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Report for Clinical Trial NCT04293562

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

A Phase 3 Randomized Trial for Patients With De Novo AML Comparing Standard Therapy Including Gemtuzumab Ozogamicin (GO) to CPX-351 With GO, and the Addition of the FLT3 Inhibitor Gilteritinib for Patients With FLT3 Mutations

This phase III trial compares standard chemotherapy to therapy with CPX-351 and/or gilteritinib for patients with newly diagnosed acute myeloid leukemia with or without FLT3 mutations. Drugs used in chemotherapy, such as daunorubicin, cytarabine, and gemtuzumab ozogamicin, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. CPX-351 is made up of daunorubicin and cytarabine and is made in a way that makes the drugs stay in the bone marrow longer and could be less likely to cause heart problems than traditional anthracycline drugs, a common class of chemotherapy drug. Some acute myeloid leukemia patients have an abnormality in the structure of a gene called FLT3. Genes are pieces of DNA (molecules that carry instructions for development, functioning, growth and reproduction) inside each cell that tell the cell what to do and when to grow and divide. FLT3 plays an important role in the normal making of blood cells. This gene can have permanent changes that cause it to function abnormally by making cancer cells grow. Gilteritinib may block the abnormal function of the FLT3 gene that makes cancer cells grow. The overall goals of this study are, 1) to compare the effects, good and/or bad, of CPX-351 with daunorubicin and cytarabine on people with newly diagnosed AML to find out which is better, 2) to study the effects, good and/or bad, of adding gilteritinib to AML therapy for patients with high amounts of FLT3/ITD or other FLT3 mutations and 3) to study changes in heart function during and after treatment for AML. Giving CPX-351 and/or gilteritinib with standard chemotherapy may work better in treating patients with acute myeloid leukemia compared to standard chemotherapy alone.

NCT04293562 Acute Myeloid Leukemia

14 Interventions

Name: Allogeneic Hematopoietic Stem Cell Transplantation

Description: Undergo allogeneic HSCT
Type: Procedure
Group Labels: 6

Arm A High Risk Group Arm AC High Risk Group Arm AD High Risk Group Arm B High Risk Group Arm BC High Risk Group Arm BD High Risk Group

Name: Asparaginase

Description: Given IM or IV
Type: Drug
Group Labels: 8

Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC Low Risk Group 2 Arm AD Low Risk Group 2 Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC Low Risk Group 2 Arm BD Low Risk Group 2

Name: Asparaginase Erwinia chrysanthemi

Description: Given IM or IV
Type: Drug
Group Labels: 8

Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC Low Risk Group 2 Arm AD Low Risk Group 2 Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC Low Risk Group 2 Arm BD Low Risk Group 2

Name: Cogstate Assessment Battery

Description: Ancillary studies
Type: Behavioral
Group Labels: 14

Arm A High Risk Group Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Gro Arm AD Low Risk Group 2 Arm B High Risk Group Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2

Name: Cytarabine

Description: Given IV or IT
Type: Drug
Group Labels: 14

Arm A High Risk Group Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2 Arm B High Risk Group Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2

Name: Daunorubicin Hydrochloride

Description: Given IV
Type: Drug
Group Labels: 7

Arm A High Risk Group Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2

Name: Dexrazoxane Hydrochloride

Description: Given IV
Type: Drug
Group Labels: 9

Arm A High Risk Group Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2 Arm BC Low Risk Group 2 Arm BD Low Risk Group 2

Name: Etoposide

Description: Given IV
Type: Drug
Group Labels: 14

Arm A High Risk Group Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2 Arm B High Risk Group Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2

Name: Gemtuzumab Ozogamicin

Description: Given IV
Type: Drug
Group Labels: 14

Arm A High Risk Group Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2 Arm B High Risk Group Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2

Name: Gilteritinib Fumarate

Description: Given PO
Type: Drug
Group Labels: 8

Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2

Name: Liposome-encapsulated Daunorubicin-Cytarabine

Description: Given IV
Type: Drug
Group Labels: 7

Arm B High Risk Group Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2

Name: Methotrexate

Description: Given IT
Type: Drug
Group Labels: 14

Arm A High Risk Group Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2 Arm B High Risk Group Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2

Name: Mitoxantrone Hydrochloride

Description: Given IV
Type: Drug
Group Labels: 6

Arm A Low Risk Group 2 Arm AC Low Risk Group 2 Arm AD Low Risk Group 2 Arm B Low Risk Group 2 Arm BC Low Risk Group 2 Arm BD Low Risk Group 2

Name: Therapeutic Hydrocortisone

Description: Given IT
Type: Drug
Group Labels: 15

Arm A High Risk Group Arm A Low Risk Group 1 Arm A Low Risk Group 2 Arm AC High Risk Group Arm AC Low Risk Group Arm AC Low Risk Group 2 Arm AD High Risk Group Arm AD Low Risk Group 2 Arm B High Risk Group Arm B Low Risk Group 1 Arm B Low Risk Group 2 Arm BC High Risk Group Arm BC Low Risk Group 2 Arm BD High Risk Group Arm BD Low Risk Group 2


Primary Outcomes

Description: The Kaplan-Meier method will be used to estimate 3-year EFS, defined as the time from study entry until induction failure, relapse, secondary malignancy, or death.

Measure: Event-free survival (EFS)

Time: Up to 3 years

Secondary Outcomes

Description: The Kaplan-Meier method will be used to estimate 3-year OS, defined as the time from study entry until death.

Measure: Overall survival (OS)

Time: Up to 3 years

Description: The proportion of patients MRD+ at end of induction 1 (EOI1) will be estimated as the number of patients MRD+ divided by the number of patients with evaluable EOI1 MRD results along with a corresponding 95% confidence interval determined using a binomial exact method.

Measure: Proportion of patients positive for minimal residual disease (MRD+)

Time: Up to 4 weeks

Description: The proportion of patients who died during protocol therapy will be estimated along with the corresponding 95% confidence interval determined using a binomial exact method.

Measure: Proportion of patients who died during protocol therapy

Time: Up to 2 years

Description: Cumulative incidence estimates will be used to determine the 3 year relapse rate defined as time from study entry to induction failure or relapse where deaths or secondary malignancies are competing events.

Measure: Relapse rate

Time: Up to 3 years

Description: Cumulative incidence estimates will be used to determine the 3 year TRM defined as time from study entry to death where induction failure, relapse or secondary malignancies are competing events.

Measure: Treatment-related mortality rate (TRM)

Time: Up to 3 years

Description: The proportion of patients experiencing at least one grade 3 or higher non-hematologic toxicity and infection while on protocol therapy will be estimated along with the corresponding 95% confidence interval determined using a binomial exact method. Toxicity will be assessed by Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0).

Measure: Incidence of adverse events

Time: Up to 2 years

Other Outcomes

Description: Median and range of the length of course duration will be determined.

Measure: Course duration

Time: Up to 2 years

Description: Median and range of the length of hospitalization time during protocol therapy will be determined.

Measure: Length of hospitalization

Time: Up to 2 years

Description: Cumulative incidence estimates that account for competing events will be used to estimate time to count recovery in days where deaths are competing events.

Measure: Time to count recovery

Time: Up to 2 years

Purpose: Treatment

Allocation: Randomized

Parallel Assignment


There is one SNP

SNPs


1 Q12H

TREATMENT FOR PATIENTS WITHOUT FLT3 MUTATIONS: ARM A LOW RISK GROUP 1: INDUCTION 1: Patients receive cytarabine intravenously (IV) over 1-30 minutes every 12 hours (Q12H) on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, and gemtuzumab ozogamicin IV over 2 hours on day 6. --- Q12H ---

Patients also receive cytarabine IV over 1-30 minutes Q12H on days 1-8 and dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5. INTENSIFICATION 1: Patients receive methotrexate IT, hydrocortisone IT, and cytarabine IT on day 0. Patients also receive high-dose cytarabine IV over 1-3 hours Q12H and etoposide IV over 90-120 minutes on days 1-5. --- Q12H ---

Patients also receive cytarabine IV over 1-30 minutes Q12H on days 1-8 and dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5. INTENSIFICATION 1: Patients receive methotrexate IT, hydrocortisone IT, and cytarabine IT on day 0. Patients also receive high-dose cytarabine IV over 1-3 hours Q12H and etoposide IV over 90-120 minutes on days 1-5. --- Q12H --- --- Q12H ---

INTENSIFICATION 2: Patients receive high-dose cytarabine IV over 3 hours Q12H on days 1, 2, 8, and 9. Patients also receive asparaginase Erwinia chrysanthemi intramuscularly (IM) or IV over 1-2 hours and asparaginase IM or IV over 30 minutes on days 2 and 9. ARM B LOW RISK GROUP 1: INDUCTION 1: Patients receive CPX-351 IV over 90 minutes on days 1, 3, and 5, and gemtuzumab ozogamicin IV over 2 hours on day 6. --- Q12H ---

Patients also receive CPX-351 IV over 90 minutes on days 1, 3, and 5. INTENSIFICATION 1: Patients receive methotrexate IT, hydrocortisone IT, and cytarabine IT on day 0. Patients also receive high-dose cytarabine IV over 1-3 hours Q12H and etoposide IV over 90-120 minutes on days 1-5. --- Q12H ---

INTENSIFICATION 2: Patients receive high-dose cytarabine IV over 3 hours Q12H on days 1, 2, 8, and 9. Patients also receive asparaginase Erwinia chrysanthemi IM or IV over 1-2 hours and asparaginase IM or IV over 30 minutes on days 2 and 9. ARM A LOW RISK GROUP 2: INDUCTION 1: Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, and gemtuzumab ozogamicin IV over 2 hours on day 6. --- Q12H ---

