Trial Review

Did you know?

The ANZCTR now automatically displays published trial results and simplifies the addition of trial documents such as unpublished protocols and statistical analysis plans.

These enhancements will offer a more comprehensive view of trials, regardless of whether their results are positive, negative, or inconclusive.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been endorsed by the ANZCTR. Before participating in a study, talk to your health care provider and refer to this information for consumers
Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/study/NCT02577406




Registration number
NCT02577406
Ethics application status
Date submitted
14/10/2015
Date registered
16/10/2015
Date last updated
30/04/2024

Titles & IDs
Public title
An Efficacy and Safety Study of AG-221 (CC-90007) Versus Conventional Care Regimens in Older Subjects With Late Stage Acute Myeloid Leukemia Harboring an Isocitrate Dehydrogenase 2 Mutation
Scientific title
A Phase 3, Multicenter, Open-label, Randomized Study Comparing the Efficacy and Safety of AG-221 (CC-90007) Versus Conventional Care Regimens in Older Subjects With Late Stage Acute Myeloid Leukemia Harboring an Isocitrate Dehydrogenase 2 Mutation
Secondary ID [1] 0 0
AG-221-AML-004
Universal Trial Number (UTN)
Trial acronym
IDHENTIFY
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Leukemia, Myeloid 0 0
Isocitrate Dehydrogenase 0 0
Condition category
Condition code
Cancer 0 0 0 0
Leukaemia - Acute leukaemia
Cancer 0 0 0 0
Leukaemia - Chronic leukaemia
Cancer 0 0 0 0
Children's - Leukaemia & Lymphoma

Intervention/exposure
Study type
Interventional(has expanded access)
Description of intervention(s) / exposure
Treatment: Drugs - AG-221
Other interventions - BSC
Treatment: Drugs - Azacitidine
Treatment: Drugs - Low-dose cytarabine (LDAC)
Treatment: Drugs - Intermediate-dose cytarabine (IDAC)

Experimental: AG-221 plus Best supportive care (BSC) - Continuous 28-day cycles of AG 221 100 mg orally (PO) once a day (QD) for 28 days, plus BSC.

Active comparator: Conventional care regimen (CCR) - Continuous 28-day cycles of BSC only, azacitidine subcutaneously (SC) plus BSC, low-dose cytarabine (LDAC) SC plus BSC, or intermediate-dose cytarabine (IDAC) intravenously (IV) plus BSC. Subjects will be assigned by the investigator to one of the CCR treatment options based on the investigator's assessment of subjects' eligibility.


Treatment: Drugs: AG-221
Continuous 28-day cycles of AG 221 100 mg orally (PO) once a day (QD) for 28 days

Other interventions: BSC
Best supportive care includes, hydroxyurea for leukocytosis and/or differentiation-like syndrome, anti-infectives, analgesics, antiemetics, antipyretics, transfusions and nutritional support

Treatment: Drugs: Azacitidine
continuous 28-day cycles of azacitidine 75 mg/m2/day SC for 7 days, plus BSC

Treatment: Drugs: Low-dose cytarabine (LDAC)
continuous 28-day cycles of cytarabine 20 mg SC twice a day (BID) for 10 days, plus BSC

