CLINICAL TRIAL / NCT04315324
Study to Test AKR1C3-Activated Prodrug OBI-3424 (OBI-3424) in Patients With Relapsed/Refractory T-Cell Acute Lymphoblastic Leukemia (T-ALL)
- Interventional
- Recruiting
- NCT04315324
Contact Information
A Phase II Study of AKR1C3-Activated Prodrug OBI-3424 (OBI-3424) in Patients With Relapsed/Refractory T-Cell Acute Lymphoblastic Leukemia (T-ALL)
This phase II trial studies how well OBI-3424 works in treating patients with T-cell acute lymphoblastic leukemia that has come back (relapsed) or does not response to treatment (refractory). Drugs used in chemotherapy, such as OBI-3424, 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. OBI-3424 may reduce the amount of leukemia in the body.
PRIMARY OBJECTIVE:
I. To assess the response rate (complete remission [CR] or CR with incomplete count
recovery [CRi]) of AKR1C3-activated prodrug OBI-3424 (OBI-3424) in patients with
relapsed/refractory T-cell acute lymphoblastic leukemia (T-ALL).
SECONDARY OBJECTIVES:
I. To estimate the frequency and severity of toxicities of OBI-3424 in this patient
population.
II. To estimate event-free survival (EFS), relapse-free survival (RFS) and overall
survival (OS) in this patient population.
TRANSLATIONAL MEDICINE OBJECTIVES:
I. To estimate minimal/measurable residual disease (MRD) negativity (among patients who
achieve CR or CRi).
II. To assess AKR1C3 expression levels in this patient population. III. c. To evaluate
associations between AKR1C3 expression and response to OBI-3423, achievement of
MRD-negative remission, and relapse from remission.
IV. To bank specimens for future research.
OUTLINE:
Patients receive AKR1C3-activated prodrug OBI-3424 intravenously (IV) over 30 minutes on
days 1 and 8. Treatment repeats every 21 days for up to 17 cycles in the absence of
disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every month for 1 year,
every 2 months for 1 year, every 3 months for 1 year, and then every 6 months for up to 5
years from registration.
Gender
All
Age Group
18 Years and up
Accepting Healthy Volunteers
No
Inclusion Criteria:
- Patients must have a diagnosis of relapsed or refractory T-cell acute lymphoblastic
leukemia (T-ALL) based on World Health Organization (WHO) classification. Note that
patients who were diagnosed initially with lymphoblastic lymphoma but who have
relapsed with T-ALL are eligible
- Patients must have evidence of acute leukemia in their peripheral blood or bone
marrow. Patients must have >= 5% lymphoblasts in the peripheral blood or bone marrow
within 14 days prior to registration. Patients with only extramedullary disease are
not eligible
- Patients must be refractory to or have relapsed following a standard induction
chemotherapy. A standard chemotherapy induction regimen is defined as any program of
treatment that includes:
- Vincristine and prednisone
- Vincristine and dexamethasone
- Cytarabine and anthracycline, or
- High dose cytarabine (defined as at least 1 gr/m2 per individual dose unless
adjustments were required for renal/liver function)
- Patients must have no evidence of central nervous system disease within 28 days
prior to registration based on CSF studies. Patients with clinical signs or symptoms
consistent with central nervous system (CNS) involvement must have a lumbar puncture
which is negative for CNS involvement; the lumbar puncture must be completed within
28 days prior to registration. Note that the patients may receive intrathecal
chemotherapy with the initial lumbar puncture
- Prior nelarabine therapy is not required. In addition, patients who receive
nelarabine during initial induction or post-remission treatment are eligible only if
the physician does not feel they would benefit from other, multi-agent chemotherapy
- Patients must be >= 18 years of age
- Patients must have a Zubrod performance status of 0-3
- Patients must have creatinine clearance > 30 mL/min within 14 days prior to
registration according to the Cockcroft Gault equation
- Patients must have direct bilirubin =< 1.5 x institutional upper limit of normal
(ULN) within 14 days prior to registration
- Patients must have aspartate aminotransferase (AST) and alanine aminotransferase
(ALT) =< 3.0 x institutional upper limit of normal (ULN) or =< 5.0 x ULN (if thought
to be related to leukemic involvement) within 14 days prior to registration
- Prothrombin time (PT)/partial thromboplastin time (PTT)/fibrinogen (as clinically
indicated) (within 14 days prior to registration to obtain baseline measurements)
- From comprehensive metabolic panel: sodium, potassium, chloride, carbon dioxide
(CO2), and blood urea nitrogen (BUN) (within 14 days prior to registration to obtain
baseline measurements)
- Patients with known human immunodeficiency virus (HIV)-infection are eligible
providing they are on effective anti-retroviral therapy and have undetectable viral
load at their most recent viral load test within 6 months prior to registration.
(HIV viral load testing is required only for patients with known HIV infection)
- Patients with evidence of chronic hepatitis B virus (HBV) infection may be eligible
provided that they have an undetectable HBV viral load within 28 days prior to
registration. Patients may be currently receiving HBV treatment. (HBV viral load
testing is required only for patients with known HBV infection)
- Patients with known history of hepatitis C virus (HCV) infection may be eligible
provided that they have an undetectable HCV viral load within in 28 days prior to
registration. Patients may be currently receiving treatment. (HCV viral load testing
is required only for patients with known HCV infection)
- Patients must agree to have bone marrow and blood specimens submitted for MRD
testing
- Patients must be offered the opportunity to participate in specimen banking. With
patient consent, residuals from specimens submitted will be retained and banked for
future research
- 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 Oncology Patient Enrollment Network (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
Exclusion Criteria:
- Patients must not have had chemotherapy or investigational agents within 14 days
prior to registration except for steroids, oral 6-mercaptopurine, oral methotrexate,
vincristine, intrathecal chemotherapy, or hydroxyurea. For participants who have
received radiation therapy, at least 7 days must have elapsed from the end of
radiation prior to registration and participants must not currently be experiencing
toxicities from radiation therapy.
- Patients must not have undergone allogeneic hematopoietic transplant within 90 days
prior to registration
- Patients must have no evidence of >= grade 2 acute graft versus host disease (GVHD)
or moderate or severe limited chronic GVHD and must have no history of extensive
GVHD of any severity within 90 days prior to registration. Extensive GVHD is defined
as 1) generalized skin involvement or 2) localized skin involvement and/or hepatic
dysfunction plus liver histology or cirrhosis or involvement of eye or minor
salivary organ or oral mucosa or any other target organ
- Patients must not have systemic fungal, bacterial, viral or other infection that is
not controlled (defined as exhibiting ongoing signs/symptoms related to the
infection and without improvement, despite appropriate antibiotics or other
treatment) within 14 days prior to registration
- Patients must not be pregnant or nursing due to the teratogenic potential of the
drug used on this study. Females of reproductive potential must have a negative
serum pregnancy test within 14 days prior to registration. Women/men of reproductive
potential must have agreed to use an effective contraceptive method during and up to
6 months after treatment. A woman is considered to be of "reproductive potential" if
she has had menses at any time in the preceding 12 consecutive months. In addition
to routine contraceptive methods, "effective contraception" also includes
heterosexual celibacy and surgery intended to prevent pregnancy (or with a
side-effect of pregnancy prevention) defined as a hysterectomy, bilateral
oophorectomy or bilateral tubal ligation. However, if at any point a previously
celibate patient chooses to become heterosexually active during the time period for
use of contraceptive measures outlined in the protocol, he/she is responsible for
beginning contraceptive measures
- Patients must not have other active malignancies for which they have received
treatments within 6 months prior to registration excluding localized malignancies
that do not require systemic treatment.