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Dociparstat Sodium (CX-01) Combined With Standard Induction Therapy for Newly Diagnosed Acute Myeloid Leukemia

A Randomized, Phase II Study of CX-01 Combined With Standard Induction Therapy for Newly Diagnosed Acute Myeloid Leukemia

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02873338
Enrollment
75
Registered
2016-08-19
Start date
2016-08-31
Completion date
2019-06-30
Last updated
2023-09-07

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

Conditions

Acute Myeloid Leukemia

Brief summary

This was an exploratory Phase 2, open label, randomized, multicenter, parallel group study to determine whether there was evidence that the addition of dociparstat (CX-01) at 2 different does levels to standard induction therapy (cytarabine+idarubicin, 7+3) and consolidation therapy had an additive therapeutic effect for subjects newly diagnosed with acute myeloid leukemia (AML) when compared with subjects receiving standard induction chemotherapy alone.

Detailed description

The primary efficacy endpoint was to assess whether dociparstat in conjunction with standard induction therapy for AML increased the complete remission rate based on the International Working Group AML response criteria. A total of 75 subjects were to be randomized in a 1:1:1 ratio to 1 of the following treatment groups: * Group 1: cytarabine + idarubicin * Group 2: cytarabine + idarubicin + dociparstat 0.125 mg/kg/hr * Group 3: cytarabine + idarubicin + dociparstat 0.25 mg/kg/hr Subjects received up to 2 induction cycles and up to 2 consolidation cycles and participated in the study for up to 18 months. Clinical laboratory tests were conducted routinely, and bone marrow aspirates and biopsies were performed during the induction cycles. Safety was monitored through adverse events and clinical laboratory results.

Interventions

Subjects received 4 mg/kg dociparstat intravenous (IV) bolus followed by doses of 0.125 or 0.25 mg/kg/hr dociparstat given on Days 1 through 7 with standard induction therapy, on Days 1 through 5 or 7 with standard re-induction therapy, and on Days 1, 3, and 5 with standard consolidation therapy.

DRUGIdarubicin

Subjects received 12 mg/m2/day idarubicin by slow (10 to 15 minutes) intravenous (IV) injection daily on Days 1, 2 and 3 of induction therapy, and on Days 1 and 2 of re-induction therapy.

DRUGCytarabine

Subjects received 100 mg/m2/day cytarabine by continuous intravenous (IV) infusion on Days 1 through 7 of induction therapy and on Days 1 through 5 of re-induction therapy. During consolidation therapy, subjected received 1.0 g/m2 cytarabine IV infusion given over 3 hours every 12 hours on Days 1, 3, and 5.

Sponsors

Jazz Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

Subjects had to meet all the following criteria to be eligible for enrollment in this study: 1. Had newly diagnosed, de novo or secondary, previously untreated acute myeloid leukemia (AML). 2. Had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.

Exclusion criteria

Subjects who met any of the following criteria were not eligible for enrollment in this study: 1. Had acute promyelocytic leukemia 2. Had prior chemotherapy for AML. 3. Had prior intensive chemotherapy or stem cell transplantation for the treatment of myelodysplastic syndrome. 4. Had central nervous system (CNS) leukemia.

Design outcomes

Primary

MeasureTime frameDescription
Number of Subjects Who Achieved Morphologic Complete RemissionDuring induction and re-induction phases of treatment (up to 60 days after the start of each treatment cycle)Morphologic complete remission (CR) was evaluated by International Working Group (IWG) criteria and defined as absolute neutrophil count (ANC) \>1000/microliter; platelet count \>100,000, \<5% blasts in bone marrow aspirate, no blasts with Auer rods, and no evidence of extramedullary disease.

