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NCT02343939: ENTO in AML

Entospletinib Monotherapy and in Combination With Chemotherapy in Adults With Acute Myeloid Leukemia (AML)

Terminated Phase 1, PHASE2 Results posted Last updated 15 November 2019
What this trial tests

Phase 1, PHASE2 trial testing Entospletinib in Acute Myeloid Leukemia in 148 participants. Terminated before completion.

Timeline
1 July 2015
Primary endpoint
4 September 2018
21 February 2019

Quick facts

Lead sponsorGilead Sciences
PhasePhase 1, PHASE2
StatusTerminated
Study typeINTERVENTIONAL
Allocationrandomized
Designsequential
Maskingnone
Primary purposetreatment
Enrollment148
Start date1 July 2015
Primary completion4 September 2018
Estimated completion21 February 2019
Sites17 locations across Canada, United States, Germany

Drugs / interventions tested

Conditions studied

Sponsor

Gilead Sciences — full company profile →

Who can join

18 and older, any sex, with Acute Myeloid Leukemia. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Percentage of Participants Experiencing Dose Limiting Toxicities (DLTs) Primary · Group A: Cycle 0 Day 1 to Cycle 2 Day 28; Group B: Cycle 0 Day 1 to Cycle 1 Day 28; Group C: Cycle 1 Day 1 to Cycle 1 Day 28 (Cycle length: for Cycle 0 = 14 days, for all other cycles = 28 days)

DLTs refer to toxicities experienced during the first 28 days of study treatment that have been judged to be clinically significant and related to study treatment. DLT assessment was applicable only for Phase 1b and Phase 2 safety run-in participants.

GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin0
Group A Phase 1b/2 ENTO 400 mg + Cytarabine + Daunorubicin0
Group B Phase 1b ENTO 200 mg + Decitabine0
Group B Phase 1b ENTO 400 mg + Decitabine16.7
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)0
Group C Phase 1b/2 ENTO 400 mg0
Group C Phase 1b ENTO 800 mg16.7
Percentage of Participants With Morphologic Complete Remission (CR) at the End of Induction Primary · At the end of induction (Group A: up to end of Cycle 2; Group B: up to end of Cycle 4) (cycle length = up to 28 days); Group C: From Day 1 until meeting the criteria for study treatment discontinuation (up to approximately 3 years)

Clinical response was assessed according to the International Working Group criteria (Cheson 2003). Morphologic CR included CR and cytogenetic CR (CRc). CR required all of the following: \< 5% blasts in bone marrow aspirate; Neutrophils ≥ 1,000/microliter (mcL); Platelets ≥ 100,000/mcL; No extramedullary disease; No blasts with Auer rods detected; and Independent of transfusions. CRc, in addition to CR criteria, required reversion to a normal karyotype with an abnormal karyotype at the time of diagnosis.

GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin66.79.4 – 99.2
Group A Phase 1b ENTO 400 mg + Cytarabine + Daunorubicin66.729.9 – 92.5
Group A Phase 2 ENTO 400 mg + Cytarabine + Daunorubicin46.330.7 – 62.6
Group B Phase 1b ENTO 200 mg + Decitabine0.00.0 – 52.2
Group B Phase 1b ENTO 400 mg + Decitabine16.70.4 – 64.1
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)25.03.2 – 65.1
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)0.00.0 – 19.5
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)7.10.2 – 33.9
Group C Phase 1b ENTO 400 mg0.00.0 – 41.0
Group C Phase 1b ENTO 800 mg0.00.0 – 41.0
Group C Phase 2 ENTO 400 mg (Cohort C1A - R/R AML)0.00.0 – 45.9
Group C Phase 2 ENTO 400 mg (Cohort C2 - MLL)15.41.9 – 45.4
Percentage of Participants With Composite Complete Remission at the End of Induction Primary · At the end of induction (Group A: up to end of Cycle 2; Group B: up to end of Cycle 4) (cycle length = up to 28 days); Group C: From Day 1 until meeting the criteria for study treatment discontinuation (up to approximately 3 years)

Clinical response was assessed according to the International Working Group criteria (Cheson 2003). Composite complete remission included CR, CRc, and morphologic complete remission with incomplete blood count recovery (CRi). CR required all of the following: \< 5% blasts in bone marrow aspirate; Neutrophils ≥ 1,000/mcL; Platelets ≥ 100,000/mcL; No extramedullary disease; No blasts with Auer rods detected; and Independent of transfusions. CRc, in addition to CR criteria, required reversion to a normal karyotype with an abnormal karyotype at the time of diagnosis. CRi required all of the CR cri

GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin100.029.2 – 100
Group A Phase 1b ENTO 400 mg + Cytarabine + Daunorubicin77.840 – 97.2
Group A Phase 2 ENTO 400 mg + Cytarabine + Daunorubicin65.949.4 – 79.9
Group B Phase 1b ENTO 200 mg + Decitabine40.05.3 – 85.3
Group B Phase 1b ENTO 400 mg + Decitabine50.011.8 – 88.2
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)25.03.2 – 65.1
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)23.56.8 – 49.9
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)14.31.8 – 42.8
Group C Phase 1b ENTO 400 mg14.30.4 – 57.9
Group C Phase 1b ENTO 800 mg0.00.0 – 41.0
Group C Phase 2 ENTO 400 mg (Cohort C1A - R/R AML)0.00.0 – 45.9
Group C Phase 2 ENTO 400 mg (Cohort C2 - MLL)15.41.9 – 45.4
Percentage of Participants With Overall Response at the End of Induction Primary · At the end of induction (Group A: up to end of Cycle 2; Group B: up to end of Cycle 4) (cycle length = up to 28 days); Group C: From Day 1 until meeting the criteria for study treatment discontinuation (up to approximately 3 years)

Clinical response was assessed according to the International Working Group criteria (Cheson 2003). Overall response included CR, CRc, CRi, and partial remission (PR). CR required all of the following: \< 5% blasts in bone marrow aspirate; Neutrophils ≥ 1,000/mcL; Platelets ≥ 100,000/mcL; No extramedullary disease; No blasts with Auer rods detected; and Independent of transfusions. CRc, in addition to CR criteria, required reversion to a normal karyotype with an abnormal karyotype at the time of diagnosis. CRi required all of the CR criteria except the criterion of neutrophils and platelets. P

GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin100.029.2 – 100
Group A Phase 1b ENTO 400 mg + Cytarabine + Daunorubicin77.840 – 97.2
Group A Phase 2 ENTO 400 mg + Cytarabine + Daunorubicin70.754.5 – 83.9
Group B Phase 1b ENTO 200 mg + Decitabine40.05.3 – 85.3
Group B Phase 1b ENTO 400 mg + Decitabine50.011.8 – 88.2
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)25.03.2 – 65.1
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)23.56.8 – 49.9
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)14.31.8 – 42.8
Group C Phase 1b ENTO 400 mg14.30.4 – 57.9
Group C Phase 1b ENTO 800 mg0.00 – 41
Group C Phase 2 ENTO 400 mg (Cohort C1A - R/R AML)0.00 – 45.9
Group C Phase 2 ENTO 400 mg (Cohort C2 - MLL)15.41.9 – 45.4
Duration of Exposure of Entospletinib Secondary · First dose date up to approximately 3 years
GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin8.66.1 – 10.0
Group A Phase 1b/2 ENTO 400 mg + Cytarabine + Daunorubicin7.10.9 – 72.9
Group B Phase 1b ENTO 200 mg + Decitabine13.71.6 – 50.9
Group B Phase 1b ENTO 400 mg + Decitabine15.41.9 – 58.9
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)10.11.3 – 39.4
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)13.91.9 – 40.0
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)10.10.9 – 47.0
Group C Phase 1b/2 ENTO 400 mg4.41.4 – 15.6
Group C Phase 1b ENTO 800 mg7.62.0 – 9.0
Event Free Survival (EFS) Secondary · First dose date up to approximately 38 months

EFS was defined as the time interval from the start of the study therapy until the date of treatment failure, acute myeloid leukemia (AML) relapse, or death from any cause, whichever occurred first. Participants who received other anti-cancer therapy (prior to the event if any) were censored. Median EFS was analyzed using Kaplan-Meier (KM) method.

GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + DaunorubicinNANA – NA
Group A Phase 1b ENTO 400 mg + Cytarabine + Daunorubicin1.90.9 – 1.9
Group A Phase 2 ENTO 400 mg + Cytarabine + Daunorubicin9.02.3 – NA
Group B Phase 1b ENTO 200 mg + Decitabine2.20.5 – 4.7
Group B Phase 1b ENTO 400 mg + Decitabine2.91.1 – 7.7
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)2.30.5 – 9.0
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)3.20.5 – 4.2
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)2.42.1 – 3.9
Group C Phase 1b ENTO 400 mg1.80.9 – 1.9
Group C Phase 1b ENTO 800 mg1.80.5 – 1.9
Group C Phase 2 ENTO 400 mg (Cohort C1A - R/R AML)1.00.7 – 2.8
Group C Phase 2 ENTO 400 mg (Cohort C2 - MLL)1.00.8 – 2.7
Overall Survival (OS) Secondary · First dose date up to approximately 38 months

OS was defined as the time interval from the start of the study therapy to death from any cause. Median OS was analyzed using KM method.

GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin37.19.1 – NA
Group A Phase 1b ENTO 400 mg + Cytarabine + Daunorubicin34.11.2 – NA
Group A Phase 2 ENTO 400 mg + Cytarabine + DaunorubicinNA16.8 – NA
Group B Phase 1b ENTO 200 mg + Decitabine3.20.8 – 12.7
Group B Phase 1b ENTO 400 mg + Decitabine5.32.4 – NA
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)6.91.4 – NA
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)7.32.4 – NA
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)6.23.2 – 10.2
Group C Phase 1b ENTO 400 mg5.90.9 – 6.3
Group C Phase 1b ENTO 800 mg5.60.5 – 8.4
Group C Phase 2 ENTO 400 mg (Cohort C1A - R/R AML)8.20.7 – 24.3
Group C Phase 2 ENTO 400 mg (Cohort C2 - MLL)7.93.3 – 11.9
Percentage of Participants Experiencing Treatment-Emergent Adverse Events Secondary · First dose date up to the last dose date plus 30 days (maximum: 18 months)
GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin100.0
Group A Phase 1b/2 ENTO 400 mg + Cytarabine + Daunorubicin100.0
Group B Phase 1b ENTO 200 mg + Decitabine100.0
Group B Phase 1b ENTO 400 mg + Decitabine100.0
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)100.0
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)100.0
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)100.0
Group C Phase 1b/2 ENTO 400 mg100.0
Group C Phase 1b ENTO 800 mg100.0
Percentage of Participants Who Experienced Laboratory Abnormalities Secondary · First dose date up to the last dose date plus 30 days (maximum: 18 months)

Treatment-emergent laboratory abnormalities were defined as values that increase at least one toxicity grade from baseline. The most severe graded abnormality from all tests was counted for each participant.

Any Laboratory Abnormality
GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin100
Group A Phase 1b/2 ENTO 400 mg + Cytarabine + Daunorubicin100
Group B Phase 1b ENTO 200 mg + Decitabine100
Group B Phase 1b ENTO 400 mg + Decitabine100
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)100
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)94.1
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)100
Group C Phase 1b/2 ENTO 400 mg100
Group C Phase 1b ENTO 800 mg100
Grade 3 or 4 Laboratory Abnormalities
GroupValue95% CI
Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin100
Group A Phase 1b/2 ENTO 400 mg + Cytarabine + Daunorubicin98.0
Group B Phase 1b ENTO 200 mg + Decitabine100
Group B Phase 1b ENTO 400 mg + Decitabine100
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)85.7
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)94.1
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)92.9
Group C Phase 1b/2 ENTO 400 mg82.9
Group C Phase 1b ENTO 800 mg85.7

