Study of Vosaroxin and Cytarabine for the Treatment of Adults 60 Years of Age or Older With Previously Untreated AML

Primary objective: rate of complete remission (morphologic complete remission or morphologic
complete remission with incomplete blood count recovery) Secondary objectives: (1) safety of
this combination in induction therapy of older patients previously unexposed to intensive
chemotherapy; (2) progression-free survival; (3) length of stay in hospital for induction;
(4) 30- and 60-day mortality rate.

The treatment period will include up to 4 cycles of treatment (induction 1, induction 2,
consolidation 1, and consolidation 2). In each cycle, the first day of study treatment will
be considered day 1.

- Each cycle will include vosaroxin treatment on days 1 and 4 (total of 2 days) and
cytarabine treatment on days 1-5 (total of 5 days) followed by a variable interval
required to achieve hematologic recovery, defined as absolute neutrophil count (ANC) >
1000 cells/L.

- Up to 2 cycles of consolidation treatment may be completed by eligible patients in
remission (morphologic complete remission or morphologic complete remission with
incomplete blood count recovery) if safety parameters are met.

Inclusion Criteria:

- Age > 60 years

- A diagnosis of AML based on WHO classification (>20% myeloblasts in peripheral blood
or bone marrow)

- No previous treatment with chemotherapy for AML, other than hydroxyurea. Previous
treatment with hypomethylating agents is acceptable

- Patients must have an ECOG (Zubrod) performance status of 0-2 (see Appendix I).

- Patients must have adequate hepatic function with a total bilirubin < 1.5 times upper
limit normal (ULN) other than cases of Gilbert disease, and ALT and AST < 2.5 times
ULN; and adequate renal function as defined by a serum creatinine < 2 times ULN.

- Clinically significant nonhematologic toxicity after prior therapy has recovered to
grade 1 per Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 or
newer

- Patients must have the ability to understand and the willingness to sign a written
informed consent. A signed informed consent must be obtained prior to initiation of
treatment

- Left ventricular ejection fraction (LVEF) at least 40% by multiple gated acquisition
(MUGA) scan or echocardiogram (ECHO)

Exclusion Criteria:

- Patients with known central nervous system (CNS) leukemia by spinal fluid cytology,
flow cytometry or imaging. A lumbar puncture is not required unless CNS involvement
is clinically suspected. Patients with signs or symptoms of leukemic meningitis or a
history of leukemic meningitis must have a negative lumbar puncture within 2 weeks of
study enrollment.

- A diagnosis of acute promyelocytic leukemia (APL). The study does not require to rule
APL out for every subject. However, if there is clinical suspicion for APL, such
diagnosis has to be ruled out before initiation of treatment.

- Active malignancy currently undergoing chemo or radiation therapy. Hormone therapy is
acceptable.

- Active serious infection that at the discretion of treating physician makes patient
ineligible for chemotherapy.