Overview
This phase I trial tests the safety, side effects, and best dose of palbociclib or tazemetostat in combination with CPX-351 in treating patients with acute myeloid leukemia (AML) that has come back (relapsed) or does not respond to treatment (refractory). CPX-351 is a combination of the chemotherapy drugs, daunorubicin and cytarabine, which is the standard of care for AML. Chemotherapy drugs 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. Palbociclib and tazemetostat are enzyme inhibitor drugs that are approved for treating certain cancers but not AML. These drugs may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving CPX-351 chemotherapy with enzyme inhibitors palbociclib or tazemetostat may kill more cancer cells.
Description
PRIMARY OBJECTIVE:
Part 1: To determine the maximum tolerated dose (MTD) of tazemetostat in combination with CPX-351 in patients with relapsed/refractory (R/R)-acute myeloid leukemia (AML).
Part 2: To determine the maximum tolerated dose (MTD) of palbociclib in combination with CPX-351 in patients with R/R-AML.
SECONDARY OBJECTIVE:
I. To evaluate the preliminary efficacy of tazemetostat in combination with CPX-351 (part 1) and of CPX-351 following pre-treatment with palbociclib (part 2).
EXPLORATORY OBJECTIVES:
I. To determine whether treatment with the EZH2 inhibitor tazemetostat de-condenses the H3K27me3-marked chromatin of AML blasts.
Il. To determine whether cell cycle re-entry of AML cells after palbociclib treatment influences DNA damage and apoptosis induced by combining EZH2 inhibition with anthracycline-based therapy.
OUTLINE: This is a dose-escalation study of tazemetostat or palbociclib in combination with fixed dose CPX-351. Patients are assigned to 1 of 2 parts.
PART I: Patients receive tazemetostat orally (PO) twice a day (BID) on days -1 to 6, and CPX-351 intravenously (IV) over 90 minutes on days 1, 3, and 5. Patients also undergo bone marrow aspiration and biopsy and blood sample collection during screening and on study.
PART II: Patients receive palbociclib PO daily (QD) on days -3 to -1, and CPX-351 IV over 90 minutes on days 1, 3, and 5. Patients also undergo bone marrow aspiration and biopsy and blood sample collection during screening and on study.
After completion of study treatment, patients are followed up at 3 months, 6 months, and 1 year for clinical outcomes including survival.
Eligibility
Inclusion Criteria:
- Provide signed and dated informed consent form
- Willing to comply with all study procedures and be available for the duration of the study
- Male or female >= 18 years of age
- Histologically confirmed acute myeloid leukemia (non-M3) relapsed from or refractory
to at least 1 prior line of therapy. Bone marrow aspirate and biopsy within 28 days of
screening is acceptable. If no prior bone marrow biopsy is available, bone marrow
biopsy must be performed during screening unless:
- If the subject has >= 20% myeloblasts present in the peripheral blood, a bone marrow biopsy is not necessary to meet this criterion
- Treatment with a prior investigational agent is acceptable so long as it has not been
administered within 2 weeks of enrollment and any prior adverse effects have resolved to grade 1 or less with the exception of alopecia
- Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less
- Life expectancy of at least 4 weeks
- Must be able to consume oral medication
- Subjects must have recovered from the toxic effect of any prior therapy to =< grade 1 (except alopecia)
- Creatine clearance (CrCL) >= 45
- Total bilirubin < 2 x upper limit of normal (ULN)
- Female subjects of childbearing age must have a negative pregnancy test
Exclusion Criteria:
- Subjects with acute promyelocytic leukemia
- Subjects receiving any active chemotherapy agents (except hydroxyurea). Intrathecal methotrexate and cytarabine are permissible
- Subjects whose participation would result in a total cumulative dose of daunorubicin greater than 550 mg/m^2 or greater than 450 mg/m^2 if they previously received mediastinal radiation
- Subjects with evidence of active central nervous system (CNS) leukemia involvement. Lumbar puncture is not required for enrollment in the absence of neurologic symptoms
- Subjects must not be receiving growth factors (except erythropoietin)
- Subjects with currently active second malignancy with the exception of nonmelanoma skin cancer, carcinoma in situ of the cervix, resected prostate cancer with Gleason score =< 6
- Subjects with unstable cardiac disease or uncontrolled arrhythmia
- Subjects with other severe concurrent disease which, in the judgement of the investigator, would make the patient inappropriate to receive high-intensity therapy
- Subjects who are pregnant or breastfeeding
- Subjects with known allergic reactions to components of the study product(s)
- Anything that would place the individual at increased risk or preclude the individual's full compliance with or completion of the study