PD-1 Inhibitor Combined With Azacytidine and Homoharringtonine,Cytarabine, G-CSF for Refractory or Relapsed AML

NCT ID: NCT04722952

Last Updated: 2021-12-03

Study Results

Results pending

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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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-05-01

Study Completion Date

2024-01-01

Brief Summary

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This is an single center, single arm, phase 3 study to evaluate efficacy and safety of PD-1 Inhibitor combined with DNA methyltransferase inhibitor Azacytidine and HAG regimen for patients with relapsed and refractory acute myeloid leukemia.

Detailed Description

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Treatment for Acute Myeloid Leukemia(AML) that has not responded to treatment (refractory) or has returned after treatment (relapsed) often do not work. Researchers want to see if an immunotherapy drug, combined with a less intense chemotherapy, may be able to help.

Conditions

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Immunotherapy Refractory Leukemia Relapsed Adult AML Acute Myeloid Leukemia

Keywords

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Acute Myeloid Leukemia Refractory or Relapsed Azacytidine HAG regimen PD-1 inhibitor

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Anti-PD-1 mAb Combined With Azacytidine and HAG regimen

Anti-PD-1 mAb combined with DNA methyltransferase inhibitor Azacytidine and HAG regimen

Group Type EXPERIMENTAL

Visilizumab

Intervention Type DRUG

Azacytidine 75mg/(m2.d) by IV on days 1-7 of every cycle. Anti-PD-1 mAb 200mg by IV on day 8 of every cycle. Homoharringtonine(HHT) 2mg/(m2.d) by IV on days 1-6 of every cycle Cytarabine 10mg/(m2.d) by SC on days 1-7 of every cycle Granulocyte colony-stimulating factor(G-CSF) 300ug/d by SC on days 1-7 of every cycle,until absolute neutrophil count(ANC) \> 5X109/L or white blood cell(WBC)\> 20X109/L.

Interventions

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Visilizumab

Azacytidine 75mg/(m2.d) by IV on days 1-7 of every cycle. Anti-PD-1 mAb 200mg by IV on day 8 of every cycle. Homoharringtonine(HHT) 2mg/(m2.d) by IV on days 1-6 of every cycle Cytarabine 10mg/(m2.d) by SC on days 1-7 of every cycle Granulocyte colony-stimulating factor(G-CSF) 300ug/d by SC on days 1-7 of every cycle,until absolute neutrophil count(ANC) \> 5X109/L or white blood cell(WBC)\> 20X109/L.

Intervention Type DRUG

Other Intervention Names

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Azacytidine Homoharringtonine Cytarabine

Eligibility Criteria

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Inclusion Criteria

* Chinese guidelines for the diagnosis and treatment of relapsed and refractory acute myeloid leukemia (2017 edition),excludes acute promyelocytic leukemia (M3、APL)

* Hematopoietic stem cell transplantation ≥3 months, Discontinue immunosuppressant ≥3 weeks, Patients without graft-versus-host disease;
* Be at least 18 years of age on day of signing informed consent.
* Have a performance status of less than or equal to 2 on the Eastern Cooperative Oncology Group(ECOG) Performance Scale
* Demonstrate adequate organ function as defined below, all screening labs should be performed before treatment initiation:

1. ALT(SGPT) less than or equal to 2.5 × Upper Limit of Norma(ULN);
2. AST (SGOT) less than or equal to 2.5 × ULN;
3. Serum total bilirubin Less than or equal to 2.0 × ULN Note: If total bilirubin \>2.0×ULN, subjects with Gilbert syndrome records are allowed to join the group
4. Serum Creatinine ≥ 30 mL/min
* Treatment without anthracycline or demethylation. Ability to comprehend the investigational nature of the study and provide informed consent

Exclusion Criteria

* Patients with chronic myeloid leukemia,AML of other myeloproliferative disorders Malignant neoplasms with other progression Those who can not control severe infections and other underlying diseases can not tolerate chemotherapy Patients with cardiac insufficiency: ejection fraction (EF)\<30%,New York Heart Association(NYHA) standards,Cardiac insufficiency II or above Patients with liver and kidney dysfunction:Serum bilirubin (SB)≥2mg/dl,AST is 2.5 times higher than normal upper limit, serum creatinine (SCr) is more than 2.5 mg/dl Serious mental illness uncooperative Refusal to join the study
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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The First Affiliated Hospital of Soochow University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Han Yue, Ph.D

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Soochow University

Locations

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The First Affiliated Hospital of Soochow University

Suzhou, Jiangsu, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Han Yue, Ph.D

Role: CONTACT

Phone: (0086)51267781856

Email: [email protected]

Wu Depei, Ph.D

Role: CONTACT

Phone: (0086)51267781856

Email: [email protected]

Facility Contacts

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Yue Han, professor

Role: primary

References

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Thol F, Schlenk RF, Heuser M, Ganser A. How I treat refractory and early relapsed acute myeloid leukemia. Blood. 2015 Jul 16;126(3):319-27. doi: 10.1182/blood-2014-10-551911. Epub 2015 Apr 7.

Reference Type BACKGROUND
PMID: 25852056 (View on PubMed)

Price SL, Lancet JE, George TJ, Wetzstein GA, List AF, Ho VQ, Fernandez HF, Pinilla-Ibarz J, Kharfan-Dabaja MA, Komrokji RS. Salvage chemotherapy regimens for acute myeloid leukemia: Is one better? Efficacy comparison between CLAG and MEC regimens. Leuk Res. 2011 Mar;35(3):301-4. doi: 10.1016/j.leukres.2010.09.002. Epub 2010 Nov 24.

Reference Type BACKGROUND
PMID: 21109304 (View on PubMed)

Tallman MS, Wang ES, Altman JK, Appelbaum FR, Bhatt VR, Bixby D, Coutre SE, De Lima M, Fathi AT, Fiorella M, Foran JM, Hall AC, Jacoby M, Lancet J, LeBlanc TW, Mannis G, Marcucci G, Martin MG, Mims A, O'Donnell MR, Olin R, Peker D, Perl A, Pollyea DA, Pratz K, Prebet T, Ravandi F, Shami PJ, Stone RM, Strickland SA, Wieduwilt M, Gregory KM; OCN; Hammond L, Ogba N. Acute Myeloid Leukemia, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019 Jun 1;17(6):721-749. doi: 10.6004/jnccn.2019.0028.

Reference Type BACKGROUND
PMID: 31200351 (View on PubMed)

Christman JK. 5-Azacytidine and 5-aza-2'-deoxycytidine as inhibitors of DNA methylation: mechanistic studies and their implications for cancer therapy. Oncogene. 2002 Aug 12;21(35):5483-95. doi: 10.1038/sj.onc.1205699.

Reference Type BACKGROUND
PMID: 12154409 (View on PubMed)

Keating GM. Azacitidine: a review of its use in higher-risk myelodysplastic syndromes/acute myeloid leukaemia. Drugs. 2009;69(17):2501-18. doi: 10.2165/11202840-000000000-00000.

Reference Type BACKGROUND
PMID: 19911860 (View on PubMed)

Gao S, Li Z, Fu JH, Hu XH, Xu Y, Jin ZM, Tang XW, Han Y, Chen SN, Sun AN, Wu DP, Qiu HY. Decitabine in the Treatment of Acute Myeloid Leukemia and Myelodysplastic Syndromes, Which Combined with Complex Karyotype Respectively. Asian Pac J Cancer Prev. 2015;16(15):6627-32. doi: 10.7314/apjcp.2015.16.15.6627.

Reference Type BACKGROUND
PMID: 26434886 (View on PubMed)

Orskov AD, Treppendahl MB, Skovbo A, Holm MS, Friis LS, Hokland M, Gronbaek K. Hypomethylation and up-regulation of PD-1 in T cells by azacytidine in MDS/AML patients: A rationale for combined targeting of PD-1 and DNA methylation. Oncotarget. 2015 Apr 20;6(11):9612-26. doi: 10.18632/oncotarget.3324.

Reference Type BACKGROUND
PMID: 25823822 (View on PubMed)

Daver N, Garcia-Manero G, Basu S, Boddu PC, Alfayez M, Cortes JE, Konopleva M, Ravandi-Kashani F, Jabbour E, Kadia T, Nogueras-Gonzalez GM, Ning J, Pemmaraju N, DiNardo CD, Andreeff M, Pierce SA, Gordon T, Kornblau SM, Flores W, Alhamal Z, Bueso-Ramos C, Jorgensen JL, Patel KP, Blando J, Allison JP, Sharma P, Kantarjian H. Efficacy, Safety, and Biomarkers of Response to Azacitidine and Nivolumab in Relapsed/Refractory Acute Myeloid Leukemia: A Nonrandomized, Open-Label, Phase II Study. Cancer Discov. 2019 Mar;9(3):370-383. doi: 10.1158/2159-8290.CD-18-0774. Epub 2018 Nov 8.

Reference Type BACKGROUND
PMID: 30409776 (View on PubMed)

Ivanoff S, Gruson B, Chantepie SP, Lemasle E, Merlusca L, Harrivel V, Charbonnier A, Votte P, Royer B, Marolleau JP. 5-Azacytidine treatment for relapsed or refractory acute myeloid leukemia after intensive chemotherapy. Am J Hematol. 2013 Jul;88(7):601-5. doi: 10.1002/ajh.23464. Epub 2013 May 30.

Reference Type BACKGROUND
PMID: 23619977 (View on PubMed)

Itzykson R, Thepot S, Berthon C, Delaunay J, Bouscary D, Cluzeau T, Turlure P, Prebet T, Dartigeas C, Marolleau JP, Recher C, Plantier I, Stamatoullas A, Devidas A, Taksin AL, Guieze R, Caillot D, Vey N, Ades L, Ifrah N, Dombret H, Fenaux P, Gardin C. Azacitidine for the treatment of relapsed and refractory AML in older patients. Leuk Res. 2015 Feb;39(2):124-30. doi: 10.1016/j.leukres.2014.11.009. Epub 2014 Nov 24.

Reference Type BACKGROUND
PMID: 25524177 (View on PubMed)

Santini V, Ossenkoppele GJ. Hypomethylating agents in the treatment of acute myeloid leukemia: A guide to optimal use. Crit Rev Oncol Hematol. 2019 Aug;140:1-7. doi: 10.1016/j.critrevonc.2019.05.013. Epub 2019 May 25.

Reference Type BACKGROUND
PMID: 31153036 (View on PubMed)

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Other Identifiers

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SOOCHOW-HY-2020

Identifier Type: -

Identifier Source: org_study_id