Clinical Trial Summary

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Phase

Phase 1

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Funding Agency/Sponsor

Institutional

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Disease

Leukemia/heme

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Enrollment Eligibility

Inclusion Criteria:
1. Confirmed diagnosis of one of the following:
1. Relapsed/refractory Acute Myelogenous Leukemia (AML) where no alternative life
prolonging therapy exists. Adverse genetic risk treatment naïve patients may also
be considered eligible if, in the opinion of the investigator, these patients are
unlikely to benefit from alternative therapy (e.g., an older patient with adverse
risk MDS who progresses to AML after failing treatment for MDS (i.e.
hypomethylating agent (HMA) or HMA and Venetoclax and is not a candidate for
traditional AML induction chemotherapy).
2. Relapsed/refractory Myelodysplastic Syndrome (MDS) those who fail to achieve a
complete remission (CR) with at least 4 cycles of HMA (e.g. decitabine or
azacitidine); or those who have progressive disease or have intolerance of HMA
therapy after at least 2 cycles. Intolerance to HMA includes those patients
forced to stop the HMA after at least 2 cycles due to severe infections/worsening
cytopenias and are otherwise considered eligible. Patients with MDS have to have
intermediate, high, or very high risk disease by International Prognostic Scoring
System - Revised (IPSS-R score).
2. Adult male or female patients 18 years of age or older.
3. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2.
4. Patients must satisfy the following laboratory criteria:
1. Pre-treatment bone marrow staining must demonstrate expression of the ST2
receptor by IHC (low or high expression is allowed).
2. Total bilirubin < 1.5 x greater upper limit of normal (UNL). Elevated indirect
bilirubin associated with post-transfusion hemolysis is allowed.
3. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) must be < 3 x
UNL
4. Creatinine < 2 x UNL or calculated creatinine clearance > 40 ml/min; or Estimated
Glomerular Filtration Rate (eGFR) <50 according to MDRD (Modification of Diet in
Renal Disease) method.
5. White blood cell count (WBC) < 25,000/uL before the administration of NEROFE on
Cycle 1 Day 1. Use of hydroxyurea to control the level of circulating leukemic
blast cell counts is allowed before and during the study.
5. Suitable venous access to allow for all study related blood sampling (safety and
research).
6. Estimated life expectancy, in the judgment of the investigator, which will permit
receipt of at least 8 weeks of treatment.
7. Voluntary written consent must be given before performance of any study related
procedure not part of standard medical care, with the understanding that consent may
be withdrawn by the patient at any time without jeopardy to future medical care.
8. Female patients who are:
1. Postmenopausal for at least one year before the screening visit, OR
2. Surgically sterile, OR
3. If they are of childbearing potential:
Agree to practice one highly effective method and one additional effective (barrier)
method of contraception, at the same time, form the time of signing the informed
consent through 4 months after the last does of study drug (female and male condoms
should not be used together), OR Agree to practice true abstinence, when this is in
line with the preferred and usual lifestyle of the participant. (Periodic abstinence
e.g. calendar, ovulation, symptothermal, postovulation methods; withdrawal;
spermicides only; and lactational amenorrhea are not acceptable methods of
contraception).
9. Male patients even if surgically sterilized (e.g. status post vasectomy), who:
1. Agree to practice effective barrier contraception during the entire study
treatment period and through four months after the last dose of study drug
(female and male condoms should not be used together), OR
2. Agree to practice true abstinence, when this is in line with the preferred and
usual lifestyle of the participant. (Periodic abstinence e.g. calendar,
ovulation, symptothermal, postovulation methods; withdrawal; spermicides only;
and lactational amenorrhea are not acceptable methods of contraception).
10. Able to undergo bone marrow examination at screening
Exclusion Criteria:
1. Patients with a diagnosis of acute promyelocytic leukemia (APL).
2. Screening bone marrow slide without staining for ST2 receptor. (Low or High expression
by Immunohistochemistry [IHC] allowed on study).
3. Therapy with any investigational products, anti-neoplastic therapy, or radiotherapy
within 14 days of Cycle 1 Day 1. Patients actively receiving hydroxyurea are eligible
