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A Randomized Phase II Study of Azacitidine in Combination With Lenalidomide (NSC-703813) vs. Azacitidine Alone vs. Azacititdine in Combination With Vorinostat (NSC-701852) for Higher-Risk Myelodysplastic Syndromes (MDS) and Chronic Myelomonocytic Leukemia (CMML)


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Chronic Myelomonocytic Leukemia, de Novo Myelodysplastic Syndromes, Previously Treated Myelodysplastic Syndromes, Refractory Anemia With Excess Blasts, Secondary Myelodysplastic Syndromes

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Trial Information

A Randomized Phase II Study of Azacitidine in Combination With Lenalidomide (NSC-703813) vs. Azacitidine Alone vs. Azacititdine in Combination With Vorinostat (NSC-701852) for Higher-Risk Myelodysplastic Syndromes (MDS) and Chronic Myelomonocytic Leukemia (CMML)


PRIMARY OBJECTIVES:

I. To test whether the response rate (complete remission, partial remission, or hematologic
improvement) of patients with higher-risk myelodysplastic syndromes (MDS) or chronic
myelomonocytic leukemia (CMML) who receive either the combination of lenalidomide and
azacitidine or the combination of vorinostat and azacitidine is improved compared to
patients who receive single-agent azacitidine.

II. To estimate relapse-free survival, overall survival and cytogenetic response rate of
patients treated on each regimen.

III. To estimate the frequency and severity of toxicities of the three regimens in this
patient population.

IV. To investigate in a preliminary manner the frequency of subgroups from pre-study
cytogenetic studies and correlate these subgroups with clinical outcomes in this patient
population.

V. To collect specimens for banking for use in future research studies.

OUTLINE: Patients are randomized to 1 of 3 treatment arms.

ARM I: Patients receive azacitidine subcutaneously (SC) or intravenously (IV) on days 1-7 or
days 1-5 and 8-9, and lenalidomide orally (PO) once daily (QD) on days 1-21.

ARM II: Patients receive azacitidine as in arm I.

ARM III: Patients receive azacitidine as in arm I and vorinostat PO twice daily (BID) on
days 3-9.

In all arms, courses repeat every 28 days for up to 5 years in the absence of disease
progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for up to 5
years.


Inclusion Criteria:



- Patients must have morphologically confirmed diagnosis of myelodysplastic syndromes
(MDS) or chronic myelomonocytic leukemia (CMML) based on one of the following:

- French-American-British (FAB) classifications:

- Refractory anemia with excess blasts (RAEB - defined as having 5-20%
myeloblasts in the bone marrow)

- CMML with 10-19% myeloblasts in the bone marrow and/or 5-19% blasts in the
blood

- World Health Organization (WHO) Classifications:

- RAEB-1 (defined as having 5-9% myeloblasts in the bone marrow)

- RAEB-2 (defined as having 10-19% myeloblasts in the bone marrow and/or
5-19% blasts in the blood)

- CMML-1 (defined as having < 5% myeloblasts in the bone marrow and/or < 10%
blasts in the blood)

- CMML-2 (defined as having 10-19% myeloblasts in the bone marrow and/or
5-19% blasts in the blood)

- International prognostic score (IPSS) of Intermediate 2 (1.5-2.0 points) or High
(>= 2.5 points); a score of Intermediate 1 (0.5-1.0 points) is only allowable in
the setting of >= 5% myeloblasts

- Patients with acute myeloid leukemia (AML) are not eligible

- Procedures to obtain specimens for establishing baseline disease must be done
within 30 days prior to registration

- Patients must not have received lenalidomide, azacitidine, vorinostat, or decitabine
as treatment previously; any hematopoietic growth factors must be stopped for at
least 14 days prior to registration

- Patients may have received low-dose cytarabine for MDS treatment previously, but
they must have discontinued its use for at least 28 days prior to registration

- Patients must not have received radiation therapy, chemotherapy, or cytotoxic therapy
to treat conditions other than MDS within 12 months prior to registration

- Patients must not have undergone prior allogeneic stem cell or bone marrow
transplantation at any time; patients that have undergone an autologous stem cell
transplant are eligible

- Patients must not have used or be using histone deacetylase (HDAC) inhibitor agents
for anticancer treatment

- Patients may not have received agents such as valproic acid for epilepsy within 30
days prior to registration

- Patients must have Zubrod performance status of 0-2

- Patients must not have any pre-existing neurotoxicity/neuropathy of >= grade 2
according to the National Cancer Institute (NCI) Common Toxicity Criteria (CTC)
Version 4.0, or prior >= grade 3 allergic reaction/hypersensitivity or rash to
thalidomide that has not resolved to < grade 2

- Patients must not have any serious medical condition, laboratory abnormality, or
psychiatric illness that, in the view of the treating physician, would place the
participant at an unacceptable risk if he or she were to participate in the study or
would prevent that person from giving informed consent

- Patients must not have history of thromboembolic event or other condition requiring
current use of anticoagulation with Coumadin (warfarin) or low molecular-weight
heparin

- Patients must not have known or suspected hypersensitivity to mannitol

- Patients must receive a 12-lead electrocardiogram (EKG), chest x-ray, serum
creatinine, complete metabolic panel including serum glutamic oxaloacetic
transaminase (SGOT) or serum glutamic pyruvic transaminase (SGPT), electrolytes, and
bilirubin testing within 28 days prior to registration in order to establish baseline
measurements; questions regarding patient safety in regards to results of these tests
should be directed to the Study Coordinator

- Females of childbearing potential (FCBP) must have a negative serum or urine
pregnancy test with a sensitivity of at least 25 mIU/mL within 10 - 14 days prior to
registration; FCBP must agree to have a second pregnancy test within 24 hours prior
to starting course 1 if randomized to receive lenalidomide

- A FCBP is a sexually mature woman who: 1) has not undergone a hysterectomy or
bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least
24 consecutive months (i.e., has had menses at any time in the preceding 24
consecutive months)

- Patients must commit to the following if they are randomized to receive lenalidomide;
FCBP must either commit to continued abstinence from heterosexual intercourse or
begin TWO acceptable methods of birth control: one highly effective method and one
additional effective method AT THE SAME TIME, at least 28 days before starting
lenalidomide; FCBP must also agree to ongoing pregnancy testing; men must agree to
use a latex condom during sexual contact with a FCBP, even if they have had a
successful vasectomy

- All patients must be counseled by a trained counselor every 28 days about
pregnancy precautions and risks of fetal exposure

- Patients not randomized to receive lenalidomide will not be required to undergo
serial pregnancy testing or lenalidomide counseling after registration

- No prior malignancy is allowed except for adequately treated basal cell (or squamous
cell) skin cancer, in situ cervical cancer, or other cancer for which the patient has
been disease-free for three years

- Cytogenetics requirements:

- Southwestern Oncology Group (SWOG) (and other sites not affiliated with Cancer
and Leukemia Group B [CALGB] or Eastern Cooperative Oncology Group [ECOG]):
Pretreatment cytogenetics must be performed on all patients; collection of
pretreatment specimens must be completed within 14 days prior to registration to
SWOG-S1117

- CALGB: CALGB patients must enroll on CALGB 8461, the cytogenetics protocol

- ECOG: Pretreatment cytogenetics must be performed on all patients; collection of
pretreatment specimens must be completed within 30 days prior to registration to
S1117

- Banking requirements:

- SWOG and ECOG (and other sites not affiliated with CALGB): Patients must be
offered participation in specimen banking

- CALGB: CALGB patients must be offered participation in CALGB 9665, the CALGB
Leukemia Tissue bank protocol

- National Cancer Institute of Canada (NCIC) Clinical Trials Group (CTG): NCIC CTG
patients must be offered participation in specimen submission and banking

- All patients must be informed of the investigational nature of this study and must
sign and give written informed consent in accordance with institutional and federal
guidelines

- As a part of the 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

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Response rate (RR) (any of complete hematological remission [CR], partial response [PR], or hematologic improvement [HI])

Outcome Description:

The final analysis will consist of two one-sided tests of whether the RR is improved in either of the combination arms compared to the single-agent azacitidine arm. Each test will be performed at the 0.05 level.

Outcome Time Frame:

Up to 5 years

Safety Issue:

No

Principal Investigator

Mikkael Sekeres

Investigator Role:

Principal Investigator

Investigator Affiliation:

Southwest Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2012-00242

NCT ID:

NCT01522976

Start Date:

March 2012

Completion Date:

Related Keywords:

  • Chronic Myelomonocytic Leukemia
  • de Novo Myelodysplastic Syndromes
  • Previously Treated Myelodysplastic Syndromes
  • Refractory Anemia With Excess Blasts
  • Secondary Myelodysplastic Syndromes
  • Anemia
  • Anemia, Refractory
  • Anemia, Refractory, with Excess of Blasts
  • Leukemia
  • Leukemia, Myelomonocytic, Chronic
  • Myelodysplastic Syndromes
  • Preleukemia
  • Leukemia, Myelomonocytic, Acute

Name

Location

Albert Einstein College of Medicine Bronx, New York  10461
Louisiana State University New Orleans, Louisiana  70112-2282
Johns Hopkins University Baltimore, Maryland  21205
Cleveland Clinic Foundation Cleveland, Ohio  44195
Roswell Park Cancer Institute Buffalo, New York  14263
Mayo Clinic Rochester, Minnesota  55905
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
University of Mississippi Medical Center Jackson, Mississippi  39216-4505
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Fairview Ridges Hospital Burnsville, Minnesota  55337
Hutchinson Area Health Care Hutchinson, Minnesota  55350
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Loyola University Medical Center Maywood, Illinois  60153
Massachusetts General Hospital Cancer Center Boston, Massachusetts  02114
CentraCare Clinic Saint Cloud, Minnesota  56303
Rapid City Regional Hospital Rapid City, South Dakota  57709
Marshfield Clinic Marshfield, Wisconsin  54449
Lehigh Valley Hospital Allentown, Pennsylvania  18103
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Waukesha Memorial Hospital Waukesha, Wisconsin  53188
Dana-Farber Cancer Institute Boston, Massachusetts  02115
North Shore University Hospital Manhasset, New York  11030
Eastern Maine Medical Center Bangor, Maine  04401
Baystate Medical Center Springfield, Massachusetts  01199
Kaiser Permanente Medical Center - Santa Clara Santa Clara, California  95051-5386
University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma  73104
Weill Medical College of Cornell University New York, New York  10021
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Montefiore Medical Center Bronx, New York  10467-2490
Parma Community General Hospital Parma, Ohio  44129
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Munson Medical Center Traverse City, Michigan  49684
Bozeman Deaconess Hospital Bozeman, Montana  59715
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
City of Hope Medical Center Duarte, California  91010
Mercy Health System Janesville, Wisconsin  53545
Front Range Cancer Specialists Fort Collins, Colorado  80528
Poudre Valley Hospital Fort Collins, Colorado  80524
Beebe Medical Center Lewes, Delaware  19958
Hematology and Oncology Associates Chicago, Illinois  60611
Galesburg Clinic Galesburg, Illinois  61401
Iredell Memorial Hospital Statesville, North Carolina  28677
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Mercy Hospital Coon Rapids, Minnesota  55433
Trinity Medical Center Moline, Illinois  61265-1291
Saint Joseph Mercy Hospital Ann Arbor, Michigan  48106
Fairview-Southdale Hospital Edina, Minnesota  55435
Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Regions Hospital Saint Paul, Minnesota  55101
Saint Francis Regional Medical Center Shakopee, Minnesota  55379
Rice Memorial Hospital Willmar, Minnesota  56201
Swedish American Hospital Rockford, Illinois  61104
Randolph Hospital Asheboro, North Carolina  27203
Miami Valley Hospital Dayton, Ohio  45409
Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Marshfield Clinic Cancer Care at Regional Cancer Center Eau Claire, Wisconsin  54701
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Longmont United Hospital Longmont, Colorado  80501
Union Hospital of Cecil County Elkton MD, Maryland  21921
Cancer Centers of the Carolinas - Grove Commons Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Mayo Clinic in Arizona Scottsdale, Arizona  85259-5404
