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Study of Dasatinib and All-Trans Retinoic Acid for Relapsed/Refractory and/or Elderly Patients With Acute Myelogenous Leukemia (AML)
This study is not yet open for participant recruitment.
Verified by University of Pittsburgh, May 2009
First Received: April 30, 2009   Last Updated: May 1, 2009   History of Changes
Sponsored by: University of Pittsburgh
Information provided by: University of Pittsburgh
ClinicalTrials.gov Identifier: NCT00892190
  Purpose

This is an open label, prospective, single institution dose-escalation study. The patient population includes non-induction candidate elderly patients with AML and/or patients with high-risk or relapsed/refractory AML. Five dose cohorts will be evaluated using a fixed dose of ATRA in combination with an escalating dose of dasatinib. The investigators will treat with an escalating dose of dasatinib from 40mg to 140mg daily. Dose escalation will proceed in a standard 3+3 fashion. A de-escalation to a 20 mg total daily dose of dasatinib is planned if DLT is greater than or equal to 33% is observed at the first dose level. Once the MTD for the combination of the drugs has been established, up to 6 additional patients will be enrolled at the MTD level to obtain additional safety information about the combination and to allow for preliminary laboratory correlate analysis.


Condition Intervention Phase
Acute Myelogenous Leukemia
Drug: dasatinib (SPRYCEL)
Drug: all trans retinoic acid (VESANOID)
Phase I

MedlinePlus related topics: Leukemia, Adult Acute Leukemia, Adult Chronic
Drug Information available for: Dasatinib Tretinoin
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study
Official Title: A Phase 1, Open-Label, Dose-Escalation Study of Dasatinib and All-Trans Retinoic Acid for Relapsed/Refractory and/or Elderly Patients With Acute Myelogenous Leukemia

Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • To determine the MTD and DLTs of dasatinib in combination with ATRA given the proposed dose escalation plan. [ Time Frame: 1.5 years ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Assessment of Differentiation. Bone marrow biopsies and aspirates will be obtained pre-treatment, on day 14, and day 28. These will be subjected to morphologic, cytochemical, and routine flow cytometric analyses. [ Time Frame: 1.5 years ] [ Designated as safety issue: Yes ]
  • Assess treatment effects on SFK (Src family kinase) activation and expression of RARA target genes. [ Time Frame: 1.5 years ] [ Designated as safety issue: Yes ]
  • PK parameters including peak concentration (Cmax),Tmax, Cmin, the area under the curve (AUC), volume of distribution, clearance terms, elimination rate constant, and elimination half-life (t1/2) will be analyzed. [ Time Frame: 1.5 years ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 36
Study Start Date: July 2009
Estimated Study Completion Date: July 2011
Estimated Primary Completion Date: January 2011 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: dasatinib (SPRYCEL)
    DL0 - 20 mg every 24 hours DL1 (START)- 20 mg every 24 hours DL2 - 40 mg every 24 hours DL3 - 60 mg every 24 hours DL4 - 70 mg every 24 hours DL5 - 80 mg every 24 hours
    Drug: all trans retinoic acid (VESANOID)
    22.5mg/m2 every 12 hours
Detailed Description:

Primary Objective:

  1. To perform a Phase I clinical trial of dasatinib and ATRA in relapsed or elderly, non-induction candidate acute myelogenous leukemia (AML) patients to determine the maximally tolerated dose, dose-limiting toxicities (DLT), and other side effects of this regimen.

Secondary Objectives:

  1. To determine the pharmacokinetic (PK) profiles of dasatinib and ATRA when administered as combination therapy for patients with AML
  2. To determine if the combination therapy of dasatinib and ATRA promotes differentiation of AML blasts as measured by flow cytometric analysis and morphologic assessment of serial bone marrow biopsies and aspirates
  Eligibility

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

Inclusion Criteria:

  • Signed informed consent form (ICF) indicating that the subject has been informed of the procedures to be followed, the experimental nature of the therapy, alternatives, potential benefits, side-effects, risks, and discomforts
  • Confirmed diagnosis of non-APL AML (WHO criteria) that is refractory to available therapy (i.e., has failed two induction regimens)-or- that has relapsed within six months of attaining a remission. Patients who relapse more than six months after achieving a remission, who cannot achieve a second remission after two standard re-induction chemotherapy regimens, will also be candidates. Patients who develop AML after a pre-existing hematologic disease (myelodysplastic syndrome, myeloproliferative syndrome) or after prior exposure to chemotherapy (secondary AML) will be considered eligible for study. Additionally we will include patients age 65 years or older with relapsed or de novo AML who are not candidates for induction chemotherapy, given the inferior prognosis in this group of patients.
  • Confirmed diagnosis of non-APL AML in a patient age 65 or older
  • Males or non-pregnant, non-breastfeeding females 18 years of age or older
  • ECOG Performance Status less than or equal to 3
  • Life expectancy of at least 2 months
  • Subjects with reproductive capability must agree to practice adequate contraception methods. Males must be surgically sterilized or be willing to use condoms from the first dose of study drug until at least 30 days after the last dose. Females must be surgically sterilized, postmenopausal for at least 1 year, or willing to use an appropriate double barrier method or oral, patch, implant, or injectable contraception from the first dose of study drug until at least 30 days after the last dose
  • Adequate baseline laboratory assessments:
  • Total bilirubin level ≤1.5 times institutional upper limit of normal (ULN), alanine aminotransferase (ALT) or aspartate aminotransferase (AST)

    • 2.5 x ULN
  • Estimated plasma creatinine clearance of ≥50 mL/min (using the Cockroft-Gault equation) (Cockroft-Gault, 1976): CLcreat = ((140 - age) x body mass x 0.85 if female) / 72 x creatinine where age is given in years, body mass is given in kg, and creatinine is given in mg/dL

Exclusion Criteria:

  • Patient with a diagnosis of Acute Promyelocytic Leukemia
  • Known or clinically suspected CNS involvement
  • Treatment with an investigational agent within 30 days prior to the first dose of dasatinib/ATRA or planning to receive an investigational agent during the study
  • Currently receiving anticancer therapy
  • Screening ECG QTc interval ≥500 msec for females, ≥470 msec for males.
  • Chronic diarrhea
  • Gastrointestinal diseases that could affect drug absorption including post surgical states such as gastric bypass
  • Gastrointestinal diseases that could alter the assessment of safety, including irritable bowel syndrome, ulcerative colitis, Crohn's disease, or hemorrhagic coloproctitis.
  • Positive HIV serology
  • Uncontrolled, life-threatening infection that is not responding to antimicrobial therapy
  • Pregnant or Breastfeeding
  • A diagnosis of another active malignancy with the exception of non-melanoma skin cancer or cervical cancer
  • History of psychiatric disorder which may compromise compliance
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00892190

Contacts
Contact: Robert Redner, MD 412-623-3257 rednerrl@upmc.edu

Locations
United States, Pennsylvania
University of Pittsburgh Cancer Institute - Hillman Cancer Center
Pittsburgh, Pennsylvania, United States, 15232
Sponsors and Collaborators
University of Pittsburgh
Investigators
Principal Investigator: Robert Redner, MD University of Pittsburgh
  More Information

No publications provided

Responsible Party: University of Pittsburgh Medical Center ( Robert Redner, MD )
Study ID Numbers: UPCI 08-160
Study First Received: April 30, 2009
Last Updated: May 1, 2009
ClinicalTrials.gov Identifier: NCT00892190     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pittsburgh:
AML
Dasatinib
all trans retinoic acid
relapsed AML
refractory AML
Relapsed/Refractory Acute myelogenous leukemia
Elderly subjects (age 65 or older) with acute myelogenous leukemia

Study placed in the following topic categories:
Keratolytic Agents
Leukemia
Acute Myelocytic Leukemia
Acute Myeloid Leukemia, Adult
Dasatinib
Tretinoin
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Protein Kinase Inhibitors

Additional relevant MeSH terms:
Neoplasms by Histologic Type
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Protein Kinase Inhibitors
Pharmacologic Actions
Keratolytic Agents
Leukemia
Neoplasms
Dasatinib
Therapeutic Uses
Tretinoin
Dermatologic Agents

ClinicalTrials.gov processed this record on May 07, 2009