Overview

Ruxolitinib Phosphate or Dasatinib With Chemotherapy in Treating Patients With Relapsed or Refractory Philadelphia Chromosome-Like Acute Lymphoblastic Leukemia

Status:
Completed
Trial end date:
2021-01-20
Target enrollment:
0
Participant gender:
All
Summary
This phase II trial studies the side effects and best dose of ruxolitinib phosphate and how well it works compared to dasatinib when given with chemotherapy in treating patients with Philadelphia chromosome-like acute lymphoblastic leukemia that has come back (relapsed) or has not responded to treatment (refractory). Ruxolitinib phosphate and dasatinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy 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. It is not yet known whether giving ruxolitinib phosphate or dasatinib with chemotherapy works better in treating patients with previously treated acute lymphoblastic leukemia.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
M.D. Anderson Cancer Center
Collaborators:
Incyte Corporation
National Cancer Institute (NCI)
Treatments:
6-Mercaptopurine
Antibodies
Antibodies, Monoclonal
Antineoplastic Agents, Immunological
BB 1101
Cortisone
Cyclophosphamide
Cytarabine
Dasatinib
Daunorubicin
Dexamethasone
Dexamethasone 21-phosphate
Dexamethasone acetate
Doxorubicin
Immunoglobulins
Lenograstim
Leucovorin
Levoleucovorin
Liposomal doxorubicin
Mercaptopurine
Mesna
Methotrexate
Methylprednisolone
Methylprednisolone acetate
Methylprednisolone Hemisuccinate
Prednisolone
Prednisolone acetate
Prednisolone hemisuccinate
Prednisolone phosphate
Prednisone
Rituximab
Vincristine
Criteria
Inclusion Criteria:

- Patients with previously treated B-cell ALL (relapsed and/or refractory after prior
therapy)

- Bone marrow involvement with >= 5% lymphoblasts

- Documented genetic lesion(s) known to confer susceptibility to inhibition by either
ruxolitinib or dasatinib or cytokine receptor-like factor 2 (CRLF2) positivity by flow
cytometry (for the ruxolitinib cohort)

- Eastern Cooperative Oncology Group (ECOG) performance status =< 2

- Total bilirubin < 2.0 mg/dL

- Serum glutamate pyruvate transaminase (SGPT) or serum glutamic oxaloacetic
transaminase (SGOT) < 3 x upper limit of normal (ULN)

- Creatinine < 2 mg/dL

- Females of childbearing potential must have a negative serum or urine beta human
chorionic gonadotropin (beta-hCG) pregnancy test result within 14 days prior to the
first dose of study drugs and must agree to use an effective contraception method
during the study and for 30 days following the last dose of study drug; females of
non-childbearing potential are those who are postmenopausal greater than 1 year or who
have had a bilateral tubal ligation or hysterectomy; appropriate methods of birth
control include the following: any 2 of the following methods used together: birth
control implants, injections, or pills (except for progesterone only pills),
intrauterine device (IUD), vasectomy, tubal ligation, barrier method (female or male
condom with spermicide, cervical cap with spermicide, diaphragm with spermicide); male
condom with spermicide and diaphragm; male condom with spermicide and cervical cap;
unacceptable methods of birth control include using no birth control, withdrawal,
rhythm method, vaginal sponge, any barrier method that does not use spermicide,
progesterone only pills, and using male and female condoms at the same time

- Males who have partners of childbearing potential must agree to use an effective
contraceptive method during the study and for 30 days following the last dose of study
drug

- Patients or their legally authorized representative must provide written informed
consent

Exclusion Criteria:

- Burkitt's leukemia or lymphoma, T-cell ALL or lymphoblastic lymphoma

- Patients having undergone prior allogeneic stem cell transplant within 3 months or
having active graft versus host disease

- Patient is pregnant or breastfeeding

- Patients with uncontrolled active infections (fever >= 38 degrees Celsius [C], septic
shock)

- Isolated extramedullary relapse (i.e. testicular, central nervous system)

- Current or chronic hepatitis B or C infection, or known seropositivity for human
immunodeficiency virus (HIV)

- Concurrent chemotherapy (except intrathecal chemotherapy)

- Major surgery within 4 weeks prior to first study dose

- Systemic chemotherapy/radiotherapy/investigational therapy within 14 days (with the
exception of hydroxyurea and steroids) prior to starting therapy; for patients
receiving ALL maintenance with 6-mercaptopurine, methotrexate, vincristine, and
steroids - these agents should be discontinued at least 48 hours prior to start of
study drugs; for patients on oral targeted therapies (such as imatinib, dasatinib,
ponatinib), - these agents should be discontinued at least 48 hours prior to start of
study drugs

- Patients must have recovered from acute non hematologic toxicity (to =< grade 1) of
all previous therapy prior to enrollment

- Known active central nervous system (CNS) leukemia, as defined by unequivocal
morphologic evidence of lymphoblasts in the cerebrospinal fluid (CSF), use of
CNS-directed local treatment for active disease within the prior 28 days, symptomatic
CNS leukemia (i.e., cranial nerve palsies or other significant neurologic dysfunction)
within 28 days; patients may have history of CNS leukemic involvement if definitively
treated with prior therapy and no evidence of active disease (defined as >= 2
consecutive spinal fluid assessments with no evidence of disease) at the time of
registration; prophylactic intrathecal chemotherapy is not a criterion for exclusion

- Patients with active heart disease (New York Heart Association [NYHA] class 3-4 as
assessed by history and physical examination, unstable angina/stroke/myocardial
infarction within the last 6 months)

- Patients with a cardiac ejection fraction (as measured by either multi-gated
acquisition [MUGA] scan or echocardiogram) < 40%; (Note: patients who have had prior
anthracycline exposure of > 250 mg/m^2 may be eligible after discussion with the
principal investigator [PI])

- Second malignancy other than basal cell or squamous cell carcinoma of the skin or in
situ carcinoma of the cervix or the breast, unless they are successfully treated with
curative intent for more than 2 years before entering the study

- Malabsorption syndrome or other conditions that preclude enteral route of
administration

- Patients requiring strong cytochrome P450, family 3, subfamily A, polypeptide 4
(CYP3A4) inhibitors

- Other severe acute or chronic medical or psychiatric condition or laboratory
abnormality that in the opinion of the investigator may increase the risk associated
with study participation or investigational product administration or may interfere
with the interpretation of study results and/or would make the patient inappropriate
for enrollment into this study