Recruiting
Phase 1/2
A Study to Investigate Treatment of HU and VPA, or 6-MP and VPA in Unfit AML/HR-MDS Patients
Condition(s) studied
Acute Myeloid Leukemia, AdultMyelodysplastic Syndromes, Adult
Investigational drug(s) / intervention(s)
Hydroxyurea, Hydroxycarbamide: Hydroxyurea (HU/hydroxycarbamide) is a hydroxylated analogue of urea which prevents DNA synthesis by inhibiting the activity of ribonucleotide reductase (RNR). HU has been used to treat a variety of diseases. As an antineoplastic drug, HU has some advantages. It may be used by ambulatory patients and has relatively few side effects, which are relieved almost immediately after withdrawal of the drug. The drug is readily absorbed from the gastrointestinal tract following oral administration. At present, HU has an important role as standard of care for treating hyperleukocytosis in chronic and acute myeloid leukemia.
Valproic acid: Valproic acid (VPA) has been used clinically as an anticonvulsant and mood-stabilizing drug. During the last two decades, VPA has been described as a histone deacetylase (HDAC) inhibitor and gained increased interest for use in cancer therapy. VPA is administered orally with available routine measurements of serum levels and has a low toxicity profile.
6-Mercaptopurine (6-MP): In 1953, 6-MP was an approved antileukemic agent resulting in remissions in children with acute lymphocytic leukemia (ALL). After adding 6-MP to methotrexate and prednisolone in the treatment regimen, the one-year mean survival of children with ALL was increased from 29% to 50%. 6-MP, even about 70 years after its discovery, remains the standard maintenance therapy once the children are in complete remission.
Study summary
The purpose of this study is to investigate the safety, tolerability, and preliminary efficacy of the combination treatment of hydroxyurea capsules and valproic acid capsules, or the combination treatment of 6-mercaptopurine tablets and valproic acid capsules in male and female patients aged 18 years or older with acute myeloid leukemia or high- risk myelodysplastic syndrome.
The population to be studied is newly diagnosed AML patients who are considered unfit for standard induction chemotherapy, HR-MDS unfit/ineligible for standard treatment, and relapsed/refractory AML/HR-MDS patients who are considered unfit for standard therapy ,or are, for some reason, ineligible for another type of therapy. Clinically, hydroxyurea, valproic acid and 6-mercaptopurine are historically very well-known therapeutic agents with low toxicity profiles. The rationale for this study is that the combination of these drugs with low toxicity will be well tolerated in elderly AML patients with comorbidities, or lower performance status. This combination could have a beneficial therapeutic effect on overall survival and contribute to a better quality of life.
Eligibility
Inclusion Criteria:
Participants are eligible for the study only if all of the following criteria apply:
o Female or male, age 18 years or older
* Written informed consent
* Patients with Newly diagnosed AML, as defined by ELN 2022 criteria, or relapsed/refractory AML who: - are unfit, defined as HCT-CI ≥ 3, or - in the opinion of the investigator are not candidates for standard therapy or unlikely to tolerate or derive significant clinical benefit from standard therapy, or
* the patient has declined standard therapy
Newly diagnosed HR-MDS, or relapsed/refractory HR-MDS who:
* are unfit, defined as HCT-CI ≥ 3, or
* in the opinion of the investigator are not candidates for standard therapy or unlikely to tolerate or derive significant clinical benefit from standard therapy, or
* has declined standard therapy
Secondary AML (MDS-related/ therapy- induced), or
Acute promyelocytic leukemia not eligible for standard therapy and/or specific therapy.
