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Comparing New Treatments for People With Newly Diagnosed Acute Myeloid Leukemia That Has an IDH2 Gene Change (A MyeloMATCH Treatment Trial)
NCT06672146 · National Cancer Institute (NCI)
In plain English
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Official title
A Randomized Phase II Trial of ASTX727 and Venetoclax Compared With ASTX727, Venetoclax, and Enasidenib for Newly Diagnosed Older Adults With IDH2 Mutant Acute Myeloid Leukemia: A MyeloMATCH Substudy
About this study
PRIMARY OBJECTIVES:
I. To evaluate the safety of decitabine and cedazuridine (ASTX727) + venetoclax + enasidenib (Arm 2) before initiating randomization.
II. To compare the rate of measurable residual disease (MRD) negative complete remission (CR) based on multiparameter flow cytometry (MFC) after two cycles of treatment in older adults (or unfit adults age 18 or older) with IDH2 mutated Acute Myeloid Leukemia (AML) who receive ASTX727, venetoclax, and enasidenib versus ASTX727 and venetoclax alone.
SECONDARY OBJECTIVES:
I. To estimate the composite remission rate (CR + complete remission with incomplete count recovery \[CRi\] + complete remission with partial hematologic recovery \[CRh\]), relapse-free survival (RFS), event-free survival (EFS), duration of response (DOR), and overall survival (OS) of participants by treatment arm.
II. To estimate IDH2 mutated variant allele frequency, flow cytometry MRD, and molecular MRD after two cycles of therapy in participants' bone marrow aspirates and blood by treatment arm.
III. To estimate remission rates (CR with and without MRD \[MFC and molecular MRD\], CRh and CRi), and to estimate the rates of hematologic improvement by treatment arm.
IV. To estimate the frequency and severity of adverse events by treatment arm. V. To evaluate the association between MFC and molecular MRD after two cycles of protocol treatment with the outcomes RFS and OS (landmarked by date of MRD measurement) by treatment arm.
BANKING OBJECTIVE:
I. To bank specimens for future correlative studies.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM 1: Patients receive ASTX727 orally (PO) once daily (QD) on days 1-5 and venetoclax PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM 2: Patients receive ASTX727 PO QD on days 1-5, venetoclax PO QD on days 1-28, and enasidenib PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
All patients undergo blood sample collection, bone marrow aspiration, and bone marrow biopsy throughout the trial.
After completion of study treatment, patients are followed up every month for the first year, every 2 months for the second year, every 3 months for the third year, and every 6 months until 5 years after registration or death.
Eligibility criteria
Inclusion Criteria:
* Participants must have been registered to the MYELOMATCH Master Screening and Reassessment Protocol prior to consenting to this study. Participants must have disease with a detectable IDH2 mutation based on central testing through the MYELOMATCH and be assigned to this clinical trial via MATCHBox prior to registration to this study
* Note: Pre-enrollment/diagnosis labs must have already been performed under MYELOMATCH
* Participants must have newly diagnosed, untreated acute myeloid leukemia (AML) defined by having ≥ 20% blasts in the bone marrow and/or peripheral blood, excluding acute promyelocytic leukemia (APL) with PML-RARA
* Participants must not be receiving or planning to receive any other investigational agents while on protocol therapy
* Participants must not have received prior therapy for AML or myelodysplastic syndrome (MDS) and/or myeloproliferative neoplasm (MPN) with the exception of hydroxyurea, all-trans retinoic acid (ATRA), colony-stimulating factors, erythropoiesis-stimulating agents, immunosuppressive therapy, intrathecal chemotherapy, a single dose of cytarabine for cytoreduction, and/or leukapheresis
* Participants must not be currently receiving any cytarabine-containing therapy other than up to 1 g/m\^2 of cytarabine, which is allowed for urgent cytoreduction. The use of prior hydroxyurea, all-trans retinoic acid (ATRA), BCR-ABL directed tyrosine kinase inhibitor, erythropoiesis-stimulating agent, thrombopoietin receptor agonist and lenalidomide are allowed. Participants may receive hydroxyurea prior to treatment assignment on this substudy for cytoreduction but must agree to discontinue hydroxyurea prior to beginning treatment on this substudy
* White blood cell (WBC) must be \< 25 x 10\^9/L. Hydroxyurea, leukapheresis, and cytarabine \< 1 g/m\^2 are permitted to control the WBC prior to enrollment and initiation of protocol-defined therapy but must be stopped prior to initiation of protocol therapy
* Participants must be ≥ 60 years old; OR must be ≥ 18 years old and considered not eligible for cytarabine-based induction therapy
* Participants must have Zubrod Performance Status of 0-3 as determined by a history and physical (H\&P) exam completed within 14 days prior to registration
* Participants must have a complete medical history and physical exam within 14 days prior to registration
* Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) unless history of Gilbert's syndrome. Participants with history of Gilbert's syndrome must have total bilirubin ≤ 3 x institutional ULN (within 14 days prior to registration)
* Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) ≤ 3 × institutional ULN, unless considered to be elevated due to disease involvement (within 14 days prior to registration)
* Participants must have adequate kidney function as evidenced by creatinine clearance ≥ 30mL/min (by Cockcroft Gault) within 14 days prior to registration
* Participants must not have a baseline corrected QT interval ≥ 480 msec using Fridericia correction (QTcF).
* NOTE: Since older participants are at risk for prolonged QTc and may require supportive care with agents that affect QTc, an electrocardiogram (ECG) is recommended if clinically indicated. If the QTc is prolonged, they should be treated on MYELOMATCH TAP instead of MM1OA-S03
* Participants must have adequate cardiac function in the assessment of their treating physician. Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, participants must be class 2 or better
* Participants with known human immunodeficiency virus (HIV)-infection must be on effective anti-retroviral therapy at registration and have undetectable viral load test on the most recent test results obtained within 6 months prior to registration
* Participants with a known history of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load while on suppressive therapy on the most recent test results obtained within 6 months prior to registration, if indicated
* Participants with a known history of hepatitis C virus (HCV) infection must have been treated and cured. Participants currently being treated for HCV infection must have undetectable HCV viral load test on the most recent test results obtained within 6 months prior to registration, if indicated
* Participants must not have a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) has the potential to interfere with the safety or efficacy assessment of the investigational regimen
* Participants must not be pregnant or nursing (nursing includes breast milk fed to an infant by any means, including from the breast, milk expressed by hand, or pumped). Individuals who are of reproductive potential must have agreed to use an effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen
* Participants must be able to swallow and retain oral medications and have no known gastrointestinal disorders likely to interfere with absorption of oral medications
* Participants must have agreed to have specimens submitted for translational medicine for MRD under MYELOMATCH and specimens must be submitted
* Enrollment to this treatment study requires prior enrollment into the myeloMATCH Master Protocol (MYELOMATCH). Participants enrolled in MYELOMATCH will submit bone marrow samples, peripheral blood samples, and buccal swabs to the Molecular Diagnostics Network (MDNet), the Clinical Laboratory Improvement Act (CLIA) laboratory network for myeloMATCH
* In addition to the MYELOMATCH specimens, there will be specimens obtained on treatment for this substudy. These specimens will be derived from procedures performed as part of standard assessments in the clinical care and management of AML with material being sent to the MDNet laboratories as specified. After performing the required tests on the specimens, the MDNet laboratories will send the residual material for biobanking and future research. Therefore, participants must be asked for their consent for the biobanking of specimens for future unspecified research. Participants may refuse this, but it is mandatory for sites to ask participants
* Participants must be offered the opportunity to participate in specimen banking
* NOTE: 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
* Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines. For participants with impaired decision-making capabilities, legally authorized representatives may sign and give informed consent on behalf of study participants in accordance with applicable federal, local, and Central Institutional Review Board (CIRB) regulations
Study design
Enrollment target: 93 participants
Allocation: randomized
Masking: none
Age groups: adult, older_adult
Timeline
Starts: 2025-05-16
Estimated completion: 2027-03-31
Last updated: 2026-04-17
Interventions
Procedure: Biospecimen CollectionProcedure: Bone Marrow AspirationProcedure: Bone Marrow BiopsyDrug: Decitabine and CedazuridineDrug: EnasidenibDrug: Venetoclax
Primary outcomes
- • Minimal residual disease negative (MRDneg) complete remission (CR) rate (Baseline to 5 years)
Sponsor
National Cancer Institute (NCI) · nih
Contacts & investigators
InvestigatorEric J Huselton · principal_investigator, SWOG Cancer Research Network
All locations (114)
Banner University Medical Center - TucsonRecruiting
Tucson, Arizona, United States
University of Arizona Cancer Center-North CampusRecruiting
Tucson, Arizona, United States
University of Arkansas for Medical SciencesRecruiting
Little Rock, Arkansas, United States
Alta Bates Summit Medical Center-Herrick CampusRecruiting
Berkeley, California, United States
Mills Health CenterRecruiting
San Mateo, California, United States
Miami Cancer InstituteRecruiting
Miami, Florida, United States
Augusta University Medical CenterRecruiting
Augusta, Georgia, United States
Saint Luke's Cancer Institute - BoiseRecruiting
Boise, Idaho, United States
Kootenai Health - Coeur d'AleneRecruiting
Coeur d'Alene, Idaho, United States
Saint Luke's Cancer Institute - FruitlandRecruiting
Fruitland, Idaho, United States
Saint Luke's Cancer Institute - MeridianRecruiting
Meridian, Idaho, United States
Saint Alphonsus Cancer Care Center-NampaRecruiting
Nampa, Idaho, United States
Saint Luke's Cancer Institute - NampaRecruiting
Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post FallsRecruiting
Post Falls, Idaho, United States
Kootenai Clinic Cancer Services - SandpointRecruiting
Sandpoint, Idaho, United States
Northwestern UniversityRecruiting
Chicago, Illinois, United States
University of Chicago Comprehensive Cancer CenterRecruiting
Chicago, Illinois, United States
Northwestern Medicine Cancer Center KishwaukeeRecruiting
DeKalb, Illinois, United States
NorthShore University HealthSystem-Evanston HospitalRecruiting
Evanston, Illinois, United States
Northwestern Medicine Cancer Center DelnorRecruiting
Geneva, Illinois, United States
NorthShore University HealthSystem-Glenbrook HospitalRecruiting
Glenview, Illinois, United States
Northwestern Medicine Glenview Outpatient CenterRecruiting
Glenview, Illinois, United States
Northwestern Medicine Grayslake Outpatient CenterRecruiting
Grayslake, Illinois, United States
NorthShore University HealthSystem-Highland Park HospitalRecruiting
Highland Park, Illinois, United States
Northwestern Medicine Lake Forest HospitalRecruiting
Lake Forest, Illinois, United States
Loyola University Medical CenterRecruiting
Maywood, Illinois, United States
UC Comprehensive Cancer Center at Silver CrossRecruiting
New Lenox, Illinois, United States
Northwestern Medicine Orland ParkRecruiting
Orland Park, Illinois, United States
University of Chicago Medicine-Orland ParkRecruiting
Orland Park, Illinois, United States
Northwestern Medicine Cancer Center WarrenvilleRecruiting
Warrenville, Illinois, United States
UChicago Medicine Northwest IndianaRecruiting
Crown Point, Indiana, United States
The James Graham Brown Cancer Center at University of LouisvilleRecruiting
Louisville, Kentucky, United States
UofL Health Medical Center NortheastRecruiting
Louisville, Kentucky, United States
Our Lady of the Lake Physician GroupRecruiting
Baton Rouge, Louisiana, United States
Our Lady of The LakeRecruiting
Baton Rouge, Louisiana, United States
MaineHealth Cancer Care and IV Therapy - BrunswickRecruiting
Brunswick, Maine, United States
Mid Coast HospitalRecruiting
Brunswick, Maine, United States
MaineHealth Maine Medical Center - PortlandRecruiting
Portland, Maine, United States
MaineHealth Cancer Care and IV Therapy - South PortlandRecruiting
South Portland, Maine, United States
Tufts Medical CenterRecruiting
Boston, Massachusetts, United States
Trinity Health IHA Medical Group Hematology Oncology - BrightonRecruiting
Brighton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - CantonRecruiting
Canton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea HospitalRecruiting
Chelsea, Michigan, United States
Henry Ford Macomb Hospital-Clinton TownshipRecruiting
Clinton Township, Michigan, United States
Henry Ford HospitalRecruiting
Detroit, Michigan, United States
OSF Saint Francis Hospital and Medical GroupRecruiting
Escanaba, Michigan, United States
Cancer Hematology Centers - FlintRecruiting
Flint, Michigan, United States
Genesee Hematology Oncology PCSuspended
Flint, Michigan, United States
Genesys Hurley Cancer InstituteRecruiting
Flint, Michigan, United States
Allegiance HealthRecruiting
Jackson, Michigan, United States
Trinity Health Saint Mary Mercy Livonia HospitalRecruiting
Livonia, Michigan, United States
Henry Ford Medical Center-ColumbusRecruiting
Novi, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland HospitalRecruiting
Pontiac, Michigan, United States
Henry Ford West Bloomfield HospitalRecruiting
West Bloomfield, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor CampusRecruiting
Ypsilanti, Michigan, United States
Essentia Health - Deer River ClinicRecruiting
Deer River, Minnesota, United States
Essentia Health Cancer CenterRecruiting
Duluth, Minnesota, United States
Fairview Southdale HospitalRecruiting
Edina, Minnesota, United States
