Trial record 1 of 1 for:    NCT01016600
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Azacitidine and Lenalidomide for Acute Myeloid Leukemia

This study is currently recruiting participants.
Verified February 2014 by Washington University School of Medicine
Sponsor:
Collaborator:
Celgene Corporation
Information provided by (Responsible Party):
Washington University School of Medicine
ClinicalTrials.gov Identifier:
NCT01016600
First received: November 17, 2009
Last updated: February 13, 2014
Last verified: February 2014
  Purpose

Determine toxicity and remission rates of treatment with azacitidine and lenalidomide for patients with Acute Myeloid Leukemia


Condition Intervention Phase
Leukemia, Myeloid, Acute
Drug: Lenalidomide
Drug: Azacitidine
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase I/II Trial of Azacitidine Plus Lenalidomide in the Treatment of Acute Myeloid Leukemia

Resource links provided by NLM:


Further study details as provided by Washington University School of Medicine:

Primary Outcome Measures:
  • Phase I only - dose limiting toxicities and the maximum tolerated dose of the combination of lenalidomide and azacitidine [ Time Frame: 3 1/2 years (completion of the phase I portion of study) ] [ Designated as safety issue: Yes ]
    AML >= 18 years or untreated AML >=60 years

  • Phase II only - complete remission rate after lenalidomide and azacitidine therapy [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]

    untreated AML >=60 years

    pre-therapy, post induction cycle 1, post induction cycle 2, completion of cycles 2, 4, 6, 8, 10, and 12



Secondary Outcome Measures:
  • Response rate [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]
  • Morphologic leukemia-free state [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]
  • Morphologic complete remission rate (CRm) [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]
  • Cytogenetic CR (CRc) rate [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]
  • CR with incomplete blood counts rate [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]
  • Partial remission rate (PR) [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]
  • Duration of response [ Time Frame: Every 3 months for 2 years ] [ Designated as safety issue: No ]
  • Overall survival and event free survival [ Time Frame: Every 3 months for 2 years ] [ Designated as safety issue: No ]
  • Toxicity profile [ Time Frame: 30 days after completion of treatment ] [ Designated as safety issue: Yes ]
    AML >=18 years or untreated AML >=60 years

  • Expression levels of cytokines/chemokines in the bone marrow plasma, expression of chemokine receptors/ligands on leukemic blasts, and direct cytotoxic effects of lenalidomide, azacitidine, and combination of both drugs on cryopreserved AML blast cells [ Time Frame: Completion of cycle 12 maintenance therapy ] [ Designated as safety issue: No ]

Estimated Enrollment: 61
Study Start Date: April 2010
Estimated Study Completion Date: December 2015
Estimated Primary Completion Date: January 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cohort 1

Induction regimen (total 2 cycles)

Lenalidomide 50 mg PO daily days 1-28

Azacitidine 25 mg/m2 IV days 1-5

Maintenance Regimen

Lenalidomide 10 mg PO daily days 1-28

Azacitidine 75 mg/m2 IV days 1-5

Drug: Lenalidomide
Other Name: Revlimid
Drug: Azacitidine
Other Name: Vidaza
Experimental: Cohort 2

Induction regimen (total 2 cycles)

Lenalidomide 50 mg PO daily days 1-28

Azacitidine 50 mg/m2 IV days 1-5

Maintenance Regimen

Lenalidomide 10 mg PO daily days 1-28

Azacitidine 75 mg/m2 IV days 1-5

Drug: Lenalidomide
Other Name: Revlimid
Drug: Azacitidine
Other Name: Vidaza
Experimental: Cohort 3

Induction regimen (total 2 cycles)

Lenalidomide 50 mg PO daily days 1-28

Azacitidine 75 mg/m2 IV days 1-5

Maintenance Regimen

Lenalidomide 10 mg PO daily days 1-28

Azacitidine 75 mg/m2 IV days 1-5

Drug: Lenalidomide
Other Name: Revlimid
Drug: Azacitidine
Other Name: Vidaza
Experimental: Phase II

Induction regimen (total 2 cycles)

Lenalidomide 50 mg PO daily days 1-28

Azacitidine 75 mg/m2 (dose determined in Phase I) mg/m2 IV days 1-5

Maintenance Regimen

Lenalidomide 10 mg PO daily days 1-28

Azacitidine 75 mg/m2 IV days 1-5

Drug: Lenalidomide
Other Name: Revlimid
Drug: Azacitidine
Other Name: Vidaza

Detailed Description:

Primary:

Phase 1:

To determine the toxicity and feasibility of combining lenalidomide and azacitidine in patients with relapsed/ refractory AML ≥ 18 years or untreated AML ≥60 years.

Phase 2:

To assess the complete remission (CRm plus CRi) rate after lenalidomide + azacitidine therapy in untreated AML ≥60 years.

