Inotuzumab Ozogamicin and Chemotherapy in Treating Patients With Recurrent or Refractory B-cell Acute Lymphoblastic Leukemia
NCT ID: NCT03991884
Last Updated: 2023-07-06
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
PHASE1
24 participants
INTERVENTIONAL
2019-09-24
2023-06-28
Brief Summary
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Detailed Description
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Patients receive etoposide, doxorubicin, and vincristine intravenously (IV) via continuous infusion on days 1-4, prednisone orally (PO) or IV twice daily (BID) on days 1-5, and cyclophosphamide IV over 1 hour on day 5. Patients also receive inotuzumab ozogamicin IV over 1 hour on days 8 and 15. Treatment repeats every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days then annually for up to 5 years.
Conditions
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Study Design
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NON_RANDOMIZED
SEQUENTIAL
TREATMENT
NONE
Study Groups
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Dose -1 (0.3 mg/m^2)
Patients receive etoposide, doxorubicin, and vincristine IV via continuous infusion on days 1-4, prednisone PO or IV BID on days 1-5, and cyclophosphamide IV over 1 hour on day 5. Patients also receive inotuzumab ozogamicin IV over 1 hour on day 8. Treatment repeats approximately every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
Etoposide
Given IV
Doxorubicin
Given IV
Vincristine
Given IV
Prednisone
Given PO or IV
Cyclophosphamide
Given IV
Inotuzumab Ozogamicin
Given IV
Dose 1 (0.3 mg/m^2)
Dose 1 patients receive etoposide, doxorubicin, and vincristine IV via continuous infusion on days 1-4, prednisone PO or IV BID on days 1-5, and cyclophosphamide IV over 1 hour on day 5. Patients also receive inotuzumab ozogamicin IV over 1 hour on days 8 and 15. Treatment repeats approximately every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
Etoposide
Given IV
Doxorubicin
Given IV
Vincristine
Given IV
Prednisone
Given PO or IV
Cyclophosphamide
Given IV
Inotuzumab Ozogamicin
Given IV
Dose 2 (0.6 mg/m^2, 0.3 mg/m^2)
Dose 2 patients receive etoposide, doxorubicin, and vincristine IV via continuous infusion on days 1-4, prednisone PO or IV BID on days 1-5, and cyclophosphamide IV over 1 hour on day 5. Patients also receive inotuzumab ozogamicin IV over 1 hour on days 8 and 15. Treatment repeats approximately every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
Etoposide
Given IV
Doxorubicin
Given IV
Vincristine
Given IV
Prednisone
Given PO or IV
Cyclophosphamide
Given IV
Inotuzumab Ozogamicin
Given IV
Dose 3 (0.6 mg/m^2, 0.3 mg/m^2)
Dose 3 patients receive etoposide, doxorubicin, and vincristine IV via continuous infusion on days 1-4, prednisone PO or IV BID on days 1-5, and cyclophosphamide IV over 1 hour on day 5. Patients also receive inotuzumab ozogamicin IV over 1 hour on days 8 and 15. Treatment repeats approximately every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
Etoposide
Given IV
Doxorubicin
Given IV
Vincristine
Given IV
Prednisone
Given PO or IV
Cyclophosphamide
Given IV
Inotuzumab Ozogamicin
Given IV
Interventions
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Etoposide
Given IV
Doxorubicin
Given IV
Vincristine
Given IV
Prednisone
Given PO or IV
Cyclophosphamide
Given IV
Inotuzumab Ozogamicin
Given IV
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Relapsed or refractory disease, as defined by any of the following:
* Unable to achieve complete response (CR) despite \>= 4 weeks of initial course of systemic therapy.
* Recurrence of disease at any point after CR was achieved.
* (Note: patients with Ph-positive disease must have received \>= 1 second- or third-generation ABL kinase inhibitor as part of their prior treatment to be eligible.)
* Detectable disease, as defined by any of the following:
* Presence of \>= 5% abnormal blasts in the bone marrow or peripheral blood by morphology or MFC.
* Patients with isolated extramedullary disease will be permitted if there is \>= 1 site of disease that measures \>= 1.5 cm in longest diameter on cross-sectional imaging.
* Absolute neutrophil count (ANC) \>= 1,000/uL.
