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Acute Myeloid LeukemiaPhase 1BISECTNCT05456269

A Study of Bisantrene Combined With Cytarabine or With Decitabine for Adult Subjects With Extramedullary AML and MDS

A Phase 1 study testing Bisantrene Dihydrochloride (high dose), Bisantrene Dihydrochloride (low dose) and Cytarabine Hydrochloride in people with Acute Myeloid Leukemia and Recurrent Acute Myeloid Leukemia, run by Racura Oncology Ltd at 1 site in Australia.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

This is a two strata Phase 1b study to assess the safety and efficacy of bisantrene (RC110) in combination with a) cytarabine arabinoside (Ara-C) treatment for patients with relapsed or refractory (R/R) Acute Myeloid Leukemia (AML) with extramedullary disease and able to tolerate intensive chemotherapy; b) in… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Bisantrene Dihydrochloride (high dose), Bisantrene Dihydrochloride (low dose) and Cytarabine Hydrochloride
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
1 siteAustralia
Study dates
29 Jul 2022to 31 Aug 2023
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • [Both Stratums]
  • Patients must be able to understand and provide informed written consent.
  • Patients must be of age ≥ 18 years at the time of signing the informed consent.
  • Extramedullary disease (i.e., AML) by 18F-FDG PET/CT and/or clinical morphology (histopathology of chloroma, leukemia cutis or AML) at pre-screening
  • Patients who have undergone stem cell transplantation (SCT), maybe included if they are ≥ 8 weeks from stem cell infusion (autologous or allogeneic), have no active graft versus host disease (GVHD), are off immune suppression for at least 2 weeks, and do not have a history of veno occlusive disease (VOD).
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.0 for intensive Stratum 1 patients and ≤ 3.0 for low intensity treatment Stratum 2 patients.
Show all 15Show fewer
  • Life expectancy estimated to be > 3 months.
  • Adequate organ function as evidenced by serum total bilirubin ≤ 2.0 mg/dL, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤ 5 × the upper limit of normal (ULN), serum creatinine ≤ 1.5 mg/dL or calculated creatinine clearance of ≥ 60 mL/min.
  • Cardiac ejection fraction ≥ 50%, assessed by 2-Dimensional (2D) echocardiogram.
  • Females of childbearing potential must have a negative serum pregnancy test at enrolment or within 14 days before study entry and must agree to use an adequate method of contraception, i.e., barrier method, during the study until 30 days after the last treatment. Males must be surgically or biologically sterile or agree to use an adequate method of contraception, i.e., barrier method, during the study until 30 days after the last treatment.
  • [Stratum 1 only]
  • Diagnosis of R/R AML, defined as ≥ 5% blasts in a patient with known prior history of AML according to World Health Organization (WHO) criteria. Patients with AML that have relapsed at least once or are primary induction failure will be eligible.
  • [Stratum 2 only]
  • Patients with diagnosis of de novo AML with EMD, or R/R AML with EMD.
  • Patients with MDS or CMML, diagnosed according to the 2016 WHO classification with high-risk disease per the International Prognostic Scoring System (IPSS) of intermediate 2 or higher for both MDS and CMML. Revised IPSS intermediate risk patients can be considered after discussion with the Investigator.

Who cannot join

  • [Both Stratums]
  • Acute promyelocytic leukemia (APML) M3 subtype of AML.
  • Central nervous system manifestations of AML, unless treated and with no residual manifestations (either by cerebrospinal fluid (CSF) cytology, radiologically or by other clinical assessments) in the last 2 weeks.
  • Evidence or recent history of CNS disease, including primary or metastatic brain tumors, seizure disorders unless there is evidence for clearance of CNS leukemia (2 leukemia free CSFs by morphology and /or flow cytometry 1 week apart).
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, cirrhosis, chronic obstructive or restrictive pulmonary disease, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.
  • Other active malignancy (including other hematologic malignancies) or other malignancy within the last 12 months except non-melanoma skin cancer or cervical intraepithelial neoplasia.
  • Major surgery within 4 weeks of treatment.
  • Any medical, psychological, or social condition that may interfere with study patient or compliance or may compromise the patient's safety in the opinion of the Investigator.

Trial locations and contacts

1 site in 1 country.

Australia1 site
  • Calvary Mater

    Newcastle, New South Wales, 2298

Other trials in Australia

About this study

Official title: An Open-label Two Strata Study of Bisantrene in Combination With Cytarabine Arabinoside or Bisantrene in Combination With Oral Decitabine/Cedazuridine for the Treatment of Acute Myeloid Leukemia Patients With Extramedullary Disease

This is a two strata Phase 1b study to assess the safety and efficacy of bisantrene (RC110) in combination with a) cytarabine arabinoside (Ara-C) treatment for patients with relapsed or refractory (R/R) Acute Myeloid Leukemia (AML) with extramedullary disease and able to tolerate intensive chemotherapy; b) in combination with decitabine/cedazuridune (ASTX727) new or relapsed or refractory AML or high risk MDS or CMML with extramedullary disease and unable or not willing to have intensive chemotherapy.

