Phase 2 Study of Pracinostat With Azacitidine in Patients With Previously Untreated Myelodysplastic Syndrome

Inclusion criteria

• Voluntary written informed consent
• Histologically or cytologically documented diagnosis of MDS (any French-American-British [FAB] classification subtype; that is classified as intermediate 2 (1.5 to 2.0 points) or high risk (≥2.5 points) according to the International Prognostic Scoring System risk category, with >5% and <30% blasts, and a peripheral blast count of <20,000
• Bone marrow aspirate smears and bone marrow biopsies within 28 days of first study treatment
• There must be a clinical indication for treatment with azacitidine.
• Previously untreated with hypomethylating agents (prior therapy with transfusions, hematopoietic growth factors, or immunosuppressive therapy is allowed)
• Eastern Cooperative Oncology Group performance status of 0, 1, or 2
• Adequate organ function as evidenced by:

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 x the upper limit of normal (ULN) (≤5 x ULN for patients with hepatic metastases
• Total bilirubin ≤1.5 x ULN or total bilirubin of 2, whichever is higher
• Serum creatinine <2 mg/dL, or creatinine clearance ≤1.5 x ULN
• QTcF interval ≤470 msec
• Female or male patients ≥18 years-of-age
• Male patients who are surgically sterile or willing to use adequate contraceptive measures or abstain from heterosexual intercourse during the entire study treatment period
• Female patients who are surgically sterile or post menopausal or female patients who are not of child-bearing potential and female patients of child-bearing potential who agree to use adequate contraceptive measures or abstain from intercourse during the study treatment period, who are not breastfeeding, and who have had a negative serum pregnancy test ≤7 days prior to first study treatment.
• Willingness and ability to comply with the trial and follow-up procedures

Exclusion criteria

• Received any of the following within the specified time frame prior to administration of study medication:

• Any investigational agent within 14 days or 5 half-lives prior to first study treatment, whichever is longer
• Previous therapy for malignancy within 21 days prior to first study treatment, including any chemotherapy, immunotherapy, biological or hormonal therapy (6 weeks for nitrosoureas or mitomycin C)
• Hydroxyurea within 48 hours prior to first study treatment
• Hematopoietic growth factors: erythropoietin, granulocyte colony stimulating factor (G-CSF), granulocyte macrophage colony stimulating factor (GM-CSF), or thrombopoietin receptor agonists at least 7 days (14 days for Aranesp) prior to study enrollment
• Major surgery within 4 weeks prior to first study treatment
• Patients that have not recovered from side effects of previous therapy
• Cardiopulmonary function exclusion:

• Current unstable arrhythmia requiring treatment
• History of symptomatic congestive heart failure (New York Heart Association Classes III or IV)
• History of myocardial infarction within 6 months of enrollment
• Current unstable angina
• Concomitant treatment with histone deacetylase (HDAC) inhibitors or drugs with significant action as HDAC inhibitors, such as valproic acid, is not permitted
• Clinical evidence of central nervous system involvement
• Patients with gastrointestinal (GI) tract disease, causing the inability to take oral medication, malabsorption syndrome, a requirement for IV alimentation, prior surgical procedures affecting absorption, uncontrolled inflammatory GI disease (e.g., Crohn's disease, ulcerative colitis).
• Active infection with HIV or chronic hepatitis B or C
• Life-threatening illness unrelated to cancer, or any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with participation in this study
• Presence of a malignant disease within the last 12 months, with the exception of adequately treated in-situ carcinomas, basal or squamous cell carcinoma, or non-melanomatous skin cancer
• Inability (including psychological, familial, sociological, or geographical conditions) to comply with trial and/or follow-up procedures