Phase 3 Randomized, Open-Label Study of Guadecitabine vs Treatment Choice in Previously Treated Acute Myeloid Leukemia
Study Details
Study Description
Brief Summary
Multicenter, randomized, open-label, parallel-group study of guadecitabine vs treatment choice (TC). Subjects will be randomly assigned in a 1:1 ratio to either guadecitabine or TC. TC options include the 8 high or low intensity, locally available regimens below; or Best supportive Care (BSC) alone:
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High intensity (intermediate or high dose cytarabine [HiDAC]; mitoxantrone, etoposide, and cytarabine [MEC]; or fludarabine, cytarabine, granulocyte colony stimulating factor [G-CSF], +/- idarubicin [FLAG/FLAG-Ida]).
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Low intensity (low dose cytarabine [LDAC], decitabine, or azacitidine).
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BSC.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
Detailed Description
This Phase 3, randomized, open-label, parallel-group multicenter study of the efficacy and safety of guadecitabine in adults with previously treated AML will be conducted in approximately 20 countries. There will be a 14-day screening period, a treatment period, a safety follow-up visit, and a long-term follow-up period. The study is expected to last approximately 2 years. Duration of individual subject participation will vary, and subjects may continue to receive treatment for as long as they continue to benefit.
Approximately 404 subjects from approximately 100 study centers will be randomly assigned to either guadecitabine or treatment choice (TC) in a 1:1 ratio (approximately 202 subjects per group). TC is as follows:
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High intensity: intermediate or high dose cytarabine (HiDAC); mitoxantrone, etoposide, and cytarabine (MEC); or fludarabine, cytarabine, G-CSF, +/- idarubicin (FLAG/FLAG-Ida).
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Low intensity: low dose cytarabine (LDAC), decitabine, or azacitidine.
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Best Supportive Care (BSC).
Guadecitabine will be given SC at a dose of 60 mg/m2 in 28-day cycles. In Cycle 1, guadecitabine will be given for 10 days on Days 1-5 and Days 8-12. Cycle 2 will be either the 5-day regimen (Days 1-5) or 10-day regimen (Days 1-5 and 8-12) based on assessment of disease response and hematologic recovery at the end of Cycle 1. In subsequent cycles, guadecitabine treatment will be for 5 days only (Days 1-5).
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: guadecitabine Guadecitabine will be given SC at a dose of 60 mg/m2 in 28-day cycles (delayed as necessary to allow blood count recovery). |
Drug: guadecitabine
In Cycle 1, guadecitabine will be given for 10 days on Days 1-5 and Days 8-12. In Cycle 2, the guadecitabine dose will be 60 mg/m2 for either 10 days (Days 1-5 and 8-12) or 5 days (Days 1-5 only) based on assessment of disease response, and hematological recovery by Day ≥28.
Other Names:
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Active Comparator: Treatment Choice (TC) High intensity Low intensity Best supportive care (BSC). |
Drug: Treatment Choice (TC)
High intensity: Intermediate or high dose cytarabine (HiDAC).
Low intensity:
LDAC.
Decitabine.
Azacitidine.
Best supportive care only: given according to standard and institutional practice.
|
Outcome Measures
Primary Outcome Measures
- Overall survival [24 months]
Number of days from day subject was randomized to date of death, regardless of cause.
Secondary Outcome Measures
- Event-free survival [24 months]
Number of days from randomization to earliest date of disease progression, treatment discontinuation, start of anti-leukemia therapy, or death.
- Long-term survival [24 months]
Survival at one year.
- Number of days alive and out of the hospital (NDAOH). [24 months]
Number of days subject alive and out of hospital during first 6 months of the study.
- Transfusion independence rate [24 months]
Number of subjects without RBC or platelet transfusion for any 8-week period after treatment divided by total number of subjects in efficacy analysis.
- Complete response rate [24 months]
Number of subjects with best response of CR divided by total number of subjects in efficacy analysis.
- Composite complete response [24 months]
Number of subjects with best response of CR, CRp, or CRi divided by total number of subjects in efficacy analysis.
- Hematopoietic cell transplant (HCT) rate [24 months]
Number of subjects who received HCT after randomization divided by total number of subjects in efficacy analysis.
- Duration of complete response (CR) [24 months]
Duration of CR (in number of days) will be calculated from the first time a CR is observed to time of relapse (defined as the earliest time point whereby BM assessment or PB assessment indicate relapse/disease progression due to confirmed reappearance of ≥5% leukemic blasts in PB or ≥5% leukemic blasts in BM.
- Quality of life [6 months]
The calculation for EQ-5D-5L index value will be performed according to EuroQol group's EQ-5D-5L User Guide.
- Incidence and severity of adverse events [24 months]
Subject reported and investigator-observed AEs and 30- and 60-day all-cause mortality, along with clinical laboratory tests (hematology, chemistries), concomitant Medications, physical examination, vital signs, ECOG performance status and ECGs.
- 30- and 60-day all-cause mortality [24 months]
Number of deaths, regardless of cause, within 30 or 60 days from the first study dose divided by the total number of subjects included in the safety analysis set.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adult subjects ≥18 years of age who are able to understand study procedures, comply with them, and provide written informed consent before any study-specific procedure.
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History of cytologically or histologically confirmed diagnosis of AML (except acute promyelocytic leukemia) according to the 2008 World Health Organization (WHO) classification (bone marrow [BM] or peripheral blood [PB] blast counts ≥20%).
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Performance status (Eastern Cooperative Oncology Group; ECOG) of 0-2.
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Subjects with AML previously treated with initial induction therapy using a standard intensive chemotherapy regimen, including cytarabine and an anthracycline, and who are refractory to initial induction (primary refractory) or in relapse after such initial induction with or without prior HCT.
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Subjects must have either PB or BM blasts ≥5% at time of randomization.
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Creatinine clearance or glomerular filtration rate ≥30 mL/min as estimated by the Cockroft-Gault (C-G) or other medically acceptable formulas, such as MDRD (Modification of Diet in Renal Disease) or CKD-EPI (the Chronic Kidney Disease Epidemiology Collaboration).
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Women of child-bearing potential must not be pregnant or breastfeeding and must have a negative pregnancy test at screening. Women of child-bearing potential and men with female partners of child-bearing potential must agree to practice 2 highly effective contraceptive measures of birth control and must agree not to become pregnant or father a child (a) while receiving treatment of guadecitabine, decitabine, or azacitidine and for at least 3 months after completing treatment and (b) while receiving treatment with high-intensity TC or LDAC and for at least 6 months after completing treatment.
Exclusion Criteria:
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Known clinically active central nervous system (CNS) or extramedullary AML, except leukemia cutis.
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Subjects who are in first relapse after initial induction, if they had a response duration of >12 months from date when first response first documented or if they are good candidates for HCT.
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BCR-ABL-positive leukemia (chronic myelogenous leukemia in blast crisis).
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Second malignancy currently requiring active therapy, except breast or prostate cancer stable on or responding to endocrine therapy.
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Grade 3 or higher Graft Versus Host Disease (GVHD), or GVHD on either a calcineurin inhibitor or prednisone more than 5 mg/day.
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Prior treatment with guadecitabine for any indication, or more than 2 cycles of prior decitabine or azacitidine.
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Hypersensitivity to decitabine, guadecitabine, or any of their excipients.
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Treated with any investigational therapy within 2 weeks of the first dose of study treatment.
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Total serum bilirubin >2.5 × upper limit of normal (ULN; except for subjects with Gilbert's Syndrome for whom direct bilirubin is <2.5 × ULN), or liver cirrhosis, or chronic liver disease Child-Pugh Class B or C.
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Known active human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) infection. Inactive hepatitis carrier status or low viral hepatitis titer on antivirals is allowed.
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Known significant mental illness or other condition such as active alcohol or other substance abuse or addiction that, in the opinion of the investigator, predisposes the subject to high risk of noncompliance with the protocol.
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Refractory congestive heart failure unresponsive to medical treatment; active infection resistant to all antibiotics; or non-AML-associated pulmonary disease requiring >2 liters per minute (LPM) oxygen, or any other condition that puts the subject at an imminent risk of death.
