Temozolomide Plus Vorinostat in Relapse/Refractory Acute Myeloid Leukemia (AML)

The primary endpoint of the study is to determine the clinical efficacy as determined by the rate of morphological complete remission, of 2 different treatment regimens of temozolomide and vorinostat administered to 2 distinct groups of participants patients with AML and poor prognostic features. Participants will be allocated to treatment on the basis of O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status.

Inclusion criteria

• Histologically- or cytologically-confirmed acute myeloid leukemia (AML)
• Relapsed or refractory (AML), after at least 1 prior induction regimen
• Age ≥ 18 years
• Life expectancy > 2 months.
• Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 2
• Calculated creatinine clearance ≤ 2.0 mg/dL (OR ≥ 30 mL/min for patients with serum creatinine levels > 2.0 mg/dL)
• Serum total bilirubin ≤ 1.5 X upper limit of normal (ULN)
• Aspartate aminotransferase (AST) ≤ 2.5 X ULN
• Alanine aminotransferase (ALT) ≤ 2.5 X ULN
• Alkaline phosphatase (liver fraction) ≤ 2.5 X ULN
• If male, must agree to use an adequate method of contraception for the duration of the study and 1 month following coming off study or of study completion
• If female of childbearing potential, must a negative serum pregnancy test within 72 hours prior to receiving the first dose of vorinostat.
• If female, must be one of the following:

• Post-menopausal (free from menses for ≥ 2 years),
• Surgically-sterilized
• Willing to use 2 adequate barrier methods of contraception
• Agree to abstain from heterosexual activity throughout the study, starting with Visit 1
• Available at the treating institution for study assessments and procedures for the duration of the study
• Written informed consent

Exclusion criteria

• Received chemotherapy; radiotherapy; or biological therapy within 30 days (42 days for nitrosoureas or mitomycin C) prior to initial dosing with study drug(s), or has not recovered from adverse events due to agents administered more than 30 days earlier, except for hydroxyurea-related adverse events.
• Currently participating or within 30 days of initial dosing with study drug(s), has participated in a study with an investigational compound or device
• Receiving any other investigational agents or concomitant radiotherapy, chemotherapy, or immunotherapy.
• Received a histone deacetylase (HDAC) inhibitor [eg, romidepsin (Depsipeptide), NSC-630176, MS 275, LAQ-824, belinostat (PXD-101), LBH589, MGCD0103, CRA024781, etc] within the past 30 days. Patients who have received valproic acid or other compounds with HDAC inhibitor-like activity, as anti-tumor therapy should not enroll in this study. Patients who have received such compounds for other indications, eg, valproic acid for epilepsy, may enroll after a 30-day washout period.
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to temozolomide; vorinostat; dacarbazine (DTIC-Dome, DIC, imidazole carboxamide)
• History of gastrointestinal disease or significant bowel resection that could interfere with drug absorption or inability to swallow tablets.
• Uncontrolled intercurrent illness (as defined by the investigators) including, but not limited to, ongoing or active infection (HIV, Hepatitis B or Hepatitis C), symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Prior allogeneic stem cell transplantation within 2 months of trial enrollment or prior radiation up to more than 25% of bone marrow.
• Currently active 2nd malignancy, other than nonmelanoma skin cancer and carcinoma in situ of the cervix (completed therapy for a prior malignancy, and disease-free from prior malignancies for >5 years or are considered by their physician to be at less than 30% risk of relapse is not considered to be an "currently active" malignancy)
• Known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial
• Pregnant or breast feeding
• Expecting to conceive or father children within the projected duration of the study.
• Uncontrolled intercurrent illness or circumstances that could limit compliance with the study, including, but not limited to the following: active infection, acute or chronic graft versus host disease, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric conditions.
• History or current evidence of any condition, therapy, or lab abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study, or is not in the best interest of the patient to participate.