Vorinostat and Combination Chemotherapy With Rituximab in Treating Patients With HIV-Related Diffuse Large B-Cell Non-Hodgkin Lymphoma or Other Aggressive B-Cell Lymphomas

Sponsor
National Cancer Institute (NCI) (NIH)
Overall Status
Completed
CT.gov ID
NCT01193842
Collaborator
(none)
107
35
2
131.4
3.1
0

Study Details

Study Description

Brief Summary

This partially randomized phase I/II trial studies the side effects and the best dose of vorinostat when given together with combination chemotherapy and rituximab to see how well it works compared to combination chemotherapy alone in treating patients with human immunodeficiency virus-related diffuse large B-cell non-Hodgkin lymphoma or other aggressive B-cell lymphomas. Vorinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy 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. Monoclonal antibodies, such as rituximab, may interfere with the ability of cancer cells to grow and spread. Giving vorinostat together with combination chemotherapy and rituximab may kill more cancer cells.

Detailed Description

PRIMARY OBJECTIVES:
  1. Determine the recommended phase II dose (RPTD) of vorinostat that may be used in combination with dose-adjusted etoposide, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride and rituximab (R-DA-EPOCH) (in high-risk disease) in participants with human immunodeficiency virus (HIV)-associated aggressive cluster of differentiation (CD)20 positive non-Hodgkin lymphoma (NHL). (Phase I) II. Determine the overall toxicity rates of R-DA-EPOCH (in high-risk disease) with and without vorinostat. (Phase II) III. Determine the efficacy of the combinations of R-DA-EPOCH (in high-risk disease) with and without vorinostat in HIV-associated aggressive CD20 positive NHL using complete response (CR) rates as study endpoints. (Phase II)
SECONDARY OBJECTIVES:
  1. Determine 1-year event-free survival (EFS) and 1 year overall survival (OS). II. Assess the effect of vorinostat and chemotherapy on latent HIV in memory T cells.

  2. Assess the effect of vorinostat and/or chemotherapy on HIV, Epstein-Barr virus (EBV), and human herpes virus 8 (HHV-8) viral loads on banked specimens.

  3. Assess the effect of vorinostat and/or chemotherapy on T-cell subsets (CD4 and CD8) and plasma immunoglobulin levels.

  4. Assess the effect of concurrent vorinostat and rituximab on plasma steady-state concentrations of etoposide, doxorubicin (doxorubicin hydrochloride), and vincristine (vincristine sulfate) (on Phase I only).

  5. Perform wide human gene expression profiling and methylation studies in tumors banked at baseline.

  6. Evaluate EBV and HHV-8 gene expression patterns in positive tumors banked at baseline.

OUTLINE: This is a phase I, dose-escalation study of vorinostat followed by a phase II study.

PHASE I: Patients receive vorinostat orally (PO) once daily (QD) on days 1-5; rituximab intravenously (IV) on day 1; etoposide IV over 24 hours, doxorubicin hydrochloride IV over 24 hours, and vincristine sulfate IV over 24 hours on days 1-4; prednisone PO daily on days 1-5; and cyclophosphamide IV over 1 hour on day 5. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.

PHASE II: Patients are randomized to 1 of 2 treatment arms.

ARM A (VR-DA-EPOCH): Patients receive vorinostat, rituximab, etoposide, doxorubicin hydrochloride, vincristine sulfate, prednisone, and cyclophosphamide as in Phase I.

ARM B (DA-R-EPOCH): Patients receive rituximab, etoposide, doxorubicin hydrochloride, vincristine sulfate, prednisone, and cyclophosphamide as in Arm A.

In all arms, treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Study Design

Study Type:
Interventional
Actual Enrollment :
107 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Sequential Phase I/Randomized Phase II Trial of Vorinostat and Risk-Adapted Chemotherapy With Rituximab in HIV-Related B-Cell Non-Hodgkin's Lymphoma
Actual Study Start Date :
Oct 6, 2010
Actual Primary Completion Date :
Nov 12, 2016
Actual Study Completion Date :
Sep 17, 2021

Arms and Interventions

Arm Intervention/Treatment
Experimental: Arm A (VR-DA-EPOCH)

Patients receive vorinostat PO QD on days 1-5; rituximab IV on day 1; etoposide IV over 24 hours, doxorubicin hydrochloride IV over 24 hours, and vincristine sulfate IV over 24 hours on days 1-4; prednisone PO daily on days 1-5; and cyclophosphamide IV over 1 hour on day 5. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.

Drug: Cyclophosphamide
Given IV
Other Names:
  • (-)-Cyclophosphamide
  • 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
  • Carloxan
  • Ciclofosfamida
  • Ciclofosfamide
  • Cicloxal
  • Clafen
  • Claphene
  • CP monohydrate
  • CTX
  • CYCLO-cell
  • Cycloblastin
  • Cycloblastine
  • Cyclophospham
  • Cyclophosphamid monohydrate
  • Cyclophosphamide Monohydrate
  • Cyclophosphamidum
  • Cyclophosphan
  • Cyclophosphane
  • Cyclophosphanum
  • Cyclostin
  • Cyclostine
  • Cytophosphan
  • Cytophosphane
  • Cytoxan
  • Fosfaseron
  • Genoxal
  • Genuxal
  • Ledoxina
  • Mitoxan
  • Neosar
  • Revimmune
  • Syklofosfamid
  • WR- 138719
  • Drug: Doxorubicin Hydrochloride
    Given IV
    Other Names:
  • 5,12-Naphthacenedione, 10-[(3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, hydrochloride, (8S-cis)- (9CI)
  • ADM
  • Adriacin
  • Adriamycin
  • Adriamycin Hydrochloride
  • Adriamycin PFS
  • Adriamycin RDF
  • ADRIAMYCIN, HYDROCHLORIDE
  • Adriamycine
  • Adriblastina
  • Adriblastine
  • Adrimedac
  • Chloridrato de Doxorrubicina
  • DOX
  • DOXO-CELL
  • Doxolem
  • Doxorubicin HCl
  • Doxorubicin.HCl
  • Doxorubin
  • Farmiblastina
  • FI 106
  • FI-106
  • hydroxydaunorubicin
  • Rubex
  • Drug: Etoposide
    Given IV
    Other Names:
  • Demethyl Epipodophyllotoxin Ethylidine Glucoside
  • EPEG
  • Lastet
  • Toposar
  • Vepesid
  • VP 16
  • VP 16-213
  • VP-16
  • VP-16-213
  • VP16
  • Other: Laboratory Biomarker Analysis
    Correlative studies

