AKT Inhibitor MK-2206 in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia
Study Details
Study Description
Brief Summary
This phase II trial is studying how well AKT inhibitor MK-2206 works in treating patients with relapsed or refractory acute myeloid leukemia (AML). AKT inhibitor MK-2206 may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
Detailed Description
PRIMARY OBJECTIVES:
- Determine the proportion of patients achieving Morphologic Complete Response (CR), Morphologic CR with incomplete count recovery (CRp) or Partial Response (PR) as best response within 3 cycles of therapy with MK-2206.
SECONDARY OBJECTIVES:
-
Describe the disease-free survival of patients that achieve CR/CRp.
-
Determine the toxicity profile of single-agent MK-2206 in this patient population.
-
To determine the biologic effects of MK-2206 on leukemia cells.
OUTLINE:
Patients receive AKT inhibitor MK-2206 orally (PO) once weekly. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up periodically.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Treatment (Akt inhibitor MK2206) Akt inhibitor MK2206 200 mg orally once a week for each 28 day treatment cycle |
Drug: Akt inhibitor MK2206
200 mg orally (PO) once weekly. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Other Names:
Other: laboratory biomarker analysis
Correlative studies
|
Outcome Measures
Primary Outcome Measures
- Number of Participants With a Response of CR, CRp, or PR [12 weeks of treatment]
Responses defined by International Working Group (IWG) 2003 Response Criteria: Morphologic Complete Response (CR): Peripheral blood counts: No circulating blasts, Neutrophil count >/= 1.0 x10^9/L, Platelet count >/= 100 x10^9/L; Bone marrow aspirate and biopsy: </= 5% blasts, No detectable Auer rods, No extramedullary leukemia. Partial Response (PR): No circulating blasts, Neutrophil count >/=1.0 x10^9/L, Platelet count >/= 100 x10^9/L, >/= 50 % reduction in bone marrow blast to 6% to 25%, or blasts </= 5% if Auer rods are present. Morphologic CR with incomplete count recovery (CRp): All criteria for CR except for residual neutropenia (<1x10^9/L) or thrombocytopenia (<100 x10^9/L).
- Number of Participants With Treatment-related Non-hematological Toxicity [Up to 30 days post-treatment]
Toxicity assessed using the NIH-NCI Common Terminology Criteria for Adverse Events, version 4.0 (CTCAEv4.0)
Secondary Outcome Measures
- Maximum Percentage Change in Apoptosis [Baseline to 12 courses]
Peripheral blood Acute Myeloid Leukemia (AML) cells (total 2 x 10^6) used to determine induction of apoptosis in AML stem cells by 4-color flow cytometry assay (CD34/CD38/CD123/annexin). Two-sample t-test conducted to compare changes between the responders and non-responders. Responders are participants who obtain a CR, CRp, or PR, with or without cytogenetic response.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients must have histologically or cytologically confirmed AML other than acute promyelocytic leukemia (2008 World Health Organization (WHO) classification)
-
Patients must have persistent or relapsing disease requiring 2nd salvage therapy (e.g. treatment for second or higher relapse or for primary refractory disease after failure of two prior treatment regimens); duration of prior complete remission < 12 months if not refractory disease; patients with prior autologous and allogeneic hematopoietic stem cell transplantation are eligible if patients are off immunosuppression for >1 month and have no evidence of active graft versus host disease (GVHD) except grade 1 skin GVHD
