AZD1775 in Advanced Acute Myeloid Leukemia, Myelodysplastic Syndrome and Myelofibrosis

• Sponsor: NYU Langone Health (Other)
• Overall Status: Terminated
• CT.gov ID: NCT03718143
• Collaborator: (none)
• Enrollment: 6
• Location: 1
• Arms: 3
• Actual Duration (Months): 4.7
• Patients Per Site Per Month: 1.3

Study Details

Study Description

Brief Summary

A phase II study testing the efficacy of combined AZD1775 with AraC or single agent activity of AZD1775 in three arms: Arm A has subjects age 60 years or older who are newly diagnosed with AML receiving the combination of the drugs; Arm B has subjects who are have relapsed/refractory AML and HMA failure MDS patients being allocated to either the combination Arm B or single agent AZD1775 Arm C.

Condition or Disease	Intervention/Treatment	Phase
Myelofibroses; Acute Myeloid Leukemia; Myelodysplastic Syndromes	Drug: Combination AZD1775 with AraC; Drug: AZD1775 only	Phase 2

Detailed Description

A phase II study testing the clinical efficacy of combined AZD1775 with AraC or single agent activity of AZD1775 in three patient strata: Elderly(> 60 years) newly diagnosed AML patients (Arm A) will only receive the combination; whereas relapsed/refractory AML patients and HMA failure MDS patients will be allocated to either the combination (Arm B) or single agent AZD1775 (Arm C). The study will have a run in safety cohort of six patients in each of the three arms to determine the safe use of combined AraC /AZD1775 or single agent AZD1775 in the patient populations. This will be followed by an expansion phase of up to 20 and 21 eligible patients in each arm respectively where elderly patients with newly diagnosed AML will receive a combination of AZD1775 and AraC (Arm A) while patients with relapsed or refractory AML or HMA failure MDS will be allocated to receive either AZD1775 with AraC (Arm B) or AZD1775 alone (Arm C). An early toxicity check will be conducted to determine safety and tolerability. If indicated, dose levels will be reduced. The study will continue to enroll the rest of the patients at the tolerated dose.

Study Design

• Study Type: Interventional
• Actual Enrollment: 6 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 2 Study of WEE1 Inhibition and AZD1775 Alone or Combined With Cytarabine in Patients With Advanced Acute Myeloid Leukemia, Myelodysplastic Syndrome and Myelofibrosis
• Actual Study Start Date: May 8, 2019
• Actual Primary Completion Date: Sep 27, 2019
• Actual Study Completion Date: Sep 27, 2019

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Arm A: Elderly Newly diagnosed AML Combination AZD1775 with AraC Elderly, newly diagnosed AML	Drug: Combination AZD1775 with AraC; AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12
Experimental: Arm B:Relapsed AML and MDS Combination AZD1775 with AraC Relapsed/Refractory AML & HMA failure AML/ MDS	Drug: Combination AZD1775 with AraC; AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12
Active Comparator: Arm C: Relapsed AML, MDS and MF AZD1775 only Relapsed/Refractory AML & HMA failure AML/ MDS and Relapsed/Refractory Primary & Secondary MF	Drug: AZD1775 only; AZD1775 days 1-5 & 8-12

Outcome Measures

Primary Outcome Measures

1. Complete Remission (CR) Rate [4 months]

   Less than 5% blasts in a non-hypocellular marrow with a granulocyte count ≥ 1.0, and a platelets count of ≥ 100 with complete resolution of extramedullary disease and absence of peripheral blood blasts.

Secondary Outcome Measures

1. Incomplete Measure of Complete Remission (CRi) [4 months]

   is called if patient meets all CR criteria except for residual neutropenia (ANC<1 x109/L) or thrombocytopenia (platelets<100 x109/L)

2. Complete Cytogenetic Remission (CCyR) [4 Months]

   The absence of chromosome abnormalities (if present at diagnosis) on conventional cytogenetic study using G-banding (at least 10 metaphases present).

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years to 99 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion:

Inclusion Criteria

• Dose escalation part of trial for combined AraC + AZD1775 (Arm A)

• untreated elderly (>60 years) AML if in the poor-risk cytogenetic group (please reference Appendix V).

• untreated elderly (>60 years) AML if in the intermediate and poor-risk cytogenetic group (please reference Appendix V)

• relapsed or refractory AML (≥ 18 years)

• any MDS (≥ 18 years) having failed or been intolerant to prior hypomethylating agent (HMA) treatment.

• Failure is defined as any disease progression while on HMA, relapse after HMA treatment or no response after 4 cycles of 5-Azacitidine or decitabine

• Patients with isolated 5q-/5q- syndrome must have failed, not tolerated, or progressed on lenalidomide in addition to having failed or been intolerant to HMA treatment.

