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    Clinical Trial Results:
    A randomized phase II multicenter study with a safety run-in to assess the tolerability and efficacy of the addition of oral tosedostat to standard induction therapy in AML and RAEB ≥ 66 years and very poor risk AML ≥ 18 years. A study in the frame of the masterprotocol of parallel randomized phase II studies in elderly AML

    Summary
    EudraCT number
    2009-014455-68
    Trial protocol
    NL   BE   NO  
    Global end of trial date
    19 Sep 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Jan 2026
    First version publication date
    03 Jan 2026
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    HOVON103AMLTosedostat
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    HOVON
    Sponsor organisation address
    Dr. Molewaterplein 40, Rotterdam, Netherlands,
    Public contact
    HOVON Data Center, Erasmus MC, +31 107041560, hdc@erasmusmc.nl
    Scientific contact
    HOVON Data Center, Erasmus MC, +31 107041560, hdc@erasmusmc.nl
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    29 Dec 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Dec 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Sep 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    For part A of the study (if applicable): 1. To assess the safety and tolerability of tosedostat added to standard induction chemotherapy for AML (frequency and severity of toxicities and the durations of neutropenia and thrombocytopenia) and select the feasible dose level for part B 2. To assess in a randomized comparison the effect of tosedostat on the CR rate. For part B: 1. To assess the safety and tolerability of tosedostat added to standard induction chemotherapy for AML (frequency and severity of toxicities and the durations of neutropenia and thrombocytopenia) as regards the selected dose level of tosedostat 2. To assess in a randomized comparison the effect of tosedostat on the CR rate.
    Protection of trial subjects
    Insurance and monitoring
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Sep 2010
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Switzerland: 34
    Country: Number of subjects enrolled
    Netherlands: 192
    Country: Number of subjects enrolled
    Belgium: 54
    Worldwide total number of subjects
    280
    EEA total number of subjects
    246
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    280
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    All subjects gave written informed consent and were screened according to the inclusion- and exclusion criteria

    Period 1
    Period 1 title
    Overall period
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Control Group
    Arm description
    -
    Arm type
    Active comparator

    Investigational medicinal product name
    Daunomycin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Daunomycin Days 45mg/m2 3hr infusion on days 1,2,3

    Investigational medicinal product name
    Cytarabine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7

    Arm title
    Experimental
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Daunomycin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Daunomycin Days 45mg/m2 3hr infusion on days 1,2,3

    Investigational medicinal product name
    Cytarabine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7

    Investigational medicinal product name
    Tosedostat
    Investigational medicinal product code
    CHR2797
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    120, 180 or 240 mg/day for part A as dose finding phase. Part B onwards: dose of 120mg/day days 1 thru 56 Stop after day 35 if platelets < 30x109/l and/or ANC< 0.5x109/l

    Number of subjects in period 1
    Control Group Experimental
    Started
    141
    139
    Completed
    90
    52
    Not completed
    51
    87
         Adverse reactions
    18
    28
         Consent withdrawn by subject
    -
    8
         Other
    11
    9
         Lack of efficacy
    22
    42

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall period
    Reporting group description
    -

    Reporting group values
    Overall period Total
    Number of subjects
    280 280
    Age categorical
    Units: Subjects
        From 65-84 years
    280 280
    Age continuous
    Units: years
        median (full range (min-max))
    70 (66 to 81) -
    Gender categorical
    Units: Subjects
        Female
    101 101
        Male
    179 179

    End points

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    End points reporting groups
    Reporting group title
    Control Group
    Reporting group description
    -

    Reporting group title
    Experimental
    Reporting group description
    -

    Primary: Primary endpoint

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    End point title
    Primary endpoint [1]
    End point description
    End point type
    Primary
    End point timeframe
    See publication
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: See attached chart/documents for results
    End point values
    Control Group Experimental
    Number of subjects analysed
    141
    139
    Units: Whole
    141
    139
    Attachments
    List of reported non-SAE's
    List of reported SAE's
    Statistical data section from publication
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events will be reported from the first study-related procedure until 30 days following the last protocol treatment or until the start of subsequent systemic therapy for the disease under study, if earlier.
    Adverse event reporting additional description
    Adverse events occurring after 30 days should also be reported if considered related to study drug. Grade 3 or 4 adverse events considered related to study drug must be followed until recovery or until 6 months after the last protocol treatment, whichever comes first.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4
    Reporting groups
    Reporting group title
    Control Group
    Reporting group description
    -

