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Cancer. 2017 May 15;123(6):994-1002. doi: 10.1002/cncr.30533. Epub 2017 Jan 17.

Phase 2, randomized, double-blind study of pracinostat in combination with azacitidine in patients with untreated, higher-risk myelodysplastic syndromes.

Author information

1
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2
Sarah Cannon Research Institute, Nashville, Tennessee.
3
Oncology/Hematology Care, Cincinnati, Ohio.
4
Cancer Care Center of South Texas, San Antonio, Texas.
5
Colorado Blood Cancer Institute, Denver, Colorado.
6
Southern Cancer Center, Daphne, Alabama.
7
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland.
8
Fort Wayne Medical Oncology and Hematology, Fort Wain, Indiana.
9
Florida Cancer Specialists-North, Jacksonville, Florida.
10
Tennessee Oncology, Chattanooga, Tennessee.
11
Center for Cancer and Blood Disorders, Bethesda, Maryland.
12
H. Lee Moffitt Cancer Center, Tampa, Florida.
13
Department of Internal Medicine, Division of Hematology Oncology, Henry Ford Hospital, Detroit, Michigan.
14
Florida Cancer Specialists-South, Cape Coral, Florida.
15
Leukemia Program, Cleveland Clinic, Cleveland, Ohio.
16
MEI Pharma, San Diego, California.
17
Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical.

Abstract

BACKGROUND:

The prognosis of patients with higher-risk myelodysplastic syndromes (MDS) remains poor despite available therapies. Histone deacetylase inhibitors have demonstrated activity in patients with MDS and in vitro synergy with azacitidine.

METHODS:

A phase 2 randomized, placebo-controlled clinical trial of azacitidine and pracinostat was conducted in patients who had International Prognostic Scoring System intermediate-2-risk or high-risk MDS. The primary endpoint was the complete response (CR) rate by cycle 6 of therapy.

RESULTS:

Of 102 randomized patients, there were 51 in the pracinostat group and 51 in the placebo group. The median age was 69 years. The CR rate by cycle 6 of therapy was 18% and 33% (P = .07) in the pracinostat and placebo groups, respectively. No significant differences in overall survival (median, 16 vs 19 months, respectively; hazard ratio, 1.21; 95% confidence interval, 0.66-2.23) or progression-free survival (11 vs 9 months, respectively; hazard ratio, 0.82; 95% confidence interval, 0.546-1.46) were observed between groups. Grade ≥3 adverse events occurred more frequently in the pracinostat group (98% vs 74%), leading to more treatment discontinuations (20% vs 10%).

CONCLUSIONS:

The combination of azacitidine with pracinostat did not improve outcomes in patients with higher-risk MDS. Higher rates of treatment discontinuation may partially explain these results, suggesting alternative dosing and schedules to improve tolerability may be required to determine the potential of the combination. Cancer 2017;123:994-1002. © 2016 American Cancer Society.

KEYWORDS:

azacitidine combinations; clinical trial; histone deacetylase; myelodysplastic syndromes

PMID:
28094841
PMCID:
PMC5432122
DOI:
10.1002/cncr.30533
[Indexed for MEDLINE]
Free PMC Article

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