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Vorinostat and Idarubicin in Treating Patients With Relapsed or Refractory Leukemia or Myelodysplastic Syndromes
This study has been completed.

First Received on May 30, 2006.   Last Updated on June 3, 2010   History of Changes
Sponsor: M.D. Anderson Cancer Center
Collaborator: National Cancer Institute (NCI)
Information provided by: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00331513
  Purpose

RATIONALE: Drugs used in chemotherapy, such as vorinostat and idarubicin, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Vorinostat may also stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving vorinostat together with idarubicin may kill more cancer cells.

PURPOSE: This randomized phase I trial is studying the side effects and best dose of vorinostat when given together with idarubicin in treating patients with relapsed or refractory leukemia or myelodysplastic syndromes.


Condition Intervention Phase
Leukemia
Myelodysplastic Syndromes
Drug: Idarubicin
Drug: SAHA (Vorinostat)
Phase I

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I Study of Suberoylanilide Hydroxamic Acid (Vorinostat, SAHA) in Combination With Idarubicin in Relapsed or Refractory Leukemia

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Maximum tolerated dose of vorinostat (SAHA) as measured by NCI CTCAE v.30 [ Time Frame: Every 21-day cycle ] [ Designated as safety issue: Yes ]
  • Dose-limiting toxicities of vorinostat (SAHA) as measured by NCI CTCAE v.30 [ Time Frame: Every 21-day cycle ] [ Designated as safety issue: Yes ]

Enrollment: 41
Study Start Date: March 2006
Study Completion Date: January 2010
Primary Completion Date: January 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 14 Days SAHA
Arm I: Oral SAHA 3x daily on Days 1-14 + Idarubicin IV over 15 minutes daily on Days 1-3, repeated every 21 days for 6 courses.
Drug: Idarubicin
12 mg/m^2 IV daily for 3 days on days 1 to 3 of each cycle
Other Name: Idamycin
Drug: SAHA (Vorinostat)
Starting dose level of 100 mg by mouth (PO) three times daily x 14 days for Arm 1, and 100 mg PO three times daily x 3 days for Arm 1. Cycle is every 21 days.
Other Names:
  • Zolinza
  • MSK-390
  • Suberoylanilide Hydroxamic Acid
Experimental: 3 Days SAHA
Arm II: Oral SAHA 3x daily on Days 1-3 + Idarubicin IV over 15 minutes daily on Days 1-3, repeated every 21 days for 6 courses
Drug: Idarubicin
12 mg/m^2 IV daily for 3 days on days 1 to 3 of each cycle
Other Name: Idamycin
Drug: SAHA (Vorinostat)
Starting dose level of 100 mg by mouth (PO) three times daily x 14 days for Arm 1, and 100 mg PO three times daily x 3 days for Arm 1. Cycle is every 21 days.
Other Names:
  • Zolinza
  • MSK-390
  • Suberoylanilide Hydroxamic Acid

Detailed Description:

OBJECTIVES:

  • Determine the maximum tolerated dose and dose-limiting toxicities of vorinostat (SAHA) in combination with standard-dose idarubicin in patients with relapsed or refractory acute myeloid leukemia, acute lymphocytic leukemia, myelodysplastic syndromes, acute promyelocytic leukemia, or chronic myelogenous leukemia in blastic phase.
  • Describe the clinical activity of this regimen in these patients.
  • Determine the in vivo molecular effects of this regimen, including the effects on DNA topoisomerase IIα mRNA expression and on the induction of γH2AX, histone H3 and H4 acetylation, as well as changes in the gene expression profile.
  • Determine the pharmacokinetic characteristics of this regimen in these patients.

OUTLINE: This is a randomized, dose-escalation study of vorinostat (SAHA). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive oral SAHA three times daily on days 1-14 and idarubicin IV over 15 minutes once daily on days 1-3. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.*
  • Arm II: Patients receive oral SAHA three times daily and idarubicin IV over 15 minutes once daily on days 1-3. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.* NOTE: *Patients completing 6 courses of therapy or who reach the maximum cumulative dose of idarubicin or an equivalent anthracycline and achieve clinical benefit may continue treatment with SAHA alone 3 times daily on days 1-14 of each course, in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of SAHA until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience a dose-limiting toxicity. An additional 10 patients are treated at the MTD.

Patients undergo blood collection and bone marrow biopsies periodically during the study for pharmacologic, biomarker, and genetic studies.