Secondary

MeasureTime frameDescription
Time to Leukemia-free SurvivalRandomization until disease relapse or patient death from any cause, whichever occurs first, assessed up to 30 monthsLeukemia-free survival was assessed as a secondary endpoint only in subjects who achieved composite complete remission and was measured from randomization until disease relapse or death from any cause, whichever occurred first. Assessments were performed every 3 months until death or 18 months after the last subject was randomized, whichever occurred first.
Number of Subjects Who Achieved Overall SurvivalRandomization to end of study (18 months)Overall survival was measured from the date of randomization until death from any cause. Assessments were performed every 3 months and continued until death or 18 months after the last patient was randomized, whichever came first.
Number of Subjects Who Achieved Composite Complete RemissionUp to 60 days after the start of each treatment cycleThe composite complete remission (CR) rate included CR, CR without recovery of platelets (CRp), and CR without recovery of neutrophils and/or platelets (CRi), as defined by the International Working Group criteria during the induction and re-induction phases of treatment. CR was defined as an Absolute Neutrophil Count (ANC) \>1000/μL, platelet count \>100,000/μL, \<5% blasts in bone marrow aspirate, no blasts with Auer rods, and no evidence of extramedullary disease. CRi was defined as an ANC \<1000/μL and/or platelet count \<100,000/, \<5% blasts in bone marrow aspirate, no blasts with Auer rods, and no evidence of extramedullary disease.
Duration of Morphologic Complete RemissionRandomization to end of study (18 months)The duration of morphologic complete remission was assessed only in subjects who had achieved morphologic complete remission and was defined as the time from achievement of complete response to the detection or relapse. Relapse was defined as the reappearance of leukemia blasts in the peripheral blood, \>5% blasts in the bone marrow not attributable to another cause, or appearance/reappearance of extramedullary disease and with a bone marrow blast percentage of \>5% but ≤20%. If the latter, a repeat bone marrow examination was performed at least 7 days after the first marrow examination; documentation of the bone marrow blast percentage of \>5% was necessary to establish relapse. Assessments were performed every 3 months and continued until death or 18 months after the last subject was randomized, whichever occurred first. Duration of morphologic complete remission (time from the achievement of complete response to the detection of relapse)
Duration of Event-free SurvivalRandomization up to 30 monthsEvent-free survival was measured as date of randomization until treatment failure. Treatment failure was defined as failure to achieve composite completed morphological remission during the induction and re-induction phase of the study lasting up to 60 days, relapse from complete response, or death from any cause, whichever occurred first.
Time to Platelet RecoveryRandomization to platelet recovery, for up to 60 days after the start of each treatment cyclePlatelet recovery was measured from randomization to platelet recovery (platelet count \>20,000/µL and \>100,000/µL)
Number of Subjects Who Died by Day 3030 days (from first day of induction treatment to 30 days after)Mortality (rate of death) of subjects by Day 30, measured from the first day of induction treatment to 30 days post-induction.
Number of Subjects Who Died by Day 60.60 days (from the first day of induction treatment to 60 days after)Mortality (rate of death) of subjects by Day 60, measured from the first day of induction treatment to 60 days post-induction.
Number of Subjects Who Died by Day 9090 days (from the first day of induction treatment to 90 days after)Mortality (rate of death) of subjects at Day 90, measured from the first day of induction treatment to 90 days post-induction.
Time to Recovery of NeutrophilsRandomization to ANC recovery, for up to 60 days after the start of each treatment cycleNeutrophil recovery was assessed from randomization to Absolute Neutrophil Count (ANC) recovery (ANC \>500/µL and \>1000/µL) for up to 60 days after the start of each treatment cycle.

Countries

United States

Participant flow

Pre-assignment details

Note that 2 randomized subjects did not receive study treatment: 1 subject in the control group and 1 subject in the dociparstat 0.25 mg/kg group. Therefore, these 2 subjects are not included in the safety analysis, but are included in the efficacy analyses.

Participants by arm

ArmCount
Control (Idarubicin+Cytarabine)
Induction: * Idarubicin 12 mg/m2/day by slow (10 to 30 minutes) intravenous (IV) injection/infusion daily (Days 1, 2, and 3) * Cytarabine 100 mg/m2/day continuous 24-hour IV infusion (Days 1 to 7) Re-induction: * Idarubicin 12 mg/m2/day slow (10 to 30 minutes) IV injection/infusion daily (Days 1 and 2) * Cytarabine 100 mg/m2/day continuous 24-hour IV infusion (Days 1 to 5) Consolidation: • Cytarabine 1.0 g/m2 over 3 hours, every 12 hours (Days 1, 3, and 5)
26
Dociparstat 0.125 mg/kg
Induction: * Dociparstat 4 mg/kg initial bolus 30 minutes post-idarubicin dose (Day 1), followed by dociparstat 0.125 mg/kg/hr continuous 24-hour intravenous (IV) infusion (Days 1 to 7) * Idarubicin 12 mg/m2/day slow IV injection/infusion daily (Days 1, 2, and 3) * Cytarabine 100 mg/m2/day continuous 24-hour IV infusion (Days 1 to 7) Re-induction: * Dociparstat 4 mg/kg initial bolus 30 minutes post-idarubicin dose (Day 1), followed by dociparstat 0.125 mg/kg/hr continuous 24-hour IV infusion (Days 1 to 5) * Idarubicin 12 mg/m2/day slow IV injection/infusion daily (Days 1 and 2) * Cytarabine 100 mg/m2/day continuous 24-hour IV infusion (Days 1 to 5) Consolidation: * Dociparstat 4 mg/kg initial bolus 30 minutes post-3-hour cytarabine infusion (Day 1), followed by dociparstat 0.125 mg/kg/hr continuous 24-hour IV infusion on (Days 1 to 5; total 120 hours) * Cytarabine 1.0 g/m2 over 3 hours, every 12 hours (Days 1, 3, and 5)
25
Dociparstat 0.25 mg/kg
Induction: * Dociparstat 4 mg/kg initial bolus 30 minutes post-idarubicin dose (Day 1), followed by dociparstat 0.25 mg/kg/hr continuous 24-hour intravenous (IV) infusion (Days 1 to 7) * Idarubicin 12 mg/m2/day slow IV injection/infusion daily (Days 1, 2, and 3) * Cytarabine 100 mg/m2/day continuous 24-hour IV infusion (Days 1 to 7) Re-induction: * Dociparstat 4 mg/kg initial bolus 20 minutes post-idarubicin dose (Day 1), followed by dociparstat 0.25 mg/kg/hr continuous 24-hour IV infusion (Days 1 to 5) * Idarubicin 12 mg/m2/day slow IV injection/infusion daily (Days 1 and 2) * Cytarabine 100 mg/m2/day continuous 24-hour IV infusion (Days 1 to 5) Consolidation: * Dociparstat 4 mg/kg initial bolus 30 minutes post-3-hour cytarabine infusion (Day 1), followed by dociparstat 0.25 mg/kg/hr continuous 24-hour IV infusion (Days 1 to 5; total 120 hours) * Cytarabine 1.0 g/m2 over 3 hours, every 12 hours (Days 1, 3, and 5)
24
Total75

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyAdverse Event021
Overall StudyDeath211
Overall StudyLack of Efficacy020
Overall StudyOther or Missing141513
Overall StudyWithdrawal by Subject213

Baseline characteristics

CharacteristicTotalDociparstat 0.25 mg/kgDociparstat 0.125 mg/kgControl (Idarubicin+Cytarabine)
Acute myeloid leukemia (AML) subtype
De novo
62 Participants22 Participants18 Participants22 Participants
Acute myeloid leukemia (AML) subtype
Secondary
13 Participants2 Participants7 Participants4 Participants
Age, Continuous67 years
STANDARD_DEVIATION 4.2
68 years
STANDARD_DEVIATION 4.3
67 years
STANDARD_DEVIATION 4.8
67 years
STANDARD_DEVIATION 3.6
Baseline blasts in bone marrow46 percentage
STANDARD_DEVIATION 24.6
46 percentage
STANDARD_DEVIATION 26.6
47 percentage
STANDARD_DEVIATION 22.3
44 percentage
STANDARD_DEVIATION 25.9
Race (NIH/OMB)
American Indian or Alaska Native
2 Participants1 Participants1 Participants0 Participants
Race (NIH/OMB)
Asian
1 Participants0 Participants0 Participants1 Participants
Race (NIH/OMB)
Black or African American
4 Participants1 Participants1 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
3 Participants2 Participants1 Participants0 Participants
Race (NIH/OMB)
White
65 Participants20 Participants22 Participants23 Participants
Sex: Female, Male
Female
29 Participants13 Participants10 Participants6 Participants
Sex: Female, Male
Male
46 Participants11 Participants15 Participants20 Participants
Time since acute myeloid leukemia (AML) diagnosis1.1 weeks
STANDARD_DEVIATION 1.04
1.0 weeks
STANDARD_DEVIATION 0.75
1.2 weeks
STANDARD_DEVIATION 1.15
1.1 weeks
STANDARD_DEVIATION 1.19

