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A Study of ASTX030 (Cedazuridine in Combination With Azacitidine) in MDS, CMML, or AML

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04256317
Recruitment Status : Recruiting
First Posted : February 5, 2020
Last Update Posted : December 3, 2020
Sponsor:
Information provided by (Responsible Party):
Astex Pharmaceuticals, Inc.

Brief Summary:
Study ASTX030-01 is designed to move efficiently from Phase 1 to Phase 3. Phase 1 consists of an open-label Dose Escalation Stage (Stage A) using multiple cohorts at escalating dose levels of oral cedazuridine and azacitidine (only one study drug will be escalated at a time) followed by a Dose Expansion Stage (Stage B) of ASTX030. Phase 2 is a randomized open-label crossover study to compare oral ASTX030 to subcutaneous (SC) azacitidine. Phase 3 is a randomized open-label crossover study comparing the final oral ASTX030 tablet to SC azacitidine. The duration of the study is expected to be approximately 36 months.

Condition or disease Intervention/treatment Phase
Myelodysplastic Syndromes Chronic Myelocytic Leukemia Acute Myeloid Leukemia Myelodysplastic Syndrome/Neoplasm Drug: Azacitidine Drug: ASTX030 (cedazuridine + azacitidine) Drug: Cedazuridine Phase 2 Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 245 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Multi-phase, Dose-Escalation Followed by an Open-label, Randomized, Crossover Study of Oral ASTX030 (Cedazuridine and Azacitidine Given in Combination) Versus Subcutaneous Azacitidine in Subjects With Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), or Acute Myeloid Leukemia (AML)
Actual Study Start Date : May 21, 2020
Estimated Primary Completion Date : April 2023
Estimated Study Completion Date : April 2023


Arm Intervention/treatment
Experimental: Phase 1, Stage A (Dose Escalation)
In Cycle 1 (28 days per cycle), single dose oral azacitidine will be administered, followed by subcutaneous (SC) azacitidine, ASTX030 and oral cedazuridine on a specific dosing schedule; in Cycle 2, oral ASTX030 (cedazuridine + azacitidine) will be administered
Drug: Azacitidine
Tablets for oral administration and powder for reconstitution to aqueous suspension for subcutaneous administration
Other Name: Vidaza

Drug: ASTX030 (cedazuridine + azacitidine)
Tablets for oral administration

Drug: Cedazuridine
Tablets for oral administration

Experimental: Phase 1, Stage B (Dose Expansion)
Oral cedazuridine + azacitidine will be administered at the recommended dose for expansion (RDE) as individual separate tablets
Drug: ASTX030 (cedazuridine + azacitidine)
Tablets for oral administration

Experimental: Phase 2, Sequence A
Oral ASTX030 (cedazuridine + azacitidine) will be administered in Cycle 1, followed by SC azacitidine in Cycle 2; all participants will receive ASTX030 in subsequent cycles (Cycles ≥3)
Drug: Azacitidine
Tablets for oral administration and powder for reconstitution to aqueous suspension for subcutaneous administration
Other Name: Vidaza

Drug: ASTX030 (cedazuridine + azacitidine)
Tablets for oral administration

Experimental: Phase 2, Sequence B
SC azacitidine will be administered in Cycle 1, followed by oral cedazuridine + azacitidine tablets in Cycle 2; all participants will receive ASTX030 in subsequent cycles (Cycles ≥3)
Drug: Azacitidine
Tablets for oral administration and powder for reconstitution to aqueous suspension for subcutaneous administration
Other Name: Vidaza

Drug: ASTX030 (cedazuridine + azacitidine)
Tablets for oral administration

Experimental: Phase 3, Sequence A
Participants will receive ASTX030 tablets in Cycle 1, followed by SC azacitidine in Cycle 2; all participants will receive ASTX030 in subsequent cycles (Cycles ≥3)
Drug: Azacitidine
Tablets for oral administration and powder for reconstitution to aqueous suspension for subcutaneous administration
Other Name: Vidaza

Drug: ASTX030 (cedazuridine + azacitidine)
Tablets for oral administration

Experimental: Phase 3, Sequence B
Participants will receive SC azacitidine in Cycle 1 followed by ASTX030 tablets in Cycle 2; all participants will receive ASTX030 in subsequent cycles (Cycles ≥3)
Drug: Azacitidine
Tablets for oral administration and powder for reconstitution to aqueous suspension for subcutaneous administration
Other Name: Vidaza

Drug: ASTX030 (cedazuridine + azacitidine)
Tablets for oral administration




Primary Outcome Measures :
  1. Total cycle area under the curve (AUC)0-24 exposures [ Time Frame: Up to 2 months ]
    Ratio of azacitidine total cycle AUC0-24 exposures after oral ASTX030 over SC azacitidine


Secondary Outcome Measures :
  1. Safety: Number of TEAEs [ Time Frame: Up to 36 months ]
    Number of participants with treatment-emergent adverse events (TEAEs)

  2. Change in DNA methylation [ Time Frame: Baseline in Phase 1 to the end of Cycle 2 in Phase 3 (28 days per cycle) ]
    Percent long interspersed nuclear elements 1 (LINE-1) methylation change (demethylation) from baseline in Cycle 1 (Phase 1) and compared between SC azacitidine and ASTX030 in Cycles 1 and 2 (Phase 2 and 3)

  3. Best clinical response rate for participants with MDS, CMML, or MDS/myeloproliferative neoplasms (MPN) [ Time Frame: Up to 36 months ]
    The number of participants with a complete response (CR), marrow complete response (mCR), partial response (PR), and hematologic improvement (HI) will be evaluated using International Working Group (IWG) 2006 MDS response criteria

  4. Best clinical response rate for participants with AML [ Time Frame: Up to 36 months ]
    The number of participants with CR, CRi (CR with incomplete hematologic recovery), CRh (complete response with partial hematological recovery), and PR will be evaluated using European LeukemiaNet (ELN) 2017 AML response criteria and Kantarjian et al. (2017)

  5. AML-free survival for participants with MDS, CMML, or MDS/MPN [ Time Frame: Up to 36 months ]
    Number of days from the date of randomization (date of first treatment in Phase 1) to either the date of MDS, CMML, or MDS/MPN progression to AML or the date of death from any cause

  6. Duration of response [ Time Frame: Up to 36 months ]
    Number of days from the date that criteria are met for response until the first date that recurrent or progressive disease is documented by the investigating physician

  7. Overall survival [ Time Frame: Up to 36 months ]
    Number of days from the date the participant was randomized (date of first treatment in Phase 1) to the date of death, regardless of cause

  8. Time to response [ Time Frame: Up to 36 months ]
    Number of days from the start of treatment until the participant's first day of best response

  9. Red blood cell (RBC) transfusion independence (TI) [ Time Frame: Up to 36 months ]
    Number of participants with RBC TI, defined as no RBC transfusion for 56 consecutive days while maintaining hemoglobin ≥8 g/dL

  10. Platelet transfusion independence (TI) [ Time Frame: Up to 36 months ]
    Number of participants with platelet TI, defined as no platelet transfusion for 56 consecutive days while maintaining platelets ≥20×10^9/L

  11. Pharmacokinetic parameter AUC [ Time Frame: Up to Day 8 in Cycle 2 (28 days per cycle) ]
    Area under the curve (AUC)

  12. Pharmacokinetic parameter Cmax [ Time Frame: Up to Day 8 in Cycle 2 (28 days per cycle) ]
    Maximum plasma concentration (Cmax)

  13. Pharmacokinetic parameter Tmax [ Time Frame: Up to Day 8 in Cycle 2 (28 days per cycle) ]
    Time to reach maximum plasma concentration (Tmax)



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

Inclusion Criteria:

  1. Confirmed MDS, CMML, MDS/MPN, or AML who are candidates to receive and benefit from single agent azacitidine as follows and as applicable according to local country approvals and/or local institution standard practice:

    1. French-American-British myelodysplastic syndrome subtypes: refractory anemia (RA) or refractory anemia with ringed sideroblasts (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-T), or MDS with intermediate-2 or high risk MDS according to the International Prognostic Scoring System (IPSS). MDS/MPN patients including CMML according to the WHO 2016 classification are also eligible if they are candidates to receive single agent azacitidine per local institution standards; or
    2. Previously untreated AML with 20% to 30% blasts present in bone marrow and multi-lineage dysplasia (Phase 2 and 3 only); or
    3. Previously untreated AML with >30% blasts present in bone marrow, who are not eligible for stem cell transplant and unfit for intensive chemotherapy induction (Phase 2 and 3 only).
  2. Participants with Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
  3. Participants with adequate organ function defined as:

