A Study to Evaluate the Pharmacokinetics, Safety,and Efficacy of Omacetaxine Given Subcutaneously as a Fixed Dose in Patients With Chronic Phase (CP) or Accelerated Phase (AP) Chronic Myeloid Leukemia (CML) (Referred to as the SYNSINCT Study)

NCT02078960 | Terminated Phase 1 Results DMC FDA Drug

• 2 other identifiers: C41443/20572013-005320-42
• Study Type: interventional
• Target: 10
• Locations: 4 countries
• Sites: 10

Brief Summary

To satisfy a postmarketing requirement, the sponsor has been requested to conduct a Phase 1/Phase 2 single-group clinical study to investigate the pharmacokinetics and preliminary safety and efficacy of omacetaxine following a fixed-dose administration to patients with CP or AP CML who have failed 2 or more tyrosine kinase inhibitor (TKI) therapies.

Conditions

Chronic Myeloid Leukemia

Keywords

Chronic Phase; Accelerated Phase; CML; Chronic Myeloid Leukemia

Outcome Measures

Primary Outcomes (1)

• Number of Participants Who Achieved a Major Response at Any Time During Treatment

  The Independent Data Monitoring Committee assessments are summarized. Major response for participants with chronic phase CML was a major cytogenetic response (MCyR) defined as a complete cytogenetic response with no Ph+ metaphases, or a partial cytogenetic response with up to 35% Ph+ metaphases. Note that a complete hematologic response was not considered a major response. Major response for participants with accelerated phase CML was a major hematologic response (MaHR) defined as a complete hematologic response or no evidence of leukemia, and/or a major cytogenic response (MCyR).

  Day 1 up to Month 15 (longest treatment duration)

Secondary Outcomes (12)

• Longest Duration of Response At Study Termination

  Day 1 to Day 541 (longest progression/survival follow-up)

• Number of Participants Who Had a Molecular Response at Any Time During Treatment

  Day 1 up to Month 15

• Number of Participants Who Were Alive and Progression-Free at Study Termination

  Day 1 to Day 541 (longest progression/survival follow-up)

• Number of Participants Who Were Alive at Study Termination

  Day 1 to Day 541 (longest progression/survival follow-up)

• Maximum Observed Plasma Concentration (Cmax) for Omacetaxine

  Cycle 1 - Day 1 (predose, 15, 30, 45 minutes, 1, 2, 4, 8, 24, 48, 72 hours post-dose) Day 10 (predose, 2 samples postdose), Day 13 (predose) Cycles 2+3 - Day 1 (2 samples postdose), Days 10 and 17 (1 sample predose)

Study Arms (1)

Omacetaxine mepesuccinate.

EXPERIMENTAL

The study will consist of up to a 7-day screening period, and treatment for up to 12 months, in Phase 1 and Phase 2 portions, depending on response and tolerability. Patients will also have an end-of-treatment follow-up visit approximately 28 days after the last dose of omacetaxine. Each patient will be monitored for progression and survival for at least 1 year after their last dose of omacetaxine, death, or lost to follow-up, whichever comes first, regardless of patients receiving other anticancer treatment.

Drug: Omacetaxine mepesuccinate

Interventions

Omacetaxine mepesuccinate DRUG

3.5 mg omacetaxine mepesuccinate and 10 mg mannitol; The first dose of the day for cycle 1 will be administered at the investigational center. Subsequent doses (in prefilled syringes) may be administered on an outpatient basis after training takes place

Also known as: C41443, SYNRIBO®

Omacetaxine mepesuccinate.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• The patient has a confirmed diagnosis of Philadelphia chromosome (Ph) positive chronic myelogenous leukemia in either CP or AP. Accelerated phase will be defined as disease having 1 of the following: ≥15% to \<30% blasts in peripheral blood or bone marrow; ≥30% blasts + promyelocytes in peripheral blood or bone marrow; ≥20% basophils in peripheral blood or bone marrow; platelet count \<100x109/L unrelated to therapy; or clonal evolution.
• The patient has either failed, demonstrated intolerance, or a combination of prior failure and intolerance, to prior treatments with at least 2 tyrosine kinase inhibitors (TKI's). Failure of TKI treatment may either be primary (never achieved a response) or secondary resistance (loss of response).
• TKI treatment failure will be defined as 1 of the following:
• no CHR by 12 weeks (whether lost or never achieved)
• no partial cytogenetic response by 24 weeks (ie, 1 to 35% Ph-positive) (whether lost or never achieved) no major cytogenetic response by 52 weeks (ie, ≤35% Ph-positive) (whether lost or never achieved)
• progressive leukocytosis, defined as increasing white blood cell (WBC) count on at least 2 consecutive evaluations, at least 2 weeks apart and doubling from the nadir to ≥20000/μL or absolute increase in WBC by ≥50000/μL above the post-treatment nadir
• Intolerance to TKI therapy will be defined as 1 of the following:
• grade 3 to 4 nonhematologic toxicity that does not resolve with adequate intervention
• grade 4 hematologic toxicity lasting more than 7 days, or a documented inability to sustain the TKI therapy because of recurrent grade 3 or 4 hematologic toxicity with re-initiation of the same therapy
• any grade 2 or greater toxicity that is unacceptable to the patient
• Patients must have completed all previous anticancer therapy for at least 2 weeks prior to the first planned dose of omacetaxine, except as noted below, and must have fully recovered from side effects of a previous therapy.
• In patients with rapidly proliferating disease, hydroxyurea may be administered before study entry, if clinically indicated, to control disease. In such cases, complete hematologic response (CHR) must be sustained for at least 4 weeks for accelerated CML, and at least 8 weeks for chronic phase CML, following the discontinuation of hydroxyurea, to be considered as a CHR.
• Patients may receive anagrelide for up to 28 days (in countries where the product is registered). Leukapheresis is allowed up to 24 hours prior to the first treatment cycle with omacetaxine.
• Patients must have adequate hepatic and renal function as evidenced by bilirubin 2.0 times the upper limit of the normal range (ULN) or lower, alanine aminotransferase (ALT) and asparate aminotransferase (AST) 3 times the ULN or lower, serum creatinine 1.5 times the ULN or lower. Patients with nonclinically significant elevations of bilirubin up to 5.0 g/dL (85500 μmol/L) due to known or suspected Gilbert's disease are eligible; this must be documented on the medical history page of the case report form (CRF).
• Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2

You may not qualify if:

• The patient has New York Heart Association (NYHA) class III or IV heart disease, active ischemia, or any other uncontrolled cardiac condition such as angina pectoris, clinically significant cardiac arrhythmia requiring therapy, uncontrolled hypertension, or congestive heart failure.
• The patient has had a myocardial infarction in the previous 12 weeks. (Prior to study entry, electrocardiogram \[ECG\] abnormalities at screening must be documented by the investigator as not medically relevant.)
• The patient has received radiotherapy within 30 days prior to the start of study drug, or has not recovered from the acute toxicities associated with prior approved therapies including investigational drugs.
• The patient has another concurrent illness that would preclude study conduct and assessment, including, but not limited to, another active malignancy (excluding squamous or basal cell skin cancer and in situ cervical cancer), uncontrolled medical conditions, uncontrolled and active infection (considered opportunistic, life threatening, or clinically significant), uncontrolled risk of bleeding, or uncontrolled diabetes mellitus.
• The patient underwent autologous or allogeneic stem cell transplant within 60 days prior to receiving the first dose of omacetaxine and has any evidence of ongoing graft versus host disease (GVHD), or GVHD requiring immunosuppressive therapy.
• The patient has a human leukocyte antigen (HLA)-matched donor and is eligible for allogeneic transplantation for CML treatment.
• The patient has known positive human immunodeficiency virus (HIV) or known active human t-cell lymphotropic virus (HTLV) I/II disease, whether on treatment or not.
• The patient has known active hepatitis B or C. The determination of active hepatitis B or C is left to the investigator.
• The patient has lymphoid Ph+ blast crisis or blast phase CML.
• The patient participated in another clinical investigation within 30 days of enrollment or is receiving another investigational agent.
• The patient received omacetaxine or has a history of hypersensitivity.
• Other criteria may apply, please contact the investigator for additional information

Sponsors & Collaborators

• Teva Branded Pharmaceutical Products R&D, Inc.: lead

Study Sites (10)

Teva Investigational Site 12545

Jacksonville, Florida, 32207, United States

Location

Teva Investigational Site 12550

Atlanta, Georgia, 30322, United States

Location

Teva Investigational Site 12543

Indianapolis, Indiana, 46237, United States

Location

Teva Investigational Site 12547

Buffalo, New York, 14263, United States

Location

Teva Investigational Site 12546

Cincinnati, Ohio, 45219, United States

Location

Teva Investigational Site 12544

Houston, Texas, 77030, United States

Location

Teva Investigational Site 37048

Ghent, 9000, Belgium

Location

Teva Investigational Site 37047

Leuven, 3000, Belgium

Location

Teva Investigational Site 35157

Pierre-Bénite, 69 495, France

Location

Teva Investigational Site 87026

Seoul, 137-701, South Korea

Location

MeSH Terms

Conditions

Leukemia, Myelogenous, Chronic, BCR-ABL Positive

Interventions

Homoharringtonine

Condition Hierarchy (Ancestors)

Leukemia, Myeloid; Leukemia; Neoplasms by Histologic Type; Neoplasms; Myeloproliferative Disorders; Bone Marrow Diseases; Hematologic Diseases; Hemic and Lymphatic Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Harringtonines; Alkaloids; Heterocyclic Compounds; Benzazepines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds, 4 or More Rings

Limitations and Caveats

Small sample size made it not possible to make meaningful comparisons between cohorts.

Results Point of Contact

• Title: Director, Clinical Research
• Organization: Teva Branded Pharmaceutical Products, R&D Inc.

USMedInfo@tevapharm.com

1-888-483-8279

Study Officials

• Sponsor's Medical Expert, MD

  Teva Branded Pharmaceutical Products R&D, Inc.

  STUDY DIRECTOR

Publication Agreements

• PI is Sponsor Employee: No
• Restriction Type: OTHER
• Restrictive Agreement: Yes

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: OTHER
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 28, 2014
• First Posted: March 5, 2014
• Study Start: October 9, 2014
• Primary Completion: July 6, 2017
• Study Completion: November 27, 2017
• Last Updated: November 9, 2021
• Results First Posted: January 14, 2019

Record last verified: 2021-11

Locations

FR (1); US (6); KR (1); BE (2)