Essentia Health Hibbing ClinicRecruiting
Hibbing, Minnesota, United States
Park Nicollet Clinic - Saint Louis ParkRecruiting
Saint Louis Park, Minnesota, United States
Regions HospitalRecruiting
Saint Paul, Minnesota, United States
United HospitalRecruiting
Saint Paul, Minnesota, United States
Essentia Health SandstoneRecruiting
Sandstone, Minnesota, United States
Essentia Health Virginia ClinicRecruiting
Virginia, Minnesota, United States
Community Hospital of AnacondaRecruiting
Anaconda, Montana, United States
Billings Clinic Cancer CenterRecruiting
Billings, Montana, United States
Bozeman Health Deaconess HospitalRecruiting
Bozeman, Montana, United States
Benefis Sletten Cancer InstituteRecruiting
Great Falls, Montana, United States
Logan Health Medical CenterRecruiting
Kalispell, Montana, United States
Community Medical CenterRecruiting
Missoula, Montana, United States
Saint Barnabas Medical CenterRecruiting
Livingston, New Jersey, United States
Monmouth Medical CenterRecruiting
Long Branch, New Jersey, United States
Rutgers Cancer Institute of New JerseyRecruiting
New Brunswick, New Jersey, United States
Community Medical CenterRecruiting
Toms River, New Jersey, United States
University of New Mexico Cancer CenterRecruiting
Albuquerque, New Mexico, United States
Roswell Park Cancer InstituteRecruiting
Buffalo, New York, United States
University of RochesterRecruiting
Rochester, New York, United States
Carolinas Medical Center/Levine Cancer InstituteRecruiting
Charlotte, North Carolina, United States
Duke University Medical CenterRecruiting
Durham, North Carolina, United States
East Carolina UniversityRecruiting
Greenville, North Carolina, United States
Wake Forest University Health SciencesRecruiting
Winston-Salem, North Carolina, United States
University of Oklahoma Health Sciences CenterRecruiting
Oklahoma City, Oklahoma, United States
Oregon Health and Science UniversityRecruiting
Portland, Oregon, United States
Geisinger Medical CenterRecruiting
Danville, Pennsylvania, United States
Thomas Jefferson University HospitalRecruiting
Philadelphia, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)Recruiting
Pittsburgh, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer CenterRecruiting
Wilkes-Barre, Pennsylvania, United States
Rhode Island HospitalRecruiting
Providence, Rhode Island, United States
Prisma Health Cancer Institute - SpartanburgRecruiting
Boiling Springs, South Carolina, United States
Prisma Health Cancer Institute - EasleyRecruiting
Easley, South Carolina, United States
Prisma Health Cancer Institute - ButternutRecruiting
Greenville, South Carolina, United States
Prisma Health Cancer Institute - FarisRecruiting
Greenville, South Carolina, United States
Prisma Health Cancer Institute - EastsideRecruiting
Greenville, South Carolina, United States
Prisma Health Cancer Institute - GreerRecruiting
Greer, South Carolina, United States
Prisma Health Cancer Institute - SenecaRecruiting
Seneca, South Carolina, United States
Huntsman Cancer Institute/University of UtahRecruiting
Salt Lake City, Utah, United States
VCU Massey Comprehensive Cancer CenterRecruiting
Richmond, Virginia, United States
Swedish Cancer Institute-EdmondsRecruiting
Edmonds, Washington, United States
Swedish Cancer Institute-IssaquahRecruiting
Issaquah, Washington, United States
Swedish Medical Center-First HillRecruiting
Seattle, Washington, United States
Duluth Clinic AshlandRecruiting
Ashland, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green BayRecruiting
Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary'sRecruiting
Green Bay, Wisconsin, United States
Gundersen Lutheran Medical CenterRecruiting
La Crosse, Wisconsin, United States
William S Middleton VA Medical CenterRecruiting
Madison, Wisconsin, United States
Medical College of WisconsinRecruiting
Milwaukee, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Oconto FallsRecruiting
Oconto Falls, Wisconsin, United States
Saint Vincent Hospital Cancer Center at SheboyganRecruiting
Sheboygan, Wisconsin, United States
Sheboygan Physicians GroupRecruiting
Sheboygan, Wisconsin, United States
Marshfield Medical Center-River Region at Stevens PointRecruiting
Stevens Point, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Sturgeon BayRecruiting
Sturgeon Bay, Wisconsin, United States
Marshfield Medical Center - WestonRecruiting
Weston, Wisconsin, United States
Centro Comprensivo de Cancer de UPRRecruiting
San Juan, Puerto Rico
San Juan City HospitalRecruiting
San Juan, Puerto Rico