Ziftomenib for the Treatment of Patients With NPM1 Mutated or KMT2A Rearranged Acute Myeloid Leukemia Not Eligible for Standard Therapy

NCT ID: NCT06930352

Last Updated: 2025-10-02

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

NOT_YET_RECRUITING

Clinical Phase

PHASE2

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-10

Study Completion Date

2027-12-31

Brief Summary

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This phase II trial tests how well ziftomenib works in treating patients with NPM1 mutated or KMT2A rearranged acute myeloid leukemia (AML) and are not eligible to receive standard therapy. AML is often due to genetic changes in the cancer cells, including mutations in the NPM1 gene and rearrangements involving the KMT2A gene. These mutations result in activation of the menin pathway. Menin is a type of protein in the body that helps to regulate some of the naturally occurring processes in the body, but can also be involved in some types of cancers. Ziftomenib blocks this menin pathway and may prevent the cancer cells from continuing to grow. Giving ziftomenib may kill more cancer cells in patients with NPM1 mutated or KMT2A rearranged AML that are not eligible to receive standard therapy.

Detailed Description

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PRIMARY OBJECTIVE:

I. To determine the efficacy of ziftomenib in treatment-naïve patients with KMT2A-rearranged (r) and NPM1-mutated (m) AML who are not candidates for standard therapy, with primary endpoint of complete remission (CR) + CR/response with hematologic improvement (CRh), assessed after 6 cycles of treatment using the best response achieved in that time.

SECONDARY OBJECTIVES:

I. To determine rates of transfusion independence for 8- and 16-week periods. II. To determine response including CR, composite CR (CRc) (CR + CRh + CR with incomplete blood count recovery \[CRi\] + CR with incomplete platelet recovery \[CRp\]), proportion of patients achieving CRc with negative measurable residual disease (MRD), overall response rate (ORR) (CRc + partial response \[PR\] + morphologic leukemia free state \[MLFS\]).

III. To determine duration of response (DOR). IV. To determine overall survival (OS), and event free survival (EFS) at 24 months.

V. To evaluate if ziftomenib treatment improves quality of life using the Patient Reported Outcomes Measurement Information System (PROMIS)-29+2 version (v) 2.1 questionnaire.

VI. To assess safety in this patient population by determining the number of patients experiencing adverse events/serious adverse events.

EXPLORATORY OBJECTIVES:

I. To assess efficacy in patients with mutations thought to be sensitive to menin inhibition, other than KMT2A rearrangements and NPM1 mutations.

II. To perform measurable residual disease (MRD) monitoring via liquid biopsy to monitor clonal dynamics during treatment.

III. To assess the clonal, biochemical and differentiation changes in AML cells during treatment with menin inhibition using flow cytometry, cytogenetics and serial next generation sequencing on bone marrow specimens before and during treatment to assess for potential resistance mutations or clonal evolution that may be predictors of relapse.

OUTLINE:

Patients receive ziftomenib orally (PO) once daily (QD) on days 1-28 of each cycle. Cycles repeat every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. Patients may also undergo cytoreduction therapy with hydroxyurea up to end of cycle 1, cytarabine within 7 days of starting treatment, or leukapheresis within 7 days of treatment to reduce white blood cell count to =\< 10,000/uL. Additionally, patients undergo echocardiography (ECHO) or multigated acquisition scan (MUGA) at screening and bone marrow biopsy and/or aspiration and blood sample collection throughout the study.

After completion of study treatment, patients are followed up every 6 months for up to 24 months.

Conditions

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Acute Myeloid Leukemia

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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Treatment (ziftomenib)

Patients receive ziftomenib PO QD on days 1-28 of each cycle. Cycles repeat every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. Patients may also undergo cytoreduction therapy with hydroxyurea up to end of cycle 1, cytarabine within 7 days of starting treatment, or leukapheresis within 7 days of treatment to reduce white blood cell count to =\< 10,000/uL. Additionally, patients undergo ECHO or MUGA at screening and bone marrow biopsy and/or aspiration and blood sample collection throughout the study.

Group Type EXPERIMENTAL

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Bone Marrow Aspiration

Intervention Type PROCEDURE

Undergo bone marrow biopsy and/or aspiration

Bone Marrow Biopsy

Intervention Type PROCEDURE

Undergo bone marrow biopsy and/or aspiration

Cytarabine

Intervention Type DRUG

Given cytarabine

Echocardiography Test

Intervention Type PROCEDURE

Undergo ECHO

Hydroxyurea

Intervention Type DRUG

Given hydroxyurea

Leukapheresis

Intervention Type PROCEDURE

Undergo leukapheresis

Multigated Acquisition Scan

Intervention Type PROCEDURE

Undergo MUGA

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Ziftomenib

Intervention Type DRUG

Given PO

Interventions

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Biospecimen Collection

Undergo blood sample collection

Intervention Type PROCEDURE

Bone Marrow Aspiration

Undergo bone marrow biopsy and/or aspiration

Intervention Type PROCEDURE

Bone Marrow Biopsy

Undergo bone marrow biopsy and/or aspiration

Intervention Type PROCEDURE

Cytarabine

Given cytarabine

Intervention Type DRUG

Echocardiography Test

Undergo ECHO

Intervention Type PROCEDURE

Hydroxyurea

Given hydroxyurea

Intervention Type DRUG

Leukapheresis

Undergo leukapheresis

Intervention Type PROCEDURE

Multigated Acquisition Scan

Undergo MUGA

Intervention Type PROCEDURE

Questionnaire Administration

Ancillary studies

Intervention Type OTHER

Ziftomenib

Given PO

Intervention Type DRUG

Other Intervention Names

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Biological Sample Collection Biospecimen Collected Specimen Collection Biopsy of Bone Marrow Biopsy, Bone Marrow .beta.-Cytosine arabinoside 1-.beta.-D-Arabinofuranosyl-4-amino-2(1H)pyrimidinone 1-.beta.-D-Arabinofuranosylcytosine 1-Beta-D-arabinofuranosyl-4-amino-2(1H)pyrimidinone 1-Beta-D-arabinofuranosylcytosine 1.beta.-D-Arabinofuranosylcytosine 2(1H)-Pyrimidinone, 4-Amino-1-beta-D-arabinofuranosyl- 2(1H)-Pyrimidinone, 4-amino-1.beta.-D-arabinofuranosyl- Alexan Ara-C ARA-cell Arabine Arabinofuranosylcytosine Arabinosylcytosine Aracytidine Aracytin Aracytine Beta-Cytosine Arabinoside CHX-3311 Cytarabinum Cytarbel Cytosar Cytosine Arabinoside Cytosine-.beta.-arabinoside Cytosine-beta-arabinoside Erpalfa Starasid Tarabine PFS U 19920 U-19920 Udicil WR-28453 EC Echocardiography Droxia Hydrea Hydroxycarbamide Litalir Onco-Carbide Oncocarbide Oxeron SQ 1089 SQ-1089 Syrea WR 83799 Leukocyte Adsorptive Apheresis Leukocytopheresis Therapeutic Leukopheresis White Blood Cell Reduction Apheresis Blood Pool Scan Equilibrium Radionuclide Angiography Gated Blood Pool Imaging Gated Heart Pool Scan MUGA MUGA Scan Multi-Gated Acquisition Scan Radionuclide Ventriculogram Scan Radionuclide Ventriculography RNV Scan RNVG SYMA Scanning Synchronized Multigated Acquisition Scanning KO 539 KO-539 KO539 Menin-KMT2A Inhibitor KO 539 Menin-Mixed Lineage Leukemia Protein-Protein Interaction Inhibitor KO 539 Menin-MLL Inhibitor KO-539 Menin-MLL Interaction Inhibitor KO 539

Eligibility Criteria

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Inclusion Criteria

* Signed informed consent must be obtained prior to participation in the study
* Morphologically confirmed diagnosis of the following based on 2022 World Health Organization (WHO) Classification:

* Treatment-naïve acute myeloid leukemia
* KMT2A rearrangement (defined as KMT2A translocations) OR NPM1 mutation (defined as NPM1 mutation resulting in cytoplasmic localization, or NPM1c) OR other mutations that have been shown to exhibit sensitivity to menin inhibition. Mutation status will be known from initial diagnosis using standard of care testing, which can be performed locally
* Patients ineligible or unwilling to receive standard of care induction therapy, such as 7+3, hypomethylating agent, venetoclax, or other standard of care (SOC) regimens with ineligibility defined by the following:

* ≥ 75 years of age with both of the following;

* Subject must have adequate renal function as demonstrated by a creatinine clearance ≥ 30 mL/min; calculated by the Cockcroft Gault formula or measured by 24-hours urine collection
* Subject must have adequate liver function as demonstrated by aspartate aminotransferase (AST) ≤ 3.0 x upper limit of normal (ULN) and alanine aminotransferase (ALT) ≤ 3.0 x ULN (unless considered due to leukemic organ involvement) OR
* ≥ 18 to 74 years of age with at least one of the following co-morbidities:

* Eastern Cooperative Oncology Group (ECOG) performance status of 2 or 3;
* Cardiac history of congestive heart failure (CHF) requiring treatment or ejection fraction ≤ 50% or chronic stable angina;
* Diffusion capacity of the lung for carbon monoxide (DLCO) ≤ 65% or forced expiratory volume in 1 second (FEV1) ≤ 65%;
* Creatinine clearance ≥ 30 mL/min to \< 45 ml/min;
* Moderate hepatic impairment with total bilirubin \> 1.5 to ≤ 3.0 x ULN;
* Venous thromboembolism benefitting from prolonged anticoagulation or presence of prosthetic heart valve or any indication for therapeutic anticoagulation with a single agent
* Prior history of severe infection requiring hospitalization with risk of recurrence with subsequent immunosuppression
* Any other comorbidity that the physician judges to be incompatible with standard frontline therapy must be reviewed and approved by the study team before study enrollment
* Peripheral white blood cell (WBC) counts ≤ 10,000/uL. Patients may receive hydroxyurea, cytarabine, or leukapheresis to control and maintain white blood cell count until the end of cycle 1
* Women of childbearing potential must be willing to use a highly effective method of contraception throughout the study and for at least 180 days after the last dose of study treatment
* Non-sterile male patients must agree to use a highly effective method of contraception with partner(s) throughout the study and for at least 90 days after the last dose of study treatment

Exclusion Criteria

* Diagnosis of acute promyelocytic leukemia
* Diagnosis of chronic myelogenous leukemia in blast crisis
* Clinically active central nervous system (CNS) leukemia
* Prior treatment for AML except for hydroxyurea and/or cytarabine used for control of leukocytosis
* Treatment with concomitant drugs that are strong inhibitors or inducers of cytochrome P450-isozyme 3A4 (CYP3A4) with the exception of antibiotics, antifungals, and antivirals that are used as standard of care or to prevent or treat infections and other such drugs that are considered absolutely essential for the care of the patient
* Detectable viral load for human immunodeficiency virus, hepatitis C, or hepatitis B surface antigen indicative of active infection. Patients with controlled disease will not be excluded from study enrollment
* Pre-existing disorder predisposing the patient to a serious or life-threatening infection (e.g. cystic fibrosis, congenital or acquired immunodeficiency, bleeding disorder, or cytopenias not related to AML)
* Active uncontrolled acute or chronic systemic fungal, bacterial, viral, or other infection
* Mean Fridericia's formula-corrected QT interval (QTcF) \> 480 ms on triplicate electrocardiogram (ECG)
* Any psychiatric illness that prevents patient from informed consent process
* Women who are pregnant or lactating. All female patients with reproductive potential must have a negative serum pregnancy test within 72 hours prior to starting treatment
* Participants requiring dual antiplatelet therapy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kura Oncology

UNKNOWN

Sponsor Role collaborator

Uma Borate

OTHER

Sponsor Role lead

Responsible Party

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Uma Borate

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Uma M Borate, MBBS, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Ohio State University Comprehensive Cancer Center

Locations

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Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Site Status

Countries

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United States

Central Contacts

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Ohio State University Comprehensive Cancer Center

Role: CONTACT

800-293-5066

Facility Contacts

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Uma M. Borate, MBBS, MD, MSc

Role: primary

614-685-9828

Related Links

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Other Identifiers

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NCI-2025-02414

Identifier Type: REGISTRY

Identifier Source: secondary_id

OSU-24309

Identifier Type: -

Identifier Source: org_study_id

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