Official Title
A Phase III Trial to Evaluate the Efficacy of the Addition of Inotuzumab Ozogamicin (a Conjugated Anti-CD22 Monoclonal Antibody) to Frontline Therapy in Young Adults (Ages 18-39 Years) With Newly Diagnosed Precursor B-Cell ALL
Summary:
This partially randomized phase III trial studies the side effects of inotuzumab ozogamicin
and how well it works when given with frontline chemotherapy in treating patients with newly
diagnosed B acute lymphoblastic leukemia. Monoclonal antibodies, such as inotuzumab
ozogamicin, may block cancer growth in different ways by targeting certain cells. Drugs used
in chemotherapy work in different ways to stop the growth of tumour cells, either by killing
the cells, by stopping them from dividing, or by stopping them from spreading. Giving
inotuzumab ozogamicin with chemotherapy may work better in treating young adults with B acute
lymphoblastic leukemia.
Trial Description
Primary Outcome:
Secondary Outcome:
- DFS
- OS
- Proportion of patients who achieve CR or any response to induction therapy
- Overall induction response rates
- Incidence of adverse events as assessed by Common Terminology Criteria for Adverse Events version 4.0
- Proportion of patients who go off treatment due to adverse reactions
- Proportion
of patients who refuse further treatment for lesser toxicities that
inhibit their willingness to continue participation on the trial
PRIMARY OBJECTIVES:
-
To confirm tolerability of the combination regimen with the addition of inotuzumab
ozogamicin to the pediatric-inspired regimen of cancer and leukemia group B (CALGB) 10403.
- To determine whether the addition of inotuzumab ozogamicin significantly improves the
event-free survival (EFS) in patients who achieve an induction response achieved with the
pediatric-inspired regimen of CALGB 10403, without censoring for transplant. (Phase III)
SECONDARY OBJECTIVES:
-
To determine the impact of inotuzumab ozogamicin on disease-free (DFS) and overall
survival (OS) in patients who achieve an induction response.
- To determine whether the addition of inotuzumab ozogamicin significantly improves the
event-free survival (EFS) in patients who achieve an induction response achieved with the
pediatric-inspired regimen of CALGB 10403, with censoring for transplant.
- To determine the impact of inotuzumab ozogamicin on minimal residual disease (MRD) and
correlate this with the EFS, DFS and OS.
- To determine the prognosis based on patients' low-density array (LDA) gene signature in
terms of EFS, DFS, and OS after treatment with or without inotuzumab ozogamicin when added to
the C10403 backbone regimen.
- To evaluate the toxicity and tolerability of the addition of inotuzumab ozogamicin to the
pediatric-inspired regimen of CALGB 10403.
TERTIARY OBJECTIVES:
-
To assess both the correlation of MRD post-induction and at sequential timepoints with LDA
signature.
- To evaluate the influence of MRD status (detectable vs. not and as a continuous measure)
in relation to EFS both in the univariate setting as well as adjusting for other clinical
features including initial white blood cell (WBC), ethnicity, gender and age at diagnosis.
- To evaluate the impact of inotuzumab ozogamicin (inotuzumab) on the kinetics of MRD
during treatment with inotuzumab in patients randomized to the experimental treatment arm.
- To perform genomic analyses to identify and evaluate the incidence and clinical
significance of recurring novel fusion genes including those associated with the
BCR-ABL1-like signature and to correlate with MRD status, CR rate, EFS and OS.
- To assess whether rs4958351 is correlated with L-asp allergic reaction in the adolescent
and young adult (AYA) population.
- To assess the incidence of inherited genetic variants in the GR1A1, CEP72, CPA2, TPMT,
NUDT15, GRIN3A, GRIK1, and other genes (which can be found using a whole genome association
study [GWAS]), are correlated with increased rates of target toxicities including peripheral
neuropathy, hepatotoxicity, pancreatitis, myelosuppression, neurotoxicity, thrombosis, and
osteonecrosis, and correlate with treatment discontinuation and other clinical response
parameters including complete response (CR) rate, EFS, and OS.
- To evaluate asparaginase pharmacokinetics in adolescents and young adults, and
investigate its correlation with toxicities and treatment outcomes.
