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Clinical Trial ECOGHEMS1203

Title

A Randomized Phase III Study of Standard Cytarabine plus Daunorubicin (7+3) Therapy or Idarubicin with High Dose Cytarabine (IA) versus IA with Vorinostat (IA+V) in Younger Patients with Previously Untreated Acute Myeloid Leukemia (AML)

Principal Investigator(s)

Stephen Strickland

Details

  • Protocol No. ECOGHEMS1203
  • Open Date: 07/26/2013
  • Staging: Phase III
  • Age Group: Adults
  • Scope: National
  • Objective: a. (Chemotherapy): To compare event-free survival (EFS) between patients with AML who receive standard 7+3 or idarubicin and high-dose cytarabine (IA) to patients who receive IA + vorinostat. b. (Transplant): To determine whether it is possible to get 60% or more of adults with high-risk AML in first complete
  • Disease Sites: Leukemia
  • Therapies: Chemotherapy - cytotoxic
  • Drugs: AraC; Daunorubicin (Daunomycin); Idarubicin; Vorinostat (ZOLINZA)
  • Participating Institutions: Vanderbilt University
  • National Clinical Trial ID: NCT01802333
  • Secondary Protocol No: S1203

Description

The purpose of this study is to compare the effects, good and/or bad of three drug combinations. The first combination is the standard treatment of daunorubicin plus AraC. This is called "7+3" treatment. The second combination is another standard treatment of idarubicin plus AraC. This is called "IA" treatment. Both of these treatments have been approved for your cancer. The third combination will add the drug vorinostat to the standard IA therapy. Vorinostat is approved for other types of cancer, but has not been approved for this type of cancer, so it is considered investigational for this study. Study doctors want to compare the effects of these three treatments on this type of cancer. Study doctors want to see if the study treatments will get rid of leukemia cells and keep them from coming back for patients who may benefit from stem cell transplant. They also want to find stem cell transplant donors for patients who might benefit from a transplant according to standard practice, beginning at the time participants register for the study. Participants are being asked to take part in this study because they have acute myeloid leukemia that has not been treated yet.

Eligibility

Ages Eligible for Study:18 Years to 60 Years
Genders Eligible for Study:Both
Accepts Healthy Volunteers:No

Criteria

Inclusion Criteria:
• STEP 1•INDUCTION/RE-INDUCTION
• Patients must have morphologically confirmed newly diagnosed acute myelogenous leukemia (AML) with blood or bone marrow disease; patients with only extramedullary disease in the absence of bone marrow or blood involvement are not eligible; note: this protocol uses World Health Organization (WHO) diagnostic criteria for AML; patients with acute promyelocytic leukemia (APL, French-American-British [FAB], M3) or blastic transformation of chronic myelogenous leukemia (CML) are not eligible; patients with known core binding factor (CBF) or fms-like tyrosine kinase 3 (FLT3) related leukemias are eligible for this study, but should preferentially be placed on National Cancer Institute (NCI)-sponsored protocols specific for these subtypes, if available
• Patients must have diagnostic/pre-treatment specimens obtained within 28 days prior to registration submitted for cytogenetic (and fluorescent in situ hybridization [FISH] if possible) analysis to determine risk status; high risk classification will be defined as del(5q)/-5, del(7q)/-7, abn3q26 [inv(3)/t(3;3)], 11q23 rearrangement [except t(9;11)], 17p-, t(6;9), t(9;22), complex (at least 3 unrelated abnormalities [abn]), and monosomal karyotype (either loss of two different chromosomes or loss of one chromosome along with a structural chromosome abnormality other than add, ring and mar); karyograms and cytogenetics/FISH analysis reports must be submitted for discipline review
• Patients must be chemo-naïve, i.e., not have received any prior Induction chemotherapy for AML or myelodysplastic syndrome (MDS); temporary prior measures such as apheresis or hydroxyurea are allowed; prior anthracycline therapy is allowed, but must not exceed a dose of 200 mg/m^2 daunorubicin or equivalent; prior all-trans retinoic acid (ATRA) for suspected APL is allowed; prior methotrexate for central nervous system (CNS) involvement is allowed; patients with prior history of MDS must not have received azacitidine, decitabine, lenalidomide or vorinostat
• Patients must have peripheral blood and bone marrow aspirate specimens obtained within 28 days prior to registration submitted for translational medicine; with patient consent, residuals will be banked for future research
• Patients must have Zubrod performance status =< 3
• Patients must have either echocardiogram (ECHO) or multi gated acquisition scan (MUGA) with ejection fraction >= 45% within 28 days prior to registration
• Patients must not have prolonged corrected QT (QTc) interval (> 500 msec) determined by electrocardiogram (EKG) within 28 days prior to registration
• Patients must not have cardiac disease defined as: New York Heart Association (NYHA) > class II; patients must not have unstable angina (angina symptoms at rest) or new onset angina (began within the last 3 months) or myocardial infarction within the past 6 months
• Patients must not have any coexisting medical condition that is likely to interfere with study procedures or results, and must be reasonable candidates for intensive chemotherapy, in the opinion of their treating physicians
• Patients who are known to be human immunodeficiency virus (HIV) positive (+) are eligible providing they meet all of the following additional criteria within 28 days prior to registration:
• Cluster of differentiation (CD) 4 cells >= 500/mm^3
• Viral load < 50 copies of HIV messenger ribonucleic acid (mRNA)/mm^3 if on combination antiretroviral therapy (cART) or < 25,000 copies of HIV mRNA if not on cART
• No zidovudine or stavudine as part of cART; patients who are HIV+ and do not meet all of these criteria are not eligible for this study
• Patients with known hepatitis B or hepatitis C infection may be eligible providing they have viral load < 800,000 IU/L within 28 days prior to registration
• Patients must be able to take oral medications
• Patients must have a history and physical examination obtained within 28 days prior to registration
• Patients must not be pregnant or nursing; women/men of reproductive potential must have agreed to use an effective contraceptive method; a woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months; in addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures
• Prior malignancy is allowed providing it does not require concurrent therapy; exception: active hormonal therapy is allowed
• Patients must not be receiving valproic acid
• All patients must be informed of the investigational nature of this study; patients or a legally authorized representative must sign and give written informed consent in accordance with institutional and federal guidelines
• As part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system
• STEP 2•CONSOLIDATION
• Patients may be registered for Consolidation provided that they were eligible for the initial Induction/Re-Induction registration and satisfy the following additional criteria:
• Patients must have achieved morphologic remission (complete remission [CR] or complete remission with incomplete platelet recover [CRi]) after completion of Induction or Re-Induction therapy; patient must remain in remission until beginning Consolidation and this must be documented by bone marrow and peripheral blood examination within 28 days prior to registration to Step 2
• All non-hematologic treatment related toxicities that are deemed clinically significant by the treating physician must have resolved to =< grade 2
• Patients must not have received allogeneic stem cell transplant