PF-04449913 For Patients With Acute Myeloid Leukemia at High Risk of Relapse After Donor Stem Cell Transplant

Sponsor
University of Colorado, Denver (Other)
Overall Status
Completed
CT.gov ID
NCT01841333
Collaborator
The Leukemia and Lymphoma Society (Other)
31
2
1
81.2
15.5
0.2

Study Details

Study Description

Brief Summary

This phase II trial will test whether the Hedgehog signaling pathway inhibitor PF-04449913 can decrease disease relapse in high-risk patients with acute myeloid leukemia after donor stem cell transplant.

Detailed Description

Disease relapse is the most common cause of death after allogeneic stem cell transplantation for acute myeloid leukemia. Patients at high risk for relapse may benefit from a novel, biologically rational therapeutic intervention to prevent this outcome. PF-04449913 is a small molecule inhibitor of the hedgehog (Hh) pathway that inhibits the protein Smoothened (SMO). Aberrant Hh signaling may contribute to the survival and expansion of the leukemia stem cell, and inhibiting the Hh pathway can eliminate these cells. Therefore, targeting Hh may be a logical intervention in the post-transplantation setting for those with high risk of relapse. The investigators propose a phase 2 study of PF-04449913 in patients with acute myeloid leukemia who have received an allogeneic stem cell transplantation and are at high risk of relapse.

This is an open label, phase 2 study employing PF-04449913 in acute myeloid leukemia patients who received an allogeneic stem cell transplantation and are at high risk of relapse. Patients will receive consecutive 28-day cycles of PF-04449913 at 100 mg/day, beginning on post-transplantation day 80 +/- 10 days, after their routine post-transplant bone marrow biopsy. Treatment will continue for up to one year or until they experience toxicity or disease relapse. 50 patients will be required for a 90% power to detect a 20% difference in one-year relapse-free survival.

Study Design

Study Type:
Interventional
Actual Enrollment :
31 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase 2 Study of PF-04449913 for the Treatment of Acute Myeloid Leukemia Patients With High Risk of Post-Allogeneic Stem Cell Transplantation Relapse
Actual Study Start Date :
Apr 29, 2013
Actual Primary Completion Date :
May 8, 2019
Actual Study Completion Date :
Feb 4, 2020

Arms and Interventions

Arm Intervention/Treatment
Experimental: PF-04449913

Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity.

Drug: PF-04449913
100mg given orally
Other Names:
  • Hedgehog inhibitor
  • Outcome Measures

    Primary Outcome Measures

    1. Relapse-free Survival in Days [1 year]

      Days after transplant until disease relapse or death as measured by Kaplan-Meier statistical method.

    Secondary Outcome Measures

    1. Remission Duration [Up to 5 years]

      Length of time before remission measured in days

    2. Number of Patients With Adverse Events (AE) Related to Glasdegib [30 days]

      Subjects will be evaluated for AEs at each visit with the NCI-CTCAE version 4.03 used as a guide for the grading of severity.

    3. Overall Survival of All Patients [1 year]

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • WHO-confirmed AML

    • Age ≥18 years

    • Between days 28 and 50 post transplantation at the time of initiation of the study drug

    • ECOG performance status ≤ 2 (See Appendix A: ECOG Performance Status Scale)

    • Life expectancy > 2 months

    • Recipient of a myeloablative or non-myeloablative allogeneic HSCT

    • Conditioning regimen to be prescribed at investigator's discretion, but will be prospectively defined as myeloablative or non-myeloablative

    • Stable engraftment, as defined by absolute neutrophil count (ANC) ≥ 1000/mm3 and platelets ≥ 25,000/mm3

    • In morphologic remission (< 5% marrow blasts) based on BM biopsy performed +/- 5 days of day 28 post- transplantation

    • Without clinical signs of active central nervous system disease

    • For non-myeloablative transplants, ≥50% CD3 donor chimerism at screening

    • High risk of relapse after HSCT, defined as the presence of minimal residual disease as measured by flow cytometry in the absence of evidence of morphologic disease on a bone marrow biopsy prior to HSCT