    Other: Pharmacological Study
    Correlative studies

    Drug: Prednisone
    Given PO
    Other Names:
  • .delta.1-Cortisone
  • 1, 2-Dehydrocortisone
  • Adasone
  • Cortancyl
  • Dacortin
  • DeCortin
  • Decortisyl
  • Decorton
  • Delta 1-Cortisone
  • Delta-Dome
  • Deltacortene
  • Deltacortisone
  • Deltadehydrocortisone
  • Deltasone
  • Deltison
  • Deltra
  • Econosone
  • Lisacort
  • Meprosona-F
  • Metacortandracin
  • Meticorten
  • Ofisolona
  • Orasone
  • Panafcort
  • Panasol-S
  • Paracort
  • Perrigo Prednisone
  • PRED
  • Predicor
  • Predicorten
  • Prednicen-M
  • Prednicort
  • Prednidib
  • Prednilonga
  • Predniment
  • Prednisone Intensol
  • Prednisonum
  • Prednitone
  • Promifen
  • Rayos
  • Servisone
  • SK-Prednisone
  • Biological: Rituximab
    Given IV
    Other Names:
  • ABP 798
  • BI 695500
  • C2B8 Monoclonal Antibody
  • Chimeric Anti-CD20 Antibody
  • CT-P10
  • IDEC-102
  • IDEC-C2B8
  • IDEC-C2B8 Monoclonal Antibody
  • MabThera
  • Monoclonal Antibody IDEC-C2B8
  • PF-05280586
  • Rituxan
  • Rituximab ABBS
  • Rituximab Biosimilar ABP 798
  • Rituximab Biosimilar BI 695500
  • Rituximab Biosimilar CT-P10
  • Rituximab Biosimilar GB241
  • Rituximab Biosimilar IBI301
  • Rituximab Biosimilar JHL1101
  • Rituximab Biosimilar PF-05280586
  • Rituximab Biosimilar RTXM83
  • Rituximab Biosimilar SAIT101
  • Rituximab Biosimilar SIBP-02
  • rituximab biosimilar TQB2303
  • rituximab-abbs
  • RTXM83
  • Truxima
  • Drug: Vincristine Sulfate
    Given IV
    Other Names:
  • Kyocristine
  • Leurocristine Sulfate
  • Leurocristine, sulfate
  • Oncovin
  • Vincasar
  • Vincosid
  • Vincrex
  • Vincristine, sulfate
  • Drug: Vorinostat
    Given PO
    Other Names:
  • L-001079038
  • MSK-390
  • SAHA
  • Suberanilohydroxamic Acid
  • Suberoylanilide Hydroxamic Acid
  • Zolinza
  • Experimental: ARM B (DA-R-EPOCH)

    Patients receive rituximab, etoposide, doxorubicin hydrochloride, vincristine sulfate, prednisone, and cyclophosphamide as in Arm A. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.

    Drug: Cyclophosphamide
    Given IV
    Other Names:
  • (-)-Cyclophosphamide
  • 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
  • Carloxan
  • Ciclofosfamida
  • Ciclofosfamide
  • Cicloxal
  • Clafen
  • Claphene
  • CP monohydrate
  • CTX
  • CYCLO-cell
  • Cycloblastin
  • Cycloblastine
  • Cyclophospham
  • Cyclophosphamid monohydrate
  • Cyclophosphamide Monohydrate
  • Cyclophosphamidum
  • Cyclophosphan
  • Cyclophosphane
  • Cyclophosphanum
  • Cyclostin
  • Cyclostine
  • Cytophosphan
  • Cytophosphane
  • Cytoxan
  • Fosfaseron
  • Genoxal
  • Genuxal
  • Ledoxina
  • Mitoxan
  • Neosar
  • Revimmune
  • Syklofosfamid
  • WR- 138719
  • Drug: Doxorubicin Hydrochloride
    Given IV
    Other Names:
  • 5,12-Naphthacenedione, 10-[(3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, hydrochloride, (8S-cis)- (9CI)
  • ADM
  • Adriacin
  • Adriamycin
  • Adriamycin Hydrochloride
  • Adriamycin PFS
  • Adriamycin RDF
  • ADRIAMYCIN, HYDROCHLORIDE
  • Adriamycine
  • Adriblastina
  • Adriblastine
  • Adrimedac
  • Chloridrato de Doxorrubicina
  • DOX
  • DOXO-CELL
  • Doxolem
  • Doxorubicin HCl
  • Doxorubicin.HCl
  • Doxorubin
  • Farmiblastina
  • FI 106
  • FI-106
  • hydroxydaunorubicin
  • Rubex
  • Drug: Etoposide
    Given IV
    Other Names:
  • Demethyl Epipodophyllotoxin Ethylidine Glucoside
  • EPEG
  • Lastet
  • Toposar
  • Vepesid
  • VP 16
  • VP 16-213
  • VP-16
  • VP-16-213
  • VP16
  • Other: Laboratory Biomarker Analysis
    Correlative studies

    Other: Pharmacological Study
    Correlative studies

    Drug: Prednisone
    Given PO
    Other Names:
  • .delta.1-Cortisone
  • 1, 2-Dehydrocortisone
  • Adasone
  • Cortancyl
  • Dacortin
  • DeCortin
  • Decortisyl
  • Decorton
  • Delta 1-Cortisone
  • Delta-Dome
  • Deltacortene
  • Deltacortisone
  • Deltadehydrocortisone
  • Deltasone
  • Deltison
  • Deltra
  • Econosone
  • Lisacort
  • Meprosona-F
  • Metacortandracin
  • Meticorten
  • Ofisolona
  • Orasone
  • Panafcort
  • Panasol-S
  • Paracort
  • Perrigo Prednisone
  • PRED
  • Predicor
  • Predicorten
  • Prednicen-M
  • Prednicort
  • Prednidib
  • Prednilonga
  • Predniment
  • Prednisone Intensol
  • Prednisonum
  • Prednitone
  • Promifen
  • Rayos
  • Servisone
  • SK-Prednisone
  • Biological: Rituximab
    Given IV
    Other Names:
  • ABP 798
  • BI 695500
  • C2B8 Monoclonal Antibody
  • Chimeric Anti-CD20 Antibody
  • CT-P10
  • IDEC-102
  • IDEC-C2B8
  • IDEC-C2B8 Monoclonal Antibody
  • MabThera
  • Monoclonal Antibody IDEC-C2B8
  • PF-05280586
  • Rituxan
  • Rituximab ABBS
  • Rituximab Biosimilar ABP 798
  • Rituximab Biosimilar BI 695500
  • Rituximab Biosimilar CT-P10
  • Rituximab Biosimilar GB241
  • Rituximab Biosimilar IBI301
  • Rituximab Biosimilar JHL1101
  • Rituximab Biosimilar PF-05280586
  • Rituximab Biosimilar RTXM83
  • Rituximab Biosimilar SAIT101
  • Rituximab Biosimilar SIBP-02
  • rituximab biosimilar TQB2303
  • rituximab-abbs
  • RTXM83
  • Truxima
  • Drug: Vincristine Sulfate
    Given IV
    Other Names:
  • Kyocristine
  • Leurocristine Sulfate
  • Leurocristine, sulfate
  • Oncovin
  • Vincasar
  • Vincosid
  • Vincrex
  • Vincristine, sulfate
  • Outcome Measures

    Primary Outcome Measures

    1. Percentage of Participants With Complete Response (CR) as Assessed by Response Evaluation Criteria in Solid Tumors (Phase II) [Up to 6 months]

      Percentage of participants with complete response as assessed by Response Evaluation Criteria in Solid Tumors (Phase II) according to treatment arm. Participants are planned to be treated for a total of 6 cycles (21 day cycle length). Participants with CR after Cycle 4 will receive two additional cycles of chemotherapy and complete 6 cycles of chemotherapy. Participants who achieve a partial response (PR) only after Cycle 4 may continue on protocol therapy or they may be removed from the study at the AMC discretion of the physician (local Principal Investigator). Participants with stable disease after 4 cycles (i.e., who did not achieve at least a PR) or progressive disease at any time will be removed from study.

    2. Percentage of Participant Experiencing Adverse Events (AEs) for Each Treatment Arm as Assessed by Common Terminology Criteria for Adverse Events Version 4.0 (CTCAE v4.0) (Phase II) [Up to 5 years]

      The percentage of participants with AEs and their worst severity will be tabulated for each treatment arm. If a participant has more than one AE, the most severe AE is analyzed. All adverse events will be assessed by the investigator from the first dose of protocol therapy through the post-treatment discontinuation visit. Participants are planned to be treated for a total of 6 cycles (21 day cycle length), or roughly 4 months. After this evaluation, assessment and reporting of AEs will only be required for all grade 5 AEs and any serious AE (SAE) that the investigator considers related to protocol therapy.

