Oxidative Phosphorylation Inhibitor IACS-010759 in Treating Patients with Relapsed or Refractory Acute Myeloid Leukemia

Inclusion Criteria

• Subjects with acute myeloid leukemia (AML) should have failed any prior induction therapy regimen or have relapsed after prior therapy (defined as patients in first relapse and less than 12 months from diagnosis [short first remission] or in second or later relapse: dose-escalation phase: subjects with confirmed relapsed or refractory AML and no available treatment options with known benefit; expansion phase: subjects with relapsed/refractory AML who have failed therapy with up to one prior salvage regimen and no available treatment options with known benefit; exception: stem cell transplant (SCT) or stem cell therapy for subjects who previously underwent SCT/stem cell therapy, and are currently in remission will not be considered a salvage regimen
• Eastern Cooperative Oncology Group (ECOG) =< 2
• Patients who have had prior SCT are eligible if they have a relapse > 3 months since autologous or allogeneic stem cell transplantation provided, 1) no clinically significant active graft-versus-host disease (GVHD > grade 1); 2) no treatment with high dose steroids for GVHD (i.e. > 20 mg prednisolone or equivalent per day); 3) no treatment with immunosuppressive drugs with the exception of cyclosporine and tacrolimus
• Subjects with history of central nervous system (CNS) disease are allowed if at the time of day 1 of the study there is no evidence of active CNS disease as documented by negative imaging or spinal fluid analysis carried out at least 2 weeks prior to the first study drug administration in a subject with no clinical signs of CNS disease
• Serum creatinine =< 2.0 X upper limit of normal (ULN)
• Total bilirubin =< 2 times the upper limit of normal (ULN) (or =< 3.0 x ULN if deemed to be elevated due to Gilbert’s disease or leukemia)
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 times ULN (=< 5.0 x ULN if due to leukemic involvement)
• Negative urine pregnancy test within 72 hours prior to the first dose of study therapy for women of child-bearing potential (WCBP), defined as a sexually mature woman who has not undergone a hysterectomy or who has not been naturally post- menopausal for at least 24 consecutive months (i.e., who has had menses any time in the preceding 24 consecutive months)
• Have been informed of other treatment options and is not a candidate for standard treatment options or stem cell transplant at the time of enrollment
• In the absence of rapidly progressing disease, the interval from prior treatment to time of initiation of IACS-010759 administration will be at least 2 weeks or 5 half-lives (whichever is shorter) for cytotoxic/noncytotoxic agents and biological/immune therapies, including investigational agents; the half-life for the therapy in question will be based on published pharmacokinetic literature (abstracts, manuscripts, investigator brochures, or drug-administration manuals) and will be documented in the protocol eligibility document; the use of chemotherapeutic or anti-leukemic agents is not permitted during the study with the following exceptions: (1) intrathecal therapy for subjects with controlled CNS leukemia at the discretion of the principal investigator (PI) and with the agreement of the sponsor; (2) use of hydroxyurea for subjects with rapidly proliferative disease is allowed before the start of study therapy and for the first 2 cycles on therapy; these medications will be recorded in the case-report form
• Women of childbearing potential must agree to use an adequate method of contraception during the study and until 3 months after the last treatment; males must be surgically or biologically sterile or agree to use an adequate method of contraception during the study until 3 months after the last treatment; adequate methods of contraception include: * Total abstinence when this is in line with the preferred and usual lifestyle of the subject; periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception * Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy) or tubal ligation at least six weeks before taking study treatment; in case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment * Male sterilization (at least 6 months prior to screening); for female subjects on the study, the vasectomized male partner should be the sole partner for that subject * Combination of any of the two following (a+b or a+c or b+c): a. use of oral, injected or implanted hormonal methods of contraception or other forms of hormonal contraception that have comparable efficacy (failure rate < 1%), for example hormone vaginal ring or transdermal hormone contraception; b. placement of an intrauterine device (IUD) or intrauterine system (IUS); c. barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/ vaginal suppository; in case of use of oral contraception, women should have been stable on the same pill before taking study treatment * Note: oral contraceptives are allowed but should be used in conjunction with a barrier method of contraception; women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks ago; in the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential
• Able and willing to give valid written informed consent

Exclusion Criteria

• Prior exposure to IACS-010759 or other oxidative phosphorylation inhibitors
• Unstable cardiovascular function: * Symptomatic ischemia, or * Uncontrolled clinically significant conduction abnormalities (i.e., ventricular tachycardia on antiarrhythmic agents are excluded; 1st degree atrioventricular [AV] block or asymptomatic left anterior fascicular block/right bundle branch block [LAFB/RBBB] will not be excluded), or * Congestive heart failure (CHF) New York Heart Association (NYHA) class >= 3, or * Myocardial infarction (MI) within 6 months * Left ventricular ejection fraction < 40 % * Hypertension > 160 mm Hg systolic or > 100 mm Hg diastolic with or without antihypertensive therapy
• Major surgery, other than diagnostic surgery, within 4 weeks prior to day 1, without complete recovery from the surgical procedure
• Presence of >= Common Terminology Criteria for Adverse Events (CTCAE) grade 2 toxicity (except alopecia or peripheral neuropathy) due to prior cancer therapy
• Known positive for human immunodeficiency virus (HIV), hepatitis B virus surface antigen (HBsAg), or hepatitis C virus (HCV)
• Active uncontrolled infection; infections controlled on concurrent anti-microbial agents are acceptable, and anti-microbial prophylaxis per institutional guidelines is acceptable
• Participation in any other clinical trial involving another investigational agent for the treatment of AML within 2 weeks prior to day 1 of the study or at least 5 half-lives of the investigational agent, whichever is shorter
• Lactate levels > 2 mmol/L and or and serum pH < 7.35 at screening
• Subject currently being treated with biguanides or other agents known to increase risk of lactic acidosis
• Subject has significant gastrointestinal abnormalities, including ulcerative colitis, chronic diarrhea associated with intestinal malabsorption, Crohn's disease, and/or prior surgical procedures affecting absorption or requirement for intravenous (IV) alimentation
• Subjects with uncontrolled type I or II diabetes mellitus
• Mental impairment that may compromise the ability to give informed consent and comply with the requirements of the study
• Women who are breast-feeding or pregnant as evidenced by positive urine pregnancy test done within 72 hours of first dosing
• Subject has a concurrent active malignancy under treatment, with the exception of: * Adequately treated carcinoma in situ of the breast or cervix uteri * Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin * Low-grade, early-stage prostate cancer with no requirement for therapy * Previous malignancy confined
• Acute promyelocytic leukemia
• Any concomitant disease or condition that, in the clinical judgment of the treating physician, is likely to prevent the subject from complying with any aspect of the protocol or that may put the subject at unacceptable risk
• Subjects with >= grade 1 peripheral neuropathy at screening