Study of safety and efficacy of ONUREG in combination with VENETOCLAX in higher-risk myelodysplastic syndromes ineligible for allogenic transplantation

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Groupe Francophone Des Myelodysplasies

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Hemic and Lymphatic Diseases [C15]

Trial duration

6 Dec 2023 → ongoing

Decision date (initial)

2024-10-29

Transition trial

Yes

Low-intervention

No

Rare-disease indication

Yes

Vulnerable population

Yes

Funding sources

AbbVie · BMS

External identifiers

EU CT number

2024-514876-41-00

EudraCT number

2022-000634-41

ClinicalTrials.gov

NCT05782127

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Therapy, Efficacy, Safety

To establish the optimal dose and treatment duration of ONUREG (CC-486) in combination with VENETOCLAX

Secondary objectives 2

1. To assess the tolerance and efficacy of this two-drug regimen in high risk MDS patients as well as quality of life (QoL)
2. To determine biomarkers which may be predictive of clinical response, quality of life and outcome measures of OS

Conditions and MedDRA coding

Higher-risk myelodysplastic syndromes untreated and ineligible for allogenic transplantation

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 12

1. Subjects must understand and voluntarily sign and date an informed consent form (ICF) indicating the investigational nature of the study, approved by an independent EC/IRB, prior to the initiation of any screening or study-specific procedures.
2. Age ≥ 18 years at the date of signing the ICF
3. Diagnosis of MDS according to the 2016 WHO classification, with presence of < 20% bone marrow blasts per bone marrow aspirate at screening, confirmed by local investigator with HR-MDS, based on the revised International Prognostic Scoring System (IPSS-R) >3 (intermediate, high or very high) and a blast percentage of 5 or more
4. Previously untreated HR-MDS: no prior therapy for MDS with any HMA (AZA or decitabine) chemotherapy, allo-HSCT or experimental agent. All other treatments are not considered prior therapy.
5. Not immediately eligible for allo-HSCT or intensive chemotherapy at the time of screening due to individual clinical factors such as age, comorbidities and performance status, donor availability.
6. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
7. Total white blood cell (WBC) count ≤ 10 G/L; Treatment with hydroxyurea is permitted to lower the WBC to reach this inclusion criterion and will be stopped at least 48 hours before treatment initiation.
8. Adequate liver functions as demonstrated by: Serum alanine transaminase (ALT) < 3.0 × upper limit of normal [ULN] ; Serum aspartate transaminase (AST) < 3.0 × ULN ; Serum total bilirubin ≤ 2.0 × ULN (except in the setting of isolated Gilbert syndrome, where participants may only be included with total bilirubin ≤ 3.0 x ULN).
9. Adequate renal function with calculated creatinine clearance ≥ 40 mL/min/1.73 m2 (estimation based on Modification of Diet in Renal Disease (MDRD) formula or CKD-EPI, by local laboratory)
10. Participant is able to communicate with the investigator, and has the ability to comply with the requirements of the study procedures, available for regular blood sampling, study related assessments, including bone marrow aspirates and appropriate clinical management at the treating institution for the duration of the study
11. Females of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy, or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months). FCBP must agree to undergo medically supervised pregnancy test prior to starting study drug, during the course of the study, and after end of study therapy: Have one negative pregnancy test as verified by the Investigator prior to starting study therapy. The first pregnancy test will be performed at screening (within 3 days prior to first study drug administration), and a negative urinary test before starting all subsequent cycles. This applies even if the participant practices true abstinence from heterosexual contact or agree to use, and be able to comply with highly effective contraception without interruption, 28 days prior to starting investigational product, during the study therapy (including dose interruptions), and for 6 months after last dose of Onureg, or at least 1 month after the last dose of venetoclax, whichever is later or longer if required by local regulations. Female patients are either post-menopausal, free from menses for > 2 years, surgically sterilized or willing to use 2 adequate barrier methods of contraception to prevent pregnancy or agree to abstain from becoming pregnant throughout the study, starting with Visit 1. Females of reproductive potential as well as fertile men and their partners who are female of reproductive potential must agree to abstain from sexual intercourse or to use two highly effective forms of contraception from the time of giving informed consent, during the study and for 6 months for females and 3 months for males following the last dose of treatment.
12. Male participants must practice true abstinence (which must be reviewed on a monthly basis) or agree to use an adequate method of contraception for the duration of the study. Men should be advised not to father a child while receiving treatment and for 3 months post study. Men must agree to learn about the procedures for preservation of sperm before starting treatment.

