Sorafenib, Busulfan and Fludarabine in Treating Patients With Recurrent or Refractory Acute Myeloid Leukemia Undergoing Donor Stem Cell Transplant

Running, not enrolling · Phase 1/Phase 2

Conditions studied: Recurrent Acute Myeloid Leukemia, Refractory Acute Myeloid Leukemia

In brief

This phase I/II trial studies the best dose of sorafenib when given together with busulfan and fludarabine in treating patients with acute myeloid leukemia that has come back or does not respond to treatment and who are undergoing donor stem cell transplant. Sorafenib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as busulfan and fludarabine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving sorafenib with busulfan and fludarabine may work better in treating patients with recurrent or refractory acute myeloid leukemia.

Key facts

Study ID: NCT03247088
Run by: M.D. Anderson Cancer Center
People needed: 74
Starts: 2017-07-30
Expected to finish: 2027-12-31
Last updated by the study team: 2026-06-10

Who can join

Age: 18 and older, up to 70. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Age >= 18 and =< 70 years
Patients with acute myeloid leukemia both flt3 positive and negative
Human leukocyte antigen (HLA)-identical sibling or 8/8 matched unrelated donor available
Life expectancy of at least 12 weeks (3 months)
Direct bilirubin =< 1 mg/dL
Alanine transaminase (ALT) =< 3 x upper limit of normal
Serum creatinine =< 1.5 x the upper limit of normal
Creatinine clearance >= 50
Diffusing capacity for carbon monoxide (DLCO) > 50% of predicted corrected for hemoglobin
Left ventricular ejection fraction (LVEF) >= 50%
Subjects must be able to understand and be willing to sign the written informed consent form. A signed informed consent form must be appropriately obtained prior to the conduct of any trial-specific procedure
Women of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of study drug. Post-menopausal women (defined as no menses for at least 1 year) and surgically sterilized women are not required to undergo a pregnancy test
Subjects (men and women) of childbearing potential must agree to use adequate contraception beginning at the signing of the informed consent form (ICF) until at least 30 days after the last dose of study drug. The definition of adequate contraception will be based on the judgment of the principal investigator or a designated associate
Subject must be able to swallow and retain oral medication

You may not qualify if…

Acute myeloid leukemia in first complete molecular remission and favorable risk disease as defined by presence of t(8:21) or inv (16)
Patients with a comorbidity score > 3. The principal investigator is the final arbiter of eligibility for comorbidity score > 3
Uncontrolled hypertension (systolic pressure > 140 mm Hg or diastolic pressure > 90 mm Hg [NCI-Common Terminology Criteria for Adverse Events (CTCAE) version (v)4.0] on repeated measurement) despite optimal medical management
Active or clinically significant cardiac disease including:
Congestive heart failure - New York Heart Association (NYHA) > class II
Active coronary artery disease
Cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers or digoxin
Unstable angina (anginal symptoms at rest), new-onset angina within 3 months before randomization, or myocardial infarction within 6 months before randomization
Evidence or history of bleeding diathesis or coagulopathy. Patients with bleeding due to prior thrombocytopenia are permitted
Subject with any pulmonary hemorrhage/bleeding event of NCI-CTCAE v. 4.0 grade 2 or higher within 4 weeks before randomization; any other hemorrhage/bleeding event of NCI-CTCAE v. 4.0 grade 3 or higher within 4 weeks before randomization
Subjects with thrombotic, embolic, venous, or arterial cerebrovascular event (including transient ischemic attacks) within 6 months of informed consent
Subjects who have used strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, phenobarbital, St. John's wort [Hypericum perforatum], dexamethasone at a dose of greater than 16 mg daily, or rifampin [rifampicin], and/or rifabutin) within 28 days before randomization
Subjects with any previously untreated or concurrent cancer except cervical cancer in-situ, treated basal cell carcinoma, or superficial bladder tumor. Subjects surviving a cancer that was curatively treated and without evidence of disease for more than 3 years before randomization are allowed. All cancer treatments must be completed at least 3 years prior to study entry (i.e., signature date of the informed consent form)
Presence of a non-healing wound, non-healing ulcer, or bone fracture
History of organ allograft (including corneal transplant)
Known or suspected allergy or hypersensitivity to any of the study drugs, study drug classes, or excipients of the formulations given during the course of this trial
Any malabsorption condition
Women who are pregnant or breast-feeding
Inability to comply with the protocol and/or not willing or not available for follow-up assessments
Any medical, psychological, or psychosocial condition which, in the investigator's opinion, makes the subject unsuitable for trial participation
Major surgery within 30 days prior to start of study drug
Patients who received inotuzumab and/or gemtuzumab in the past
Therapeutic anticoagulation with vitamin-K antagonists (e.g., warfarin) or with heparins and heparinoids
However, prophylactic anticoagulation as described below is allowed:
Low dose warfarin (1 mg orally, once daily) with prothrombin time international normalized ratio (PT-INR). =< 1.5 x upper limit of normal (ULN) is permitted. Infrequent bleeding or elevations in PT-INR have been reported in some subjects taking warfarin while on sorafenib or capecitabine therapy. Therefore, subjects taking concomitant warfarin should be monitored regularly for changes in PT, PT-INR or clinical bleeding episodes

Where it is running

M D Anderson Cancer Center — Houston, Texas, United States

Full record on ClinicalTrials.gov

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