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MS-275 and Azacitidine in Treating Patients With Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, or Acute Myeloid Leukemia
This study is ongoing, but not recruiting participants.
Sponsors and Collaborators: Sidney Kimmel Comprehensive Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00101179
  Purpose

RATIONALE: MS-275 may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as azacitidine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving MS-275 together with azacitidine may kill more cancer cells.

PURPOSE: This phase I trial is studying the side effects and best dose of MS-275 when given together with azacitidine in treating patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, or acute myeloid leukemia.


Condition Intervention Phase
Leukemia
Myelodysplastic Syndromes
Drug: azacitidine
Drug: entinostat
Phase I

MedlinePlus related topics: Cancer Leukemia, Adult Acute Leukemia, Adult Chronic
Drug Information available for: Azacitidine
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: A Dose-Finding Trial of the Histone Deacetylase Inhibitor MS-275 (NSC 706995) in Combination With 5-Azacitidine (5AC, NSC 102816) in Patients With Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMMoL) and Acute Myeloid Leukemia

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Safety and toxicity of MS-275 in combination with 5-azacitidine during treatment [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Response rate measured by IWG criteria following 4 courses of treatment [ Designated as safety issue: No ]
  • Optimal dose combination at study completion [ Designated as safety issue: No ]
  • Correlate MS-275 pharmacokinetics with clinical and molecular outcomes measured by Cmax, AUC, H2AX gamma induction, histone acetylation, and promoter methylation reversal following 1 course of treatment [ Designated as safety issue: No ]

Estimated Enrollment: 63
Study Start Date: November 2004
Detailed Description:

OBJECTIVES:

  • Determine the safety and toxicity of MS-275 and azacitidine in patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, or acute myeloid leukemia.
  • Determine the maximum tolerated dose and optimal phase II dose of MS-275 when combined with azacitidine in these patients.
  • Determine, preliminarily, the potential therapeutic activity of this regimen in these patients.
  • Correlate MS-275 pharmacokinetics with clinical response and laboratory correlative endpoints in patients treated with this regimen.

OUTLINE: This is a multicenter, dose-escalation study of MS-275.

Patients receive azacitidine subcutaneously on days 1-10 and oral MS-275 on days 3 and 10. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses* of MS-275 until the maximum tolerated dose (MTD) is determined. Patients receive adjusted doses of azacitidine based on clinical response. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Up to 9 additional patients are treated at the MTD.

NOTE: *Patients who do not achieve hematologic improvement or partial or complete response but who have stable disease after 4 courses of therapy may receive an additional 4 courses of therapy at a higher dose than what was originally assigned

PROJECTED ACCRUAL: A total of 63 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of 1 of the following:

    • Histologically confirmed myelodysplastic syndromes (MDS) by bone marrow aspiration and/or biopsy

      • International Prognostic Scoring System (IPSS) score of intermediate-1, intermediate-2, or high
      • Low IPSS score allowed provided patient has a clinically significant cytopenia (i.e., absolute neutrophil count < 1,000/mm^3, untransfused hemoglobin < 8 g/dL, platelet count < 20,000/mm^3, or anemia requiring transfusion)
    • Chronic myelomonocytic leukemia
    • Acute myeloid leukemia (AML)

      • Relapsed or refractory disease
      • Untreated AML allowed provided patient meets ≥ 1 of the following criteria:

        • Age 60 and over
        • AML arising in the setting of an antecedent hematologic disorder (including MDS-AML)
        • High-risk cytogenetic abnormalities (e.g., abnormalities of chromosome 5 or 7 or complex cytogenetic abnormalities)
        • Medical conditions that may compromise the ability to give cytotoxic chemotherapy as the primary modality
        • Refused cytotoxic chemotherapy
      • WBC < 30,000/mm^3 for ≥ 2 weeks before study entry
      • Acute promyelocytic leukemia allowed provided patient is in at least second relapse and has already received treatment regimens containing arsenic trioxide and isotretinoin
  • No clinical evidence of CNS or pulmonary leukostasis or CNS leukemia

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • Zubrod 0-2

Life expectancy

  • At least 6 months

Hematopoietic

  • See Disease Characteristics
  • Hemoglobin ≥ 8 g/dL (transfusion allowed)
  • No disseminated intravascular coagulation

Hepatic

  • Bilirubin normal unless due to hemolysis or Gilbert's syndrome
  • AST and ALT ≤ 2.5 times upper limit of normal

Renal

  • Creatinine normal OR
  • Creatinine clearance ≥ 60 mL/min

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 3 months after study treatment
  • No untreated, active infection
  • No other serious or uncontrolled medical condition

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • More than 3 weeks since prior hematopoietic growth factors for this malignancy

Chemotherapy

  • See Disease Characteristics
  • At least 3 weeks since prior hydroxyurea (2 weeks for AML patients)
  • No concurrent hydroxyurea

Endocrine therapy

  • Not specified

Radiotherapy

  • Not specified

Surgery

  • Not specified

Other

  • Recovered from all prior therapy
  • At least 2 weeks since prior cytotoxic therapy (AML patients)
  • More than 3 weeks since other prior therapy for this malignancy
  • No other concurrent investigational or commercial agents or therapies for this malignancy
  • No concurrent valproic acid
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00101179

Locations
United States, Maryland
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231-2410
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
Bethesda, Maryland, United States, 20892-1182
United States, New York
Mount Sinai School of Medicine
New York, New York, United States, 10029
Sponsors and Collaborators
Sidney Kimmel Comprehensive Cancer Center
Investigators
Principal Investigator: Steven D. Gore, MD Sidney Kimmel Comprehensive Cancer Center
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000405841, JHOC-J0443, NCI-6591, JHOC-04061109
Study First Received: January 7, 2005
Last Updated: December 6, 2008
ClinicalTrials.gov Identifier: NCT00101179  
Health Authority: United States: Food and Drug Administration

Keywords provided by National Cancer Institute (NCI):
chronic myelomonocytic leukemia
de novo myelodysplastic syndromes
previously treated myelodysplastic syndromes
secondary myelodysplastic syndromes
recurrent adult acute myeloid leukemia
untreated adult acute myeloid leukemia
secondary acute myeloid leukemia

Study placed in the following topic categories:
Myelodysplastic syndromes
Precancerous Conditions
Chronic myelomonocytic leukemia
Hematologic Diseases
Leukemia, Myelomonocytic, Chronic
Myelodysplasia
Myelodysplastic Syndromes
Acute myelogenous leukemia
Myeloproliferative Disorders
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Recurrence
Leukemia, Myelomonocytic, Acute
Myelodysplastic myeloproliferative disease
Leukemia
Signs and Symptoms
Preleukemia
Azacitidine
Neoplasm Metastasis
Acute myeloid leukemia, adult
Myelodysplastic-Myeloproliferative Diseases
Bone Marrow Diseases
Acute myelocytic leukemia

Additional relevant MeSH terms:
Antimetabolites
Neoplasms
Antimetabolites, Antineoplastic
Pathologic Processes
Disease
Neoplasms by Histologic Type
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Therapeutic Uses
Syndrome
Enzyme Inhibitors
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 14, 2009