A Phase III Randomized, Double-Blind Study of Induction (Daunorubicin/Cytarabine) and Consolidation (High-Dose Cytarabine) Chemotherapy + Midostaurin (PKC412) (IND #101261) or Placebo in Newly Diagnosed Patients < 60 Years of Age With FLT3 Mutated Acute Myeloid Leukemia (AML)
cytarabine
+ daunorubicin
+ midostaurin
Congenital Abnormalities+20
+ Bone Marrow Diseases
+ Leukemia, Erythroblastic, Acute
Treatment Study
Summary
Study start date: April 1, 2008
Actual date on which the first participant was enrolled.In this study, patients will receive either the experimental agent (midostaurin) or placebo combined with chemotherapy treatment. Patients are stratified according to FLT3 mutation status (internal tandem duplication \[ITD\] allelic ratio < 0.7 vs ITD allelic ratio ≥ 0.7 vs tandem kinase domain \[TKD\]). There are three parts to the study treatment: remission induction therapy, remission consolidation therapy and continuation therapy. Remission Induction Therapy: * Cytarabine 200 mg/m2/day by continuous intravenous infusion on days 1-7 * Daunorubicin 60 mg/m2/day by intravenous push or short infusion on days 1-3 * Midostaurin 50 mg (two 25 mg capsules) or placebo for midostaurin (2 capsules) twice a day by mouth on days 8-21 * A bone marrow aspiration will be performed in all patients on Day 21 to determine the need for a second induction cycle. Remission Consolidation (Four Remission Consolidation Cycles): * High dose cytarabine 3000 mg/m2 will be given by intravenous infusion over 3 hours every 12 hours on days 1, 3 and 5. Serial neurologic evaluation will be performed before and following the infusion of high-dose cytarabine. * Dexamethasone 0.1% or other corticosteroid ophthalmic solution 2 drops to each eye once daily to begin 6-12 hours prior to the initiation of the cytarabine infusion and to continue for at least 24 hours after the last cytarabine dose. * Midostaurin 50 mg (two 25 mg capsules) or placebo for midostaurin (2 capsules) twice a day by mouth on days 8-21 Midostaurin/Placebo Continuation Therapy: * Midostaurin 50 mg (two 25 mg capsules) or placebo for midostaurin (2 capsules) by mouth twice a day for 28 days. Each cycle will be 28 days in length. Continuation therapy with midostaurin/placebo will continue until relapse or for 12 cycles maximum. The primary and secondary objectives of this study are: Primary objective: * To determine if the addition of midostaurin to daunorubicin/cytarabine induction, high-dose cytarabine consolidation, and continuation therapy improves overall survival (OS) in both the mutant FLT3-ITD and FLT3-TKD AML patients Secondary objectives: * To compare the overall survival (OS) in the two groups using an analysis in which patients who receive a stem cell transplant are censored at the time of transplant * To compare the complete response (CR) rate between the two treatment groups * To compare the event-free survival (EFS) between the two treatment groups * To compare the disease free survival (DFS) of the two treatment groups * To compare the disease free survival rate one year after completion of the continuation phase of the two groups * To assess the toxicity of the experimental combination * To describe the interaction between treatment outcome and pretreatment characteristics such as age, performance status, white blood cell (WBC) count, morphology, cytogenetics, and molecular and pharmacodynamic features * To assess the population pharmacokinetics (popPK) of midostaurin and its two major metabolites (CGP52421 and CGP62221). The potential association(s) between PK exposure and FLT3 status, OS, EFS and clinical response will be explored There is a pharmacokinetic sub-study (CALGB 60706) within CALGB 10603. This embedded companion study must be offered to all patients enrolled on CALGB 10603, although patients may opt not to participate in CALGB 60706. After study entry, patients are followed periodically for up to 10 years.
Protocol
This section provides details of the study plan, including how the study is designed and what the study is measuring.717 patients to be enrolled
Total number of participants that the clinical trial aims to recruit.Treatment Study
Eligibility
Researchers look for people who fit a certain description, called eligibility criteria: person's general health condition or prior treatments.Any sex
Biological sex of participants that are eligible to enroll.From 18 to 59 Years
Range of ages for which participants are eligible to join.Healthy volunteers not allowed
If individuals who are healthy and do not have the condition being studied can participate.Conditions
Pathology
Criteria
1. Documentation of Disease: * Unequivocal diagnosis of AML ( \> 20% blasts in the bone marrow based on the WHO classification), excluding M3 (acute promyelocytic leukemia). Patients with neurologic symptoms suggestive of CNS leukemia are recommended to have a lumbar puncture. Patients whose CSF is positive for AML blasts are not eligible. * Documented FLT3 mutation (ITD or point mutation), determined by analysis in a protocol- designated FLT3 screening laboratory. 2. Age Requirement: * Age ≥ 18 and \< 60 years 3. Prior Therapy: * No prior chemotherapy for leukemia or myelodysplasia with the following exceptions: * emergency leukapheresis * emergency treatment for hyperleukocytosis with hydroxyurea for ≤ 5 days * cranial RT for CNS leukostasis (one dose only) * growth factor/cytokine support * AML patients with a history of antecedent myelodysplasia (MDS) remain eligible for treatment on this trial, but must not have had prior cytotoxic therapy (e.g., azacitidine or decitabine) * Patients who have developed therapy related AML after prior RT or chemotherapy for another cancer or disorder are not eligible. 4. Cardiac Function: Patients with symptomatic congestive heart failure are not eligible. 5. Initial Laboratory Value: Total bilirubin \< 2.5 x ULN (Upper Limit of Normal) 6. Pregnancy and Nursing Status: * Non-pregnant and non-nursing due to the unknown teratogenic potential of midostaurin in humans, pregnant or nursing patients may not be enrolled. * Women of childbearing potential must have a negative serum or urine pregnancy test within a sensitivity of at least 50 mIU/mL within 16 days prior to registration. * Women of child-bearing potential must either commit to continued abstinence from heterosexual intercourse or commit to TWO acceptable methods of birth control: * one highly effective method (eg, IUD, hormonal (non-oral contraceptive), tubal ligation, or partner's vasectomy) and * one additional effective method (e.g., latex condom, diaphragm or cervical cap) * The two acceptable methods of birth control must be used AT THE SAME TIME, before beginning midostaurin/placebo therapy and continuing for 12 weeks after completion of all therapy. * Note that oral contraceptives are not considered a high effective method because of the possibility of a drug interaction with midostaurin. * Women of childbearing potential is defined as a sexually active mature woman who has not undergone a hysterectomy or who has not had menses at any time in the preceding 24 consecutive months. * Men must agree not to father a child and must use a latex condom during any sexual contact with women of childbearing potential while taking midostaurin/placebo and for 12 weeks after therapy is stopped, even if they have undergone a successful vasectomy.
Study Plan
Find out more about all the medication administered in this study, their detailed description and what they involve.2 intervention groups are designated in this study
This study does not include a placebo group
Treatment Groups
Group I
ExperimentalGroup II
Active ComparatorStudy Objectives
Primary Objectives
Secondary Objectives
Study Centers
These are the hospitals, clinics, or research facilities where the trial is being conducted. You can find the location closest to you and its status.This study has 176 locations
UAB Comprehensive Cancer Center
Birmingham, United StatesOpen UAB Comprehensive Cancer Center in Google MapsArkansas Cancer Research Center at University of Arkansas for Medical Sciences
Little Rock, United StatesUniversity of California Davis Cancer Center
Sacramento, United StatesAurora Presbyterian Hospital
Aurora, United States