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UCN-01 and Perifosine in Treating Patients With Relapsed or Refractory Acute Leukemia, Chronic Myelogenous Leukemia or High Risk Myelodysplastic Syndromes
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), November 2008
First Received: March 9, 2006   Last Updated: January 28, 2009   History of Changes
Sponsors and Collaborators: University of Maryland Greenebaum Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00301938
  Purpose

RATIONALE: UCN-01 may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as perifosine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving UCN-01 together with perifosine may kill more cancer cells.

PURPOSE: This phase I trial is studying the side effects and best dose of UCN-01 when given together with perifosine in treating patients with relapsed or refractory acute leukemia, chronic myelogenous leukemia, or myelodysplastic syndromes.


Condition Intervention Phase
Leukemia
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Diseases
Drug: 7-hydroxystaurosporine
Drug: perifosine
Phase I

MedlinePlus related topics: Cancer Leukemia, Adult Acute Leukemia, Adult Chronic
Drug Information available for: UCN 01 Perifosine
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: A Phase 1 Study of UCN-01 in Combination With Perifosine in Patients With Relapsed and Refractory Acute Leukemias and High Risk MDS

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

Primary Outcome Measures:
  • Define toxicities and maximum tolerated dose of UCN-01 and perifosine by NCI Common Toxicity Criteria with continuous monitoring [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Pharmacodynamic and pharmacokinetic effects of this regimen periodically during first and subsequent courses [ Designated as safety issue: No ]
  • Response rate following first course and at the time of progressive disease or off study [ Designated as safety issue: No ]

Estimated Enrollment: 30
Study Start Date: March 2006
Estimated Primary Completion Date: February 2007 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Define the maximum tolerated dose and recommended phase II dose of UCN-01 administered after perifosine in patients with relapsed or refractory acute leukemia, chronic myelogenous leukemia, or high risk myelodysplastic disorders.

Secondary

  • Evaluate the safety and toxicity of UCN-01 administered after perifosine in these patients.
  • Evaluate the safety and toxicity of perifosine administered after UCN-01 in these patients.
  • Document responses in patients treated with this regimen.
  • Observe the pharmacokinetics of both perifosine and UCN-01 when administered in combination.
  • Study the pharmacodynamics of perifosine alone, UCN-01 alone, and in combination in leukemic blast cells.

OUTLINE: This is a multicenter, dose-escalation study of UCN-01. The first patients enrolled in the study are assigned to group 1. Once the maximum tolerated dose (MTD) is determined in group 1, subsequent patients are enrolled in group 2.

  • Group 1: Patients receive a loading dose of oral perifosine every 6 hours on day 1 followed by a maintenance dose once daily on days 2-28 of course 1 and then once daily on days 1-28 in all subsequent courses. Patients also receive UCN-01 IV over 3 hours on day 4.

Cohorts of 3-6 patients receive escalating doses of UCN-01 until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity.

  • Group 2: Patients receive UCN-01 IV over 3 hours on day 1 at the MTD determined in group I. Patients also receive oral perifosine as a loading dose every 6 hours on day 4 followed by a maintenance dose once daily on days 5-28 of course 1 and then once daily on days 1-28 in all subsequent courses.

In both groups, treatment repeats every 28 days for ≥ 2 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve a complete remission (CR) or a CR with incomplete hematologic recovery receive 4 additional courses beyond documentation of CR. Patients who achieve a partial remission or hematologic improvement may continue treatment in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed for 30 days and then periodically thereafter.

PROJECTED ACCRUAL: A total of 30 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 or cytologically confirmed hematologic malignancy of 1 of the following types:

    • Relapsed or refractory acute myelogenous leukemia (AML)

      • Patients with acute promyelocytic leukemia t(15;17) are eligible provided they failed a prior tretinoin and arsenic-containing regimen

        • Patients should be either refractory to both agents (absence of durable hematologic response) OR relapsed after a complete response duration of < 6 months
    • Relapsed or refractory pre-B-cell or T-cell acute lymphoblastic leukemia (ALL)
    • Chronic myelogenous leukemia (CML) in accelerated or blastic phase that is refractory to imatinib mesylate

      • Must have evidence of disease progression despite continued treatment with imatinib mesylate
    • AML arising in the setting of underlying myelodysplastic syndromes (MDS) and/or myeloproliferative disorders (MPD)
    • Secondary or therapy-related AML
    • De novo AML or pre-B-cell or T-cell ALL in adults > 60 years of age with poor-risk features, such as complex (≥ 3) or adverse cytogenetics

      • The following are considered adverse cytogenetic abnormalities for AML:

        • -5q = 7q- = 9q- = 20q-
        • abn12p
        • +21
        • +8
        • t(6;9)
        • t(6;11)
        • t(11;19)
        • -7
        • -5
        • inv3/t(3;3)
        • abn11q23
        • abn17p
        • abn21q
        • t(9;22) refractory to imatinib mesylate
      • The following are considered adverse cytogenetic abnormalities for ALL:

        • t(9;22) refractory to imatinib mesylate
        • Hypodiploidy
        • t(4;11)
        • t(1;19)
    • Myelodysplastic Syndromes (MDS) meeting 1 of the following criteria:

      • Intermediate and high risk (i.e., International Prognostic Scoring System [IPSS] ≥ 1.5) MDS that is refractory or has progressed after treatment with azacitidine and/or decitabine
      • Intermediate and high risk (i.e., IPSS ≥ 1.5) MDS with a 5q- cytogenetic abnormality that is refractory or has progressed after treatment with lenalidomide, azacitidine, or decitabine
      • Intermediate 2 and high risk MDS without 5q- cytogenetic abnormality that is refractory or has progressed after azacitidine or decitabine

        • Original 5q must also be refractory to lenalidomide
  • Received OR ineligible for established curative regimens, including stem cell transplantation
  • No active CNS leukemia

PATIENT CHARACTERISTICS:

  • ECOG performance status (PS) 0-2 OR Karnofsky PS ≥ 60%
  • Total or direct bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • AST/ALT ≤ 2.5 times ULN
  • Creatinine ≤ 2 mg/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 3 months after completion of study treatment
  • No hyperleukocytosis (i.e., WBC > 30,000/mm^3) (recent treatment with hydroxyurea to prevent impending leukostasis allowed provided there has been no dose increase for ≥ 1 week)
  • No history of allergic reactions attributed to compounds of similar chemical or biologic composition to UCN-01 or perifosine
  • No intrinsic impaired organ function
  • No active, uncontrolled infection

    • Infection that is controlled with antibiotics allowed
  • No symptomatic cardiac disease
  • No active ischemia on EKG
  • LVEF ≥ 40% by echocardiogram or MUGA

    • Patients with a history of cardiac disease or mediastinal radiation should undergo testing of ventricular function
  • No poorly controlled diabetes mellitus
  • No psychiatric illness or social situation that would preclude giving informed consent or complying with study requirements
  • No HIV positivity

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 4 weeks since prior cytotoxic chemotherapy (6 weeks for carmustine or mitomycin C) and recovered
  • At least 4 weeks since prior radiotherapy and recovered
  • At least 4 weeks since prior autologous stem cell transplantation (SCT)
  • At least 90 days since prior allogeneic SCT

    • No evidence of graft vs host disease
  • At least 2 weeks since prior immunosuppressive therapy
  • No concurrent hematopoietic growth factors or biologic agents
  • No other concurrent investigational agents, chemotherapy, radiotherapy, or immunotherapy
  • No other concurrent anticancer therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00301938

Locations
United States, Maryland
Greenebaum Cancer Center at University of Maryland Medical Center Recruiting
Baltimore, Maryland, United States, 21201
Contact: Clinical Trials Office - Greenebaum Cancer Center at Universit     800-888-8823        
United States, Pennsylvania
Abramson Cancer Center of the University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104-4283
Contact: Clinical Trials Office - Abramson Cancer Center of the Univers     800-474-9892        
Sponsors and Collaborators
University of Maryland Greenebaum Cancer Center
Investigators
Principal Investigator: Ivana Gojo, MD University of Maryland Greenebaum Cancer Center
  More Information

Additional Information:
No publications provided

Study ID Numbers: CDR0000465368, MSGCC-0507, MSGCC-H-27229-0507, NCI-7311
Study First Received: March 9, 2006
Last Updated: January 28, 2009
ClinicalTrials.gov Identifier: NCT00301938     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
accelerated phase chronic myelogenous leukemia
blastic phase chronic myelogenous leukemia
relapsing chronic myelogenous leukemia
recurrent adult acute lymphoblastic leukemia
T-cell adult acute lymphoblastic leukemia
adult acute myeloid leukemia with t(15;17)(q22;q12)
secondary acute myeloid leukemia
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute minimally differentiated myeloid leukemia (M0)
adult acute myeloblastic leukemia with maturation (M2)
adult acute myeloblastic leukemia without maturation (M1)
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
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)
recurrent adult acute myeloid leukemia
adult acute promyelocytic leukemia (M3)
untreated adult acute lymphoblastic leukemia
untreated adult acute myeloid leukemia
myelodysplastic/myeloproliferative diseases
previously treated myelodysplastic syndromes

Study placed in the following topic categories:
Leukemia, Monocytic, Acute
Blast Crisis
Leukemia, Lymphoid
Precancerous Conditions
Acute Myelomonocytic Leukemia
Acute Monoblastic Leukemia
Leukemia, Myeloid, Acute
Protein Kinase Inhibitors
Leukemia
Acute Erythroblastic Leukemia
Preleukemia
Acute Myelocytic Leukemia
Acute Myeloid Leukemia, Adult
Staurosporine
Leukemia, Promyelocytic, Acute
Neoplasm Metastasis
Congenital Abnormalities
Myelodysplastic Myeloproliferative Disease
Acute Lymphoblastic Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Hematologic Diseases
Myelodysplastic Syndromes
Myeloproliferative Disorders
7-hydroxystaurosporine
Leukemia, Myeloid
Recurrence
Leukemia, Myelomonocytic, Acute
Leukemia, Erythroblastic, Acute
Leukemia, Myeloid, Accelerated Phase
Leukemia, Myelogenous, Chronic, BCR-ABL Positive

Additional relevant MeSH terms:
Disease
Neoplasms by Histologic Type
Molecular Mechanisms of Pharmacological Action
Precancerous Conditions
Antineoplastic Agents
Hematologic Diseases
Myelodysplastic Syndromes
Myeloproliferative Disorders
Enzyme Inhibitors
7-hydroxystaurosporine
Leukemia, Myeloid
Protein Kinase Inhibitors
Pharmacologic Actions
Leukemia
Preleukemia
Neoplasms
Pathologic Processes
Therapeutic Uses
Syndrome
Staurosporine
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Myelodysplastic-Myeloproliferative Diseases
Bone Marrow Diseases

ClinicalTrials.gov processed this record on May 07, 2009