Background:
The myelodysplastic syndromes (MDS) are a group of clonal bone marrow neoplasms
characterized by ineffective hematopoiesis, cytopenia, and high risk for transformation
to acute myeloid leukemia (AML).
MDS is primarily a disease of the elderly, with about 80% of participants being older
than 65-years of age; with 10,000 new diagnoses per year in the United States (U.S.)
The only curative treatment for participants with MDS is allogeneic hematopoietic stem
cell transplantation (HSCT) and only a small portion of participants are eligible.
Depending on risk stratification, the median survival of high- and low-risk MDS
participants is 1.5 to 5.9 years, respectively.
Deoxyribonucleic acid (DNA) methyltransferase inhibitors (DNMTi) are the standard of care
therapy for high-risk MDS. However, less than half of participants respond to DNMTi, and
even the best responses are transient and non-curative. More effective and less toxic
therapies are needed.
Interleukin-8 (IL-8) is a proinflammatory chemokine from the chemokine (C-X-C motif) CXC
family and a potent chemoattractant of granulocytes and related cells to the site of
inflammation. IL-8 is uniquely upregulated and found at high levels in both the
peripheral blood and bone marrow aspirates of MDS participants. In purified MDS/Acute
myeloid leukemia (AML) long-term/short term stem cells and granulocyte-macrophage
progenitor cells both IL-8 and the IL-8 receptor, CXCR2, are overexpressed.
Preclinical data showed that CXCR2 inhibition led to significantly reduce proliferation
of leukemic cell lines. In addition, MDS cluster of differentiation 34 (CD34+) cell
cultures treated with neutralizing anti-IL-8 showed improvement in erythroid colony
formation.
BMS-986253 is a fully human Immunoglobulin G1 (IgG1) neutralizing antibody that showed a
favorable safety profile in participants with advanced solid tumors.
Concomitant treatment with DNMTi and BMS-986253 may improve treatment responses in
participants with MDS by attenuating chemoattraction of myeloid derived suppressor cells
to the bone marrow, indirectly disinhibiting natural killer (NK)- and T-cell responses
against MDS stem cells, reducing neoangiogenesis, and improving cytopenia.
Objectives:
Primary objectives:
Phase I: To determine the optimal biological dose (OBD) and recommended phase 2 dose
(RP2D) of BMS-986253 with or without DNMTi (decitabine and cedazuridine) therapy in MDS
participants, and to describe the safety and tolerability of BMS-986253.
Phase II: To determine overall response rate (ORR) to BMS-986253 with or without DNMTi
(decitabine and cedazuridine) therapy in MDS, measured according to the proposed revised
International Working Group (IWG) 2018 response criteria.
Eligibility:
Participants must have histologically or cytologically confirmed MDS according to 2016
World Health Organization (WHO) criteria and
- have higher risk (HR) MDS Revised International Prognostic Scoring System (R-IPSS >=
3.5) and received a minimum of 2 and maximum of 8 cycles of DNMTi for Phase I (and a
maximum of 4 cycles for Phase 2), or
- have lower risk (LR) MDS (R-IPSS <3.5) and at least one cytopenia (for both Phases I
and II).
Age >=18 years
Eastern Cooperative Oncology Group (ECOG) performance status <=2 (KPS >= 60%)
Design:
This study consists of two phases:
Phase I: safety evaluation with determination of optimal biological dose (OBD) of
BMS-986253 with or without DNMTi (decitabine and cedazuridine), and
Phase II: efficacy evaluation of BMS-986253 with or without DNMTi (decitabine and
cedazuridine)
In both Phase I and II, participants will be enrolled into two cohorts:
A) Higher-risk cohort (HR-MDS), including high-risk and higher intermediate-risk disease,
defined as those with R-IPSS >= 3.5: treatment with BMS-986253 in combination with DNMTi
(decitabine and cedazuridine)
B) Lower-risk cohort (LR-MDS), including low-risk and lower intermediate-risk disease
participants, defined as those with R-IPSS <3.5: treatment with BMS-986253 given as
monotherapy
For Phase I, the safety endpoint will be dose limiting-toxicity (DLT) by D28 with the
objective of defining the OBD and RP2D for BMS-986253. In addition, follow up for safety
will be assessed 100 days after the end of the treatment cycle. For Phase II, the primary
endpoint will be overall response rate after 6 cycles, reported separately by cohort.