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
14 / 2614 / 259 / 24
other
Total, other adverse events
25 / 2525 / 2523 / 23
serious
Total, serious adverse events
7 / 258 / 2513 / 23

Outcome results

Primary

Number of Subjects Who Achieved Morphologic Complete Remission

Morphologic complete remission (CR) was evaluated by International Working Group (IWG) criteria and defined as absolute neutrophil count (ANC) \>1000/microliter; platelet count \>100,000, \<5% blasts in bone marrow aspirate, no blasts with Auer rods, and no evidence of extramedullary disease.

Time frame: During induction and re-induction phases of treatment (up to 60 days after the start of each treatment cycle)

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Control (Idarubicin+Cytarabine)Number of Subjects Who Achieved Morphologic Complete Remission14 Participants
Dociparstat 0.125 mg/kgNumber of Subjects Who Achieved Morphologic Complete Remission8 Participants
Dociparstat 0.25 mg/kgNumber of Subjects Who Achieved Morphologic Complete Remission11 Participants
Secondary

Duration of Event-free Survival

Event-free survival was measured as date of randomization until treatment failure. Treatment failure was defined as failure to achieve composite completed morphological remission during the induction and re-induction phase of the study lasting up to 60 days, relapse from complete response, or death from any cause, whichever occurred first.

Time frame: Randomization up to 30 months

Population: Note: In the Dociparstat 0.125 mg/kg group, fewer than half of the subjects achieved complete CR, and thus were assessed as having an event on Day 1.

ArmMeasureValue (MEDIAN)
Control (Idarubicin+Cytarabine)Duration of Event-free Survival243.5 days
Dociparstat 0.125 mg/kgDuration of Event-free Survival1 days
Dociparstat 0.25 mg/kgDuration of Event-free Survival171.5 days
Secondary

Duration of Morphologic Complete Remission

The duration of morphologic complete remission was assessed only in subjects who had achieved morphologic complete remission and was defined as the time from achievement of complete response to the detection or relapse. Relapse was defined as the reappearance of leukemia blasts in the peripheral blood, \>5% blasts in the bone marrow not attributable to another cause, or appearance/reappearance of extramedullary disease and with a bone marrow blast percentage of \>5% but ≤20%. If the latter, a repeat bone marrow examination was performed at least 7 days after the first marrow examination; documentation of the bone marrow blast percentage of \>5% was necessary to establish relapse. Assessments were performed every 3 months and continued until death or 18 months after the last subject was randomized, whichever occurred first. Duration of morphologic complete remission (time from the achievement of complete response to the detection of relapse)

Time frame: Randomization to end of study (18 months)

Population: This analysis only included subjects who had achieved morphologic complete remission.~The following number of subjects were censored in each treatment group for this analysis; however the full ranges include censored subjects:~* Control: 7/14 (50%) subjects~* Dociparstat 0.125 mg/kg: 6/8 (75.0%) subjects~* Dociparstat 0.25 mg/kg: 9/11 (81.8%) subjects

ArmMeasureValue (MEDIAN)
Control (Idarubicin+Cytarabine)Duration of Morphologic Complete Remission233 days
Dociparstat 0.125 mg/kgDuration of Morphologic Complete Remission494 days
Dociparstat 0.25 mg/kgDuration of Morphologic Complete Remission294 days
Secondary

Number of Subjects Who Achieved Composite Complete Remission

The composite complete remission (CR) rate included CR, CR without recovery of platelets (CRp), and CR without recovery of neutrophils and/or platelets (CRi), as defined by the International Working Group criteria during the induction and re-induction phases of treatment. CR was defined as an Absolute Neutrophil Count (ANC) \>1000/μL, platelet count \>100,000/μL, \<5% blasts in bone marrow aspirate, no blasts with Auer rods, and no evidence of extramedullary disease. CRi was defined as an ANC \<1000/μL and/or platelet count \<100,000/, \<5% blasts in bone marrow aspirate, no blasts with Auer rods, and no evidence of extramedullary disease.

Time frame: Up to 60 days after the start of each treatment cycle

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Control (Idarubicin+Cytarabine)Number of Subjects Who Achieved Composite Complete Remission16 Participants
Dociparstat 0.125 mg/kgNumber of Subjects Who Achieved Composite Complete Remission9 Participants
Dociparstat 0.25 mg/kgNumber of Subjects Who Achieved Composite Complete Remission15 Participants
Secondary

Number of Subjects Who Achieved Overall Survival

Overall survival was measured from the date of randomization until death from any cause. Assessments were performed every 3 months and continued until death or 18 months after the last patient was randomized, whichever came first.

Time frame: Randomization to end of study (18 months)

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Control (Idarubicin+Cytarabine)Number of Subjects Who Achieved Overall SurvivalSubjects died14 Participants
Control (Idarubicin+Cytarabine)Number of Subjects Who Achieved Overall SurvivalSubjects still alive12 Participants
Dociparstat 0.125 mg/kgNumber of Subjects Who Achieved Overall SurvivalSubjects died14 Participants
Dociparstat 0.125 mg/kgNumber of Subjects Who Achieved Overall SurvivalSubjects still alive11 Participants
Dociparstat 0.25 mg/kgNumber of Subjects Who Achieved Overall SurvivalSubjects died9 Participants
Dociparstat 0.25 mg/kgNumber of Subjects Who Achieved Overall SurvivalSubjects still alive15 Participants
Secondary

Number of Subjects Who Died by Day 30

Mortality (rate of death) of subjects by Day 30, measured from the first day of induction treatment to 30 days post-induction.

Time frame: 30 days (from first day of induction treatment to 30 days after)

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Control (Idarubicin+Cytarabine)Number of Subjects Who Died by Day 302 Participants
Dociparstat 0.125 mg/kgNumber of Subjects Who Died by Day 301 Participants
Dociparstat 0.25 mg/kgNumber of Subjects Who Died by Day 303 Participants
Secondary

Number of Subjects Who Died by Day 60.

Mortality (rate of death) of subjects by Day 60, measured from the first day of induction treatment to 60 days post-induction.

Time frame: 60 days (from the first day of induction treatment to 60 days after)

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Control (Idarubicin+Cytarabine)Number of Subjects Who Died by Day 60.2 Participants
Dociparstat 0.125 mg/kgNumber of Subjects Who Died by Day 60.2 Participants
Dociparstat 0.25 mg/kgNumber of Subjects Who Died by Day 60.3 Participants
Secondary

Number of Subjects Who Died by Day 90

Mortality (rate of death) of subjects at Day 90, measured from the first day of induction treatment to 90 days post-induction.

Time frame: 90 days (from the first day of induction treatment to 90 days after)

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Control (Idarubicin+Cytarabine)Number of Subjects Who Died by Day 902 Participants
Dociparstat 0.125 mg/kgNumber of Subjects Who Died by Day 903 Participants
Dociparstat 0.25 mg/kgNumber of Subjects Who Died by Day 903 Participants
Secondary

Time to Leukemia-free Survival

Leukemia-free survival was assessed as a secondary endpoint only in subjects who achieved composite complete remission and was measured from randomization until disease relapse or death from any cause, whichever occurred first. Assessments were performed every 3 months until death or 18 months after the last subject was randomized, whichever occurred first.

