Resumen

Este es un ensayo clínico de Fase III, multicéntrico, doble ciego y aleatorizado de pracinostat versus placebo con azacitidina (AZA) como terapia de fondo en pacientes ≥18 años con leucemia mieloide aguda (LMA) de diagnóstico reciente, excluyendo la leucemia promielocítica aguda y la LMA de bajo riesgo citogenético, que no son aptos para recibir quimioterapia intensiva de inducción de remisión debido a edad ≥75 años o comorbilidades. Los pacientes serán aleatorizados en una relación 1:1 a uno de dos grupos: Grupo A (grupo experimental) para recibir pracinostat más AZA y Grupo B (grupo control) para recibir placebo más AZA. La aleatorización será estratificada por categoría de riesgo citogenético (intermedio versus riesgo desfavorable, según las Definiciones de Categoría de Riesgo Citogenético de SWOG) y estado funcional ECOG (0-1 versus 2). Los tratamientos se administrarán en ciclos de 28 días, con pracinostat/placebo administrado por vía oral una vez en días alternos, 3 veces por semana durante 3 semanas, seguido de una semana sin tratamiento, y AZA administrada durante 7 días de cada ciclo. El tratamiento del ensayo clínico deberá continuarse hasta que se documente progresión de la enfermedad, recaída desde la remisión completa (RC) o toxicidad no manejable. Puede requerirse un mínimo de 6 ciclos para lograr una remisión completa. Una vez que el paciente interrumpa permanentemente el tratamiento del ensayo clínico, ingresará en la fase de Seguimiento a Largo Plazo del ensayo y será seguido para la evaluación de la progresión de la enfermedad, si corresponde, y de la supervivencia cada 3 meses (±1 mes) hasta el fallecimiento. El fin de este ensayo clínico se define cuando hayan ocurrido 390 eventos (muertes) y el ensayo se desenmascara para el análisis final de supervivencia global. Los pacientes que estén recibiendo tratamiento del ensayo clínico al final del estudio podrán tener la oportunidad de continuar recibiendo los fármacos del ensayo a los que fueron aleatorizados (Período de Observación Post-Estudio) hasta que el Patrocinador informe a los Investigadores sobre el curso de acción apropiado según los resultados del estudio. El Período de Observación Post-Estudio se define como el período que comienza desde el fin del estudio por un máximo de 12 meses.

Elegibilidad

Edad mínima: 18 YearsSexo: ALL

Criterios de inclusión

Male or female patient ≥ 18 years of age with newly diagnosed, histologically or cytologically confirmed, AML including de novo, secondary to antecedent hematologic disorders, or treatment-related disease with intermediate or unfavorable-risk cytogenetics
Unable to receive intensive chemotherapy regimens at enrollment, based on one of the following:
I. Age ≥ 75 years, or
II. Age \< 75 years with at least 1 of the following co-morbidities:
An ECOG performance status of 2
Clinically significant cardiovascular disease defined as:
i. Left ventricular ejection fraction (LVEF) ≤ 50%, measured within 3 months prior to Day 1 confirmed by ECHO/MUGA ii. Congestive heart failure requiring medical therapy iii. Chronic stable angina requiring medical therapy iv. Prior cerebrovascular accident with sequelae c. Clinically significant pulmonary disease defined as: i. Forced expiratory volume in 1 second (FEV1) ≤ 65% of expected ii. Lung diffusing capacity for carbon monoxide (DLCO) ≤ 65% of expected Confirmed by pulmonary tests. d. Diabetes mellitus with symptomatic end-organ damage (e.g., retinopathy, nephropathy, neuropathy, vasculopathy) e. Autoimmune inflammatory conditions (e.g., rheumatoid arthritis, systemic lupus erythematous, inflammatory bowel disease, or similar) requiring chronic disease modifying therapy (e.g., etanercept, adalimumab, infliximab, rituximab, methotrexate, or similar) f. Class III obesity defined as a Body Mass Index (BMI) \> 40 kg/m2 g. Renal impairment defined as serum creatinine \> 1.3 mg/dL (\> 115 µmol/L) or creatinine clearance \<70 ml/min h. Clinically significant cognitive impairment defined as requiring medical therapy and/or assistance with activities of daily living
% blasts in bone marrow
Peripheral white blood cell (WBC) count 30,000/µL For cyto-reduction, hydroxyurea is allowed during screening and up to Cycle 1, Days 1-14, to reduce WBC count to \< 30,000 µL prior to Day 1. After Cycle 1, Day 14, hydroxyurea is prohibited.
ECOG performance status ≤ 2
Adequate organ function as evidenced by the following laboratory findings:
Total bilirubin ≤ 2 × upper limit of normal (ULN) or \< 3 x ULN for patients with Gilbert-Meulengracht Syndrome
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × ULN
Serum creatinine ≤ 1.5 × ULN according to institutional standards or creatinine clearance ≥ 50 mL/min
QT-interval corrected according to Fridericia's formula (QTcF) ≤ 450 ms on electrocardiogram (ECG) at Screening
Male patient who is surgically sterile, or male patient who is willing to agree to remain completely abstinent (refrain from heterosexual intercourse) or who use barrier contraceptive measures and agree to refrain from donating sperm during the entire study treatment period and for 3 months after the last administration of study drug
Female patient who is of childbearing potential willing to use adequate contraceptive measures while participating on study, OR willing to completely abstain from heterosexual intercourse during the entire study treatment period
Female patient who is of childbearing potential must have a negative serum pregnancy test result within 3 weeks prior to starting study drugs.
Willing to provide voluntary written informed consent before performance of any study related procedure not part of normal medical care
Willing and able to understand the nature of this study and to comply with the study and follow-up procedures.

Criterios de exclusión

Able to receive intensive induction chemotherapy
AML-associated inv(16)/t(16;16)/del(16q), t(15;17) (i.e. promyelocytic leukemia) with/without secondary aberrations; t(8;21) lacking del (9q) or complex karyotypes
Presence of an active malignant disease within the last 12 months, with the exception of adequately treated cervical cancer in-situ, non-melanoma skin cancer and superficial bladder tumors (Ta \[non-invasive tumor\], Tis \[carcinoma in situ\] and T1 \[tumor invades lamina propria\]). Other malignancies may be considered after consultation with the Medical Monitor
Life-threatening illnesses other than AML, uncontrolled medical conditions or organ system dysfunction that, in the Investigator's opinion, could compromise the patient's safety or put the study outcomes at risk
Uncontrolled arrhythmias; any Class 3-4 cardiac diseases as defined by the New York Heart Association (NYHA) functional classification
Evidence of AML central nervous system (CNS) involvement
Previous chemotherapy for AML except for the following, which are allowed:
Hydroxyurea for cytoreduction
One course of hypomethylating agent therapy (i.e.; up to 7 doses of azacitidine or 3-5 days of decitabine) within 30 days prior to enrollment (Day 1)
Use of experimental drugs ≤ 30 days prior to screening
Received prior HDAC inhibitor therapy
Received prior treatment with a hypomethylating agent, except as allowed in Exclusion Criterion 7.b
Known hypersensitivity to any components of pracinostat, azacitidine, or mannitol
History of human immunodeficiency virus (HIV) or an active and uncontrolled infection with hepatitis C virus (HCV) or hepatitis B virus (HBV)
Gastrointestinal (GI) tract disease that causes an inability to take oral medication, malabsorption syndrome, or a requirement for IV alimentation; prior surgical procedures affecting absorption; or uncontrolled inflammatory GI disease (e.g., Crohn's disease, ulcerative colitis)
Any disease(s), psychiatric condition, metabolic dysfunction, or findings from a physical examination or clinical laboratory test result that would cause reasonable suspicion of a disease or condition, that contraindicates the use of pracinostat and/or AZA, that may increase the risk associated with study participation, that may affect the interpretation of the results, or that would make the patient inappropriate for this study
Breast-feeding woman
current smokers(use of patches, chewing gums and vaping nicotine conaining fluids is permitted). Patients who stopped smoking at least 8 day prior to first pracinostat dosing can be enrolled, provided they refrain from smoking during the whole study
prohibited concomitant medications
uncontrolled infections
receive more than 1 prior cycle of HMA or bone marrow transplant for any prior hematological disorder antecedent to AML

Ubicaciones

Hospital italiano de Buenos Aires

Ciudad Autonoma de Buenos Aire, Buenos Aires, Argentina

Instituto Medico Especializado Alexander Fleming

Ciudad Autonoma de Buenos Aire, Buenos Aires, Argentina

hospital Italiano la Plata

La Plata, Buenos Aires, Argentina

Sanatorio Britanico SA Paraguay 40, 3P

Rosario, Santa Fe Province, Argentina

sanatorio Allende

Córdoba, Argentina

H ospi tal Privado de Cordoba

Córdoba, Argentina

Ensayo clínico de Fase III, doble ciego, controlado con placebo, multicéntrico y aleatorizado de pracinostat en combinación con azacitidina en pacientes ≥18 años con leucemia mieloide aguda de diagnóstico reciente no aptos para quimioterapia de inducción estándar

Resumen

Elegibilidad

Criterios de inclusión

Criterios de exclusión

Intervenciones

Pracinostat

Placebos

Azacitidine