Belinostat and Azacitidine in Treating Patients With Advanced Hematologic Cancers or Other Diseases

Conditions:Cancer, Other Indications, Blood Cancer, Women's Studies, Hematology
Therapuetic Areas:Hematology, Oncology, Other, Reproductive
Age Range:Any
Start Date:June 2006

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A Phase I Study of PXD101 in Combination With Azacitidine (5-Aza) for Advanced Hematologic Malignancies

This phase I trial is studying the side effects and best dose of belinostat when given
together with azacitidine in treating patients with advanced hematologic cancers or other
diseases. Belinostat may stop the growth of cancer cells by blocking some of the enzymes
needed for cell growth and by blocking blood flow to the cancer. Drugs used in chemotherapy,
such as azacitidine, work in different ways to stop the growth of cancer cells, either by
killing the cells or by stopping them from dividing. Giving belinostat together with
azacitidine may kill more cancer cells


I. Determine the maximum tolerated dose of PXD101 (belinostat) when given in combination
with azacitidine (when azacitidine is utilized at a dose range where its effects on cellular
differentiation are known to be predominant) in patients with advanced hematologic cancers
or other diseases.


I. Identify any additive or synergistic effects of this regimen on pharmacodynamic
parameters, including apoptosis and re-expression of specific target genes.

II. Assess any evidence of clinical activity (complete remission, partial remission,
hematologic improvement, stable disease) of this regimen in these patients.

OUTLINE: This is a dose-escalation study of belinostat followed by a randomized study.

Patients receive azacitidine subcutaneously (SC) and belinostat intravenously (IV) over 30
minutes on days 1-5. Courses repeat every 28 days in the absence of disease progression or
unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of belinostat until
the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding
that at which 2 of 6 patients experience dose-limiting toxicity. After the MTD is
determined, additional patients with myelodysplastic syndromes (MDS) or acute myeloid
leukemia (with trilineage dysplasia or arising from MDS) are randomized to 1 of 2 treatment

Arm I: Patients receive azacitidine SC on days 1-5.

Arm II: Patients receive azacitidine as in arm I and belinostat at the MTD IV over 30
minutes on days 1-5.

In both arms, courses repeat every 28 days in the absence of disease progression or
unacceptable toxicity. After receiving one course, patients randomized to arm I may
crossover to receive treatment on arm II.

For patients enrolled in the randomized portion of the study, bone marrow aspirates are
obtained at baseline, and after course 1 for correlative studies. Samples are examined by
gene expression analysis of p15 and p21, DNA methylation of p15INK4B, and apoptosis by
RT-PCR and flow cytometry. Pharmacodynamic assays are also performed.

After completion of study treatment, patients are followed periodically for up to 2 years.

Inclusion Criteria:

- Histologically confirmed diagnosis of 1 of the following:

- Relapsed or refractory acute myeloid leukemia (AML)

- Relapsed or refractory acute promyelocytic leukemia (must have failed both
tretinoin and arsenic trioxide)

- Relapsed or refractory acute lymphoblastic leukemia

- Secondary AML, including AML arising from antecedent hematologic diseases, such
as myelodysplastic syndromes (MDS) or myeloproliferative disorders, OR
therapy-related AML

- Chronic myelogenous leukemia in accelerated or blast phase

- Advanced phases of Philadelphia chromosome-negative (Ph-) chronic
myeloproliferative disorders, as defined by ≥ 1 of the following:

- Presence of anemia (hemoglobin < 10 g/dL and/or red blood cell transfusion

- Presence of palpable splenomegaly

- MDS, including chronic myelomonocytic leukemia

- Must have intermediate or high-risk International Prognostic Scoring System
(IPSS) scores (≥ 0.5)

- Low-risk IPSS scores allowed provided ≥ 1 of the following criteria are

- Hemoglobin < 10 g/dL and/or red blood cell transfusion dependent

- Platelet count < 50,000/mm³

- Absolute neutrophil count < 1,000/mm³

- Refractory disease OR no standard therapy exists

- Evidence of AML associated with dysplasia on bone marrow histology for elderly
patients (i.e., > 60 years old) who are previously untreated and not candidates for
or unwilling to undergoing induction therapy

- No known active CNS involvement with disease

- CALGB performance status (PS) 0-2 OR Karnofsky PS 60-100%

- Bilirubin ≤ 2.0 mg/dL (unless due to Gilbert's syndrome)

- ALT ≤ 3 times upper limit of normal (unless due to disease)

- Creatinine ≤ 2 mg/dL

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to PXD101 or Azacitidine

- No history of allergic reactions to mannitol

- No history of dose-limiting toxicity during prior treatment with Azacitidine

- No concurrent uncontrolled illness including, but not limited to, the following:

- Ongoing or active infection

- Symptomatic congestive heart failure

- Unstable angina pectoris

- Cardiac arrhythmia

- Psychiatric illness or social situation that would preclude compliance with
study requirements

- No marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a
QTc interval > 500 msec)

- No long QT syndrome

- No uncontrolled cardiovascular disease, including the following:

- Severe uncontrolled hypertension

- Uncontrolled congestive heart failure related to primary cardiac disease

- Uncontrolled cardiac arrhythmia

- Uncontrolled ischemic or severe valvular heart disease

- Myocardial infarction within the past 6 months

- See Disease Characteristics

- Recovered from prior therapy

- At least 2 weeks since prior chemotherapy (6 weeks for mitomycin C or nitrosoureas)

- At least 2 weeks since prior radiotherapy

- At least 4 weeks since prior investigational agents

- At least 24 hours since prior hydroxyurea

- At least 2 weeks since prior valproic acid

- No concurrent combination antiretroviral therapy for HIV-positive patients

- No other concurrent investigational agents

- No concurrent medication that may cause torsade de pointes

- No other concurrent anticancer therapy, including chemotherapy, radiotherapy, or
biological agents
We found this trial at
5841 S Maryland Ave
Chicago, Illinois 60637
University of Chicago Comprehensive Cancer Center The University of Chicago Comprehensive Cancer Center (UCCCC) is...
Chicago, IL
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600 Highland Ave
Madison, Wisconsin 53792
(608) 263-6400
University of Wisconsin Hospital and Clinics UW Health strives to meet the health needs of...
Madison, WI
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