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    Summary
    EudraCT Number:2020-004772-18
    Sponsor's Protocol Code Number:ASTX727-07
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Temporarily Halted
    Date on which this record was first entered in the EudraCT database:2022-02-02
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2020-004772-18
    A.3Full title of the trial
    A Single-Arm, Open-Label Pharmacokinetic, Safety, and Efficacy Study of ASTX727 in Combination with Venetoclax in Adult Patients with Acute Myeloid Leukemia
    Estudio abierto de un solo grupo de la farmacocinética, la seguridad y la eficacia de ASTX727 en combinación con venetoclax en pacientes adultos con leucemia mieloide aguda
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study of the Pharmacokinetics, Safety, and Efficacy of ASTX727 in Combination with Venetoclax in AML
    Estudio de la farmacocinética, la seguridad y la eficacia de ASTX727 en combinación con venetoclax en casos de LMA
    A.4.1Sponsor's protocol code numberASTX727-07
    A.5.4Other Identifiers
    Name:Regulatory Agency Identifier NumberNumber:IND 116145
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorAstex Pharmaceuticals, Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportAstex Pharmaceuticals, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAstex Pharmaceuticals, Inc.
    B.5.2Functional name of contact pointRegulatory Affairs
    B.5.3 Address:
    B.5.3.1Street Address4420 Rosewood Drive, Suite 200
    B.5.3.2Town/ cityPleasanton
    B.5.3.3Post code94588
    B.5.3.4CountryUnited States
    B.5.4Telephone number+19255602810
    B.5.6E-mailElaine.Lee@astx.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameASTX727 (decitabine and cedazuridine)
    D.3.2Product code ASTX727
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDecitabine
    D.3.9.1CAS number 2353-33-5
    D.3.9.2Current sponsor codeDAC, DCT-0416, 182, 31022
    D.3.9.4EV Substance CodeSUB06932MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number35
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCEDAZURIDINE
    D.3.9.1CAS number 1141397-80-9
    D.3.9.2Current sponsor codeE7727
    D.3.9.4EV Substance CodeSUB194550
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Venclyxto
    D.2.1.1.2Name of the Marketing Authorisation holderAbbVie Deutschland GmbH & Co. KG
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameVenetoclax
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVenetoclax
    D.3.9.1CAS number 1257044-40-8
    D.3.9.4EV Substance CodeSUB176260
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Venclyxto
    D.2.1.1.2Name of the Marketing Authorisation holderAbbVie Deutschland GmbH & Co. KG
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameVenetoclax
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVenetoclax
    D.3.9.1CAS number 1257044-40-8
    D.3.9.4EV Substance CodeSUB176260
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Venclyxto
    D.2.1.1.2Name of the Marketing Authorisation holderAbbVie Deutschland GmbH & Co. KG
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameVenetoclax
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVenetoclax
    D.3.9.1CAS number 1257044-40-8
    D.3.9.4EV Substance CodeSUB176260
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Acute Myeloid Leukemia (AML)
    Leucemia mieloide aguda (LMA)
    E.1.1.1Medical condition in easily understood language
    Acute Myeloid Leukemia (AML)
    Leucemia mieloide aguda (LMA)
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10000880
    E.1.2Term Acute myeloid leukaemia
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Phase I:
    To evaluate the potential of drug-drug interaction: effect of ASTX727 on PK of venetoclax.

    Phase II:
    - To evaluate clinical responsea with ASTX727 and venetoclax combination therapy.
    - To evaluate the potential of drug-drug interactions: effect of ASTX727 on PK of venetoclax.
    Fase I:
    Evaluar la posibilidad de que se produzcan interacciones farmacológicas: efecto de ASTX727 en la FC del venetoclax.

    Fase II:
    — Evaluar la respuesta clínica con el tratamiento combinado de ASTX727 y venetoclax.
    — Evaluar la posibilidad de interacciones farmacológicas: efecto de ASTX727 en la FC del venetoclax.
    E.2.2Secondary objectives of the trial
    Ph.1
    To evaluate potential of drug-drug interactions: effect of venetoclax on PK of ASTX727
    To evaluate the safety of ASTX727 and venetoclax combination therapy
    To evaluate clinical response with ASTX727 and venetoclax combination therapy
    To evaluate preliminary efficacy as determined by time-to-event endpoints with ASTX727 and venetoclax combination therapy
    To evaluate secondary PK parameters of venetoclax, decitabine, and cedazuridine

    Ph.2
    To evaluate the safety of ASTX727 and venetoclax combination therapy
    To evaluate the potential of drug-drug interactions: effect of venetoclax on PK of ASTX727
    To evaluate composite clinical response rates with ASTX727 and venetoclax combination therapy
    To evaluate preliminary efficacy as determined by time-to-event endpoints with ASTX727 and venetoclax combination therapy
    To evaluate secondary PK parameters of venetoclax, decitabine, and cedazuridine
    Exploratory (Ph.2)
    To correlate AML genetic markers with various efficacy endpoints
    Fase I
    Ev. la posib. de producirse inter. farmacologicas: efecto del venetoclax en la FC de ASTX727. Ev. la seg. del trat. Comb. de ASTX727 y venetoclax. Ev. resp. Clin. del trat. Comb. de ASTX727 y venetoclax. Ev. la efic. preliminar según los crit. de val. del tiempo transcurrido hasta el acontecimiento con el trat. Comb. de ASTX727 y venetoclax. Ev. los param. FC secundarios del venetoclax, la decitabina y la cedazuridina.
    Fase II
    Ev. la seg. del trat. Comb. de ASTX727 y venetoclax. Ev. la posib. de que se produzcan inter. farmacologicas: efecto del venetoclax en la FC de ASTX727. Ev. las tasas de resp. Clin. compuestas con el trat. Comb. de ASTX727 y venetoclax. Ev. la eficacia preliminar según crit. de valoración del tiempo transcurrido hasta el acontecimiento con el trat. Comb. de ASTX727 y venetoclax. Ev. los param. FC secundarios del venetoclax, la decitabina y la cedazuridina.
    Exploratorios; Relacionar marcadores gen. de la LMA con distintos crit. de val. de la eficacia
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Age
    1) Participant must be 18 years of age or older.
    Type of Participant and Disease Characteristics
    2) Histological confirmation of newly diagnosed AML by World Health Organization (WHO) 2016 criteria (Swerdlow et al 2017).
    3) Projected life expectancy of at least 3 months.
    4) Participants must be considered ineligible for intensive induction chemotherapy defined by the following:
    a) Age 75 years or older, or
    b) Age 18 to 74 years with at least one of the following comorbidities:
    i) Severe cardiac disorder (eg, congestive heart failure requiring treatment, ejection fraction ≤50%, or chronic stable angina).
    ii) Severe pulmonary disorder (eg, diffusing capacity of the lung for carbon monoxide (DLCO) ≤65% or forced expiratory volume in 1 second [FEV1] ≤65%).
    iii) Creatinine clearance ≥30 mL/min to <45 mL/min.
    iv) Moderate hepatic impairment with total bilirubin >1.5 to ≤3.0 × upper limit of normal (ULN).
    v) Phase 1: Eastern Cooperative Oncology Group (ECOG) Performance Status of 2 (subjects with ECOG ≥3 are not eligible); Phase 2: ECOG Performance Status of 2 or 3 (subjects with ECOG 4 are not eligible).
    5) For Phase 1, ECOG 0-2. For Phase 2, ECOG 0-3.
    Sex and Contraceptive Barrier Requirements
    6) Participant can be male or female.
    a) Male participants:
    Male participants are eligible to participate if they agree to the following during the treatment period and for at least 3 months after the last dose of study treatment:
    i) Refrain from donating sperm.
    PLUS either:
    ii) Abstinence from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent.
