 2.5 years
Population: The outcome for the secondary response, duration of response was only done on the Phase II portion of this study.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Phase 2 | Duration of Response | 7.7 Months |
Secondary
Overall Survival
Overall Survival (OS) is defined: Time of presentation to date of death or censored at last follow-up date.
Time frame: Up to 2 years
Population: The outcome for the secondary response, overall response was only done on the Phase II portion of this study.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Phase 2 | Overall Survival | 3.5 Months |