Not provided
| ID | Type | Description | Link |
|---|---|---|---|
| NCI-2018-02998 | Registry Identifier | CTRP (Clinical Trial Reporting Program) |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| Jazz Pharmaceuticals | INDUSTRY |
Not provided
Not provided
Not provided
This trial evaluates how well CPX-351 and enasidenib work in treating patients with acute myeloid leukemia characterized by IHD2 mutation. Drugs used in chemotherapy, such as CPX-351, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Enasidenib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving CPX-351 and enasidenib may work better in treating patients with acute myeloid leukemia, compared to giving only one of these therapies alone.
PRIMARY OBJECTIVE:
I. To estimate the remission rate (defined as complete remission [CR]/ CR with incomplete hematologic recovery [CRi]) of the combination of liposome-encapsulated daunorubicin-cytarabine (CPX-351) plus enasidenib mesylate (enasidenib) in adults with relapsed acute myeloid leukemia (AML) characterized by a 2-hydroxyglutarate (2-HG) producing IDH2 mutations that include IDH2^R172 and IDH2^R140.
SECONDARY OBJECTIVES:
I. To evaluate persistent severe hematologic toxicity at induction day 60 in patients with a morphologic leukemia-free state (bone marrow blasts < 5%).
II. To evaluate delayed CR/CRi with enasidenib maintenance in participants with stable disease after induction with CPX-351.
III. To estimate the rate of CR plus complete remission with partial hematologic recovery (CRp) of the combination of CPX-351 plus enasidenib.
IV. To evaluate time to return of normal hematopoiesis after induction therapy. V. To evaluate 30- and 60-day survival. VI. To evaluate CPX-351 plus enasidenib as a bridge to allogeneic hematopoietic stem cell transplantation (HSCT).
EXPLORATORY OBJECTIVES:
I. To determine the co-existing mutations that are present with the IDH2 mutation and describe those that are present in patients who achieve CR/CRi.
II. To determine the depth of molecular response to induction by minimal residual disease (MRD) using next generation sequencing.
III. To estimate the subclinical cardiotoxicity of CPX-351 as measured by troponin I, electrocardiography (ECG), and echocardiography.
OUTLINE:
INDUCTION: Patients receive liposome-encapsulated daunorubicin-cytarabine intravenously (IV) over 90 minutes on days 1, 3, and 5, and enasidenib mesylate orally (PO) on days 10-60 in the absence of disease progression or unacceptable toxicity. Patients whose bone marrow is not hypoplastic receive re-induction including liposome-encapsulated daunorubicin-cytarabine IV on days 1 and 3, and enasidenib mesylate PO on days 8-60 in the absence of disease progression or unacceptable toxicity.
CONSOLIDATION: Participants who achieve CR/CRi may proceed directly to allogeneic HSCT or receive up to 4 cycles of consolidation. Patients < 60 years receive cytarabine twice daily (BID) on days 1, 3, and 5, and patients >= 60 years receive cytarabine IV once daily on days 1-5. Patients also receive enasidenib mesylate PO on days 6-55. Treatment repeats every 28-55 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients who maintain CR/CRi after completion of consolidation therapy undergo allogeneic HSCT at the discretion of the treating physician.
MAINTENANCE: Participants who have stable disease (not meeting criteria for progressive disease, but also not achieving CR/CRi) at day 60 receive enasidenib mesylate PO daily in the absence of disease progression or unacceptable toxicity. Routine follow-up visits will be conducted at least once every 3 months for the duration of the trial.
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment (CPX-351, enasidenib mesylate) | Experimental | See detailed description |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Enasidenib Mesylate | Drug | Given PO |
|
| Measure | Description | Time Frame |
|---|---|---|
| Complete remission (CR)/CR with incomplete hematologic recovery (CRi) after induction therapy | Up to day 60 |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients with persistent grade 4 hematologic toxicity per Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 | The proportion along with the exact 95% confidence interval will reported. | At day 60 |
| Proportion of patients who achieve CR/CRi during maintenance therapy |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients who have a particular co-occurring mutation with an allelic frequency >= 10% along with the IDH2 mutation, and have achieved CR/CRi | Will be reported along with an exact 95% confidence interval. | Up to 2 years |
| Proportion of patients who achieved CR/CRi then achieve minimal residual disease negativity based on Invivoscribe assay |
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Caspian Oliai, MD | UCLA / Jonsson Comprehensive Cancer Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UCLA / Jonsson Comprehensive Cancer Center | Los Angeles | California | 90095 | United States | ||
| University of California Davis Comprehensive Cancer Center |
Not provided
Not provided
| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Apr 25, 2024 | May 20, 2024 | 13 |
| ID | Term |
|---|---|
| D015470 | Leukemia, Myeloid, Acute |
| ID | Term |
|---|---|
| D007951 | Leukemia, Myeloid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
Not provided
Not provided
| ID | Term |
|---|---|
| D019840 | 2-Propanol |
| C045880 | methanesulfonic acid |
| C000605269 | enasidenib |
| C000629812 | CPX-351 |
| D007267 | Injections |
| D003561 | Cytarabine |
| ID | Term |
|---|---|
| D020005 | Propanols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
| D004333 | Drug Administration Routes |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Liposome-encapsulated Daunorubicin-Cytarabine | Drug | Given IV |
|
|
This is calculated only among patients who had stable disease after induction therapy and have received maintenance enasidenib monotherapy. |
| Up to 2 years |
| Proportion of patients who achieve CR/complete remission with partial hematologic recovery (CRp) after induction therapy | Up to 2 years |
| Time to return of normal hematopoiesis | Defined as time from day 1 of induction to absolute neutrophil count (ANC) >= 1000/uL and platelet count >= 100,000/uL. The median time to return of normal hematopoiesis will be reported along with the corresponding range. | From day 1 of induction assessed up to 2 years |
| Overall survival | Will be estimated using Kaplan-Meier methods. The survival estimate at these two time points will be reported along with a 95% confidence interval. | From day 1 of induction therapy, assessed at day 30 and 60 |
| Proportion of patients who go on to receive allogeneic hematopoietic stem cell transplantation (HSCT) after achieving CR/CRi | Will be reported along with an exact 95% confidence interval. | Up to 2 years |
| Up to 2 years |
| Proportion of abnormal troponin levels without concurrent elevated creatinine | Up to 2 years |
| Proportion of abnormal electrocardiogram (ECG) findings (new T-wave inversions or new ST segment abnormalities) | Up to 2 years |
| Proportion of echocardiogram findings with left ventricular ejection fraction reduction by >= 25% | Up to 2 years |
| Sacramento |
| California |
| 95817 |
| United States |
| University of California San Diego | San Diego | California | 92103 | United States |
| D006402 |
| Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D004358 |
| Drug Therapy |
| D013812 | Therapeutics |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D001087 | Arabinonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |