Pacritinib + Azacitidine for Leukemia

Overseen By Katherine Vandris

Age: 18+

Sex: Any

Trial Phase: Phase 1 & 2

Sponsor: Douglas Tremblay

Must not be taking: CYP3A4 inhibitors, CYP450 inducers

Disqualifiers: Active GVHD, Serious infection, Others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

26 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests the combination of two drugs, pacritinib (a JAK inhibitor) and azacitidine (a hypomethylating agent), to determine their effectiveness in treating Chronic Myelomonocytic Leukemia (CMML), a cancer affecting blood cells. Researchers are particularly interested in how these drugs work together for individuals who have never used a JAK inhibitor and may have taken up to one cycle of a hypomethylating agent. This trial suits those diagnosed with CMML, who haven't tried JAK inhibitors, and are experiencing symptoms like very high white blood cell counts. As a Phase 1, Phase 2 trial, the research focuses on understanding the treatment's effects and measuring its effectiveness in an initial, smaller group.

Will I have to stop taking my current medications?

The trial requires that you stop taking certain medications, such as strong CYP3A4 inhibitors or strong CYP450 inducers, at least 14 days before starting the trial. Additionally, you must stop any medications that increase the risk of bleeding, like certain blood thinners, 14 days before the trial begins.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that the combination of pacritinib and azacitidine might be safe and generally well-tolerated. Previous studies tested this combination in patients with blood disorders like Chronic Myelomonocytic Leukemia (CMML) and suggested that patients usually experienced manageable side effects.

Pacritinib blocks certain enzymes that cancer cells need to grow, while azacitidine can slow down or stop cancer cell growth. Together, they have shown promise in treating patients without causing severe harm.

Although more research is needed to confirm their safety, reaching this stage of testing indicates some confidence in their safety for humans. Always consult healthcare providers to make the best choice for individual needs. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising for leukemia?

Researchers are excited about the combination of Pacritinib and Azacitidine for leukemia because it offers a fresh approach compared to current treatments. Unlike standard options that primarily focus on chemotherapy or other kinase inhibitors, Pacritinib targets specific signaling pathways involved in cancer cell growth, potentially offering a more precise attack on leukemia cells. Additionally, Pacritinib is taken orally, which can be more convenient compared to treatments requiring intravenous administration. This combination might enhance the overall effectiveness and reduce the side effects often seen with traditional treatment methods.

What evidence suggests that this treatment might be an effective treatment for leukemia?

Research has shown that using pacritinib with azacitidine, the combination studied in this trial, may help treat Chronic Myelomonocytic Leukemia (CMML). Pacritinib might stop cancer cells from growing by blocking certain necessary proteins, while azacitidine helps by slowing or stopping cell growth. Studies have found that pacritinib can enhance the effects of azacitidine. Early results suggest this combination could be a useful approach for people with CMML. ^{1 2 3 6 7}

Who Is on the Research Team?

Douglas Tremblay, MD

Principal Investigator

Icahn School of Medicine

Are You a Good Fit for This Trial?

Adults diagnosed with Chronic Myelomonocytic Leukemia (CMML) who haven't taken JAK inhibitors and have had at most one cycle of hypomethylating agents. They should be in a specific risk category, have a life expectancy over 24 weeks, and an ECOG status ≤3. Participants must not have certain other health conditions or recent treatments that could interfere with the study.

Inclusion Criteria

Participants must have a life expectancy of at least 24 weeks per investigator.

Females of reproductive potential should use effective contraception during treatment with azacitidine and for 6 months after the last dose and males with female partners of reproductive potential should use effective contraception during treatment with azacitidine and for 3 months after the last dose.

I have never taken JAK inhibitor medications.

Exclusion Criteria

I do not have uncontrolled HIV.

If a patient is identified to have COVID-19 during the screening period, participants may be considered eligible if in the opinion of the investigator there are no COVID-19 sequlae that may place the patient at a higher risk of receiving investigational treatment.

I have not had serious heart problems in the last 6 months.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Phase 1

Pacritinib is tested at a dose of 200mg twice daily in combination with azacitidine 75mg/m2 for 7 days in a 28-day cycle. Dose escalation to pacritinib 100mg twice daily if needed.

up to 6 cycles (each cycle is 28 days)

Treatment Phase 2

Continuation of treatment with the recommended phase 2 dose (RP2D) using a Simon two-stage design. Includes interim analysis for futility.

up to 6 cycles (each cycle is 28 days)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of adverse events and overall survival.

up to 24 months

What Are the Treatments Tested in This Trial?

Interventions

• Azacitidine
• Pacritinib

Trial Overview The trial is testing pacritinib combined with azacitidine on CMML patients. It starts with phase 1 to find the safest dose level, followed by phase 2 to assess effectiveness using criteria from the MDS/MPN IWG. The treatment involves taking pacritinib twice daily and azacitidine for seven days every four-week cycle.

How Is the Trial Designed?

Group I: Pacritinib in combination with Azacitidine Experimental Treatment 2 Interventions

Participants will take pacritinib 200 mg BID for each 28 day cycle, azacitidine 75mg/m2 will be administered IV or SQ QD D1-7 of each 28 day cycle

Azacitidine is already approved in European Union, United States, Canada, Japan for the following indications:

Approved in European Union as Vidaza for:

• Acute myeloid leukemia
• Chronic myelomonocytic leukemia
• Myelodysplastic syndromes

Approved in United States as Vidaza for:

• Myelodysplastic syndromes
• Chronic myelomonocytic leukemia

Approved in Canada as Vidaza for:

• Myelodysplastic syndromes
• Acute myeloid leukemia

Approved in Japan as Vidaza for:

• Myelodysplastic syndromes
• Acute myeloid leukemia

Who Is Running the Clinical Trial?

Douglas Tremblay

Lead Sponsor

Trials

1

Recruited

30+

Sobi, Inc.

Industry Sponsor

Trials

14

Recruited

1,000+

Published Research Related to This Trial

In a study of 149 patients with higher-risk myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML), azacitidine treatment resulted in a median progression-free survival (PFS) of 10.9 months and an overall survival (OS) of 14.1 months, demonstrating its effectiveness in a real-world clinical setting.

The safety profile of azacitidine was consistent with previous clinical trials, and factors such as Eastern Cooperative Oncology Group (ECOG) performance status and red blood cell transfusion prior to treatment were identified as predictive factors for better PFS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of performance status and transfusion dependency on outcome of patients with myelodysplastic syndrome, acute myeloid leukemia and chronic myelomonocytic leukemia treated with azacitidine (PIAZA study). Wehmeyer, J., Zaiss, M., Losem, C., et al.[2019]

In a real-life study of 49 patients with myelodysplastic syndrome (MDS), acute myeloid leukaemia (AML), and chronic myelomonocytic leukaemia (CMML), azacitidine demonstrated a clinically acceptable safety profile, with 67.3% of patients experiencing treatment-related adverse events.

Efficacy results showed that 41.4% of MDS and CMML patients achieved a complete or partial response, and 43.8% of transfusion-dependent patients became transfusion-independent, with a median overall survival of 490 days.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of azacitidine in Belgian patients with high-risk myelodysplastic syndromes, acute myeloid leukaemia, or chronic myelomonocytic leukaemia: results of a real-life, non-interventional post-marketing survey. Beguin, Y., Selleslag, D., Meers, S., et al.[2015]

Azacitidine (Vidaza) has received approval for the treatment of juvenile myelomonocytic leukemia, a rare blood cancer primarily affecting children under the age of four.

This approval highlights the drug's potential efficacy in addressing a specific and challenging pediatric cancer, providing a new treatment option for affected children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Drug Receives New Indication for Juvenile Myelomonocytic Leukemia. Aschenbrenner, DS.[2022]

Azacitidine (Vidaza) is the only drug approved in the EU that significantly prolongs survival in adults with high-risk myelodysplastic syndromes (MDS) and acute myeloid leukaemia (AML), making it a crucial treatment option for patients not eligible for stem cell transplantation.

The treatment is associated with a lower risk of AML progression and higher rates of remission and blood transfusion independence, while maintaining an acceptable safety profile, with peripheral cytopenias being the most common side effect.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Azacitidine: a review of its use in higher-risk myelodysplastic syndromes/acute myeloid leukaemia. Keating, GM.[2021]

Histone deacetylase inhibitors (HDACi) like trichostatin A (TSA) and valproic acid (VPA) significantly enhance the effectiveness of etoposide in inducing apoptosis in HL60 leukemia cells, indicating a potential for improved cancer treatment strategies.

The synergistic effect of combining HDACi with etoposide on apoptosis is cell-type dependent, as similar results were not observed in U937 cells, highlighting the importance of considering specific cancer characteristics in treatment plans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of histone deacetylase inhibitors trichostatin A and valproic acid on etoposide-induced apoptosis in leukemia cells. Jasek, E., Lis, GJ., Jasinska, M., et al.[2013]

The Vidaza Access Program in Belgium successfully facilitated access to azacitidine treatment for 175 patients with myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), and chronic myelomonocytic leukemia (CMML) by streamlining the approval process for patient dossiers.

Out of the 175 patient dossiers submitted, 163 were approved by Celgene, demonstrating the program's effectiveness in ensuring timely treatment initiation without financial risk to hospitals, which is crucial for patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Azacitidine access program for Belgian patients with myelodysplastic syndromes, acute myeloid leukemia or chronic myelomonocytic leukemia. Meers, S., Selleslag, D., Potier, H., et al.[2018]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT07148947

Pacritinib With Standard of Care Azacitidine or Decitabine ... Pacritinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Azacitidine and decitabine are in a class ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0006497123098506

Phase 1/2 Study of Pacritinib in Combination with ... In this phase 1/2 trial, we will evaluate the safety and efficacy of pacritinib and azacitidine in newly diagnosed or previously treated CMML.

3. ash.confex.com ash.confex.com/ash/2015/webprogramscheduler/Paper83828.html

Pacritinib (PAC) Synergistically Potentiates Azacitidine ... These data identified PAC as a preclinical therapeutic in CMML that is synergistic with 5AZA and may serve as a clinical feasible therapeutic strategy.

4. cancer.gov cancer.gov/research/participate/clinical-trials-search/v?id=NCI-2024-00051

Pacritinib in Combination with Azacitidine for the Treatment ... This phase I/II trial studies the safety, best dose, and effectiveness of pacritinib in combination with azacitidine in treating patients with ...

5. mpncancerconnection-org.clinicaltrialconnect.com mpncancerconnection-org.clinicaltrialconnect.com/trials/NCT06159491

Pacritinib in CMML - MPN Cancer Connection This is a phase 1/2 trial of pacritinib in combination with azacitidine in patients with Chronic Myelomonocytic Leukemia (CMML). ... data on effectiveness ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT02323607

NCT02323607 | Pacritinib and Chemotherapy in Treating ... This phase I trial studies the side effects and best dose of pacritinib when given together with chemotherapy in treating patients with acute myeloid leukemia ...

7. researchgate.net researchgate.net/publication/376157864_Phase_12_Study_of_Pacritinib_in_Combination_with_Azacitidine_in_Chronic_Myelomonocytic_Leukemia

Phase 1/2 Study of Pacritinib in Combination with ... Methods In this phase 1/2 trial, we will evaluate the safety and efficacy of pacritinib and azacitidine in newly diagnosed or previously treated CMML. Patients ...