Trials / Active Not Recruiting

Active Not RecruitingNCT05761171

A Study of Revumenib in Combination With Chemotherapy for Patients Diagnosed With Relapsed or Refractory Leukemia

A Phase 2 Study of SNDX-5613 in Combination With Chemotherapy for Patients With Relapsed or Refractory KMT2A-Rearranged Infant Leukemia

Status: Active Not Recruiting
Phase: Phase 2
Study type: Interventional
Enrollment: 78 (estimated)

Sponsor: Children's Oncology Group · Network
Sex: All
Age: 1 Month – 6 Years
Healthy volunteers: Not accepted

Summary

This phase II trial tests the safety and best dose of revumenib in combination with chemotherapy, and evaluates whether this treatment improves the outcome in infants and young children who have leukemia that has come back (relapsed) or does not respond to treatment (refractory) and is associated with a KMT2A (MLL) gene rearrangement (KMT2A-R). Leukemia is a cancer of the white blood cells, where too many underdeveloped (abnormal) white blood cells, called "blasts", are found in the bone marrow, which is the soft, spongy center of the bones that produces the three major blood cells: white blood cells to fight infection; red blood cells that carry oxygen; and platelets that help blood clot and stop bleeding. The blasts crowd out the normal blood cells in the bone marrow and spread to the blood. They can also spread to the brain, spinal cord, and/or other organs of the body. The leukemia cells of some children have a genetic change in which a gene (KMT2A) is broken and combined with other genes that typically do not interact with one another; this is called "rearranged". This genetic rearrangement alters how other genes are turned on or off in the cell, turning on genes that drive the development of leukemia. Patients with KMT2A rearrangement have higher risk for cancer coming back after treatment. Revumenib is an oral medicine that directly targets the changes that occur in a cell with a KMT2A rearrangement and has been shown to specifically kill these leukemia cells in preclinical laboratory settings and in animals. Drugs used in chemotherapy, such as vincristine, prednisone, asparaginase, fludarabine and cytarabine work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. This trial is being done to find out if the combination of revumenib and chemotherapy would be safe and/or effective in treating infants and young children with relapsed or refractory KMT2A-R leukemia.

Detailed description

PRIMARY OBJECTIVES: I. To determine the recommended phase 2 dose (RP2D) of revumenib administered in combination with chemotherapy in patients with relapsed or refractory (R/R) KMT2A-rearranged (KMT2A-R) acute lymphoblastic leukemia (ALL). II. To estimate the minimal residual disease (MRD) negative remission rate of patients age \>= 6 months at enrollment with R/R infant KMT2A-R ALL treated with revumenib in combination with chemotherapy. SECONDARY OBJECTIVES: I. To characterize the pharmacokinetics (PK) of revumenib administered with chemotherapy in patients with R/R infant KMT2A-R ALL. II. To estimate the 18-month event-free survival (EFS) of patients with R/R infant KMT2A-R ALL treated with revumenib in combination with chemotherapy. III. To estimate 18-month overall survival (OS) of patients with R/R infant KMT2A-R ALL treated with revumenib in combination with chemotherapy. IV. To characterize the tolerability of revumenib given as monotherapy in patients with R/R infant KMT2A-R ALL. EXPLORATORY OBJECTIVES: I. To assess the biologic activity of revumenib administered with chemotherapy in patients with R/R KMT2A-R ALL. II. To estimate the MRD negative remission rate of patients with R/R non-infant KMT2A-R ALL treated with revumenib in combination with chemotherapy. III. To characterize the PK of calaspargase pegol and describe associated toxicities for patients with R/R KMT2A-R ALL. IV. To describe the anti-cancer therapies received before and after administration of revumenib by patients with R/R KMT2A-R ALL. V. To describe the MRD negative remission rate of patients age \< 6 months at enrollment with R/R infant KMT2A-R ALL treated with revumenib in combination with chemotherapy. OUTLINE: Patients with acute lymphoblastic leukemia (ALL), acute leukemia of ambiguous lineage (ALAL), or mixed phenotype acute leukemia (MPAL) are assigned to 1 of 2 regimens, by physician discretion. Patients with acute myeloid leukemia (AML) are assigned to Regimen B. REGIMEN A: COMBINATION CYCLE 1: Patients receive revumenib orally (PO) or via nasogastric (NG), nasojejunal (NJ), nasoduodenal (ND) or gastrostomy tube (G-tube) every 12 hours continuously. Patients also receive "3-drug re-induction" consisting of vincristine intravenously (IV) on days 1, 8, 15, and 22, prednisone or prednisolone PO or via NG, ND, NJ, or G-tube twice daily (BID) on days 1-28, calaspargase pegol IV over 1-2 hours on day 4, as well as methotrexate (MTX) intrathecally (IT) on days 1 and 8 then optionally weekly, hydrocortisone IT, and cytarabine IT. Patients who have early progressive disease may continue to Combination Cycle 2 early before fully completing cycle 1. COMBINATION CYCLE 2: Patients receive revumenib PO or via NG, NJ, ND, or G-tube every 12 hours continuously, "FLA" consisting of fludarabine IV over 60 minutes and high-dose cytarabine IV over 1-3 hours on days 1-5, and MTX IT, hydrocortisone IT, and cytarabine IT on day 0 then optionally on days 8, 15, and 22. After completion of Combination Cycle 2, patients who experienced early progressive disease in Combination Cycle 1 continue to Combination Cycle 3. All other patients proceed to Monotherapy. COMBINATION CYCLE 3: Patients receive revumenib PO or via NG, NJ, ND, or G-tube every 12 hours continuously, "FLA" as in Combination Cycle 2, MTX IT, hydrocortisone IT, and cytarabine IT on day 0. MONOTHERAPY: Patients receive revumenib PO or via NG, NJ, ND, or G-tube every 12 hours continuously. Cycles repeat every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients may also receive MTX IT, hydrocortisone IT, and cytarabine IT on day 0 of cycles 1-2 or day 28 of cycles 2, 4, 8, and 12 as clinically indicated. REGIMEN B: COMBINATION CYCLES 1-2: Patients receive revumenib PO or via NG, ND, NJ, or G-tube every 12 hours continuously, "FLA" IV on days 1-5, and MTX IT, hydrocortisone IT, and cytarabine IT on day 0 of cycles 1-2 and optionally on days 8, 15, and 22 of cycle 1. Cycles repeat every 28 days for 2 cycles. MONOTHERAPY: Patients receive revumenib PO or via NG, ND, NJ, or G-tube every 12 hours continuously. Cycles repeat every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients may also receive MTX IT, hydrocortisone IT, and cytarabine IT on day 0 of cycles 1-2 or day 28 of cycles 2, 4, 8, and 12 as clinically indicated. All patients also undergo echocardiography (ECHO) or multigated acquisition scan (MUGA), collection of blood and cerebrospinal fluid (CSF) samples, lumbar puncture, and bone marrow aspiration throughout the trial.

Conditions

Interventions

Type	Name	Description
PROCEDURE	Biospecimen Collection	Undergo collection of blood and CSF samples
PROCEDURE	Bone Marrow Aspiration	Undergo bone marrow aspiration
DRUG	Calaspargase Pegol	Given IV
DRUG	Cytarabine	Given IV and IT
PROCEDURE	Echocardiography Test	Undergo ECHO
DRUG	Fludarabine Phosphate	Given IV
DRUG	Hydrocortisone Sodium Succinate	Given IT
PROCEDURE	Lumbar Puncture	Undergo lumbar puncture
DRUG	Methotrexate	Given IT
PROCEDURE	Multigated Acquisition Scan	Undergo MUGA scan
DRUG	Prednisolone	Given PO or via NG, NJ, ND or G-tube
DRUG	Prednisone	Given PO or via NG, NJ, ND or G-tube
DRUG	Revumenib	Given PO or via NG, NJ, ND or G-tube
DRUG	Vincristine Sulfate	Given IV

Timeline

Start date: 2024-01-08
Primary completion: 2027-12-31
Completion: 2027-12-31
First posted: 2023-03-09
Last updated: 2026-03-31

Locations

84 sites across 2 countries: United States, Canada

Regulatory

FDA-regulated drug study

Source: ClinicalTrials.gov record NCT05761171. Inclusion in this directory is not an endorsement.