Vyxeos for Re-induction Treatment of Acute Myeloid Leukemia Patients With Persistent Disease After Induction
Open-Label Phase 2 Trial of Vyxeos in Patients With Intermediate and High-Risk Acute Myeloid Leukemia Who Have Failed an Initial Cycle of Standard Cytarabine and Daunorubicin Chemotherapy
Who can join
As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.
- Age
- 18 Years to 75 Years
- Sex
- All sexes
- Healthy volunteers
- Not accepted
- Compensation
- Not stated
Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.
What to expect
No one can promise a trial will help you personally — that is what the research is trying to find out.
What participation involves
- Time periods mentioned: 60 days, 2 years
Only what the study's summary and detailed description on ClinicalTrials.gov say. Time periods may describe the whole study or a part of it — ask the study team what applies to you.
Show the study's own words
- "After completion of study treatment, patients are followed up weekly for 60 days, then at least monthly for 2 years."
- Compensation
- Not stated
- Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
- Participants are monitored closely by the research team throughout the study.
- Some participants may receive access to an investigational treatment, which is still being studied.
- Your participation helps researchers learn whether this approach could help future patients.
About this study
In plain language
This study tests the side effects of Vyxeos and how well it works for acute myeloid leukemia (AML), a blood cancer. It is for people with medium- or high-risk AML that remains after the first round of standard chemotherapy. Vyxeos combines two chemotherapy drugs inside tiny fat bubbles.
This phase II trial studies the side effects and how well Vyxeos works in treating patients with intermediate and high-risk acute myeloid leukemia who have failed an initial cycle of standard cytarabine and daunorubicin chemotherapy. Vyxeos is a combination of both chemotherapy drugs cytarabine and daunorubicin contained in a liposome. Drugs used in chemotherapy, such as cytarabine and daunorubicin, 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. Cytarabine and daunorubicin given together in liposomes may have fewer side effects and work better than cytarabine and daunorubicin given alone in patients with acute myeloid leukemia.
Compensation is read from the study's own description and may be missing — always confirm with the study team.
Eligibility
Who can join
- You must have AML and be able to give written consent to join.
- You must have received standard “7+3” chemotherapy 14–33 days before study treatment. Bone marrow tests must show that leukemia remains, as confirmed by your doctor.
- Your doctor must believe you need more treatment to clear the leukemia and can handle strong chemotherapy.
- You must be able to care for yourself and be out of bed or a chair for at least half of your waking hours.
- Your heart must pump normally, with an ejection fraction of at least 50%. Your lifetime daunorubicin dose must be below 462 mg/m², or the matching limit for similar drugs.
- Your liver and kidney blood tests must meet the study’s limits.
- If you can become pregnant, you must have a negative pregnancy test and use two forms of birth control from screening until 6 months after your last dose.
- If you are a man with a partner who can become pregnant, you must avoid sex that could cause pregnancy or have your partner use two forms of birth control during that same period. You must also avoid sperm donation.
Who can't join
- You cannot join if you have certain AML types or gene changes: acute promyelocytic leukemia, core binding factor AML, or changes that turn off TP53 or show loss of p53 activity.
- You cannot join if you have had a serious allergic reaction to the study drugs or their ingredients, or have Wilson’s disease or another illness that causes problems handling copper.
- You cannot join if your lifetime dose of daunorubicin is above 462 mg/m², or above the matching limit for similar drugs.
- You cannot join if you are pregnant or cannot follow the birth control rules. Avoid breastfeeding for at least 14 days after the last dose.
- An uncontrolled infection must be treated and brought under control before you join.
- You cannot join too soon after an experimental drug or before its side effects have eased enough. The wait depends on how long the drug stays in your body; if unknown, wait 4 weeks.
- You cannot join if serious illness, heart problems, mental health concerns, abnormal tests, or personal circumstances make treatment unsafe or prevent consent or study follow-up. A heart attack within the past 6 months also rules you out.
- You cannot join if another cancer needs active treatment, except minor surgery for non-melanoma skin cancer or hormone-related treatment.
Simplified for readability. The official criteria below are what the study team uses.