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Subjects with high PB blasts >50% AND poor ECOG PS of 2.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | University of Southern California | Los Angeles | California | United States | 90033 |
2 | The University of Chicago Medical Center | Chicago | Illinois | United States | 60637 |
3 | Franciscan Research Center | Indianapolis | Indiana | United States | 46237 |
4 | John Theurer Cancer Center at Hackensack University Medical Center | Hackensack | New Jersey | United States | 07601-1915 |
5 | University of New Mexico School of Medicine | Albuquerque | New Mexico | United States | 87106 |
6 | Roswell Park Cancer Institute | Buffalo | New York | United States | 14263 |
7 | Weill Cornell Medical College | New York | New York | United States | 10021 |
8 | Duke Cancer Institute | Durham | North Carolina | United States | 27710 |
9 | University of Oklahoma Medical Center | Oklahoma City | Oklahoma | United States | 73104-5418 |
10 | Hospital of the University of Pennsylvania | Philadelphia | Pennsylvania | United States | 19104 |
11 | Temple University Hospital | Philadelphia | Pennsylvania | United States | 19111-2433 |
12 | Vanderbilt University Medical Center | Nashville | Tennessee | United States | 37232 |
13 | Baylor Research Institute | Dallas | Texas | United States | 75246 |
14 | MD Anderson Cancer Center | Houston | Texas | United States | 77030 |
15 | West Virginia University Hospitals, Inc. | Morgantown | West Virginia | United States | 26506 |
16 | AZ Sint-Jan Brugge-Oostende AV | Brugge | Belgium | 8000 | |
17 | Cliniques Universitaires Saint-Luc | Brussels | Belgium | 1200 | |
18 | Universitair Ziekenhuis Gent | Gent | Belgium | 9000 | |
19 | Tom Baker Cancer Centre | Calgary | Alberta | Canada | T2N 4N2 |
20 | University of Alberta Hospital | Edmonton | Alberta | Canada | T6G 2V2 |
21 | Princess Margaret Cancer Centre | Toronto | Ontario | Canada | M5G 2C1 |
22 | McGill University Health Centre | Montreal | Quebec | Canada | H4A 3J1 |
23 | Hopital Maisonneuve Rosemont | Montreal | Canada | H1T 2M4 | |
24 | Aarhus University Hospital | Aarhus C | Denmark | 8000 | |
25 | Rigshospitalet | Copenhagen | Denmark | 2100 | |
26 | Centre Hospitalier de la Côte Basque | Bayonne | France | 64100 | |
27 | Hôpital de la Conception | Marseille | France | 13385 | |
28 | CHRU Montpellier - Saint Eloi | Montpellier | France | 34295 | |
29 | Groupe Hospitalier de la Région de Mulhouse et Sud Alsace | Mulhouse | France | 68100 | |
30 | Hôpital Saint-Louis | Paris | France | 75475 | |
31 | CHU Hopitaux de Bordeaux - Hôpital Haut-Lévêque | Pessac | France | 33604 | |
32 | Centre Hospitalier Lyon-Sud | Pierre Bénite | France | 69310 | |
33 | Centre Henri Becquerel | Rouen cedex 1 | France | 76038 | |
34 | Institut Universitaire du Cancer de Toulouse - Oncopole | Toulouse | France | 31059 | |
35 | Universitätsklinikum Leipzig | Leipzig | Sachsen | Germany | 4103 |
36 | Städtisches Klinikum Braunschweig gGmbH | Braunschweig | Germany | 38114 | |
37 | Marien Hospital Düsseldorf GmbH | Düsseldorf | Germany | 40479 | |
38 | Universitätsklinikum Halle (Saale) | Halle | Germany | 6120 | |
39 | Universitätsklinikum Schleswig-Holstein | Kiel | Germany | 24105 | |
40 | Medizinischen Fakultät Mannheim der Universität Heidelberg | Mannheim | Germany | ||
41 | Klinikum der Universität München | Muenchen | Germany | 81377 | |
42 | Universitätsklinikum Ulm | Ulm | Germany | 89081 | |
43 | SE ÁOK I. sz. Belgyógyászati Klinika | Budapest | Hungary | 1083 | |
44 | Debreceni Egyetem Klinikai Központ | Debrecen | Hungary | 4032 | |
45 | Somogy Megyei Kaposi Mór Oktató Kórház | Kaposvar | Hungary | 7400 | |
46 | Pecsi Tudomanyegyetem Klinikai Központ | Pécs | Hungary | ||
47 | Szegedi Tudományegyetem | Szeged | Hungary | 6725 | |
48 | IRCCS AOU San Martino - IST | Genova | Italy | 16132 | |
