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A Phase I Study Of Decitabine (DAC) (IND # 50733) In Children With Relapsed Or Refractory Acute Leukemia


Phase 1
N/A
21 Years
Not Enrolling
Both
Childhood Acute Myeloblastic Leukemia With Maturation (M2), Childhood Acute Promyelocytic Leukemia (M3), Recurrent Childhood Acute Lymphoblastic Leukemia, Recurrent Childhood Acute Myeloid Leukemia, Secondary Acute Myeloid Leukemia

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Trial Information

A Phase I Study Of Decitabine (DAC) (IND # 50733) In Children With Relapsed Or Refractory Acute Leukemia


PRIMARY OBJECTIVES:

I. Determine the maximum tolerated dose of decitabine that is associated with consistent
evidence of deoxyribonucleic acid (DNA) demethylation in children with relapsed or
refractory acute myeloid leukemia or acute lymphoblastic leukemia.

II. Determine the dose-limiting toxicity, pharmacokinetics, and antitumor activity of this
drug in these patients.

III. Determine the biologic correlates of decitabine-induced DNA demethylation by
characterizing, before and after treatment, global and specific DNA methylation status
(using methylation microarrays) and hemoglobin F levels in these patients.

IV. Determine the biologic correlates of decitabine-induced DNA demethylation by
characterizing, before and after treatment, global changes in gene expression profiles using
cDNA microarrays and drug sensitivity of blast cells by MTT assays in these patients.

V. Determine the biologic correlates of decitabine-induced DNA demethylation by
characterizing, before and after treatment, deletions and single nucleotide polymorphisms in
genomic DNA of deoxycytidine kinase and cytidine deaminase genes in these patients.

VI. Determine the biologic correlates of decitabine-induced DNA demethylation by
characterizing, before and after treatment, acetylation and methylation of histones H3 and
H4 and helicase protein expression in these patients.

OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to
disease type (acute myeloid leukemia vs acute lymphoblastic leukemia).

Patients receive decitabine IV over 1 hour on days 1-5 and 8-12. Treatment repeats every 4-6
weeks for a minimum of 4 courses in the absence of disease progression or unacceptable
toxicity.

Cohorts of 3-6 patients receive escalating doses of decitabine until the maximum tolerated
dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2
of 3 or 2 of 6 patients experience dose-limiting toxicity.

PROJECTED ACCRUAL: A total of 15-21 patients will be accrued for this study within 7.5-21
months.


Inclusion Criteria:



- Histologically confirmed acute myeloid leukemia (AML) or acute lymphoblastic leukemia
that is considered refractory to conventional therapy or for which no conventional
therapy exists

- For patients with AML:

- M3 marrow

- M2 marrow with at least 15% blasts

- Secondary AML allowed

- CNS involvement allowed

- Performance status - Karnofsky 50-100% (age 17 to 21)

- Performance status - Lansky 50-100% (age 16 and under)

- At least 8 weeks

- See Chemotherapy

- WBC no greater than 30,000/mm^3

- Patients with granulocytopenia, anemia, and/or thrombocytopenia are eligible but are
not evaluable for hematological toxicity

- Bilirubin no greater than 1.5 times normal

- ALT no greater than 5 times normal

- Albumin at least 2 g/dL

- Creatinine no greater than 1.5 times normal

- Creatinine clearance or radioisotope glomerular filtration rate at least lower limit
of normal

- Shortening fraction at least 27% by echocardiogram

- Ejection fraction at least 50% by MUGA scan

- No evidence of dyspnea at rest

- No exercise intolerance

- Oxygen saturation greater than 94% by pulse oximetry

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- Concurrent seizure disorder allowed if well controlled on anticonvulsants

- No grade 2 or greater CNS toxicity

- No uncontrolled infection (i.e., infections associated with fever, dissemination,
hemodynamic instability [requiring pressor support], and progression while on
therapy)

- No active graft-versus-host disease (GVHD)

- GVHD well controlled on cyclosporine allowed

- Recovered from prior immunotherapy

- At least 1 week since prior biologic agents

- At least 6 months since prior allogeneic bone marrow transplantation (BMT)

- At least 3 months since prior autologous BMT

- No concurrent sargramostim (GM-CSF)

- No concurrent prophylactic filgrastim (G-CSF) during the first course of therapy

- Recovered from prior chemotherapy

- At least 4 weeks since prior cytarabine

- At least 24 hours since prior cytoreductive therapy with hydroxyurea (20-30
mg/kg/day for no more than 7 days) to lower the WBC to no greater than 30,000/mm^3

- No concurrent intrathecal therapy during the first course of decitabine

- Recovered from prior radiotherapy

- At least 2 weeks since prior local palliative radiotherapy (small port)

- At least 6 weeks since prior cranial or craniospinal radiotherapy

- No concurrent medications that induce cytidine deaminase or deoxycytidine kinase
(e.g., cytarabine)

- No concurrent medications that mask poor or deteriorating organ function

- No concurrent CNS prophylaxis during the first course of decitabine

- Concurrent anticonvulsants with no known interactions with decitabine allowed

- Concurrent antibacterial or antifungal therapies for controlled infections allowed

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

MTD defined as the highest dose at which fewer than one-third of patients experience DLT assessed using CTC version 2.0

Outcome Time Frame:

4 weeks

Safety Issue:

Yes

Principal Investigator

Norman Lacayo

Investigator Role:

Principal Investigator

Investigator Affiliation:

Children's Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2012-01873

NCT ID:

NCT00042796

Start Date:

December 2002

Completion Date:

Related Keywords:

  • Childhood Acute Myeloblastic Leukemia With Maturation (M2)
  • Childhood Acute Promyelocytic Leukemia (M3)
  • Recurrent Childhood Acute Lymphoblastic Leukemia
  • Recurrent Childhood Acute Myeloid Leukemia
  • Secondary Acute Myeloid Leukemia
  • Leukemia
  • Leukemia, Lymphoid
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Leukemia, Myeloid, Acute
  • Leukemia, Myeloid
  • Leukemia, Promyelocytic, Acute

Name

Location

Children's Oncology GroupArcadia, California  91006-3776