Mitoxantrone, etoposide, and cytarabine with or without valspodar in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome: A phase III trial (E2995)

Peter L. Greenberg, Sandra J. Lee, Ranjana Advani, Martin S. Tallman, Branimir I. Sikic, Louis Letendre, Kathleen Dugan, Bert Lum, David L. Chin, Gordon Dewald, Elisabeth M. Paietta, John M. Bennett, Jacob M. Rowe

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Abstract

Purpose: To determine whether adding the multidrug resistance gene-1 (MDR-1) modulator valspodar (PSC 833; Novartis Pharmaceuticals, Hanover, NJ) to chemotherapy provided clinical benefit to patients with poor-risk acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Patients and Methods: A phase III randomized study was performed using valspodar plus mitoxantrone, etoposide, and cytarabine (PSC-MEC; n = 66) versus MEC (n = 63) to treat patients with relapsed or refractory AML and high-risk MDS. Results: For the PSC-MEC versus MEC arms, complete response (CR) was achieved in 17% versus 25% of patients, respectively (P = not significant). For patients who had not received prior intensive chemotherapy (ie, with secondary AML or high-risk MDS), the CR rate was increased-35% versus 15% for the remaining patients (P = .018); CR rates did not differ between treatment arms. The median disease-free survival in those achieving CR was similar in the two arms (10 versus 9.3 months) as was the patients' overall survival (4.6 versus 5.4 months). The CR rates in MDR+ (69% of patients) versus MDR- patients were similar for those receiving either chemotherapy regimen (16% versus 24%). The CR rate for unfavorable cytogenetic patients (45% of patients) was 13% compared to the remainder, 28% (P = .09). Population pharmacokinetic analysis demonstrated that the clearances of mitoxantrone and etoposide were decreased by 59% and 50%, respectively, supporting the empiric dose reductions in the PSC-MEC arm designed in anticipation of drug interactions between valspodar and the chemotherapeutic agents. Conclusion: CR rates and overall survival were not improved by using PSC-MEC compared to MEC chemotherapy alone in patients with poor-risk AML or high-risk MDS.

Original languageEnglish (US)
Pages (from-to)1078-1086
Number of pages9
JournalJournal of Clinical Oncology
Volume22
Issue number6
DOIs
StatePublished - 2004
Externally publishedYes

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Mitoxantrone
Myelodysplastic Syndromes
Cytarabine
Etoposide
Acute Myeloid Leukemia
Drug Therapy
valspodar
MDR Genes
Drug Interactions
Cytogenetics
Disease-Free Survival
Survival Rate
Pharmacokinetics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Mitoxantrone, etoposide, and cytarabine with or without valspodar in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome : A phase III trial (E2995). / Greenberg, Peter L.; Lee, Sandra J.; Advani, Ranjana; Tallman, Martin S.; Sikic, Branimir I.; Letendre, Louis; Dugan, Kathleen; Lum, Bert; Chin, David L.; Dewald, Gordon; Paietta, Elisabeth M.; Bennett, John M.; Rowe, Jacob M.

In: Journal of Clinical Oncology, Vol. 22, No. 6, 2004, p. 1078-1086.

Research output: Contribution to journalArticle

Greenberg, Peter L. ; Lee, Sandra J. ; Advani, Ranjana ; Tallman, Martin S. ; Sikic, Branimir I. ; Letendre, Louis ; Dugan, Kathleen ; Lum, Bert ; Chin, David L. ; Dewald, Gordon ; Paietta, Elisabeth M. ; Bennett, John M. ; Rowe, Jacob M. / Mitoxantrone, etoposide, and cytarabine with or without valspodar in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome : A phase III trial (E2995). In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 6. pp. 1078-1086.
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title = "Mitoxantrone, etoposide, and cytarabine with or without valspodar in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome: A phase III trial (E2995)",
abstract = "Purpose: To determine whether adding the multidrug resistance gene-1 (MDR-1) modulator valspodar (PSC 833; Novartis Pharmaceuticals, Hanover, NJ) to chemotherapy provided clinical benefit to patients with poor-risk acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Patients and Methods: A phase III randomized study was performed using valspodar plus mitoxantrone, etoposide, and cytarabine (PSC-MEC; n = 66) versus MEC (n = 63) to treat patients with relapsed or refractory AML and high-risk MDS. Results: For the PSC-MEC versus MEC arms, complete response (CR) was achieved in 17{\%} versus 25{\%} of patients, respectively (P = not significant). For patients who had not received prior intensive chemotherapy (ie, with secondary AML or high-risk MDS), the CR rate was increased-35{\%} versus 15{\%} for the remaining patients (P = .018); CR rates did not differ between treatment arms. The median disease-free survival in those achieving CR was similar in the two arms (10 versus 9.3 months) as was the patients' overall survival (4.6 versus 5.4 months). The CR rates in MDR+ (69{\%} of patients) versus MDR- patients were similar for those receiving either chemotherapy regimen (16{\%} versus 24{\%}). The CR rate for unfavorable cytogenetic patients (45{\%} of patients) was 13{\%} compared to the remainder, 28{\%} (P = .09). Population pharmacokinetic analysis demonstrated that the clearances of mitoxantrone and etoposide were decreased by 59{\%} and 50{\%}, respectively, supporting the empiric dose reductions in the PSC-MEC arm designed in anticipation of drug interactions between valspodar and the chemotherapeutic agents. Conclusion: CR rates and overall survival were not improved by using PSC-MEC compared to MEC chemotherapy alone in patients with poor-risk AML or high-risk MDS.",
author = "Greenberg, {Peter L.} and Lee, {Sandra J.} and Ranjana Advani and Tallman, {Martin S.} and Sikic, {Branimir I.} and Louis Letendre and Kathleen Dugan and Bert Lum and Chin, {David L.} and Gordon Dewald and Paietta, {Elisabeth M.} and Bennett, {John M.} and Rowe, {Jacob M.}",
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language = "English (US)",
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TY - JOUR

T1 - Mitoxantrone, etoposide, and cytarabine with or without valspodar in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome

T2 - A phase III trial (E2995)

AU - Greenberg, Peter L.

AU - Lee, Sandra J.

AU - Advani, Ranjana

AU - Tallman, Martin S.

AU - Sikic, Branimir I.

AU - Letendre, Louis

AU - Dugan, Kathleen

AU - Lum, Bert

AU - Chin, David L.

AU - Dewald, Gordon

AU - Paietta, Elisabeth M.

AU - Bennett, John M.

AU - Rowe, Jacob M.

PY - 2004

Y1 - 2004

N2 - Purpose: To determine whether adding the multidrug resistance gene-1 (MDR-1) modulator valspodar (PSC 833; Novartis Pharmaceuticals, Hanover, NJ) to chemotherapy provided clinical benefit to patients with poor-risk acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Patients and Methods: A phase III randomized study was performed using valspodar plus mitoxantrone, etoposide, and cytarabine (PSC-MEC; n = 66) versus MEC (n = 63) to treat patients with relapsed or refractory AML and high-risk MDS. Results: For the PSC-MEC versus MEC arms, complete response (CR) was achieved in 17% versus 25% of patients, respectively (P = not significant). For patients who had not received prior intensive chemotherapy (ie, with secondary AML or high-risk MDS), the CR rate was increased-35% versus 15% for the remaining patients (P = .018); CR rates did not differ between treatment arms. The median disease-free survival in those achieving CR was similar in the two arms (10 versus 9.3 months) as was the patients' overall survival (4.6 versus 5.4 months). The CR rates in MDR+ (69% of patients) versus MDR- patients were similar for those receiving either chemotherapy regimen (16% versus 24%). The CR rate for unfavorable cytogenetic patients (45% of patients) was 13% compared to the remainder, 28% (P = .09). Population pharmacokinetic analysis demonstrated that the clearances of mitoxantrone and etoposide were decreased by 59% and 50%, respectively, supporting the empiric dose reductions in the PSC-MEC arm designed in anticipation of drug interactions between valspodar and the chemotherapeutic agents. Conclusion: CR rates and overall survival were not improved by using PSC-MEC compared to MEC chemotherapy alone in patients with poor-risk AML or high-risk MDS.

AB - Purpose: To determine whether adding the multidrug resistance gene-1 (MDR-1) modulator valspodar (PSC 833; Novartis Pharmaceuticals, Hanover, NJ) to chemotherapy provided clinical benefit to patients with poor-risk acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Patients and Methods: A phase III randomized study was performed using valspodar plus mitoxantrone, etoposide, and cytarabine (PSC-MEC; n = 66) versus MEC (n = 63) to treat patients with relapsed or refractory AML and high-risk MDS. Results: For the PSC-MEC versus MEC arms, complete response (CR) was achieved in 17% versus 25% of patients, respectively (P = not significant). For patients who had not received prior intensive chemotherapy (ie, with secondary AML or high-risk MDS), the CR rate was increased-35% versus 15% for the remaining patients (P = .018); CR rates did not differ between treatment arms. The median disease-free survival in those achieving CR was similar in the two arms (10 versus 9.3 months) as was the patients' overall survival (4.6 versus 5.4 months). The CR rates in MDR+ (69% of patients) versus MDR- patients were similar for those receiving either chemotherapy regimen (16% versus 24%). The CR rate for unfavorable cytogenetic patients (45% of patients) was 13% compared to the remainder, 28% (P = .09). Population pharmacokinetic analysis demonstrated that the clearances of mitoxantrone and etoposide were decreased by 59% and 50%, respectively, supporting the empiric dose reductions in the PSC-MEC arm designed in anticipation of drug interactions between valspodar and the chemotherapeutic agents. Conclusion: CR rates and overall survival were not improved by using PSC-MEC compared to MEC chemotherapy alone in patients with poor-risk AML or high-risk MDS.

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