    Reporting group title
    Experimental
    Reporting group description
    -

    Serious adverse events
    Control Group Experimental
    Total subjects affected by serious adverse events
         subjects affected / exposed
    55 / 141 (39.01%)
    87 / 135 (64.44%)
         number of deaths (all causes)
    108
    126
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Additional description: All combined
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 135 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Vascular disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 141 (0.71%)
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    General disorders and administration site conditions
    Additional description: All combined
         subjects affected / exposed
    2 / 141 (1.42%)
    8 / 135 (5.93%)
         occurrences causally related to treatment / all
    2 / 2
    6 / 8
         deaths causally related to treatment / all
    1 / 1
    4 / 4
    Immune system disorders
    Immune system disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 135 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
    Additional description: All combined
         subjects affected / exposed
    12 / 141 (8.51%)
    13 / 135 (9.63%)
         occurrences causally related to treatment / all
    9 / 12
    12 / 15
         deaths causally related to treatment / all
    4 / 5
    6 / 7
    Psychiatric disorders
    Psychiatric disorders
    Additional description: All combined
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
    Additional description: All combined
         subjects affected / exposed
    1 / 141 (0.71%)
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac disorders
    Additional description: All combined
         subjects affected / exposed
    7 / 141 (4.96%)
    15 / 135 (11.11%)
         occurrences causally related to treatment / all
    4 / 7
    12 / 15
         deaths causally related to treatment / all
    2 / 2
    3 / 5
    Nervous system disorders
    Nervous system disorders
    Additional description: All combined
         subjects affected / exposed
    6 / 141 (4.26%)
    9 / 135 (6.67%)
         occurrences causally related to treatment / all
    3 / 6
    4 / 9
         deaths causally related to treatment / all
    1 / 2
    0 / 3
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
    Additional description: All combined
         subjects affected / exposed
    4 / 141 (2.84%)
    4 / 135 (2.96%)
         occurrences causally related to treatment / all
    4 / 4
    3 / 4
         deaths causally related to treatment / all
    2 / 2
    0 / 1
    Eye disorders
    Eye disorders
    Additional description: All combined
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal disorders
    Additional description: All combined
         subjects affected / exposed
    7 / 141 (4.96%)
    6 / 135 (4.44%)
         occurrences causally related to treatment / all
    5 / 7
    5 / 7
         deaths causally related to treatment / all
    3 / 3
    0 / 0
    Hepatobiliary disorders
    Hepatobiliary disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 135 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
    Additional description: All combined
         subjects affected / exposed
    0 / 141 (0.00%)
    1 / 135 (0.74%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal and urinary disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 141 (0.71%)
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    1 / 1
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Infections and infestations
    Infections and infestations
    Additional description: All combined
         subjects affected / exposed
    22 / 141 (15.60%)
    49 / 135 (36.30%)
         occurrences causally related to treatment / all
    21 / 23
    45 / 53
         deaths causally related to treatment / all
    8 / 8
    22 / 24
    Metabolism and nutrition disorders
    Metabolism and nutrition disorders
    Additional description: All combined
         subjects affected / exposed
    2 / 141 (1.42%)
    2 / 135 (1.48%)
         occurrences causally related to treatment / all
    2 / 2
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Control Group Experimental
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    134 / 141 (95.04%)
    133 / 135 (98.52%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Additional description: All combined
         subjects affected / exposed
    4 / 141 (2.84%)
    0 / 135 (0.00%)
         occurrences all number
    4
    0
    Vascular disorders
    Vascular disorders
    Additional description: All combined
         subjects affected / exposed
    35 / 141 (24.82%)
    26 / 135 (19.26%)
         occurrences all number
    45
    30
    Surgical and medical procedures
    Surgical and medical procedures
    Additional description: All combined
         subjects affected / exposed
    1 / 141 (0.71%)
    0 / 135 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    General disorders and administation site conditions
    Additional description: All combined
         subjects affected / exposed
    38 / 141 (26.95%)
    45 / 135 (33.33%)
         occurrences all number
    55
    62
    Immune system disorders
    Immune system disorders
    Additional description: All combined
         subjects affected / exposed
    4 / 141 (2.84%)
    10 / 135 (7.41%)
         occurrences all number
    4
    12
    Reproductive system and breast disorders
    Reproductive systema and breast disorders