-
Patients age >= 60 years with less than two prior treatment regimens not candidates for or have refused standard chemotherapy, excluding subjects with acute promyelocytic leukemia (APL) or with favorable cytogenetic abnormalities [inv16, t(8;21)]
-
Patient at the time of enrollment should not be a candidate for allogeneic stem cell transplantation
-
The Eastern Cooperative Oncology Group (ECOG) performance status =< 2
-
Serum creatinine or calculated creatinine clearance =< 1.5 * upper limit of normal (ULN) OR >= 60 mL/min for patients with creatinine levels > 1.5 * institutional ULN
-
Serum total bilirubin =< 2 * ULN OR direct bilirubin =< ULN for patients with total bilirubin levels > 2 * ULN, unless elevation is thought to be due to hepatic infiltration by AML, Gilbert's syndrome, or hemolysis
-
asparate aminotransferase (AST/SGOT) and alanine aminotransferase (ALT /SGPT) =< 2.5 * ULN or =< 5 * ULN unless considered to be secondary to leukemic involvement
-
Fasting serum glucose =< 150 mg/dl
-
HBA1c =< 9%
-
Female patient of childbearing potential must have a negative serum or urine pregnancy test beta- Human chorionic gonadotropin (hCG) within 72 hours prior to receiving the first dose of study medication; the effects of MK-2206 on the developing human fetus at the recommended therapeutic dose are unknown; for this reason women of childbearing potential and men must use two forms of contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, the patient should inform the treatment physician immediately
-
Patient, or the patient"s legal representative, has voluntarily agreed to participate by giving written informed consent
-
Patient is able to swallow tablets and has no surgical or anatomical condition that will preclude the patient from swallowing and absorbing oral medications on an ongoing basis
Exclusion Criteria:
-
Patients may not be receiving any other investigational agents
-
Major surgery, other than diagnostic surgery, within 4 weeks prior to Day 1, without complete recovery
-
Active uncontrolled infection
-
Systemic chemotherapy (with the exception of hydroxyurea) within 14 days (or within 5 half-lives for an investigational agent) prior to first dose of study drug, unless there is evidence of rapidly progressive disease; persistent chronic clinically significant toxicities from prior chemotherapy must not be > grade 1
-
Patients with central nervous system (CNS) involvement
-
Patient has known hypersensitivity to the components of study drug or its analogs
-
Uncontrolled congestive heart failure, unstable angina pectoris
-
Uncontrolled cardiac arrhythmia
-
History or current evidence of a myocardial infarction during the last 6 months
-
corrected Q-T interval (QTc) prolongation > 450 msec (Bazett's Formula)
-
Congenitally long QT syndrome, has received any marketed or experimental compound in the last 4 weeks or 5 half lives (whichever is shorter) prior to entering the study with possible or known effects of QT prolongation
-
Patient with symptomatic bradycardia, or a history of clinically significant bradyarrhythmias such as sick sinus syndrome, 2nd degree AV block (Mobitz Type 2)
-
Patient with uncontrolled hypertension (i.e., i.e., sustained systolic blood pressure
= 160 or diastolic >= 90); patients who are controlled on antihypertensive medication will be allowed to enter the study
-
Patient with poorly controlled diabetes defined as HBA1C > 9%
-
Patient is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the study
-
Patient is known to be Human Immunodeficiency Virus (HIV)-positive with history of AIDS defining conditions; or CD4 cells prior to leukemia onset =< 400 cells/mm^3; or patients receiving antiretroviral therapy that affects CYP3A4 such as protease inhibitors, efavirenz, nevirapine, or zidovudine
-
Patient has active Hepatitis B or C or active Hepatitis A
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | UT MD Anderson Cancer Center | Houston | Texas | United States | 77030 |
2 | Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium | Seattle | Washington | United States | 98109 |
Sponsors and Collaborators
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Marina Konopleva, MD, PHD, UT MD Anderson Cancer Center
Study Documents (Full-Text)
None provided.More Information
Additional Information:
- UT MD Anderson Cancer Center Official Website
- Fred Hutchinson Cancer Research Center Official Website
Publications
None provided.- NCI-2010-02186
- NCI-2010-02186
- 2010-0243
- 8731
- N01CM00039
- NCT01654978
Study Results
Participant Flow
Recruitment Details | Recruitment Period: October 27, 2010 to October 30, 2012. All recruitment done in medical clinics, either UT MD Anderson Cancer Center or Fred Hutchinson Cancer Research Center. |
---|---|
Pre-assignment Detail |
Arm/Group Title | Treatment (Akt Inhibitor MK2206) |
---|---|
Arm/Group Description | Akt inhibitor MK2206 200 mg orally once a week for each 28 day treatment cycle |
Period Title: Overall Study | |
STARTED | 19 |
COMPLETED | 17 |
NOT COMPLETED | 2 |
Baseline Characteristics
Arm/Group Title | Treatment (Akt Inhibitor MK2206) |
---|---|
Arm/Group Description | Akt inhibitor MK2206 200 mg orally once a week for each 28 day treatment cycle |
Overall Participants | 19 |
Age (years) [Mean (Full Range) ] | |
Mean (Full Range) [years] |
72
|
Sex: Female, Male (Count of Participants) | |
Female |
7
36.8%
|
Male |
12
63.2%
|
Race (NIH/OMB) (Count of Participants) | |
American Indian or Alaska Native |
0
0%
|
Asian |
1
5.3%
|
Native Hawaiian or Other Pacific Islander |
0
0%
|
Black or African American |
1
5.3%
|
White |
16
84.2%
|
More than one race |
0
0%
|
Unknown or Not Reported |
1
5.3%
|
Region of Enrollment (participants) [Number] | |
United States |
19
100%
|
Outcome Measures
Title | Number of Participants With a Response of CR, CRp, or PR |
---|---|
Description | Responses defined by International Working Group (IWG) 2003 Response Criteria: Morphologic Complete Response (CR): Peripheral blood counts: No circulating blasts, Neutrophil count >/= 1.0 x10^9/L, Platelet count >/= 100 x10^9/L; Bone marrow aspirate and biopsy: </= 5% blasts, No detectable Auer rods, No extramedullary leukemia. Partial Response (PR): No circulating blasts, Neutrophil count >/=1.0 x10^9/L, Platelet count >/= 100 x10^9/L, >/= 50 % reduction in bone marrow blast to 6% to 25%, or blasts </= 5% if Auer rods are present. Morphologic CR with incomplete count recovery (CRp): All criteria for CR except for residual neutropenia (<1x10^9/L) or thrombocytopenia (<100 x10^9/L). |
Time Frame | 12 weeks of treatment |
Outcome Measure Data
Analysis Population Description |
---|
No participant was not evaluable for response. |
Arm/Group Title | Treatment (Akt Inhibitor MK2206) |
---|---|
Arm/Group Description | Akt inhibitor MK2206 200 mg orally once a week for each 28 day treatment cycle |
Measure Participants | 18 |
CR |
0