Official eligibility criteria
Inclusion Criteria: * Subject must be able to provide written informed consent * Patients must have a diagnosis of acute myeloid leukemia * Patients must have received standard induction chemotherapy (cytarabine 100-200mg/m2 by continuous infusion on days 1-7 and either daunorubicin 45-90mg/m2 or idarubicin 10-12mg/ m2 daily for 3 days during days 1-7) within the 14-33 days prior to starting trial treatment and have documented persistent disease (13-29 days from the start of 7+3 treatment). Patients who have received a 7+3 regimen utilizing gemtuzumab ozogamicin may enroll. Patients who received lower doses of the above agents due to appropriate adjustments for reduced renal or hepatic clearance may also enroll. Persistent disease will be defined as bone marrow cellularity of \>10-20% and bone marrow blast percentage of \>5-10% or clear evidence of immunophenotypically aberrant leukemia cells in the bone marrow. The final determination of persistent AML will be made by the treating physician, but must meet NCCN criteria for persistent disease1. Enrollment of patients with less than 20% cellularity or less than 10% blasts will require approval of the principal investigator. Patients who received concomitant treatment with another targeted therapy for AML that is FDA-approved for administration with 7+3 (e.g. midostaurin) may enroll and can continue to receive this treatment (according to the FDA-approved 7+3 re-induction dosing schedule) during Vyxeos treatment. * Patients must be deemed by the treating physician to be unlikely to achieve complete response (CR) without further therapy * Patients must be deemed by the treating physician to be able to tolerate intensive chemotherapy (similar to 7+3 chemotherapy) * Normal left ventricular ejection fraction (\>= 50% by echocardiography or multi-gated acquisition radionuclide angiocardiography \[MUGA\]) and lifetime daunorubicin dose of less than 462mg/m\^2 (including recent course of 7+3), or equivalent doses of another anthracycline medications. (This is 550mg/m\^2 \[maximum lifetime dose\] minus 88mg/m\^2 \[planned dose of Vyxeos on study\].) * Eastern Cooperative Oncology Group (ECOG) functional status of 0, 1, or 2 * Aspartate aminotransferase (AST) \< 5 x upper limit of normal (ULN) for the local laboratory * Alanine aminotransferase (ALT) \< 5 x ULN for the local laboratory * Total bilirubin \< 1.5 x ULN (except for patients with known Gilbert?s syndrome) for the local laboratory * Calculated creatinine clearance (according to the Cockcroft-Gault equation) \> 40 mL/min OR serum creatinine \< 1.5 x the ULN for the local laboratory * Female patients of childbearing potential must agree to use two forms of contraception from screening visit until 6 months following the last dose of study treatment. Female patients must have a documented negative pregnancy test * Male patients of childbearing potential having intercourse with females of childbearing potential must agree to abstain from heterosexual intercourse or have their partner use two forms of contraception from screening visit until 6 months after the last dose of study treatment. They must also refrain from sperm donation from screening visit until 6 months following the last dose of study treatment Exclusion Criteria: * Acute promyelocytic leukemia (or M3 AML) * Patients known to have core binding factor AML (defined as presence of t(8;21), inv(16), or other cytogenetically equivalent abnormalities) * Patients known to have inactivating mutations of TP53 or evidence of an absence of p53 protein activity as indicated by a monosomal karyotype. Monosomal karyotype will be defined as two or more monosomies (loss of an entire chromosome or the entire long arm of a chromosome \[such as 7q-\]) or a single monosomy in the setting of a complex karyotype. Patients with a complex karyotype without a monosomy are eligible to enroll * Patients that the treating physician does not feel are able to tolerate intensive chemotherapy * History of serious (\>= grade 3) hypersensitivity reaction to cytarabine, daunorubicin, or any component of the formulation * Known Wilson's disease or other symptomatic abnormality of copper metabolism (laboratory screening is not required in the absence of clinical or historical evidence of Wilson's disease or other problems of copper metabolism) * Total lifetime daunorubicin dose of more than 462 mg/m\^2 (including recent course of 7+3) or equivalent total doses of other anthracycline medications. (This is 550mg/m\^2 maximum dose - 88mg/m\^2 planned dose of Vyxeos on study.) * Pregnancy or inability to use highly effective method of contraception for 6 months following last dose of Vyxeos. Potentially fertile patients must have documented negative serum pregnancy test. Breastfeeding should be avoided for at least 14 days after the last dose Vyxeos * Patients with uncontrolled infection shall not be enrolled until infection is treated and brought under control. As infection is a common feature of AML, patients with active infections are permitted to enroll provided that the infection is under control * Patients who have received an investigational agent (for any indication) within 5 half-lives of the agent and until toxicity from this has resolved to grade 1 or less; if the half-life of the agent is unknown, patients must wait 4 weeks prior to first dose of study treatment. An investigational agent is one for which there is no approved indication by the United States (US) Food and Drug Administration (FDA) * Patients with psychological, familial, social, or geographic factors that otherwise preclude them from giving informed consent, following the protocol, or potentially hamper compliance with study treatment and follow-up * Any other significant medical condition, including psychiatric illness or laboratory abnormality, that would preclude the patient participating in the trial or would confound the interpretation of the results of the trial * Patients with the following will be excluded: uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, serious cardiac arrhythmia, myocardial infarction within 6 months prior to enrollment, New York Heart Association (NYHA) class III or IV heart failure, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities * Other malignancy currently requiring active therapy (except minor surgery for non-melanoma skin cancer and for hormonal/anti-hormonal treatment, e.g. in prostate or breast cancer)
Study sites (2)
CA
- UC Davis Comprehensive Cancer Center · Sacramento, CA 95817More trials in Sacramento
OH
- Ohio State University Comprehensive Cancer Center · Columbus, OH 43210Gregory K. Behbehani, MD, PhD · Study contact · gregory.behbehani@osumc.eduAna Swatzell · Study contact · 614-685-9573 · adriana.swatzell@osumc.eduGregory K. Behbehani, MD, PhD · Principal investigatorMore trials in Columbus