Effectiveness and Safety of Therapy Based on Attenuated ATO Plus Low-Dose ATRA in Patients With APL

NCT05497310 — Phase 1 / Phase 2, Unknown, 15 participants, Hospital Universitario Dr. Jose E. Gonzalez

ClinicalTrials Daily  ·  Areas  ·  Conditions  ·  Drugs  ·  Sponsors  ·  

Effectiveness and Safety of Therapy Based on Attenuated Arsenic Trioxide Plus Low Doses of All-trans Retinoic Acid as Remission Induction Therapy in Patients With Acute Promyelocytic Leukemia Phase 1/2 Clinical Trial

RegistryNCT05497310
StatusUnknown
PhasePhase 1 / Phase 2
Study typeInterventional; na, single group, masking: none, treatment
Enrollment15 (Estimated)
SponsorHospital Universitario Dr. Jose E. Gonzalez (Other)
ConditionsPromyelocytic Leukemia
InterventionsArsenic trioxide, all-trans retinoic acid (Drug)
Datesstart 2022-07-01, primary completion 2025-06-30 (estimated), completion 2025-07-31 (estimated), first posted 2022-08-11, last updated 2022-10-26
Locations1 site in Mexico

Related Papers Related Patents Related Grants Related Experts
All trials for Promyelocytic Leukemia All trials of Arsenic trioxide All trials of all-trans retinoic acid

-Summary

ATRA is the standard of care for all patients with APL. The use of lower doses of ATRA has been shown since the 1990s to achieve therapeutic efficacy with doses of 25mg/m2/day. ATO demonstrated considerable effectiveness in this disease. More recently, an attenuated regimen has been proven to be effective. In this study we intent to demonstrate the effectiveness of combined therapy of low-dose ATRA plus attenuated dose ATO.

Expand all sections  ·  Collapse all

+Detailed description

The use of lower doses of ATRA has been shown since the 1990s to achieve therapeutic plasma concentrations sufficient to achieve therapeutic efficacy with doses of 25mg/m2/day. ATO alone demonstrated considerable effectiveness in this disease. More recently, an attenuated regimen has been proven to be effective in inducing similar remission rates and achieving prolonged survival, also demonstrating a reduction in associated toxicities, mainly hepatic and cardiac when using this new scheme.

The investigators will conduct a phase 1/2, non-randomized, single center, non-comparative clinical trial to demonstrate the effectiveness of combined therapy of low-dose ATRA plus attenuated dose ATO which is accessible to a population with limited resources while maintaining acceptable efficacy and safety.

+Arms and interventions

ArmTypeInterventionsDescription
Induction with attenuated ATO plus low-dose ATRAExperimentalDrug: Arsenic trioxide; Drug: all-trans retinoic acidRemission induction therapy will be administrated as ATRA 25/mg/m2/day for 28 continuous days without interruption if APL is suspected. ATO 0.3mg/kg/day for days 1-5 (5 doses) and then 0.25 mg/kg/day every other day twice a week for the next 3 weeks (6 doses).
  • Arsenic trioxide (Drug), also known as Trisenox: Patients will receive ATO 0.3mg/kg/day for days 1-5 (5 doses) and then 0.25 mg/kg/day every other day twice a week for the next 3 weeks (6 doses).
  • all-trans retinoic acid (Drug), also known as Vesanoid: Patients will receive ATRA 25/mg/m2/day for 28 continuous days without interruption.

+Outcome measures

Primary outcomes

  • Incidence of Treatment-Emergent Adverse Events [28 days]: Safety will be defined by the number of patients deceased after 1 induction cycle of 28 days

Secondary outcomes

  • Overall response [28 days]: Overall response rate was definide as partial response plus complete response after 1
  • Progression-free survival [6 months]: Time from achievement of complete hematologic remission to relapse
  • Event-free survival [6 months]: Time from registration to induction failure, relapse, or death.
  • Rate of treatment discontinuation due to toxicity. [28 days]: Rate of treatment discontinuation due to toxicity.

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age >18 years
* Both genders
* new diagnosis of APL
* Diagnosis of relapsed APL who have not been previously treated with ATO
* Morphological diagnosis of APL confirmed by PCR or FISH

Exclusion Criteria:

* Poor functional status (ECOG>2)
* Organic dysfunction (Marshall score ≥2)
* Pregnancy
* Heart failure (NYHA III or IV)
* Renal failure (GFR <30 ml/min/1.72m2)
* History of ventricular arrhythmias or uncontrolled arrhythmias
* Acute myocardial infarction, unstable angina, or stable angina in the last six months
* Uncontrolled active infection
* Liver disease (Child-Pugh C)

+Locations (1)

FacilityCityCountryStatus
Hopsital Universitario Dr. Jose E. Gonzalez, Centro Universitario contra el CancerMonterrey, Nuevo LeónMexicoRecruiting

+Publications

  • Huang ME, Ye YC, Chen SR, Chai JR, Lu JX, Zhoa L, Gu LJ, Wang ZY. Use of all-trans retinoic acid in the treatment of acute promyelocytic leukemia. Blood. 1988 Aug;72(2):567-72. PMID 3165295
  • Chen GQ, Zhu J, Shi XG, Ni JH, Zhong HJ, Si GY, Jin XL, Tang W, Li XS, Xong SM, Shen ZX, Sun GL, Ma J, Zhang P, Zhang TD, Gazin C, Naoe T, Chen SJ, Wang ZY, Chen Z. In vitro studies on cellular and molecular mechanisms of arsenic trioxide (As2O3) in the treatment of acute promyelocytic leukemia: As2O3 induces NB4 cell apoptosis with downregulation of Bcl-2 expression and modulation of PML-RAR alpha/PML proteins. Blood. 1996 Aug 1;88(3):1052-61. PMID 8704214
  • Castaigne S, Lefebvre P, Chomienne C, Suc E, Rigal-Huguet F, Gardin C, Delmer A, Archimbaud E, Tilly H, Janvier M, et al. Effectiveness and pharmacokinetics of low-dose all-trans retinoic acid (25 mg/m2) in acute promyelocytic leukemia. Blood. 1993 Dec 15;82(12):3560-3. PMID 8260694
  • Chen GQ, Shen ZX, Wu F, Han JY, Miao JM, Zhong HJ, Li XS, Zhao JQ, Zhu J, Fang ZW, Chen SJ, Chen Z, Wang ZY. Pharmacokinetics and efficacy of low-dose all-trans retinoic acid in the treatment of acute promyelocytic leukemia. Leukemia. 1996 May;10(5):825-8. PMID 8656678
  • Jaime-Perez JC, Gonzalez-Leal XJ, Pinzon-Uresti MA, Gomez-De Leon A, Cantu-Rodriguez OG, Gutierrez-Aguirre H, Gomez-Almaguer D. Is There Still a Role for Low-Dose All-Transretinoic Acid in the Treatment of Acute Promyelocytic Leukemia in the Arsenic Trioxide Era? Clin Lymphoma Myeloma Leuk. 2015 Dec;15(12):816-9. doi: 10.1016/j.clml.2015.09.002. Epub 2015 Sep 25. PMID 26500134
  • Burnett AK, Russell NH, Hills RK, Bowen D, Kell J, Knapper S, Morgan YG, Lok J, Grech A, Jones G, Khwaja A, Friis L, McMullin MF, Hunter A, Clark RE, Grimwade D; UK National Cancer Research Institute Acute Myeloid Leukaemia Working Group. Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2015 Oct;16(13):1295-305. doi: 10.1016/S1470-2045(15)00193-X. Epub 2015 Sep 14. PMID 26384238