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Part 1 will be conducted as an open-label, non-randomized, non-placebo-controlled dose escalation study using pre-specified doses. Subjects with the following advanced hematological disorders and no available therapies, and who satisfy all inclusion/exclusion criteria will be enrolled. The purpose is to identify the recommended dose of oral ORH-2014 in subjects with advanced hematological disorders.
Part 2 will be an expansion phase conducted as a single-arm, open-label study to further evaluate the safety and tolerability of ORH-2014 at the maximum tolerated dose (MTD) or recommended dose determined from Part 1 in the fasted state. Subjects with the same disease types as in Part 1 will be enrolled. All subjects will receive oral ORH-2014, in the fasted state, at the recommended dose for an initial period of up to 12 weeks. The purpose is to evaluate the safety and tolerability of oral ORH-2014 in a population of subjects with advanced hematological disorders when administered at the recommended dose.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Part 1 | Experimental | Subjects will receive oral ORH-2014 at a planned starting dose of 5 mg once daily (QD) in the fasted state. If escalation criteria are met, the administered dose will increase by 5 mg increments to a maximum of 50 mg QD. The starting daily dose is approximately half the typical IV dose (0.15 milligram per kilogram [mg/kg]) extrapolated to a 70-kg person. |
|
| Part 2 | Experimental | Subjects will receive a daily oral dose of ORH-2014 at the recommended dose identified in Part 1. ORH-2014 will be administered in the fasted state. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ORH-2014 | Drug | ORH-2014 capsule 5 mg orally with dose escalations of 5 mg intervals. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| To identify the recommended dose | The recommended dose is determined by the number of patients who experience a dose limiting toxicity (DLT). | From baseline to Week 4 |
| Number of Participants With Adverse Events (AE) as a Measure of Safety and Tolerability of ORH-2014 when administered at the MTD or recommended dose | To evaluate safety and tolerability the aggregate review will include but is not limited to:
| Up to Week 28 |
| Measure | Description | Time Frame |
|---|---|---|
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by maximum observed concentration (Cmax) | Baseline up to Week 24 | |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by time to maximum concentration (Tmax) |
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Inclusion Criteria:
Female and male subjects ≥18 years of age with one of the following:
Negative pregnancy test at the Screening visit for women of childbearing potential and willingness to use adequate birth control
Not willing to undergo, not a candidate for, or not having a donor for immediate (within 3 months from the Screening date) bone marrow transplantation.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Farhad Ravandi-Kashani, MD | MD Anderson | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Memorial Sloan-Kettering Cancer Center | New York | New York | 10065 | United States | ||
| Weill Cornell Medical College |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31558670 | Derived | Ravandi F, Koumenis I, Johri A, Tallman M, Roboz GJ, Strickland S, Garcia-Manero G, Borthakur G, Naqvi K, Meyer M, Pudipeddi M, Nidarmarthy S, Vaddi K, Kantarjian H. Oral arsenic trioxide ORH-2014 pharmacokinetic and safety profile in patients with advanced hematologic disorders. Haematologica. 2020 Jun;105(6):1567-1574. doi: 10.3324/haematol.2019.229583. Epub 2019 Sep 26. |
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Part 1 of the study is parallel. Part 2 will be an expansion phase.
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| ORH-2014 |
| Drug |
ORH-2014 capsule at recommended dose orally. |
|
| Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by apparent terminal elimination half-life (t1/2) | Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by area under the concentration-time curve from 0 to 24 hours (AUC0-24) | Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by area under the concentration-time curve extrapolated to infinity (AUC0-infinity) | Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by apparent terminal elimination rate constant (λZ) | Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by apparent total clearance (CL/F) | Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by apparent total clearance normalized by body weight (CL/F/kg) | Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by apparent total volume of distribution (Vz/F) | Baseline up to Week 24 |
| To determine the plasma pharmacokinetic (PK) profiles of total arsenic as measured by accumulation ratio (AR) | Baseline up to Week 24 |
| To evaluate the effect of ORH-2014 on QT-interval corrected for heart rate using Fridericia's formula (QTcF) | Baseline up to Week 28 |
| Safety Assessment during the expansion phase of the study on the effect of oral ORH-2014 on safety parameters | During the expansion phase of the study, an aggregate clinical data review (ACDR) will be conducted. This review will collect data from electronic data capture, the ECG central review vendor (ERT), and other sources to include but is not limited to:
| Baseline up to Week 28 |
| The number of participants with a complete response (CR) or partial response (PR) according to International Working Group (IWG) response criteria | Bone marrow aspirates and/or biopsies will be obtained at the designated timepoints for evaluation of efficacy. Response criteria will be according to the International Working Group. Responders are participants who obtain complete remission (CR) or partial remission (PR), with or without cytogenetic response, and marrow complete remission. | Up to Week 24 |
| New York |
| New York |
| 10065 |
| United States |
| Vanderbilt University | Nashville | Tennessee | 37240 | United States |
| MD Anderson | Houston | Texas | 77030 | United States |
| ID | Term |
|---|---|
| D015473 | Leukemia, Promyelocytic, Acute |
| ID | Term |
|---|---|
| D015470 | Leukemia, Myeloid, Acute |
| D007951 | Leukemia, Myeloid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
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