
    lack of efficacy
  
['myelodysplastic syndromes']
['tipifarnib']

        Inclusion Criteria:

          -  Subject is at least 18 years of age.

          -  Documented pathological evidence of MDS as defined by the World Health Organization
             (WHO) criteria

          -  Must have transfusion-dependent anemia that meets the following criteria:

               1. Average transfusion requirement of ≥ 2 units per 28 days of packed RBCs confirmed
                  for a minimum of 112 days immediately preceding Cycle 1 Day 1.

               2. No consecutive 56 days that was RBC transfusion-free during the 112 days
                  immediately preceding Cycle 1 Day 1.

               3. Hemoglobin levels at the time of or within 7 days prior to transfusions must have
                  been ≤ 9.0 g/dL for the transfusions to qualify as required for the purpose of
                  providing evidence of transfusion-dependent anemia.

          -  Must be unresponsive or refractory to erythropoiesis-stimulating agents (ESA), based
             on one of the following:

               1. Transfusion-dependence in subjects previously treated with an ESA (requires a
                  minimum ESA trial of > 40,000 U/week recombinant human erythropoietin (rHuEPO) x
                  8 weeks or equivalent dose of darbepoetin or other erythropoietin agent), or

               2. Serum erythropoietin level of > 500 mU/mL in subjects not previously treated with
                  an ESA.

          -  Risk category very low, low or intermediate (Revised International Prognostic Scoring
             System, IPSS-R)

          -  Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.

          -  Subjects have no known curative treatment.

          -  At least 1 week since the last systemic therapy regimen prior to Cycle 1 Day 1.
             Subjects must have recovered to NCI CTCAE v. 4.03 < Grade 2 from all acute toxicities
             (excluding Grade 2 toxicities that are not considered a safety risk by the Sponsor and
             Investigator) or toxicity must be deemed irreversible by the Investigator.

          -  Acceptable hematological function:

               1. Absolute neutrophil count > 500/mm3

               2. Platelet count > 25,000/mm3

          -  Acceptable liver function:

               1. Total or direct bilirubin ≤ 1.5 times upper limit of normal (x ULN); does not
                  apply to subjects with Gilbert's syndrome diagnosed as per institutional
                  guidelines.

               2. AST (SGOT) and ALT (SGPT) ≤ 2.5 x ULN.

          -  Acceptable renal function with serum creatinine ≤ 1.5 x ULN or a calculated creatinine
             clearance ≥ 60 mL/min using the Cockcroft-Gault or Modification of Diet in Renal
             Disease formulas.

          -  Female subjects must be either:

               1. Of non-child-bearing potential (surgically sterilized or at least 2 years
                  post-menopausal); or

               2. If of child-bearing potential, subject must use an adequate method of
                  contraception consisting of two-barrier method or one barrier method with a
                  spermicide or intrauterine device. Both females and male subjects with female
                  partners of child-bearing potential must agree to use an adequate method of
                  contraception for 2 weeks prior to screening, during, and at least 4 weeks after
                  last dose of study medication. Female subjects must have a negative serum or
                  urine pregnancy test within 72 hours prior to start of study medication.

               3. Not breast feeding at any time during the study.

        Exclusion Criteria:

          -  Known prior progression to acute myeloid leukemia (AML), defined by at least 20%
             blasts in the blood or bone marrow.

          -  Myelodysplastic or myeloproliferative syndrome other than MDS.

          -  More than two prior systemic treatments for MDS. Prior systemic therapies are those
             that have been received at standard doses for at least one full treatment cycle.

          -  Prior cytoreductive therapy.

          -  Use of an ESA within the 4 weeks prior to Cycle 1 Day 1.

          -  Participation in any interventional study within 4 weeks or 5 half lives (whichever is
             longer) of Cycle 1 Day 1.

          -  Ongoing treatment with an anticancer agent for MDS not contemplated in this protocol.

          -  Prior treatment (at least 1 full treatment cycle) with a farnesyltransferase
             inhibitor.

          -  Clinically significant anemia due to iron, B12, or folate deficiencies, or autoimmune
             or hereditary hemolytic anemia, or gastrointestinal bleeding. If marrow stain for iron
             is not available, the transferrin saturation (iron/total iron binding capacity
             Fe/TIBC) must be >20% or serum ferritin must be >100 ng/dL.

          -  Active coronary artery disease requiring treatment, myocardial infarction within the
             prior year, New York Heart Association grade III or greater congestive heart failure,
             cerebro-vascular attack within the prior year, or current serious cardiac arrhythmia
             requiring medication except atrial fibrillation.

          -  Major surgery, other than diagnostic surgery, within 2 weeks prior to Cycle 1 Day 1,
             without complete recovery.

          -  Active, concurrent malignancy requiring radiation, chemotherapy, or immunotherapy
             (excluding non-melanoma skin cancer, adjuvant hormonal therapy for breast cancer and
             hormonal treatment for castration sensitive prostate cancer).

          -  Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic
             therapy. Known infection with human immunodeficiency virus (HIV), or an active
             infection with hepatitis B or hepatitis C.

          -  Subjects who have exhibited allergic reactions to tipifarnib, or structural compounds
             similar to tipifarnib or to its excipients.

          -  Concomitant disease or condition that could interfere with the conduct of the study,
             or that would, in the opinion of the investigator, pose an unacceptable risk to the
             subject in this study.

          -  The subject has legal incapacity or limited legal capacity.

          -  Significantly altered mental status that would limit the understanding or rendering of
             informed consent and compliance with the requirements of this protocol. Unwillingness
             or inability to comply with the study protocol for any reason.
      