Pharmacokinetics, Safety, and Efficacy of ASTX727 in Combination With Venetoclax in Acute Myeloid Leukemia (AML)

NCT ID: NCT04657081

Last Updated: 2025-12-08

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 101 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-02-09
• Study Completion Date: 2026-12-31

Brief Summary

The Phase 1 portion of this study is a single-arm, open-label, multicenter, non-randomized interventional study to evaluate the pharmacokinetic (PK) interaction, safety, and efficacy of ASTX727 when given in combination with venetoclax for the treatment of newly diagnosed acute myeloid leukemia (AML) in adults who are age 75 years or older, or who have comorbidities that preclude use of intensive induction chemotherapy. The primary purpose of the study is to rule out drug-drug interactions between ASTX727 and venetoclax combination therapy by evaluating area under the curve (AUC) and maximum plasma concentration (Cmax) exposure. The Phase 2 portion of the study is to assess the efficacy of ASTX727 and venetoclax when given in combination and to evaluate potential PK interactions. Phase 2 will follow the same overall study design as Phase 1 and has two parts, Part A and Part B.

Conditions

Acute Myeloid Leukemia

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Oral administration of ASTX727 and Venetoclax combination

Cycle 1: ASTX727 according to a prescribed dosing regimen and venetoclax on day 1 (100 mg daily), day 2 (200 mg daily), and days 3-28 (400 mg daily) of a 28-day cycle.

Cycle 2 and beyond: ASTX727 according to a prescribed dosing regimen and venetoclax on days 1-28 (400 mg daily) of a 28-day cycle.

Group Type: EXPERIMENTAL

Decitabine and Cedazuridine (ASTX727)

Intervention Type: DRUG

Route of administration: oral in the form of a tablet

Venetoclax

Intervention Type: DRUG

Route of administration: oral in the form of a tablet

Interventions

Decitabine and Cedazuridine (ASTX727)

Route of administration: oral in the form of a tablet

Intervention Type: DRUG

Venetoclax

Route of administration: oral in the form of a tablet

Intervention Type: DRUG

Other Intervention Names

INQOVI; Venclexta

Eligibility Criteria

Inclusion Criteria

1. Participant must be 18 years of age or older.

2. Histological confirmation of newly diagnosed AML by World Health Organization (WHO) 2016 criteria.

3. Projected life expectancy of at least 3 months.

4. Participants must be considered ineligible for intensive induction chemotherapy defined by the following: a) Age 75 years or older, or b) Age 18 to 74 years with at least one of the following comorbidities: i) Severe cardiac disorder (eg, congestive heart failure requiring treatment, ejection fraction ≤50%, or chronic stable angina), ii) Severe pulmonary disorder (eg, diffusing lung capacity for carbon monoxide DLCO ≤65% or forced expiratory volume in 1 second [FEV1] ≤65%), iii) Creatinine clearance ≥30 mL/min to <45 mL/min, iv) Moderate hepatic impairment with total bilirubin >1.5 to ≤3.0 × upper limit of normal (ULN), v) Phase 1: Eastern Cooperative Oncology Group (ECOG) Performance Status of 2 (participants with ECOG ≥3 are not eligible); Phase 2, Parts A and B: ECOG Performance Status of 2 or 3 (participants with ECOG 4 are not eligible).

5. Phase 1: ECOG Performance Status of 0-2; Phase 2, Parts A and B: ECOG 0-3.

6. Women of child-bearing potential (according to recommendations of the Clinical Trial Facilitation Group [CTFG]) must not be pregnant or breastfeeding and must have a negative pregnancy test at screening.

7. Participants and their partners with reproductive potential must agree to use a highly effective contraceptive measure during the study and for 3 months after the last dose of study treatment, including refraining from sperm donation. Effective contraception includes methods such as oral contraceptives or double-barrier method (eg, use of a condom AND diaphragm, with spermicide).

8. Capable of giving legally effective informed consent, which includes compliance with the requirements and restrictions listed in the informed consent form and protocol, and willing to participate in the study.

Exclusion Criteria

1. History of myeloproliferative neoplasm including myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia with or without BCR-ABL1 translocation and AML with BCR-ABL1 translocation.

2. The following karyotype abnormalities: t(8;21), inv(16) or t(15;17), or other acute promyelocytic leukemia variants that remain sensitive to all-trans retinoic acid (ATRA) therapy.

3. Known active central nervous system involvement from AML.

4. Known human immunodeficiency virus (HIV) infection (due to potential drug-drug interactions between antiretroviral medications and venetoclax). Human immunodeficiency virus testing will be performed at Screening, only if indicated per local guidelines or institutional standards.

5. Known active hepatitis B or C infection (detectable viral load). Hepatitis B or C testing will be performed at Screening, only if indicated per local guidelines or institutional standards.

6. Severe hepatic impairment defined as: bilirubin >1.5×upper limit of normal (ULN) for participants ≥75 years or >3×ULN for participants <75 years; or aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) or alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SGPT) >3×ULN (unless considered to be due to leukemic organ involvement).

7. Severe renal impairment defined as: calculated creatinine clearance or glomerular filtration rate <30 mL/min.

8. A malabsorption syndrome or other condition that precludes enteral route of administration.

9. Cardiovascular disability status of New York Heart Association Class >2. Class 2 is defined as cardiac disease in which patients are comfortable at rest but ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain.

10. Chronic respiratory disease that requires continuous oxygen, or significant history of renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, hepatic, cardiovascular disease, any other medical condition or known hypersensitivity to any of the study medications that in the opinion of the investigator would adversely affect his/her participating in this study.

11. Clinically significant uncontrolled systemic infection requiring therapy (viral, bacterial, or fungal).

12. History of other malignancies prior to study entry, with the exception of adequately treated in situ carcinoma of the breast or cervix uteri; localized basal cell carcinoma or squamous cell carcinoma of the skin; previous malignancy confined and surgically resected (or adequately treated and controlled with other modalities); and any early stage malignancy for which no definitive therapy is required.

13. White blood cell (WBC) count >25,000/μL (Hydroxyurea treatment is permitted to meet this criterion).

14. Treatment with the following: a) A hypomethylating agent (azacitidine or decitabine), or venetoclax including prior treatment for myelodysplastic syndrome (MDS), b) Chimeric Antigen Receptor (CAR)-T cell therapy, c) Investigational therapies for MDS or AML.

15. Participants who cannot discontinue concomitant prophylactic antifungal therapy with CYP3A inhibitor activity or other concomitant medications with moderate or strong CYP3A inhibitor activity ≥7 days or 5 half-lives, whichever is greater, prior to cycle 1 day 1 (C1D1).

16. Participants who cannot discontinue concomitant drugs that are strong CYP3A or P-gp inhibitors ≥7 days or 5 half-lives, whichever is greater, prior to C1D1.

17. Participants who cannot avoid concomitant drugs known as moderate or strong CYP3A inducers.

18. Current participation in another research study requiring interventions such as drug therapy or study procedures.

19. Known or suspected hypersensitivity to decitabine, cedazuridine, venetoclax, or any of their excipients.

20. Known significant mental illness or other condition such as active alcohol or other substance abuse or addiction that, in the opinion of the investigator, predisposes the participant to high risk of noncompliance with the protocol.

21. Participants who consume grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or starfruit ≤7 days prior to C1D1.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Taiho Oncology, Inc.

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

USC Norris Comprehensive Cancer Center

Los Angeles, California, United States

Stanford University

Palo Alto, California, United States

Yale University

New Haven, Connecticut, United States

Baptist MD Anderson Cancer Center

Jacksonville, Florida, United States

Boca Raton Clinical Research

Plantation, Florida, United States

The University of Chicago Medical Center

Chicago, Illinois, United States

Indiana University Simon Cancer Center

Indianapolis, Indiana, United States

Tufts Medical Center

Boston, Massachusetts, United States

Massachusetts General Hospital

Boston, Massachusetts, United States

University of Massachusetts, Memorial Medical Center

Worcester, Massachusetts, United States

Health Midwest Ventures Group, Inc.

Kansas City, Missouri, United States

Hackensack University of Medical Center

Hackensack, New Jersey, United States

Roswell Park Comprehensive Cancer Center

Buffalo, New York, United States

Weill Cornell Medical College

New York, New York, United States

University of Rochester

Rochester, New York, United States

The Research Foundation of the State University of New York (SUNY)

Syracuse, New York, United States

East Carolina University

Greenville, North Carolina, United States

The Ohio State University

Columbus, Ohio, United States

Penn State Milton S. Hershey Medical Center

Hershey, Pennsylvania, United States

UPMC Hillman Cancer Center

Pittsburgh, Pennsylvania, United States

Vanderbilt University Medical Center

Nashville, Tennessee, United States

MD Anderson Cancer Center

Houston, Texas, United States

Baylor Scott & White Research Institute

Temple, Texas, United States

Seattle Cancer Care Alliance

Seattle, Washington, United States

University of Calgary - Health Sciences Centre

Calgary, Alberta, Canada

University of Alberta

Edmonton, Alberta, Canada

The Ottawa Hospital, General Campus

Ottawa, Ontario, Canada

Jewish General Hospital

Montreal, , Canada

Hospital Universitario Central de Asturias

Oviedo, Austrias, Spain

Institut Catala d'Oncologia-Hospital Duran i Reynals

L'Hospitalet de Llobregat, Barcelona, Spain

Clinica Universidad de Navarra, Pamplona

Pamplona, Navarre, Spain

Universitario Gregorio Marañon

Madrid, , Spain

Hospital Universitario de Salamanca

Salamanca, , Spain

Hospital Universitari i Politecnic La Fe

Valencia, , Spain

Countries

United States; Canada; Spain

Other Identifiers

ASTX727-07

Identifier Type: -

Identifier Source: org_study_id