- To investigate the effect of anti-polyethylene glycol (PEG) and anti-agouti signaling
protein (ASP) antibodies (PEG-ASP) on ASP enzyme activity.
- To measure adherence to oral 6 mercaptopurine (MP) and methotrexate in AYAs with acute
lymphoblastic leukemia (ALL) and to examine sociodemographic and behavioural determinants of
adherence.
- To determine the impact of adherence on risk of relapse among AYAs with ALL.
OUTLINE:
COURSE I (REMISSION INDUCTION THERAPY): All patients receive allopurinol orally (PO) once
daily until peripheral blasts and extramedullary disease are reduced and cytarabine
intrathecally (IT) over 1 minute on day 1. Patients also receive daunorubicin hydrochloride
intravenously (IV) and vincristine sulfate IV on days 1, 8, 15 and 22, dexamethasone PO or IV
twice daily (BID) on days 1-7 and 15-21, pegylated L-aspiraginase IV on day 4, 5, or 6, and
methotrexate IT over 1 minute on days 8 and 29. Patients with central nervous system (CNS) 3
disease receive methotrexate IT over 1 minute also on days 15 and 22. All patients then
undergo bone marrow aspirate and biopsy on day 29.
Patients with response to remission induction therapy are randomized to 1 of 2 arms. Patients
with no response are omitted from the study.
ARM I:
COURSE II (REMISSION CONSOLIDATION CHEMOTHERAPY): Patients receive cyclophosphamide IV on
days 1 and 29, cytarabine IV or SC on days 1-4, 8-11, 29-32, and 36-39, mercaptopurine PO on
days 1-14 and 29-42, and vincristine sulfate IV on days 15, 22, 43, and 50. Patients also
receive pegylated L-aspiraginase IV on days 15 and 43, and methotrexate IT on days 1, 8, 15,
and 22. Patients with CNS3 receive methotrexate IT only on days 1 and 8. CD20 positive (+)
patients receive rituximab IV on days 1, 8, 29, and 36. Patients then undergo bone marrow
aspirate and biopsy on day 56.
COURSE III (INTERIM MAINTENANCE CHEMOTHERAPY): Patients receive vincristine sulfate IV on
days 1, 11, 21, 31, and 41, methotrexate IV and IT on days 1, 11, 21, 31, and 41, and
pegylated L-aspiraginase IV on days 2 and 22. CD20+ patients receive rituximab IV on days 1
and 11.
COURSE IV (DELAYED INTENSIFICATION): Patients receive vincristine sulfate IV on days 1, 8,
15, 43, and 50, dexamethasone PO or IV BID on days 1-7 and 15-21, doxorubicin IV on days 1,
8, and 15, and pegylated L-aspiraginase IV on day 4, 5, or 6 and day 43. Patients also
receive cyclophosphamide IV on day 29, cytarabine IV or SC on days 29-32 and 36-39,
thioguanine PO on days 29-42 and methotrexate IT on days 1, 29, and 36. CD20+ patients
receive rituximab IV on days 1 and 8. Patients then undergo bone marrow aspirate and biopsy
on day 50.
COURSE V (MAINTENANCE THERAPY): Patients receive vincristine sulfate IV on days 1, 29, and
57, dexamethasone PO or IV BID on days 1-5, 29-33, and 57-61, and mercaptopurine PO on days
1-84. Patients also receive methotrexate IT or PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64,
71, and 78. Treatment repeats every 12 weeks for up to 3 years in the absence of disease
progression or unacceptable toxicity.
ARM II: Patients receive inotuzumab ozogamicin IV on days 1, 8, and 15 and undergo bone
marrow aspirate and biopsy on day 28. Treatment repeats every 28 days for up to 2 courses in
the absence of disease progression or unacceptable toxicity. Patients also receive remission
consolidated chemotherapy, interim maintenance chemotherapy, delayed intensification, and
maintenance therapy as in Arm I.
After completion of study treatment, patients are followed up every month for the first year,
every 2 months for the second year, every 3 months for the third year, and every 6 months for
the fourth through tenth year.
View this trial on ClinicalTrials.gov
