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Tolerability and Efficacy of Midostaurin to 10-day Decitabine in Unfit Adult AML and High Risk MDS Patients (HO155)

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ClinicalTrials.gov Identifier: NCT04097470
Recruitment Status : Not yet recruiting
First Posted : September 20, 2019
Last Update Posted : September 20, 2019
Sponsor:
Collaborator:
Swiss Group for Clinical Cancer Research
Information provided by (Responsible Party):
Stichting Hemato-Oncologie voor Volwassenen Nederland

Brief Summary:
The aim of this study is to investigate how safe and effective the addition of the new medicine midostaurin to decitabine is for the treatment of unfit acute myeloid leukemia (AML) and high-risk myelodysplasia (MDS) patients. Patients who are ineligible for intensive chemotherapy because of accompanying diseases may opt for gentler treatment. This does not produce a cure but serves to allow the quality of life to be acceptable for as long as possible. Decitabine is an example of a gentler treatment. It is effective against leukemia and has fewer side effects than intensive chemotherapy. Given in courses of 5 successive days, decitabine is registered for the treatment of AML. There is scientific research to suggest that decitabine is more effective and generally well tolerated when given in courses of 10 successive days. Therefore, treatment with 10-day courses of decitabine is the standard treatment in this scientific research. The aim is to investigate whether this standard treatment can be improved by adding a new product, midostaurin. Midostaurin is a medicine that is directed against a specific protein on leukaemia cells (FLT3).

Condition or disease Intervention/treatment Phase
AML/MDS Drug: Decitabine Drug: Midostaurin Phase 2

Detailed Description:

This trial aims to develop effective treatments for unfit (i.e. Hematopoietic cell transplantation co-morbidity index (HCT-CI) ≥ 3) in adult (≥ 18 yrs) AML patients, for whom current treatment strategies are highly unsatisfactory. Therefore new treatment modalities are introduced and evaluated in multiple parallel randomized phase II studies that will be conducted within the frame of a master protocol. The scheme of this new design consists of one arm with one of the currently considered best available treatments for unfit AML patients (i.e. 10-day decitabine). After a maximum of 3 10-day courses, or less in case of good response, treatment will be continued with 5-day decitabine courses. This treatment will be compared to investigational treatments in combination with decitabine.

The competitor of the 10-day decitabine schedule will be 10-day decitabine combined (sequential) with the tyrosine kinase inhibitor midostaurin (independent of the presence of FLT3 mutations). The rationale for midostaurin is: 1) single agent midostaurin has shown efficacy in both FLT3 wild type and mutant AML; 2) it has shown efficacy in a phase III randomized controlled trial when combined with intensive chemotherapy in FLT3-mutated AML (RATIFY study); 3) midostaurin has been successfully combined with hypomethylating agents (azacitidine and decitabine) and improved the response compared with historical response rates of these drugs, suggesting at least additive affects of midostaurin with hypomethylating agents.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 140 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Phase II Multicenter Study to Assess the Tolerability and Efficacy of the Addition of Midostaurin to 10-day Decitabine Treatment in Unfit Adult Acute Myeloid Leukemia and High Risk Myelodysplasia Patients
Estimated Study Start Date : September 16, 2019
Estimated Primary Completion Date : October 2021
Estimated Study Completion Date : March 2026


Arm Intervention/treatment
Active Comparator: Arm A: Decitabine

Cycles 1-3: Decitabine 10-day; depending on day +28 bone marrow (BM) blasts after the previous cycle, next cycle consists of either 5-day (BM blasts < 5%) or 10-day (BM blasts ≥5%) decitabine. Cycles 4 and beyond: 5-day decitabine (in cycles of 4-8 weeks); continuation of these cycles until progression.

Dosage for Decitabine 20 mg/m2 i.v.

Drug: Decitabine
Decitabine dosage 20mg/m2 i.v.
Other Name: Dacogen

Experimental: Arm B: Decitabine and Midostaurin

Cycle 1:Decitabine; 10-day schedule (start day +1) + midostaurin (start day +11). Midostaurin is given until 2 days before start next cycle of decitabine. Cycles 2-3: Decitabine 5 or 10-day schedule; depending on day +28 bone marrow blasts of the previous cycle, next cycle consist of either 5-day (BM blasts < 5%) or 10-day (BM blasts ≥5%) decitabine + midostaurin (daily, starting the day after the last dose of decitabine (i.e. day +6 or +11). Midostaurin is given until 2 days before start next cycle. Cycles 4 and beyond: 5-day decitabine (in cycles of 4-8 weeks) followed by midostaurin starting at day +6 until two days before start of next cycle of decitabine; continuation of these cycles until progression. Midostaurin is given until 2 days before start next cycle of decitabine.

Dosage for Decitabine 20 mg/m2 i.v.

Dosage for Midostaurin 50 mg b.i.d.

Drug: Decitabine
Decitabine dosage 20mg/m2 i.v.
Other Name: Dacogen

Drug: Midostaurin
Midostaurin 50 mg b.i.d.
Other Name: Rydapt




Primary Outcome Measures :
  1. Cumulative Complete Remission (CR) / CR with incomplete blood count (CRi) rate [ Time Frame: 4-5 months ]
    Cumulative CR/CRi rate during 3 cycles


Secondary Outcome Measures :
  1. Safety and tolerability of midostaurin determined by the type, frequency, severity and relationship of adverse events to study treatment [ Time Frame: 5 years ]
    Safety and tolerability of midostaurin added to 10-day decitabine treatment for AML (type, frequency, severity and relationship of adverse events to study treatment).

  2. Efficacy profile [ Time Frame: 4-9 months ]
    The response rate after first three cycles together with the best response during three cycles and after 9 months will determinine the efficacy profile.

  3. Event free survival (EFS) [ Time Frame: 5 years ]
    The time from registration to induction failure, death or relapse whichever occurs first).

  4. Overall survival (OS) [ Time Frame: 5 years ]
    The time from the date of randomization to the date of death, whatever the cause. Patients still alive at the date last contact will be censored.

  5. Hospital stay duration [ Time Frame: 4-5 months ]
    Days of staying in hospital during 3 cycles.

  6. Transfusion need [ Time Frame: 4-5 months ]
    Number of participants with transfusion needs during 3 cycles.

  7. Prognostic value of MRD [ Time Frame: 9 months and at relapse ]
    Assessment of the prognostic value of Minimal Residual Disease (MRD) by flowcytometry or PCR

  8. Predictive value of gene mutations [ Time Frame: 5 years ]
    Assessment of the predictive value of gene mutations by exploratory analysis

  9. Prognostic value of baseline physical conditions as measured by the short physical performance battery [ Time Frame: 5 years ]
    Assessment of the prognostic value of baseline physical and functional conditions using a comprehensive geriatric assessment tool, short physical performance battery (SPPB), on treatment outcome. Total scores (range 0 to 12) will be used to determine physical performance.

  10. Prognostic value of baseline functional conditions as measured by the activities of daily living [ Time Frame: 5 years ]
    Assessment of the prognostic value of baseline functional conditions using a comprehensive geriatric assessment tool, activities of daily living (ADL), on treatment outcome. Total points (range 0 to 6) will be used to determine functional condition.



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 100 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with:

    • a diagnosis of AML and related precursor neoplasms according to WHO 2016 classification (excluding acute promyelocytic leukemia) including secondary AML (after an antecedent hematological disease (e.g. MDS) and therapy-related AML, or
    • a diagnosis of myelodysplastic syndrome with excess of blasts (MDS) and International Prognostic Score System (IPSS) > 4.5
  • Patients 18 years and older.
  • Patients NOT eligible for standard chemotherapy, defined as hematopoietic cell transplantation comorbidity index (HCT-CI) ≥ 3.

or Patients NOT eligible for standard chemotherapy for other reasons (wish of patient).

  • White blood cell (WBC) ≤ 30 x109/L (prior hydroxyurea allowed for a maximum of 5 days, stop 2 days before start decitabine treatment)
  • Adequate renal and hepatic functions unless clearly disease related as indicated by the following laboratory values:

    • Serum creatinine ≤ 221.7 µmol/L (≤ 2.5 mg/dL ), unless considered AML-related
    • Serum bilirubin ≤ 2.5 x upper limit of normal (ULN), unless considered AML-related or due to Gilbert's syndrome
    • Alanine transaminase (ALT) ≤ 2.5 x ULN, unless considered AML-related
  • WHO performance status 0, 1 or 2.
  • Patient is willing and able to use adequate contraception during and until 5 months after the last protocol treatment.
  • Written informed consent.
  • Patient is capable of giving informed consent.

Exclusion Criteria:

  • Acute promyelocytic leukemia.
  • Acute leukemia's of ambiguous lineage according to WHO 2016
  • Patient has symptomatic central nervous system (CNS) leukemia (NO routinely lumbar puncture required to investigate CNS involvement)
  • Blast crisis of chronic myeloid leukemia.
  • Diagnosis of any previous or concomitant malignancy is an exclusion criterion:
  • except when the patient completed successfully treatment (chemotherapy and/or surgery and/or radiotherapy) with curative intent for this malignancy at least 6 months prior to randomization. OR
  • except for basal and squamous cell carcinoma of the skin or in situ carcinoma of the cervix
  • Patients previously treated for AML (any antileukemic therapy including investigational agents), a short treatment period ( ≤ 5 days) with Hydroxyurea is allowed
  • Current concomitant chemotherapy, radiation therapy, or immunotherapy; other than hydroxyurea
  • Concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled diabetes, infection, hypertension, pulmonary disease etc.)
  • Cardiac dysfunction as defined by:

    • Myocardial infarction within the last 3 months of study entry, or
    • Reduced left ventricular function with an ejection fraction < 40% as measured by MUGA scan or echocardiogram or
    • Unstable angina or
    • New York Heart Association grade IV congestive heart failure or
    • Unstable cardiac arrhythmias.
  • History of stroke or intracranial hemorrhage within 6 months prior to randomization.
  • Patient has a history of human immunodeficiency virus or active infection with Hepatitis C or B.
  • Patients known to be pregnant
  • Patients with a history of non-compliance to medical regimens or who are considered unreliable with respect to compliance.
  • Patients with any serious concomitant medical condition which could, in the opinion of the investigator, compromise participation in the study.
  • Patients who have senile dementia, mental impairment or any other psychiatric disorder that prohibits the patient from understanding and giving informed consent.
  • Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule

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 ClinicalTrials.gov identifier (NCT number): NCT04097470


Contacts
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Contact: Gerwin Huls, Prof. +31503612354 g.huls@umcg.nl
Contact: E. Ammatuna, Dr. +31503612354 e.ammatuna@umcg.nl

Locations
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Germany
UH Magdeburg Not yet recruiting
Magdeburg, Germany
Principal Investigator: Fischer         
Netherlands
Rijnstate Not yet recruiting
Arnhem, Netherlands
Contact: Cuijpers         
Principal Investigator: Cuijpers         
Reinier de Graaf Groep Not yet recruiting
Delft, Netherlands
Principal Investigator: Posthuma         
Jeroen Bosch Ziekenhuis Not yet recruiting
Den Bosch, Netherlands
Principal Investigator: Herbers         
HagaZiekenhuis Not yet recruiting
Den Haag, Netherlands
Principal Investigator: van Lammeren         
Slingeland Ziekenhuis Not yet recruiting
Doetinchem, Netherlands
Principal Investigator: Aboosy         
Albert Schweitzer Ziekenhuis Not yet recruiting
Dordrecht, Netherlands
Principal Investigator: Westerweel         
Gelderse Vallei Not yet recruiting
Ede, Netherlands
Principal Investigator: Velders         
Catharina Ziekenhuis Not yet recruiting
Eindhoven, Netherlands
Principal Investigator: Cruijsen         
Maxima MC Not yet recruiting
Eindhoven, Netherlands
Principal Investigator: Tick         
UMCG Not yet recruiting
Groningen, Netherlands
Principal Investigator: Huls         
St. Antonius Ziekenhuis Not yet recruiting
Nieuwegein, Netherlands
Principal Investigator: Söhne         
Canisius Wilhelmina Ziekenhuis Not yet recruiting
Nijmegen, Netherlands
Principal Investigator: de Jonge-Peeters         
UMCU Not yet recruiting
Utrecht, Netherlands
Principal Investigator: Van Rhenen         
Switzerland
KSA Not yet recruiting
Aarau, Switzerland
Principal Investigator: Bargetzi         
USB Not yet recruiting
Basel, Switzerland
Principal Investigator: Heim         
IOSI Not yet recruiting
Bellinzona, Switzerland
Principal Investigator: Stussi         
Insel Not yet recruiting
Bern, Switzerland
Principal Investigator: Pabst         
HFR Not yet recruiting
Fribourg, Switzerland
Principal Investigator: Betticher         
HCUGE Not yet recruiting
Geneva, Switzerland
Principal Investigator: Chalandon         
CHUV Not yet recruiting
Lausanne, Switzerland
Principal Investigator: Blum         
KSL Not yet recruiting
Luzern, Switzerland
Principal Investigator: Gregor         
KSSG Not yet recruiting
Saint Gallen, Switzerland
Principal Investigator: Fehr         
USZ Not yet recruiting
Zürich, Switzerland
Principal Investigator: Manz         
Sponsors and Collaborators
Stichting Hemato-Oncologie voor Volwassenen Nederland
Swiss Group for Clinical Cancer Research
Investigators
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Principal Investigator: Gerwin Huls, Prof UMCG / HOVON

Additional Information:
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Responsible Party: Stichting Hemato-Oncologie voor Volwassenen Nederland
ClinicalTrials.gov Identifier: NCT04097470     History of Changes
Other Study ID Numbers: HOVON 155 AML
2018-000047-31 ( EudraCT Number )
2018-674 ( Other Identifier: METc UMCG )
NL64632.042.18 ( Other Identifier: CCMO )
First Posted: September 20, 2019    Key Record Dates
Last Update Posted: September 20, 2019
Last Verified: September 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Decitabine
Midostaurin
Staurosporine
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors
Protein Kinase Inhibitors