Combination Therapy for Acute Lymphoblastic Leukemia

Recruiting in Palo Alto (17 mi)

Overseen by Jessica T. Leonard

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1

Recruiting

Sponsor: OHSU Knight Cancer Institute

Must not be taking: Investigational agents

Disqualifiers: Chronic myelogenous leukemia, Serious infections, Uncontrolled cardiac illness, others

No Placebo Group

Breakthrough Therapy

Trial Summary

What is the purpose of this trial?

This trial tests a combination of five drugs to treat a specific type of aggressive leukemia. The drugs work together to stop cancer cell growth, reduce inflammation, and help the immune system target cancer cells. The trial aims to find the best dose and assess the safety and effectiveness of this treatment.

Will I have to stop taking my current medications?

The trial requires that participants stop taking certain medications before starting. Specifically, if you are taking strong or moderate CYP3A inhibitors, inducers, P-glycoprotein inhibitors, or warfarin, you must wait at least 3 half-lives of the medication before starting the trial. Additionally, if you have recently received a live vaccine, you must wait at least 4 weeks before starting.

What data supports the effectiveness of the drug combination for treating acute lymphoblastic leukemia?

Research shows that the combination of dasatinib and venetoclax is highly effective in treating a type of acute lymphoblastic leukemia (ALL) with a specific genetic marker (Philadelphia chromosome-positive). This combination was more effective than using either drug alone in reducing leukemia cells and was well-tolerated in studies. ^{1 2 3 4 5}

What makes this drug combination unique for treating acute lymphoblastic leukemia?

This combination therapy is unique because it includes venetoclax, a drug that targets BCL-2 proteins to help kill cancer cells, and dasatinib, which targets specific proteins in cancer cells to stop their growth. Together, they may enhance the effectiveness of treatment for certain types of acute lymphoblastic leukemia, especially those with specific genetic markers, by overcoming resistance to other treatments. ^{2 3 4 6 7}

Research Team

Jessica T. Leonard

Principal Investigator

OHSU Knight Cancer Institute

Eligibility Criteria

Adults with newly diagnosed or relapsed Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) can join this trial. They must have good kidney function, no prior dasatinib treatment for relapsed cases, and be able to take oral medication. Pregnant or breastfeeding individuals, those with certain heart conditions, recent other cancer treatments, or active serious infections cannot participate.

Inclusion Criteria

Alanine aminotransferase (ALT) < 2.5 x ULN

Aspartate aminotransferase (AST) < 2.5 x upper limit of normal (ULN)

Unless considered due to leukemic organ involvement. Note: subjects with Gilbert's Syndrome may have a bilirubin > 1.5 x ULN per discussion between the investigator and AbbVie medical monitor

Exclusion Criteria

I haven't taken any experimental cancer treatments recently.

I am not pregnant or breastfeeding.

You have had allergic reactions to drugs similar to dasatinib or other drugs being used in the study.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Induction Phase Cycle 1

Patients receive prednisone, dasatinib, venetoclax, rituximab, and methotrexate as part of the induction therapy

4 weeks

Multiple visits for drug administration and monitoring

Induction Phase Cycles 2-3

Continuation of induction therapy with dasatinib, venetoclax, rituximab, and methotrexate

8 weeks

Multiple visits for drug administration and monitoring

Consolidation Cycles 4-7

Patients receive blinatumomab, dasatinib, venetoclax, and methotrexate as part of consolidation therapy

24 weeks

Regular visits for drug administration and monitoring

Maintenance Therapy Cycles 8+

Continuation of maintenance therapy with dasatinib, venetoclax, and methotrexate

20 weeks

Regular visits for drug administration and monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

Follow-up visits every 12 weeks

Treatment Details

Interventions

• Dasatinib (Tyrosine Kinase Inhibitor)
• Prednisone (Corticosteroid)
• Rituximab (Monoclonal Antibodies)
• Venetoclax (Bcl-2 Inhibitor)

Trial Overview The trial is testing a combination of venetoclax with dasatinib, prednisone, and rituximab in patients. Venetoclax targets proteins that cancer cells need to survive; dasatinib blocks enzymes for cell growth; prednisone lowers immune response; rituximab may stop cancer spread.

Participant Groups

Group I: Treatment (prednisone, dasatinib, venetoclax, rituximab) Experimental Treatment 9 Interventions

See detailed description

Dasatinib is already approved in Canada for the following indications:

Approved in Canada as Sprycel for:

• Chronic myeloid leukemia (CML)
• Acute lymphoblastic leukemia (ALL)

Who Is Running the Clinical Trial?

OHSU Knight Cancer Institute

Lead Sponsor

Trials

239

Recruited

2,089,000+

Dr. Shivaani Kummar

OHSU Knight Cancer Institute

Chief Executive Officer

MD, FACP

Dr. Gordon Mills

OHSU Knight Cancer Institute

Chief Medical Officer since 2022

MD, PhD

AbbVie

Industry Sponsor

Trials

1,079

Recruited

535,000+

Founded

2013

Headquarters

North Chicago, USA

Known For

Immunology treatments

Top Products

Humira (adalimumab), Skyrizi (risankizumab), Rinvoq (upadacitinib)

Dr. Roopal Thakkar

AbbVie

Chief Medical Officer since 2023

MD from Wayne State University School of Medicine

Robert A. Michael

AbbVie

Chief Executive Officer

Bachelor's degree in Finance from the University of Illinois

Oregon Health and Science University

Collaborator

Trials

1,024

Recruited

7,420,000+

John Hunter

Oregon Health and Science University

Chief Medical Officer since 2024

MD, specific details unavailable

Ann Madden Rice

Oregon Health and Science University

Chief Executive Officer

FACHE certification, extensive leadership experience in academic health centers

Findings from Research

The combination of venetoclax with bendamustine-rituximab (BR) was found to be safe and tolerable in a study of 60 patients with relapsed/refractory non-Hodgkin's lymphoma, with the recommended phase II dose established at 800 mg daily.

The overall response rate to the treatment was 65%, with a median duration of response of 38.3 months, indicating preliminary efficacy for this combination therapy in managing B-cell NHL.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Venetoclax, bendamustine, and rituximab in patients with relapsed or refractory NHL: a phase Ib dose-finding study. de Vos, S., Swinnen, LJ., Wang, D., et al.[2021]

The combination of tyrosine kinase inhibitors (TKIs) like dasatinib and ponatinib with the BCL-2 inhibitor venetoclax shows strong synergy in reducing cell viability and inducing apoptosis in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+)ALL) cells, suggesting a promising new treatment strategy.

In tests with primary Ph(+)ALL patient samples in mice, the dasatinib-venetoclax combination was well-tolerated and demonstrated superior effectiveness compared to either drug alone, indicating its potential to enhance treatment outcomes for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting BCL-2 and ABL/LYN in Philadelphia chromosome-positive acute lymphoblastic leukemia. Leonard, JT., Rowley, JS., Eide, CA., et al.[2021]

Venetoclax is a highly effective treatment for relapsed or refractory chronic lymphocytic leukemia (CLL), achieving response rates of about 80% in clinical trials involving 240 patients from 2011 to 2016.

While venetoclax has an acceptable safety profile, common side effects include neutropenia and diarrhea, and there is a risk of tumor lysis syndrome (TLS), which can be managed through careful dose ramp-up and patient education, leading to no reported TLS events in ongoing trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Venetoclax: Management and Care for Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia . Brumbaugh Paradis, H., Alter, D., Llerandi, D.[2018]

Venetoclax is an effective oral treatment for relapsed or refractory chronic lymphocytic leukemia (CLL), showing durable responses and a manageable safety profile in clinical trials, including patients with poor prognostic factors.

In combination with rituximab, venetoclax significantly improved progression-free survival and achieved undetectable minimal residual disease compared to bendamustine plus rituximab, with benefits lasting for at least 36 months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Venetoclax: A Review in Relapsed/Refractory Chronic Lymphocytic Leukemia. Scott, LJ.[2020]

In the phase III CLL14 trial, a 12-month treatment with venetoclax combined with obinutuzumab significantly improved progression-free survival and rates of undetectable minimal residual disease compared to traditional chemoimmunotherapy with chlorambucil and obinutuzumab in patients with untreated chronic lymphocytic leukaemia.

Venetoclax + obinutuzumab is a well-tolerated, chemotherapy-free treatment option for CLL, with manageable side effects like neutropenia, making it suitable for patients who cannot undergo intensive chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Venetoclax: A Review in Previously Untreated Chronic Lymphocytic Leukaemia. Blair, HA.[2021]

In a study involving 272 patients with relapsed or refractory chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), higher concentrations of venetoclax led to a quicker reduction in lymphocyte counts and tumor size, resulting in a high objective response rate (ORR) of 84.8% at a daily dose of 400 mg.

Importantly, increasing the dose of venetoclax did not correlate with a higher risk of serious adverse events like neutropenia or infections, suggesting that the 400 mg daily regimen is both effective and safe for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Venetoclax Exposure on Clinical Efficacy and Safety in Patients with Relapsed or Refractory Chronic Lymphocytic Leukemia. Freise, KJ., Jones, AK., Eckert, D., et al.[2018]

In a study of 15 patients with relapsed or refractory early T-cell precursor acute lymphoblastic leukemia (R/R ETP-ALL), Venetoclax combined with multidrug chemotherapy resulted in a 67.7% overall response rate and a 60% complete response rate, indicating significant efficacy.

The treatment was found to be safe, with manageable hematological toxicities and no severe adverse reactions, suggesting that Venetoclax combined with chemotherapy could be a promising option for this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Clinical efficacy and safety of venetoclax combined with multidrug chemotherapy in the treatment of 15 patients with relapsed or refractory early T-cell precursor acute lymphoblastic leukemia]. Kong, JY., Zong, LH., Pu, Y., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Venetoclax, bendamustine, and rituximab in patients with relapsed or refractory NHL: a phase Ib dose-finding study. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Targeting BCL-2 and ABL/LYN in Philadelphia chromosome-positive acute lymphoblastic leukemia. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Venetoclax: Management and Care for Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia . [2018]

4. France pubmed.ncbi.nlm.nih.gov

Venetoclax: A Review in Relapsed/Refractory Chronic Lymphocytic Leukemia. [2020]

5. New Zealand pubmed.ncbi.nlm.nih.gov

Venetoclax: A Review in Previously Untreated Chronic Lymphocytic Leukaemia. [2021]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Impact of Venetoclax Exposure on Clinical Efficacy and Safety in Patients with Relapsed or Refractory Chronic Lymphocytic Leukemia. [2018]

7. China pubmed.ncbi.nlm.nih.gov

[Clinical efficacy and safety of venetoclax combined with multidrug chemotherapy in the treatment of 15 patients with relapsed or refractory early T-cell precursor acute lymphoblastic leukemia]. [2023]