and may continue to receive this medication during treatment on this protocol.
4. Candidates for standard and/or potentially curative treatments. (A candidate is
defined as a patient that is both eligible and willing to have these treatments.)
5. Major surgery within 30 days of the first dose of any study drug or a scheduled
surgery during study period.
6. Grade 2 or higher diarrhea (as defined by NCI CTCAE Version 5.0) despite optimal
anti-diarrheal supportive care within 7 days prior to Cycle 1 Day 1.
7. Known cardiopulmonary disease as defined by one of the following:
1. Clinically significant arrhythmia including: history of polymorphic ventricular
fibrillation or torsade de pointes; atrial fibrillation > 7 days and requiring
cardioversion in the 4 weeks before screening; incompletely controlled,
symptomatic atrial fibrillation. Patients with Afib are permitted to enroll if it
is < Grade 3 for a period of 6 months or greater and the rate is controlled with
a stable regimen.
2. Congestive heart failure (New York Heart Association (NYHA) Class III or IV; or
Class II with a recent decompensation requiring hospitalization or referral to a
heart failure clinic within four weeks of screening; myocardial infarction (MI)
and/or revascularization (e.g.
coronary bypass graft/stent) within 6 months of first dose of study drug.;
3. Patients with ischemic heart disease who have had acute coronary syndrome (ACS),
MI< and/or revascularization greater than 6 months before screening and who are
without cardiac symptoms may enroll.
4. Moderate to severe aortic and/or mitral valve stenosis or other ongoing
valvulopathy;
5. Pulmonary hypertension (symptomatic)
6. Prolonged rate corrected QT (QTc) interval >480 msec, calculated according to
institutional guidelines;
7. Known, active left ventricular ejection fraction (LVEF) < 50% as assessed by
echocardiogram or radionuclide angiography (not required at screening);
8. Known moderate to severe chronic obstructive pulmonary disease (COPD),
interstitial lung disease and/or pulmonary fibrosis (e.g., requiring home O2
therapy).
8. Active and uncontrolled infection or severe infectious disease, such as severe
pneumonia, meningitis, or septicemia (stable or resolving infection on antibiotics is
allowed).
9. Known human immunodeficiency virus (HIV) seropositive.
10. Known Hepatitis B surface antigen seropositive (note: patients who have isolated
positive hepatitis B core antibody [e.g. in the setting of negative hepatitis B
surface antigen and negative hepatitis B surface antibody] must have an undetectable
hepatitis viral load).
11. Known or suspected active hepatitis C infection. Patients with treated Hep C treated
with a negative viral load are eligible.
12. Females of child bearing potential who refuse to practice two effective methods of
contraception at the same time or abstain from heterosexual intercourse from the time
of signing consent through four months after the last dose of study drug.
13. Males of child bearing potential who refuse to practice effective barrier methods of
contraception at the same time or abstain from heterosexual intercourse from the time
of signing consent through four months after the last dose of study drug.
14. Female patients who are both lactating or breastfeeding, or have a positive serum
pregnancy test during the screening period or a positive urine pregnancy test on Day 1
before the first dose of study drug.
15. Female patients who intend to donate eggs (ova) during the course of this study or
within four months after receiving their last dose of study drug.
16. Male patients who intend to donate sperm during the course of this study or within
four months after receiving their last dose of study drug.
17. Any serious medical or psychiatric illness that could, in the investigator's opinion,
potentially interfere with the completion of study procedures.
18. Symptomatic central nervous system (CNS) involvement.
19. Diagnosed or treated for another malignancy within 2 years with evidence of residual
disease.
20. Known hepatic cirrhosis or severe pre-existing hepatic impairment.
21. Patients with uncontrolled coagulopathy or bleeding disorder.
22. Use of systemic steroids (prednisone) >10mg/day or any equivalent corticosteroids
within 7 days of Cycle 1 Day 1. Patients on other immunosuppression (such as
post-transplant) and also ineligible. Patients with active, uncontrolled GVHD (Graft
Versus Host Disease) are also ineligible. Otherwise patients are eligible post-bone
marrow transplantation.
23. Life-threatening illnesses unrelated to cancer.

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