Exclusion criteria 16

1. Previous treatment for MDS, any approved or investigational antineoplastic agents or radiotherapy
2. Previous diagnosis of: MDS evolving from a pre-existing myeloproliferative neoplasm (MPN) ; MDS/MPN including chronic myelomonocytic leukemia (CMML), atypical chronic myeloid leukemia (aCML), juvenile myelomonocytic leukemia (JMML) and unclassifiable MDS/MPN
3. Participant has an active, uncontrolled systemic fungal, bacterial, or viral infection. The participant should be afebrile and off antibiotics for at least 72 hours and off antifungals for 7 days. In the case of prior SARS-CoV-2 infection, symptoms must have completely resolved and based on Investigator assessment in consultation with the Medical Monitor, there are no sequelae that would place the patient at a higher risk of receiving investigational treatment.
4. History of clinically significant medical conditions, laboratory abnormality, psychiatric illness or any other reason that the investigator determines would interfere with the subject's participation in this study, would make the subject an unsuitable candidate to receive study drug or predisposes the participant to high risk of noncompliance with the protocol.
5. History of active malignancy within the past year prior to screening, with the exception of: Adequately treated carcinoma in situ of the uterine cervix ; Adequately treated basal cell carcinoma or localized squamous cell carcinoma of the skin ; Asymptomatic prostate cancer without known metastatic disease and with no requirement for therapy. Patients with ongoing hormonotherapy could be included.
6. Participant has received strong or moderate CYP3A inhibitors or inducers or p-gp inhibitors within 7 days prior to initiation of study treatment with prolonged treatment required without therapeutic alternatives. Azols are the only exception and may be permitted after cycle 1 at investigator's discretion and will result in VEN dose reduction.
7. Consumption of grapefruit products, Seville oranges or starfruit within 3 days prior to first dose of venetoclax
8. Received live attenuated vaccines prior to initiation of study treatment
9. History of clinically significant (per investigator's judgment) drug or alcohol abuse within the last 6 months
10. Conditions that could interfere with drug absorption including short gut syndrome, dysphagia, gastroparesis, or other conditions that limit the ingestion or gastrointestinal absorption of drugs administered orally
11. Participant has uncontrolled hypertension (systolic blood pressure [BP] > 180 mmHg or diastolic BP > 100 mmHg) or has not been stable for at least 1 month prior to treatment
12. Significant active cardiac disease within the previous 6 months prior to signing the ICF, including: New York Heart Association (NYHA) Class III or IV congestive heart failure ; Unstable angina or angina requiring surgical or medical intervention ; Significant cardiac arrhythmia ; And/or myocardial infarction
13. Participant is a pregnant or lactating female
14. Participant has known or suspected to have hypersensitivity to any of the components of the assigned study treatments
15. Positive test result(s) for human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Subjects with serologic evidence of prior vaccination to hepatitis B virus (i.e., hepatitis B surface antigen [HBsAg] negative, anti-hepatitis B surface [HBs] antibody positive and anti-hepatitis B core [HBc] antibody negative) may participate.
16. Absence of social security affiliation

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 2

1. Dose-limiting toxicity (DLT) at day 28 of cycle 1
2. Overall response (OR) measured at day 28 of cycle 1 according to modified IWG-MDS 2006

Secondary endpoints 12

1. Best response evaluated according to modified IWG-MDS 2006 criteria in the first 6 cycles (complete remission (CR), partial remission (PR), marrow complete response (mCR), stable disease (SD), failure, relapse after CR or PR, cytogenetic response, disease progression). Overall response (OR) defined as CR + PR + mCR
2. Best hematological improvement (HI) according to IWG-MDS 2006 criteria (erythroid HI (HI-E), neutrophil HI (HI-N), platelet HI (HI-P))
3. Best response evaluated according to IWG-HR-MDS 2023 criteria in the first 6 cycles (complete remission (CR), complete remission equivalent (CR equivalent), partial remission (PR), complete remission with limited count recovery (CRL), complete remission with partial hematological recovery (CRh), hematologic improvement (HI), overall response rate (ORR), no response, not evaluable, cytogenetic response, disease progression, disease relapse)
4. Time to response
5. Duration of response
6. Progression to AML
7. Time to next treatment
8. Outcome and survival: Early mortality rate at day 28 ; overall survival (OS) ; event-free-survival (EFS) ; progression-free survival (PFS) ; time to relapse (DFS)
9. RBC and platelet transfusion independence for transfusion-dependent patients at baseline
10. Duration of transfusion independence
11. Toxicity profile including cytopenia duration, life-threatening or fatal cytopenias, unscheduled hospitalization, infectious complications, RBC and platelets transfusions needs
12. Patient-reported outcomes and QoL auto-assessment: Fatigue - FACIT-An (Functionnal Assessment of Chronic Illness Therapy Anemia) ; Health Utility Index - 5 levels of EuroQoL-5D (EQ-5D-5L) ; Patient global impression of change (PGIC) ; Patient global impression of severity (PGIS). Change in QoL from baseline, as measured by questionnaires above.

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 3

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Groupe Francophone Des Myelodysplasies

Sponsor organisation

Groupe Francophone Des Myelodysplasies

Address

Opital St Louis Hemato Seniors T4, 1 Avenue Claude Vellefaux 1 Avenue Claude Vellefaux

City

Paris

Postcode

75010

Country

France

Scientific contact point

Organisation

Groupe Francophone Des Myelodysplasies

Contact name

Colombe SAILLARD

Public contact point

Organisation

Groupe Francophone Des Myelodysplasies

Contact name

Colombe SAILLARD

Locations

1 EU/EEA country · 25 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 7 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

2 submissions — initial application plus substantial / non-substantial modifications