VAH vs VA in Newly Diagnosed Elderly AML

Официальное название

Venetoclax, Azacitidine Combined With Homoharringtonine Versus Venetoclax and Azacitidine in Newly Diagnosed Elderly (60-75 Years) Acute Myeloid Leukemia: A Multicenter, Open-label, Randomized, Controlled Clinical Trial

Обзор

This is a multicenter, open-label, randomized, controlled phase III clinical trial designed to evaluate the efficacy and safety of the combination of Venetoclax, Azacitidine, and Homoharringtonine (VAH) compared to Venetoclax and Azacitidine (VA) alone in newly diagnosed elderly patients with Acute Myeloid Leukemia (AML). A total of 308 treatment-naïve patients aged 60-75 years with AML (non-APL) will be enrolled and randomly assigned in a 1:1 ratio to either the control arm (VA) or the experimental arm (VAH). The study aims to determine if the addition of Homoharringtonine to the standard VA regimen can improve response rates. To mitigate bias in this open-label study, the primary and key secondary efficacy endpoints will be assessed by an Independent Review Committee or central laboratory blinded to treatment allocation.

Вмешательства

• Препарат Venetoclax
  Venetoclax: 100 mg orally on Day 1, 200 mg on Day 2, then 400 mg orally on Days 3-28 of a 28-day cycle (dose ramp-up recommended for newly diagnosed patients).
• Препарат Azacitidine
  Azacitidine: 75 mg/m² subcutaneously or intravenously on Days 1-7.
• Препарат Homoharringtonine
  Homoharringtonine (HHT): 1 mg/m² intravenously on Days 1-7.

Первичные конечные точки

• Composite Complete Remission Rate (CRc) [Срок оценки: Up to approximately 8 weeks (from randomization to initiation of Cycle 3; each cycle is planned as 28 days).]

Вторичные конечные точки (6)

• Event-Free Survival (EFS) [Срок оценки: up to 36 months]
• Overall Survival (OS) [Срок оценки: up to 36 months]
• CR/CRi Rate by Cycle 1 and Cycle 2 [Срок оценки: End of Cycle 1 and end of Cycle 2 (each cycle is planned as 28 days; assessments performed prior to initiation of Cycle 2 and Cycle 3)]
• Complete Remission (CR) Rate [Срок оценки: From randomization through the end of Cycle 3 (approximately 12 weeks).]
• Minimal Residual Disease (MRD) Negativity Rate [Срок оценки: Up to 2 years after completion of treatment.]
• Time to First Composite Complete Remission (CR or CRi) [Срок оценки: From randomization until the first documented CR or CRi during study treatment (up to approximately 12 months).]

Критерии участия

Критерии включения

• Diagnosis of acute myeloid leukemia (AML), non-APL, according to the 2022 International Consensus Classification (ICC) criteria.
• Age 60 to 75 years, inclusive.
• Life expectancy of at least 12 weeks.
• Eastern Cooperative Oncology Group (ECOG) performance status 0 to 3.
• Adequate organ function unless abnormalities are considered due to leukemic organ involvement:

Serum creatinine ≤ 1.5 × upper limit of normal (ULN). Oxygen saturation > 92% on room air. Total bilirubin ≤ 3.0 × ULN. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3.0 × ULN.

If laboratory abnormalities are considered due to leukemic organ involvement, total bilirubin ≤ 5.0 × ULN and ALT/AST ≤ 5.0 × ULN are permitted.

• Female subjects of childbearing potential must be postmenopausal or surgically sterile. Male subjects must agree to use effective contraception or abstain from sperm donation from study start through 90 days after the last dose of study treatment.
• Ability to understand and voluntarily sign an informed consent form prior to any study-related procedures.

Критерии исключения

• Prior treatment with hypomethylating agents for myelodysplastic syndrome (MDS). Prior chemotherapy for AML, except hydroxyurea. Prior CAR-T cell therapy.
• Prior investigational therapy for AML.
• Documented history of myeloproliferative neoplasm (MPN).
• Favorable-risk AML according to 2022 European LeukemiaNet (ELN) criteria.
• Known active central nervous system (CNS) involvement of AML.
• Known human immunodeficiency virus (HIV) infection.
• Active hepatitis B or hepatitis C requiring antiviral therapy. Risk of hepatitis B reactivation (hepatitis B surface antigen positive or hepatitis B core antibody positive without antiviral prophylaxis).
• History of another malignancy within 5 years prior to screening, except adequately treated cervical carcinoma in situ, basal cell or squamous cell skin cancer, localized prostate cancer treated with curative intent, or ductal carcinoma in situ treated with curative intent.
• Unstable systemic disease including unstable angina, cerebrovascular accident, or transient ischemic attack within 3 months prior to screening. Myocardial infarction within 3 months prior to screening. Congestive heart failure New York Heart Association class III or IV. Recent pacemaker implantation. Severe liver, kidney, or metabolic disease requiring ongoing treatment. Pulmonary arterial hypertension. Clinically significant or uncontrolled arrhythmias including persistent atrial fibrillation or flutter, symptomatic ventricular arrhythmias, QTc ≥ 470 ms in males or ≥ 480 ms in females, second- or third-degree atrioventricular block without pacemaker, or arrhythmias requiring continuous antiarrhythmic therapy.
• Malabsorption syndrome or any condition preventing enteral drug administration. Active systemic infection requiring treatment.
• Significant neurological or psychiatric disorders requiring treatment including epilepsy grade 2 or higher, paralysis, aphasia, recent cerebral infarction, severe traumatic brain injury, dementia, Parkinson's disease, or schizophrenia.
• Fertile males or females of childbearing potential unwilling to use effective contraception during treatment and for 12 months after completion of treatment.
• White blood cell count > 25 × 10⁹/L at screening (hydroxyurea permitted to reduce count to meet eligibility).

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Китай · 1 центр

• Shanghai General Hospital — Шанхай

Публикации

• Peyrade F, Gastaud L, Re D, Pacquelet-Cheli S, Thyss A. Treatment decisions for elderly patients with haematological malignancies: a dilemma. Lancet Oncol. 2012 Aug;13(8):e344-52. doi: 10.1016/S1470-2045(12)70234-6. PMID 22846839
• Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, Wang SA, Bagg A, Barbui T, Branford S, Bueso-Ramos CE, Cortes JE, Dal Cin P, DiNardo CD, Dombret H, Duncavage EJ, Ebert BL, Estey EH, Facchetti F, Foucar K, Gangat N, Gianelli U, Godley LA, Gokbuget N, Gotlib J, Hellstrom-Lindberg E, Hobbs GS, Hoffman R, Jabbour EJ, Kiladjian JJ, Larson RA, Le Beau MM, Loh ML, Lowenberg B, Maci PMID 35767897

Идентификаторы

NCT: NCT07469046 · SHSYXY-202508-VAH-VA

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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