    3. Recommended Phase II Dose of Vorinostat Determined According to Dose-limiting Toxicities Graded Using Common Terminology Criteria for Adverse Events Version 4.0 (CTCAE v4.0) (Phase I) [21 days]

      Recommended phase II dose of vorinostat is defined as the dose level at which 0/6 or 1/6 subjects experience dose limiting toxicity (DLT) with the next higher dose having at least 2/3 or 2/6 subjects encountering DLT (Phase I). Toxicities will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Using a 3+3 design, the recommended phase II dose is defined as the level at which 0/6 or 1/6 patients experiences at dose-limiting toxicity in the first cycle.

    Secondary Outcome Measures

    1. Change in CD8 Cell Counts (Phase I) [Baseline up to 12 months]

      Differences from baseline (specified follow-up assessment minus baseline) in absolute CD8 counts.

    2. Changes in Absolute CD4 Cell Counts (Phase I) [Baseline up to 12 months]

      Differences from baseline (specified follow-up assessment minus baseline) in absolute CD4 counts.

    3. Changes in Epstein-Barr Virus (EBV) Viral Load [Baseline up to 12 months]

      Differences from baseline (specified follow-up assessment minus baseline) in EBV viral load.

    4. Changes in Human Herpes Virus (HHV)-8 Viral Load [Baseline up to 12 months]

      Differences from baseline (specified follow-up assessment minus baseline) in (HHV)-8 viral load.

    5. Changes in Human Immunodeficiency Virus (HIV) Viral Load [Baseline up to 12 months]

      Differences from baseline (specified follow-up assessment minus baseline) in HIV viral load. Undetectable viral load results were treated as 0 values.

    6. Event-free Survival (EFS) (Phase II) [1 year]

      The percentage of participants surviving without events (relapse or death) one year after starting treatment.

    7. Overall Survival (OS) (Phase II) [1 year]

      The percentage of participants surviving one year after starting treatment.

    8. Change in Plasma Associated Human Immunodeficiency Virus (HIV)-1 Ribonucleic Acid (RNA) (Phase I) [Baseline up to 12 months]

      Differences from baseline (specified follow-up assessment minus baseline) in HIV viral load. Undetectable viral load results were treated as 0 values.

    9. Pharmacokinetic Clearance (Phase I) [24-48, 48-72, and 72-96 hours after the start of the first chemotherapy infusion]

      Serial plasma samples for pharmacokinetic analysis were collected at 24-48, 48-72, and 72-96 hours after the start of the first chemotherapy infusion. Doxorubicin, etoposide, and vincristine concentrations were determined using a validated liquid chromatography-tandem mass spectrometry method. The clearance was determined by dividing the drug-infusion rate by the steady-state concentrations, which was the average of the three time points.

    10. Tumor Response (Phase I) [Up to 2 years post treatment]

      The percentage of participants whose best tumor response is complete response (CR) or partial response (PR). Based on clinical, radiologic (CT), and pathologic criteria, CR requires 1) complete disappearance of all detectable disease and disease-related symptoms if present before therapy, 2) bone marrow aspirate and biopsy to confirm a CR if initially positive or if clinically indicated by new abnormalities in the peripheral blood counts or blood smear, 3) negative PET results, depending on typically, variably, or unknown pre-treatment FDG status, and 4) spleen and/or liver, if considered to be enlarged before therapy on physical examination or CT scan, not being palpable on physical examination and considered normal size by imaging studies, and nodules related to lymphoma disappeared. PR includes 1) ≥50% decrease in sum of product of diameters (SPD), 2) no increase in size of nodes, liver, or spleen, 3) splenic/hepatic nodules regressed by ≥ 50% SPD, 4) no new sites of disease

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Participants with histologically or cytologically documented diffuse large B-cell lymphoma (DLBCL) must meet at least 1 of the following risk criteria:

    • Age-adjusted International Prognostic Index (IPI) score: 2-3

    • Ki-67 >= 80%

    • Histologically, or cytologically documented activated B-cell-like (ABC, also known as post-GCB) subtype

    • Double hit variant, defined as having v-myc avian myelocytomatosis viral oncogene homolog (MYC) gene rearrangement in the presence of B-cell chronic lymphocytic leukemia (CLL)/lymphoma (BCL) 2 or BCL6 gene rearrangement

    • Other aggressive non-DLBCL non-Burkitt non-Hodgkin B-cell lymphoma variants as defined by the 2008 World Health Organization (WHO) classification, including rare CD20 negative B-cell lymphomas (i.e. plasmablastic lymphoma, and primary effusion lymphoma) are also eligible; grade 3B follicular lymphoma is also eligible as long as one the above risk criteria is met

    • Participants who are untreated or who received a maximum of one (1) cycle of combination chemotherapy, including rituximab-containing regimens, prior are eligible; the start of previous chemotherapy cycle must occur at least 21 days prior to beginning treatment under this protocol, and such cycle will count towards the total maximum of 6 cycles under this study

    • Documentation of HIV infection at any time prior to study entry; documentation may be molecular (detectable viral ribonucleic acid [RNA] by polymerase chain reaction [PCR]), serologic (positive enzyme-linked immunosorbent assay [ELISA] and positive Western blot), or other federally approved licensed HIV test; prior documentation of HIV seropositivity is acceptable

    • All stages of disease

    • Measurable or non-measurable tumor parameter(s); non-measurable tumor parameters are defined as not having bidimensional measurements (e.g., gastric or marrow involvement), but can be followed for response by other diagnostic tests such as gallium, positron emission tomography (PET) imaging, and/or bone marrow biopsy

    • Performance status (PS) 0, 1, or 2 per the Eastern Cooperative Oncology Group (ECOG) performance status scale (Karnofsky performance score >= 50%)

    • Able to provide informed consent

    • Total bilirubin =< 1.5 institutional upper limit of normal (ULN), unless elevated secondary to lymphomatous involvement of liver or biliary system, or due to other HIV medications (e.g., indinavir, tenofovir, or atazanavir); for direct bilirubin > 1.2 due to hepatic involvement by tumor for the initial dose of EPOCH drug adjustment

    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 times ULN (unless elevated due to secondary lymphomatous involvement of the liver)

    • Negative for hepatitis B, or if infected with hepatitis B, receiving anti-hepatitis B therapy; all participants will be required to be screened for hepatitis B and C; per Infectious Disease Society of America (IDSA) and American Association for the Study of Liver Diseases (AASD) guidelines, those participants that show no immunity, defined by the lack of hepatitis B surface antibody, and show evidence of chronic infection (i.e. hepatitis B surface antigen positive [HBsAg+], hepatitis B core antibody positive [HBcore+], hepatitis surface antibody negative [HBsAB-]) will be required to be on anti-hepatitis B therapy, during the study, in order to be eligible; participants will be permitted to enroll in the study provided liver function tests meet criteria, and there is no evidence of cirrhosis; the exact hepatitis B therapy will be at the discretion of the infection disease specialist or investigator; however all participants who present with acute hepatitis B or show normal transaminases and are HBsAg+ and immunoglobulin (Ig)M+ for hepatitis core antigen will not be eligible for trial enrollment; participants who are hepatitis C antibody positive, with or without a positive hepatitis C RNA level, will be permitted to enroll in the study provided liver function tests meet criteria, and have no evidence of cirrhosis; participants diagnosed with hepatitis C less than 6 months from trial enrollment, will be considered to have acute hepatitis C and will be excluded from study unless hepatitis (hep) C viral load is undetectable

    • Creatinine clearance >= 60 mL/min, unless secondary to renal involvement by lymphoma; for creatinine clearance < 50 mL/min due to kidney involvement by tumor

    • Granulocytes/absolute neutrophil count (ANC) >= 1,000/mm^3

    • Platelets >= 75,000/mm^3 (unless these parameters are abnormal secondary to lymphomatous involvement of bone marrow); all participants must cease colony-stimulating factor therapy at least 24 hours prior to institution of cycle 1 chemotherapy

    • Left ventricular ejection fraction (LVEF) that is at or above the lower institutional limits of normal, as assessed by multiple gated acquisition (MUGA) scan or echocardiogram within the 6 weeks prior to registration

    • Concurrent radiation, with or without steroids, or steroids alone for emergency conditions secondary to lymphoma (i.e. cord compression, etc.) will be permitted

    • Female participants must have a negative pregnancy test within 7 days of entering into the study; both men and women of child bearing potential must agree to use adequate methods of contraception for the duration of the treatment; women must avoid pregnancy, and men must avoid fathering children while in the study and for 6 months following the last study drug treatment

    • Participants on an antiretroviral regimen should be receiving treatment that is in accordance with the current International acquired immune deficiency syndrome (AIDS) Society guidelines; the specific agents are at the discretion of the investigator and use of agents currently available on an expanded access basis is allowed but use of experimental antiretroviral agents or those containing zidovudine (including Combivir and Trizivir) are prohibited; changes to highly active anti-retroviral therapy (HAART) therapy may be made if medically necessary (toxicity, failure of regimen, etc.); antiretroviral naïve participants: participants who are not on HAART at study entry MUST begin therapy (utilizing the above guidelines) AFTER one cycle of chemotherapy has been completed under protocol; changes to HAART therapy may be made if medically necessary (toxicity, failure of regimen, etc.); concurrent therapy with zidovudine or a zidovudine-containing regimen (including Combivir and Trizivir) will be prohibited until 2 months following the participant's completion of chemotherapy as part of this protocol; the use of cobicistat (e.g., Tybost), or cobicistat containing single tablet regimens (e.g., Stribild) is prohibited during concurrent chemotherapy under this protocol; participants taking cobicistat or cobicistat-containing single table regimens must switch to a different agent or regimen prior to enrollment, and will remain on the regimen until at least 2 months following treatment discontinuation; Cobicistat is a pure and potent cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) inhibitor and has the potential to increase the area under the curve (AUC) of CYP3A4 substrates; therefore, both vincristine and doxorubicin would have the potential for drug drug interaction (DDI) with cobicistat since they are CYP3A4 substrates

    • Participants already receiving erythropoietin or colony-stimulating factor therapy are eligible for participation, although the latter must be discontinued at least 24 hours prior to receiving chemotherapy

    • Participants must be able to swallow oral medications

    Exclusion Criteria:
    • Participants who have received more than one (1) prior cycle of chemotherapy similar to cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (CHOP) or EPOCH with or without rituximab

    • Absolute CD4 count of < 50 cells/ mm^3

    • Presence of second active tumor, other than non-melanoma skin cancer, carcinoma in situ of the cervix, or Kaposi's sarcoma (KS) that requires systemic therapy

    • Central nervous system (CNS) involvement by lymphoma including parenchymal brain or spinal cord lymphoma or known presence of leptomeningeal disease prior to registration

    • Participants with viral hepatitis who do not meet the criteria will not be eligible; all participants who present with acute hepatitis B including those with normal transaminases who are HBsAg+ and IgM + for hepatitis core antigen will not be eligible; participants who are hepatitis B core antibody positive are eligible only if they start or are on prophylactic therapy; a hepatitis B viral load should be confirmed negative on all participants who are hepatitis B core antibody positive, but hepatitis B antigen negative; participants refusing to take any anti-hepatitis B therapy during study will also be excluded; participants diagnosed with hepatitis C are eligible if they meet criteria

    • Pregnant women or nursing mothers

    • ECOG performance score >= 3 (Karnofsky performance status [KPS] < 50%)

    • Expected survival < 2 months

    • Unable to comply with the requirements of the protocol, or unable to provide adequate informed consent in the opinion of the principal investigator

    • Serious, ongoing, non-malignant disease or infection, which in the opinion of the investigator and/or the sponsor would compromise other protocol objectives; participants with active opportunistic infections are ineligible

    • Major surgery, other than diagnostic surgery, occurring 4 weeks prior to study entry; splenectomy will not be considered an exclusionary major surgery

    • Rituximab therapy within the 12 months prior to study entry; participants treated with rituximab within 12 months prior to study registration are eligible only if it was given for indications other than the treatment of aggressive lymphoma

    • Prior cytotoxic chemotherapy or radiotherapy for this lymphoma

    • History of cutaneous or mucocutaneous reactions, or diseases in the past, due to any cause, severe enough to cause hospitalization or an inability to eat or drink for > 2 days; this exclusion relates to the long-term possibility of severe cutaneous or mucocutaneous reactions to rituximab that might occur at increased frequency in participants who have had severe skin disease or reactions in the past

    • Use of zidovudine or cobicistat as part of the HAART regimen (a drug substitution at the time of study entry is allowed)

    • Any acute, inter-current infection that may interfere with planned protocol treatment; participants with mycobacterium avium will not be excluded from study entry; chronic therapy with potentially myelosuppressive agents is allowed provided that entry hematologic criteria are met

    • Myocardial infarction (MI) within 6 months prior to study entry, New York Heart Association (NYHA) class II or greater heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, clinically significant pericardial disease, or electrocardiographic evidence of acute ischemic or active conduction system abnormalities

    • Participants should not have taken valproic acid or another histone deacetylase inhibitor for at least 2 weeks prior to study enrollment

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Jackson Hospital and Clinic Montgomery Alabama United States 36106
    2 UC San Diego Moores Cancer Center La Jolla California United States 92093
    3 UCLA Center for Clinical AIDS Research and Education Los Angeles California United States 90035
    4 UCLA / Jonsson Comprehensive Cancer Center Los Angeles California United States 90095
    5 San Diego VA Medical Center San Diego California United States 92161
    6 Zuckerberg San Francisco General Hospital San Francisco California United States 94110
    7 UCSF Medical Center-Parnassus San Francisco California United States 94143
    8 Jackson Memorial Hospital-Holtz Children's Hospital Miami Florida United States 33136
    9 University of Miami Miller School of Medicine-Sylvester Cancer Center Miami Florida United States 33136
    10 UM Sylvester Comprehensive Cancer Center at Kendall Miami Florida United States 33176
    11 Northwestern University Chicago Illinois United States 60611
    12 John H Stroger Jr Hospital of Cook County Chicago Illinois United States 60612
    13 Stroger Hospital of Cook County MBCCOP Chicago Illinois United States 60612
    14 Louisiana State University Health Science Center New Orleans Louisiana United States 70112
    15 University Medical Center New Orleans New Orleans Louisiana United States 70112
    16 Johns Hopkins University/Sidney Kimmel Cancer Center Baltimore Maryland United States 21287
    17 Boston Medical Center Boston Massachusetts United States 02118
    18 Beth Israel Deaconess Medical Center Boston Massachusetts United States 02215
    19 Siteman Cancer Center at Washington University Saint Louis Missouri United States 63110
    20 Washington University - Jewish Saint Louis Missouri United States 63110
    21 Washington University School of Medicine Saint Louis Missouri United States 63110
    22 Montefiore Medical Center-Einstein Campus Bronx New York United States 10461
    23 Montefiore Medical Center-Weiler Hospital Bronx New York United States 10461
    24 Montefiore Medical Center - Moses Campus Bronx New York United States 10467
    25 Memorial Sloan Kettering Cancer Center New York New York United States 10065
    26 UNC Lineberger Comprehensive Cancer Center Chapel Hill North Carolina United States 27599
    27 Ohio State University Comprehensive Cancer Center Columbus Ohio United States 43210
    28 Pennsylvania Hospital Philadelphia Pennsylvania United States 19107
    29 Miriam Hospital Providence Rhode Island United States 02906
    30 Thomas Street Clinic Houston Texas United States 77009
    31 Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center Houston Texas United States 77030
    32 Ben Taub General Hospital Houston Texas United States 77030
    33 Virginia Mason Medical Center Seattle Washington United States 98101
    34 Harborview Medical Center Seattle Washington United States 98104
    35 Seattle Cancer Care Alliance Seattle Washington United States 98109

    Sponsors and Collaborators

    • National Cancer Institute (NCI)

    Investigators

    • Principal Investigator: Juan C Ramos, AIDS Malignancy Consortium

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    National Cancer Institute (NCI)
    ClinicalTrials.gov Identifier:
    NCT01193842
    Other Study ID Numbers:
    • NCI-2011-02508
    • NCI-2011-02508
    • CDR0000683379
    • AMC #75
    • AMC-075
    • AMC-075
    • UM1CA121947
    First Posted:
    Sep 2, 2010
    Last Update Posted:
    Mar 15, 2022
    Last Verified:
    Feb 1, 2022

    Study Results

    Participant Flow

    Recruitment Details
    Pre-assignment Detail
    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1 Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Arm/Group Description Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual. Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A, but without Vorinostat
    Period Title: Phase I: VR-DA-EPOCH, Dose Level (DL) 1
    STARTED 3 0 0 0 0
    COMPLETED 3 0 0 0 0
    NOT COMPLETED 0 0 0 0 0
    Period Title: Phase I: VR-DA-EPOCH, Dose Level (DL) 1
    STARTED 0 7 0 0 0
    COMPLETED 0 6 0 0 0
    NOT COMPLETED 0 1 0 0 0
    Period Title: Phase I: VR-DA-EPOCH, Dose Level (DL) 1
    STARTED 4 0 0 0 0
    COMPLETED 3 0 0 0 0
    NOT COMPLETED 1 0 0 0 0
    Period Title: Phase I: VR-DA-EPOCH, Dose Level (DL) 1
    STARTED 0 0 2 0 0
    COMPLETED 0 0 1 0 0
    NOT COMPLETED 0 0 1 0 0
    Period Title: Phase I: VR-DA-EPOCH, Dose Level (DL) 1
    STARTED 0 0 0 45 46
    COMPLETED 0 0 0 33 36
    NOT COMPLETED 0 0 0 12 10

    Baseline Characteristics

    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1 Phase II, V+DA-EPOCH Phase II, DA-R-EPOCH Total
    Arm/Group Description Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual. Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A, but without Vorinostat Total of all reporting groups
    Overall Participants 6 6 1 45 45 103
    Age (years) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [years]
    45.7
    (12.4)
    50.4
    (10.1)
    59.5
    (0)
    49.2
    (10.1)
    45
    (9.2)
    47.2
    (9.8)
    Sex: Female, Male (Count of Participants)
    Female
    0
    0%
    1
    16.7%
    0
    0%
    6
    13.3%
    0
    0%
    7
    6.8%
    Male
    6
    100%
    5
    83.3%
    1
    100%
    39
    86.7%
    45
    100%
    96
    93.2%
    Ethnicity (NIH/OMB) (Count of Participants)
    Hispanic or Latino
    1
    16.7%
    1
    16.7%
    0
    0%
    14
    31.1%
    13
    28.9%
    29
    28.2%
    Not Hispanic or Latino
    5
    83.3%
    5
    83.3%
    1
    100%
    29
    64.4%
    30
    66.7%
    70
    68%
    Unknown or Not Reported
    0
    0%
    0
    0%
    0
    0%
    2
    4.4%
    2
    4.4%
    4
    3.9%
    Race (NIH/OMB) (Count of Participants)
    American Indian or Alaska Native
    0
    0%
    0
    0%
    0
    0%
    0
    0%
    1
    2.2%
    1
    1%
    Asian
    0
    0%
    0
    0%
    0
    0%
    2
    4.4%
    1
    2.2%
    3
    2.9%
    Native Hawaiian or Other Pacific Islander
    0
    0%
    0
    0%
    0
    0%
    0
    0%
    0
    0%
    0
    0%
    Black or African American
    2
    33.3%
    0
    0%
    0
    0%
    12
    26.7%
    8
    17.8%
    22
    21.4%
    White
    4
    66.7%
    6
    100%
    1
    100%
    23
    51.1%
    31
    68.9%
    65
    63.1%
    More than one race
    0
    0%
    0
    0%
    0
    0%
    0
    0%
    0
    0%
    0
    0%
    Unknown or Not Reported
    0
    0%
    0
    0%
    0
    0%
    8
    17.8%
    4
    8.9%
    12
    11.7%
    Region of Enrollment (Count of Participants)
    United States
    6
    100%
    6
    100%
    1
    100%
    45
    100%
    45
    100%
    103
    100%

    Outcome Measures

    1. Primary Outcome
    Title Percentage of Participants With Complete Response (CR) as Assessed by Response Evaluation Criteria in Solid Tumors (Phase II)
    Description Percentage of participants with complete response as assessed by Response Evaluation Criteria in Solid Tumors (Phase II) according to treatment arm. Participants are planned to be treated for a total of 6 cycles (21 day cycle length). Participants with CR after Cycle 4 will receive two additional cycles of chemotherapy and complete 6 cycles of chemotherapy. Participants who achieve a partial response (PR) only after Cycle 4 may continue on protocol therapy or they may be removed from the study at the AMC discretion of the physician (local Principal Investigator). Participants with stable disease after 4 cycles (i.e., who did not achieve at least a PR) or progressive disease at any time will be removed from study.
    Time Frame Up to 6 months

    Outcome Measure Data

    Analysis Population Description
    Reviewed responses from participants who completed at least one cycle of treatment.
    Arm/Group Title Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Arm/Group Description Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A, but without Vorinostat
    Measure Participants 40 42
    Number (95% Confidence Interval) [percentage of participants]
    67.5
    1125%
    76.2
    1270%
    2. Primary Outcome
    Title Percentage of Participant Experiencing Adverse Events (AEs) for Each Treatment Arm as Assessed by Common Terminology Criteria for Adverse Events Version 4.0 (CTCAE v4.0) (Phase II)
    Description The percentage of participants with AEs and their worst severity will be tabulated for each treatment arm. If a participant has more than one AE, the most severe AE is analyzed. All adverse events will be assessed by the investigator from the first dose of protocol therapy through the post-treatment discontinuation visit. Participants are planned to be treated for a total of 6 cycles (21 day cycle length), or roughly 4 months. After this evaluation, assessment and reporting of AEs will only be required for all grade 5 AEs and any serious AE (SAE) that the investigator considers related to protocol therapy.
    Time Frame Up to 5 years

    Outcome Measure Data

    Analysis Population Description
    Eligible randomized participants
    Arm/Group Title Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Arm/Group Description Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A, but without Vorinostat
    Measure Participants 45 45
    Death
    28.9
    481.7%
    20.0
    333.3%
    Life-threatening
    37.8
    630%
    28.9
    481.7%
    Severe
    20.0
    333.3%
    31.1
    518.3%
    Moderate
    8.9
    148.3%
    17.8
    296.7%
    Mild
    2.2
    36.7%
    0
    0%
    3. Primary Outcome
    Title Recommended Phase II Dose of Vorinostat Determined According to Dose-limiting Toxicities Graded Using Common Terminology Criteria for Adverse Events Version 4.0 (CTCAE v4.0) (Phase I)
    Description Recommended phase II dose of vorinostat is defined as the dose level at which 0/6 or 1/6 subjects experience dose limiting toxicity (DLT) with the next higher dose having at least 2/3 or 2/6 subjects encountering DLT (Phase I). Toxicities will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Using a 3+3 design, the recommended phase II dose is defined as the level at which 0/6 or 1/6 patients experiences at dose-limiting toxicity in the first cycle.
    Time Frame 21 days

