Arsenic Trioxide and Tyrosine Kinase Inhibitors for Chronic Myelogenous Leukemia (CML)

This study is currently recruiting participants. (see Contacts and Locations)
Verified September 2014 by Dana-Farber Cancer Institute
Sponsor:
Collaborators:
Cephalon
Information provided by (Responsible Party):
David Avigan, MD, Beth Israel Deaconess Medical Center
ClinicalTrials.gov Identifier:
NCT01397734
First received: July 18, 2011
Last updated: September 15, 2014
Last verified: September 2014
  Purpose

In this research study, the investigators are looking to see whether the combination of arsenic trioxide with a tyrosine kinase inhibitor is safe, and what effects it has on chronic myelogenous leukemia.


Condition Intervention Phase
Chronic Myelogenous Leukemia
Drug: Arsenic trioxide
Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Targeting of the Leukemia Stem Cell Population With Arsenic Trioxide and Tyrosine Kinase Inhibitors for CML

Resource links provided by NLM:


Further study details as provided by Dana-Farber Cancer Institute:

Primary Outcome Measures:
  • Number of Participants with Adverse Events as a Measure of Safety and Toxicity [ Time Frame: 1, 2, 6, 12 months ] [ Designated as safety issue: Yes ]
    To assess the safety and toxicity of arsenic in combination with TKI therapy for chronic phase CML patients


Secondary Outcome Measures:
  • Disease Response [ Time Frame: 1, 2, 6, 12 months ] [ Designated as safety issue: No ]
    To assess disease response after combined therapy arsenic trioxide and imatinib (cohort 1), dasatinib (cohort 2) or nilotinib (cohort 3) by bone marrow cytogenetic assessment and serial BCR-ABL QPCR from peripheral blood and bone marrow measurements. Rates of major and complete cytogenetic and molecular responses will be determined.

  • PML Expression [ Time Frame: 1, 6, 12 months ] [ Designated as safety issue: No ]
    To assess whether combined therapy with arsenic and imatinib, dasatinib or nilotinib results in decreased PML expression on the CML stem cell compartment, and decreased capacity of CML stem cells to maintain long term proliferative capacity.


Estimated Enrollment: 18
Study Start Date: September 2011
Estimated Primary Completion Date: September 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cohort 1
Patients who are receiving Imatinib as part of their standard of care therapy for CML.
Drug: Arsenic trioxide
0.15mg/kg/day Arsenic trioxide given IV on days 1-5 of the cycle.
Experimental: Cohort 2
Patients who are receiving Dasatinib as part of their standard of care therapy for CML.
Drug: Arsenic trioxide
0.15mg/kg/day Arsenic trioxide given IV on days 1-5 of the cycle.
Experimental: Cohort 3
Patients who are receiving Nilotinib as part of their standard of care therapy for CML.
Drug: Arsenic trioxide
0.15mg/kg/day Arsenic trioxide given IV on days 1-5 of the cycle.

  Eligibility

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

Inclusion Criteria:

  • Participants must have a diagnosis of chronic myelogenous leukemia as confirmed by fluorescent In Situ Hybridization (FISH) for BCR/ABL translocation and/or standard cytogenetics analysis.
  • Participants may have received prior hydroxyurea but may not be currently being treated with hydroxyurea at the time of study initiation.
  • Participants may have received prior TKI therapy, however must be on a stable dose of their current TKI for at least one month prior to enrollment.
  • Participants must demonstrate evidence of persistent disease either by cytogenetics/FISH or by PCR for BCR/ABL in the peripheral blood or bone marrow.
  • Greater than or equal to 18 years in age. Because little dosing or adverse event data are currently available on the use of Arsenic in participants <18 years of age, children are excluded from this study.
  • Life expectancy of greater than 3 months
  • ECOG performance status <2
  • Participants must have normal organ and marrow function as defined below:

    • Bilirubin ≤ 2.0 mg/dL
    • Creatinine ≤ 2 mg/dL
    • ALT < 2.5 X institutional upper limit of normal
    • AST < 2.5 X institutional upper limit of normal
    • WBC > 2.0 K/uL
    • Platelets >100K
  • Oxygen saturation > 95% on room air
  • The effects of Arsenic on the developing human fetus are unknown. For this reason, women of child-bearing potential must have a documented negative pregnancy test; in addition, agreement to use adequate contraception (hormonal or barrier method of birth control; abstinence) must be documented for both women of child-bearing potential and men prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
  • All patients must demonstrate the ability to understand the investigational nature of this study and must sign a written informed consent document in accordance with institutional and federal guidelines

Exclusion Criteria:

  • History of acute myocardial infarction, unstable angina, congestive heart failure, or arrhythmia within the last three months
  • Participants may not be receiving any other study agent
  • Mean QTc> 450 ms at time of screening
  • Use of potassium wasting diuretics during study treatment
  • Patients should not be taking drugs that are generally accepted to have a risk of causing Torsades de Pointes. The following must be discontinued at least 7 days prior to enrollment to be eligible: quinidine, procainamide, disopyramide, amiodarone, sotalol, ibutilide, dofetilide, erythromycins, clarithromycin, chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide, cisapride, bepridil, droperidol, methadone, chloroquine, domperidone, halofantrine, levomethadyl, pentamidine, sparfloxacin, lidoflazine
  • Drugs that are highly dependent on CYP3A4 for metabolism and have a narrow therapeutic index (see Appendix A) are allowed but must be used with caution
  • Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Concurrent and or uncontrolled psychiatric or medical condition which may interfere with the study completion.
  • Pregnant women are excluded from this study because the risk of Arsenic to a developing fetus is unknown. Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with Arsenic, breastfeeding should be discontinued if the mother is treated on this clinical trial
  • Individuals with a history of a different malignancy are ineligible except for the following circumstances. Individuals with a history of other malignancies are eligible if they have been disease-free for at least 5 years and are deemed by the investigator to be at low risk for recurrence of that malignancy. Individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: cervical cancer in situ, and basal cell or squamous cell carcinoma of the skin
  • HIV-positive individuals on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with TKI therapy and Arsenic. In addition, these individuals are at increased risk of lethal infections when treated with marrow-suppressive therapy.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01397734

Contacts
Contact: David E Avigan, MD 617-667-9920 davigan@bidmc.harvard.edu
Contact: Jennifer Paolini, MS 617-667-9923 jpaolini@bidmc.harvard.edu

Locations
United States, Massachusetts
Beth Israel Deaconess Medical Center Recruiting
Boston, Massachusetts, United States, 02215
Contact: David E Avigan, MD    617-667-9920    davigan@bidmc.harvard.edu   
Contact: Jennifer Paolini, MS    617-667-9923    jpaolini@bidmc.harvard.edu   
Sub-Investigator: Jacalyn Rosenblatt, MD         
Sub-Investigator: Robin Joyce, MD         
Sub-Investigator: James D Levine, MD         
Sub-Investigator: Dimitrios Tzachanis, MD         
Sub-Investigator: Vassiliki Boussiotis, MD         
Sub-Investigator: Jon E Arnason, M.D.         
Sub-Investigator: Jeffrey I Zwicker, MD         
Sub-Investigator: Katarina Luptakova, MD         
Sub-Investigator: Ayad Hamdan, MD         
Sponsors and Collaborators
Beth Israel Deaconess Medical Center
Cephalon
Investigators
Principal Investigator: David E Avigan, MD Beth Israel Deaconess Medical Center
  More Information

No publications provided

Responsible Party: David Avigan, MD, Prinicipal Investigator, Beth Israel Deaconess Medical Center
ClinicalTrials.gov Identifier: NCT01397734     History of Changes
Other Study ID Numbers: 11-107
Study First Received: July 18, 2011
Last Updated: September 15, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Dana-Farber Cancer Institute:
CML
Chronic myelogenous leukemia
Chronic Myeloid leukemia
Arsenic
Arsenic trioxide
Imatinib
Dasatinib
Nilotinib
TKI
Tyrosine kinase inhibitor

Additional relevant MeSH terms:
Leukemia
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid
Bone Marrow Diseases
Hematologic Diseases
Myeloproliferative Disorders
Neoplasms
Neoplasms by Histologic Type
Arsenic trioxide
Antineoplastic Agents
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on October 21, 2014