Memorial Medical Center Springfield, Illinois  62781
Doylestown Hospital Doylestown, Pennsylvania  18901
Northwestern University Chicago, Illinois  60611
Hennepin County Medical Center Minneapolis, Minnesota  
University of Rochester Rochester, New York  14642
Case Western Reserve University Cleveland, Ohio  44106
Wayne State University Detroit, Michigan  48202
University of Arizona Health Sciences Center Tucson, Arizona  85724
University of Massachusetts Medical School Worcester, Massachusetts  01605
Providence Portland Medical Center Portland, Oregon  97213-3635
Mid Dakota Clinic Bismarck, North Dakota  58501
Presbyterian - Saint Lukes Medical Center - Health One Denver, Colorado  80218
University of Kentucky Lexington, Kentucky  40536-0098
Huntsman Cancer Institute/University of Utah Salt Lake City, Utah  84112
Metro-Minnesota CCOP St. Louis Park, Minnesota  
Lakeview Hospital Stillwater, Minnesota  55082
Decatur Memorial Hospital Decatur, Illinois  62526
Florida Hospital Orlando, Florida  32803
Hillcrest Hospital Cancer Center Mayfield Heights, Ohio  44124
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
University of Southern California Los Angeles, California  90033
Providence Newberg Medical Center Newberg, Oregon  97132
Parker Adventist Hospital Parker, Colorado  80138
Froedtert and the Medical College of Wisconsin Milwaukee, Wisconsin  53226
Kaiser Permanente-Oakland Oakland, California  94611
Kaiser Permanente-Richmond Richmond, California  94801
Kaiser Permanente-South Sacramento Sacramento, California  95823
Kaiser Permanente - Sacramento Sacramento, California  95825
Kaiser Permanente-San Francisco San Francisco, California  94115
Kaiser Permanente-Santa Teresa-San Jose San Jose, California  95119
Kaiser Permanente-San Rafael San Rafael, California  94903
Kaiser Permanente-South San Francisco South San Francisco, California  94080
Kaiser Permanente-Walnut Creek Walnut Creek, California  94596
The Medical Center of Aurora Aurora, Colorado  80012
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
Saint Mary Corwin Medical Center Pueblo, Colorado  81004
Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
The Hospital of Central Connecticut New Britain, Connecticut  06050
Oncare Hawaii Inc-POB II Honolulu, Hawaii  96813
Oncare Hawaii Inc-Kuakini Honolulu, Hawaii  96817
University of Hawaii Honolulu, Hawaii  96813
Evanston CCOP-NorthShore University HealthSystem Evanston, Illinois  60201
Illinois CancerCare-Ottawa Clinic Ottawa, Illinois  61350
Illinois Oncology Research Association CCOP Peoria, Illinois  61615
Illinois CancerCare-Peoria Peoria, Illinois  61615
Premier Oncology Hematology Associates Merrillville, Indiana  46410
McFarland Clinic Ames, Iowa  50010
Covenant Medical Center Waterloo, Iowa  50702
Stormont-Vail Regional Health Center Topeka, Kansas  66604
Green Bay Oncology - Escanaba Escanaba, Michigan  49431
Grand Rapids Clinical Oncology Program Grand Rapids, Michigan  49503
Green Bay Oncology - Iron Mountain Iron Mountain, Michigan  49801
Unity Hospital Fridley, Minnesota  55432
Saint John's Hospital - Healtheast Maplewood, Minnesota  55109
Minnesota Oncology Hematology PA-Maplewood Maplewood, Minnesota  55109
North Memorial Medical Health Center Robbinsdale, Minnesota  55422
Park Nicollet Clinic - Saint Louis Park Saint Louis Park, Minnesota  55416
Minnesota Oncology and Hematology PA-Woodbury Woodbury, Minnesota  55125
Saint Luke's Hospital of Kansas City Kansas City, Missouri  64111
Saint John's Mercy Medical Center Saint Louis, Missouri  63141
Billings Clinic Billings, Montana  59107-7000
Cooper Hospital University Medical Center Camden, New Jersey  08103
Presbyterian Kaseman Hospital Albuquerque, New Mexico  87110
Wayne Memorial Hospital Goldsboro, North Carolina  27534
Margaret R Pardee Memorial Hospital Hendersonville, North Carolina  28791
Kinston Medical Specialists PA Kinston, North Carolina  28501
Cleveland Clinic Cancer Center Independence Independence, Ohio  44131
North Coast Cancer Care Sandusky, Ohio  44870
University of Toledo Toledo, Ohio  43614
Cleveland Clinic Wooster Specialty Center Wooster, Ohio  44691