    Outcome Measure Data

    Analysis Population Description
    Eligible Phase I Arm A (VR-DA-EPOCH) participants who completed at least 1 cycle of treatment. This arm includes participants treated at 300 mg once a day (n=6) or 400 mg once a day (n=6) of Vorinostat for days 1-5.
    Arm/Group Title Phase I: VR-DA-EPOCH
    Arm/Group Description Phase I, Arm A (VR-DA-EPOCH)
    Measure Participants 12
    Number [Mg per day of Vorinostat]
    300
    4. Secondary Outcome
    Title Change in CD8 Cell Counts (Phase I)
    Description Differences from baseline (specified follow-up assessment minus baseline) in absolute CD8 counts.
    Time Frame Baseline up to 12 months

    Outcome Measure Data

    Analysis Population Description
    Eligible participants who returned for follow-up with evaluable data.
    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1
    Arm/Group Description Phase I, Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Phase I, Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual.
    Measure Participants 4 5 1
    End of cycle 2
    35.5
    -115
    -172
    Treatment discontinuation
    -164.5
    211
    -81
    6-month follow-up
    -56
    275
    -16
    12-month follow-up
    604
    154
    128
    5. Secondary Outcome
    Title Changes in Absolute CD4 Cell Counts (Phase I)
    Description Differences from baseline (specified follow-up assessment minus baseline) in absolute CD4 counts.
    Time Frame Baseline up to 12 months

    Outcome Measure Data

    Analysis Population Description
    Eligible participants who completed at least 1 cycle of treatment with evaluable data.
    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1
    Arm/Group Description Phase I, Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Phase I, Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Phase I, Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual.
    Measure Participants 6 6 1
    End of cycle 2
    92
    -9
    -218
    Treatment discontinuation
    -39
    -29
    -190
    6-month follow-up
    76
    31
    -175
    12-month follow-up
    169
    31
    -84
    6. Secondary Outcome
    Title Changes in Epstein-Barr Virus (EBV) Viral Load
    Description Differences from baseline (specified follow-up assessment minus baseline) in EBV viral load.
    Time Frame Baseline up to 12 months

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title
    Arm/Group Description
    7. Secondary Outcome
    Title Changes in Human Herpes Virus (HHV)-8 Viral Load
    Description Differences from baseline (specified follow-up assessment minus baseline) in (HHV)-8 viral load.
    Time Frame Baseline up to 12 months

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title
    Arm/Group Description
    8. Secondary Outcome
    Title Changes in Human Immunodeficiency Virus (HIV) Viral Load
    Description Differences from baseline (specified follow-up assessment minus baseline) in HIV viral load. Undetectable viral load results were treated as 0 values.
    Time Frame Baseline up to 12 months

    Outcome Measure Data

    Analysis Population Description
    Phase II participants who returned for follow-up with evaluable data.
    Arm/Group Title Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Arm/Group Description Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A, but without Vorinostat
    Measure Participants 42 41
    End of Cycle 2
    -20
    -25
    At treatment discontinuation
    -87
    -22.5
    6-month follow-up
    -20
    -18
    12-month follow-up
    0
    -20
    9. Secondary Outcome
    Title Event-free Survival (EFS) (Phase II)
    Description The percentage of participants surviving without events (relapse or death) one year after starting treatment.
    Time Frame 1 year

    Outcome Measure Data

    Analysis Population Description
    Eligible randomized participants.
    Arm/Group Title Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Arm/Group Description Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A, but without Vorinostat
    Measure Participants 45 45
    Number (95% Confidence Interval) [percentage of participants]
    75.6
    1260%
    82.2
    1370%
    10. Secondary Outcome
    Title Overall Survival (OS) (Phase II)
    Description The percentage of participants surviving one year after starting treatment.
    Time Frame 1 year

    Outcome Measure Data

    Analysis Population Description
    Eligible randomized participants.
    Arm/Group Title Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Arm/Group Description Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A, but without Vorinostat
    Measure Participants 45 45
    Number (95% Confidence Interval) [percentage of participants]
    77.6
    1293.3%
    86.7
    1445%
    11. Secondary Outcome
    Title Change in Plasma Associated Human Immunodeficiency Virus (HIV)-1 Ribonucleic Acid (RNA) (Phase I)
    Description Differences from baseline (specified follow-up assessment minus baseline) in HIV viral load. Undetectable viral load results were treated as 0 values.
    Time Frame Baseline up to 12 months

    Outcome Measure Data

    Analysis Population Description
    Eligible participants who returned for follow-up with evaluable data.
    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1
    Arm/Group Description Phase I, Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Phase I, Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Phase I, Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual.
    Measure Participants 6 6 1
    End of cycle 2
    -14518
    -12.5
    28
    Treatment discontinuation
    -4517
    0
    0
    6-month follow-up
    -55116
    0
    0
    12-month follow-up
    0
    0
    0
    12. Secondary Outcome
    Title Pharmacokinetic Clearance (Phase I)
    Description Serial plasma samples for pharmacokinetic analysis were collected at 24-48, 48-72, and 72-96 hours after the start of the first chemotherapy infusion. Doxorubicin, etoposide, and vincristine concentrations were determined using a validated liquid chromatography-tandem mass spectrometry method. The clearance was determined by dividing the drug-infusion rate by the steady-state concentrations, which was the average of the three time points.
    Time Frame 24-48, 48-72, and 72-96 hours after the start of the first chemotherapy infusion

    Outcome Measure Data

    Analysis Population Description
    Phase I participants with evaluable pharmacokinetic data
    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1
    Arm/Group Description Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual.
    Measure Participants 6 5 0
    Doxorubicin
    78.6
    (48.0)
    76.0
    (47.9)
    Etoposide
    3.0
    (1.6)
    2.4
    (0.7)
    Vincristine
    22.4
    (10.2)
    16.8
    (8.9)
    13. Secondary Outcome
    Title Tumor Response (Phase I)
    Description The percentage of participants whose best tumor response is complete response (CR) or partial response (PR). Based on clinical, radiologic (CT), and pathologic criteria, CR requires 1) complete disappearance of all detectable disease and disease-related symptoms if present before therapy, 2) bone marrow aspirate and biopsy to confirm a CR if initially positive or if clinically indicated by new abnormalities in the peripheral blood counts or blood smear, 3) negative PET results, depending on typically, variably, or unknown pre-treatment FDG status, and 4) spleen and/or liver, if considered to be enlarged before therapy on physical examination or CT scan, not being palpable on physical examination and considered normal size by imaging studies, and nodules related to lymphoma disappeared. PR includes 1) ≥50% decrease in sum of product of diameters (SPD), 2) no increase in size of nodes, liver, or spleen, 3) splenic/hepatic nodules regressed by ≥ 50% SPD, 4) no new sites of disease
    Time Frame Up to 2 years post treatment

    Outcome Measure Data

    Analysis Population Description
    Eligible participants who completed at least 1 cycle of treatment.
    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: Arm C (VR-CHOP) Dose Level 1
    Arm/Group Description Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual.
    Measure Participants 6 6 1
    Complete response
    83.3
    1388.3%
    83.3
    1388.3%
    100
    10000%
    Partial Response
    16.7
    278.3%
    16.7
    278.3%
    0
    0%