* Adequate renal and hepatic functions unless clearly disease related as indicated by the following laboratory values:
* Serum creatinine ≤1.5 x ULN;
* Estimated creatinine clearance ≥ 40 mL/min (Cockcroft-Gault equation);
* Hepatic function;
i. Serum bilirubin ≤ 1.5 x upper limit of normal (ULN); ii. Aspartate aminotransferase (AST)
1. ≤2.5 × ULN
2. ≤5 × ULN for patients with liver metastases
iii. Alanine aminotransferase (ALT)
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1. ≤2.5 × ULN
2. ≤5 × ULN for patients with liver metastases
iv. Alkaline phosphatase (ALP)
1\. ≤2.5 × ULN
* European Cooperative Oncology Group (ECOG) performance status 0, 1, 2 or 3
* Female patients of childbearing potential must have a negative serum pregnancy test within 3 days prior to taking their first dose of study medication. Male patients and female patients of reproductive potential must agree to practice highly effective methods of contraception (such as hormonal implants, combined oral contraceptives, injectable contraceptives, intrauterine device with hormone spirals, total sexual abstinence, vasectomy) throughout the study and for \>3 months after the last dose of study medication. Female patients are considered NOT of childbearing potential if they have a history of surgical sterility or evidence of post-menopausal status defined as any of the following:
1. Natural menopause with last menses \>1 year ago
2. Radiation induced oophorectomy with last menses \>1 year ago
3. Chemotherapy induced menopause with last menses \>1 year ago
Exclusion Criteria:
Participants are excluded from the study if any of the following criteria apply:
* Patients on treatment for AML (any anti-leukemic therapy including investigational agents) or treated less than 2 weeks before inclusion.
* Concurrent history of active malignancy in the past six months prior to diagnosis except for
* basal and squamous cell carcinoma of the skin
* in situ carcinoma of the cervix
* Concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled diabetes, infection, hypertension, pulmonary disease et cetera) at the investigators discretion.
* Breastfeeding women
* Cardiac dysfunction as defined by:
* myocardial infarction within the last 3 months of study entry, or
* congestive heart failure NYHA class IV or
* unstable angina, or
* unstable cardiac arrhythmias
* SARS-CoV-2 infection \< 7 days or Covid-19-vaccine \< 7 days from study onset
* 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 that could, in the opinion of the investigator, compromise participation in the study.
* Patients with senile dementia, mental impairment or any other psychiatric disorder that prohibits the patient from understanding and giving informed consent.
* Current concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol.
* Known hypersensitivity to study medications or its excipients.
* Any psychological, familial, sociological, and geographical condition potentially hampering compliance with the study protocol and follow-up schedule.
Primary outcome measure(s)
- Safety and tolerability of the treatment combinations of hydroxyurea + valproic acid, and 6-mercaptopurine + valproic acid administered at established clinical doses. — Evaluation every 4th week, i.e. after each treatment cycle.
Safety and tolerability assessed by monitoring the incidence, frequency, and severity of AEs by using CTCAE v5.0, including evaluation of the following:
* DLTs
* Physical examinations
* Clinical laboratory blood samples
- Preliminary efficacy of the treatment combination of hydroxyurea and valproic acid administered at established clinical doses. — Evaluation every 4th week, i.e. after each treatment cycle.
Clinical benefit in patients receiving hydroxyurea in combination with valproic acid.
Clinical benefit in patients receiving 6-mercaptopurine in combination with valproic acid.
Clinical benefit, in this protocol, is defined as stable disease, partial response (decrease of bone marrow blast percentage to between 5% to 25% and decrease of pre-treatment bone marrow blast percentage by at least 50%), or better response \[European Leukemia Net (ELN) 2022 response criteria in AML\], and/or stable or improved ECOG performance status.
- Changes in patients performance status from baseline and during the study period. — Evaluation at baseline, i.e. before onset treatment, after 4 weeks on treatment (i.e.after first cycle), and every 4th week to a total of 24 weeks. (i.e. after each treatment cycle, up to a total of 6 cycles).
Baseline and longitudinal ECOG performance status of the patient (Eastern Cooperative Oncology Group). The ECOG performance status scale is best at 0 (fully active, able to carry on all pre-disease performance without restriction), and worst at 5 (dead).
Trial sites (1)
| Facility | City | Region | Status |
|---|
| Haukeland University Hospital |
Bergen |
Bergen |
Recruiting |
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