Legacy Good Samaritan Hospital and Medical Center Portland, Oregon  97210
Providence Saint Vincent Medical Center Portland, Oregon  97225
Greenville CCOP Greenville, South Carolina  29615
Greenville Memorial Hospital Greenville, South Carolina  29605
Upstate Carolina CCOP Spartanburg, South Carolina  29303
Sanford Cancer Center-Oncology Clinic Sioux Falls, South Dakota  57104
The Don and Sybil Harrington Cancer Center Amarillo, Texas  79106
Saint Vincent Hospital Green Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's Hospital Green Bay, Wisconsin  54303
Saint Mary's Hospital Green Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent Hospital Green Bay, Wisconsin  54301-3526
Aurora BayCare Medical Center Green Bay, Wisconsin  54311-6519
Dean Hematology and Oncology Clinic Madison, Wisconsin  53717
Vince Lombardi Cancer Clinic-Marinette Marinette, Wisconsin  54143
Oconomowoc Memorial Hospital-ProHealth Care Inc Oconomowoc, Wisconsin  53066-3896
Green Bay Oncology - Oconto Falls Oconto Falls, Wisconsin  54154
Marshfield Clinic at James Beck Cancer Center Rhinelander, Wisconsin  54501
Marshfield Clinic-Rice Lake Center Rice Lake, Wisconsin  54868
Saint Michael's Hospital Stevens Point, Wisconsin  54481
Green Bay Oncology - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Jupiter Medical Center Jupiter, Florida  33458
University of Illinois Chicago, Illinois  60612
Roger Maris Cancer Center Fargo, North Dakota  58122
Mount Sinai Medical Center CCOP Miami Beach, Florida  33140
Illinois CancerCare-Bloomington Bloomington%, Illinois  61701
Illinois CancerCare-Canton Canton, Illinois  61520
Illinois CancerCare-Carthage Carthage, Illinois  62321
Illinois CancerCare-Eureka Eureka, Illinois  61530
Illinois CancerCare-Havana Havana, Illinois  62644
Illinois CancerCare-Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare-Macomb Macomb, Illinois  61455
Illinois CancerCare-Monmouth Monmouth, Illinois  61462
Illinois CancerCare-Community Cancer Center Normal, Illinois  61761
Illinois CancerCare-Pekin Pekin, Illinois  61603
Illinois CancerCare-Peru Peru, Illinois  61354
Illinois CancerCare-Princeton Princeton, Illinois  61356
University of Missouri - Ellis Fischel Columbia, Missouri  65203
Moses Cone Health System-Regional Cancer Center Greensboro, North Carolina  27403
Annie Penn Memorial Hospital Reidsville, North Carolina  27320
Cancer Centers of the Carolinas - Faris Greenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Medical Oncology Greer, South Carolina  29650
Marshfield Clinic Cancer Care at Saint Michael's Hospital Stevens Point, Wisconsin  54481
Aurora Medical Center in Summit Summit, Wisconsin  53066
Monter Cancer Center Lake Success, New York  11042
FirstHealth of the Carolinas-Moore Regional Hosiptal Pinehurst, North Carolina  28374
Arizona Cancer Center at University Medical Center North Tucson, Arizona  85719
Kaiser Permanente-Deer Valley Medical Center Antioch, California  94531
Kaiser Permanente Moanalua Medical Center Honolulu, Hawaii  96819
Kansas City CCOP Prairie Village, Kansas  66208
Cleveland Clinic Cancer Center Beachwood Beachwood, Ohio  44122
Cancer Care Associates-Mercy Oklahoma City, Oklahoma  73120
Saint Francis Hospital Greenville, South Carolina  29601
Gundersen Lutheran La Crosse, Wisconsin  54601
Siouxland Hematology Oncology Associates Sioux City, Iowa  51101
Georgia Health Sciences University Augusta, Georgia  30912
Sanford Clinic North-Fargo Fargo, North Dakota  58102
Sanford Medical Center-Fargo Fargo, North Dakota  58122
Sanford USD Medical Center - Sioux Falls Sioux Falls, South Dakota  57117-5134
Sanford Clinic North-Bemidgi Bemidji, Minnesota  56601
Sanford Bismarck Medical Center Bismarck, North Dakota  58501
Aurora Cancer Care-Milwaukee West Wauwatosa, Wisconsin  53226
Christiana Care Health System-Christiana Hospital Newark, Delaware  19718
Cleveland Clinic Cancer Center/Fairview Hospital Cleveland, Ohio  44111
PeaceHealth Southwest Medical Center Vancouver, Washington  98664
Cleveland Clinic Cancer Center-Strongsville Strongsville, Ohio  44136
Cancer Care Associates-Norman Norman, Oklahoma  73071
Providence Willamette Falls Medical Center Oregon City, Oregon  97045