Enasidenib in Combination With Cobimetinib for the Treatment of Relapsed or Refractory Acute Myeloid Leukemia

Inclusion Criteria:

Documented informed consent of the participant and/or legally authorized representative
Age: >= 18 years
Eastern Cooperative Oncology Group (ECOG) performance status =< 2

Patients with histologically confirmed acute myeloid leukemia (AML), according to World Health Organization (WHO) criteria, with refractory/relapsed (R/R) disease who are ineligible for therapies known to be effective for treatment of their acute myeloid leukemia (AML)

Patients with non-central nervous system (CNS) extramedullary disease may be included if they also have marrow involvement
Patients with acute promyelocytic leukemia (APL) will not be eligible
Patients with IDH2 mutations, who were previously treated with enasidenib are allowed
Have a confirmed susceptible IDH2 mutation (R140 or R172) with a concomitant RAS-pathway mutation, involving NRAS, KRAS, PTPN11, CBL or NF1 genes
Fully recovered from the acute toxic effects (except alopecia) to =< Grade 1 to prior anti-cancer therapy
Ability to swallow pills
Total bilirubin =< 1.5 X upper limit of normal (ULN) (unless has Gilbert's disease) (performed within 14 days prior to day 1 of protocol therapy)
Aspartate aminotransferase (AST) =< 2.0 x ULN (performed within 14 days prior to day 1 of protocol therapy)
Alanine aminotransferase (ALT) =< 2.0 x ULN (performed within 14 days prior to day 1 of protocol therapy)
Creatinine clearance of >= 50 mL/min per 24 hour urine test or the Cockcroft-Gault formula (performed within 14 days prior to day 1 of protocol therapy)
International normalized ratio (INR) OR prothrombin (PT) =< 1.5 x ULN
Activated partial thromboplastin time (aPTT) =< 1.5 x ULN (performed within 14 days prior to day 1 of protocol therapy)

Left ventricular ejection fraction (LVEF) >= 50%

Note: Echocardiogram scan to be performed within 7 days prior to day 1 of protocol therapy

Tricuspid valve regurgitation jet (TRJ) velocity < 2.5 m/sec

Note: To be performed within 7days prior to day 1 of protocol therapy

Corrected QT (QTc) =< 480 ms

Note: To be performed within 28 days prior to day 1 of protocol therapy
Women of childbearing potential (WOCBP): negative urine or serum pregnancy test If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required

Agreement by females and males of childbearing potential* to use an effective method of birth control (non-hormonal) or abstain from heterosexual activity from 4 weeks prior to first dose of study treatment through at least 2 months after the last dose of protocol therapy. Coadministration of enasidenib may increase or decrease the concentrations of combined hormonal contraceptives

Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only).
Also, male subjects should refrain from sperm donation from the start of treatment throughout the study treatment period and for 6 months following the last dose of treatment

Exclusion Criteria:

Current or planned use of other investigational agents, antineoplastic, chemotherapy, radiation therapy, biological therapy, immunotherapy or major surgery within 4 weeks or 5 half-lives, whichever is shorter, prior to Day 1 of protocol therapy (exception: hydroxyurea is allowed in cycles 1 and 2 for control of rapidly progressing leukemia or for treatment of enasidenib-related leukocytosis)
Systemic steroid therapy > 10 mg/day (=< 10mg/day prednisone equivalent ok) or any other form of immunosuppressive medication within 28 days, except as required for treatment of differentiation syndrome
Strong and moderate CYP3A4 inducers/inhibitors (moderate CYP3A4 inhibitors only allowed on principal Investigator approval) within 14 days prior to Day 1 of protocol therapy
Foods/supplements that are strong and moderate inhibitors or inducers of CYP3A (such as grapefruit, Seville oranges, starfruit and St. John's wort) within 7 days prior to initiation of and during study treatment
Received a live-virus vaccination within 28 days of planned treatment start
Concurrent use of granulocyte-macrophage colony stimulating factor (GMCSF) or granulocyte colony stimulating factor (G-CSF), erythropoietin, eltrombopag, or other hematopoietic growth factors 14 days prior to start of study
Class III/IV cardiovascular disability according to the New York Heart Association Classification
Participants with clinically significant arrhythmia or arrhythmias not stable on medical management within two weeks of enrollment. Subjects with controlled, asymptomatic atrial fibrillation can enroll
History of acute cardiovascular ischemic event, i.e., myocardial infarction or unstable angina within 6 months of enrollment

Participant has ophthalmologic conditions, including any of the following:

Current or past history of central serous retinopathy
Current or past history of retinal vein occlusion
Intraocular pressure (IOP) > 21 mmHg or uncontrolled glaucoma
Gastrointestinal disorder such as malabsorption syndrome or any other disorder that may interfere with oral drug absorption
History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent
Active central nervous system (CNS) disease
Clinically significant uncontrolled illness
Active infection requiring antibiotics
Other active malignancy
Females only: Pregnant or breastfeeding
Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics).