HDAC Inhibitor Valproic Acid as an Effective Therapy for Chronic Lymphocytic Leukemia
All participants will be treated with valproic acid (VPA) at a starting dose of 15 mg/kg/day
orally in divided doses. This dose produces a VPA plasma level of 346-693 μM and is the
recommended starting dose for patients with seizure disorder. Each week a pre-dose serum VPA
level will be determined by immunoassay and the daily dose increased by 5 mg/kg/d to ensure
a predose level > 1mM. Once the target dose has been achieved serum VPA levels will be
determined on a monthly basis to ensure a pre dose level >1mM.
After completing 28 days of therapy participants will be examined and have lab work drawn
(CBC with differential, electrolytes, BUN, creatinine, total protein, albumin, calcium, LDH,
total and direct bilirubin, ALT/AST, and β2-microglobulin. Females of child bearing age will
undergo a pregnancy test prior to each 28 day cycle). For participants identified as having
stable or progressive disease (National Cancer Institute Criteria), Fludarabine (Flu)
therapy will be added to VPA on a 28 day cycle. Oral Flu will be administered at a dose of
40 mg/m2/day on days 1-3 of a 28 day cycle in addition to VPA as described above. Dose
adjustments for Flu will be based on creatinine clearance. All participants receiving
fludarabine will receive irradiated blood products and pneumocystis carnii prophylaxis.
Treatment will be continued with VPA ± Flu to a maximum of six 28 day cycles. Therapy will
be discontinued prior to six 28 day cycles if: a) the participant requests discontinuation,
b) if the participant is unable to comply with the protocol, c) the medical care team thinks
a change of therapy would be in the best interest of the participant, d) there is evidence
of progressive disease after two cycles of VPA + Flu, e) if the participant experiences
unacceptable toxicity attributable to the study drugs such as ≥3 non-hematological toxicity
or prolonged grade 4 hematological toxicity (NCI common toxicity criteria, Table 5 of the
protocol), f) if the AST/ALT increase to > 6x the upper limit of normal or g) the
participant becomes pregnant.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Best clinical response as defined by NCIWG criteria for CLL
6 months after commencing therapy
No
David Szwajcer, MD
Principal Investigator
CancerCare Manitoba / University of Manitoba
Canada: Health Canada
CCM-001
NCT00524667
January 2008
July 2011
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