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This dose-escalating study is to determine the safety, pharmacokinetics, and preliminary efficacy of venetoclax in combination with navitoclax and chemotherapy in adult and pediatric participants with relapsed/refractory acute lymphoblastic leukemia (ALL) or relapsed/refractory lymphoblastic lymphoma. A safety expansion cohort of approximately 20 patients may be enrolled in addition to the 50 participants in dose-escalation cohort.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Venetoclax + Navitoclax + Chemotherapy | Experimental | Venetoclax weight-adjusted doses administered orally every day (QD) starting on Day 1 + navitoclax various, weight-adjusted doses administered orally QD starting on Day 3 + chemotherapy (peg-asparaginase [or any other forms of asparaginase], vincristine, dexamethasone) and tyrosine kinase inhibitor [TKI, if applicable]). This regimen and any of its components may be delayed, reduced or omitted at the discretion of the Investigator. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Navitoclax | Drug | tablet |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Cmax of Venetoclax + Navitoclax | Maximum observed plasma concentration (Cmax) of venetoclax + navitoclax | Up to approximately 9 months |
| AUC of Venetoclax + Navitoclax | Area under the plasma concentration-time curve (AUC) of venetoclax + navitoclax | Up to approximately 9 months |
| Tmax of Venetoclax + Navitoclax | Time to Cmax (Tmax) of Venetoclax + Navitoclax | Up to approximately 9 months |
| CL/F of Venetoclax + Navitoclax | Apparent oral clearance (CL/F) of venetoclax + navitoclax | Up to approximately 9 months |
| Number of participants with dose-limiting toxicities (DLT) | A DLT is any Grade 3 or higher non-hematologic adverse event (AE) with exceptions outlined in the protocol. AEs and toxicities that occur beyond the DLT assessment period will also be evaluated by the investigator and AbbVie and may be considered as dose-limiting. | Up to approximately 28 days after initial dose of study drug |
| Measure | Description | Time Frame |
|---|---|---|
| Progression-free survival (PFS) | PFS is defined as the number of days from the date of enrollment to the date of earliest disease progression or death. | Up to 9 months after the last subject has enrolled into the study |
| Partial Response (PR) rate |
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Inclusion Criteria:
Must have relapsed or refractory acute lymphoblastic leukemia (ALL) or relapsed or refractory lymphoblastic lymphoma (LL). Refractory is defined as persistent disease after at least 2 courses of chemotherapy.
Participants <= 18 years of age who do not have a standard of care treatment option available.
Must weigh greater than or equal to 20 kg.
Must be able to swallow pills.
Must have adequate hepatic and kidney function.
Must have adequate performance status:
Exclusion Criteria:
Participant has central nervous system (CNS) disease with cranial involvement that requires radiation.
Participants who are less than 100 days post-transplant, or greater than 100 days post-transplant with active graft versus host disease (GVHD), or are still continuing post-transplant immunosuppressant therapy within 7 days prior to the first dose of study drug.
Participants who have received any of the following prior to the first dose of study drug:
Inotuzumab within 30 days (if participant received inotuzumab > 30 days prior to Day 1, must have ALT, AST and bilirubin < ULN).
A biologic agent (i.e., monoclonal antibodies) for anti-neoplastic intent within 30 days
CAR-T infusion or other cellular therapy within 30 days
Any anti-cancer therapy including blinatumomab, chemotherapy, radiation therapy targeted small molecule agents or investigational agents within 14 days, or 5 half-lives, whichever is shorter
Steroid therapy for anti-neoplastic intent within 5 days
Hydroxyurea that is ongoing (hydroxyurea is permitted up to the first dose)
A strong or moderate CYP3A inhibitor or inducer within 7 days
Aspirin within 7 days, or 5 half-lives, whichever is longer
An excluded antiplatelet/anticoagulant drug or a herbal supplement that affects platelet function within 7 days, or 5 half-lives, whichever is longer
Participants with malabsorption syndrome or any other condition that precludes enteral administration.
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| Name | Affiliation | Role |
|---|---|---|
| AbbVie Inc. | AbbVie | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| City of Hope /ID# 169029 | Duarte | California | 91010 | United States | ||
| LPCH Stanford /ID# 163337 |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39368878 | Derived | Badawi M, Gopalakrishnan S, Engelhardt B, Palenski T, Karol SE, Rubnitz JE, Menon R, Salem AH. Dosing of Venetoclax in Pediatric Patients with Relapsed Acute Myeloid Leukemia: Analysis of Developmental Pharmacokinetics and Exposure-Response Relationships. Clin Ther. 2024 Oct;46(10):759-767. doi: 10.1016/j.clinthera.2024.09.008. Epub 2024 Oct 5. |
| Label | URL |
|---|---|
| clinical study report synopsis | View source |
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| Chemotherapy | Drug | peg-asparaginase (or other form of asparaginase, per local standard of care (intravenous) + vincristine (intravenous) + dexamethasone (oral) + tyrosine kinase inhibitor (TKI) (if applicable, oral) |
|
| Venetoclax | Drug | tablet |
|
|
PR defined as no peripheral blasts or peripheral blood absolute blast count decreased by ≥ 50% from baseline, bone marrow with 5 - 25% blasts and at least a 50% decrease in bone marrow blast percent from baseline, no evidence of extramedullary disease.
| Up to 9 months after the last subject has enrolled into the study |
| Number of Participant who Proceed to Stem Cell Transplantation or Chimeric antigen receptor T-cell (CAR-T) Therapy | Determine the number of participants who proceed to stem cell transplantation or CAR-T therapy. | Up to 9 months after the last subject has enrolled into the study |
| Overall survival (OS) | OS is defined as the number of days from the date of enrollment to the date of death. | Up to 9 months after the last subject has enrolled into the study |
| Objective response rate (ORR) | The proportion of subjects with objective response rate (complete response [CR] + CR incomplete recovery [CRi] + CR without platelet recovery [CRp]) for ALL subjects and (CR+PR) for LL subjects. | Up to 9 months after the last subject has enrolled into the study |
| Complete Response (CR) rate | CR defined as hematologic recovery (absolute neutrophil count [ANC] greater than or equal to 500/μL; platelet counts greater than or equal to 75,000/μL), evidence of trilineage hematopoiesis in the bone marrow and less than 5% blasts in the bone marrow, absence of circulating blasts, and no evidence of extramedullary disease. | Up to 9 months after the last subject has enrolled into the study |
| Palo Alto |
| California |
| 94304 |
| United States |
| University of Chicago /ID# 163369 | Chicago | Illinois | 60637 | United States |
| Washington University-School of Medicine /ID# 165689 | St Louis | Missouri | 63110 | United States |
| Univ NC Chapel Hill /ID# 163509 | Chapel Hill | North Carolina | 27514-4220 | United States |
| Cincinnati Children's Hospital /ID# 164619 | Cincinnati | Ohio | 45229 | United States |
| Nationwide Childrens Hospital /ID# 163372 | Columbus | Ohio | 43205 | United States |
| Oregon Health and Science University /ID# 165690 | Portland | Oregon | 97239 | United States |
| St Jude Children's Research Hospital /ID# 163335 | Memphis | Tennessee | 38105 | United States |
| UT Southwestern Medical Center /ID# 163346 | Dallas | Texas | 75390-7208 | United States |
| MD Anderson Cancer Center at Texas Medical Center /ID# 163327 | Houston | Texas | 77030-4000 | United States |
| University of Wisconsin-Madiso /ID# 165691 | Madison | Wisconsin | 53705 | United States |
| Alfred Hospital /ID# 169576 | Melbourne | Victoria | 3004 | Australia |
| Victorian Comprehensive Cancer /ID# 165710 | Melbourne | Victoria | 3050 | Australia |
| Royal Children's Hospital /ID# 163322 | Melbourne | Victoria | 3052 | Australia |
| ID | Term |
|---|---|
| D054198 | Precursor Cell Lymphoblastic Leukemia-Lymphoma |
| D009369 | Neoplasms |
| ID | Term |
|---|---|
| D007945 | Leukemia, Lymphoid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| C528561 | navitoclax |
| D004358 | Drug Therapy |
| C579720 | venetoclax |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
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