    • Adequate organ function as indicated by the following laboratory values:

    • Aspartate aminotransferase (AST), alanine aminotransferase, (ALT) ≤ 3.0 x institutional upper limit of normal (ULN)

    • Total bilirubin ≤ 2.0 x institutional ULN, unless documented Gilbert's syndrome

    • Either creatinine <1.5 x institutional upper limit of normal (ULN) or creatinine clearance >60 mL/min as calculated by institution's standard formula

    • Serum/urine pregnancy test (for females of childbearing potential) that is negative within 72 hours prior to initiation of first dose of treatment (a patient is of childbearing potential if, in the opinion of the investigator, she is biologically capable of having children and is sexually active)

    • Female patients of childbearing potential and sexually active males and female partners of childbearing potential must agree to use a highly effective method of contraception throughout the study and for at least 90 days after the last dose of assigned treatment.

    • Subject is able to comply with study procedures and follow-up examinations.

    Exclusion Criteria:
    • Concomitant treatment with other anti-neoplastic agents, with the exception, when clinically indicated, of prophylaxis in the post-transplantation setting with intrathecal chemotherapy

    • Use of any other experimental drug or therapy within 28 days of baseline

    • Inability to swallow or absorb drug

    • Active uncontrolled acute fungal, bacterial, or other infection that is unresponsive to therapy at time of study drug dosing

    • Unstable angina pectoris

    • New York Heart Association Class III or IV heart failure

    • QTc interval (using Fridericia's correction formula, QTcF, if prolonged) >470 msec

    • Active cardiac arrhythmias with rapid ventricular response (defined as heart rate greater than 100 beats/minute)

    • Known HIV infection

    • Grade III/IV acute GVHD

    • Current use or anticipated need for food or drugs that are known moderate/strong CYP3A4 inducers (See Table 1 and section 5.9.2: Prohibited Concomitant Therapy), with the exception of azole antifungals, which are permitted.

    • Any medical, psychiatric, addictive or other kind of disorder which compromises the ability of the subject to give written informed consent and/or to comply with procedures.

    • Pregnant or lactating females

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 University of Colorado Cancer Center Aurora Colorado United States 80045
    2 Ohio State University Columbus Ohio United States 43210

    Sponsors and Collaborators

    • University of Colorado, Denver
    • The Leukemia and Lymphoma Society

    Investigators

    • Principal Investigator: Daniel A Pollyea, MD, MS, University of Colorado, Denver

    Study Documents (Full-Text)

    More Information

    Publications

    None provided.
    Responsible Party:
    University of Colorado, Denver
    ClinicalTrials.gov Identifier:
    NCT01841333
    Other Study ID Numbers:
    • 12-1558.cc
    • NCI-2013-00824
    First Posted:
    Apr 26, 2013
    Last Update Posted:
    Jan 25, 2022
    Last Verified:
    Dec 1, 2021
    Individual Participant Data (IPD) Sharing Statement:
    No
    Plan to Share IPD:
    No
    Keywords provided by University of Colorado, Denver
    Additional relevant MeSH terms:

    Study Results

    Participant Flow

    Recruitment Details Location: two tertiary care referral centers Dates of recruitment were April 2013 to May 2019
    Pre-assignment Detail
    Arm/Group Title PF-04449913
    Arm/Group Description Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. PF-04449913: 100mg given orally
    Period Title: Overall Study
    STARTED 31
    COMPLETED 31
    NOT COMPLETED 0

    Baseline Characteristics

    Arm/Group Title High Risk for Relapse Postallogeneic Stem Cell Transplant
    Arm/Group Description AML and MDS patients at high risk for postallogeneic stem cell transplant relapse
    Overall Participants 31
    Age (years) [Median (Full Range) ]
    Median (Full Range) [years]
    58
    Sex: Female, Male (Count of Participants)
    Female
    17
    54.8%
    Male
    14
    45.2%
    Race/Ethnicity, Customized (Count of Participants)
    Race : White
    29
    93.5%
    Race : Black or African American
    1
    3.2%
    Race : American Indian or Alaska Native
    1
    3.2%

