E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Treatment of children and young adults with molecular relapse of acute myeloid leukemia
(AML) after first complete remission (CR1). |
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E.1.1.1 | Medical condition in easily understood language |
Acute Myeloid Leukemia is a type of cancer that starts in cells that form new blood cells. AML starts in the bone marrow but in most cases it quickly moves into the blood. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10000886 |
E.1.2 | Term | Acute myeloid leukemia |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Safety Run-in Part
-To establish a safe and tolerable dose of azacitidine to be used in the randomized part of the study.
Randomized Part
-To evaluate the effect of azacitidine treatment in AML subjects at molecular relapse after CR1 when compared to no treatment with regard to the progression-free rate (PFR) at Day 84 (±4 days) postrandomization. |
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E.2.2 | Secondary objectives of the trial |
Safety Run-in Part
-To establish azacitidine plasma pharmacokinetic (PK) parameters in subjects with molecular relapse AML after CR1 and to assess efficacy.
Randomized Part
-To evaluate the safety, pharmacodynamics (PD), and efficacy of azacitidine treatment in subjects with molecular relapse AML after CR1. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
•Patients≥ 3months and less than 21 years old, who (subject and when applicable parental/ legal representative(s)) must understand and voluntarily sign an Informed Consent or Informed Assent Form.
Note: for the Safety Run-in, Patients≥ 3months and less than 18 years old at the time of informed consent/assent
•At the time of signing the ICF/IAF, patients must have documented diagnosis of Acute Myeloid Leukemia and documentation of molecular remission confirmed at the start of last consolidation course or within 1 month after completion of consolidation treatment.
•Safety Run-In (At the time of signing ICF/IAF): Detection of molecular relapse within 7 days prior to signing consent/assent and confirmation of molecular relapse during the screening period.
Randomized Part (At the time of pre-drug verification visit); Detection of molecular relapse within 7 days prior to signing consent/assent and confirmation of molecular relapse during the screening period.
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E.4 | Principal exclusion criteria |
•Concomitant treatment with any other anticancer therapy except those specific in protocol and no maintenance therapy after end of consolidation therapy and confirmed remission.
•Hematopoietic Stem Cell Transplantation within previous 3 months
•Pregnant or breastfeeding females
•Patients with a current disease that can interfere with protocol procedures or study treatment
•Hypersensitivity to azacitidine
•Symptomatic CNS-involvement or isolated extramedullary disease at initial diagnosis.
•FAB type M3 leukemia (acute promyelocytic leukemia)
•Therapy-related AML
•AML of Down syndrome or other congenital syndromes giving rise to leukemia or treatment complications.
•Symptomatic cardiac disorders (CTCAE Grade 3 or 4).
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E.5 End points |
E.5.1 | Primary end point(s) |
Safety Run-in Part :
-Identification of a safe and tolerable dose for the randomized part of the study
-Assessment of treatment-related dose-limiting toxicities (DLTs)
-Frequency and severity of treatment-related AEs
Randomized Part :
-Progression-free rate at Day 84 (±4 days) post randomization: Proportion of subjects
free from clinical progression (clinical relapse and death from any cause) and from molecular progression (defined as lack of stabilization or lack of decrease in molecular aberrations concerning FLT3-ITD mutated, CBF leukemias (eg, t(8;21) and/or inv(16)), MLL-gene rearrangements or NPM1-mutations using central assessment of BM samples by the central laboratories identified for the study, obtained at time points identically prespecified in both randomization arms) at Day 84 (±4 days) post randomization. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Safety Run-in:
The rate of the following treatment-related DLTs as per National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAEs) version 4.0, occurring during Cycle 1 only will be considered in determining the tolerability of the 100 mg/m2 dose of azacitidine.
Once 6 subjects have completed their first cycle of treatment (if not having stopped earlier due to a DLT), safety will be evaluated by an external independent Safety Monitoring Committee (SMC) and investigators on the trial.
Randomized Part:
PFR at Day 84 (±4 days) post randomization, will be assessed at Day 80 to 88 (approximately end of Cycle 3 of active treatment) post
randomization for both the control and the experimental arm. |
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E.5.2 | Secondary end point(s) |
Safety Run-Part :
-Molecular response at Day 84 (±4 days) post Cycle 1 Day 1 (or end of Cycle 3, if not the same date)
- Azacitidine plasma PK parameters
- Leukemia-free survival (LFS)
- Minimal residual disease pre-HSCT
- Overall survival
Randomized Part:
- Changes in DNA methylation (assessments of BM samples using Nano-HELP assay)
- Leukemia-free survival
- Proportion treated with HSCT
- MRD pre-, and 3 and 6 months post-HSCT
- Overall survival
- Molecular response
- Treatment-related mortality/morbidity
- Toxicity data after HSCT
- Safety |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Safety run-in part:
-Cycle 1
-Screening, C1D15, C2D1,C3D1, D84 (±4 days) post randomization, and pre-, and 3 and 6 months post-HSCT
-at F/U period for up to 2 years from enrollment of last subject
-Screening, C2D1 and C3D1, D84 (±4 days) post randomization, and pre-, and 3 and 6 months post-HSCT. If the treatment is discontinued prior 3 cycles, MRD analysis will continue every 28 days until clinical relapse.
-during the F/U period for up to 2 years from enrollment of the last subject .
Randomized Part:
Evaluation of each end point is done as for safety run in phase see (1-5) and incl:
-MRD analysis; screening period every 28 days from ICF/IAF, at the Predrug Verification Visit, C2D1 and C2D1, at D84 (±4 days) post randomization, and finally pre-, and 3 and 6 months post-HSCT |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 15 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Is the date of the last visit of the last subject to complete the study, or the date of receipt of the last data point from the last subject that is required for primary, secondary, and/or exploratory analysis, as prespecified in the protocol and/or the Statistical Analysis Plan, whichever is the later date. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 8 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 8 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |