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Phase I/II Study of Decitabine and Valproic Acid in Relapsed/Refractory Leukemia or Myelodysplastic Syndromes
This study has been completed.
First Received: December 29, 2003   Last Updated: November 19, 2008   History of Changes
Sponsors and Collaborators: M.D. Anderson Cancer Center
Eisai Medical Research Inc.
Information provided by: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00075010
  Purpose

Valproic acid is a medication that is currently used in the prevention of seizures, bipolar disorder, and migraine headaches. Researchers hope that it may improve the effects of decitabine. Decitabine is a chemotherapy drug with known activity in leukemia and myelodysplastic syndromes.


Condition Intervention Phase
Leukemia
Myelodysplastic Syndromes
Drug: Decitabine
Drug: Valproic acid
Phase I
Phase II

MedlinePlus related topics: Cancer Leukemia, Adult Acute Leukemia, Adult Chronic Leukemia, Childhood
Drug Information available for: Divalproex sodium Valproic acid Valproate Sodium 5-Aza-2'-deoxycytidine
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Active Control, Single Group Assignment, Safety/Efficacy Study
Official Title: Phase I/II Study of 5-Aza-2'-Deoxycytidine and Valproic Acid in Patients With Relapsed/Refractory Leukemia or Myelodysplastic Syndromes

Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • To determine the safety and tolerability of valproic acid when combined with 5-aza-2'-deoxycytidine (decitabine) i.v. daily for 10 days [ Time Frame: November 2006 ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • To determine the clinical activity of this combination in patients with leukemia and MDS [ Time Frame: November 2006 ] [ Designated as safety issue: No ]

Enrollment: 54
Study Start Date: January 2004
Study Completion Date: November 2006
Primary Completion Date: March 2005 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental
Decitabine + Valproic acid
Drug: Decitabine
15mg/m2 IV over 1 hour times 10 days
Drug: Valproic acid
20mg/kg daily times 10 days

Detailed Description:

Recent studies have shown synergy between demethylating agents and histone deacetylase inhibitors. It has been shown that both DNA methylation and histone deacetylation work together in affecting gene expression.

Therefore, drugs that inhibit DNA methylation and those that inhibit histone deacetylase can reactivate silenced genes in combination better than they can individually. Decitabine (5 aza-2'deoxycytidine), a drug that produces marked DNA hypomethylator, has demonstrated antileukemic activity at low doses. There are several drugs that have been shown to have histone acetylase activity. One of these is valproic acid that has been used safely for many years as an anti-seizure medication.

  Eligibility

Ages Eligible for Study:   2 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

INCLUSION FOR PHASE I COMPONENT OF THE STUDY:

  • Patients with refractory or relapsed: acute myelogenous leukemia (AML), acute lymphocytic leukemia (ALL), and myelodysplastic syndrome (MDS) are eligible. Patients with chronic lymphocytic leukemia (CLL) are eligible if fludarabine based therapy has failed. Patients with chronic myeloid leukemia (CML) are eligible if they have documented hematologic resistance to imatinib mesylate or have not achieved or lost any cytogenetic response to imatinib mesylate after 12 months of therapy.
  • Untreated patients older than 60 years of age with AML or MDS who refuse or are not eligible for frontline chemotherapy, are eligible.
  • Performance status of < 2 by the ECOG scale.
  • Signed informed consent indicating that patients are aware of the investigational nature of this study in keeping with the policies of UTMDACC.
  • Age > 2 years. Valproic acid has been associated with a higher rate of severe liver toxicity in children younger than 2 years.
  • Patients must have been off chemotherapy for 2 weeks prior to entering this study and recovered from the toxic effects of that therapy, unless there is evidence of rapidly progressive disease. Use of hydroxyurea for patients with rapidly proliferative disease is allowed for the first two weeks on therapy. Imatinib mesylate (Gleevec) and anagrelide must also be stopped 2 weeks prior to entering this study.
  • Adequate liver function (bilirubin of < 2mg%, SGPT 3 x ULN) and renal function (creatinine < 2mg%).
  • Women of childbearing potential must practice contraception. Men and women must continue birth control for the duration of the trial.

INCLUSION OF PHASE II PORTION OF THE STUDY:

  • As in the phase I portion buy only patients with AML or high-risk MDS (blasts > or = 10%), including untreated patients older than 60 years of age with AML or MDS who refuse or are not eligible for frontline chemotherapy, will be eligible in this portion of the study.

Exclusions

  • Nursing and pregnant females are excluded.
  • Patients with active and uncontrolled infections are excluded.
  • Patients with a known ornithine transcarbamylase disorder, history of unexplained coma or a family history of ornithine transcarbamylase disorder are excluded from this study.
  • Uncontrolled intercurrent illness including, but not limited to symptomatic congestive heart failure, unstable angina pectoris, pancreatitis, psychiatric illness that would limit compliance with study requirements.
  • Patients with history of hepatitis B, C, alcoholic liver disease or evidence of hepatopathy will be excluded.
  • Patients already receiving valproic acid or receiving other anticonvulsants will be excluded.
  • Untreated patients younger than 60 years will not be candidates for this study.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00075010

Locations
United States, Texas
M.D. Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
Eisai Medical Research Inc.
Investigators
Principal Investigator: Guillermo Garcia-Manero, M.D. M.D. Anderson Cancer Center
  More Information

Additional Information:
No publications provided by M.D. Anderson Cancer Center

Additional publications automatically indexed to this study by National Clinical Trials Identifier (NCT ID):
Responsible Party: The University of Texas M.D. Anderson Cancer Center ( Guillermo Garcia-Manero M.D./Associate Professor )
Study ID Numbers: 2003-0314
Study First Received: December 29, 2003
Last Updated: November 19, 2008
ClinicalTrials.gov Identifier: NCT00075010     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by M.D. Anderson Cancer Center:
Relapsed/Refractory Leukemia
Myelodysplastic Syndromes

Study placed in the following topic categories:
Antimetabolites
Neurotransmitter Agents
Tranquilizing Agents
Precancerous Conditions
Hematologic Diseases
Myelodysplastic Syndromes
Psychotropic Drugs
Central Nervous System Depressants
Decitabine
Antimanic Agents
Valproic Acid
Leukemia
Preleukemia
Bone Marrow Diseases
Anticonvulsants

Additional relevant MeSH terms:
Antimetabolites
Neurotransmitter Agents
Antimetabolites, Antineoplastic
Precancerous Conditions
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Physiological Effects of Drugs
Psychotropic Drugs
Valproic Acid
Leukemia
Preleukemia
Pathologic Processes
Syndrome
Therapeutic Uses
Disease
Neoplasms by Histologic Type
Tranquilizing Agents
Hematologic Diseases
Myelodysplastic Syndromes
Central Nervous System Depressants
Enzyme Inhibitors
Decitabine
Antimanic Agents
Pharmacologic Actions
Neoplasms
GABA Agents
Bone Marrow Diseases
Central Nervous System Agents
Anticonvulsants

ClinicalTrials.gov processed this record on May 06, 2009