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Study of AR-67 (DB-67) in Myelodysplastic Syndrome (MDS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00956787
Recruitment Status : Unknown
Verified August 2009 by Arno Therapeutics.
Recruitment status was:  Recruiting
First Posted : August 11, 2009
Last Update Posted : June 24, 2014
Information provided by (Responsible Party):
Arno Therapeutics

Brief Summary:
The purpose of this study is to determine if AR-67 is effective in the treatment for patients with MDS.

Condition or disease Intervention/treatment Phase
Myelodysplastic Syndrome Drug: AR-67 (20S)-7-t-Butyldimethylsilyl-10-hydroxycamptothecin) Phase 2

Detailed Description:

The management of MDS has been, until recently, based mostly on supportive care. This includes transfusion support, hematopoietic growth factors, and management of complications. With this management, the disease would run its natural course and the patient eventually died either from progression to acute leukemia or from complications associated with MDS itself (e.g., infections, hemorrhage). Recently, hypomethylating agents have offered promise for the management of patients with MDS. Although both agents have shown efficacy in a subset of patients, responses are usually either partial or hematologic improvement only, with CR rates <10%. In addition, responses have a median duration of less than 12 months. Thus, although both of these agents have improved the outcome of patients with MDS and been approved by the FDA for this purpose, there is clearly need for additional and more effective agents for this disease.

In vitro data suggested that topoisomerase I inhibitors could have activity in MDS, and a prolonged exposure appeared to be particularly effective. Topotecan was the first agent of this class explored for this purpose. A phase I study established the maximum tolerated dose (MTD) at 2 mg/m2/day as a continuous infusion for 5 days. Using this dose, a phase II study in patients with MDS and CMML, a complete remission rate of 31% was achieved. These agents are now considered the most effective available to date in the treatment of MDS and constitute standard therapy. Because of the different times when the studies were conducted and the different eligibility criteria used (e.g., patients with secondary MDS not eligible for decitabine, only patients with high-risk MDS eligible for topotecan), comparisons are somehow limited. However, results with topotecan compare favorably to those obtained with both 5-azacytidine and decitabine. The CR rate is the highest achieved with any of these agents. Response duration is shorter than that reported for AZA, but the remission duration for AZA includes hematologic improvements which constitute most of the responses with AZA. In addition, the AZA study continued therapy until the response was lost, while the topotecan study (as well as the decitabine study) administered by design only 4-6 cycles of therapy. Survival was shorter for patients treated with topotecan, but this is not unexpected considering that this population included 50% of patients with CMML and 32% with secondary MDS, both important adverse prognostic characteristics in MDS. The AZA study had the best survival, but it included 37% patients with RA or RAES and only 20% with intermediate-2 or high IPSS. Because the eligibility included patients with greater than 10% blasts, all MDS patients would have had a score of at least 1.5 and thus be classified in the intermediate-2 risk group.

Based on the favorable activity of topotecan as a single agent, topotecan was also used in combination with cytarabine in high-risk MDS (i.e., RAEB with >10% blasts or RAEBt). A CR rate of 56% was achieved, with a low rate of induction mortality (7%) in a population with a median age of 68 years. These results were at least equivalent to those achieved with an idarubicin and cytarabine combination both in a retrospective comparison of two different trials, and in a prospective randomized trial.

Overall, these results suggest that additional exploration of topoisomerase I inhibitors in myelodysplastic syndrome is warranted.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 25 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 2 Study of AR-67 (DB-67) in Myelodysplastic Syndrome(MDS)
Study Start Date : June 2009
Estimated Primary Completion Date : July 2014
Estimated Study Completion Date : December 2014

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Treatment with AR-67
Patients will receive AR-67 at an initial dose of 7.5 mg/m2 IV over 1 hour daily for 5 days.
Drug: AR-67 (20S)-7-t-Butyldimethylsilyl-10-hydroxycamptothecin)
Patients will receive AR-67 at an initial dose of 7.5 mg/m2 IV over 1 hour daily for 5 days. In patients with stable disease, treatment may continue for up to a total of 12 courses of therapy; about 1 to 2 years.
Other Names:
  • AR-67
  • (20S)-7-t-Butyldimethylsilyl-10-hydroxycamptothecin)

Primary Outcome Measures :
  1. To estimate the efficacy of AR-67 in treating patients with MDS who have failed prior therapies [ Time Frame: 4 cycles (approximately 16 weeks) ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients with either of the following diagnoses:

    • MDS and >5% blasts, or IPSS risk group intermediate-1, intermediate-2 or high risk
    • Chronic myelomonocytic leukemia (CMML)
  2. Patients must have failed prior therapy with either a hypomethylating agent (e.g., azacytidine, decitabine) alone or in combination with other agents. Patients with abnormalities in chromosome 5q, should have failed either a hypomethylating agent or lenalidomide.

    • Patients intolerant or unable to receive these agents will be considered eligible.
  3. Age > 18 years. Because no dosing or adverse event data are currently available on the use of AR-67 in patients < 18 years of age, children are excluded from this study but will be eligible for future pediatric single-agent trials, if applicable.
  4. ECOG performance status 0-2.
  5. Patients must have normal organ function as defined below:

    • Total bilirubin: < 1.5 x institutional upper limit of normal
    • ALT (SGPT): < 2.5 X institutional upper limit of normal
    • Creatinine: < 1.5 x institutional upper limit of normal
  6. The effects of AR-67 on the developing human fetus at the recommended therapeutic dose are unknown. For this reason women of child-bearing potential (i.e., not post-menopausal for at least 12 months and not surgically sterile) and men must agree to use effective methods of contraception. Women of childbearing potential (any women who is not surgically sterile or > 2 years post menopause) must give consent for using a reliable method of contraception (e.g. double-barrier, tubal ligation or stable hormonal contraception) throughout 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.
  7. Ability to understand and the willingness to sign a written informed consent document.
  8. Patients must have been off chemotherapy for 2 weeks prior to entering this study unless there is evidence of rapidly progressive disease. Patients must have recovered from the toxic effects of prior therapy to grade ≤1. The use of hydroxyurea is allowed to control counts up to 24 hrs prior to the start of therapy with AR-67.

Exclusion Criteria:

  1. Nursing or pregnant females or females who plan pregnancy during the duration of the study.
  2. Active and uncontrolled systemic infections.
  3. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or psychiatric illness/social situations that would limit compliance with study requirements.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00956787

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Contact: Jorge Cortes, MD (713) 794-5783
Contact: Sheela Mathews, RN 713-792-1046

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United States, Texas
The University of Texas MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Sheela Mathews, RN    713-792-1046   
Principal Investigator: Jorge Cortes, MD         
Sponsors and Collaborators
Arno Therapeutics
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Principal Investigator: Jorge Cortes, MD The University of Texas MD Anderson Cancer Center
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Responsible Party: Arno Therapeutics Identifier: NCT00956787    
Obsolete Identifiers: NCT00930540
Other Study ID Numbers: ARN-AR67-IIS201
First Posted: August 11, 2009    Key Record Dates
Last Update Posted: June 24, 2014
Last Verified: August 2009
Keywords provided by Arno Therapeutics:
Myelodysplastic Syndrome
Additional relevant MeSH terms:
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Myelodysplastic Syndromes
Pathologic Processes
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Antineoplastic Agents, Phytogenic
Antineoplastic Agents