    Adverse Events

    Time Frame Up to 5 years. Participants are planned to be treated for a total of 6 cycles (21 day cycle length), or roughly 4 months. All adverse events will be assessed by the investigator from the first dose of protocol therapy through the post-treatment discontinuation visit. After this evaluation, assessment and reporting of AEs will only be required for all grade 5 AEs and any SAE that the investigator considers related to protocol therapy.
    Adverse Event Reporting Description
    Arm/Group Title Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1 Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Arm/Group Description Arm A (VR-DA-EPOCH) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1) Arm A (VR-DA-EPOCH) with Vorinostat at 400 mg once a day on days 1-5 of a cycle (Phase I Dose Level 2) Arm C (VR-CHOP) with Vorinostat at 300 mg once a day on days 1-5 of a cycle (Phase I Dose Level 1 for low risk participants). This arm was discontinued due to low accrual. Arm A (VR-DA-EPOCH) at the recommended phase II dose of Vorinostat (300 mg once a day for days 1-5 of a cycle) Arm B (DA-R-EPOCH), which is the same treatment as Arm A but without Vorinostat
    All Cause Mortality
    Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1 Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 2/7 (28.6%) 1/7 (14.3%) 0/2 (0%) 13/45 (28.9%) 9/46 (19.6%)
    Serious Adverse Events
    Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1 Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 5/7 (71.4%) 3/7 (42.9%) 0/2 (0%) 25/45 (55.6%) 21/46 (45.7%)
    Blood and lymphatic system disorders
    Febrile Neutropenia 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 10/45 (22.2%) 8/46 (17.4%)
    Anemia 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 2/46 (4.3%)
    Cardiac disorders
    Atrial Fibrillation 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Cardiac Arrest 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 3/45 (6.7%) 2/46 (4.3%)
    Cardiac Disorders - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Pericardial Effusion 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Gastrointestinal disorders
    Abdominal Pain 2/7 (28.6%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 1/46 (2.2%)
    Colitis 2/7 (28.6%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Diarrhea 2/7 (28.6%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Esophageal Ulcer 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Esophagitis 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Gastric Hemorrhage 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Intra-Abdominal Hemorrhage 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Mucositis Oral 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Nausea 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 1/46 (2.2%)
    Rectal Pain 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Small Intestinal Obstruction 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Vomiting 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 3/46 (6.5%)
    General disorders
    Death Nos 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Fatigue 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Multi-Organ Failure 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Non-Cardiac Chest Pain 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Infections and infestations
    Enterocolitis Infectious 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Infections And Infestations - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Kidney Infection 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Lung Infection 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 2/46 (4.3%)
    Sepsis 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 3/45 (6.7%) 3/46 (6.5%)
    Soft Tissue Infection 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Tooth Infection 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Urinary Tract Infection 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Injury, poisoning and procedural complications
    Spinal Fracture 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Investigations
    Alanine Aminotransferase Increased 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Lymphocyte Count Decreased 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 0/46 (0%)
    Neutrophil Count Decreased 5/7 (71.4%) 2/7 (28.6%) 0/2 (0%) 12/45 (26.7%) 2/46 (4.3%)
    Platelet Count Decreased 0/7 (0%) 3/7 (42.9%) 0/2 (0%) 11/45 (24.4%) 0/46 (0%)
    White Blood Cell Decreased 5/7 (71.4%) 0/7 (0%) 0/2 (0%) 5/45 (11.1%) 1/46 (2.2%)
    Metabolism and nutrition disorders
    Dehydration 1/7 (14.3%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Hyperglycemia 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms Benign, Malignant And Unspecified (Incl Cysts And Polyps) - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 7/45 (15.6%) 4/46 (8.7%)
    Nervous system disorders
    Encephalopathy 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 0/46 (0%)
    Headache 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Nervous System Disorders - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Psychiatric disorders
    Delirium 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Renal and urinary disorders
    Acute Kidney Injury 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Renal And Urinary Disorders - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Renal Colic 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Respiratory, thoracic and mediastinal disorders
    Dyspnea 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 0/46 (0%)
    Pneumonitis 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Respiratory Failure 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Surgical and medical procedures
    Surgical And Medical Procedures - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Vascular disorders
    Thromboembolic Event 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Other (Not Including Serious) Adverse Events
    Phase I: VR-DA-EPOCH, Dose Level 1 Phase I: VR-DA-EPOCH, Dose Level 2 Phase I: VR-CHOP, Dose Level 1 Phase II: VR-DA-EPOCH Phase II: DA-R-EPOCH
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 7/7 (100%) 6/7 (85.7%) 2/2 (100%) 43/45 (95.6%) 43/46 (93.5%)
    Blood and lymphatic system disorders
    Anemia 2/7 (28.6%) 4/7 (57.1%) 1/2 (50%) 27/45 (60%) 23/46 (50%)
    Febrile Neutropenia 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 3/45 (6.7%) 0/46 (0%)
    Leukocytosis 0/7 (0%) 0/7 (0%) 0/2 (0%) 3/45 (6.7%) 1/46 (2.2%)
    Cardiac disorders
    Pericarditis 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Sinus Tachycardia 0/7 (0%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 2/46 (4.3%)
    Eye disorders
    Watering Eyes 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Gastrointestinal disorders
    Abdominal Pain 1/7 (14.3%) 1/7 (14.3%) 0/2 (0%) 8/45 (17.8%) 4/46 (8.7%)
    Anal Mucositis 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Colitis 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 3/46 (6.5%)
    Constipation 3/7 (42.9%) 2/7 (28.6%) 0/2 (0%) 20/45 (44.4%) 18/46 (39.1%)
    Diarrhea 3/7 (42.9%) 1/7 (14.3%) 0/2 (0%) 17/45 (37.8%) 10/46 (21.7%)
    Dyspepsia 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 2/46 (4.3%)
    Esophagitis 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Gastroesophageal Reflux Disease 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 3/46 (6.5%)
    Gastrointestinal Disorders - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 3/46 (6.5%)
    Mucositis Oral 2/7 (28.6%) 2/7 (28.6%) 0/2 (0%) 9/45 (20%) 9/46 (19.6%)
    Nausea 6/7 (85.7%) 3/7 (42.9%) 1/2 (50%) 20/45 (44.4%) 22/46 (47.8%)
    Vomiting 2/7 (28.6%) 1/7 (14.3%) 1/2 (50%) 10/45 (22.2%) 9/46 (19.6%)
    General disorders
    Chills 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 5/45 (11.1%) 0/46 (0%)
    Edema Limbs 0/7 (0%) 0/7 (0%) 0/2 (0%) 10/45 (22.2%) 4/46 (8.7%)
    Fatigue 2/7 (28.6%) 2/7 (28.6%) 2/2 (100%) 18/45 (40%) 13/46 (28.3%)
    Fever 0/7 (0%) 2/7 (28.6%) 0/2 (0%) 8/45 (17.8%) 2/46 (4.3%)
    Flu Like Symptoms 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    General Disorders And Administration Site Conditions - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 3/46 (6.5%)
    Infusion Related Reaction 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 2/46 (4.3%)
    Non-Cardiac Chest Pain 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 1/46 (2.2%)
    Pain 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 3/46 (6.5%)
    Infections and infestations
    Abdominal Infection 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Esophageal Infection 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Infections And Infestations - Other, Specify 0/7 (0%) 0/7 (0%) 0/2 (0%) 5/45 (11.1%) 0/46 (0%)
    Mucosal Infection 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 1/45 (2.2%) 4/46 (8.7%)
    Nail Infection 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 1/46 (2.2%)
    Rhinitis Infective 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Upper Respiratory Infection 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 2/45 (4.4%) 2/46 (4.3%)
    Injury, poisoning and procedural complications
    Seroma 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Investigations
    Alanine Aminotransferase Increased 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 18/45 (40%) 9/46 (19.6%)
    Alkaline Phosphatase Increased 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 11/45 (24.4%) 9/46 (19.6%)
    Aspartate Aminotransferase Increased 1/7 (14.3%) 1/7 (14.3%) 0/2 (0%) 15/45 (33.3%) 10/46 (21.7%)
    Blood Bilirubin Increased 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 2/46 (4.3%)
    Creatinine Increased 0/7 (0%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 4/46 (8.7%)
    Ggt Increased 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 3/46 (6.5%)
    Lymphocyte Count Decreased 1/7 (14.3%) 3/7 (42.9%) 1/2 (50%) 20/45 (44.4%) 19/46 (41.3%)
    Lymphocyte Count Increased 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 2/46 (4.3%)
    Neutrophil Count Decreased 4/7 (57.1%) 2/7 (28.6%) 0/2 (0%) 24/45 (53.3%) 19/46 (41.3%)
    Platelet Count Decreased 4/7 (57.1%) 3/7 (42.9%) 1/2 (50%) 27/45 (60%) 19/46 (41.3%)
    Weight Loss 1/7 (14.3%) 1/7 (14.3%) 0/2 (0%) 3/45 (6.7%) 0/46 (0%)
    White Blood Cell Decreased 3/7 (42.9%) 2/7 (28.6%) 0/2 (0%) 25/45 (55.6%) 21/46 (45.7%)
    Metabolism and nutrition disorders
    Anorexia 0/7 (0%) 0/7 (0%) 0/2 (0%) 3/45 (6.7%) 4/46 (8.7%)
    Hyperglycemia 0/7 (0%) 2/7 (28.6%) 0/2 (0%) 23/45 (51.1%) 16/46 (34.8%)
    Hyperkalemia 0/7 (0%) 0/7 (0%) 0/2 (0%) 3/45 (6.7%) 4/46 (8.7%)
    Hypernatremia 0/7 (0%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 2/46 (4.3%)
    Hypertriglyceridemia 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 2/46 (4.3%)
    Hyperuricemia 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 4/46 (8.7%)
    Hypoalbuminemia 0/7 (0%) 0/7 (0%) 0/2 (0%) 14/45 (31.1%) 15/46 (32.6%)
    Hypocalcemia 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 11/45 (24.4%) 16/46 (34.8%)
    Hypoglycemia 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 5/46 (10.9%)
    Hypokalemia 2/7 (28.6%) 1/7 (14.3%) 0/2 (0%) 23/45 (51.1%) 15/46 (32.6%)
    Hypomagnesemia 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 6/45 (13.3%) 7/46 (15.2%)
    Hyponatremia 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 14/45 (31.1%) 10/46 (21.7%)
    Hypophosphatemia 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 7/45 (15.6%) 8/46 (17.4%)
    Musculoskeletal and connective tissue disorders
    Back Pain 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 4/45 (8.9%) 0/46 (0%)
    Bone Pain 1/7 (14.3%) 0/7 (0%) 1/2 (50%) 2/45 (4.4%) 4/46 (8.7%)
    Chest Wall Pain 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 4/46 (8.7%)
    Muscle Weakness Lower Limb 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 0/46 (0%)
    Myalgia 2/7 (28.6%) 0/7 (0%) 0/2 (0%) 3/45 (6.7%) 1/46 (2.2%)
    Neck Pain 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 3/46 (6.5%)
    Nervous system disorders
    Cognitive Disturbance 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Dizziness 0/7 (0%) 0/7 (0%) 0/2 (0%) 6/45 (13.3%) 5/46 (10.9%)
    Dysesthesia 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Headache 2/7 (28.6%) 0/7 (0%) 0/2 (0%) 9/45 (20%) 17/46 (37%)
    Paresthesia 0/7 (0%) 0/7 (0%) 1/2 (50%) 3/45 (6.7%) 3/46 (6.5%)
    Peripheral Motor Neuropathy 0/7 (0%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 2/46 (4.3%)
    Peripheral Sensory Neuropathy 2/7 (28.6%) 1/7 (14.3%) 0/2 (0%) 12/45 (26.7%) 20/46 (43.5%)
    Dysgeusia 0/7 (0%) 0/7 (0%) 0/2 (0%) 5/45 (11.1%) 1/46 (2.2%)
    Psychiatric disorders
    Anxiety 0/7 (0%) 0/7 (0%) 0/2 (0%) 5/45 (11.1%) 3/46 (6.5%)
    Depression 0/7 (0%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 2/46 (4.3%)
    Insomnia 1/7 (14.3%) 1/7 (14.3%) 0/2 (0%) 5/45 (11.1%) 7/46 (15.2%)
    Renal and urinary disorders
    Urinary Frequency 0/7 (0%) 0/7 (0%) 0/2 (0%) 2/45 (4.4%) 4/46 (8.7%)
    Urinary Tract Pain 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 3/46 (6.5%)
    Reproductive system and breast disorders
    Oligospermia 0/7 (0%) 0/7 (0%) 1/2 (50%) 0/45 (0%) 0/46 (0%)
    Respiratory, thoracic and mediastinal disorders
    Allergic Rhinitis 0/7 (0%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 4/46 (8.7%)
    Cough 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 10/46 (21.7%)
    Dyspnea 1/7 (14.3%) 0/7 (0%) 1/2 (50%) 4/45 (8.9%) 3/46 (6.5%)
    Hiccups 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 1/45 (2.2%) 2/46 (4.3%)
    Hoarseness 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 3/46 (6.5%)
    Hyperhidrosis 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Skin and subcutaneous tissue disorders
    Alopecia 1/7 (14.3%) 0/7 (0%) 1/2 (50%) 4/45 (8.9%) 6/46 (13%)
    Bullous Dermatitis 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Dry Skin 0/7 (0%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 1/46 (2.2%)
    Nail Discoloration 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 1/46 (2.2%)
    Pruritus 0/7 (0%) 1/7 (14.3%) 0/2 (0%) 0/45 (0%) 2/46 (4.3%)
    Rash Maculo-Papular 0/7 (0%) 2/7 (28.6%) 0/2 (0%) 2/45 (4.4%) 2/46 (4.3%)
    Vascular disorders
    Flushing 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)
    Hypertension 0/7 (0%) 0/7 (0%) 0/2 (0%) 4/45 (8.9%) 3/46 (6.5%)
    Hypotension 0/7 (0%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 4/46 (8.7%)
    Lymphedema 1/7 (14.3%) 0/7 (0%) 0/2 (0%) 0/45 (0%) 0/46 (0%)

    Limitations/Caveats

    Experimental Arm C (VR-CHOP) was discontinued early in phase I due to low accrual; only 2 participants received VR-CHOP.

    More Information

    Certain Agreements

    Principal Investigators are NOT employed by the organization sponsoring the study.

    The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is less than or equal to 60 days. The sponsor cannot require changes to the communication and cannot extend the embargo.

    Results Point of Contact

    Name/Title AMC Statistical Center
    Organization AIDS Malignancy Consortium
    Phone 501-526-6712
    Email jylee@uams.edu
    Responsible Party:
    National Cancer Institute (NCI)
    ClinicalTrials.gov Identifier:
    NCT01193842
    Other Study ID Numbers:
    • NCI-2011-02508
    • NCI-2011-02508
    • CDR0000683379
    • AMC #75
    • AMC-075
    • AMC-075
    • UM1CA121947
    First Posted:
    Sep 2, 2010
    Last Update Posted:
    Mar 15, 2022
    Last Verified:
    Feb 1, 2022