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Vadastuximab Talirine (SGN-CD33A; 33A) Combined With Azacitidine or Decitabine in Older Patients With Newly Diagnosed Acute Myeloid Leukemia

A Randomized, Double-blind Phase 3 Study of Vadastuximab Talirine (SGN-CD33A) Versus Placebo in Combination With Azacitidine or Decitabine in the Treatment of Older Patients With Newly Diagnosed Acute Myeloid Leukemia (AML)

Status
Terminated
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02785900
Acronym
CASCADE
Enrollment
240
Registered
2016-05-30
Start date
2016-05-31
Completion date
2017-10-03
Last updated
2018-12-12

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

Conditions

Acute Myeloid Leukemia

Keywords

Antibodies, monoclonal, Antibody drug conjugate, Antigens, cluster of differentiation 33 (CD33), Drug therapy, Immunotherapy

Brief summary

The purpose of this study in AML patients is to test whether vadastuximab talirine (SGN-CD33A; 33A) combined with either azacitidine or decitabine improves remission rates and extends overall survival as compared to placebo combined with either azacitidine or decitabine.

Detailed description

Hypomethylating agents (HMAs), such as decitabine or azacitidine, are considered a standard treatment for older patients with AML. The primary goals of this study are to test whether patients treated with an HMA (either decitabine or azacitidine) in combination with 33A will have better anti-tumor activity and/or survive longer than patients treated with an HMA in combination with placebo. Patients who meet eligibility criteria will be randomly assigned to one of two treatment groups: 1) 33A plus HMA (Experimental Arm); or 2) placebo plus HMA (Comparator Arm). In addition to evaluating survival and remission rates, the minimal residual disease (MRD)-negative remission rate, duration of remission, event free- and leukemia-free survival, and safety and tolerability will be compared between arms.

Interventions

DRUG33A

33A, 10 mcg/kg, every 4 weeks via intravenous (IV) push

DRUGplacebo

Volume equivalent to 10 mcg/kg, every 4 weeks via IV push

DRUGazacitidine

75 mg/m2 given subcutaneously (SC) or IV x 7 days, every 4 weeks

DRUGdecitabine

20 mg/m2 given IV x 5 days, every 4 weeks

Sponsors

Seagen Inc.
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

* Newly diagnosed, previously untreated, cytologically/histologically confirmed de novo or secondary AML according to World Health Organization (WHO) classification (except for acute promyelocytic leukemia (APL)) * Intermediate or adverse cytogenetic risk * Eligible for therapy with either decitabine or azacitidine * Acceptable hematologic and organ function

Exclusion criteria

* AML associated with favorable risk karyotypes including inv(16), t(8;21), t(16;16), or t(15;17) * Patients who are candidates for allogeneic stem cell transplant at the time of enrollment * Patients with a history of one of the following myeloproliferative neoplasms: essential thrombocythemia, polycythemia vera, and primary myelofibrosis * Received prior treatment with HMA or chemotherapy for antecedent myelodysplastic syndrome (MDS)

Design outcomes

Primary

MeasureTime frameDescription
Overall SurvivalUp to 1.5 yearsTime from randomization to death due to any cause
Composite Complete Remission (CRc) RateUp to 1.5 yearsNumber of patients who achieved complete remission (CR) or complete remission with incomplete blood count recovery (CRi) according to the modified response criteria for acute myeloid leukemia (AML) per Cheson 2003.

Secondary

MeasureTime frameDescription
Event-free SurvivalUp to approximately 11.24 monthsEvent-free survival is calculated from the time of randomization to the first documentation of progression, relapse, or death, whichever comes first. Patients who do not have event (progression, relapse, or death) prior to analysis cutoff date are censored at the date of last response assessment. Patients who started another anticancer therapy before progression, relapse, or death are censored at the date of last response assessment prior to the start of new therapy. Patients who do not have response assessment post-baseline are censored at the date of randomization.
Leukemia-free SurvivalUp to approximately 9.49 monthsLeukemia-free survival is calculated from the first documentation of blast clearance (CR, CRi, mLFS) to the first documentation of disease relapse or death, whichever comes first. Patients who are in remission at the time of analysis cutoff are censored at the date of last response assessment. Patients who started another anticancer therapy before relapse or death are censored at the date of last response assessment prior to start of new therapy.
Type, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsUp to 1.5 yearsTreatment-emergent adverse events (TEAEs) are presented and defined as newly occurring (not present at baseline) or worsening after first dose of investigational product. SAE = serious adverse event. Study treatment in this data set refers to blinded study treatment.
Minimal Residual Disease (MRD)-Negative Composite Complete Remission RateUp to 1.5 yearsNumber of patients who achieve both remission (CR or CRi) and MRD-negative status
Time to Complete RemissionUp to 1.5 yearsTime to CR or CRi is the time from randomization to the first documentation of CR/CRi
Mortality Rates at Day 30 and Day 60Up to 60 days30- and 60-day survival from date of randomization. Estimated using Kaplan-Meier method.
Incidence of Grade 3 or Higher Laboratory AbnormalitiesUp to 1.5 yearsParticipants who experienced a laboratory grade increase to Grade 3 or higher (per National Cancer Institute's Common Terminology Criteria for Adverse Events \[NCI CTCAE\], v4.03)
Duration of RemissionUp to approximately 9.5 monthsDuration of remission is calculated from the first documentation of CR or CRi to the first documentation of disease relapse or death, whichever comes first. Patients who are in remission at the time of analysis cutoff are censored at the date of last response assessment. Patients who started another anticancer therapy before relapse or death are censored at the date of last response assessment prior to start of new therapy.

Countries

Australia, Austria, Belgium, Czechia, France, Germany, Hungary, Israel, Italy, Luxembourg, Poland, South Korea, Spain, Taiwan, United Kingdom, United States

Participant flow

Participants by arm

ArmCount
33A + HMA
33A plus azacitidine or decitabine 33A: 33A, 10 mcg/kg, every 4 weeks via intravenous (IV) push azacitidine: 75 mg/m2 given subcutaneously (SC) or IV x 7 days, every 4 weeks decitabine: 20 mg/m2 given IV x 5 days, every 4 weeks
117
Placebo + HMA
placebo plus azacitidine or decitabine placebo: Volume equivalent to 10 mcg/kg, every 4 weeks via IV push azacitidine: 75 mg/m2 given subcutaneously (SC) or IV x 7 days, every 4 weeks decitabine: 20 mg/m2 given IV x 5 days, every 4 weeks
123
Total240

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath4632
Overall StudyPhysician Decision32
Overall StudyStudy Termination by Sponsor6481
Overall StudyWithdrawal by Subject48

Baseline characteristics

CharacteristicPlacebo + HMATotal33A + HMA
Age, Continuous75.0 years75.0 years75.0 years
Age, Customized
Age Group
65 - 74 years
55 Participants110 Participants55 Participants
Age, Customized
Age Group
>65 years
3 Participants6 Participants3 Participants
Age, Customized
Age Group
75 - 79 years
41 Participants74 Participants33 Participants
Age, Customized
Age Group
>= 80 years
24 Participants50 Participants26 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
Grade 0: Normal activity
23 Participants46 Participants23 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
Grade 1: Symptoms but ambulatory
80 Participants158 Participants78 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
Grade 2: In bed less than 50% of the time
20 Participants36 Participants16 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
2 Participants5 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
111 Participants209 Participants98 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
10 Participants26 Participants16 Participants
Race/Ethnicity, Customized
Race
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Race
Asian
16 Participants28 Participants12 Participants
Race/Ethnicity, Customized
Race
Black or African American
1 Participants4 Participants3 Participants
Race/Ethnicity, Customized
Race
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Race
Not Reportable
10 Participants23 Participants13 Participants
Race/Ethnicity, Customized
Race
Other
1 Participants3 Participants2 Participants
Race/Ethnicity, Customized
Race
Unknown
1 Participants3 Participants2 Participants
Race/Ethnicity, Customized
Race
White
94 Participants179 Participants85 Participants
Region of Enrollment
Australia
11 participants21 participants10 participants
Region of Enrollment
Austria
0 participants3 participants3 participants
Region of Enrollment
Belgium
8 participants12 participants4 participants
Region of Enrollment
Czechia
6 participants9 participants3 participants
Region of Enrollment
France
10 participants23 participants13 participants
Region of Enrollment
Germany
6 participants8 participants2 participants
Region of Enrollment
Hungary
6 participants11 participants5 participants
Region of Enrollment
Israel
7 participants12 participants5 participants
Region of Enrollment
Italy
3 participants5 participants2 participants
Region of Enrollment
South Korea
7 participants13 participants6 participants
Region of Enrollment
Spain
6 participants11 participants5 participants
Region of Enrollment
Taiwan
5 participants10 participants5 participants
Region of Enrollment
United Kingdom
3 participants8 participants5 participants
Region of Enrollment
United States
45 participants94 participants49 participants
Sex: Female, Male
Female
67 Participants136 Participants69 Participants
Sex: Female, Male
Male
56 Participants104 Participants48 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
43 / 11134 / 128
other
Total, other adverse events
105 / 111123 / 128
serious
Total, serious adverse events
92 / 11189 / 128

Outcome results

Primary

Composite Complete Remission (CRc) Rate

Number of patients who achieved complete remission (CR) or complete remission with incomplete blood count recovery (CRi) according to the modified response criteria for acute myeloid leukemia (AML) per Cheson 2003.

