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A Phase 1 Study of Vorinostat (Suberoylanilide Hydroxamic Acid; SAHA) in Combination With Decitabine in Patients With Advanced Solid Tumors, Relapsed or Refractory Non-Hodgkin's Lymphoma, Acute Myeloid Leukemia, Acute Lymphocytic Leukemia, or Chronic Myelogenous Leukemia in Blast Crisis


Phase 1
18 Years
N/A
Open (Enrolling)
Both
Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities, Adult Acute Myeloid Leukemia With Inv(16)(p13;q22), Adult Acute Myeloid Leukemia With t(15;17)(q22;q12), Adult Acute Myeloid Leukemia With t(16;16)(p13;q22), Adult Acute Myeloid Leukemia With t(8;21)(q22;q22), Blastic Phase Chronic Myelogenous Leukemia, Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue, Nodal Marginal Zone B-cell Lymphoma, Recurrent Adult Acute Lymphoblastic Leukemia, Recurrent Adult Acute Myeloid Leukemia, Recurrent Adult Burkitt Lymphoma, Recurrent Adult Diffuse Large Cell Lymphoma, Recurrent Adult Diffuse Mixed Cell Lymphoma, Recurrent Adult Diffuse Small Cleaved Cell Lymphoma, Recurrent Adult Immunoblastic Large Cell Lymphoma, Recurrent Adult Lymphoblastic Lymphoma, Recurrent Grade 1 Follicular Lymphoma, Recurrent Grade 2 Follicular Lymphoma, Recurrent Grade 3 Follicular Lymphoma, Recurrent Mantle Cell Lymphoma, Recurrent Marginal Zone Lymphoma, Recurrent Small Lymphocytic Lymphoma, Secondary Acute Myeloid Leukemia, Splenic Marginal Zone Lymphoma, Stage III Adult Burkitt Lymphoma, Stage III Adult Diffuse Large Cell Lymphoma, Stage III Adult Diffuse Mixed Cell Lymphoma, Stage III Adult Diffuse Small Cleaved Cell Lymphoma, Stage III Adult Immunoblastic Large Cell Lymphoma, Stage III Adult Lymphoblastic Lymphoma, Stage III Grade 1 Follicular Lymphoma, Stage III Grade 2 Follicular Lymphoma, Stage III Grade 3 Follicular Lymphoma, Stage III Mantle Cell Lymphoma, Stage III Marginal Zone Lymphoma, Stage III Small Lymphocytic Lymphoma, Stage IV Adult Burkitt Lymphoma, Stage IV Adult Diffuse Large Cell Lymphoma, Stage IV Adult Diffuse Mixed Cell Lymphoma, Stage IV Adult Diffuse Small Cleaved Cell Lymphoma, Stage IV Adult Immunoblastic Large Cell Lymphoma, Stage IV Adult Lymphoblastic Lymphoma, Stage IV Grade 1 Follicular Lymphoma, Stage IV Grade 2 Follicular Lymphoma, Stage IV Grade 3 Follicular Lymphoma, Stage IV Mantle Cell Lymphoma, Stage IV Marginal Zone Lymphoma, Stage IV Small Lymphocytic Lymphoma, Unspecified Adult Solid Tumor, Protocol Specific, Untreated Adult Acute Lymphoblastic Leukemia, Untreated Adult Acute Myeloid Leukemia

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Trial Information

A Phase 1 Study of Vorinostat (Suberoylanilide Hydroxamic Acid; SAHA) in Combination With Decitabine in Patients With Advanced Solid Tumors, Relapsed or Refractory Non-Hodgkin's Lymphoma, Acute Myeloid Leukemia, Acute Lymphocytic Leukemia, or Chronic Myelogenous Leukemia in Blast Crisis


PRIMARY OBJECTIVES:

I. Establish the maximum tolerated dose and recommended phase II dose of vorinostat in
conjunction with decitabine in patients with advanced solid tumors or relapsed or refractory
non-Hodgkin's lymphoma, acute myeloid leukemia, acute lymphocytic leukemia, or chronic
myelogenous leukemia in blast crisis.

SECONDARY OBJECTIVES:

I. Identify the minimal effective dose of vorinostat in conjunction with decitabine that
will lead to DNA demethylation, histone acetylation, and gene reactivation with tolerable
toxicity in these patients.

II. Determine the pharmacokinetic profiles of vorinostat and decitabine in these patients.
Correlate pharmacokinetic profiles of vorinostat and decitabine with toxicity and biological
activity in these patients.