0%
|
CRp |
1
5.3%
|
PR |
0
0%
|
Title | Number of Participants With Treatment-related Non-hematological Toxicity |
---|---|
Description | Toxicity assessed using the NIH-NCI Common Terminology Criteria for Adverse Events, version 4.0 (CTCAEv4.0) |
Time Frame | Up to 30 days post-treatment |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Treatment (Akt Inhibitor MK2206) |
---|---|
Arm/Group Description | Akt inhibitor MK2206 200 mg orally once a week for each 28 day treatment cycle Akt inhibitor MK2206: 200 mg orally (PO) once weekly. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. laboratory biomarker analysis: Correlative studies |
Measure Participants | 18 |
Neutropenic Fever |
2
10.5%
|
Documented infection |
6
31.6%
|
Pneumonia |
2
10.5%
|
Fever of Unknown Origin |
2
10.5%
|
QTc Prolongation |
4
21.1%
|
Maculopapular Rash |
10
52.6%
|
Hyperglycemia |
12
63.2%
|
Posterior reversible encephalopathy (PRES Syndrome |
1
5.3%
|
Title | Maximum Percentage Change in Apoptosis |
---|---|
Description | Peripheral blood Acute Myeloid Leukemia (AML) cells (total 2 x 10^6) used to determine induction of apoptosis in AML stem cells by 4-color flow cytometry assay (CD34/CD38/CD123/annexin). Two-sample t-test conducted to compare changes between the responders and non-responders. Responders are participants who obtain a CR, CRp, or PR, with or without cytogenetic response. |
Time Frame | Baseline to 12 courses |
Outcome Measure Data
Analysis Population Description |
---|
The Assay did not work so no comparison can be made. |
Arm/Group Title | Treatment (Akt Inhibitor MK2206) |
---|---|
Arm/Group Description | Akt inhibitor MK2206 200 mg orally once a week for each 28 day treatment cycle |
Measure Participants | 0 |
Adverse Events
Time Frame | Participants followed for up to a total of 12 cycles (up to 36 weeks), with serious adverse events captured from consent until 30 days after last dose of drug. Overall adverse events were collected from January 26, 2011 to October 22, 2012. | |
---|---|---|
Adverse Event Reporting Description | ||
Arm/Group Title | Treatment (Akt Inhibitor MK2206) | |
Arm/Group Description | Akt inhibitor MK2206 200 mg orally once a week for each 28 day treatment cycle | |
All Cause Mortality |
||
Treatment (Akt Inhibitor MK2206) | ||
Affected / at Risk (%) | # Events | |
Total | / (NaN) | |
Serious Adverse Events |
||
Treatment (Akt Inhibitor MK2206) | ||
Affected / at Risk (%) | # Events | |
Total | 12/19 (63.2%) | |
Blood and lymphatic system disorders | ||
Leukocytosis | 1/19 (5.3%) | 1 |
Neutrophil count decreased | 1/19 (5.3%) | 1 |
Platelet count decreased | 1/19 (5.3%) | 1 |
Cardiac disorders | ||
Myocardial infarction | 1/19 (5.3%) | 1 |
General disorders | ||
Fatigue | 3/19 (15.8%) | 3 |
Infections and infestations | ||
Anorectal infection | 1/19 (5.3%) | 1 |
Febrile neutropenia | 5/19 (26.3%) | 6 |
Infections | 2/19 (10.5%) | 2 |
Sepsis | 3/19 (15.8%) | 3 |
Soft Tissue Infection (cellulitis) | 1/19 (5.3%) | 1 |
Investigations | ||
Pain in extremity | 1/19 (5.3%) | 1 |
Metabolism and nutrition disorders | ||
Hyperglycemia | 5/19 (26.3%) | 6 |
Hyperkalemia | 1/19 (5.3%) | 1 |
Hypertension | 1/19 (5.3%) | 1 |
Musculoskeletal and connective tissue disorders | ||
Back pain | 1/19 (5.3%) | 1 |
Neoplasms benign, malignant and unspecified (incl cysts and polyps) | ||
Neoplasms | 1/19 (5.3%) | 1 |
Nervous system disorders | ||
Reversible posterior leukoencephalopathy syndrome | 1/19 (5.3%) | 1 |
Respiratory, thoracic and mediastinal disorders | ||
Hypoxia | 1/19 (5.3%) | 1 |
Lung infection | 1/19 (5.3%) | 1 |
Bilateral carck in lungs | 1/19 (5.3%) | 1 |
Skin and subcutaneous tissue disorders | ||
Pruritus | 1/19 (5.3%) | 1 |
Rash acneiform | 1/19 (5.3%) | 1 |
Rash maculo-papular | 4/19 (21.1%) | 4 |
Mucor fungal infection | 1/19 (5.3%) | 1 |
Other (Not Including Serious) Adverse Events |
||
Treatment (Akt Inhibitor MK2206) | ||
Affected / at Risk (%) | # Events | |
Total | 19/19 (100%) | |
Blood and lymphatic system disorders | ||
Edema limbs | 3/19 (15.8%) | 3 |
Cardiac disorders | ||
Electrocardiogram QT corrected interval prolonged | 1/19 (5.3%) | 1 |
Sinus tachycardia | 1/19 (5.3%) | 1 |
Ear and labyrinth disorders | ||
Hearing impaired | 1/19 (5.3%) | 1 |
Endocrine disorders | ||
Hidradenitis | 1/19 (5.3%) | 1 |
Eye disorders | ||
Periorbital edema | 1/19 (5.3%) | 1 |
Gastrointestinal disorders | ||
Anorexia | 2/19 (10.5%) | 2 |
Diarrhea | 10/19 (52.6%) | 11 |
Poor Appetitue, Gastrointestinal | 1/19 (5.3%) | 1 |
Hemorrhoids | 1/19 (5.3%) | 1 |
Mucositis oral | 2/19 (10.5%) | 2 |
Nausea | 2/19 (10.5%) | 2 |
Oral hemorrhage | 1/19 (5.3%) | 1 |
Sore throat | 1/19 (5.3%) | 1 |
Vomiting | 2/19 (10.5%) | 2 |
General disorders | ||
Epistaxis | 3/19 (15.8%) | 3 |
Fatigue | 8/19 (42.1%) | 8 |
Infections and infestations | ||
Throat Yeast infection | 1/19 (5.3%) | 1 |
Injury, poisoning and procedural complications | ||
Fall | 1/19 (5.3%) | 1 |
Investigations | ||
Chills | 1/19 (5.3%) | 1 |
Fever | 3/19 (15.8%) | 3 |
Pancytopenia | 1/19 (5.3%) | 1 |
Metabolism and nutrition disorders | ||
Creatinine increased | 1/19 (5.3%) | 1 |
Hyperglycemia | 13/19 (68.4%) | 26 |
Hypokalemia | 1/19 (5.3%) | 1 |
Musculoskeletal and connective tissue disorders | ||
Arthralgia | 1/19 (5.3%) | 1 |
Back Pain | 1/19 (5.3%) | 1 |
Bone Pain | 1/19 (5.3%) | 1 |
Gait disturbance | 1/19 (5.3%) | 1 |
Generalized muscle weakness | 1/19 (5.3%) | 1 |
Pain | 2/19 (10.5%) | 5 |
Nervous system disorders | ||
Dizziness | 1/19 (5.3%) | 1 |
Headache | 3/19 (15.8%) | 3 |
Intracranial hemorrhage | 1/19 (5.3%) | 1 |
Tremor | 1/19 (5.3%) | 1 |
Psychiatric disorders | ||
Anxiety | 1/19 (5.3%) | 1 |
Depression | 1/19 (5.3%) | 1 |
Insomnia | 2/19 (10.5%) | 2 |
Irritability | 1/19 (5.3%) | 1 |
Renal and urinary disorders | ||
Hematuria | 1/19 (5.3%) | 1 |
acute renal insufficiency, elevated creatinine | 1/19 (5.3%) | 1 |
Urinary frequency | 1/19 (5.3%) | 1 |
Urinary tract pain | 1/19 (5.3%) | 1 |
Respiratory, thoracic and mediastinal disorders | ||
Cough | 4/19 (21.1%) | 4 |
Dyspnea | 10/19 (52.6%) | 11 |
Laryngitis | 1/19 (5.3%) | 1 |
Skin and subcutaneous tissue disorders | ||
Bruising | 2/19 (10.5%) | 2 |
Dry skin | 1/19 (5.3%) | 1 |
Flushing | 1/19 (5.3%) | 1 |
Hyperhidrosis | 1/19 (5.3%) | 1 |
Pruritus | 4/19 (21.1%) | 4 |
Rash maculo-papular | 5/19 (26.3%) | 6 |
Night Sweats | 1/19 (5.3%) | 1 |
Petechiae | 1/19 (5.3%) | 1 |
Skin ulceration | 3/19 (15.8%) | 3 |
Leukemia Cutis | 1/19 (5.3%) | 1 |
Limitations/Caveats
More Information
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is less than or equal to 60 days. The sponsor cannot require changes to the communication and cannot extend the embargo.
Results Point of Contact
Name/Title | Marina Konopleva, MD, PHD / Professor |
---|---|
Organization | The University of Texas (UT) MD Anderson Cancer Center |
Phone | |
CR_Study_Registration@mdanderson.org |
- NCI-2010-02186
- NCI-2010-02186
- 2010-0243
- 8731
- N01CM00039
- NCT01654978