Tosedostat in Combination With Cytarabine or Decitabine in Treating Patients With Newly Diagnosed Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome

PRIMARY OBJECTIVES: I. To determine the 4 month survival and complete remission (CR) rates of tosedostat in combination with either cytarabine or decitabine in untreated acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS). SECONDARY OBJECTIVES: I. To assess safety and tolerability of tosedostat in combination with either cytarabine or decitabine. II. To determine the treatment related mortality defined as death within the first 30 days of beginning treatment. III. To estimate rates of disease-free survival (DFS) and the 1 year overall survival (OS). OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients receive tosedostat orally (PO) once daily (QD) on days 1-35 and cytarabine intravenously (IV) on days 1-5. ARM II: Patients receive tosedostat PO QD on days 1-35 and decitabine IV on days 1-5. If the patient develops a significant increase in their circulating or bone marrow blast count, the subsequent cycle may be started as early as day 21 of the current cycle. In both arms, treatment repeats every 35 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients achieving CR or partial CR (pCR) may receive 2 additional courses of treatment. After completion of study treatment, patients are followed up every 3 months for 2 years and then annually for 3 years.