• advanced progressive MF, defined as intermediate and high risk primary and secondary MF, or any other MF failed or intolerant to JAK2 inhibitor therapy requiring medical therapy

• If appropriate, patients can have failed other prior therapies for their disease (i.e. JAK2 inhibitor, interferon, hydroxyurea or IMIDs). Patients may have failed more than one JAK2 inhibitor and JAK2 inhibitor must not have been the most recent treatment (e.g. other therapies as last therapy prior to study given after failure of previous JAK2 inhibitor).

• Failure/ intolerance of Ruxolitinib

• The following laboratory values obtained 7 days prior to registration.

• Total bilirubin ≤ 1.5 mg/dL (except Gilbert's syndrome or known hemolysis or leukemic infiltration)

• AST (SGOT) and ALT (SGPT) ≤ 2.5 x Upper Limit normal (ULN) or < 5 x ULN if organ involvement

• Alkaline Phosphatase < 5 x ULN - Serum creatinine ≤1.5 x ULN, or measured creatinine clearance (CrCl) ≥45 mL/min as calculated by the Cockcroft-Gault method (confirmation of creatinine clearance is only required when creatinine is >1.5 x institutional ULN) CrCl (glomerular filtration rate [GFR]) = (140-age) x (weight/kg) x Fa (72 x serum creatinine mg/dL) a where F= 0.85 for females and F=1 for males

• ECOG Performance Status (PS) 0, 1 (Appendix I).

• Ability to provide informed written consent and be able to adhere to the study visit schedule and other protocol requirements.

• Willing to return to enrolling institution for follow-up (during the Active Monitoring Phase of the study).

• Willing to provide blood and bone marrow aspirate samples for correlative research purposes

• Negative serum pregnancy test done ≤7 days prior to registration, for women of childbearing potential only.

• Female patients who are not of child-bearing potential and fertile females of childbearing potential

• Male patients should be willing to abstain or use barrier contraception (i.e., condoms) for the duration of the study drug exposure and for 3 months after study treatment discontinuation.

• Patients who have undergone stem cell transplantation (SCT), autologous or allogeneic, are eligible provided that they are > 60 days from stem cell infusion, have GVHD < grade 1 and are off immunosuppressive agents for > 28 days at time of registration.

Exclusion:

• AML patients who are suitable for and willing to receive intensive chemotherapy

• Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:

• Pregnant women

• Nursing women

• Men or women of childbearing potential who are unwilling to employ adequate contraception

• Subject has had prescription or non-prescription drugs or other products known to be sensitive CYP3A4 substrates or CYP3A4 substrates

• The preferred azole anti-fungal medication is Fluconazole (alternatively Posaconazole) which can be given during treatment with AZD1775 (section 9.5).

• Pateints may not be on an inhibitor of BCRP as outlined in Appendix VI.

• Not willing to avoid grapefruit, grapefruit juices, grapefruit hybrids, Seville oranges, pummelos, and exotic citrus fruits from 7 days prior to the dose of study medication

• Mean resting corrected QTc interval using the Fridericia formula (QTcF) >450 msec/male and >470 msec/female (as calculated per institutional standards) obtained from 3 electrocardiograms (ECGs) 2-5 minutes apart at study entry, or congenital long QT syndrome

• Herbal preparations/medications

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	NYU Langone Health	New York	New York	United States	10016

Sponsors and Collaborators

• NYU Langone Health

Investigators

None specified.

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Aug 23, 2019

More Information

Publications

None provided.

• Responsible Party: NYU Langone Health
• ClinicalTrials.gov Identifier: NCT03718143
• Other Study ID Numbers: 17-01816
• First Posted: Oct 24, 2018
• Last Update Posted: Jun 2, 2020
• Last Verified: May 1, 2020

• Individual Participant Data (IPD) Sharing Statement: Yes
• Plan to Share IPD: Yes
• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Additional relevant MeSH terms: Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Preleukemia; Myelodysplastic Syndromes; Primary Myelofibrosis; Syndrome; Adavosertib

Study Results

Participant Flow

Arm/Group Title	Arm A: Elderly Newly Diagnosed AML	Arm B:Relapsed AML and MDS	Arm C: Relapsed AML, MDS and MF
Arm/Group Description	Combination AZD1775 with AraC Elderly, newly diagnosed AML Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	Combination AZD1775 with AraC Relapsed/Refractory AML & HMA failure AML/ MDS Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	AZD1775 only Relapsed/Refractory AML & HMA failure AML/ MDS and Relapsed/Refractory Primary & Secondary MF AZD1775 only: AZD1775 days 1-5 & 8-12
Period Title: Overall Study
STARTED	3	2	1
COMPLETED	0	0	0
NOT COMPLETED	3	2	1

Baseline Characteristics

Arm/Group Title	Total Participants
Arm/Group Description	Participants from all 3 arms: Arm A: Elderly Newly Diagnosed AML Arm B: Relapsed AML and MDS Arm C: Relapsed AML, MDS, and MF Baseline information cannot be separated by diagnoses due to data privacy reasons
Overall Participants	6
Age (Count of Participants)
<=18 years	0 0%
Between 18 and 65 years	1 16.7%
>=65 years	5 83.3%
Sex: Female, Male (Count of Participants)
Female	0 0%
Male	6 100%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	2 33.3%
Not Hispanic or Latino	4 66.7%
Unknown or Not Reported	0 0%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%
Asian	0 0%
Native Hawaiian or Other Pacific Islander	0 0%
Black or African American	2 33.3%
White	2 33.3%
More than one race	0 0%
Unknown or Not Reported	2 33.3%
Region of Enrollment (participants) [Number]
United States	6 100%

Outcome Measures

1. Primary Outcome

Title	Complete Remission (CR) Rate
Description	Less than 5% blasts in a non-hypocellular marrow with a granulocyte count ≥ 1.0, and a platelets count of ≥ 100 with complete resolution of extramedullary disease and absence of peripheral blood blasts.
Time Frame	4 months

Outcome Measure Data

Analysis Population Description

No data was collected for this outcome measure due to early termination of study.

Arm/Group Title	Arm A: Elderly Newly Diagnosed AML	Arm B:Relapsed AML and MDS	Arm C: Relapsed AML, MDS and MF
Arm/Group Description	Combination AZD1775 with AraC Elderly, newly diagnosed AML Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	Combination AZD1775 with AraC Relapsed/Refractory AML & HMA failure AML/ MDS Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	AZD1775 only Relapsed/Refractory AML & HMA failure AML/ MDS and Relapsed/Refractory Primary & Secondary MF AZD1775 only: AZD1775 days 1-5 & 8-12
Measure Participants	0	0	0

2. Secondary Outcome

Title	Incomplete Measure of Complete Remission (CRi)
Description	is called if patient meets all CR criteria except for residual neutropenia (ANC<1 x109/L) or thrombocytopenia (platelets<100 x109/L)
Time Frame	4 months

Outcome Measure Data

Analysis Population Description

No data was collected for this outcome measure due to early termination of study.

Arm/Group Title	Arm A: Elderly Newly Diagnosed AML	Arm B:Relapsed AML and MDS	Arm C: Relapsed AML, MDS and MF
Arm/Group Description	Combination AZD1775 with AraC Elderly, newly diagnosed AML Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	Combination AZD1775 with AraC Relapsed/Refractory AML & HMA failure AML/ MDS Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	AZD1775 only Relapsed/Refractory AML & HMA failure AML/ MDS and Relapsed/Refractory Primary & Secondary MF AZD1775 only: AZD1775 days 1-5 & 8-12
Measure Participants	0	0	0

3. Secondary Outcome

Title	Complete Cytogenetic Remission (CCyR)
Description	The absence of chromosome abnormalities (if present at diagnosis) on conventional cytogenetic study using G-banding (at least 10 metaphases present).
Time Frame	4 Months

Outcome Measure Data

Analysis Population Description

No data was collected for this outcome measure due to early termination of study.

Arm/Group Title	Arm A: Elderly Newly Diagnosed AML	Arm B:Relapsed AML and MDS	Arm C: Relapsed AML, MDS and MF
Arm/Group Description	Combination AZD1775 with AraC Elderly, newly diagnosed AML Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	Combination AZD1775 with AraC Relapsed/Refractory AML & HMA failure AML/ MDS Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12	AZD1775 only Relapsed/Refractory AML & HMA failure AML/ MDS and Relapsed/Refractory Primary & Secondary MF AZD1775 only: AZD1775 days 1-5 & 8-12
Measure Participants	0	0	0

Adverse Events

Time Frame	4 months
Arm/Group Title	Arm A: Elderly Newly Diagnosed AML		Arm B:Relapsed AML and MDS		Arm C: Relapsed AML, MDS and MF
Arm/Group Description	Combination AZD1775 with AraC Elderly, newly diagnosed AML Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12		Combination AZD1775 with AraC Relapsed/Refractory AML & HMA failure AML/ MDS Combination AZD1775 with AraC: AZD1775 days 1-5 & 8-12 AraC days 1-5 & 8-12		AZD1775 only Relapsed/Refractory AML & HMA failure AML/ MDS and Relapsed/Refractory Primary & Secondary MF AZD1775 only: AZD1775 days 1-5 & 8-12
All Cause Mortality
	Arm A: Elderly Newly Diagnosed AML		Arm B:Relapsed AML and MDS		Arm C: Relapsed AML, MDS and MF
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	1/3 (33.3%)		0/2 (0%)		0/1 (0%)
Serious Adverse Events
	Arm A: Elderly Newly Diagnosed AML		Arm B:Relapsed AML and MDS		Arm C: Relapsed AML, MDS and MF
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	1/3 (33.3%)		0/2 (0%)		0/1 (0%)
General disorders
Progression of Disease	1/3 (33.3%)		0/2 (0%)		0/1 (0%)
Other (Not Including Serious) Adverse Events
	Arm A: Elderly Newly Diagnosed AML		Arm B:Relapsed AML and MDS		Arm C: Relapsed AML, MDS and MF
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/3 (0%)		0/2 (0%)		0/1 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE 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.