After completion of study treatment, patients are followed at 4 weeks and then periodically thereafter.

PROJECTED ACCRUAL: A total of 40 patients will be accrued for this study.

  Eligibility

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

Inclusion Criteria:

  1. Patients must have histologically or cytologically confirmed relapsed/refractory acute myelogenous leukemia, acute lymphocytic leukemia, myelodysplastic syndrome or blastic phase chronic myelogenous leukemia.
  2. Patients that have received cumulative doses (or its equivalent to other anthracycline) of more than 290 mg/m^2 of idarubicin will be excluded from the study. No other limitations in terms of number of prior therapies or type of therapies apply to this study.
  3. Patients with blastic phase CML need to have failed imatinib based therapy.
  4. Patients must have been off chemotherapy for 2 weeks prior to entering this study and recovered from the toxic effects of that therapy, unless there is evidence of rapidly progressive disease.
  5. Use of hydroxyurea for patients with rapidly proliferative disease is allowed but should be stopped 24 hours prior to initiation of therapy.
  6. Imatinib mesylate must be stopped 2 weeks prior to entering this study.
  7. Other histone deacetylase inhibitors, including valproic acid, should be stopped 2 weeks prior to entering this study.
  8. Age > or = to 18 years. Because no dosing or adverse event data are currently available on the use of vorinostat in combination with idarubicin in patients <18 years of age, children are excluded from this study, but will be eligible for future pediatric phase 1 combination trials.
  9. ECOG performance status < or = to 2 (Karnofsky >60%).
  10. Patients must have normal organ function as defined below: total bilirubin < or = 2 mg/dL, AST(SGOT)/ALT(SGPT) < or = 2.5 X institutional upper limit of normal, creatinine < or = 2 mg/dL, cardiac ejection fraction > or = 50%
  11. The effects of vorinostat on the developing human fetus are unknown. For this reason and because HDAC inhibitors as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) 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.
  12. Patients with acute promyelocytic leukemia should have received prior therapy containing all-trans retinoic acid (ATRA) and arsenic trioxide.
  13. Patients with MDS should have received therapy with either 5-azacytidine or 5-aza-2'-deoxycytidine, unless the patient had a contraindication to such therapy, and should require therapy.
  14. Ability to understand and the willingness to sign a written informed consent document.
  15. Both men and women of all races and ethnic groups are eligible for this trial.

Exclusion Criteria:

  1. Patients may not be receiving any other investigational agents.
  2. Patients with clinical evidence of CNS disease should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  3. History of allergic reactions attributed to compounds of similar chemical or biologic composition to vorinostat or other agents used in study.
  4. 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.
  5. Pregnant women are excluded from this study because vorinostat is an HDAC inhibitor with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with vorinostat, breastfeeding should be discontinued if the mother is treated with vorinostat. These potential risks may also apply to other agents used in this study.
  6. HIV-positive patients receiving combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with vorinostat. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated.
  7. Patients who are eligible for potential curative therapy, such allogeneic stem cell transplantation, with or without a more standard induction therapy should be excluded unless they have specifically refused those options.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00331513

Locations
United States, Texas
M. D. Anderson Cancer Center at University of Texas
Houston, Texas, United States, 77030-4009
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Study Chair: Guillermo Garcia-Manero, MD M.D. Anderson Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Guillermo Garcia-Manero MD, UT MD Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00331513     History of Changes
Other Study ID Numbers: 2005-0031, U01CA062461, P30CA016672, MDA-2005-0031, NCI-6892, CDR0000472062
Study First Received: May 30, 2006
Last Updated: June 3, 2010
Health Authority: United States: Food and Drug Administration

Keywords provided by M.D. Anderson Cancer Center:
recurrent adult acute myeloid leukemia
adult acute promyelocytic leukemia (M3)
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
recurrent adult acute lymphoblastic leukemia
previously treated myelodysplastic syndromes
blastic phase chronic myelogenous leukemia
relapsing chronic myelogenous leukemia
secondary acute myeloid leukemia
secondary myelodysplastic syndromes
de novo myelodysplastic syndromes
SAHA
Vorinostat
Zolinza
MSK-390
Suberoylanilide Hydroxamic Acid
Idarubicin
Idamycin

Additional relevant MeSH terms:
Leukemia
Myelodysplastic Syndromes
Preleukemia
Neoplasms by Histologic Type
Neoplasms
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Idarubicin
Vorinostat
Antibiotics, Antineoplastic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Histone Deacetylase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on February 09, 2012