Azacitidine and Arsenic Trioxide in Treating Patients With Myelodysplastic Syndromes or Chronic Myelomonocytic Leukemia
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Purpose
RATIONALE: Drugs used in chemotherapy, such as azacitidine and arsenic trioxide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells.
PURPOSE: This phase II trial is studying how well giving azacitidine together with arsenic trioxide works in treating patients with myelodysplastic syndromes or chronic myelomonocytic leukemia.
| Condition | Intervention | Phase |
|---|---|---|
|
Leukemia Myelodysplastic Syndromes |
Drug: arsenic trioxide Drug: azacitidine |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Non-Randomized Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Phase II Study of Arsenic Trioxide in Combination With 5-Azacitidine in Myelodysplastic Syndromes |
- Response rate (overall and confirmed) as measured by International Working Group (IWG) standardized criteria for MDS at day 113 and then every 4 weeks until completion of study treatment [ Designated as safety issue: No ]
- Time to treatment failure as assessed by the Kaplan-Meier method at completion of study treatment [ Designated as safety issue: No ]
- Progression-free survival as assessed by the Kaplan-Meier method at completion of study treatment [ Designated as safety issue: No ]
- Toxicity as assessed by the Kaplan-Meier method and NCI-CTCAE version 3.0 during treatment until 30 days after completion of study treatment [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 41 |
| Study Start Date: | April 2005 |
| Study Completion Date: | July 2008 |
| Primary Completion Date: | July 2008 (Final data collection date for primary outcome measure) |
OBJECTIVES:
Primary
- Determine the response rate in patients with myelodysplastic syndromes or chronic myelomonocytic leukemia treated with azacitidine and arsenic trioxide.
Secondary
- Determine time to treatment failure in patients treated with this regimen.
- Determine the tolerability and toxicity of this regimen in these patients.
- Determine progression-free survival of patients treated with this regimen.
OUTLINE: This a multicenter, non-randomized, open-label, study.
Patients receive azacitidine subcutaneously once daily on days 1-5 and arsenic trioxide IV over 1-2 hours on days 1, 2, 8, 9, 15, 16, 22, and 23. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients are evaluated for response on day 113 (week 17). Patients with disease progression or no response are removed from the study. Patients achieving a complete response (CR) receive 2 additional courses of therapy and then undergo observation. Patients achieving a partial response receive 2 additional courses of therapy and then receive arsenic trioxide alone twice weekly in the absence of CR, disease progression, or unacceptable toxicity.
After completion of study treatment, patients are followed every 2 months for at least 1 year.
PROJECTED ACCRUAL: A total of 19-41 patients will be accrued for this study within 18 months.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
- Diagnosis of myelodysplastic syndrome or chronic myelomonocytic leukemia
International Prognostic Scoring System (IPSS) score ≥ intermediate-1
Low IPSS score allowed provided patient meets ≥ 1 of the following criteria:
- Platelet count ≤ 50,000/mm^3
- Required platelet or packed red cell transfusions within the past 4 weeks
- Neutropenic (i.e., absolute neutrophil count < 1,000/mm^3) AND has infections requiring antibiotic treatment
- No prior leukemia or refractory anemia with excess blasts in transformation
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- ECOG 0-2
Life expectancy
- More than 12 weeks
Hematopoietic
- See Disease Characteristics
Hepatic
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
- AST and ALT ≤ 2.5 times ULN
Renal
- Creatinine ≤ 1.5 times ULN
Cardiovascular
- No symptomatic congestive heart failure
- No unstable angina pectoris
- No cardiac arrhythmia
- Baseline QTc < 500 msec
- QTc interval < 460 msec with potassium > 4.0 mEq/L and magnesium > 1.8 mg/L
Immunologic
- No history of allergic reaction attributed to compounds of similar chemical or biologic composition to study drugs
- No ongoing or active infection
- HIV negative
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 6 months after study participation
- No psychiatric illness or social situation that would preclude study compliance
- No other uncontrolled illness
- No other malignancy within the past 12 months
PRIOR CONCURRENT THERAPY:
Biologic therapy
More than 4 weeks since prior administration of any of the following:
- Interferon
- Filgrastim (G-CSF), sargramostim (GM-CSF), epoetin alfa, or other hematopoietic cytokines
- Thalidomide or thalidomide analogs
- No concurrent epoetin alfa
Chemotherapy
- More than 4 weeks since prior chemotherapy
- No prior arsenic trioxide or azacitidine
- No other concurrent chemotherapy
Endocrine therapy
- More than 4 weeks since prior steroids
No concurrent androgenic steroids
- Concurrent steroids for adrenal failure or as prophylaxis for nausea allowed
Radiotherapy
- Not specified
Surgery
- Not specified
Other
- More than 4 weeks since prior retinoids
- No other concurrent investigational agents
- No other concurrent anticancer therapy
Contacts and Locations| United States, South Carolina | |
| Hollings Cancer Center at Medical University of South Carolina | |
| Charleston, South Carolina, United States, 29425 | |
| Study Chair: | Robert K. Stuart, MD | Medical University of South Carolina |
More Information
Additional Information:
No publications provided
| ClinicalTrials.gov Identifier: | NCT00118196 History of Changes |
| Other Study ID Numbers: | CDR0000433313, MUSC-MDS2773, MUSC-15348 |
| Study First Received: | July 8, 2005 |
| Last Updated: | April 26, 2012 |
| Health Authority: | United States: Federal Government |
Keywords provided by Medical University of South Carolina:
|
de novo myelodysplastic syndromes previously treated myelodysplastic syndromes secondary myelodysplastic syndromes chronic myelomonocytic leukemia |
Additional relevant MeSH terms:
|
Leukemia Leukemia, Myelomonocytic, Chronic Myelodysplastic Syndromes Preleukemia Leukemia, Myelomonocytic, Acute Neoplasms by Histologic Type Neoplasms Leukemia, Myeloid Myelodysplastic-Myeloproliferative Diseases Bone Marrow Diseases Hematologic Diseases |
Precancerous Conditions Azacitidine Arsenic trioxide Antimetabolites, Antineoplastic Antimetabolites Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Antineoplastic Agents Therapeutic Uses Enzyme Inhibitors |
ClinicalTrials.gov processed this record on May 16, 2013