* Hemoglobin \>= 8 g/dL.
* Platelets \>= 50,000/uL.
* Note: Transfusions and growth factor support will be permitted within 3 days of initiation of study treatment to reach these thresholds. As patients with relapsed/refractory ALL frequently have cytopenias due to marrow infiltration by the disease, no hematologic parameters will be required for enrollment if cytopenias can be attributed to disease.
* Total serum bilirubin =\< 1.5 x upper limit of normal (ULN); (unless due to Gilbert syndrome or hemolysis; =\< 2 x ULN for hepatic abnormalities considered disease-related).
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 2.5 x ULN.
* Serum creatinine =\< 1.5 x ULN or serum creatinine level associated with a measured or calculated creatinine clearance of \>= 40 mL/min.
* Corrected QT (QTc) interval =\< 500 msec; if assessed, left ventricular ejection fraction \>= 40%.
* An Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.
* Must agree to the use of effective contraception while on study treatment, unless they are highly unlikely to conceive (defined as \[1\] surgically sterilized, or \[2\] women who are and men whose sexual partner\[s\] is/are postmenopausal \[i.e., a woman who is \> 50 years old or who has not had menses for \>= 1 year\], or \[3\] not heterosexually active for the duration of the study).
Exclusion Criteria
* Except for management of circulating blasts noted above, adequate duration from prior therapy must be achieved before initiation of study treatment, as defined below:
* No cytotoxic or targeted systemic therapy \< 2 weeks or 5 half-lives (whichever is shorter).
* No blinatumomab \< 2 weeks.
* No radiation therapy \< 4 weeks.
* No monoclonal antibody therapy \< 6 weeks (except for prior InO, as discussed below).
* Patients previously treated with InO will be eligible, unless they meet ANY of the following criteria:
* \> 6 individual doses (e.g., \> 2 standard cycles) were administered.
* Any documented hepatic toxicity observed was grade 3 or higher.
* The most recent dose was administered \< 3 months from the initiation of study treatment.
* For patients that have received prior allogeneic HCT, they must be \>= 4 months from the date of stem cell infusion, with no prior history of sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD), and off all treatment for graft-vs-host disease (GVHD) for \>= 2 weeks. Patients with minimal active symptoms that can be controlled with topical therapies and/or the equivalent of prednisone =\< 10 mg/day will be eligible.
* For patients that have received other forms of cellular immunotherapy (e.g., chimeric antigen receptor-modified \[CAR\] T cells), they must be \>= 21 days from cell infusion, and any specific manifestations of cytokine release syndrome or neurologic toxicity attributable to the cellular therapy have completely resolved (i.e., \< grade 1)
* Patients with a known history of chronic liver disease, including but not limited to cirrhosis, steatohepatitis, and chronic viral hepatitis. Patients with a history of GVHD of the liver will be permitted, provided they meet all of the other eligibility criteria.
* Patients with isolated testicular or central nervous system disease.
* Known hypersensitivity or intolerance to any of the agents under investigation.
* May not be pregnant or nursing.
18 Years
ALL
No
Sponsors
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Pfizer
INDUSTRY
University of Washington
OTHER
Responsible Party
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Principal Investigators
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Ryan Cassaday
Role: PRINCIPAL_INVESTIGATOR
Fred Hutch/University of Washington Cancer Consortium
Locations
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Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Countries
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References
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Kopmar NE, Quach K, Gooley TA, Martino CH, Cherian S, Percival MM, Halpern AB, Ghiuzeli CM, Oehler VG, Abkowitz JL, Walter RB, Cassaday RD. Dose-Adjusted EPOCH Plus Inotuzumab Ozogamicin in Adults With Relapsed or Refractory B-Cell ALL: A Phase 1 Dose-Escalation Trial. JAMA Oncol. 2024 Jul 1;10(7):961-965. doi: 10.1001/jamaoncol.2024.0967.
Provided Documents
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Document Type: Informed Consent Form
Other Identifiers
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NCI-2019-03811
Identifier Type: REGISTRY
Identifier Source: secondary_id
8786
Identifier Type: OTHER
Identifier Source: secondary_id
RG1004854
Identifier Type: -
Identifier Source: org_study_id
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