Sunitinib in Treating Patients With Myelodysplastic Syndromes or Chronic Myelomonocytic Leukemia

OBJECTIVES:

I. Determine the overall response rate (complete response, partial response, or hematological
improvement) in patients with intermediate-2 or high-risk myelodysplastic syndromes or
chronic myelomonocytic leukemia treated with sunitinib malate.

II. Determine the duration of response in patients treated with this drug. III. Determine the
overall survival of patients treated with this drug. IV. Determine the progression-free
survival of patients treated with this drug. V. Determine the time to disease progression in
patients treated with this drug.

VI. Determine the toxicity of this drug in these patients.

OUTLINE: This is a multicenter study.

Patients receive oral sunitinib malate once daily on days 1-28. Courses repeat every 4 weeks
in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed at 3-4 weeks and then monthly
thereafter.

Inclusion Criteria:

- MDS syndromes meeting 1 of the following: Intermediate-2 disease, high-risk disease
(IPSS score>=1.5)

- CMML: WBC>12,000/mm^3, Intermediate-2 disease with WBC=<12,000/mm^3, high-risk disease
(IPSS score>=1.5) with WBC=<12,000/mm^3

- Patients with insufficient/inadequate metaphases for cytogenetic analysis are eligible
if bone marrow blasts are >10% and/or 2-3 cytopenias are present

- No known brain metastases

- Life expectancy>12 weeks

- ECOG PS 0-2/Karnofsky PS 60-100%

- Calcium=<3.0 mmol/L

- Bilirubin normal

- AST and ALT=<2.5 times upper limit of normal

- Creatinine normal/creatinine clearance>=60 mL/min

Exclusion Criteria:

- No history of significant ECG abnormalities including but not limited to: ventricular
arrhythmias (ventricular tachycardia, ventricular fibrillation>=3 beats in a row); QTc
prolongation (i.e.QTc interval>=500msec)

- No history of allergic reaction to compounds of similar chemical/biological
composition to sunitinib malate

- No NYHA class III-IV congestive heart failure

- Patients with history of NYHA class II congestive heart failure who are asymptomatic
on treatment are eligible

- No abdominal fistula/G perforation/intraabdominal abscess within past 28 days

- No serious cardiovascular disease within past 12 months including: cerebrovascular
accident or transient ischemic attack, myocardial infarction, cardiac arrhythmia,
stable or unstable angina, symptomatic congestive heart failure, coronary or
peripheral artery bypass graft or stenting

- No pulmonary embolism within past 12 months

- No uncontrolled hypertension (systolic BP>=140 mmHg/diastolic BP>=90 mmHg)

- No condition impairing ability to swallow/retain sunitinib malate tablets including:
GI tract disease resulting in inability to take oral medication, requirement for IV
alimentation, prior surgical procedures affecting absorption, active peptic ulcer
disease

- No serious/nonhealing wound, ulcer, or bone fracture

- No uncontrolled pre-existing thyroid abnormality

- No concurrent uncontrolled illness including ongoing/active infection

- No psychiatric illness/social situation that would preclude study participation

- Not pregnant/nursing

- Negative pregnancy test

- Fertile patients must use effective barrier contraception

- 4 weeks since prior major surgery

- Prior central thoracic radiotherapy that included heart in radiotherapy port allowed
provided NYHA congestive heart failure=
- Prior anthracycline exposure allowed provided NYHA congestive heart failure=
- No other prior therapy for MDS/CMML except epoetin alfa, darbepoetin alfa, filgrastim
or sargramostim

- At least 2 weeks since prior epoetin alfa

- At least 4 weeks since prior darbepoetin alfa

- No other prior antiangiogenic agents including but not limited to: bevacizumab,
sorafenib tosylate, pazopanib hydrochloride, AZD2171, vatalanib, VEGF Trap

- More than 7 days since prior and no concurrent potent CYP3A4 inhibitors

- More than 12 days since prior and no concurrent potent CYP3A4 inducers including:
Rifampin, Rifabutin, Carbamazepine, Phenobarbital, Phenytoin, Hypericum perforatum,
Efavirenz, Tipranavir

- No concurrent birth control patch/oral birth control pills/depot/injectable birth
control methods

- No concurrent therapeutic coumarin-derivative anticoagulants

- Low dose(=<2mg) warfarin for prophylaxis of thrombosis allowed

- Low molecular weight heparin allowed if INR=<1.5

- No concurrent agents with proarrhythmic potential including: Terfenadine, Quinidine,
Procainamide, Disopyramide, Sotalol, Probucol, Bepridil, Haloperidol, Risperidone,
Indapamide, Flecainide acetate

- No concurrent combination antiretroviral therapy for HIV-positive patients

- No other concurrent investigational agents