Adverse events — posted to ClinicalTrials.gov

Time frame: - All-Cause Mortality: First dose date up to approximately 38 months. - Adverse Events: First dose date up to the last dose date plus 30 days (maximum: 18 months). Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Group A Phase 1b ENTO 200 mg + Cytarabine + Daunorubicin
Serious: 0/3 (0%)
Deaths: 2/3
Group A Phase 1b/2 ENTO 400 mg + Cytarabine + Daunorubicin
Serious: 23/50 (46%)
Deaths: 21/50
Group B Phase 1b ENTO 200 mg + Decitabine
Serious: 5/5 (100%)
Deaths: 5/5
Group B Phase 1b ENTO 400 mg + Decitabine
Serious: 5/6 (83%)
Deaths: 4/6
Group B Phase 2 ENTO 400 mg + Azacitidine (Safety Run-In)
Serious: 7/8 (88%)
Deaths: 5/8
Group B Phase 2 ENTO 400 mg + Decitabine (Randomized)
Serious: 11/17 (65%)
Deaths: 12/17
Group B Phase 2 ENTO 400 mg + Azacitidine (Randomized)
Serious: 7/14 (50%)
Deaths: 11/14
Group C Phase 1b/2 ENTO 400 mg
Serious: 19/35 (54%)
Deaths: 30/35
Group C Phase 1b ENTO 800 mg
Serious: 4/7 (57%)
Deaths: 6/7

Serious adverse events (74 terms)

ReactionSystemGroup A Phase 1b ENTO 200 …Group A Phase 1b/2 ENTO 40…Group B Phase 1b ENTO 200 …Group B Phase 1b ENTO 400 …Group B Phase 2 ENTO 400 m…Group B Phase 2 ENTO 400 m…Group B Phase 2 ENTO 400 m…Group C Phase 1b/2 ENTO 40…Group C Phase 1b ENTO 800 mg
Febrile neutropeniaBlood and lymphatic system disorders
Cardiac failure congestiveCardiac disorders
HaematemesisGastrointestinal disorders
PyrexiaGeneral disorders
Device related infectionInfections and infestations
Lung infectionInfections and infestations
PneumoniaInfections and infestations
SepsisInfections and infestations
Angina pectorisCardiac disorders
Atrial fibrillationCardiac disorders
Cardiac arrestCardiac disorders
Cardiac failure chronicCardiac disorders
Sinus bradycardiaCardiac disorders
ColitisGastrointestinal disorders
ConstipationGastrointestinal disorders
Gastric haemorrhageGastrointestinal disorders
Gastrointestinal haemorrhageGastrointestinal disorders
HaematocheziaGastrointestinal disorders
Intestinal ischaemiaGastrointestinal disorders
Large intestine perforationGastrointestinal disorders
OesophagitisGastrointestinal disorders
ProctalgiaGastrointestinal disorders
StomatitisGastrointestinal disorders
VomitingGastrointestinal disorders
AstheniaGeneral disorders
Other adverse events (287 terms — click to expand)