III. Assess the antitumor activity of vorinostat and decitabine in these patients.

OUTLINE: This is a parallel group, multicenter, dose-escalation study of vorinostat.
Patients are stratified according to disease (solid tumors or non-Hodgkin's lymphoma [NHL]
vs hematological malignancies).

Patients receive 1 of 2 dosing regimens.

Regimen 1 (sequential dosing): Patients receive oral vorinostat two or three times daily on
days 6-21 or days 6-12 (patients with solid tumors or NHL only) and decitabine IV over 1
hour on days 1-5. Courses repeat every 28 days in the absence of disease progression or
unacceptable toxicity.

Regimen 2 (concurrent dosing): Patients receive oral vorinostat two or three times daily on
days 1-21, days 1-14 (patients with hematological malignancies only), or two times daily on
days 1-12 (patients with solid tumors or NHL only) and decitabine IV over 1 hour on days
1-5.

Courses repeat every 28 days or 21 days (patients with hematological malignancies only) in
the absence of disease progression or unacceptable toxicity. In both groups, cohorts of 3-6
patients receive escalating doses of vorinostat until the maximum tolerated dose (MTD) is
determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients
experience dose-limiting toxicity. The dose level just below MTD would be declared the
recommended phase II dose (RPTD). Up to 10 patients are treated at the RPTD. After
completion of study treatment, patients are followed at 4 weeks.


Inclusion Criteria:



- Diagnosis of 1 of the following:

- Confirmed relapsed or refractory acute myeloid leukemia (AML) or acute
lymphoblastic leukemia (ALL) or chronic myelogenous leukemia in blast crisis
(CML-BC)

- Patients with acute promyelocytic leukemia who have relapsed while on
tretinoin allowed

- Patients with previously untreated AML who refuse induction chemotherapy
allowed

- Patients who are not candidates for aggressive management (those that have
medical conditions that prevent the administration of standard curative
chemotherapy or those who require an allogeneic bone marrow transplantation
for curative therapy but lack an appropriate donor) are allowed

- Histologically or cytologically confirmed relapsed or refractory non-Hodgkin's
lymphoma (NHL)

- Histologically confirmed solid tumor that is metastatic or unresectable or for
which standard curative or palliative measures do not exist or are no longer
effective

- Clinically or radiologically documented disease

- Patients whose only evidence of disease is tumor marker elevation are not
eligible

- Patients with AML, ALL, or CML-BC who have cerebral spinal fluid involvement may be
included

- May be treated with intrathecal cytarabine and/or methotrexate prior to and/or
during the study

- No known brain metastases in patients with solid tumors or NHL

- ECOG performance status 0-2

- Karnofsky 60-100%

- Life expectancy > 12 weeks for patients with solid tumors (including non-Hodgkin's
lymphoma) and 6 weeks for patients with hematological malignancies

- Patients with solid tumors (including NHL) must also have normal marrow function as
defined below:

- Leukocytes ≥ 3,000/mm^3

- Absolute neutrophil count ≥ 1,500/mm^3

- Platelets ≥ 100,000/mm^3

- Creatinine ≤ 150 μmol/L

- Creatinine clearance ≥ 60 mL/min

- Bilirubin normal

- AST/ALT ≤ 2.5 times upper limit of normal (ULN)

- Women of child-bearing potential and men must agree to use adequate contraception
(barrier method of birth control or abstinence) prior to study entry and for the
duration of study participation

- Not pregnant or nursing

- Negative pregnancy test

- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to vorinostat or other agents used in study

- Able to take oral medications

- Patients who have a clinical or radiological diagnosis of bowel obstruction are
ineligible

- No ongoing or active infection

- No symptomatic congestive heart failure

- No unstable angina pectoris

- No cardiac arrhythmia

- No psychiatric illness/social situations that would limit compliance with study
requirements

- No other uncontrolled intercurrent illness

- No limitation on the number or types of prior therapy

- At least 3 weeks since prior radiotherapy, chemotherapy (6 weeks for nitrosoureas or
mitomycin C), or molecularly targeted agents

- Exceptions may be made for low-dose, non-myelosuppressive radiotherapy

- At least 2 weeks since prior valproic acid or any other histone deacetylase inhibitor

- Must have recovered from prior therapy

- Patients with hematological malignancies may receive hydroxyurea until 24 hours prior
to starting study medications

- Previous surgery is permitted provided that wound healing has occurred

- No prior decitabine

- No other concurrent investigational agents

- No other concurrent investigational or commercial agents or therapies administered
with the intent to treat the patient's malignancy

- No HIV-positive patients receiving combination antiretroviral therapy

- No concurrent prophylactic hematopoietic growth factors (e.g. filgrastim [G-CSF],
sargramostim [GM-CSF], thrombopoietin, or epoetin alfa)

- Hematopoietic growth factors colony stimulating factors for the treatment of
cytopenia may be permitted at the discretion of the principal investigator

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Maximum tolerated dose and recommended phase II dose of vorinostat and decitabine

Outcome Description:

Graded using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0.

Outcome Time Frame:

Course 1

Safety Issue:

Yes

Principal Investigator

Karen Yee

Investigator Role:

Principal Investigator

Investigator Affiliation:

Princess Margaret Hospital Phase 2 Consortium

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00092

NCT ID:

NCT00275080

Start Date:

February 2006

Completion Date:

Related Keywords:

  • Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities
  • Adult Acute Myeloid Leukemia With Inv(16)(p13;q22)
  • Adult Acute Myeloid Leukemia With t(15;17)(q22;q12)
  • Adult Acute Myeloid Leukemia With t(16;16)(p13;q22)
  • Adult Acute Myeloid Leukemia With t(8;21)(q22;q22)
  • Blastic Phase Chronic Myelogenous Leukemia
  • Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue
  • Nodal Marginal Zone B-cell Lymphoma
  • Recurrent Adult Acute Lymphoblastic Leukemia
  • Recurrent Adult Acute Myeloid Leukemia
  • Recurrent Adult Burkitt Lymphoma
  • Recurrent Adult Diffuse Large Cell Lymphoma
  • Recurrent Adult Diffuse Mixed Cell Lymphoma
  • Recurrent Adult Diffuse Small Cleaved Cell Lymphoma
  • Recurrent Adult Immunoblastic Large Cell Lymphoma
  • Recurrent Adult Lymphoblastic Lymphoma
  • Recurrent Grade 1 Follicular Lymphoma
  • Recurrent Grade 2 Follicular Lymphoma
  • Recurrent Grade 3 Follicular Lymphoma
  • Recurrent Mantle Cell Lymphoma
  • Recurrent Marginal Zone Lymphoma
  • Recurrent Small Lymphocytic Lymphoma
  • Secondary Acute Myeloid Leukemia
  • Splenic Marginal Zone Lymphoma
  • Stage III Adult Burkitt Lymphoma
  • Stage III Adult Diffuse Large Cell Lymphoma
  • Stage III Adult Diffuse Mixed Cell Lymphoma
  • Stage III Adult Diffuse Small Cleaved Cell Lymphoma
  • Stage III Adult Immunoblastic Large Cell Lymphoma
  • Stage III Adult Lymphoblastic Lymphoma
  • Stage III Grade 1 Follicular Lymphoma
  • Stage III Grade 2 Follicular Lymphoma
  • Stage III Grade 3 Follicular Lymphoma
  • Stage III Mantle Cell Lymphoma
  • Stage III Marginal Zone Lymphoma
  • Stage III Small Lymphocytic Lymphoma
  • Stage IV Adult Burkitt Lymphoma
  • Stage IV Adult Diffuse Large Cell Lymphoma
  • Stage IV Adult Diffuse Mixed Cell Lymphoma
  • Stage IV Adult Diffuse Small Cleaved Cell Lymphoma
  • Stage IV Adult Immunoblastic Large Cell Lymphoma
  • Stage IV Adult Lymphoblastic Lymphoma
  • Stage IV Grade 1 Follicular Lymphoma
  • Stage IV Grade 2 Follicular Lymphoma
  • Stage IV Grade 3 Follicular Lymphoma
  • Stage IV Mantle Cell Lymphoma
  • Stage IV Marginal Zone Lymphoma
  • Stage IV Small Lymphocytic Lymphoma
  • Unspecified Adult Solid Tumor, Protocol Specific
  • Untreated Adult Acute Lymphoblastic Leukemia
  • Untreated Adult Acute Myeloid Leukemia
  • Congenital Abnormalities
  • Blast Crisis
  • Burkitt Lymphoma
  • Leukemia
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • Leukemia, Lymphoid
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Leukemia, Myeloid, Acute
  • Leukemia, Myeloid
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive
  • Lymphoma
  • Lymphoma, Follicular
  • Lymphoma, Large B-Cell, Diffuse
  • Lymphoma, Non-Hodgkin
  • Lymphoma, B-Cell
  • Lymphoma, Large-Cell, Immunoblastic
  • Lymphoma, B-Cell, Marginal Zone
  • Neoplasms
  • Lymphoma, Mantle-Cell

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