Time frame: Up to 1.5 years

Population: Intent-to-treat analysis set

ArmMeasureValue (NUMBER)
33A + HMAComposite Complete Remission (CRc) Rate30 participants
Placebo + HMAComposite Complete Remission (CRc) Rate26 participants
Primary

Overall Survival

Time from randomization to death due to any cause

Time frame: Up to 1.5 years

Population: Intent-to-treat analysis set

ArmMeasureValue (MEDIAN)
33A + HMAOverall Survival5.1 months
Placebo + HMAOverall SurvivalNA months
Secondary

Duration of Remission

Duration of remission is calculated from the first documentation of CR or CRi to the first documentation of disease relapse or death, whichever comes first. Patients who are in remission at the time of analysis cutoff are censored at the date of last response assessment. Patients who started another anticancer therapy before relapse or death are censored at the date of last response assessment prior to start of new therapy.

Time frame: Up to approximately 9.5 months

Population: Patients who achieved complete remission (CR) or CR with incomplete hematologic recovery (CRi).

ArmMeasureValue (MEDIAN)
33A + HMADuration of Remission5.1 months
Placebo + HMADuration of Remission7.5 months
Secondary

Event-free Survival

Event-free survival is calculated from the time of randomization to the first documentation of progression, relapse, or death, whichever comes first. Patients who do not have event (progression, relapse, or death) prior to analysis cutoff date are censored at the date of last response assessment. Patients who started another anticancer therapy before progression, relapse, or death are censored at the date of last response assessment prior to the start of new therapy. Patients who do not have response assessment post-baseline are censored at the date of randomization.

Time frame: Up to approximately 11.24 months

Population: Intent-to-treat analysis set

ArmMeasureValue (MEDIAN)
33A + HMAEvent-free Survival4.2 months
Placebo + HMAEvent-free Survival6.7 months
Secondary

Incidence of Grade 3 or Higher Laboratory Abnormalities

Participants who experienced a laboratory grade increase to Grade 3 or higher (per National Cancer Institute's Common Terminology Criteria for Adverse Events \[NCI CTCAE\], v4.03)

Time frame: Up to 1.5 years

Population: Safety Analysis Set: 7 patients randomized to the HMA+33A received only HMA and are included in the HMA+Placebo safety set. 1 patient randomized to the HMA+placebo arm received 33A+HMA treatment. 1 patient in the HMA+placebo arm did not receive any study treatment.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPotassium (mEq/L) - High1 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAlbumin (g/dL) - Low2 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPotassium (mEq/L) - Low5 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesCalcium (mg/dL) - Low8 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesSodium (mEq/L) - Low13 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAmylase (IU/L) - High1 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesTriacylglycerol Lipase (IU/L) - High10 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesCreatinine (mg/dL) - High0 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesUrate (mg/dL) - High4 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAlanine Aminotransferase (IU/L) - High0 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesHemoglobin (g/dL) - Low59 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesGlucose (mg/dL) - High12 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLeukocytes (x10^3/uL) - High0 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAspartate Aminotransferase (IU/L) - High1 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLeukocytes (x10^3/uL) - Low86 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesMagnesium (mg/dL) - High2 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLymphocytes (x10^3/uL) - High1 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAlkaline Phosphatase (IU/L) - High0 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLymphocytes (x10^3/uL) - Low51 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPhosphate (mg/dL) - Low17 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesNeutrophils (x10^3/uL) - Low63 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPlatelets (x10^3/uL) - Low77 Participants
33A + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesBilirubin (mg/dL) - High1 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPlatelets (x10^3/uL) - Low75 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAlanine Aminotransferase (IU/L) - High2 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAlbumin (g/dL) - Low4 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAlkaline Phosphatase (IU/L) - High2 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAmylase (IU/L) - High0 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesAspartate Aminotransferase (IU/L) - High2 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesBilirubin (mg/dL) - High1 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesCalcium (mg/dL) - Low3 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesCreatinine (mg/dL) - High1 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesGlucose (mg/dL) - High9 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesMagnesium (mg/dL) - High0 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPhosphate (mg/dL) - Low9 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPotassium (mEq/L) - High0 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesPotassium (mEq/L) - Low14 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesSodium (mEq/L) - Low12 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesTriacylglycerol Lipase (IU/L) - High4 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesUrate (mg/dL) - High7 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesHemoglobin (g/dL) - Low66 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLeukocytes (x10^3/uL) - High3 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLeukocytes (x10^3/uL) - Low70 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLymphocytes (x10^3/uL) - High4 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesLymphocytes (x10^3/uL) - Low29 Participants
Placebo + HMAIncidence of Grade 3 or Higher Laboratory AbnormalitiesNeutrophils (x10^3/uL) - Low43 Participants
Secondary

Leukemia-free Survival

Leukemia-free survival is calculated from the first documentation of blast clearance (CR, CRi, mLFS) to the first documentation of disease relapse or death, whichever comes first. Patients who are in remission at the time of analysis cutoff are censored at the date of last response assessment. Patients who started another anticancer therapy before relapse or death are censored at the date of last response assessment prior to start of new therapy.

Time frame: Up to approximately 9.49 months

Population: Patients who achieved CR/CRi

ArmMeasureValue (MEDIAN)
33A + HMALeukemia-free Survival5.1 months
Placebo + HMALeukemia-free Survival7.5 months
Secondary

Minimal Residual Disease (MRD)-Negative Composite Complete Remission Rate

Number of patients who achieve both remission (CR or CRi) and MRD-negative status

Time frame: Up to 1.5 years

Population: Intent-to-treat analysis set

ArmMeasureGroupValue (NUMBER)
33A + HMAMinimal Residual Disease (MRD)-Negative Composite Complete Remission RateMRD-negative CRc rate18 participants
33A + HMAMinimal Residual Disease (MRD)-Negative Composite Complete Remission RateMRD-negative CR rate8 participants
33A + HMAMinimal Residual Disease (MRD)-Negative Composite Complete Remission RateMRD-negative CRi rate10 participants
Placebo + HMAMinimal Residual Disease (MRD)-Negative Composite Complete Remission RateMRD-negative CRc rate10 participants
Placebo + HMAMinimal Residual Disease (MRD)-Negative Composite Complete Remission RateMRD-negative CR rate5 participants
Placebo + HMAMinimal Residual Disease (MRD)-Negative Composite Complete Remission RateMRD-negative CRi rate5 participants
Secondary

Mortality Rates at Day 30 and Day 60

30- and 60-day survival from date of randomization. Estimated using Kaplan-Meier method.

Time frame: Up to 60 days

Population: Intent-to-Treat Analysis Set

ArmMeasureGroupValue (NUMBER)
33A + HMAMortality Rates at Day 30 and Day 6030-day Mortality Rate11 percentage of participants
33A + HMAMortality Rates at Day 30 and Day 6060-day Mortality Rate23 percentage of participants
Placebo + HMAMortality Rates at Day 30 and Day 6030-day Mortality Rate6 percentage of participants
Placebo + HMAMortality Rates at Day 30 and Day 6060-day Mortality Rate13 percentage of participants
Secondary

Time to Complete Remission

Time to CR or CRi is the time from randomization to the first documentation of CR/CRi

Time frame: Up to 1.5 years

Population: Intent-to-Treat Analysis Set - Patients who Achieved CR/CRi.

ArmMeasureValue (MEDIAN)
33A + HMATime to Complete Remission9.3 weeks
Placebo + HMATime to Complete Remission9.4 weeks
Secondary

Type, Incidence, Severity, Seriousness, and Relatedness of Adverse Events

Treatment-emergent adverse events (TEAEs) are presented and defined as newly occurring (not present at baseline) or worsening after first dose of investigational product. SAE = serious adverse event. Study treatment in this data set refers to blinded study treatment.

Time frame: Up to 1.5 years

Population: Safety analysis set: 7 patients randomized to the HMA+33A received only HMA and are included in the HMA+Placebo safety set. 1 patient randomized to the HMA+placebo arm received 33A+HMA treatment. 1 patient in the HMA+placebo arm did not receive any study treatment.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
33A + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with any AE related to study treatment83 Participants
33A + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with any SAE related to study treatment51 Participants
33A + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with any SAE92 Participants
33A + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with Grade 3 or Higher AE103 Participants
33A + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatient with any TEAE111 Participants
Placebo + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with Grade 3 or Higher AE112 Participants
Placebo + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatient with any TEAE125 Participants
Placebo + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with any AE related to study treatment59 Participants
Placebo + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with any SAE89 Participants
Placebo + HMAType, Incidence, Severity, Seriousness, and Relatedness of Adverse EventsPatients with any SAE related to study treatment20 Participants

Source: ClinicalTrials.gov · Data processed: Feb 28, 2026