    OR
    iii) Must agree to use contraception/barrier as detailed below:
    o Agree to use 1 highly effective method when having sexual intercourse with a woman of childbearing potential who is not currently pregnant, and one other method as described in Appendix 2 (Section 10.2).
    o Female partner should be advised of the benefit of using an additional highly effective contraceptive method with a failure rate of <1% per year as described in Appendix 2 (Section 10.2) as a condom may break or leak.
    b) Female participants:
    A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    i) Is not a woman of childbearing potential (as described in Appendix 2 [Section 10.2]).
    OR
    ii) Is a woman of childbearing potential and using a contraceptive method that is highly effective (eg, male condom in addition to hormonal contraception) with a failure rate of <1% per year as described in Appendix 2 (Section 10.2), during the treatment period and for at least 6 months after the last dose of study treatment and agrees not to donate eggs (ova, oocytes) for the purpose of reproduction during this period. The investigator should evaluate the effectiveness of the contraceptive method in relationship to the first dose of study treatment.
    iii) A woman of childbearing potential must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) within 24 hours before the first dose of study treatment.
    iv) The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
    Informed Consent
    7) Capable of giving legally effective informed consent (as described in Appendix 1 [Section 10.1.3]), which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol, and willing to participate in the study.
    Edad
    1) El participante debe tener 18 años o más.
    Tipo de participante y características de la enfermedad
    2) Confirmación histológica de LMA recién diagnosticada según los criterios de 2016 de la Organización Mundial de la Salud (OMS) (Swerdlow et al., 2017).
    3) Esperanza de vida prevista de 3 meses como mínimo.
    4) Los siguientes factores definen a un participante como no apto para la quimioterapia de inducción intensiva:
    a) Tener más de 75 años, o
    b) Tener entre 18 y 74 años con al menos una de las siguientes enfermedades concomitantes:
    i) Enfermedad cardíaca grave (p. ej., insuficiencia cardíaca congestiva que requiere tratamiento, fracción de expulsión ≤50 % o angina estable crónica).
    ii) Enfermedad pulmonar grave (p. ej., capacidad de difusión pulmonar para el monóxido de carbono (DLCO) ≤65 % o volumen espiratorio máximo en el primer segundo [VEM1] ≤65 %).
    iii) Aclaramiento de la creatinina ≥30 ml/min a <45 ml/min.
    iv) Insuficiencia hepática moderada con un valor de bilirrubina total de >1,5 a ≤3,0 × el límite superior de la normalidad (LSN).
    v) Fase I: estado general 2 según el Grupo Oncológico Cooperativo de la Costa Este de los EE. UU. (Eastern Cooperative Oncology Group, ECOG), no serán aptos los participantes con una puntuación ECOG ≥3; fase II: estado general de 2 o 3 según el ECOG (no serán aptos los participantes con puntuación 4 según el ECOG).
    5) Para la fase I, 0-2 según el ECOG. Para la fase II, 0-3 según el ECOG.
    Vida sexual y requisitos de anticoncepción o métodos de barrera
    6) Ambos sexos podrán participar.
    a) Participantes varones:
    Los participantes varones podrán participar si aceptan lo siguiente durante el periodo de tratamiento y durante al menos los 3 meses posteriores a la última dosis del tratamiento del estudio:
    i) Abstenerse de donar esperma.
    Y:
    ii) Abstenerse de mantener relaciones heterosexuales cuando se trate de su modo de vida preferido y habitual (abstinencia de forma prolongada y persistente) y aceptar seguir absteniéndose.
    O BIEN
    iii) Aceptar usar un método anticonceptivo o de barrera como los detallados a continuación:
    o Aceptar usar un método anticonceptivo muy eficaz al mantener relaciones sexuales con mujeres con posibilidad de quedarse embarazadas que no estén embarazadas, junto con otros métodos que se describen en el anexo 2 (apartado 10.2).
    o Avisar a la pareja de las ventajas de usar otro método anticonceptivo muy eficaz con una tasa de ineficacia <1 % al año, tal como se describe en el anexo 2 (apartado 10.2), ya que los preservativos pueden romperse o tener fugas.
    b) Participantes mujeres:
    Las mujeres serán aptas para participar si no están embarazada ni en periodo de lactancia, y si se cumplen por lo menos uno de los siguientes requisitos:
    i) Mujeres sin posibilidad de quedarse embarazadas (como se describe en el anexo 2, apartado 10.2).
    O BIEN
    ii) Mujeres con posibilidad de quedarse embarazadas que usen un método anticonceptivo muy eficaz (p. ej., un preservativo masculino además de anticonceptivos hormonales) con una tasa de ineficacia <1 % al año, tal como se describe en el anexo 2 (apartado 10.2), durante el periodo de tratamiento y durante al menos 6 meses después de la última dosis del tratamiento del estudio y que acepten no donar óvulos destinados a la reproducción durante este periodo. El investigador debe evaluar la eficacia del método anticonceptivo en relación con la primera dosis del tratamiento del estudio.
    iii) Mujeres con posibilidad de quedarse embarazadas que obtengan un resultado negativo en una prueba de embarazo de alta sensibilidad (en orina o suero, según la normativa local) en las 24 horas previas a la primera dosis del tratamiento del estudio.
    iv) El investigador será responsable de revisar los antecedentes médicos, los antecedentes relativos a la menstruación y la actividad sexual reciente para reducir el riesgo de incluir a mujeres con un embarazo no detectado al comienzo de la gestación.
    Consentimiento informado
    7) Tener la capacidad de otorgar un consentimiento informado válido a efectos legales (como se describe en el anexo 1, apartado 10.1.3), lo que incluye el cumplimiento de los requisitos y restricciones que se indican en el formulario de consentimiento informado (FCI) y en este protocolo, y la voluntad de participar en el estudio.
    E.4Principal exclusion criteria
    Medical Conditions
    1) History of myeloproliferative neoplasm including myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia with or without BCR-ABL1 translocation and AML with BCR-ABL1 translocation.
    2) The following karyotype abnormalities: t(8;21), inv(16) or t(15;17), or other acute promyelocytic leukemia variants that remain sensitive to all-trans retinoic acid (ATRA) therapy.
    3) Known active central nervous system involvement from AML.
    4) Known human immunodeficiency virus (HIV) infection (due to potential drug-drug interactions between antiretroviral medications and venetoclax). Human immunodeficiency virus testing will be performed at Screening, only if indicated per local guidelines or institutional standards.
    5) Known active hepatitis B or C infection (detectable viral load). Hepatitis B or C testing will be performed at Screening, only if indicated per local guidelines or institutional standards.
    6) Severe hepatic impairment defined as: bilirubin >1.5×upper limit of normal (ULN) for subjects ≥75 years or >3×ULN for subjects <75 years; or aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) or alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SGPT) >3×ULN (unless abnormalities are considered to be due to leukemic organ involvement or bilirubinemia is due to known Gilbert’s Syndrome).
    7) Severe renal impairment defined as: calculated creatinine clearance or glomerular filtration rate <30 mL/min.
    8) A malabsorption syndrome or other condition that precludes enteral route of administration.
    9) Cardiovascular disability status of New York Heart Association Class >2. Class 2 is defined as cardiac disease in which patients are comfortable at rest but ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain.
    10) Significant history of renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, hepatic, cardiovascular or pulmonary disease, any other medical condition or known hypersensitivity to any of the study medications that in the opinion of the investigator would adversely affect his/her participating in this study.
    11) Clinically significant uncontrolled systemic infection requiring therapy (viral, bacterial, or fungal).
    12) History of other malignancies prior to study entry, with the exception of adequately treated in situ carcinoma of the breast or cervix uteri; localized basal cell carcinoma or squamous cell carcinoma of the skin; previous malignancy confined and surgically resected (or adequately treated and controlled with other modalities); and any early stage malignancy for which no definitive therapy is required.
    13) WBC count >25,000/μL. (Hydroxyurea treatment is permitted to meet this criterion.)
    Prior/Concomitant Therapy
    14) Treatment with the following:
    a) A hypomethylating agent (azacitidine or decitabine), or venetoclax including prior treatment for MDS.
    b) Chimeric Antigen Receptor (CAR)-T cell therapy.
    c) Investigational therapies for MDS or AML.
    15) Participants who cannot discontinue concomitant prophylactic antifungal therapy with CYP3A inhibitor activity or other concomitant medications with moderate or strong CYP3A inhibitor activity ≥7 days or 5 half-lives, whichever is greater, prior to C1D1.
    16) Participants who cannot discontinue concomitant drugs that are strong CYP3A or P-gp inhibitors ≥7 days or 5 half-lives, whichever is greater, prior to C1D1.
    17) Participants who cannot avoid concomitant drugs known as moderate or strong CYP3A inducers.
    Prior/Concurrent Clinical Study Experience
    18) Current participation in another research requiring interventions such as drug therapy or study procedures.
    Other Exclusions
    19) Known or suspected hypersensitivity to decitabine, cedazuridine, venetoclax, or any of their excipients.
    20) Known significant mental illness or other condition such as active alcohol or other substance abuse or addiction that, in the opinion of the investigator, predisposes the subject to high risk of noncompliance with the protocol.
    21) Patients who consume grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or starfruit ≤7 days prior to C1D1.
    Enfermedades y problemas de salud
    1) Antecedentes de neoplasia mieloproliferativa como la mielofibrosis, la trombocitemia esencial, la policitemia vera, la leucemia mielógena crónica con o sin translocación de BCR-ABL1 y LMA con translocación de BCR-ABL1.
    2) Las siguientes anomalías del cariotipo: t(8;21), inv(16) o t(15;17) u otras variantes de leucemia promielocítica aguda que siguen siendo sensibles al tratamiento con ácido retinoico (AR).
    3) Afectación conocida del sistema nervioso central debida a la LMA.
    4) Infección conocida por el virus de la inmunodeficiencia humana (VIH) (debido a las posibles interacciones farmacológicas entre los antirretrovíricos y el venetoclax). La prueba de detección del virus de la inmunodeficiencia humana se hará en la selección y solo si las directrices locales o las normas del centro lo indican.
    5) Infección activa conocida por hepatitis B o C (concentración vírica detectable). Las pruebas de detección del virus de la hepatitis B o C se harán en la selección y solo si las directrices locales o las normas del centro lo indican.
    6) Insuficiencia hepática grave definida como: bilirrubina >1,5 veces el límite superior de la normalidad (LSN) para los participantes ≥75 años o >3 veces el LSN para los participantes <75 años; aspartato aminotransferasa (AST)/aspartato transaminasa sérica (SGOT) o alanina aminotransferasa (ALT)/alanina transaminasa sérica (SGPT) >3 veces el LSN (a menos que las anomalías se consideren debidas a la afectación de los órganos o que la bilirrubinemia se deba a un síndrome de Gilbert confirmado).
    7) Insuficiencia renal grave definida como: aclaramiento de la creatinina calculado o filtración glomerular <30 ml/min.
    8) Síndrome de hipoabsorción u otra afección que impida la administración por vía intestinal.
    9) Estado de discapacidad cardiovascular >2 según la Asociación Neoyorquina de Cardiología (New York Heart Association). La clase 2 se define como enfermedad cardíaca en la que los pacientes están cómodos en reposo, pero la actividad física habitual ocasiona fatiga, palpitaciones, disnea o dolor anginoso.
    10) Antecedentes significativos de enfermedad renal, neurológica, psiquiátrica, endocrinológica, metabólica, inmunitaria, hepática, cardiovascular o pulmonar, o cualquier otra afección médica o hipersensibilidad conocida a cualquiera de los fármacos del estudio que, según la opinión del investigador, pudiera afectar de manera negativa a su participación en este estudio.
    11) Infección generalizada no estabilizada clínicamente importante que requiera tratamiento (vírica, bacteriana o fúngica).
    12) Antecedentes de otras neoplasias malignas previas a la entrada en el estudio, salvo el carcinoma localizado mamario o cervicouterino suficientemente tratado, el carcinoma basocelular localizado o el carcinoma epidermoide localizados; una neoplasia maligna localizada y extirpada quirúrgicamente (o suficientemente tratada con otras modalidades) y cualquier neoplasia maligna de estadio temprano para la que no se requiera tratamiento definitivo.
    13) Cifra de leucocitos >25 000/μl. (se permite el tratamiento con hidroxicarbamida para cumplir este criterio).
    Tratamiento previo o simultáneo
    14) Tratamiento con los siguientes:
    a) Un hipometilante (azacitidina o decitabina) o venetoclax, incluido el tratamiento previo para el SMD.
    b) Tratamiento con linfocitos T con receptor quimérico para el antígeno (CAR).
    c) Tratamientos en investigación para el SMD o la LMA.
    15) Participantes que no puedan interrumpir el tratamiento antifúngico preventivo simultáneo con la actividad de los inhibidores de CYP3A u otros fármacos simultáneos con actividad moderada o potente del inhibidor de CYP3A ≥7 días o 5 semividas, lo que sea mayor, antes del D1C1.
    16) Participantes que no puedan interrumpir los fármacos simultáneos que sean inhibidores potentes de CYP3A o de la gp-P ≥7 días o 5 semividas, lo que sea mayor, antes del D1C1.
    17) Participantes que no puedan evitar los fármacos simultáneos conocidos como inductores moderados o fuertes de CYP3A.
    Participación previa o simultánea en estudios clínicos
    18) Participación actual en otro estudio que requiera intervenciones, como tratamientos farmacológicos o procedimientos de investigación.
    Otras exclusiones
    19) Antecedentes conocidos o sospecha de hipersensibilidad a la decitabina, la cedazuridina, el venetoclax o cualquiera de sus excipientes.
    20) Enfermedad mental significativa conocida u otra afección, como alcoholismo activo u otra toxicomanía o adicción que, según la opinión del investigador, predisponga al participante a un alto riesgo de incumplimiento terapéutico del protocolo.
    21) Pacientes que consuman pomelo o productos con pomelo, naranjas amargas (incluida la mermelada que contenga naranjas amargas) o carambola ≤7 días antes del D1C1.
    E.5 End points
    E.5.1Primary end point(s)
    Ph.1
    - Venetoclax AUC0-24 and Cmax on Day 5 with ASTX727 and Day 15 without ASTX727 in Cycle 2

    Ph.2
    - CR rate
    - Venetoclax AUC0-24 and Cmax on Day 5 with ASTX727 and Day 15 without ASTX727 in Cycle 2.
    Fase I
    — Venetoclax: ABC0-24 y Cmáx. el día 5 con ASTX727 y el día 15 sin ASTX727 en el ciclo 2.

    Fase II
    — Tasa de RC.
    — Venetoclax: ABC0-24 y Cmáx. el día 5 con ASTX727 y el día 15 sin ASTX727 en el ciclo 2.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Day 5, Day 15
    Día 5, Día 15
    E.5.2Secondary end point(s)
    Ph.1
    - Decitabine and cedazuridine AUC0-24 and Cmax on Day 5 with venetoclax and cedazuridine AUC0-8 and on Day 5 with venetoclax in Cycle 2.
    - Incidence and severity of adverse events (AEs) as well as other safety assessments.
    - CR rate
    - CR+CRh rate
    - CR+CRi rate
    - Time to CR or CRh
    - Duration of CR or CRh
    - Overall survival
    - 5-day cumulative decitabine AUC in Cycle 2.
    - Decitabine AUC0-24 and Cmax on Days 1 and 2 in Cycle 2
    Cedazuridine AUC0-8 on Days 1, 2, and 5 in Cycle 2; AUC0-24, AUC0-inf, and Cmax on Days 1, 2, and 5 in Cycle 2.
    Cmax, Cmin, Tmax, T1/2 and other secondary PK parameters

    Ph.2
    - Incidence and severity of adverse events (AEs) as well as other safety assessments.
    - Decitabine and cedazuridine AUC0-24, Cmax, AUC0-8, and AUC0-inf on Day 5 with venetoclax in Cycle 2.
    - CR+CRh rate
    - CR+CRi rate
    - Time to CR or CRh
    - Duration of CR or CRh
    - Overall survival
    - Cmax, Cmin, Tmax, T1/2, and other secondary PK parameters

    Exploratory, Ph.2:
    - CR rate
    - CR+CRh rate
    - CR+CRi rate
    - Duration of CR or CRh
    - Overall survival
    Fase I
    — Decitabina y cedazuridina: AUC0-24 y Cmáx. el día 5 con venetoclax; cedazuridina: ABC0-8 el día 5 con venetoclax en el ciclo 2.
    — Frecuencia y gravedad de los acontecimientos adversos (AA) y otras evaluaciones de la seguridad.
    — Tasa de RC.
    — Tasa de RC + RCh.
    — Tasa de RC + RCi.
    — Tiempo hasta la RC o RCh.
    — Duración de la RC o RCh.
    — Supervivencia global.
    — ABC acumulada de la decitabina de 5 días en el ciclo 2.
    — Decitabina: ABC0-24 y Cmáx. los días 1 y 2 del ciclo 2.
    Cedazuridina: ABC0-8 los días 1, 2 y 5 en el ciclo 2; ABC0-24, ABC0-inf y Cmáx. los días 1, 2 y 5 en el ciclo 2.
    Cmáx., Cmín., Tmáx., t1/2 y otros parámetros FC secundarios

    Fase II
    — Frecuencia y gravedad de los acontecimientos adversos (AA) y otras evaluaciones de la seguridad.
    — Decitabina y cedazuridina: ABC0-24, Cmáx., ABC0-8 y ABC0-inf el día 5 con venetoclax en el ciclo 2.
    — Tasa de RC + RCh.
    — Tasa de RC + RCi.
    — Tiempo hasta la RC o RCh.
    — Duración de la RC o RCh.
    — Supervivencia global.
    — Cmáx., Cmín., Tmáx., t1/2 y otros parámetros FC secundarios.

    Exploratorios, fase II:
    — Tasa de RC.
    — Tasa de RC + RCh.
    — Tasa de RC + RCi.
    — Duración de la RC o RCh.
    — Supervivencia global.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Assessments will be performed at regular intervals during the trial. Refer to Sections 5.3.1 and 6.1 for details on study treatment administration.
    Las evaluaciones se realizarán a intervalos regulares durante el ensayo. Consulte las Secciones 5.3.1 y 6.1 para obtener más detalles sobre la administración del tratamiento del estudio.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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.8.4.1Number of sites anticipated in Member State concerned3
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Canada
    Spain
    United States
    E.8.7Trial has a data monitoring committee No
    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
    In Phase 1, the primary analysis of AUC will be performed after the last subject completes Cycle 2. In Phase 2, the primary analysis of efficacy will be performed after the last evaluable subject enrolled has achieved best response or reached end of Cycle 3, whichever is first. Each study phase will be considered complete after all subjects have died or otherwise withdrawn from the study or when median OS time has been reached
    En la fase I, el análisis princ. del ABC se realizará después de que el último participante complete el ciclo 2. En la fase II, el análisis princ. de la eficacia se realizará después de que el último participante evaluable inscrito haya alcanzado la mejor respuesta o haya alcanzado el final del ciclo 3, lo que ocurra antes. Cada fase se considerará completa cuando todos los participantes hayan fallecido o se hayan retirado del estudio, o cuando se haya alcanzado la mediana del tiempo de SG.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months2
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 10
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 10
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 20
    F.4.2.2In the whole clinical trial 100
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-05-30
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-02-25
    P. End of Trial
    P.End of Trial StatusTemporarily Halted
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