ClinicalTrials.gg
RecruitingNCT06014489HO171Updated Sep 23, 2026

A Trial to Assess Cobicistat Boosted Venetoclax in Combination With Azacitidine in Adult Patients With Newly Diagnosed AML

A Phase 2 interventional study of azacitidine and Venetoclax in AML, Adult, sponsored by Stichting Hemato-Oncologie voor Volwassenen Nederland. Recruiting at 19 sites in Netherlands. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-23.

Sponsored by Stichting Hemato-Oncologie voor Volwassenen Nederland · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Started Jan 2024; still recruiting 2 years 9 months later.
Phase
Phase 2
Study type
Interventional
Enrollment
142
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

The treatment of older unfit patients with acute myeloid leukemia (AML) is challenging. The hypomethylating agents (HMA) azacitidine and decitabine have relatively mild side effects and have proven to be feasible for the treatment of older patients and patients with co-morbidities. Currently, venetoclax added to an HMA agent is the new standard of treatment. Since this new standard comes with a substantial societal financial burden, there is a rational to optimize the venetoclax dosing schedule. The CYP3A4 inhibitor cobicistat (COBI) can be used to increase venetoclax exposure, thereby allowing to reduce the dose of venetoclax and thus costs substantially.

02

Conditions studied

  • AML, Adult
03

In context

Leukemia, Myeloid, Acute

3,667 studies on the registry are indexed under Leukemia, Myeloid, Acute; 816 are open to participants now.

This study's planned enrollment of 142 is above the median of 40 across 3,005 interventional studies indexed under Leukemia, Myeloid, Acute.

Browse Leukemia, Myeloid, Acute studies →

Lead sponsor

Stichting Hemato-Oncologie voor Volwassenen Nederland is the lead sponsor of 27 studies on the registry; 11 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

In order to be eligible to participate in this study, a patient must meet all of the following criteria:

  • Patients with: a diagnosis of AML and related precursor neoplasms according to ICC-2022 classification (excluding acute promyelocytic leukaemia) (appendix A). Patients may have had previous treatment with erythropoiesis stimulating agents (ESA) for an antecedent phase of MDS. ESAs must be stopped at least two weeks before registration.
  • Patients 18 years and older who are considered not fit for intensive chemotherapy or who decline the option of intensive chemotherapy.
  • 0, 1 or 2 (appendix E).
  • Leukocytes \< 30 x109/L
  • Adequate renal and hepatic functions unless clearly disease related as indicated by the following laboratory values:

    • Adequate renal function as demonstrated by a ≥ 30 mL/min; calculated by the Cockcroft Gault formula or measured by 24 hours urine collection.
    • Serum ≤ 3 x (ULN), unless considered AML-related or due to Gilbert's syndrome.
    • (ALT) ≤ 3 x ULN, unless considered AML-related.
  • Male subjects who are sexually active, must agree, from Study Day 1 until at least 90 days after the last dose of study drug, to practice the protocol specified . Male subjects must agree to refrain from sperm donation from initial study drug administration through at least 90 days after the last dose of study drug.
  • Female subjects must be either defined as: Age >55 years with no menses for ≥12 months, without an alternative medical cause. OR willing and able to use adequate contraception during and until 180 days after the last protocol treatment.
  • Written .
  • Patient is capable of giving informed consent.
  • Patient agrees not to participate in another interventional study while on treatment without approval of the (co-) Principal Investigator.

Exclusion criteria

Exclusion Criteria:

A patient who meets any of the following criteria cannot be included in this study:

  • Acute promyelocytic leukemia.
  • Myelodysplastic syndrome (MDS).
  • Patients previously treated for AML or MDS (any anti-leukemic therapy including agents; excluding: 1) erythropoiesis stimulating agents (ESAs); 2) hydroxyurea ((previous treatment with hydroxyurea is allowed for the control of peripheral leukemic blasts in patients with leukocytosis).
  • Diagnosis of any previous or concomitant is an exclusion criterion:

    • except when the patient successfully completed treatment (chemotherapy and/or surgery and/or radiotherapy) with curative intent for this malignancy at least 24 months prior to registration;
    • except for basal and squamous cell carcinoma of the skin or in situ carcinoma of the cervix.
  • Blast crisis of chronic myeloid leukemia.
  • Concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled diabetes, infection, hypertension, pulmonary disease etc.).
  • Cardiac dysfunction as defined by:

    • Myocardial infarction within the last 3 months of study entry, or
    • Reduced left ventricular function with an \< 40% as measured by MUGA scan or echocardiogram, or
    • Unstable angina or (NYHA) grade IV congestive heart failure (see Appendix G), or
    • Unstable cardiac arrhythmias.
  • History of stroke or intracranial haemorrhage within 6 months prior to registration.
  • Symptomatic central nervous system (CNS) leukemia (NO routinely lumbar puncture required to investigate CNS involvement).
  • History of non-compliance to medical regimens or considered unreliable with respect to compliance.
  • Senile dementia, mental impairment or any other psychiatric disorder that prohibits the patient from understanding and giving .
  • Current concomitant chemotherapy, radiation therapy, or immunotherapy; other than hydroxyurea.
  • Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule.
  • Unreplaceable use of strong inhibitors or inducers of or CYP3A/p-GP substrates with a narrow therapeutic window (e.g. cobicistat or ritonavir for treatment). Please check with Appendix I.
  • Intolerability, or allergy to one of the study drugs.
Terms in these criteria, in plain language(15)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Postmenopausal

Periods have stopped for good: usually no period for 12 months in a row without another medical reason, sometimes confirmed by a blood test (FSH).

