Combining Ivosidenib and Venetoclax with or without Azacitidine for treating IDH1 mutated blood cancers

Phase Ib/II Investigator Initiated Study of the IDH1-Mutant Inhibitor Ivosidenib (AG120) With the BCL2 Inhibitor Venetoclax +/- Azacitidine in IDH1-Mutated Hematologic Malignancies

This study is testing a combination of two drugs, ivosidenib and venetoclax, with or without azacitidine, to see if it helps people with certain types of blood cancers that have an IDH1 mutation.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 96 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: M.D. Anderson Cancer Center (Academic / other)
• Drugs / interventions: chemotherapy, immunotherapy
• Locations: 4 sites (Boston, Massachusetts and 3 other locations)
• Trial ID: NCT03471260 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the safety and effectiveness of the drug combination of ivosidenib and venetoclax, with or without azacitidine, in patients with IDH1-mutated hematologic malignancies. The study aims to determine the maximum tolerated dose and overall response rate of this combination therapy in treating conditions such as acute myeloid leukemia and myelodysplastic syndromes. It also evaluates the pharmacokinetics of the drugs and explores potential biomarkers for treatment response. The trial is designed to assess both the immediate effects and long-term outcomes of the treatment regimen.

Who should consider this trial

Good fit: Ideal candidates include adults over 18 with IDH1-R132 mutated hematologic malignancies who have relapsed or refractory acute myeloid leukemia or high-risk myelodysplastic syndromes.

Not a fit: Patients without IDH1 mutations or those with rapidly proliferative disease may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new effective option for patients with difficult-to-treat IDH1-mutated hematologic malignancies.

How similar studies have performed: Other studies have shown promise with similar drug combinations in treating hematologic malignancies, suggesting potential for success in this approach.

Eligibility criteria

Inclusion Criteria:

1. Age \> 18 years.
2. ECOG performance status of \< 2.
3. IDH1-R132 mutated disease status as assessed by local laboratory. 2HG-producing IDH1 variants outside of R132 (i.e. R100) may be eligible after discussion with the PI.
4. Relapsed/refractory AML, or treatment-naïve patients with AML who are not eligible for standard induction chemotherapy. Patients with high-risk MDS, MDS/MPN or MPN (defined as \> 10% bone marrow blasts, or intermediate or high risk by IPSS, R-IPSS or D-IPSS) that have failed standard therapy may also be eligible after discussion with the PI.
5. Adequate hepatic function (direct bilirubin \< 2 x ULN, ALT and/or AST \< 3x ULN) unless deemed to be related to underlying leukemia.
6. Adequate renal function including creatinine clearance \> 30 ml/min based on the Cockcroft-Gault equation.
7. Willing and able to provide informed consent
8. In the absence of rapidly proliferative disease, the interval from prior treatment to time of initiation will be at least 7 days for cytotoxic or non-cytotoxic (immunotherapy) agents.
9. Male subjects must agree to refrain from unprotected sex and sperm donation from initial study drug administration until 90 days after the last dose of study drug.

Exclusion Criteria:

1. Patients with known allergy or hypersensitivity to ivosidenib or venetoclax.
2. Patients who have previously received either ivosidenib or venetoclax.
3. Patients with any concurrent uncontrolled clinically significant medical condition including infection, laboratory abnormality, or psychiatric illness, which could place the patient at unacceptable risk of study treatment.
4. The use of other chemotherapeutic agents or anti-leukemic agents is not permitted during study with the following exceptions (1) intrathecal chemotherapy for prophylactic use or for controlled CNS leukemia. (2) use of hydroxyurea and/or one dose of cytarabine (up to 2 g/m2) for patients with rapidly proliferative disease is allowed before the start of study therapy and for the first four weeks on therapy.
5. Patients receiving concomitant strong CYP3A inducers (avasimibe, carbamazepine, phenytoin, rifampin, rifabutin, St. John's wort) within 3 days of start of study therapy.
6. Patients with active graft-versus-host-disease (GVHD) status post stem cell transplant (patients without active GVHD on chronic suppressive immunosuppression and/or phototherapy for chronic skin GVHD are permitted after discussion with the PI).
7. Patients with any severe gastrointestinal or metabolic condition which could interfere with the absorption of oral study medications.
8. Patients with a concurrent active malignancy under treatment.
9. QTc interval using Fridericia's formula (QTcF) \> 450 msec. Bundle branch block and prolonged QTc interval are permitted after discussion with the PI.
10. Known active hepatitis B (HBV) or Hepatitis C (HCV) infection or known HIV infection.
11. Subject has a white blood cell count \> 25 x 10⁹/L. (Note: Hydroxyurea is permitted to meet this criterion.)
12. Nursing women, women of childbearing potential (WOCBP) with positive urine pregnancy test, or women of childbearing potential who are not willing to maintain adequate contraception a. Appropriate highly effective method(s) of contraception include oral or injectable hormonal birth control, IUD, and double barrier methods (for example a condom in combination with a spermicide).

Where this trial is running

Boston, Massachusetts and 3 other locations

• Dana-Farber Cancer Institute — Boston, Massachusetts, United States (Recruiting)
• Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center — Cleveland, Ohio, United States (Recruiting)
• Oregon Health and Science University — Portland, Oregon, United States (Recruiting)
• M D Anderson Cancer Center — Houston, Texas, United States (Recruiting)

Study contacts

• Principal investigator: Courtney DiNardo, MD — M.D. Anderson Cancer Center
• Study coordinator: Courtney DiNardo, MD

Conditions Acute Myeloid Leukemia; Hematopoietic and Lymphoid System Neoplasm; Myelodysplastic Syndrome; Myeloproliferative Neoplasm; Recurrent Acute Myeloid Leukemia; Refractory Acute Myeloid Leukemia