    Additional description: All combined
         subjects affected / exposed
    2 / 141 (1.42%)
    0 / 135 (0.00%)
         occurrences all number
    2
    0
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
    Additional description: All combined
         subjects affected / exposed
    32 / 141 (22.70%)
    35 / 135 (25.93%)
         occurrences all number
    45
    50
    Psychiatric disorders
    Psychiatric disorders
    Additional description: All combined
         subjects affected / exposed
    16 / 141 (11.35%)
    20 / 135 (14.81%)
         occurrences all number
    19
    21
    Investigations
    Investigations
    Additional description: All combined
         subjects affected / exposed
    42 / 141 (29.79%)
    57 / 135 (42.22%)
         occurrences all number
    105
    127
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
    Additional description: All combined
         subjects affected / exposed
    5 / 141 (3.55%)
    4 / 135 (2.96%)
         occurrences all number
    6
    4
    Cardiac disorders
    Cardiac disorders
    Additional description: All combined
         subjects affected / exposed
    23 / 141 (16.31%)
    44 / 135 (32.59%)
         occurrences all number
    31
    55
    Nervous system disorders
    Nervous system disorders
    Additional description: All combined
         subjects affected / exposed
    21 / 141 (14.89%)
    20 / 135 (14.81%)
         occurrences all number
    27
    25
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
    Additional description: All combined
         subjects affected / exposed
    84 / 141 (59.57%)
    67 / 135 (49.63%)
         occurrences all number
    152
    107
    Ear and labyrinth disorders
    Ear and labyrinth disorders
    Additional description: All combined
         subjects affected / exposed
    5 / 141 (3.55%)
    3 / 135 (2.22%)
         occurrences all number
    5
    3
    Eye disorders
    Eye disorders
    Additional description: All combined
         subjects affected / exposed
    12 / 141 (8.51%)
    11 / 135 (8.15%)
         occurrences all number
    13
    13
    Gastrointestinal disorders
    Gastrointestinal disorders
    Additional description: All combined
         subjects affected / exposed
    92 / 141 (65.25%)
    88 / 135 (65.19%)
         occurrences all number
    197
    173
    Hepatobiliary disorders
    Hepatobiliary disorders
    Additional description: All combined
         subjects affected / exposed
    5 / 141 (3.55%)
    3 / 135 (2.22%)
         occurrences all number
    5
    5
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
    Additional description: All combined
         subjects affected / exposed
    68 / 141 (48.23%)
    62 / 135 (45.93%)
         occurrences all number
    101
    93
    Renal and urinary disorders
    Renal and urinary disorders
    Additional description: All combined
         subjects affected / exposed
    12 / 141 (8.51%)
    15 / 135 (11.11%)
         occurrences all number
    17
    15
    Endocrine disorders
    Endocrine disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 141 (0.71%)
    1 / 135 (0.74%)
         occurrences all number
    1
    1
    Musculoskeletal and connective tissue disorders
    Musculoskeletal and connective tissue disorders
    Additional description: All combined
         subjects affected / exposed
    13 / 141 (9.22%)
    8 / 135 (5.93%)
         occurrences all number
    17
    8
    Infections and infestations
    Infections and infestations
    Additional description: All combined
         subjects affected / exposed
    96 / 141 (68.09%)
    88 / 135 (65.19%)
         occurrences all number
    201
    197
    Metabolism and nutrition disorders
    Metabolism and nutrition disorders
    Additional description: All combined
         subjects affected / exposed
    60 / 141 (42.55%)
    60 / 135 (44.44%)
         occurrences all number
    149
    142

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    30 May 2011
    Amendment 1 The reason for this amendment is to add participating centers and an update in the pharmacokinetics paragraph.
    04 Mar 2013
    Amendment 2 The reason for this amendment/addendum is: New version of the IMPD in which the shelf life of the medication is extended from 48 months to 60 months Update ABR and EudraCT form with already added centers Non-substantial amendment of the protocol (see summary of changes)
    27 Jun 2024
    Amendment 3 The reason for this amendment is to follow the advice given by the Federal Drug Association (FDA) following a previously imposed partial hold on all clinical tosedostat studies due to reports of several serious cardiac adverse events. This hold was reported on June 21, 2013. A risk-benefit evaluation was conducted regarding potential cardiac toxicities. Based on this evaluation, the FDA advised to: Limit the tosedostat dose to 120 mg per day Recommend specific criteria for excluding patients with cardiac risks Recommend minimal cardiac monitoring during the study We have taken this advice to heart and incorporated the recommendations into the protocol. Additionally, we have modified the inclusion and exclusion criteria for the following reasons: Exclude patients aged 18–65 years with high-risk AML due to the existence of another HOVON study in which these patients could be included Standardize criteria for liver and kidney function Adjust AML diagnosis to current criteria

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/33562393
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