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Vorinostat and Decitabine in Treating Patients With Relapsed, Refractory, or Poor-Prognosis Hematologic Cancer or Other Diseases
This study is ongoing, but not recruiting participants.
Sponsors and Collaborators: M.D. Anderson Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00357708
  Purpose

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

PURPOSE: This phase I trial is studying the side effects and best dose of vorinostat and decitabine in treating patients with relapsed, refractory, or poor-prognosis hematologic cancer or other diseases.


Condition Intervention Phase
Chronic Myeloproliferative Disorders
Leukemia
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Diseases
Drug: decitabine
Drug: vorinostat
Phase I

MedlinePlus related topics: Cancer Leukemia, Adult Acute Leukemia, Adult Chronic
Drug Information available for: Suberoylanilide hydroxamic acid 5-Aza-2'-deoxycytidine
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: A Phase I Trial of Vorinostat (IND 71976, NSC 701852) and Decitabine (IND 50733, NSC 127716) in Patients With Relapsed, Refractory, or Poor Prognosis Leukemia

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

Primary Outcome Measures:
  • Maximum tolerated dose (i.e., recommended phase II dose) of vorinostat (SAHA) and decitabine [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Clinical activity [ Designated as safety issue: No ]
  • Pharmacokinetics [ Designated as safety issue: No ]

Estimated Enrollment: 50
Study Start Date: June 2006
Estimated Primary Completion Date: February 2007 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the maximum tolerated dose and dose-limiting toxicity of vorinostat (SAHA) and decitabine in patients with relapsed, refractory, or poor-prognosis acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic syndromes, or chronic myelogenous leukemia in accelerated or blastic phase.

Secondary

  • Determine the clinical activity of this regimen in these patients.
  • Determine the pharmacokinetics of this regimen in these patients.
  • Determine the in vivo molecular effects of this regimen, in terms of DNA methylation, histone H3 and H4 acetylation, and changes in gene expression, in these patients.

OUTLINE: This is a dose-escalation study.

Patients receive decitabine IV over 1 hour on days 1-5 and oral vorinostat (SAHA) three times daily on days 6-19. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Cohorts of 6 patients receive escalating doses of decitabine and SAHA until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, 10 additional patients are treated at that dose.

After completion of study treatment, patients are followed for 4 weeks.

PROJECTED ACCRUAL: A total of 50 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:

  • Histologically confirmed hematologic cancer or other disease, including any of the following:

    • Acute myeloid leukemia (AML)

      • Acute promyelocytic leukemia (APL) allowed provided patient has disease progression after standard chemotherapy, tretinoin, and arsenic trioxide
      • Patients > 60 years of age with previously untreated AML (except APL) who are not eligible for standard therapy are allowed
    • Acute lymphoblastic leukemia (ALL)
    • Chronic myelogenous leukemia (CML)

      • Accelerated or blastic phase disease
      • Documented hematologic resistance to imatinib mesylate OR no cytogenetic response to imatinib mesylate after 12 months of therapy
      • Chronic myelomonocytic leukemia or Philadelphia chromosome-negative CML allowed provided 1 of the following criteria is met:

        • Disease is not controlled by standard therapy (e.g., hydroxyurea)
        • Signs of disease progression on standard therapy (i.e., blast count > 5% and platelet count < 100,000/mm^3)
    • Myelodysplastic syndromes (MDS)

      • International Prognostic Scoring System (IPSS) score ≥ intermediate 1
      • Patients > 60 years of age with previously untreated MDS (with IPSS score ≥ intermediate 1) who are not eligible for standard therapy are allowed
    • Myeloproliferative disease (MPD)
  • Relapsed, refractory, or poor prognosis disease
  • No clinical evidence of CNS disease

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy > 8 weeks
  • Bilirubin ≤ 2 mg/dL
  • AST or ALT ≤ 2.5 times upper limit of normal
  • Creatinine ≤ 2 mg/dL
  • Cardiac ejection fraction ≥ 50%
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No history of allergic reactions attributed to compounds of similar chemical or biologic composition to vorinostat (SAHA) or decitabine
  • No other uncontrolled illness including, but not limited to, any of the following:

    • Ongoing or active infection
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia
    • Psychiatric illness or social situation that would limit compliance with study requirements

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 2 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) and recovered

    • Hydroxyurea allowed < 2 weeks prior to study entry and during the first course of study treatment if there is evidence of rapidly progressive disease
  • No prior or other concurrent histone deacetylase (HDAC) inhibitors or compounds with HDAC inhibitor-like activity (e.g., valproic acid) as antitumor therapy

    • Patients who have received such agents for other indications (e.g., epilepsy) may enroll in study after a 30-day washout period
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • No other concurrent investigational agents
  • No other concurrent anticancer agents or therapies
  • No concurrent prophylactic hematopoietic colony-stimulating factors

    • Epoetin alfa or colony-stimulating factors allowed, per institutional guidelines, after the first course of study therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00357708

Locations
United States, Texas
M. D. Anderson Cancer Center at University of Texas
Houston, Texas, United States, 77030-4009
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Study Chair: Jean-Pierre Issa, MD M.D. Anderson 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: CDR0000489104, MDA-2005-0723, NCI-6878
Study First Received: July 26, 2006
Last Updated: October 3, 2008
ClinicalTrials.gov Identifier: NCT00357708  
Health Authority: United States: Food and Drug Administration

Keywords provided by National Cancer Institute (NCI):
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
adult acute minimally differentiated myeloid leukemia (M0)
adult acute myeloblastic leukemia without maturation (M1)
adult acute myeloblastic leukemia with maturation (M2)
adult acute promyelocytic leukemia (M3)
adult acute myelomonocytic leukemia (M4)
adult acute monoblastic leukemia (M5a)
adult acute monocytic leukemia (M5b)
adult erythroleukemia (M6a)
adult pure erythroid leukemia (M6b)
adult acute megakaryoblastic leukemia (M7)
atypical chronic myeloid leukemia
chronic eosinophilic leukemia
chronic idiopathic myelofibrosis
chronic myelomonocytic leukemia
chronic neutrophilic leukemia
essential thrombocythemia
myelodysplastic/myeloproliferative disease, unclassifiable
Philadelphia chromosome negative chronic myelogenous leukemia
polycythemia vera
previously treated myelodysplastic syndromes
recurrent adult acute lymphoblastic leukemia
recurrent adult acute myeloid leukemia
relapsing chronic myelogenous leukemia
secondary acute myeloid leukemia
secondary myelodysplastic syndromes

Study placed in the following topic categories:
Polycythemia
Philadelphia Chromosome
Blast Crisis
Chronic myelogenous leukemia
Chronic myelomonocytic leukemia
Di Guglielmo's syndrome
Preleukemia
Hemorrhagic thrombocythemia
Neoplasm Metastasis
Leukemia, Promyelocytic, Acute
Thrombocythemia, Hemorrhagic
Acute myeloid leukemia, adult
Myelodysplastic syndromes
Essential thrombocytosis
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Hematologic Diseases
Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative
Leukemia, Myelomonocytic, Chronic
Myeloproliferative Disorders
Acute myelogenous leukemia
Acute promyelocytic leukemia
Leukemia, Myeloid
Myelodysplastic myeloproliferative disease
Leukemia, Erythroblastic, Acute
Leukemia, Myeloid, Accelerated Phase
Acute monoblastic leukemia
Leukemia, Monocytic, Acute
Leukemia, Lymphoid
Hematologic Neoplasms
Precancerous Conditions

Additional relevant MeSH terms:
Anticarcinogenic Agents
Anti-Inflammatory Agents
Antimetabolites
Neoplasms by Histologic Type
Disease
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Physiological Effects of Drugs
Enzyme Inhibitors
Protective Agents
Pharmacologic Actions
Neoplasms
Pathologic Processes
Sensory System Agents
Analgesics, Non-Narcotic
Syndrome
Therapeutic Uses
Anti-Inflammatory Agents, Non-Steroidal
Peripheral Nervous System Agents
Analgesics
Antirheumatic Agents
Central Nervous System Agents

ClinicalTrials.gov processed this record on January 16, 2009