49 | Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico | Milano | Italy | 20122 | |
50 | Ospedale San Raffaele - Milano | Milano | Italy | 20132 | |
51 | A.O.R.N. "A. Cardarelli" | Napoli | Italy | 80131 | |
52 | A.S.U Integrata di Udine - Presidio Ospedaliero Santa Maria della Misericordia | Udine | Italy | 33100 | |
53 | Akita University Hospital | Akita-shi | Japan | 010-8543 | |
54 | Chugoku Central Hospital | Fukuyama-Shi | Japan | 720-0001 | |
55 | Tokai University Hospital | Isehara-shi | Japan | 259-1193 | |
56 | Saitama Medical Center | Kawagoe-Shi | Japan | 350-8550 | |
57 | Kobe City Medical Center General Hospital | Kobe-shi | Japan | 650-0047 | |
58 | Japanese Red Cross Kyoto Daini Hospital | Kyoto-shi | Japan | 602-8026 | |
59 | University Hospital, Kyoto Prefectural University of Medicine | Kyoto-shi | Japan | 602-8566 | |
60 | Gunmaken Saiseikai Maebashi Hospital | Maebashi-shi | Japan | 371-0821 | |
61 | Nagasaki University Hospital | Nagasaki-shi | Japan | 852-8501 | |
62 | The Japanese Red Cross Nagasaki Genbaku Hospital | Nagasaki-Shi | Japan | 852-8511 | |
63 | Kindai University Hospital | Osakasayama-Shi | Japan | 589-8511 | |
64 | Saga University Hospital | Saga-shi | Japan | 849-8501 | |
65 | NTT Medical Center Tokyo | Shinagawa-Ku | Japan | 141-8625 | |
66 | Shizuoka Cancer Center | Shizuoka | Japan | 411-8777 | |
67 | National Hospital Organization Disaster Medical Center | Tachikawa-Shi | Japan | 190-0014 | |
68 | Yamagata University Hospital | Yamagata-Shi | Japan | 990-9585 | |
69 | University of Fukui Hospital | Yoshida-Gun | Japan | 910-1193 | |
70 | Pusan National University Hospital | Busan | Korea, Republic of | 49241 | |
71 | Seoul National University Hospital | Seoul | Korea, Republic of | 3080 | |
72 | Severance Hospital | Seoul | Korea, Republic of | 3722 | |
73 | Asan Medical Center | Seoul | Korea, Republic of | 5505 | |
74 | Samsung Medical Center | Seoul | Korea, Republic of | 6351 | |
75 | The Catholic University of Korea, Seoul St. Mary's Hospital | Seoul | Korea, Republic of | 6591 | |
76 | Ulsan University Hospital (UUH) | Ulsan | Korea, Republic of | 44033 | |
77 | Instytut Hematologii i Transfuzjologi | Warszawa | Poland | 02-776 | |
78 | Hospital Clínic de Barcelona | Barcelona | Spain | 8036 | |
79 | Hospital de la Santa Creu i Sant Pau | Barcelona | Spain | 8041 | |
80 | Hospital Duran i Reynals | Barcelona | Spain | 8907 | |
81 | Vall d'Hebron Institut d'Oncologia | Barcelona | Spain | ||
82 | Hospital San Pedro de Alcántara | Cáceres | Spain | 10003 | |
83 | Hospital Universitario Reina Sofía | Córdoba | Spain | 14004 | |
84 | Hospital General Universitario Gregorio Marañón | Madrid | Spain | 28007 | |
85 | Hospital Universitario Central de Asturias | Oviedo | Spain | 33011 | |
86 | Hospital Universitario Virgen del Rocío | Sevilla | Spain | 41013 | |
87 | Hospital Universitario Dr. Peset | Valencia | Spain | 46017 | |
88 | Hospital Universitari i Politècnic La Fe | Valencia | Spain | 46026 | |
89 | Sahlgrenska University Hospital | Göteborg | Sweden | 413 45 | |
90 | Khmelnytskyi Regional Hospital | Khmelnytskyi | Ukraine | 29000 | |
91 | Poltava Regional Clinical Hospital named after M. V. Sklifosovskoho | Poltava | Ukraine | 36011 | |
92 | Heart of England NHS Foundation Trust - Heartlands Hospital | Birmingham | United Kingdom | B9 5SS | |
93 | University Hospitals Bristol NHS Foundation Trust - Bristol Haematology and Oncology Centre | Bristol | United Kingdom | BS2 8ED | |
94 | East Kent Hospitals University NHS Foundation Trust - Kent and Canterbury Hospital | Canterbury | United Kingdom | CT1 3NG | |
95 | St. James's University Hospital | Leeds | United Kingdom | LS9 7TF |
Sponsors and Collaborators
- Astex Pharmaceuticals, Inc.
Investigators
- Study Director: Harold N Keer, MD, PhD, Astex Pharmaceuticals, Inc.
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- SGI-110-06