ReactionSystemGroup A Phase 1b ENTO 200 …Group A Phase 1b/2 ENTO 40…Group B Phase 1b ENTO 200 …Group B Phase 1b ENTO 400 …Group B Phase 2 ENTO 400 m…Group B Phase 2 ENTO 400 m…Group B Phase 2 ENTO 400 m…Group C Phase 1b/2 ENTO 40…Group C Phase 1b ENTO 800 mg
Febrile neutropeniaBlood and lymphatic system disorders
DiarrhoeaGastrointestinal disorders
NauseaGastrointestinal disorders
Oedema peripheralGeneral disorders
Platelet count decreasedInvestigations
AnaemiaBlood and lymphatic system disorders
Decreased appetiteMetabolism and nutrition disorders
Rash maculo-papularSkin and subcutaneous tissue disorders
ConstipationGastrointestinal disorders
HeadacheNervous system disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
White blood cell count decreasedInvestigations
CoughRespiratory, thoracic and mediastinal disorders
VomitingGastrointestinal disorders
Neutrophil count decreasedInvestigations
InsomniaPsychiatric disorders
FatigueGeneral disorders
DizzinessNervous system disorders
Abdominal painGastrointestinal disorders
Blood bilirubin increasedInvestigations
HypertensionVascular disorders
Lung infectionInfections and infestations
DysgeusiaNervous system disorders
HypoxiaRespiratory, thoracic and mediastinal disorders
Vision blurredEye disorders
Mucosal inflammationGeneral disorders
HypokalaemiaMetabolism and nutrition disorders
EpistaxisRespiratory, thoracic and mediastinal disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
PyrexiaGeneral disorders
Device related infectionInfections and infestations
DyspepsiaGastrointestinal disorders
StomatitisGastrointestinal disorders
ChillsGeneral disorders
Alanine aminotransferase increasedInvestigations
Aspartate aminotransferase increasedInvestigations
Acute kidney injuryRenal and urinary disorders
Atrial fibrillationCardiac disorders
Abdominal distensionGastrointestinal disorders
Non-cardiac chest painGeneral disorders

Most-reported serious reactions: Febrile neutropenia, Cardiac failure congestive, Haematemesis, Pyrexia, Device related infection, Lung infection, Pneumonia, Sepsis.

Data from ClinicalTrials.gov NCT02343939 adverse events section.

Sponsor's own description

This study will evaluate the efficacy, safety, and tolerability of entospletinib when administered as monotherapy or in combination with chemotherapy in adults with acute myeloid leukemia (AML).

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Syk inhibitors in clinical development for hematological malignancies.
    Liu D, Mamorska-Dyga A. · · 2017 · cited 130× · PMID 28754125 · DOI 10.1186/s13045-017-0512-1
  2. Current status and future perspectives in targeted therapy of NPM1-mutated AML.
    Ranieri R, Pianigiani G, Sciabolacci S, Perriello VM, et al · · 2022 · cited 91× · PMID 36008542 · DOI 10.1038/s41375-022-01666-2
  3. Targeting Tyrosine Kinases in Acute Myeloid Leukemia: Why, Who and How?
    Fernandez S, Desplat V, Villacreces A, Guitart AV, et al · · 2019 · cited 34× · PMID 31336846 · DOI 10.3390/ijms20143429
  4. Inhibitors of Chemoresistance Pathways in Combination with Ara-C to Overcome Multidrug Resistance in AML. A Mini Review.
    Fajardo-Orduña GR, Ledesma-Martínez E, Aguiñiga-Sánchez I, Mora-García ML, et al · · 2021 · cited 27× · PMID 34066940 · DOI 10.3390/ijms22094955
  5. Combinatorial efficacy of entospletinib and chemotherapy in patient-derived xenograft models of infant acute lymphoblastic leukemia.
    Loftus JP, Yahiaoui A, Brown PA, Niswander LM, et al · · 2021 · cited 22× · PMID 32414848 · DOI 10.3324/haematol.2019.241729
  6. The rocky road to personalized medicine in acute myeloid leukaemia.
    Brinda B, Khan I, Parkin B, Konig H. · · 2018 · cited 15× · PMID 29327808 · DOI 10.1111/jcmm.13478
  7. Acute Myeloid Leukemia: From Biology to Clinical Practices Through Development and Pre-Clinical Therapeutics.
    Roussel X, Daguindau E, Berceanu A, Desbrosses Y, et al · · 2020 · cited 14× · PMID 33363031 · DOI 10.3389/fonc.2020.599933
  8. Entospletinib with decitabine in acute myeloid leukemia with mutant TP53 or complex karyotype: A phase 2 substudy of the Beat AML Master Trial.
    Duong VH, Ruppert AS, Mims AS, Borate U, et al · · 2023 · cited 13× · PMID 37078412 · DOI 10.1002/cncr.34780

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