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Sequential assignment
Masking
None (open label)
Enrollment
142 participants (estimated)

Study arms

  • Experimental
    single arm arm extension phase

    prior to the extention phase, there is a run-in phase with (n= 20 patients of 142 total) with the same study scheme, except that cobicistat is added from cycle 2 onwards to the treatment instead of during cycle 1

    Drug: azacitidine · Drug: Venetoclax · Drug: Cobicistat

Interventions

  • during run-in and extention phase: from Cycle 1 until relapse

  • during run-in and extention phase: from Cycle 1 until relapse

  • during run-in phase: from cycle 2 until relapse during extension phase: from cycle 1 until relapse

06

What researchers measure

Primary outcomes

  1. Pharmacokinetic equivalence of cobicistat boosted venetoclax and unboosted venetoclax (PK cycle 1 vs PK cycle 2).venetoclax and unboosted venetoclax (PK cycle 1 vs PK cycle 2).

    run-in phase

    Time frame: 6-8 months

  2. Overall survival (OS).

    extension phase

    Time frame: 48 months

Secondary outcomes

  1. Venetoclax and cobicistat CL, Cmax, Tmax, Cmin and AUC0-24.

    run-in phase

    Time frame: 6-8 months

  2. Complete remission (CR) rate defined as CR as best response during or at completion of the treatment, as determined by the Investigator, based on the European LeukemiaNet (ELN2022) recommended response criteria (see Appendix B).

    extension phase

    Time frame: 48 months

  3. CR with incomplete hematologic recovery (CRi) rate, based on the European LeukemiaNet (ELN2022) recommended response criteria (see Appendix B).

    extension phase

    Time frame: 48 months

  4. CR and CR with incomplete hematologic recovery (CRi) rate, based on the European LeukemiaNet (ELN2022) recommended response criteria (see Appendix B).

    extension phase

    Time frame: 48 months

  5. CR with partial hematologic recovery (CRh) rate, based on ELN 2022 recommendations.

    extension phase

    Time frame: 48 months

  6. CR and CR with partial hematologic recovery (CRh) rate, based on ELN 2022 recommendations.

    extension phase

    Time frame: 48 months

  7. CR or CR/CRi or CR/CRh without minimal residual disease (flow and or molecular) (CRMRD- or CR/CRiMRD- or CR/CRhMRD-).

    extension phase

    Time frame: 48 months

  8. Morphologic leukemia-free state (MLFS) rate, based on ELN2022 recommendations.

    extension phase

    Time frame: 48 months

  9. Event free survival (EFS).

    extension phase

    Time frame: 48 months

  10. Relapse-free survival (RFS).

    extension phase

    Time frame: 48 months

  11. Incidence and severity of adverse events according to CTCAE version 5.0.

    extension phase

    Time frame: 48 months

  12. Early (30-day and 60-day) mortality (in general, non-leukemic).

    extension phase

    Time frame: 48 months

  13. Time to next cycle, defined as the time from the start of the cycle until the start of the next cycle.

    extension phase

    Time frame: 48 months

  14. OS of AZA/VEN/COBI treated patients in comparison with a real-world data cohort treated during the same time period and monitored by the Dutch Cancer registry.

    extension phase

    Time frame: 48 months

  15. Prognostic/predictive impact of disease-associated genetic changes at diagnosis.

    extension phase

    Time frame: 48 months

  16. Relapse-associated genetic changes (determined at relapse). The average relative dose intensity will be computed and given by categories. The same will be done for treatment deviation.

    extension phase

    Time frame: 48 months

  17. Clonal evolution during treatment.

    extension phase

    Time frame: 48 months

  18. Exposure-response and exposure-toxicity relation of venetoclax in patients with AML.

    extension phase

    Time frame: 48 months

  19. Cost-savings on venetoclax drug costs.

    extension phase

    Time frame: 48 months

  20. Adherence to venetoclax and cobicistat.

    extension phase

    Time frame: 48 months

07

Study locations

19 of 19 sites recruiting
08

References and documents

Publications

  • Westra N, Cerro ER, Schilder E, Lub-de Hooge MN, Touw DJ, Kosterink JGW, Chitu DA, Ammatuna E, Klein SK, Westerweel PE, Cuijpers M, Cruijsen M, Corsten MMF, Alhan C, Tick L, Schuringa JJ, Huls G, Woolthuis CM, Oude Munnink TH. Pharmacological boosting of azacitidine/venetoclax in acute myeloid leukemia. Blood Neoplasia. 2026 Mar 12;3(2):100218. doi: 10.1016/j.bneo.2026.100218. eCollection 2026 May. PubMed 42007248 ↗

Related links

Individual participant data

Plan to share: Undecided

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Jan 2024 (actual). Primary completion is estimated for Dec 2028, 59 months after the start.

Of 385 non-industry phase 2 interventional studies under Leukemia, Myeloid, Acute, half reached primary completion within 67 months of starting (the median), counting those still running; a quarter within 40 and three quarters within 108. This study's planned 59 months is below that.

Counting every sponsor, half of 442 studies reached it within 60 months; a quarter within 38 and three quarters within 104.

How these figures are worked out, and which studies are left out of them.

Registered
Jul 4, 2023
First posted
Aug 28, 2023
StartActual
Jan 17, 2024
Primary completionEst.
Dec 2028
CompletionEst.
Dec 2028
Last update
Sep 23, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 23, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT06014489
Lead sponsor
Stichting Hemato-Oncologie voor Volwassenen Nederland
Responsible party
Sponsor
First posted
Aug 28, 2023
Start date
Jan 17, 2024
Primary completion
Dec 2028 (estimated)
Completion
Dec 2028 (estimated)
Last update
Sep 23, 2026

Study contacts

Gerwin Huls, prof
Contact
g.huls@umcg.nl
+3150 361 2354

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drugs tested here: Azacitidine · Venetoclax · Cobicistat

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