Time frame: Randomization until disease relapse or patient death from any cause, whichever occurs first, assessed up to 30 months

Population: This analysis only included subjects who achieved composite complete remission. The following number of subjects were censored in each treatment group:~* Control: 6/16 (37.5%) subjects~* Dociparstat 0.125 mg/kg: 4/9 (44.4%) subjects~* Dociparstat 0.25 mg/kg: 10/15 (66.7%) subjects

ArmMeasureValue (MEDIAN)
Control (Idarubicin+Cytarabine)Time to Leukemia-free Survival292 days
Dociparstat 0.125 mg/kgTime to Leukemia-free Survival448 days
Dociparstat 0.25 mg/kgTime to Leukemia-free Survival166 days
Secondary

Time to Platelet Recovery

Platelet recovery was measured from randomization to platelet recovery (platelet count \>20,000/µL and \>100,000/µL)

Time frame: Randomization to platelet recovery, for up to 60 days after the start of each treatment cycle

Population: The following number of subjects were censored in each treatment group for each analysis (platelet recovery to \>20,000µL and \>100,000µL):~* Control: 5/26 (19.2%) subjects for \>20,000µL and 7/26 (26.9%) subjects for \>100,000µL~* Dociparstat 0.125 mg/kg: 5/25 (20%) subjects for \>20,000µL and 12/25 (48.0%) subjects for \>100,000µL~* Dociparstat 0.25 mg/kg: 8/24 (33.3%) subjects for \>20,000µL and 11/24 (45.8%) subjects for \>100,000µL

ArmMeasureGroupValue (MEDIAN)
Control (Idarubicin+Cytarabine)Time to Platelet RecoveryRecovery to >20,000µL35 days
Control (Idarubicin+Cytarabine)Time to Platelet RecoveryRecovery to >100,000µL38 days
Dociparstat 0.125 mg/kgTime to Platelet RecoveryRecovery to >20,000µL36 days
Dociparstat 0.125 mg/kgTime to Platelet RecoveryRecovery to >100,000µL50 days
Dociparstat 0.25 mg/kgTime to Platelet RecoveryRecovery to >20,000µL29 days
Dociparstat 0.25 mg/kgTime to Platelet RecoveryRecovery to >100,000µL32 days
Secondary

Time to Recovery of Neutrophils

Neutrophil recovery was assessed from randomization to Absolute Neutrophil Count (ANC) recovery (ANC \>500/µL and \>1000/µL) for up to 60 days after the start of each treatment cycle.

Time frame: Randomization to ANC recovery, for up to 60 days after the start of each treatment cycle

Population: The following number of subjects were censored in each treatment group for both analyses (neutrophil recovery to \>500/µL and \>1000/µL):~* Control: 6/26 (23.1%) subjects for both analyses (\>500/µL and \>1000/µL)~* Dociparstat 0.125 mg/kg: 9/25 (36.0%) subjects for both analyses (\>500/µL and \>1000/µL)~* Dociparstat 0.25 mg/kg: 7/24 (29.2%) subjects for \>500/µL and 11/24 (45.8%) subjects for \>1000/µL

ArmMeasureGroupValue (MEDIAN)
Control (Idarubicin+Cytarabine)Time to Recovery of NeutrophilsRecovery to >500/µL32 days
Control (Idarubicin+Cytarabine)Time to Recovery of NeutrophilsRecovery to >1000/µL37 days
Dociparstat 0.125 mg/kgTime to Recovery of NeutrophilsRecovery to >500/µL43 days
Dociparstat 0.125 mg/kgTime to Recovery of NeutrophilsRecovery to >1000/µL42 days
Dociparstat 0.25 mg/kgTime to Recovery of NeutrophilsRecovery to >500/µL29 days
Dociparstat 0.25 mg/kgTime to Recovery of NeutrophilsRecovery to >1000/µL35 days

Source: ClinicalTrials.gov · Data processed: Feb 21, 2026