Myelodysplastic Syndrome, Previously Treated Myelodysplastic Syndrome, Refractory High Risk Myelodysplastic Syndrome, Secondary Myelodysplastic Syndrome, Therapy-Related Myelodysplastic Syndrome
Conditions
Brief summary
This phase I trial studies the side effects and best dose of ibrutinib when giving together with lenalidomide in treating patients with myelodysplastic syndrome. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as lenalidomide, 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 ibrutinib and lenalidomide may work better in treating patients with myelodysplastic syndrome.
Detailed description
PRIMARY OBJECTIVES: To determine the recommended Phase II dose (RP2D) for ibrutinib in combination with lenalidomide in patients with myelodysplastic syndrome (MDS). SECONDARY OBJECTIVES: To do an early assessment of the activity of the combination of ibrutinib and lenalidomide in patients with MDS. TERTIARY OBJECTIVES: To examine the pharmacodynamic and biological effects of the combination of ibrutinib and lenalidomide in MDS.
Interventions
DRUGIbrutinib
Given PO
DRUGLenalidomide
Given PO
Sponsors
University of California, Davis
Pharmacyclics LLC.
Celgene
National Cancer Institute (NCI)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Pathologically confirmed diagnosis of MDS by World Health Organization (WHO) criteria (including secondary and therapy-related disease) who have failed standard therapy, who are intolerant of prior therapy, or who refuse standard therapy; any prior therapy, including ibrutinib and/or lenalidomide (unless intolerant of one or both of these medications), is permitted * Hypomethylating agent failure is defined as disease progression or stable disease as best response to an adequate course of treatment (at least four cycles) with an injectable hypomethylating agent (azacitidine or decitabine) * International Prognostic Scoring System (IPSS)-revised (R) intermediate, high or very high risk disease * No specific hematologic parameters for study entry are required; transfusion-dependent patients are eligible and platelet counts should be maintained greater than 10,000/mm\^3 * Serum aspartate transaminase (AST) or alanine transaminase (ALT) less than or equal to 3.0 x upper limit of normal (ULN) * Estimated creatinine clearance greater than or equal to 60 ml/min (Cockcroft-Gault) * Bilirubin less than or equal to 1.5 x ULN (unless bilirubin rise is due to Gilbert's syndrome or of non-hepatic origin) * Prothrombin time (PT)/international normalized ratio (INR) less than or equal to 1.5 x ULN and partial thromboplastin time (PTT) (activated \[a\]PTT) less than or equal to 1.5 x ULN * Karnofsky performance status (KPS) performance status of 60% or greater * Ability to understand and willingness to sign an informed consent form * Ability to adhere to the study visit schedule and other protocol requirements * Female subjects who are of non-reproductive potential (i.e., post-menopausal by history - no menses for \>= 1 year; OR history of hysterectomy; OR history of bilateral tubal ligation; OR history of bilateral oophorectomy); or, female subjects of childbearing potential must have a negative serum pregnancy test upon study entry * Male and female subjects who agree to use highly effective methods of birth control (e.g., condoms, implants, injectables, combined oral contraceptives, some intrauterine devices \[IUDs\], sexual abstinence, or sterilized partner) during the period of therapy and for 30 days after the last dose of study drug * Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid Risk Evaluation and Mitigation Strategies (REMS) program * All study participants must be registered into the mandatory Revlimid REMS program, and be willing and able to comply with the requirements of the REMS program * Eligibility of patients receiving any medications or substances known to affect or with the potential to affect the activity or pharmacokinetics of ibrutinib or ability to adhere to the Revlimid REMS program will be determined following review of their case by the principal investigator
Exclusion criteria
* Anticancer therapy including chemotherapy, immunotherapy, radiotherapy, hormonal or any investigational therapy within 14 days or 5 half-lives (whichever is shorter) prior to first dose of study drug; hydroxyurea is permitted up to the day before initiation of study treatment * Prior allogeneic (allo)-hematopoietic cell transplantation (HCT) less than three months from the time of enrollment * Acute graft versus host disease (GVHD) or active chronic GVHD greater than grade 1 * Concurrent systemic immunosuppressant therapy (e.g., cyclosporine A, tacrolimus, etc., or chronic administration \[\> 14 days\] of \> 60 mg/day of prednisone or equivalent) within 28 days of the first dose of study drug * History of allergy to or intolerance of ibrutinib or lenalidomide * Vaccinated with live, attenuated vaccines within 4 weeks of first dose of study drug * Recent culture-documented infection requiring systemic intravenous treatment that was completed =\< 7 days before the first dose of study drug or any uncontrolled active systemic infection; fever of unknown origin is not an exclusion criterion, as this may be disease-related * Unresolved toxicities from prior anti-cancer therapy, defined as having not resolved to Common Terminology Criteria for Adverse Event (CTCAE, version 4.03), grade 2 or less, or to the levels dictated in the inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum tolerated dose | Up to 28 days | Data will be reported in tables with descriptive statistics used. Will be assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Effects (CTCAE) version 4.03. Tables will be created to summarize the toxicities and adverse effects by dose, course, organ and severity as well as the study demographics. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Disease free survival | From the time of first documented complete response until relapse or the date of death from any cause, assessed up to 6 months | Will be summarized with Kaplan-Meier plots. |
| Disease response | Up to 6 months | Will be assessed per modified International Working Group (IWG) 2006 response criteria. Response rates and the corresponding 95% confidence intervals will be obtained. |
| Hematologic normalization rate | Up to 6 months | Will be assessed as complete remission + partial remission + hematologic improvement. |
| Overall survival | From the time of first study drug administration until the date of death from any cause, assessed up to 6 months | Will be summarized with Kaplan-Meier plots. |
| Progression free survival | From the time of first study drug administration until the date of progression or death from any cause, assessed up to 6 months | Will be summarized with Kaplan-Meier plots. |
| Time to response | From the time of first study drug administration to the date of complete remission, partial remission, or hematologic improvement, assessed up to 6 months | Will be summarized with Kaplan-Meier plots. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORBrian Jonas
University of California, Davis
Outcome results
None listed