Trial Title:
Clinical Trial Protocol for the Combined Use of VAG in the Treatment of ND-AML
NCT ID:
NCT06536010
Condition:
Acute Myeloid Leukemia
Conditions: Official terms:
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Venetoclax
Study type:
Interventional
Study phase:
N/A
Overall status:
Recruiting
Study design:
Allocation:
N/A
Intervention model:
Single Group Assignment
Primary purpose:
Treatment
Masking:
None (Open Label)
Intervention:
Intervention type:
Drug
Intervention name:
Venetoclax 100 mg d1，200 mg d2，400 mg d3-28；
Description:
VAG in the induction phase of the ND-AML treatment protocol
Arm group label:
VAG regimen in the treatment of newly diagnosed acute myeloid leukemia (AML)
Other name:
AZA 75mg/m2 on days 1-7
Other name:
G-CSF: 50-600ug/day, starting on day 1 (adjusted based on WBC count of 10-25*10E9/L)
Summary:
This is a clinical efficacy study evaluating the VAG regimen in the treatment of newly
diagnosed acute myeloid leukemia (AML).
The main objectives of the study are to assess the efficacy and safety of the VAG regimen
and to explore the synergistic mechanisms of VAG in combating AML.
Detailed description:
This study is a single-arm, prospective, single-center phase IIb clinical efficacy study
evaluating the therapeutic effects of azacitidine and venetoclax in combination with
granulocyte colony-stimulating factor for the treatment of newly diagnosed acute myeloid
leukemia (AML).
Acute myeloid leukemia (AML) is a malignant disease originating from myeloid
hematopoietic stem/progenitor cells. It is highly aggressive, and patients have a very
low survival rate. The 5-year survival rate for diagnosed AML patients is approximately
29%, with only 5-15% for patients aged 60 and above. Currently, the 3+7 regimen is the
first-line induction chemotherapy for newly diagnosed AML patients, with about 60-80% of
young patients (<60 years old) and 40-60% of elderly patients (≥60 years old) achieving
complete remission (CR). However, among AML patients receiving the 3+7 regimen, those
with poor physical condition or high-risk cytogenetics have a worse prognosis. Therefore,
there is a need to explore new treatment regimens that are less intensive but still
effective.
Venetoclax is an oral selective Bcl-2 inhibitor. Multiple studies and clinical trials
have demonstrated that Venetoclax, in combination with demethylating agents or low-dose
cytarabine (LDAC), has synergistic anti-tumor effects and achieves higher treatment
response and disease-free survival rates in AML patients. The results of the VIALE-A
study showed that the median overall survival (OS) time with Venetoclax plus Azacitidine
(AZA) was 14.7 months compared to 9.6 months with Azacitidine alone (P<0.001). The median
duration of remission was 17.5 months with Venetoclax plus Azacitidine compared to 13.4
months with Azacitidine alone, and the CR+CRi rates were 66.4% and 28.3%, respectively
(P<0.001). This combination significantly improves the overall survival of AML patients,
with high response rates and good safety profile. In October 2020, the U.S. Food and Drug
Administration approved the use of Venetoclax in combination with Azacitidine,
Decitabine, or LDAC for the treatment of newly diagnosed AML patients aged 75 years or
older or those who are unfit for intensive induction chemotherapy due to comorbidities.
The Venetoclax plus Azacitidine regimen was also included in the AML NCCN guidelines in
2020. However, while Venetoclax in combination with demethylating agents is recommended
for the treatment of elderly AML patients, there is currently a lack of research data for
its use in young AML patients. The results of a phase II clinical trial presented at the
2022 ASH Annual Meeting, evaluating Venetoclax plus hypomethylating agents in young
adults with newly diagnosed AML and adverse ELN risk, showed a complete remission with
incomplete hematologic recovery (CRc) rate of 78% after one cycle of treatment, with a
minimal residual disease (MRD) negativity rate of 77%. After two cycles of treatment, the
CRc rate was 91.9% with an MRD negativity rate of 82.3%. The CRc rates for favorable,
intermediate, and adverse risk groups were 69.6%, 75.4%, and 61.3%, respectively.
Although the combination of Venetoclax and demethylating agents has shown promising
efficacy, there are still limitations such as adverse events including thrombocytopenia
(46%), nausea (44%), constipation (43%), neutropenia (42%), febrile neutropenia (42%),
diarrhea (41%), and tumor lysis syndrome (TLS), as well as suboptimal achievement of MRD
negativity and depth of remission after induction therapy.
Granulocyte colony-stimulating factor (G-CSF) is expressed by almost all AML cells and
binds to its receptor, G-CSFR. In pre-activation regimens, G-CSF induces tumor cells in
the quiescent phase (G0/G1) to enter the proliferative phase (S phase), enhancing the
cytotoxic effect of chemotherapy drugs on tumor cells, improving the efficacy of
chemotherapy, and reducing adverse reactions. A study conducted by Tang Xiaowen's team at
the First Affiliated Hospital of Soochow University on the efficacy and safety of
decitabine (DAC) combined with HAAG in the treatment of newly diagnosed acute myeloid
leukemia showed that after one cycle of DAC+HAAG induction therapy in 50 patients, 48
patients (96%) achieved complete remission (CR)/CR with incomplete blood count recovery
(CRp)/CR with incomplete count recovery and incomplete marrow recovery (CRi), and 2
patients (4%) achieved partial remission (PR). The median time to recovery of white blood
cell count, platelet count, and hemoglobin was 17.5 days, 19.0 days, and 20.0 days,
respectively. Only 16% (8/50) and 6% (3/50) of patients experienced grade 3-4 infections
and bleeding, while non-hematologic toxicities were mainly grade 1-2 and resolved after
symptomatic treatment.
The combination of venetoclax and hypomethylating agents is the most common approach,
which synergistically induces cell apoptosis and reduces MCL-1 levels, thereby overcoming
resistance to BCL-2 inhibitors. Additionally, the combination interferes with the energy
metabolism of leukemia cells and targets leukemia stem cells. However, there is currently
no research on the combination of azacitidine, venetoclax, and G-CSF. The investigators
has conducted a preliminary clinical study on the VAG regimen (azacitidine, venetoclax,
and granulocyte colony-stimulating factor) for newly diagnosed AML, which has shown
promising results. We plan to expand the sample size and further investigate its
mechanism of tumor cell killing.
Criteria for eligibility:
Criteria:
Inclusion Criteria:
- Age between 18 and 75 years, regardless of gender.
- Diagnosis of AML (excluding APL) according to the 2022 World Health Organization
(WHO) diagnostic criteria.
- ECOG performance status of 0-2.
- For female participants of childbearing potential or male participants with female
partners of childbearing potential, effective contraceptive measures must be taken
throughout the entire treatment period and for 6 months after the treatment period.
- Expected survival of at least 3 months.
- Ability to understand and willingness to participate in the study, and signing an
informed consent form.
Exclusion Criteria:
- Acute promyelocytic leukemia (M3 subtype).
- Central nervous system leukemia.
- Severe uncontrolled infection or other major diseases.
- Heart failure: Ejection fraction (EF) < 50%, New York Heart Association (NYHA) class
II or above.
- Impaired liver or kidney function: Serum total bilirubin ≥ 2.0 mg/dl, AST ≥ 3 times
the upper limit of normal, serum creatinine clearance rate (Ccr) ≥ 50 ml/min,
arterial oxygen saturation (SpO2) < 92%.
- Human immunodeficiency virus (HIV) positive.
- Active hepatitis B or C.
- Pregnant or lactating women.
- Other conditions in which the investigator deems the participant unsuitable for the
study.
Gender:
All
Minimum age:
18 Years
Maximum age:
75 Years
Healthy volunteers:
No
Locations:
Facility:
Name:
Huai'an Second People's Hospital
Address:
City:
Huai'an
Zip:
210000
Country:
China
Status:
Recruiting
Contact:
Last name:
Xiaotian Yang
Phone:
15695110492
Email:
15695110492@163.com
Start date:
November 3, 2021
Completion date:
July 31, 2028
Lead sponsor:
Agency:
Yang Xiaotian
Agency class:
Other
Source:
The Second People's Hospital of Huai'an
Record processing date:
ClinicalTrials.gov processed this data on November 12, 2024
Source: ClinicalTrials.gov page:
https://clinicaltrials.gov/ct2/show/NCT06536010