Read the detailed description

The study is a multicenter, open label in patients with haematological malignancy / myeloproliferative disease (AML, MDS and CMML) and extramedullary disease (EMD) investigating 2 treatment regimens:

  1. Stratum 1 will investigate use of high dose intravenous (IV) bisantrene (RC110) in combination with IV Ara-C for R/R AML with EMD able to tolerate intensive chemotherapy. This includes a run-in stage to confirm the dose of bisantrene (RC110) for induction and in combination with Ara-C for consolidation cycles and an expansion and an expansion stage that will treat additional patients at the confirmed bisantrene dose for induction and in combination with Ara-C consolidation cycles;
  2. Stratum 2 will investigate use lower doses intravenous (IV) bisantrene (RC-110) in combination with fixed-dose oral decitabine/cedazuridine (ASTX727) to determine the maximum tolerated dose (MTD) for new or R/R AML and HR-MDS/CMML unable to tolerate intensive chemotherapy.

Pre-screening will be conducted to identify patients with EMD diagnosed by standard clinical practice including histology and by fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG-PET/CT) imaging.

Being tested
Bisantrene Dihydrochloride (high dose), Bisantrene Dihydrochloride (low dose), Cytarabine Hydrochloride, Decitabine and cedazuridine
Keywords
combination treatment intervention
Medical subject headings
Leukemia, Myeloid, Acute, Leukemia, Myelomonocytic, Chronic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bisantrene Dihydrochloride (high dose)Drug

    Also called RC110, Zantrene®, Xantrene®

    Induction monotherapy cycle: IV bisantrene daily on Days 1 to 7, starting at 250 mg/m2 then adjusted to either 275 mg/m2 or 225 mg/m2 based on confirmed dose (Run-in) Consolidation combination cycle/s: IV bisantrene daily on Days 1 to 2

  • Bisantrene Dihydrochloride (low dose)Drug

    Also called RC110, Zantrene®, Xantrene®

    IV bisantrene at escalating doses for 3 dose levels of 50, 65, 85 mg/m2 on Days 3 and 5 until Maximum tolerated dose (MTD) reached.

  • Cytarabine HydrochlorideDrug

    Also called Ara-C, Cytarabine arabinoside, Cytosar-U®

    Consolidation cycles: continuous IV cytarabine (100mg/m2) on Days 1 to 5

  • Decitabine and cedazuridineDrug

    Also called ASTX727

    PO fixed-dose decitabine/cedazuridine 35/100 mg tablet daily for 5 days (Days 1 to 5), 1 hour prior bisantrene infusion

Study groups in NCT05456269
Study groupRoleWhat they receive
Stratum 1ExperimentalBisantrene infused daily for 7 days of induction cycle 1; followed by bisantrene infusion on Days 1 and 2 and cytarabine arabinoside continuous infusion on Days 1 to 5 of each consolidation cycle for up to 3 cycles. Each cycle is 28 days, with a potential to expand to 42 days to allow for full hematologic recovery.
Receives: Drug: Bisantrene Dihydrochloride (high dose); Drug: Cytarabine Hydrochloride
Stratum 2ExperimentalDecitabine/cedazuridine daily on Days 1-5, Bisantrene infusion on Days 3 and 5 in 28 day cycle. Treatment repeats every 28 days up to 12 cycles in the absence of disease progression or unacceptable toxicity. Each has potential to expand to 42 days to allow for full hematologic recovery.
Receives: Drug: Bisantrene Dihydrochloride (low dose); Drug: Decitabine and cedazuridine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Stratum 1, Stage 1: Dose confirmation

    Maximum tolerated dose (MTD) based on occurence dose limiting toxicity (DLT) graded according to the National Cancer Institute Common Terminology Criteria (NCI CTCAE) for Adverse Events v5.0 after completion of 2 cycles of treatment

    Measured: 8 weeks

  2. Stratum 1 Stage 2: Overall response

    Morphological overall response, defined as complete remission (CR), CR with incomplete hematologic recovery or morphologic leukemia free state (MLFS), after completion of first treatment cycle 1

    Measured: 4 weeks

  3. Stratum 2: Safety and tolerabillity

    Assessed based on the occurence of non-hematological Dose limiting toxicity (DLT) as graded according to the National Cancer Institute Common Terminology Criteria (NCI CTCAE) for Adverse Events v5.0 at the completion of cycle 1.

    Measured: 4 weeks

Secondary outcomes (15)
  1. Stratum 1: Minimal Residual Disease (MRD) response

    Response is defined as MRD negativity with and without morphological complete remission (CR), at low level molcular MRD with CR and MRD relapse (coversion MRD negativity to positivity) at the completion of cycle 1

    Measured: 4 weeks

  2. Stratum 1: Radiologic response

    Response evaluation by 18F-FDG-PET/CT is based on the 5-point scale Deauville criteria for complete metabolic response (defined as Deauville Score (DS) 1, 2, or 3) or for partial metabolic response (defined DS of 4 or 5 with decrease in number or activity in bone marrow/EMD disease at the completion of cycles 1,2 and 4..

    Measured: 4, 8 and 16 weeks

  3. Stratum 1: Dermal clinical response

    Dermal response based on improvement on the static investigator global assessment (IGA) 5-point disease severity scores, where higher score indicate more disease, defined as decrease of at least two points relative to baseline at the completion of cycles 1,2 3 and 4.

    Measured: 4, 8, 12, and 16 weeks

  4. Stratum 1: Dermal therapeutic response

    Dermal therapeutic improvement based on the static investigator global assessment (IGA) 5-point disease severity scores, where higher score indicate more disease, defined as decrease of at least two points relative to baseline at the completion of cycles 1,2 3 and 4.

    Measured: 4, 8, 12, and 16 weeks

  5. Stratum 1: Safety and tolerability

    Safety and tolerability based on the incidence and severity of adverse events assessed using National Cancer Institute-Common Terminology Criteria for Adverse Events [NCI-CTCAE] v5.0, grade per event, patient, and cycle of treatment.

    Measured: 4, 8, 12 and 16 weeks

  6. Stratum 1: Number of participants that recieve subsequent allogeneic hematopoietic stem cell transplant

    Proportion of patients who receive subsequent allogeneic HSCT

    Measured: 5 years

  7. Stratum 1:Event free survival (EFS)

    EFS assessed between treatment start until the date of the earliest of these events: death, progression or off protocol-treatment for any reason using the Kaplan-Meier method

    Measured: Day 1 (treatment start) to 5 years

  8. Stratum 1: Overall Survival (OS)

    OS assessed between treatment start until death due to any cause using the Kaplan-Meier method

    Measured: Day 1 (treatment start) to 5 years

  9. Stratum 2: Overall response

    Morphological overall response, defined as either CR or CR as complete remission (CR), CR with incomplete hematologic recovery, CR with incomplete count recovery or MLFS. For patients with MDS/CMML, overall response, defined as either CR or modified CR mCR with haematological improvement (HI) at the end of cycle 1

    Measured: 4 weeks

  10. Stratum 2: Minimal Residual Disease (MRD) response

    Response is defined as MRD negativity with and without morphological complete remission (CR), at low level molecular MRD with CR and MRD relapse (coversion MRD negativity to positivity) at the completion of cycle 4.

    Measured: 16 weeks

  11. Stratum 2: Radiologic response

    Response evaluation by 18F-FDG-PET/CT, based on the 5-point scale Deauville criteria for complete metabolic response (defined as as Deauville Score (DS) 1, 2, or 3) or for partial metabolic response (defined as DS of 4 or 5 with decrease in number or activity in bone marrow/EMD disease) at the the completion of cycles 4, 6, 9 and 12

    Measured: 16, 36 and 48 weeks

  12. Stratum 2: Dermal clinical response

    Dermal clinical improvement based on the static investigator global assessment (IGA) 5-point disease severity scores, where higher score indicate more disease, defined as as disease severity score of 1 (almost clear) or 0 (clear) and at least a two grade/point decrease in severity score relative to baseline the completion of cycles 4, 6, 9 and 12

    Measured: 4, 24, 36 and 48 weeks

  13. Stratum 2: Dermal therapeutic response

    Dermal therapeutic improvement based on the static investigator global assessment (IGA) 5-point disease severity scores, where higher score indicate more disease, defined as decrease of at least two points relative to baseline the completion of cycles 4, 6, 9 and 12.

    Measured: 4, 24, 36 and 48 weeks

  14. Stratum 2: Event free survival (EFS)

    EFS assessed between treatment start until the date of the earliest of these events: death, progression or off protocol-treatment for any reason assessed

    Measured: Day 1 (treatment start) up to 5 years

  15. Stratum 2: Overall survival (OS)

    OS assessed between treatment start until death due to any cause using the Kaplan-Meier method

    Measured: Day 1 (treatment start) to 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Jul 2022
  2. Study start29 Jul 2022
  3. Primary completion31 Aug 2023
  4. Study completion31 Aug 2023

Why it stopped: commercial reason

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Sequential
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05456269
Sponsor's protocol ID
RAC-006
Acronym
BISECT
Status last verified
Sep 2023
First submitted
4 Jul 2022
Last updated
3 Oct 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Bisantrene Dihydrochloride (high dose), Bisantrene Dihydrochloride (low dose) and Cytarabine Hydrochloride in people with Acute Myeloid Leukemia and Recurrent Acute Myeloid Leukemia, run by Racura Oncology Ltd at 1 site in Australia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 3 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Australia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Stratum 1, Stage 1: Dose confirmation (time frame: 8 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Oct 2023.

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