Phase I/II study augmenting TAK-659 action in relapsed/refractory AML by addition of the proteasome inhibitor Ixazomib Big Ten Cancer Research Consortium BTCRC-HEM17-092

Are you eligible to participate in this study?

You may be eligible for this study if you meet the following criteria:

  • Conditions: Acute myeloid leukemia
  • Age: Between 18 - 100 Years
  • Gender: Male or Female

Inclusion Criteria

1. Written informed consent and HIPAA authorization for release of personal health information.
NOTE: HIPAA authorization may be included in the informed consent or obtained separately.
2. Male or female patients 18 years or older at the time of consent.
3. Patients must have a diagnosis of primary or secondary AML including newly diagnosed,
relapsed or refractory disease (WHO update 2016, [34]) other than acute promyelocytic
leukemia, or complex karyotype or monosomy 7 (or containing monosomy 7) for whom no
standard therapies are anticipated to result in a durable remission according to the clinical
judgment of the treating physician, or in a patient who refuses standard therapies. For inclusion
of newly diagnosed patients, the patient must have a molecular/genetic disease profile felt by the
investigator to be inimical for response to other FDA-approved targeted therapies (eg. high comutational
burden), and to have elected not to receive, or be ineligible for standard
chemotherapy.
4. Must have submitted for Next Generation Sequencing (NGS) testing by: 1) (preferred) having submitted a tumor sample for commercial myeloid NGS from Foundation One, Mayo, Tempus, Quest, ARUP or an institutional CLIA-certified laboratory and/or 2) obtaining a bone marrow aspirate during screening for submission to Foundation One, Mayo, Tempus, Quest, ARUP or an institutional CLIA-certified laboratory and ordered as standard of care. If bone marrow aspiration has failed, a peripheral blood sample with circulating blasts may be substituted. Screening reports on tumor cytogenetics and/or mutation assays (eg, FLT-3, and NGS) performed as part of the standard of care will be recorded in the study database or obtained at the
time of screening if not previously available.
5. Patient’s disease must be characterized for the presence/absence of Flt3ITD/TKD mutation from
an FDA-approved vendor (ex. LabPMM).
6. In addition, patients for the phase 2 portion of the study must meet the following:
a. Patients, if relapsed/ refractory, must have exposure to no more than 2 prior chemotherapy
regimens. Re-induction with the same regimen or stem cell transplant will not be considered
a separate regimen.
b. Patients must not have prior exposure to any investigational Flt3 inhibitors (midostaurin or
gilteritinib are allowed)
7. Eastern Cooperative Oncology Group (ECOG) performance status 0-2
8. Life expectancy of greater than 3 months as determined by the treating physician.
9. Female patients who:
-Are postmenopausal for at least 1 year before the screening visit, OR
-Are surgically sterile, OR
-If they are of childbearing potential, agree to practice 2 effective methods of contraception at
the same time, from the time of signing the informed consent through 180 days after the last
dose of study drug, or
-Agree to practice true abstinence, when is in line with the preferred and usual lifestyle of the
subject. Periodic abstinence [eg, calendar, ovulation, symptothermal, postovulation methods],
withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of
contraception. Female and male condoms should not be used together.)
-Agree not to donate eggs (ova) during the course of this study or 180 days after receiving
their last dose of study drug.
10. Male patients, even if surgically sterilized (i.e., status post-vasectomy), who:
-Agree to practice effective barrier contraception during the entire study treatment period and
through 180 days after the last dose of study drug, or
-Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of
the subject. (Periodic abstinence [eg, calendar, ovulation, symptothermal, postovulation
methods for the female partner] and withdrawal are not acceptable methods of contraception.
Female and male condoms should not be used together.)
-Agree not to donate sperm during the course of this study or within 180 days after receiving
their last dose of study drug.
11. Voluntary written consent must be given before performance of any study related procedure not
part of standard medical care, with the understanding that consent may be withdrawn by the
patient at any time without prejudice to future medical care
12. In the absence of rapid progressive disease, the interval from prior systemic anticancer treatment
to time of TAK-659/Ixazomib administration should be at least 2 weeks for cytotoxic agents
(other than hydroxyurea), or at least 5 half-lives for noncytotoxic agents, and patients have to have recovered from acute toxicities of these therapies. Patients who are on hydroxyurea may be
included in the study and may continue on hydroxyurea for the first 28 days while participating
in this study.
13. Suitable venous access for the study-required blood sampling, and transfusion support.

Exclusion Criteria

 

1. Clinically active central nervous system leukemia.
2. Female patients who are lactating and breastfeeding (NOTE: breast milk cannot be stored for
future use while the mother is being treated on study)
3. Female patients who have a positive serum pregnancy test during the screening period or a
positive urine pregnancy test on Day 1 before first dose of study drug.
4. Any serious medical or psychiatric illness, including drug or alcohol abuse, that could, in the
investigator’s opinion, potentially jeopardize the safety of the patient or interfere with the
objectives of the study.
5. Prior treatment with investigational agents ≤ 21 days or ≤ 5 half-lives (whichever is shorter)
before the first dose of study treatment. A minimum of 10 days should elapse from prior
investigational therapy to initiating protocol therapy.
6. Persistent clinically significant toxicity from prior chemotherapy that is Grade 2 or higher by the
NCI CTCAE (v5).
7. Receipt of HSCT within 60 days of the first dose of TAK-659/Ixazomib; clinically significant
graft-versus-host disease (GVHD) requiring ongoing immunosuppressive therapy post HSCT at
the time of screening (use of topical steroids for ongoing skin GVHD is permitted).
8. Active, systemic infection requiring intravenous (IV) antibiotic, antifungal, or antiviral therapy
or other serious infection within 10 days before the first dose of study drug.
9. Major surgery within 14 days before the first dose of study drug and have not recovered fully
from any complications from surgery.
10. Radiotherapy less than 2 weeks before the first dose of study treatment or have not recovered
from acute toxic effects from radiotherapy.
11. Known human immunodeficiency virus (HIV) positive.
12. Known hepatitis B surface antigen positive, or known or suspected active hepatitis C infection
(testing not required).
13. Any of the following cardiovascular conditions:
-Acute myocardial infarction within 6 months before starting study drug.
-Current or history of New York Heart Association Class III or IV heart failure (see Study
Procedures Manual [SPM]).
-Evidence of current, uncontrolled cardiovascular conditions including cardiac arrhythmias,
angina, pulmonary hypertension, or electrocardiographic evidence of acute ischemia or active
conduction system abnormalities.
Abnormalities on 12-lead ECG including, but not limited to, changes in rhythm and intervals
that, in the opinion of the treating physician, are considered to be clinically significant.
14. Known gastrointestinal (GI) disease or GI procedure that could interfere with the oral absorption
or tolerance to study drugs, including difficulty swallowing tablets, diarrhea > Grade I despite
supportive therapy.
15. Use or consumption of any of the following medications, supplements, or foods/beverages that
are inhibitors or inducers of P-gp or strong reversible inhibitors or inducers of CYP3A within the
indicated timeframes below. Note that use or consumption of these substances is not permitted
during the study.
a) Inhibitors of P-gp and/or strong reversible inhibitors of CYP3A within 5 times the inhibitor
half-life (if a reasonable half-life estimate is known), or within 7 days (if a reasonable halflife
estimate is unknown), before the first dose of study drug. In general, the use of these
agents is not permitted during the study except in cases where an AE must be managed. See
SPM for a nonexhaustive list of strong CYP3A reversible inhibitors and/ or Pgp inhibitors
based on the FDA Draft DDI Guidance.
b) Strong CYP3A mechanism-based inhibitors or strong CYP3A inducers and/or P-gp inducers
within 7 days, or within 5 times the inhibitor or inducer half-life (whichever is longer),
before the first dose of study drug. However, if a patient has a strong indication for fungal
prophylaxis, then the moderate CYP3A inhibitors fluconazole or isovuconazole (moldactive)
is recommended for prophylaxis, and the TAK-659 dose should be reduced to 60mg,
along with increased scrutiny for toxicity. Similarly, if the patient develops a fungal infection
during a productive intervention with TAK-659/Ixazomib combination, isovuconazole
(mold-active) should be used, along with increased scrutiny for toxicity. In general, the use
of these agents is not recommended during the study except in cases where such an AE must
be managed, and the intermittent schedule of TAK-659/Ixazomib combination will not
prevent profound neutropenia. See SPM for a non-exhaustive list of strong CYP3A
mechanism-based inhibitors or strong CYP3A inducers and/or P-gp inducers based on the
FDA Draft DDI Guidance.
c) Grapefruit-containing food or beverages within 5 days before the first dose of study drug.
16. Lack of suitable venous access for the study-required blood sampling.
17. Diagnosed or treated for another malignancy within 2 years before study enrollment or
previously diagnosed with another malignancy and have any evidence of residual disease.
Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they
have undergone complete resection.

Recruitment Status

Open

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