Treatment: Drugs: Intermediate-dose cytarabine (IDAC)
28-day cycles of cytarabine 0.5 to 1.5 g/m2/day IV for 3 to 6 days, per standard institutional practice, plus BSC; only BSC given after IDAC therapy concludes per standard institutional practice
Intervention code [1] 0 0
Treatment: Drugs
Intervention code [2] 0 0
Other interventions
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Overall Survival (OS)
Timepoint [1] 0 0
From randomization to death due to any cause (up to approximately 49 months)
Secondary outcome [1] 0 0
Overall Response Rate
Timepoint [1] 0 0
From randomization up to approximately 49 months
Secondary outcome [2] 0 0
Event-Free Survival
Timepoint [2] 0 0
From randomization to the date of documented morphologic relapse after CR/CRi/CRp, PD or death from any cause, whichever occurs first. (up to approximately 49 months)
Secondary outcome [3] 0 0
Duration of Response
Timepoint [3] 0 0
From randomization to documented morphologic relapse after CR/CRi/CRp/ PD or death due to any cause, whichever occurs first (up to approximately 49 months)
Secondary outcome [4] 0 0
Time to Response
Timepoint [4] 0 0
From randomization to to first documented MLFS/CR/CRi/CRp/PR (up to approximately 49 months)
Secondary outcome [5] 0 0
Treatment Mortality at 30 Days
Timepoint [5] 0 0
From first dose to 30 days after first dose
Secondary outcome [6] 0 0
Treatment Mortality at 60 Days
Timepoint [6] 0 0
From first dose to 60 days after first dose
Secondary outcome [7] 0 0
One-Year Survival Rate
Timepoint [7] 0 0
From randomization to 1 year after randomization
Secondary outcome [8] 0 0
Overall Remission Rate
Timepoint [8] 0 0
From randomization up to approximately 49 months
Secondary outcome [9] 0 0
Complete Remission Rate
Timepoint [9] 0 0
From randomization up to approximately 49 months
Secondary outcome [10] 0 0
Hematologic Improvement Rate
Timepoint [10] 0 0
From randomization up to approximately 49 months
Secondary outcome [11] 0 0
The Number of Participants That Underwent Hematopoietic Stem Cell Transplantation (HSCT)
Timepoint [11] 0 0
From randomization up to approximately 49 months
Secondary outcome [12] 0 0
Time to Treatment Failure
Timepoint [12] 0 0
From randomization to discontinuation of study treatment due to any cause (up to approximately 49 months)
Secondary outcome [13] 0 0
The Number of Participants Experiencing Adverse Events (AEs)
Timepoint [13] 0 0
From first dose up to 28 days after last dose (up to approximately 49 months)
Secondary outcome [14] 0 0
The Percent of Participants Experiencing Clinically Significant Laboratory Abnormalities - Serum Chemistry
Timepoint [14] 0 0
From first dose up to approximately 49 months
Secondary outcome [15] 0 0
The Percent of Participants Experiencing Clinically Significant Laboratory Abnormalities - Hematology
Timepoint [15] 0 0
From first dose up to approximately 49 months
Secondary outcome [16] 0 0
The Percent of Participants Experiencing Clinically Significant Vital Sign Abnormalities
Timepoint [16] 0 0
From first dose up to approximately 49 months
Secondary outcome [17] 0 0
The Percentage of Participants Experiencing Clinically Significant Electrocardiogram (ECG) Abnormalities
Timepoint [17] 0 0
From first dose up to approximately 49 months
Secondary outcome [18] 0 0
Change From Baseline in the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30)
Timepoint [18] 0 0
From baseline to cycle 2 day 1 (up to approximately 1 month)
Secondary outcome [19] 0 0
Change From Baseline in EQ-5D-5L Health Utility Index
Timepoint [19] 0 0
From baseline up to cycle 2 day 1 (up to approximately 1 month)

Eligibility
Key inclusion criteria
Subjects must satisfy the following criteria to be enrolled in the study:

1. Subject is = 60 years of age at the time of signing the ICF
2. Subject has primary (ie, de novo) or secondary (progression of MDS or myeloproliferative neoplasms ([MPN], or therapy-related) AML according to WHO classification (Appendix B)
3. Subject has received second- or third-line of AML therapy (see Appendix G for the definition of prior AML line; note that, for subjects having AML secondary to prior higher risk [Intermediate-2 or High risk according to the International Prognostic Scoring System] MDS treated with a hypomethylating agent [eg, azacitidine or decitabine], the hypomethylating therapy can be counted as a line if there is disease progression to AML during or shortly [eg, within 60 days] after the hypomethylating therapy.)
4. Subject has the following disease status:

1. Refractory to or relapsed after second- or third-line of intensive therapy for AML (eg, the "7 + 3" regimen):

at least 5% leukemic blasts in bone marrow (the minimum number of treatment cycles of the intensive therapy is per the investigator's discretion); or
2. Refractory to or relapsed after second- or third-line low-intensity AML therapy (eg, LDAC, azacitidine or decitabine):

at least 5% leukemic blasts in bone marrow after at least 2 treatment cycles
5. Subject is eligible for and willing to receive the pre-selected CCR treatment option, according to the investigator's assessment (Note: Subjects with degenerative and toxic encephalopathies, especially after the use of methotrexate or treatment with ionizing radiation, should not receive cytarabine.)
6. Subject has Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2 (Appendix D)
7. Subject has IDH2 gene mutations tested centrally (using the "investigational use only"PCR assay, Abbott RealTime IDH2) in samples of bone marrow aspirate and peripheral blood, and confirmed positive in bone marrow aspirate and/or peripheral blood. (Note: in the event that the central laboratory result is delayed and precludes acute clinical management of a subject who has confirmed IDH2 gene mutation by local evaluation, the subject may be eligible for randomization with approval by the Medical Monitor.)
8. Subject has adequate organ function defined as:

* Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SGPT) = 3 x upper limit of normal (ULN), unless considered due to leukemic organ involvement, following review by the Medical Monitor; and
* Serum total bilirubin = 1.5 x ULN, unless considered due to Gilbert's syndrome (eg, a gene mutation in UGT1A1) or leukemic organ involvement, following review by the Medical Monitor; and
* Creatinine clearance > 30 mL/min based on the Modification of Diet in Renal Disease (MDRD) glomerular filtration rate (GFR):

GFR (mL/min/1.73 m2) = 175 × (serum creatinine)-1.154 × (Age)-0.203 × (0.742 if female) × (1.212 if African American)
9. Females of childbearing potential (FCBP)* may participate, providing they meet the following conditions:

* Agree to practice true abstinence from sexual intercourse or to use highly effective contraceptive methods (eg, combined [containing estrogen and progestogen] or progestogen-only associated with inhibition of ovulation, oral, injectable, intravaginal, patch, or implantable hormonal contraceptive; bilateral tubal occlusion; intra-uterine device; intrauterine hormone-releasing system; or male partner sterilization [note that vasectomized partner is a highly effective birth control method provided that partner is the sole sexual partner of the FCBP trial participant and that the vasectomized partner has received medical assessment of the surgical success]) at screening and throughout the study, and for 4 months following the last study treatment (6 months following the last dose of cytarabine); and
* Have a negative serum ß-subunit of human chorionic gonadotropin (ß-hCG) pregnancy test (sensitivity of at least 25 mIU/mL) at screening; and
* Have a negative serum or urine (investigator's discretion under local regulations) ß-hCG pregnancy test (sensitivity of at least 25 mIU/mL) within 72 hours prior to the start of study treatment in the Treatment Phase (note that the screening serum pregnancy test can be used as the test prior to the start of study treatment in the Treatment Phase if it is performed within the 72-hour timeframe).
10. Male subjects must agree to practice true abstinence from sexual intercourse or to the use of highly effective contraceptive methods (as described above) with non-pregnant female partners of childbearing potential at screening and throughout the course of the study, and should avoid conception with their partners during the course of the study and for 4 months following the last study treatment (6 months following the last dose of cytarabine; 6 months following the last dose of azacitidine in Canada)
11. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted
12. Subject is willing and able to adhere to the study visit schedule and other protocol requirements
Minimum age
60 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
The presence of any of the following will exclude a subject from enrollment:

1. Subject is suspected or proven to have acute promyelocytic leukemia based on morphology, immunophenotype, molecular assay, or karyotype
2. Subject has AML secondary to chronic myelogenous leukemia
3. Subject has received a targeted agent against an IDH2 mutation
4. Subject has received systemic anticancer therapy or radiotherapy < 14 days prior to the start of study treatment. Note that hydroxyurea is allowed prior to the start of study treatment for the control of leukocytosis (however, hydroxyurea should not be given within 72 hours prior to and after administration of azacitidine).
5. Subject has received non-cytotoxic or investigational agents < 14 days or 5 half-lives, whichever is longer, prior to the start of study treatment
6. Subject has undergone HSCT within 60 days prior to the start of study treatment, or on immunosuppressive therapy post HSCT at the time of screening, or with clinically significant graft-versus-host disease (GVHD). The use of a stable dose of oral steroid post-HSCT and/or topical steroids for ongoing skin GVHD is permitted.
7. Subject has persistent, clinically significant non-hematologic toxicities from prior therapies
8. Subject has or is suspected of having central nervous system (CNS) leukemia. Evaluation of cerebrospinal fluid is only required if CNS involvement by leukemia is suspected during screening.
9. Subject has active uncontrolled systemic fungal, bacterial, or viral infection (defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics, antiviral therapy, and/or other treatment)
10. Subject has immediately life-threatening, severe complications of leukemia such as uncontrolled bleeding, pneumonia with hypoxia or shock, and/or disseminated intravascular coagulation
11. Subject has significant active cardiac disease within 6 months prior to the start of study treatment, including New York Heart Association (NYHA) class III or IV congestive heart failure (Appendix E); acute coronary syndrome (ACS); and/or stroke; or left ventricular ejection fraction (LVEF) < 40% by echocardiogram (ECHO) or multi-gated acquisition (MUGA) scan obtained within 28 days prior to the start of study treatment
12. Subject has prior history of malignancy, other than MDS, MPN or AML, unless the subject has been free of the disease for = 1 year prior to the start of study treatment.

