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Phase I Study of Azacitidine in Combination With Phenylbutyrate in Patients With Recurrent, Refractory, or Untreated Acute Myeloid Leukemia or Myelodysplastic Syndrome
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outline Trial Contact Information Registry Information
Alternate Title
Azacitidine Plus Phenylbutyrate in Treating Patients With Acute Myeloid Leukemia or Myelodysplastic Syndrome
Basic Trial Information
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Phase
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Type
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Status
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Age
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Sponsor
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Protocol IDs
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Phase I
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Treatment
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Completed
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18 and over
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NCI
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JHOC-99072307 NCI-T99-0092, NCT00004871, T99-0092, JHOC-J9950
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Objectives - Determine the safety and toxicity of azacitidine in combination with phenylbutyrate in patients with recurrent, refractory, or untreated acute myeloid leukemia or myelodysplastic syndrome.
- Determine the minimal effective pharmacologic dose of azacitidine required to consistently inhibit DNA methyltransferase in this patient population.
- Obtain preliminary clinical and/or laboratory data suggesting potential therapeutic activity of this combination regimen in these patients.
Entry Criteria Disease Characteristics:
- Histologically or cytologically confirmed myelodysplastic syndrome (MDS)
indicating one of the following:
- Refractory anemia (RA)
- Primary refractory leukopenia or thrombocytopenia with
MDS morphology
- RA with excess blasts (RAEB)
- RA with ringed sideroblasts (RARS)
- Chronic myelomonocytic leukemia
- RAEB in transformation
- RA or RARS must have at least one of the following:
- Absolute neutrophil count less than 1,000/mm3
- Untransfused hemoglobin less than 8 g/dL
- Platelet count less than 20,000/mm3
- Anemia
- Thrombocytopenia requiring transfusion
- High risk chromosomal abnormalities
- Any stage of MDS allowed including:
- Previously untreated MDS
- Refractory MDS allowed if failure to achieve remission
following prior
intensive chemotherapy of at least 1 month ago
- Relapsed, refractory, or untreated acute myeloid leukemia (AML) with the
following:
- WBC less than 30,000/mm3
- Stable for at least 2 weeks
- Unlikely to require cytotoxic therapy during study
- Untreated AML with poor risk factors for response to standard therapy
including:
- Greater than 60 years old
- AML occurs in setting of antecedent hematologic disorder
- High risk chromosomes (e.g., abnormalities of
chromosome 5 or 7 or complex
cytogenetic abnormalities)
- Medical conditions that preclude cytotoxic chemotherapy
as primary therapy
- Refusal of cytotoxic chemotherapy allowed
- No clinical evidence of CNS leukostasis or CNS leukemia
Prior/Concurrent Therapy:
Biologic therapy: - At least 3 weeks since prior biologic therapy including colony
stimulating factors and recovered
Chemotherapy: - See Disease Characteristics
- At least 3 weeks since prior chemotherapy and
recovered
Endocrine therapy: - At least 3 weeks since prior hormonal therapy and
recovered
Radiotherapy: - At least 3 weeks since prior radiotherapy and
recovered
Surgery: Patient Characteristics:
Age: Performance status: Life expectancy: Hematopoietic: - See Disease Characteristics
- Hemoglobin at least 8 g/dL (transfusion allowed)
Hepatic: - Bilirubin less than 2.0 mg/dL (unless due to hemolysis or
Gilbert's disease)
Renal: - Creatinine less than 2.0 mg/dL
Cardiovascular: - No disseminated intravascular coagulation
Pulmonary: Other: - No active infection
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception 2 weeks
prior, during and 3 months after study
Expected Enrollment Approximately 32 patients will be accrued for this study within 2 years. Outline This is a dose deescalation study of azacitidine. Patients receive azacitidine subcutaneously daily on days 1-5 and 29-33
followed by phenylbutyrate IV continuously on days 5-12 and 33-40. Treatment
continues for at least 2 courses in the absence of disease progression.
Patients with responsive disease may receive an additional 2 months of
therapy. Cohorts of 3-6 patients receive deescalating doses of azacitidine until
the minimal effective pharmacologic dose (MEPD) is determined. The MEPD is
defined as the dose above the dose at which more than 1 of 6 patients do not
meet the target enzyme inhibition of greater than 90%. Once the MEPD and toxicity have been established for a 5 day schedule,
daily dose schedule of azacitidine is increased to 10, 14, and 21 days,
followed by phenylbutyrate for 7 days. Courses are repeated every 28
days.
Trial Contact Information
Trial Lead Organizations Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | Steven Gore, MD, Protocol chair | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) |
Registry Information | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | Official Title | | Phase I, Dose De-Escalation to Minimal Effective Pharmacologic Dose Trial of Sodium Phenylbutyrate (PB, NSC 657802) in Combination With 5-Azacytidine (5-AZA, NSC 102816) in Patients With Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML) | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | Trial Start Date | | 2000-05-18 | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | Registered in ClinicalTrials.gov | | NCT00004871 | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | Date Submitted to PDQ | | 2000-01-05 | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | Information Last Verified | | 2003-10-17 | ![](https://webarchive.library.unt.edu/eot2008/20081014194834im_/http://www.cancer.gov/images/spacer.gif) | NCI Grant/Contract Number | | CA06973, CA67803, CA70095 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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