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Brief Title: Safety and Efficacy of Quizartinib in Children and Young Adults With Acute Myeloid Leukemia (AML), a Cancer of the Blood
Official Title: A Phase 1/2, Multicenter, Dose-Escalating Study To Evaluate the Safety, Pharmacokinetics, Pharmacodynamics, and Efficacy Of Quizartinib Administered in Combination With Re-Induction Chemotherapy, and as a Single-Agent Continuation Therapy, in Pediatric Relapsed/Refractory AML Subjects Aged 1 Month to <18 Years (and Young Adults Aged up to 21 Years) With FLT3-ITD Mutations
Study ID: NCT03793478
Brief Summary: Quizartinib is an experimental drug. It is not approved for regular use. It can only be used in medical research. Children or young adults with a certain kind of blood cancer (FLT3-ITD AML) might be able to join this study if it has come back after remission or is not responding to treatment.
Detailed Description: The medical condition being investigated is relapsed or refractory AML in participants aged ≥1 month to ≤21 years with Feline McDonough Sarcoma (FMS)-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) mutations (FLT3-ITD AML), following failure of front-line intensive chemotherapy. The trial will be conducted in multiple phases. An independent data monitoring committee (DMC) will protect the rights, safety, and well-being of participants by monitoring the progress and results. The DMC will comprise qualified physicians and scientists who are not Investigators in the study and not otherwise directly associated with the Sponsor and will be convened at the end of Phase 1. A. Dose Escalation/De-escalation Phase: Number of participants is determined by age group. Participants will be enrolled by dose-level to determine the recommended Phase 2 dose (RP2D) of quizartinib for pediatric participants that provides similar exposure to adult patients treated at the target adult dose of 60 mg orally once daily. B. Dose-Expansion Phase: Participants will receive the RP2D of quizartinib for their respective age group. During both dose escalation and dose expansion phases, participants will receive: Re-Induction Therapy * Intrathecal (IT) triple chemotherapy prophylaxis prior to and between cycles * In re-induction Cycles 1 and 2, fludarabine/cytarabine (FLA) followed by quizartinib as a single agent Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) Period: After re-induction therapy, participants will be evaluated for eligibility to undergo allogeneic hematopoietic stem cell transplant (HSCT). Eligible participants may receive a single 28-day cycle of consolidation therapy (standard of care chemotherapy with or without quizartinib) if an allogeneic HSCT is not available immediately. The options for consolidation therapy are as follows: * High intensity chemotherapy with quizartinib, or * Low intensity chemotherapy alone, or * Low intensity therapy with quizartinib as a single agent Continuation Therapy: Participants in remission after HSCT, or who are not eligible for HSCT but achieve at least a partial remission (PR) after re-induction, will receive up to 12 continuous 28-day cycles of quizartinib continuation therapy at the same dose received during re-induction in the dose expansion phase. Long-term Follow-up: The long-term follow-up phase begins upon completion of 12 cycles of quizartinib Continuation Therapy or permanent discontinuation of quizartinib at any time. After completion of the 30-day safety follow-up visit, subsequent visits will occur at the following frequencies to assess survival and anti-leukemic treatments: * every 3 months for the first 2 years, and then * once a year thereafter until the last participant enrolled has been followed for three years from the date of enrollment
Minimum Age: 1 Month
Eligible Ages: CHILD, ADULT
Sex: ALL
Healthy Volunteers: No
Loma Linda University Cancer Center, Loma Linda, California, United States
University of California, San Francisco, San Francisco, California, United States
Children's Hospital Colorado, Aurora, Colorado, United States
A.I. duPont Hospital for Children, Wilmington, Delaware, United States
Children's National Medical Center, Washington, District of Columbia, United States
Children's Healthcare of Atlanta, Atlanta, Georgia, United States
Riley Hospital for Children - Indiana University, Indianapolis, Indiana, United States
Johns Hopkins, Baltimore, Maryland, United States
University of Minnesota/Masonic Cancer Center, Minneapolis, Minnesota, United States
University of Mississippi Medical Center, Jackson, Mississippi, United States
Washington University School of Medicine, Saint Louis, Missouri, United States
Columbia University/Herbert Irving Cancer Center, New York, New York, United States
New York Medical College, Valhalla, New York, United States
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
The University of Texas Southwestern Medical Center Children's Health, Dallas, Texas, United States
Seattle Children's Hospital, Seattle, Washington, United States
Universitair Ziekenhuis Gent, Gent, , Belgium
The Hospital for Sick Children, Toronto, Ontario, Canada
Montreal Children's Hospital, Montréal, Quebec, Canada
British Columbia Children's Hospital, Vancouver, , Canada
Rigshospitalet, Copenhagen, , Denmark
Centre Léon Bérard, Lyon, , France
Hôpital Armand-Trousseau, Paris, , France
Hôpital des Enfants, Toulouse, , France
Rambam Medical Center, Haifa, , Israel
Schneider Children's Medical Center of Israel, Petah Tikva, , Israel
Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, , Israel
Fondazione IRCCS San Gerardo dei Tintori, Monza, , Italy
IRCCS Ospedale Pediatrico Bambino Gesù, Rome, , Italy
Ospedale Infantile Regina Margherita, Torino, , Italy
Prinses Maxima Centrum voor Kinderoncologie, Utrecht, , Netherlands
Hospital Infantil Universitario Nino Jesus, Madrid, , Spain
Hospital Universitario La Paz, Madrid, , Spain
Sahlgrenska Universitetssjukhuset - Drottning Silvias Barn- och Ungdomssjukhus, Göteborg, , Sweden
NHS Greater Glasgow and Clyde - The Queen Elizabeth University Hospital, Glasgow, , United Kingdom
Name: Global Clinical Leader
Affiliation: Daiichi Sankyo
Role: STUDY_DIRECTOR