However, subjects with the following history/concurrent conditions are allowed:
* Basal or squamous cell carcinoma of the skin
* Carcinoma in situ of the cervix
* Carcinoma in situ of the breast
* Incidental histologic finding of prostate cancer (T1a or T1b using the tumor, node, metastasis clinical staging system)
13. Subject is known seropositive or active infection with human immunodeficiency virus (HIV), or active infection with hepatitis B virus (HBV) or hepatitis C virus (HCV)
14. Subject is known to have dysphagia, short-gut syndrome, gastroparesis, or other conditions that limit the ingestion or gastrointestinal absorption of drugs administered orally
15. Subjects has uncontrolled hypertension (systolic blood pressure [BP] > 180 mmHg or diastolic BP > 100 mmHg)
16. Subject is a pregnant or lactating female
17. Subject has known or suspected to have hypersensitivity to any of the components of study treatment
18. Subject is taking those medications (listed in Section 8.2) that are known to prolong QT interval unless the subject can be transferred to other medications at least 5 half-lives prior to the start of study treatment
19. Subject has QTc interval (ie, Fridericia's correction [QTcF]) = 450 ms or other factors that increase the risk of QT prolongation or arrhythmic events (eg, heart failure, hypokalemia, family history of long QT interval syndrome) at screening
20. Subject is taking the following sensitive CYP substrate medications that have a narrow therapeutic range are excluded from the study unless the subject can be transferred to other medications at least 5 half-lives prior to the start of study treatment: paclitaxel and docetaxel (CYP2C8), phenytoin (CYP2C9), S-mephenytoin (CYP2C19), thioridazine (CYP2D6), theophylline, and tizanidine (CYP1A2)
21. Subject is taking the breast cancer resistance protein (BCRP) transporter-sensitive substrate rosuvastatin should be excluded from the study unless the subject can be transferred to other medications at least 5 half-lives prior to the start of study treatment
22. Subject has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study
23. Subject has any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study
24. Subject has any condition that confounds the ability to interpret data from the study

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Phase 3
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
30/12/2015
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
25/03/2024
Sample size
Target
Accrual to date
Final
319
Recruitment in Australia
Recruitment state(s)
NSW,SA
Recruitment hospital [1] 0 0
Local Institution - 901 - Concord
Recruitment hospital [2] 0 0
Local Institution - 904 - Adelaide
Recruitment hospital [3] 0 0
Local Institution - 906 - East Melbourne
Recruitment hospital [4] 0 0
Local Institution - 905 - Melbourne
Recruitment postcode(s) [1] 0 0
2139 - Concord
Recruitment postcode(s) [2] 0 0
5000 - Adelaide
Recruitment postcode(s) [3] 0 0
3002 - East Melbourne
Recruitment postcode(s) [4] 0 0
3004 - Melbourne
Recruitment outside Australia
Country [1] 0 0
United States of America
State/province [1] 0 0
Florida
Country [2] 0 0
United States of America
State/province [2] 0 0
Illinois
Country [3] 0 0
United States of America
State/province [3] 0 0
New Jersey
Country [4] 0 0
United States of America
State/province [4] 0 0
New York
Country [5] 0 0
United States of America
State/province [5] 0 0
North Carolina
Country [6] 0 0
United States of America
State/province [6] 0 0
Ohio
Country [7] 0 0
United States of America
State/province [7] 0 0
South Carolina
Country [8] 0 0
United States of America
State/province [8] 0 0
Texas
Country [9] 0 0
Austria
State/province [9] 0 0
Linz
Country [10] 0 0
Belgium
State/province [10] 0 0
Yvoir
Country [11] 0 0
Brazil
State/province [11] 0 0
Rio Grande Do Sul
Country [12] 0 0
Brazil
State/province [12] 0 0
Jau
Country [13] 0 0
Brazil
State/province [13] 0 0
Rio de Janeiro
Country [14] 0 0
Brazil
State/province [14] 0 0
São Paulo
Country [15] 0 0
Canada
State/province [15] 0 0
Alberta
Country [16] 0 0
Canada
State/province [16] 0 0
Manitoba
Country [17] 0 0
Canada
State/province [17] 0 0
Ontario
Country [18] 0 0
Canada
State/province [18] 0 0
Quebec
Country [19] 0 0
China
State/province [19] 0 0
Beijing
Country [20] 0 0
China
State/province [20] 0 0
Chengdu, Sichuan
Country [21] 0 0
China
State/province [21] 0 0
Hangzhou City
Country [22] 0 0
China
State/province [22] 0 0
Shanghai
Country [23] 0 0
China
State/province [23] 0 0
Zhengzhou
Country [24] 0 0
Czechia
State/province [24] 0 0
Praha
Country [25] 0 0
Denmark
State/province [25] 0 0
Aalborg
Country [26] 0 0
Denmark
State/province [26] 0 0
Copenhagen
Country [27] 0 0
Denmark
State/province [27] 0 0
Odense
Country [28] 0 0
France
State/province [28] 0 0
Angers
Country [29] 0 0
France
State/province [29] 0 0
BOBIGNY Cedex
Country [30] 0 0
France
State/province [30] 0 0
Lille
Country [31] 0 0
France
State/province [31] 0 0
Marseille cedex
Country [32] 0 0
France
State/province [32] 0 0
Pessac
Country [33] 0 0
France
State/province [33] 0 0
Pierre-Bénite Cedex
Country [34] 0 0
France
State/province [34] 0 0
Toulouse Cedex
Country [35] 0 0
France
State/province [35] 0 0
Versailles
Country [36] 0 0
France
State/province [36] 0 0
Villejuif CEDEX
Country [37] 0 0
Germany
State/province [37] 0 0
Essen
Country [38] 0 0
Germany
State/province [38] 0 0
Frankfurt
Country [39] 0 0
Germany
State/province [39] 0 0
Hannover
Country [40] 0 0
Germany
State/province [40] 0 0
Leipzig
Country [41] 0 0
Germany
State/province [41] 0 0
München
Country [42] 0 0
Italy
State/province [42] 0 0
Bologna
Country [43] 0 0
Italy
State/province [43] 0 0
Brescia
Country [44] 0 0
Italy
State/province [44] 0 0
Firenze
Country [45] 0 0
Italy
State/province [45] 0 0
Naples
Country [46] 0 0
Italy
State/province [46] 0 0
Palermo
Country [47] 0 0
Italy
State/province [47] 0 0
Reggio Calabria
Country [48] 0 0
Italy
State/province [48] 0 0
Roma
Country [49] 0 0
Korea, Republic of
State/province [49] 0 0
Hwasun-gun
Country [50] 0 0
Korea, Republic of
State/province [50] 0 0
Seoul
Country [51] 0 0
Russian Federation
State/province [51] 0 0
Krasnoyarsk
Country [52] 0 0
Russian Federation
State/province [52] 0 0
Moscow
Country [53] 0 0
Russian Federation
State/province [53] 0 0
Saint-Petersburg
Country [54] 0 0
Spain
State/province [54] 0 0
Asturias
Country [55] 0 0
Spain
State/province [55] 0 0
Avda, Campanar 21
Country [56] 0 0
Spain
State/province [56] 0 0
Barcelona
Country [57] 0 0
Spain
State/province [57] 0 0
Salamanca
Country [58] 0 0
Spain
State/province [58] 0 0
Sevilla
Country [59] 0 0
Taiwan
State/province [59] 0 0
Taichung, Northern Dist.
Country [60] 0 0
Taiwan
State/province [60] 0 0
Taipei, Zhongzheng Dist.
Country [61] 0 0
Taiwan
State/province [61] 0 0
Taoyuan
Country [62] 0 0
Turkey
State/province [62] 0 0
Ankara
Country [63] 0 0
Turkey
State/province [63] 0 0
Denizli
Country [64] 0 0
Turkey
State/province [64] 0 0
Gaziantep
Country [65] 0 0
United Kingdom
State/province [65] 0 0
Nottinghamshire
Country [66] 0 0
United Kingdom
State/province [66] 0 0
London
Country [67] 0 0
United Kingdom
State/province [67] 0 0
Manchester Withington
Country [68] 0 0
United Kingdom
State/province [68] 0 0
Oxford
Country [69] 0 0
United Kingdom
State/province [69] 0 0
Sutton (Surrey)

Funding & Sponsors
Primary sponsor type
Commercial sector/industry
Name
Celgene
Address
Country

Ethics approval
Ethics application status

Summary
Brief summary
This is an international, multicenter, open-label, randomized, Phase 3 study comparing the efficacy and safety of AG-221 versus conventional care regimens (CCRs) in subjects 60 years or older with acute myeloid leukemia (AML) refractory to or relapsed after second- or third-line AML therapy and positive for an isocitrate dehydrogenase (IDH2) mutation.
Trial website
https://clinicaltrials.gov/study/NCT02577406
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 0 0
Bristol-Myers Squibb
Address 0 0
Bristol-Myers Squibb
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/study/NCT02577406