    Outcome Measures

    1. Primary Outcome
    Title Relapse-free Survival in Days
    Description Days after transplant until disease relapse or death as measured by Kaplan-Meier statistical method.
    Time Frame 1 year

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title PF-04449913
    Arm/Group Description Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. PF-04449913: 100mg given orally
    Measure Participants 31
    Median (Inter-Quartile Range) [days]
    142
    2. Secondary Outcome
    Title Remission Duration
    Description Length of time before remission measured in days
    Time Frame Up to 5 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title PF-04449913
    Arm/Group Description Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. PF-04449913: 100mg given orally
    Measure Participants 31
    Median (Inter-Quartile Range) [days]
    333
    3. Secondary Outcome
    Title Number of Patients With Adverse Events (AE) Related to Glasdegib
    Description Subjects will be evaluated for AEs at each visit with the NCI-CTCAE version 4.03 used as a guide for the grading of severity.
    Time Frame 30 days

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title PF-04449913
    Arm/Group Description Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. PF-04449913: 100mg given orally
    Measure Participants 31
    Count of Participants [Participants]
    28
    90.3%
    4. Secondary Outcome
    Title Overall Survival of All Patients
    Description
    Time Frame 1 year

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title PF-04449913
    Arm/Group Description Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. PF-04449913: 100mg given orally
    Measure Participants 31
    Number [percentage of participants]
    64.5
    208.1%

    Adverse Events

    Time Frame AE's were collected over the 1 year subjects were on glasdegib
    Adverse Event Reporting Description
    Arm/Group Title PF-04449913
    Arm/Group Description Beginning 80 days after allogeneic stem cell transplant, patients receive PF-04449913 (100mg) orally once daily on days 1-28. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. PF-04449913: 100mg given orally
    All Cause Mortality
    PF-04449913
    Affected / at Risk (%) # Events
    Total 19/31 (61.3%)
    Serious Adverse Events
    PF-04449913
    Affected / at Risk (%) # Events
    Total 2/31 (6.5%)
    Gastrointestinal disorders
    Worsening nausea, appetite changes 1/31 (3.2%)
    nausea 1/31 (3.2%)
    Other (Not Including Serious) Adverse Events
    PF-04449913
    Affected / at Risk (%) # Events
    Total 26/31 (83.9%)
    Blood and lymphatic system disorders
    Thrombocytopenia 2/31 (6.5%)
    lymphopenia 1/31 (3.2%)
    neutropenia 1/31 (3.2%)
    Gastrointestinal disorders
    Dysgeusia 4/31 (12.9%)
    Nausea 1/31 (3.2%)
    Diarrhea 3/31 (9.7%)
    Hepatobiliary disorders
    hyperbilirubinemia 1/31 (3.2%)
    LFT Increase 1/31 (3.2%)
    Metabolism and nutrition disorders
    Anorexia/Weight Loss 3/31 (9.7%)
    hypophosphatemia 1/31 (3.2%)
    hypocalcemia 1/31 (3.2%)
    hypoalbuminemia 1/31 (3.2%)
    hypertriglyceridemia 1/31 (3.2%)
    hyponatremia 1/31 (3.2%)
    Musculoskeletal and connective tissue disorders
    Cramping/Myalgias 8/31 (25.8%)
    arthralgia 1/31 (3.2%)
    Skin and subcutaneous tissue disorders
    Alopecia 1/31 (3.2%)

    Limitations/Caveats

    [Not Specified]

    More Information

    Certain Agreements

    Principal Investigators are NOT employed by the organization sponsoring the study.

    There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

    Results Point of Contact

    Name/Title Dr. Daniel Pollyea
    Organization University of Colorado
    Phone 720-848-8084
    Email DANIEL.POLLYEA@cuanschutz.edu
    Responsible Party:
    University of Colorado, Denver
    ClinicalTrials.gov Identifier:
    NCT01841333
    Other Study ID Numbers:
    • 12-1558.cc
    • NCI-2013-00824
    First Posted:
    Apr 26, 2013
    Last Update Posted:
    Jan 25, 2022
    Last Verified:
    Dec 1, 2021