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RATIONALE: Drugs used in chemotherapy, such as cytarabine and decitabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Vorinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving cytarabine together with decitabine and vorinostat may kill more cancer cells
PURPOSE: This phase I trial is studying the side effects and the best dose of cytarabine when given together with decitabine and vorinostat in treating patients with relapsed or refractory acute myeloid leukemia.
- To determine the maximum-tolerated dose of the combination of decitabine, vorinostat, and cytarabine in patients with relapsed or refractory acute myeloid leukemia (AML).
- To define the specific toxicities and the dose-limiting toxicity of this regimen in these patients.
- To determine the overall response rate in patients treated with this regimen.
- To develop a platform for specifically targeting mixed lineage leukemia partial tandem duplication (MLL PTD) for future efficacy studies.
- To examine the role of decitabine and vorinostat in re-expression of MLL- WT in patients with AML and MLL PTD.
- To determine the preliminary relationship of re-expression of MLL- WT to clinical response in these patients.
- To correlate the biological activity of decitabine as demethylating agent (changes in target gene methylation and gene expression, DNMT1 protein expression, global methylation) with clinical endpoints.
- To explore the biologic role of microRNAs in determining clinical response to this regimen and achievement of the other pharmacodynamic endpoints.
OUTLINE: This a dose-escalation study of cytarabine.
- Induction therapy: Patients receive decitabine IV over 1 hour on days 1-10, oral vorinostat on days 5-10, and high-dose cytarabine IV over 2 hours on days 12, 14, and 16 in the absence of disease progression or unacceptable toxicity. Patients who achieve complete response (CR) proceed to maintenance therapy. Patients who achieve CR with incomplete blood count recovery undergo bone marrow aspiration and biopsy at count recovery or day 42 before proceeding to maintenance therapy.
- Maintenance therapy: Patients receive decitabine IV over 1 hour on days 1-5 and oral vorinostat on days 5-10. Treatment repeats every 28 days for up to 11 courses in the absence of disease progression or unacceptable toxicity.
Blood samples and additional bone marrow aspirate and biopsy are collected at baseline and during study for re-expression of MLL- WT, changes in target gene methylation and gene expression, DNMT1 protein expression, global methylation, and other pharmacodynamic studies.
After completion of study therapy, patients are followed up for 30 days.
Masking: Open Label, Primary Purpose: Treatment
cytarabine, decitabine, vorinostat, gene expression analysis, protein expression analysis, laboratory biomarker analysis, pharmacological study
Not yet recruiting
National Cancer Institute (NCI)
Published on BioPortfolio: 2014-08-27T03:13:26-0400
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RATIONALE: Vorinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cytarabine and etoposide, work in diff...
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A form of gene interaction whereby the expression of one gene interferes with or masks the expression of a different gene or genes. Genes whose expression interferes with or masks the effects of other genes are said to be epistatic to the effected genes. Genes whose expression is affected (blocked or masked) are hypostatic to the interfering genes.
The expression of a gene in an abnormal place, or at an abnormal time in an organism. Ectopic Gene Expression is often induced artificially by genetic techniques.
A TALE-type homeodomain protein and transcription factor that functions as a regulator of PAX6 PROTEIN expression and as an activator of PLATELET FACTOR 4 gene expression. It is essential for hematopoiesis, differentiation of MEGAKARYOCYTES, and vascular patterning. It may also have a role in the induction of myeloid leukemias.
A winged-helix transcription factor that regulates GENE expression in metabolic tissues. It plays a role in HOMEOSTASIS of GLUCOSE and controls expression of GLUT2 PROTEIN.
Techniques used to add in exogenous gene sequence such as mutated genes; REPORTER GENES, to study mechanisms of gene expression; or regulatory control sequences, to study effects of temporal changes to GENE EXPRESSION.
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