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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT01483690
Registration number
NCT01483690
Ethics application status
Date submitted
29/11/2011
Date registered
1/12/2011
Date last updated
27/10/2020
Titles & IDs
Public title
A Pilot Study of Decitabine and Vorinostat With Chemotherapy for Relapsed ALL
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Scientific title
A Pilot Study of Decitabine and Vorinostat With Chemotherapy for Relapsed ALL
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Secondary ID [1]
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T2009-003
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Acute Lymphoblastic Leukemia
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Precursor B-Cell Lymphoblastic Leukemia
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Precursor T-Cell Lymphoblastic Leukemia
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Condition category
Condition code
Cancer
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Leukaemia - Acute leukaemia
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Cancer
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Leukaemia - Chronic leukaemia
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Cancer
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Children's - Leukaemia & Lymphoma
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Cancer
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Lymphoma (non Hodgkin's lymphoma) - High grade lymphoma
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Cancer
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Lymphoma (non Hodgkin's lymphoma) - Low grade lymphoma
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Decitabine
Treatment: Drugs - Vorinostat
Treatment: Drugs - Vincristine
Treatment: Drugs - Dexamethasone
Treatment: Drugs - Mitoxantrone
Treatment: Drugs - Pegaspargase
Treatment: Drugs - Methotrexate
Experimental: Initial Dose Level - Decitabine 15 mg/m2/day given IV over 1 hour on days 1 through 7 and days 15 through 21.
Vorinostat: 180 mg/m2/day (Max dose=400 mg daily) given orally on days 3 through 10 and days 17 through 24
Experimental: Modified Dose Level - Decitabine 10 mg/m2/day given IV over 1 hour on days 1 through 5 and days 15 through 19.
Vorinostat: 180 mg/m2/day (Max dose=400 mg daily) given orally on days 2 through 7 and days 16 through 21
Treatment: Drugs: Decitabine
10 mg/m2/day given IV over 1 hour on days 1 through 5 and days 15 through 19.
Treatment: Drugs: Vorinostat
180 mg/m2/day (Max dose=400mg daily) given orally on days 2 through 7 and days 16 through 21.
Treatment: Drugs: Vincristine
1.5 mg/m2/day (Max dose 2 mg) given IV push on days 10, 17, 24 and 31.
Treatment: Drugs: Dexamethasone
20 mg/m2/day divided BID given orally on days 8 through 12 and 22 through 26.
Treatment: Drugs: Mitoxantrone
10 mg/m2/day given on days 8 and 9 as a short IV infusion over 5-15 minutes; do not infuse over less than 3 minutes
Treatment: Drugs: Pegaspargase
2500 international units/m2/day IM or IV on days 10 and 24.
Treatment: Drugs: Methotrexate
Given intrathecally to all patients the dose defined by age below.
* 8 mg for patients age 1-1.99
* 10 mg for patients age 2-2.99
* 12 mg for patients 3-8.99 years of age
* 15 mg for patients \>9 years of age
CNS 1 or 2 patients get doses on day 8, 22 and 35 and CNS 3 patients should get doses on day 8, 15, 22, 29 and 35
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Number of Participants Who Experienced a Dose Limiting Toxicity (DLT).
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Assessment method [1]
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To evaluate the side effects of giving decitabine and vorinostat before and during chemotherapy using the standard drugs vincristine, dexamethasone, PEG-asparaginase and mitoxantrone.
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Timepoint [1]
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6 weeks
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Secondary outcome [1]
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Disease Response Rate After Treatment.
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Assessment method [1]
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Bone marrow evaluation was performed on Day 35 of study to evaluate treatment response. CR defined as attaining M1 marrow (\<5% blasts) with no evidence of circulating blasts or extramedullary disease in addition to recovery of peripheral blood counts (ANC \>750/uL and platelet count \>75,000/uL). CRp was defined as attaining an M1 marrow with no evidence of circulating blasts or extramedullary disease in addition to recovery of ANC but insufficient recovery of platelets. CRi was attaining M1 marrow with no evidence of circulating blasts or extramedullary disease but insufficient recovery of ANC with or without sufficient recovery of platelets. PR was defined as no evidence of circulating blasts and achievement of M2 marrow (5-25% blasts) without new sites of disease and with recovery of ANC. SD is for patients who did not meet the criteria for PR, CR, CRp, or CRi. PD is an increase of at least 25% in the absolute number of leukemia cells or development of new sites.
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Timepoint [1]
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6 weeks
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Eligibility
Key inclusion criteria
* Patients must be =1 and = 21 years of age when originally diagnosed with ALL.
Diagnosis
* Patients must have a diagnosis of acute lymphoblastic leukemia (ALL) with = 25% blasts in the bone marrow (M3), with or without extramedullary disease.
* Patients may have CNS 1, 2 or 3 disease.
* Karnofsky > 50% for patients > 16 years of age and Lansky > 50% for patients = 16 years of age.
* Prior Therapy
* Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study.
* Patients must have had 2 or more prior therapeutic attempts defined as:
* Relapse after going into remission from re-induction for the first or subsequent relapse (ie: 2nd , 3rd, 4th...relapse), OR
* Refractory disease after first or greater relapse and a re-induction attempt, OR
* Failing to go into remission from original diagnosis after 2 previous induction attempts.
* Hematopoietic Stem Cell Transplant: Patients who have experienced their relapse after a HSCT are eligible, provided they have no evidence of Graft-versus-Host Disease (GVHD) and are at least 60 days post-transplant at the time of enrollment.
* Prior anthracycline exposure: Patients must have less than 400 mg/m2 lifetime exposure of anthracycline chemotherapy. (See Appendix II for calculation worksheet)
* Hematopoietic grow factors: It must have been at least 7 days since the completion of therapy with GCSF or other growth factors at the time of enrollment. It must have been at least 14 days since the completion of therapy with pegfilgrastim (Neulasta®).
* Biologic (anti-neoplastic) therapy: It must be at least 7 days after last does of biologic agent. For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair
* Monoclonal antibodies: At least 3 half-lives of the antibody must have elapsed after the last dose of monoclonal antibody. (ie. Rituximab=66 days, Epratuzumab=69 days)
* Immunotherapy: At least 42 days after the completion of any type of immunotherapy, e.g. tumor vaccines.
Renal and Hepatic Function
* Patient's serum creatinine must be = 1.5 x institutional upper limit of normal (ULN) according to age. If the serum creatinine is greater than 1.5 times normal, the patient must have a calculated creatinine clearance or radioisotope GRF = 70mL/min/1.73m2.
* Patient's ALT and AST must be < 5 x institutional upper limit of norm ULN. The hepatic requirements are waived for patients with known or suspected liver involvement who would otherwise be eligible after consultation with the Study Chair or Vice Chair.
* Patient's total bilirubin must be = 1.5 x ULN. The hepatic requirements are waived for patients with known or suspected liver involvement who would otherwise be eligible.
Cardiac Function:
* Patient must have a shortening fraction = 27% by Echo or an ejection fraction = 50% by MUGA.
Reproductive Function
* Female patients of childbearing potential must have a negative urine or serum pregnancy test confirmed prior to enrollment.
* Female patients with infants must agree not to breastfeed their infants while on this study.
* Male and female patients of child-bearing potential must agree to use an effective method of contraception approved by the investigator during the study.
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Minimum age
1
Year
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Maximum age
21
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Patients will be excluded if they are receiving Valproic Acid (VPA) therapy.
* Patients will be excluded if they have a known allergy to any of the drugs used in the study.
* Patients will be excluded if they have a systemic fungal, bacterial, viral or other infection that is exhibiting ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics or other treatment.
* Patients will be excluded if there is a plan to administer non-protocol chemotherapy, radiation therapy, or immunotherapy during the study period.
* Patients will be excluded if they have significant concurrent disease, illness, psychiatric disorder or social issue that would compromise patient safety or compliance with the protocol treatment or procedures, interfere with consent, study participation, follow up, or interpretation of study results.
* Patients will be excluded if they have had any positive fungal culture in the last 30 days prior to enrollment.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Phase 1
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Stopped early
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/12/2011
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
31/07/2015
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Sample size
Target
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Accrual to date
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Final
23
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Recruitment in Australia
Recruitment state(s)
NSW,QLD
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Recruitment hospital [1]
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Children's Hospital at Westmead - Westmead
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Recruitment hospital [2]
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Royal Children's Hospital - Brisbane
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Recruitment hospital [3]
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Sydney Children's Hospital - Sydney
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Recruitment postcode(s) [1]
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- Westmead
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Recruitment postcode(s) [2]
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- Brisbane
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Recruitment postcode(s) [3]
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- Sydney
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Recruitment outside Australia
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California
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Colorado
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District of Columbia
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Florida
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Washington
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Funding & Sponsors
Primary sponsor type
Other
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Name
Therapeutic Advances in Childhood Leukemia Consortium
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Address
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Ethics approval
Ethics application status
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Summary
Brief summary
This is a pilot study using decitabine and vorinostat before and during chemotherapy with vincristine, dexamethasone, mitoxantrone, and peg-asparaginase in pediatric patients with acute lymphoblastic leukemia (ALL).
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Trial website
https://clinicaltrials.gov/study/NCT01483690
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Trial related presentations / publications
Burke MJ, Kostadinov R, Sposto R, Gore L, Kelley SM, Rabik C, Trepel JB, Lee MJ, Yuno A, Lee S, Bhojwani D, Jeha S, Chang BH, Sulis ML, Hermiston ML, Gaynon P, Huynh V, Verma A, Gardner R, Heym KM, Dennis RM, Ziegler DS, Laetsch TW, Oesterheld JE, Dubois SG, Pollard JA, Glade-Bender J, Cooper TM, Kaplan JA, Farooqi MS, Yoo B, Guest E, Wayne AS, Brown PA. Decitabine and Vorinostat with Chemotherapy in Relapsed Pediatric Acute Lymphoblastic Leukemia: A TACL Pilot Study. Clin Cancer Res. 2020 May 15;26(10):2297-2307. doi: 10.1158/1078-0432.CCR-19-1251. Epub 2020 Jan 22. Raetz EA, Bhatla T. Where do we stand in the treatment of relapsed acute lymphoblastic leukemia? Hematology Am Soc Hematol Educ Program. 2012;2012:129-36. doi: 10.1182/asheducation-2012.1.129.
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Public notes
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Contacts
Principal investigator
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Michael Burke, MD
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Address
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Medical College of Wisconsin
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results are available at
https://clinicaltrials.gov/study/NCT01483690
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