Acute Myeloid Leukemia, Adult
Conditions
Brief summary
This study is a single arm open exploratory clinical trial to evaluate the efficacy and safety of selinexor combined with venetoclax and azacitidine. This study will be divided into two stages: dose increasing stage and dose expanding stage. In the dose-increasing stage, the study induction therapy was designed using a 3+3 design. The induction therapy and consolidation therapy of the subjects will be administered at RP2D doses. During this study period, there were a total of 4 cycles. The treatment cycle of the subjects will include 2 cycles of induction therapy and up to 2 cycles of consolidation therapy. In addition, if the subject does not achieve remission (CR/Cr or PR) after 2 cycles of consolidation treatment (at the end of the 4th course), the study will be terminated by the subject, and the clinical doctor will choose the subsequent treatment for the subject based on clinical experience.
Detailed description
This study is a single arm open exploratory clinical trial to evaluate the efficacy and safety of selinexor combined with venetoclax and azacitidine. This study will be divided into two stages: dose increasing stage and dose expanding stage. In the dose-increasing stage, the study induction therapy was designed using a 3+3 design. In this stage, three dosage groups were set up, namely selinexor 60mg QW, 40mg BIW, or 60mg BIW, in combination with venetoclax 100mg d1 200mg d2 400mg d3-28, orally once a day, and azacitidine 75mg/m2, d1-7, subcutaneously. The regimen was repeated every 28 days. In this case, RP2D is determined based on MTD, safety, and all other data. The methods of venetoclax and azacitidine remain unchanged during consolidation therapy. Before RP2D is determined, the dosage of selinexor is determined by the researchers based on individual subject tolerance. After RP2D is determined, the study enters the second stage of dose expansion. The induction therapy and consolidation therapy of the subjects will be administered at RP2D doses. During this study period, there were a total of 4 cycles. The treatment cycle of the subjects will include 2 cycles of induction therapy and up to 2 cycles of consolidation therapy. In addition, if the subject does not achieve remission (CR/Cr or PR) after 2 cycles of consolidation treatment (at the end of the 4th course), the study will be terminated by the subject, and the clinical doctor will choose the subsequent treatment for the subject based on clinical experience. The subjects will participate in the screening period, treatment period, and follow-up period. The screening period lasts for a maximum of 28 days before medication. The treatment period lasts from the first day of the first cycle to the end of the study treatment. The follow-up period starts after the end of treatment and lasts for at least 12 months.
Interventions
DRUGSelinexor
three dosage groups were set up, selinexor 60mg QW, 40mg BIW, or 60mg BIW
DRUGVenetoclax
cycle 1 100mg d1 200mg d2 400mg d3-28 cycle 2-4 400mg d1-d28
DRUGAzacitidine
75mg/m2 d1-d7 28d/cycle 4 cycles
Sponsors
Institute of Hematology & Blood Diseases Hospital, China
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
selinexor venetoclax and azacitidine
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Newly diagnosed AML patients diagnosed according to WHO standards who are not suitable for the standard induction treatment regimen of cytarabine combined with anthracycline drugs due to age or comorbidities. 2. Age ≥ 75 years old, ECOG score 0-2 points; The patient's age range is 18-75 years old, with an ECOG score of 0-3. 3. Liver function meets the following criteria: total bilirubin\<3 × Upper limit of normal range (ULN) (\<75 years old), total bilirubin\<1.5 × ULN (≥ 75 years old), AST\<3 × ULN and ALT\<3 × ULN. 4. Renal function meets the following criteria: creatinine clearance rate ≥ 30 mL/min (Cockroft-Gault formula). 5. Expected survival time greater than 6 months
Exclusion criteria
1. patient who has received BCL2 inhibitors, demethylation drugs, chemotherapy, CAR-T therapy, or other experimental therapies. 2. History of myeloproliferative tumors (MPN). 3. Cytogenetic low risk, such as t (8; 21), inv (16), t (16; 16) or t (15; 17). 4. Acute promyelocytic leukemia. 5. AML central nervous system (CNS) involvement. 6. Pregnancy or lactation period. 7. I underwent major surgery within 4 weeks before the first study medication. 8. Subjects with unstable or active cardiovascular diseases who meet any of the following criteria: 9. Symptomatic myocardial ischemia;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| RP2D of selinexor in this study | 1 year | from the first day to the last day of the cycle |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| MRD negative rate | up to 16 weeks | MRD negative rate at the end of 2 cycles and 4 cycles of induction therapy |
| Compound complete response rate | up to 16 weeks | From first dose of treatment to first day response is documented by evaluation |
| The time to compound complete response | up to 16 weeks | From first dose of treatment to first day response is documented by evaluation |
Countries
China
Outcome results
None listed