Drug Information for Idamycin idarubicin hydrochloride for injection, USP (Pharmacia and Upjohn Co.): CLINICAL STUDIES

  • Four prospective randomized studies, three U.S. and one Italian, have been conducted to compare the efficacy and safety of idarubicin (IDR) to that of daunorubicin (DNR), each in combination with cytarabine as induction therapy in previously untreated adult patients with acute myeloid leukemia (AML). These data are summarized in the following table and demonstrate significantly greater complete remission rates for the IDR regimen in two of the three U.S. studies and significantly longer overall survival for the IDR regimen in two of the three U.S. studies.

    InductionPatients who had persistent leukemia after the first induction course received a second course.Regimen Dosein mg/m2-Daily × 3 DaysCompleteRemission Rate,All Pts RandomizedMedian Survival(Days) All Pts Randomized
    U.S. (IND Studies)
    1. MSKCCMemorial Sloan Kettering Cancer Center12cytarabine 25 mg/m2 bolus IV followed by 200 mg/m2 daily × 5 days by continuous infusion.5051/65Overall p < 0.05, unadjusted for prognostic factors or multiple endpoints.38/65508435
    (Age ≤ 60 years)(78%)(58%)
    2. SEGSoutheastern Cancer Study Group12cytarabine 100 mg/m2 daily × 7 days by continuous infusion.4576/11165/119328277
    (Age ≥ 15 years)(69%)(55%)
    3. U.S. Multicenter134568/10166/113393281
    (Age ≥ 18 years)(67%)(58%)
    Foreign (non-IND study)
    GIMEMAGruppo Italiano Malattie Ematologiche Maligne dell' Adulto124549/12449/12587169
    (Age ≥ 55 years)(40%)(39%)

    There is no consensus regarding optional regimens to be used for consolidation; however, the following consolidation regimens were used in U.S. controlled trials. Patients received the same anthracycline for consolidation as was used for induction.

    Studies 1 and 3 utilized 2 courses of consolidation therapy consisting of idarubicin 12 or 13 mg/m2 daily for 2 days, respectively (or DNR 50 or 45 mg/m2 daily for 2 days), and cytarabine, either 25 mg/m2 by IV bolus followed by 200 mg/m2 daily by continuous infusion for 4 days (Study 1), or 100 mg/m2 daily for 5 days by continuous infusion (Study 3). A rest period of 4 to 6 weeks was recommended prior to initiation of consolidation and between the courses. Hematologic recovery was mandatory prior to initiation of each consolidation course.

    Study 2 utilized 3 consolidation courses, administered at intervals of 21 days or upon hematologic recovery. Each course consisted of idarubicin 15 mg/m2 IV for 1 dose (or DNR 50 mg/m2 IV for 1 dose), cytarabine 100 mg/m2 every 12 hours for 10 doses and 6-thioguanine 100 mg/m2 orally for 10 doses. If severe myelosuppression occurred, subsequent courses were given with 25% reduction in the doses of all drugs. In addition, this study included 4 courses of maintenance therapy (2 days of the same anthracycline as was used in induction and 5 days of cytarabine).

    Toxicities and duration of aplasia were similar during induction on the 2 arms in the U.S. studies except for an increase in mucositis on the IDR arm in one study. During consolidation, duration of aplasia on the IDR arm was longer in all three studies and mucositis was more frequent in two studies. During consolidation, transfusion requirements were higher on the IDR arm in the two studies in which they were tabulated, and patients on the IDR arm in Study 3 spent more days on IV antibiotics (Study 3 used a higher dose of idarubicin).

    The benefit of consolidation and maintenance therapy in prolonging the duration of remission and survival is not proven.

    Intensive maintenance with IDAMYCIN (idarubicin hydrochloride for injection, USP) is not recommended in view of the considerable toxicity (including deaths in remission) experienced by patients during the maintenance phase of Study 2.

    A higher induction death rate was noted in patients on the IDR arm in the Italian trial. Since this was not noted in patients of similar age in the U.S. trials, one may speculate that it was due to a difference in the level of supportive care.

  • Drug Information Provided by National Library of Medicine (NLM).