PRIMARY OBJECTIVES:~I. To estimate the overall response rate (complete, partial, and hematologic improvement-major by International Working Group [IWG] criteria) in response to azacitidine and entinostat.~II. To estimate the major response rate (complete and partial responses by the IWG response criteria) to a 10-day regimen of azacitidine and to the same regimen of azacitidine in combination with entinostat administered orally on days 3 and 10 of each cycle in patients with de novo myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMMoL) (dysplastic) and acute myeloid leukemia with trilineage dysplasia (AML-TLD), as well as in patients with treatment-induced MDS, CMMoL (dysplastic) and AML-TLD.~SECONDARY OBJECTIVES:~I. To evaluate the toxicity of azacitidine and entinostat in this patient population.~II. To identify changes in gene promoter methylation and gene expression which may be associated with response to azacitidine and entinostat.~III. To identify other molecular mechanisms (such as deoxyribonucleic acid [DNA] damage) which may be associated with response to azacitidine and entinostat.~OUTLINE: Patients are randomized to 1 of 2 treatment arms.~ARM A: Patients receive azacitidine subcutaneously (SC) once daily (QD) on days 1-10.~ARM B: Patients receive azacitidine as in Arm A and entinostat orally (PO) on days 3 and 10.~In both arms, treatment repeats every 28 days for 6-24 courses in the absence of disease progression or unacceptable toxicity.~After completion of study treatment, patients are followed up for 5 years.
This randomized phase II trial studies azacitidine with or without entinostat to see how well they work compared to azacitidine alone in treating patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, or acute myeloid leukemia. Drugs used in chemotherapy, such as azacitidine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Entinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving azacitidine together with entinostat may work better in treating patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, or acute myeloid leukemia.