Study of MLN4924 Plus Azacitidine in Treatment-naive Participants With Acute Myelogenous Leukemia (AML) Who Are 60 Years or Older

Not Recruiting

Trial ID: NCT01814826


The purpose of this study is to establish the maximum tolerated dose (MTD), and to assess the safety and tolerability of MLN4924 (pevonedistat) in combination with azacitidine in treatment naive participants with AML who were 60 years of age or older.

Official Title

A Phase 1b, Open-Label, Dose-Escalation Study of MLN4924 Plus Azacitidine in Treatment-Naïve Patients With Acute Myelogenous Leukemia Who Are 60 Years or Older


Inclusion Criteria:

   1. Participants with world health organization (WHO)-defined AML, 60 years of age or
   older, who are unlikely to benefit from standard induction therapy, defined as having
   at least 1 of the following:

      - Greater than or equal to 75 years of age.

      - Antecedent hematologic disease.

      - Known adverse cytogenetic risk.

      - Eastern Cooperative Oncology Group (ECOG) PS = 2.

      - Participant must not have received definitive treatment for AML, defined as any
      prior chemotherapy with antileukemic activity.

   2. ECOG PS 0 to 2.

   3. Expected survival longer than 3 months from enrollment in the study.

   4. Female participants who are post menopausal, surgically sterile, or agree to practice
   2 effective methods of contraception or agree to practice true abstinence.

   5. Male participants who agree to practice effective barrier contraception or agree to
   practice true abstinence.

   6. Voluntary written consent must be given before performance of any study-related

   7. Suitable venous access for the study-required blood sampling.

   8. Clinical laboratory values as specified below within 3 days before the first dose of
   any study drug:

   •Total bilirubin must be less than or equal to (<=) the upper limit of the normal
   range (ULN).

      - Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) must

      - Serum creatinine <=1.5*ULN.

      - Albumin greater than or equal to (>=) 27 grams per liter (g/L).

      - Hemoglobin >9 grams per deciliter (g/dL). Note: It was permissible to transfuse
      participants with red blood cells to achieve this criterion.

      - White blood cell (WBC) count less than (<) 50,000 per microliter (/mcL) before
      administration of pevonedistat on Days 1, 3, and 5 of Cycle 1.

   Note: Hydroxyurea could be used to control the level of circulating leukemic blast
   cell counts to no lower than 10,000/mcL while on pevonedistat.

   9. Able to undergo bone marrow aspiration and biopsy at screening.

Exclusion Criteria:

   1. Previous treatment with azacitidine or decitabine.

   2. Known favorable cytogenetic risk.

   3. Any serious medical or psychiatric illness.

   4. Treatment with any investigational products.

   5. Known hypersensitivity to azacitidine or mannitol.

   6. Acute promyelocytic leukemia as diagnosed by morphologic examination of bone marrow,
   by fluorescent in situ hybridization or cytogenetics of peripheral blood or bone
   marrow, or by other accepted analysis.

   7. Active uncontrolled infection or severe infectious disease.

   8. Major surgery within 14 days before the first dose of study drug.

   9. Life-threatening illness unrelated to cancer.

10. Clinically uncontrolled central nervous system (CNS) involvement.

11. WBC count greater than (>) 50,000/ mcL.

12. Prothrombin time (PT) or activated partial thromboplastin time (aPTT) >1.5* ULN or a
   history of coagulopathy or bleeding disorder

13. Known human immunodeficiency virus (HIV) positive.

14. Known hepatitis B surface antigen-positive, or known or suspected active hepatitis C

15. Known hepatic cirrhosis or severe pre-existing hepatic impairment.

16. Known cardiac/cardiopulmonary disease defined as 1 of the following:

      - Uncontrolled high blood pressure (that is, systolic blood pressure >180
      milliliter per mercury (mm Hg), diastolic blood pressure >95 mm Hg).

      - Congestive heart failure New York Heart Association (NYHA) Class III or IV, or
      Class II with a recent decompensation that required hospitalization or referral
      to a heart failure clinic within 4 weeks before screening (see Section 15.4 of
      the protocol in Appendix 16.1.1).

      - Cardiomyopathy or history of ischemic heart disease

      - Participants with ischemic heart disease who had acute coronary syndrome (ACS),
      myocardial infarction (MI), and/or revascularization (example, coronary artery
      bypass graft, stent) in the past 6 months were excluded. However, participants
      with ischemic heart disease who had ACS, MI, and/or revascularization greater
      than 6 months before screening and who are without cardiac symptoms could be

      - Arrhythmia (example, history of polymorphic ventricular fibrillation or torsade
      de pointes). However, participants with
      a period of at least 6 months could enroll. Grade 3 a fib is symptomatic and
      incompletely controlled medically, or controlled with device (example,
      pacemaker), or ablation. Participants with paroxysmal a fib were permitted to

      - Implantable cardioverter defibrillator.

      - Moderate to severe aortic and/or mitral stenosis or other valvulopathy (ongoing).

      - Pulmonary arterial hypertension. Prolonged rate corrected QT (QTc) interval >=
      500 msec, calculated according to institutional guidelines

17. Left ventricular ejection fraction

18. Known moderate to severe chronic obstructive pulmonary disease, interstitial lung
   disease, and pulmonary fibrosis.

19. Body mass index >40 kilogram per square meter (kg/m^2).

20. Treatment with CYP3A inducers within 14 days before the first dose of MLN4924.

21. Systemic antineoplastic therapy or radiotherapy within 14 days before the first dose
   of study drug, except for hydroxyurea.


drug: MLN4924

drug: Azacitidine

Not Recruiting

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305

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