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RATIONALE: 5-Fluoro-2'-deoxycytidine (FdCyd) may inhibit cancer cell growth by increasing the production in cells of compounds that suppress growth or by otherwise killing cells. Although FdCyd is stable as a drug solution, it is rapidly inactivated by an enzyme present in people. Tetrahydrouridine (THU) is included in the treatment to inhibit the enzyme, prolonging the time FdCyd remains in the body.
PURPOSE: This randomized phase II trial is studying two different schedules of FdCyd to compare how well they work when given together with THU in treating patients with acute myeloid leukemia or myelodysplastic syndromes.
I. Conduct a safety lead-in to refine the dose of FdCyd to be used in patients with Acute Myelogenous Leukemia (AML) and Myelodysplastic Syndrome (MDS) on each of two schedules (see Treatment Schema) to be used in the Phase II portion of the protocol.
II. To determine the anti-tumor activity of FdCyd and THU on two different schedules, as assessed by the objective response rate.
III. Evaluate time to treatment failure and survival in subjects with relapsed/refractory AML, relapsed/refractory or newly diagnosed MDS at int-1 or greater, or newly diagnosed AML patients over the age of 60.
IV. Evaluate whether treatment with FdCyd and THU alters DNA methylation patterns in peripheral blood mononuclear cells, including malignant myeloid cells, by analysis of LINE-1 methylation.
V. Determine the ratio of gamma to beta-globin mRNA by RT-PCR in blood cells before and after therapy as a marker of drug effect.
VI. To determine the changes in cytokines in the circulating blood and marrow before and after treatment with FdCyd and THU.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive FdCyd IV over 3 hours and THU IV over 3 hours on days 1-5 and 15-19. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive FdCyd IV over 3 hours and THU IV over 3 hours on days 1-5 and 8-12. Courses repeat every 21days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed periodically.
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Adult Acute Myeloid Leukemia
5-fluoro-2-deoxycytidine, tetrahydrouridine, laboratory biomarker analysis, reverse transcriptase-polymerase chain reaction, DNA methylation analysis
City of Hope
City of Hope Medical Center
Published on BioPortfolio: 2014-08-27T03:16:58-0400
RATIONALE: Drugs used in chemotherapy, such as 5-fluoro-2'-deoxycytidine and tetrahydrouridine, work in different ways to stop the growth of tumor cells, either by killing the cells or by ...
Background: - Two experimental drugs, FdCyd (also called 5-fluoro-2'-deoxcytidine), and THU (also called tetrahydrouridine), are undergoing trials to test their effectiveness in ...
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A deoxycytidine analog and REVERSE TRANSCRIPTASE INHIBITOR with antiviral activity against HIV-1 and HEPATITIS B viruses. It is used to treat HIV INFECTIONS.
DNA sequences that form the coding region for retroviral enzymes including reverse transcriptase, protease, and endonuclease/integrase. "pol" is short for polymerase, the enzyme class of reverse transcriptase.
Inhibitors of reverse transcriptase (RNA-DIRECTED DNA POLYMERASE), an enzyme that synthesizes DNA on an RNA template.
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Retroviral proteins coded by the pol gene. They are usually synthesized as a protein precursor (POLYPROTEINS) and later cleaved into final products that include reverse transcriptase, endonuclease/integrase, and viral protease. Sometimes they are synthesized as a gag-pol fusion protein (FUSION PROTEINS, GAG-POL). pol is short for polymerase, the enzyme class of reverse transcriptase.
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