INTENSIFICATION 2: Patients receive high-dose cytarabine IV over 3 hours Q12H on days 1, 2, 8, and 9. Patients also receive asparaginase Erwinia chrysanthemi IM or IV over 1-2 hours and asparaginase IM or IV over 30 minutes on days 2 and 9. ARM A LOW RISK GROUP 2: INDUCTION 1: Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, and gemtuzumab ozogamicin IV over 2 hours on day 6. --- Q12H --- --- Q12H ---

INTENSIFICATION 2: Patients receive methotrexate IT, hydrocortisone IT, and cytarabine IT on day 0. Patients also receive high-dose cytarabine IV over 1-3 hours Q12H on days 1-4 and dexrazoxane IV over 5-15 minutes and mitoxantrone hydrochloride (mitoxantrone) IV over 5-15 minutes on days 3-6. --- Q12H ---

INTENSIFICATION 3: Patients receive high-dose cytarabine IV over 3 hours Q12H on days 1, 2, 8, and 9. Patients also receive asparaginase Erwinia chrysanthemi IM or IV over 1-2 hours and asparaginase IM or IV over 30 minutes on days 2 and 9. ARM B LOW RISK GROUP 2: INDUCTION 1: Patients receive CPX-351 IV over 90 minutes on days 1, 3, and 5, and gemtuzumab ozogamicin IV over 2 hours on day 6. --- Q12H ---

INTENSIFICATION 3: Patients receive high-dose cytarabine IV over 3 hours Q12H on days 1, 2, 8, and 9. Patients also receive asparaginase Erwinia chrysanthemi IM or IV over 1-2 hours and asparaginase IM or IV over 30 minutes on days 2 and 9. ARM A HIGH RISK GROUP: INDUCTION 1: Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, and gemtuzumab ozogamicin IV over 2 hours on day 6. --- Q12H ---

INTENSIFICATION 3: Patients receive high-dose cytarabine IV over 3 hours Q12H on days 1, 2, 8, and 9. Patients also receive asparaginase Erwinia chrysanthemi IM or IV over 1-2 hours and asparaginase IM or IV over 30 minutes on days 2 and 9. ARM A HIGH RISK GROUP: INDUCTION 1: Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, and gemtuzumab ozogamicin IV over 2 hours on day 6. --- Q12H --- --- Q12H ---

TREATMENT FOR PATIENTS WITH FLT3/ITD MUTATIONS (ITD AR > 0.1): ARM AC LOW RISK GROUP 2: CONTINUED INDUCTION 1 (WITH GILTERITINIB): Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, gemtuzumab ozogamicin IV over 2 hours on day 6, and gilteritinib orally (PO) once daily (QD) on days 11-31. --- Q12H ---

Patients also receive cytarabine IV over 1-30 minutes Q12H on days 1-8, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, and gilteritinib PO QD on days 11-38. --- Q12H ---

INTENSIFICATION 1 (WITH GILTERITINIB): Patients receive methotrexate IT, hydrocortisone IT, and cytarabine IT on day 0. Patients also receive high-dose cytarabine IV over 1-3 hours Q12H and etoposide IV over 90-120 minutes on days 1-5, and gilteritinib PO QD on days 6-33. --- Q12H ---

INTENSIFICATION 2 (WITH GILTERITINIB): Patients receive methotrexate IT, hydrocortisone IT, and cytarabine IT on day 0. Patients also receive high-dose cytarabine IV over 1-3 hours Q12H on days 1-4, dexrazoxane IV over 5-15 minutes and mitoxantrone IV over 5-15 minutes on days 3-6, and gilteritinib PO QD on days 7-34. --- Q12H ---

INTENSIFICATION 3 (WITH GILTERITINIB): Patients receive high-dose cytarabine IV over 3 hours Q12H on days 1, 2, 8, and 9, asparaginase Erwinia chrysanthemi IM or IV over 1-2 hours and asparaginase IM or IV over 30 minutes on days 2 and 9, and gilteritinib PO QD on days 10-37. --- Q12H ---

ARM AC HIGH RISK GROUP: CONTINUED INDUCTION 1 (WITH GILTERITINIB): Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, gemtuzumab ozogamicin IV over 2 hours on day 6, and gilteritinib orally (PO) once daily (QD) on days 11-31. --- Q12H ---

TREATMENT FOR NON-ITD FLT3 ACTIVATING MUTATIONS: ARM AD LOW RISK GROUP 2: CONTINUED INDUCTION 1 (WITH GILTERITINIB): Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, gemtuzumab ozogamicin IV over 2 hours on day 6, and gilteritinib orally (PO) once daily (QD) on days 11-31. --- Q12H ---

ARM AD HIGH RISK GROUP: CONTINUED INDUCTION 1 (WITH GILTERITINIB): Patients receive cytarabine IV over 1-30 minutes Q12H on days 1-10, dexrazoxane IV over 5-15 minutes and daunorubicin IV over 1-15 minutes on days 1, 3, and 5, gemtuzumab ozogamicin IV over 2 hours on day 6, and gilteritinib orally (PO) once daily (QD) on days 11-31. --- Q12H ---



HPO Nodes