Mitoxantrone Hydrochloride Liposome, Standard-dose of Cytarabine and Venetoclax in the Treatment of R/R AML

Trial Title: Mitoxantrone Hydrochloride Liposome, Standard-dose of Cytarabine and Venetoclax in the Treatment of R/R AML

NCT ID: NCT06621212

Condition: Relapsed/Refractory Acute Myeloid Leukaemia
Myeloid Malignancy

Conditions: Official terms:
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Cytarabine
Venetoclax
Mitoxantrone

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: mitoxantrone hydrochloride liposome
Description: Mitoxantrone hydrochloride liposome (30 mg/m^2) on day 1, every 4 weeks
Arm group label: MAV regimen

Intervention type: Drug
Intervention name: Cytarabine
Description: Cytarabine (100 mg/m^2 ) on day 1-7, every 4 weeks
Arm group label: MAV regimen

Intervention type: Drug
Intervention name: Venetoclax
Description: Venetoclax 100 mg on day 2，200 mg on day 3，400 mg on day 4-10, every 4 weeks
Arm group label: MAV regimen

Summary: The purpose of this prospective, single-center, single-arm, exploratory study is to evaluate the efficacy and safety of a combination regimen of mitoxantrone hydrochloride liposome injection, standard-dose of cytarabine and venetoclax (MAV) in the treatment of relapsed or refractory (R/R) AML. The study plan to enroll 20 R/R AML patients who are expected to receive laboratory tests of bone marrow and blood specimens at regular times after MAV treatment.

Detailed description: For patients with R/R AML, there is currently no established standard treatment. Previous research suggests that mitoxantrone could against venetoclax-resistant leukemia stem cells (LSCs) by modulating mitochondrial calcium levels. Based on the potentially synergistic killing effect of mitoxantrone and venetoclax, a phase 2 study is underway in R/R AML. Patients receive mitoxantrone hydrochloride liposome, moderate-dose of cytarabine (1.0 g/m^2, IV, q12h, d1, 3, 5) and venetoclax (MAV) when they were enrolled. Here we also conduct an exploratory study of MAV regimen with standard-dose of cytarabine in relapsed or refractory (R/R) AML, aiming to evaluate the efficacy and safety of MAV regimen. All participants will receive MAV treatment including 30 mg/m^2 mitoxantrone hydrochloride liposome on day 1, 100 mg/m^2 cytarabine on day 1-7 and 400 mg venetoclax on day 2-10 with a dose escalation on day 2-4. Each cycle consists of 4 weeks. A maximum of 2 cycles of therapy are planned.

Criteria for eligibility:
Criteria:
Inclusion Criteria: 1. Each subject must sign an informed consent form (ICF) indicating that he or she understands the purpose of and procedures required for the study and are willing to participate in the study. 2. Age ≥18 3. Clinically diagnosed relapsed/refractory AML, excluding acute promyelocytic leukemia. 1. Patients who failed after at least 1 courses of induced treatment. 2. Bone marrow blasts≥5% after CR/CRi, or reappearance of blasts in the blood in at least 2 peripheral blood samples at least one week apart, or leukemia cell infiltration appeared in extramedullary. 3. Conversion from MRD negativity to MRD positivity after CR/CRi. 4. Physical status score of Eastern Oncology Collaboration Group (ECOG) 2-3 for patients whose age ≤65, or 0-2 for patients whose age >65. 5. Life expectancy > 3 months. 6. AST/ALT≤2.5 ULN (for subjects with hepatic infiltration≤5 ULN); Total bilirubin≤1.5 ULN (for subjects with hepatic infiltration≤3 ULN); Serum creatinine≤1.5 ULN. Exclusion Criteria: 1. Previous anti-tumor therapy meets one of the following criteria: 1. Prior therapy with mitoxantrone or mitoxantrone liposome; 2. Prior therapy with doxorubicin or anthracyclines, and the cumulative dose of doxorubicin > 360 mg/m^2 (1 mg doxorubicin was equivalent to 2 mg daunorubicin or 0.5 mg idarubicin); 3. Have received other anti-tumor therapy (including chemotherapy, targeted therapy, hormone therapy, Chinese medicines with anti-tumor activity, except those that do not affect the efficacy of the study as determined by the investigator) or participated in other clinical trials and received clinical trial drugs within 4 weeks or 5 half-lives of the drug before the study; 2. Subjects who received strong or moderate CYP3A inducers/inhibitors or P-glycoprotein (P-gp) inhibitors within 7 days before starting study treatment; 3. Subjects who are unable to take oral medications or have malabsorption syndrome; 4. Cardiovascular diseases, including but not limited to: 1. QTc interval >480 ms or long QTc syndrome in screening; 2. Complete left bundle branch block, 2 or 3 grade atrioventricular block; 3. Requiring treatment of serious and uncontrolled arrhythmia; 4. New York Heart Association NYHA≥2; 5. Cardiac ejection fraction (EF) was less than 50%; 6. Myocardial infarction, unstable angina pectoris, severe unstable ventricular arrhythmia or any other history of arrhythmia or clinically serious pericardial disease that requires treatment within the first 6 months of enrollment, or electrocardiographic evidence of acute ischemic or active conduction system abnormalities. 5. Central nervous system leukemia; 6. Previous or current occurrence of other malignancies (in addition to non-melanoma basal cell carcinoma of the skin that is effectively controlled, breast/cervical carcinoma in situ, and other malignancies that have been effectively controlled without treatment within the past five years). 7. Subjects are suffering from any other uncontrollable disease (including but not limited to: uncontrolled diabetes and hypertension, and advanced infection); 8. HIV infection. 9. HBsAg or HBcAb positive, with HBV-DNA≥1x103 copies/mL; or HCV-RNA≥1x103 copies/mL; 10. A history of immediate or delayed allergy to similar drug and excipients of the investigate drug. 11. Pregnant, lactating female or subjects who refuse to use effective contraception during the study. 12. With a history of severe neurological or psychiatric illness. 13. Not suitable for this study as decided by the investigator.

Gender: All

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: The First Affiliated Hospital, Zhejiang University School of Medicine

Address:
City: Hangzhou
Zip: 310003
Country: China

Status: Recruiting

Contact:
Last name: Jie Jin

Phone: +86 571-87236896
Email: jiej0503@163.com

Investigator:
Last name: Jie Jin, M.D.
Email: Principal Investigator

Investigator:
Last name: Huafeng Wang, M.D.
Email: Sub-Investigator

Start date: July 5, 2024

Completion date: December 31, 2026

Lead sponsor:
Agency: First Affiliated Hospital of Zhejiang University
Agency class: Other

Collaborator:
Agency: CSPC Zhongnuo Pharmaceutical (Shijiazhuang) Co., Ltd.
Agency class: Industry

Source: First Affiliated Hospital of Zhejiang University

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT06621212