    1. Hepatic: Total or direct bilirubin ≤2 × upper limit of normal (ULN); aspartate aminotransferase (AST)/serum glutamic-oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SGPT) ≤2.5 × ULN.
    2. Renal: Calculated creatinine clearance >50 mL/min/1.73 m2 by Cockcroft-Gault formula or other medically acceptable formulas.
  4. For participants with prior allogeneic stem cell transplant, no evidence of graft-versus-host disease (GVHD) and must be ≥2 weeks off systemic immunosuppressive therapy before start of study treatment.
  5. Participants with no major surgery within 2 weeks before first study treatment.
  6. Participants with no cytotoxic chemotherapy within 4 weeks before first study treatment.
  7. Able to swallow the number of tablets required for the treatment assignment within a 10-minute period and tolerate 4 hours of fasting.
  8. Participants with projected life expectancy of at least 12 weeks.
  9. Women of child-bearing potential (according to recommendations of the Clinical Trial Facilitation Group) must not be pregnant or breastfeeding and must have a negative pregnancy test at screening.

Exclusion Criteria:

  1. Active uncontrolled gastric or duodenal ulcer.
  2. Poor medical risk because of other conditions such as uncontrolled systemic diseases or active uncontrolled bacterial, viral, or fungal infections.
  3. Life-threatening illness (e.g., uncontrolled bleeding and patients at risk for or are experiencing leukostasis [AML]), uncontrolled medical condition or organ system dysfunction, or other reasons, which, in the investigator's opinion, could compromise the participant's safety, interfere with the absorption or metabolism of oral cedazuridine + azacitidine or compromise the integrity of the study outcomes.
  4. Prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, prostate cancer or breast cancer under control with hormone therapy, or other cancer from which the participant has been disease free for at least 2 years.
  5. Participants with MDS/MPN who have clinical extramedullary disease including clinically palpable hepatomegaly or splenomegaly.
  6. Previous treatment with more than 1 cycles of decitabine, azacitidine, or guadecitabine (Phases 2 and 3 only).
  7. Treated with any investigational drug or therapy within 2 weeks, or 5 half lives, whichever is longer, before the protocol-defined first dose of study treatment, or ongoing clinically significant adverse events from previous treatment with investigational drug or therapy.
  8. Known or suspected hypersensitivity to cedazuridine or azacitidine, or any of their excipients.

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): NCT04256317


Contacts
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Contact: Kim-Hien Dao, DO, PhD 925-560-2952 kim-hien.dao@astx.com

Locations
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United States, New Jersey
John Theurer Cancer Center / Hackensack University Recruiting
Hackensack, New Jersey, United States, 07601
Contact: James McCloskey II, MD       James.McCloskey@hmhn.org   
Principal Investigator: James McCloskey II, MD         
United States, New York
Roswell Park Comprehensive Cancer Center Recruiting
Buffalo, New York, United States, 14263
Contact: Elizabeth Griffiths, MD       elizabeth.griffiths@roswellpark.org   
Principal Investigator: Elizabeth Griffiths, MD         
United States, Tennessee
Vanderbilt University Medical Center Recruiting
Nashville, Tennessee, United States, 37232
Contact: Michael R Savona, MD    615-936-3425    michael.savona@vumc.org   
Principal Investigator: Michael R Savona, MD         
United States, Texas
MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Guillermo Garcia-Manero, MD    713-792-2121    ggarciam@mdanderson.org   
Principal Investigator: Guillermo Garcia-Manero, MD         
United States, Washington
Seattle Cancer Care Alliance Recruiting
Seattle, Washington, United States, 98109
Contact: Bart Scott, MD       bscott@fredhutch.org   
Principal Investigator: Bart Scott, MD         
Sponsors and Collaborators
Astex Pharmaceuticals, Inc.
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Responsible Party: Astex Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT04256317    
Other Study ID Numbers: ASTX030-01
First Posted: February 5, 2020    Key Record Dates
Last Update Posted: December 3, 2020
Last Verified: December 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
Layout table for MeSH terms
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Preleukemia
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Myelodysplastic Syndromes
Syndrome
Disease
Pathologic Processes
Neoplasms by Histologic Type
Neoplasms
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Myeloproliferative Disorders
Azacitidine
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors