Phase II Part 2 Expansion of Oral Rigosertib in Combination With Azacitidine

Sponsor

Onconova Therapeutics, Inc. (Industry)

Overall Status

Completed

CT.gov ID

NCT01926587

Collaborator

(none)

Enrollment

Locations

Arm

90.5

Duration (Months)

3.5

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study, is a Phase I/II clinical trial in three parts: Phase I Dose Escalation, Phase II, Part 1 RPTD Cohort, and Phase II, Part 2 Expansion. The first two parts have been completed. The Phase II, Part 2 Expansion will assess if treatment with rigosertib in combination with azacitidine, has measurable effects in patients with myelodysplastic syndrome (MDS). Safety of patients is an objective throughout all parts of the study.

Condition or Disease	Intervention/Treatment	Phase
Myelodysplastic Syndrome Acute Myeloid Leukemia Chronic Myelomonocytic Leukemia	Drug: oral rigosertib Drug: Azacitidine	Phase 1/Phase 2

Detailed Description

This will be a Phase I/II open-label, single-arm, dose-escalating, multicenter study, in three parts: Phase I Dose Escalation, Phase II, Part 1 RPTD Cohort, and Phase II, Part 2 Expansion, in which patients with myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), or chronic myelomonocytic leukemia (CMML) will receive subcutaneous (SC) or intravenous (IV) azacitidine per approved label in combination with oral rigosertib. The first two parts of the study have been completed.

The Phase II Part 2 Expansion will enroll up to 40 patients, randomized 1:1 into 2 cohorts of up to 20 patients each, to receive 1120 mg of rigosertib over 24 hours: either 560 mg in the morning and 560 mg in the afternoon, or 840 mg in the morning and 280 mg in the afternoon. The afternoon dose in both cohorts must be administered at 3 PM (±1 hr) at least 2 hr after lunch. In the Phase II, Part 2 Expansion patients with RAEB t/non-proliferative AML will be eligible, however patients with CMML will not.

Study Design

Study Type:

Interventional

Actual Enrollment :

45 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase I/II, Multi-center, Dose-escalating Study of the Tolerability, Pharmacokinetics, and Clinical Activity of the Combined Administration of Oral Rigosertib With Azacitidine in Patients With Myelodysplastic Syndrome or Acute Myeloid Leukemia

Study Start Date :

Aug 1, 2013

Actual Primary Completion Date :

Dec 8, 2020

Actual Study Completion Date :

Feb 16, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Oral rigosertib plus azacitidine Oral rigosertib will be administered twice a day in fasting conditions for weeks 1, 2, and 3 of a 4-week cycle. Starting on Day 1 of second week (Day 8) of the cycle, azacitidine will be administered by subcutaneous injection or intravenous infusion at the labeled daily dose of 75 mg/m2, for 7 days.	Drug: oral rigosertib Oral rigosertib will be administered twice a day in fasting conditions for weeks 1, 2, and 3 of a 4-week cycle. Other Names: ON 01910.Na Drug: Azacitidine Starting on Day 1 of second week (Day 8) of the cycle, azacitidine will be administered by subcutaneous injection or intravenous infusion at the labeled daily dose of 75 mg/m2, for 7 days. Other Names: Vidaza

Arm

Intervention/Treatment

Experimental: Oral rigosertib plus azacitidine

Oral rigosertib will be administered twice a day in fasting conditions for weeks 1, 2, and 3 of a 4-week cycle. Starting on Day 1 of second week (Day 8) of the cycle, azacitidine will be administered by subcutaneous injection or intravenous infusion at the labeled daily dose of 75 mg/m2, for 7 days.

Drug: oral rigosertib

Oral rigosertib will be administered twice a day in fasting conditions for weeks 1, 2, and 3 of a 4-week cycle.

Other Names:

ON 01910.Na

Drug: Azacitidine

Starting on Day 1 of second week (Day 8) of the cycle, azacitidine will be administered by subcutaneous injection or intravenous infusion at the labeled daily dose of 75 mg/m2, for 7 days.

Other Names:

Vidaza

Outcome Measures

Primary Outcome Measures

Dose escalation part of study: Number of patients in whom Dose a Limiting Toxicity (DLT) are observed [28 days]
Dose Limiting Toxicity is defined as Grade 3 or greater non-hematological toxicity or stomatitis and/or esophagitis/dysphagitis lasting longer than 3 days.
Dose escalation part of study: Number of patients in whom adverse events are observed [Up to 48 weeks]
Adverse events will be coded using the most recent version of the Medical Dictionary for Regulatory Activities (MedDRA) and summarized by system organ class (SOC), preferred term (PT), and worst Common Terminology Criteria for Adverse Events (CTCAE) Version 4 grade per patient.
In Phase 2 of study: Number of patients in whom adverse events are observed [Up to 48 weeks]
Adverse events will be coded using the most recent version of the Medical Dictionary for Regulatory Activities (MedDRA) and summarized by system organ class (SOC), preferred term (PT), and worst Common Terminology Criteria for Adverse Events (CTCAE) Version 4 grade per patient.
In Phase 2 of study: Area Under the Curve (AUC) [Day 1 and Day 15]
The following time points will be used to collect samples to determine the AUC on Day 1 and 15: Pre-dose the first dose of the day and at 0.5, 1.0, 1.5, 2.0, 4.0, 6.0, and 8.0 hour post dose the first dose of the day.
In Phase 2 of the study: Cmax [Days 1 and 15.]
The following time points will be used to collect samples to determine the Cmax on Day 1 and 15: Pre-dose the first dose of the day and at 0.5, 1.0, 1.5, 2.0, 4.0, 6.0, and 8.0 hour post dose the first dose of the day.