Secondary:

  1. To assess the response rate (RR), morphologic leukemia-free state, morphologic complete remission rate (CRm), cytogenetic CR (CRc) rate, CR with incomplete blood counts 14 rate, and partial remission 15 rate (PR).
  2. To assess overall survival (OS) and event free survival (EFS).
  3. To assess time to progression (TTP) in untreated AML ≥60 years.
  4. To assess relapse free survival (RFS) and duration of CR for complete responders.
  5. To determine the incidence and severity of other toxicities of lenalidomide in combination with azacitidine.
  6. Assay the expression levels of cytokines/chemokines in the bone marrow plasma, expression of chemokine receptors/ligands on leukemic blasts important for the AML microenvironment and study the direct cytotoxic effects of lenalidomide, azacitidine and combination of both drugs on cryopreserved AML blast cells.
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Newly diagnosed AML age ≥ 60 years, de novo, secondary to prior therapy, or transformed from MDS, as defined by the International Working Group, except acute promyelocytic leukemia (AML M3) will be included for phase 1 and 2 study. Patients must not have abnormalities of inversion 16, t(16,16), del(16q), t(8,21) or t(15,17) as assessed by routine cytogenetics or FISH. Diagnosis of AML by WHO criteria (>20% blasts) is determined by CBC, bone marrow assessment, and immunophenotypic analysis performed within 2 weeks of study enrollment. No previous treatment for AML, however hydroxyurea, steroids, and leukopheresis are allowed.
  • Relapsed AML age ≥18 years, except acute promyelocytic leukemia (AML M3), with CR < 1 years post 1st induction chemotherapy will be included in phase 1 study only.
  • Primary refractory AML age ≥18 years, except acute promyelocytic leukemia (AML M3) post 1st induction chemotherapy will be included in phase 1 study only.
  • Relapsed or refractory AML age ≥18 years, except acute promyelocytic leukemia (AML M3), post 1st salvage chemotherapy/ autologous stem transplantation/ allogeneic stem cell transplantation will be included in phase 1 study only.
  • Understand and voluntarily sign an informed consent form.
  • Able to adhere to the study visit schedule and other protocol requirements.
  • ECOG performance status of ≤ 2 at study entry
  • Life expectancy > 2 months
  • WBC < 10,000 x 10^6/L (WBC counts may not be reduced by hydroxyurea or leukapheresis to achieve a WBC lower than 10,000 x 106 /L).
  • Adequate renal and hepatic function as defined by:

    • Serum creatinine ≤ 1.5X institution ULN
    • Total bilirubin ≤ 2.0 mg/dL ( except Gilbert's syndrome or known hemolysis)
    • AST(SGOT) and ALT (SGPT) ≤ 2.5 x ULN
  • All study participants must be registered into the mandatory Revlimid REMS® program, and be willing and able to comply with the requirements of Revlimid REMS®.
  • Females of of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of starting lenalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure.
  • Men must agree not to father a child and agree to use a latex condom during sexual contact with females of child bearing potential even if they have had a successful vasectomy. -Disease free of prior malignancies for ≥ 5 years with exception of AML, currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast.

Exclusion Criteria:

  • Newly diagnosed AML age < 60 years.
  • Newly diagnosed AML ≥ 60 years with favorable risk cytogenetic abnormalities as defined by SWOG criteria that include: inv(16)/t(16;16)/del(16q), t(15;17) with/without secondary aberrations, t(8;21) lacking del(9q) or complex karyotype 17. Prior to enrollment, FISH studies or routine cytogenetics must be completed to rule out these cytogenetic abnormalities.
  • Known CNS leukemia
  • Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  • Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
  • Use of any other experimental drug or therapy within 30 days of enrollment.
  • Known hypersensitivity to thalidomide and mannitol.
  • The development of erythema multiforme if characterized by a desquamating rash while taking thalidomide or similar drugs.
  • Any prior use of lenalidomide
  • Any prior use of azacytidine.
  • Concurrent use of other anti-cancer agents or treatments (with the exception of steroids)
  • Known positive for HIV or infectious hepatitis, type A, B or C.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01016600

Contacts
Contact: Ravi Vij, M.D. 314-454-8304 rvij@dom.wustl.edu

Locations
United States, Missouri
Washington University School of Medicine Recruiting
St. Louis, Missouri, United States, 63110
Contact: Ravi Vij, M.D.    314-454-8304    rvij@dom.wustl.edu   
Sub-Investigator: Todd Fehniger, M.D., Ph.D.         
Sub-Investigator: Camille Abboud, M.D.         
Sub-Investigator: Daniel Link, M.D.         
Sub-Investigator: Amanda Cashen, M.D.         
Sub-Investigator: John DiPersio, M.D., Ph.D.         
Sub-Investigator: Timothy Graubert, M.D.         
Sub-Investigator: Keith Stockerl-Goldstein, M.D.         
Sub-Investigator: Geoffrey Uy, M.D.         
Sub-Investigator: Matthew Walter, M.D.         
Sub-Investigator: Peter Westervelt, M.D., Ph.D.         
United States, Nebraska
University of Nebraska medical Center Recruiting
Omaha, Nebraska, United States, 68198
Contact: Lori Maness, M.D.    402-559-5520    lmaness@unmc.edu   
Principal Investigator: Lori Maness, M.D.         
Sponsors and Collaborators
Washington University School of Medicine
Celgene Corporation
Investigators
Principal Investigator: Ravi Vij, M.D. Washington University School of Medicine
  More Information

Additional Information:
No publications provided

Responsible Party: Washington University School of Medicine
ClinicalTrials.gov Identifier: NCT01016600     History of Changes
Other Study ID Numbers: 09-1816 / 201101749
Study First Received: November 17, 2009
Last Updated: February 13, 2014
Health Authority: United States: Institutional Review Board

Additional relevant MeSH terms:
Leukemia
Leukemia, Myeloid, Acute
Leukemia, Myeloid
Neoplasms by Histologic Type
Neoplasms
Azacitidine
Lenalidomide
Thalidomide
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Leprostatic Agents
Anti-Bacterial Agents
Anti-Infective Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors

ClinicalTrials.gov processed this record on April 22, 2014