Secondary Outcome Measures

Number of patients with complete or partial response [Up to 48 weeks]
Complete remission (CR) or partial remission (PR) or bone marrow CR according to 2006 International Working Group criteria.
Number of patients in whom improvements in absolute neutrophil count, platelet count, and erythroid responses are observed [Up to 48 weeks.]
Hematologic Improvement according to 2006 International Working Group criteria.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Diagnosis of MDS, CMML, or RAEB-t/non-proliferative AML (as defined by 20-30% BMBL, WBC ≤ 25,000 x 10^{9/L and stable for at least 4 weeks without intervention) according
to World Health Organization (WHO) criteria or French American British (FAB)
classification either previously treated or previously untreated. The diagnosis must
be confirmed via BM aspirate and/or biopsy within 6 weeks prior to Screening. Note:
patients with RAEB-t/non-proliferative AML (as defined by 20-30% BMBL, WBC ≤ 25,000 x
10}9/L and stable for at least 4 weeks without intervention) are not eligible for the Phase II Part 1 RPTD component of the study and patients with CMML will not be eligible for Phase II Part 2 Expansion of the study.
If the patient has been diagnosed with MDS, disease of patient must be classified as Int-1, Intermediate-2 (Int-2) or High-risk, according to International Prognosis Scoring System (IPSS) classification. Note: Only Int-2 or High-risk patients will be enrolled at French site.
Off all other treatments for MDS, CMML, or AML including an erythropoiesis-stimulating agent (ESA), for at least 4 weeks prior to Screening. Filgrastim (G-CSF) is allowed before and during the study, as clinically indicated.
For AML patients, no more than 1 prior salvage therapy.
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.
Willing to adhere to the prohibitions and restrictions specified in this protocol.
The patient must signed an informed consent form indicating that she/he understands the purpose of and procedures required for the study and is willing to participate in the study.

Exclusion Criteria:

Prior treatment with rigosertib;
Anemia due to factors other than MDS, CMML, or AML (including hemolysis or gastrointestinal bleeding).
Any active malignancy within the past year, except basal cell or squamous cell skin cancer or carcinoma in situ of the cervix or breast.
Uncontrolled intercurrent illness.
Active infection not adequately responding to appropriate therapy.
Total bilirubin ≥ 2.0 mg/dL not related to Gilbert's disease or hemolysis.
Alanine transaminase (ALT)/aspartate transaminase (AST) ≥ 2.5 x upper limit of normal (ULN).
Serum creatinine ≥ 2.0 mg/dL.
Ascites requiring active medical management including paracentesis.
Hyponatremia (defined as serum sodium value of < 130 mEq/L).
Female patients who are pregnant or lactating.
Female patients of childbearing potential and male patients with partners of childbearing potential who are unwilling to follow strict contraception requirements before entry and throughout the study, up to and including the 30-day nontreatment follow-up period.
Female patients with reproductive potential who do not have a negative blood or urine pregnancy test at Screening.
Major surgery without full recovery or major surgery within 3 weeks of Screening.
Uncontrolled hypertension (defined as a systolic pressure ≥ 160 mmHg and/or a diastolic pressure ≥ 110 mmHg).
New onset seizures (within 3 months prior to Screening) or poorly controlled seizures.
Any other investigational agent or chemotherapy, radiotherapy, or immunotherapy administered within 4 weeks prior to Screening.
Chronic use (˃ 2 weeks) of corticosteroids (˃ 10 mg/24 hr equivalent prednisone) within 4 weeks of Baseline/First Dose.
Investigational therapy within 4 weeks of Screening.
Psychiatric illness or social situation that would limit the patient's ability to tolerate and/or comply with study requirements.
Patients with RAEB-t/non-proliferative AML (as defined by 20-30% BMBL, WBC ≤ 25,000 x 10^9/L and stable for at least 4 weeks without intervention) are not eligible to participate in the Phase II Part 1 RPTD component of the study and patients with CMML will not be eligible for Phase II Part 2 of the study.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Banner MD Anderson Cancer Center	Gilbert	Arizona	United States	85234
2	City of Hope	Duarte	California	United States	91010
3	Desert Hematology Oncology Medical Group, Inc.	Rancho Mirage	California	United States	92270
4	Rush University Medical Center	Chicago	Illinois	United States	60612
5	Cancer Center of Kansas	Wichita	Kansas	United States	67214
6	Saint Louis University	Saint Louis	Missouri	United States	63110
7	Roswell Park Cancer Institute	Buffalo	New York	United States	14263
8	Mount Sinai Medical Center	New York	New York	United States	10029
9	White Plains Hospital Center for Cancer Care	White Plains	New York	United States	10601
10	Carolina Blood and Cancer Care Associates	Rock Hill	South Carolina	United States	29732
11	The University of Texas MD Anderson Cancer Center	Houston	Texas	United States	77030
12	Froedtert Hospital and the Medical College of Wisconsin	Milwaukee	Wisconsin	United States	53226
13	Hôpital St. Louis	Paris		France	75475