Panobinostat With Rituximab for Relapsed/Refractory Diffuse Large B Cell Lymphoma

Sponsor
Massachusetts General Hospital (Other)
Overall Status
Terminated
CT.gov ID
NCT01282476
Collaborator
Dana-Farber Cancer Institute (Other), Beth Israel Deaconess Medical Center (Other)
18
3
1
38
6
0.2

Study Details

Study Description

Brief Summary

Panobinostat is a drug that may slow down the growth of cancer cells or kill cancer cells by blocking certain enzymes. Panobinostat has shown effects against cancer in laboratory studies. However, it is not known if it will show the same activity in humans. Panobinostat has been given to participants with various types of cancers, including DLBCL, in previous research studies. In this study panobinostat will be given with the the antibody rituximab, which is FDA approved to be given with chemotherapy in DLBCL.

Condition or Disease Intervention/Treatment Phase
  • Drug: Panobinostat with Rituximab
Phase 2

Detailed Description

Study treatment will be given in 4 week periods called cycles. Panobinostat will be taken orally on Monday, Wednesday, and Friday of each week. Rituximab will be given as an intravenous infusion weekly during Cycle 1 and then once per month on day 1 of subsequent cycles. Subjects can receive up to 6 cycles of treatment. Blood draws and 2 EKGs (electrocardiograms) will be done weekly in Cycle 1 and then once in each cycle. PET/CT (Positron Emission Tomography/Computed Tomography) scans will be done every 2 months.

If disease has not progressed after 6 cycles on combination of panobinostat and rituximab, subjects may continue on panobinostat alone for up to 6 additional months.

Study Design

Study Type:
Interventional
Actual Enrollment :
18 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
Panobinostat in Combination With Rituximab For Relapsed/Refractory Diffuse Large B Cell Lymphoma
Actual Study Start Date :
Jun 1, 2011
Actual Primary Completion Date :
Aug 1, 2013
Actual Study Completion Date :
Aug 1, 2014

Arms and Interventions

Arm Intervention/Treatment
Experimental: Panobinostat/Rituximab

single-arm, open-label; Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.

Drug: Panobinostat with Rituximab
Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.
Other Names:
  • LBH589
  • LBH-569
  • Rituxan
  • Outcome Measures

    Primary Outcome Measures

    1. Overall Response Rate [1 year]

      Overall response rate is defined by the Revised International Workshop Response Criteria (2007) (see reference in protocol section). Overall response (OR) = Complete response (CR) + Partial response (PR)

    Secondary Outcome Measures

    1. Progression-free Survival Rate [6 months]

      Progression is defined by the Revised International Workshop Response Criteria (2007) (see reference in protocol section).

    2. Toxicities [1 year]

      Evaluate safety of this combination in relapsed/refractory DLBCL patients Grade 1 = mild, Grade 2 = moderate, Grade 3 = severe, Grade 4 = life-threatening

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Relapsed or refractory DLBCL

    • More than 1 line of prior chemotherapy

    Exclusion Criteria:
    • Currently receiving anticancer therapy or investigational agents

    • Major surgery within last 4 weeks

    • Known leptomeningeal or brain metastases

    • Known HIV infection

    • Uncontrolled fungal, bacterial, viral or other infection

    • History of another malignancy (except for non-melanoma skin cancer or in situ cervical or breast cancer) unless disease free for at least 3 years

    • Hepatitis B or C positive

    • GI disease

    • Pregnant or breastfeeding

    • Prior treatment with an HDAC inhibitor including valproic acid

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Massachusetts General Hospital Boston Massachusetts United States 02214
    2 Beth Israel Deaconess Medical Center Boston Massachusetts United States 02215
    3 Dana-Farber Cancer Institute Boston Massachusetts United States 02215

    Sponsors and Collaborators

    • Massachusetts General Hospital
    • Dana-Farber Cancer Institute
    • Beth Israel Deaconess Medical Center

    Investigators

    • Principal Investigator: Jeremy S Abramson, MD, Massachusetts General Hospital

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    Responsible Party:
    Jeremy Abramson, MD, Director, Lymphoma Program, Massachusetts General Hospital
    ClinicalTrials.gov Identifier:
    NCT01282476
    Other Study ID Numbers:
    • 10-441
    First Posted:
    Jan 25, 2011
    Last Update Posted:
    May 9, 2017
    Last Verified:
    Apr 1, 2017

    Study Results

    Participant Flow

    Recruitment Details
    Pre-assignment Detail
    Arm/Group Title Panobinostat/Rituximab
    Arm/Group Description Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.
    Period Title: Overall Study
    STARTED 18
    COMPLETED 7
    NOT COMPLETED 11

    Baseline Characteristics

    Arm/Group Title Panobinostat/Rituximab
    Arm/Group Description Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.
    Overall Participants 18
    Age (years) [Median (Full Range) ]
    Median (Full Range) [years]
    68
    Sex: Female, Male (Count of Participants)
    Female
    7
    38.9%
    Male
    11
    61.1%
    Ethnicity (NIH/OMB) (Count of Participants)
    Hispanic or Latino
    1
    5.6%
    Not Hispanic or Latino
    17
    94.4%
    Unknown or Not Reported
    0
    0%
    Race/Ethnicity, Customized (Count of Participants)
    White
    17
    94.4%
    Other
    1
    5.6%
    Region of Enrollment (participants) [Number]
    United States
    18
    100%
    Histology (Count of Participants)
    Centroblastic DLBCL(Diffuse large B cell lymphoma)
    1
    5.6%
    DLBCL follicular cell derivation w/high grade BCL
    1
    5.6%
    DLBCL not otherwise specified
    14
    77.8%
    DLBCL of follicular center derivation
    1
    5.6%
    Gray zone lymphoma
    1
    5.6%
    EKG (electrocardiogram) (Count of Participants)
    Abnormal
    3
    16.7%
    Normal
    15
    83.3%
    elevated LDH (Lactate dehydrogenase) (Count of Participants)
    Yes
    9
    50%
    No
    3
    16.7%
    Missing
    6
    33.3%
    ECOG PS (Eastern Cooperative Oncology Group Performance Status) (Count of Participants)
    00-Fully Active
    7
    38.9%
    01-Restricted
    8
    44.4%
    02-Ambulatory and Capable of Self Care
    3
    16.7%
    Disease status (Count of Participants)
    Refractory
    10
    55.6%
    Relapsed
    8
    44.4%
    Number of extranodal sites (Count of Participants)
    0
    1
    5.6%
    1
    3
    16.7%
    2
    3
    16.7%
    3
    9
    50%
    6
    2
    11.1%
    Number of target lesions (Count of Participants)
    0-2
    4
    22.2%
    3-5
    6
    33.3%
    6+
    8
    44.4%
    Number of non-target lesions (Count of Participants)
    0-2
    12
    66.7%
    3-5
    4
    22.2%
    6+
    2
    11.1%
    Time from last prior therapy (days) [Median (Full Range) ]
    Median (Full Range) [days]
    117
    Number of prior therapies (Count of Participants)
    1-4
    7
    38.9%
    5-8
    9
    50%
    9+
    2
    11.1%
    Number of prior non-surgical therapies (Count of Participants)
    0-2
    6
    33.3%
    3-5
    7
    38.9%
    6-8
    5
    27.8%
    Number of prior surgeries (Count of Participants)
    0
    12
    66.7%
    1
    2
    11.1%
    2
    2
    11.1%
    3
    1
    5.6%
    4
    1
    5.6%
    Number of prior radiation treatments (Count of Participants)
    0
    12
    66.7%
    1
    3
    16.7%
    2
    2
    11.1%
    3
    1
    5.6%

    Outcome Measures

    1. Primary Outcome
    Title Overall Response Rate
    Description Overall response rate is defined by the Revised International Workshop Response Criteria (2007) (see reference in protocol section). Overall response (OR) = Complete response (CR) + Partial response (PR)
    Time Frame 1 year

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Panobinostat/Rituximab
    Arm/Group Description Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.
    Measure Participants 18
    Number (90% Confidence Interval) [percentage of participants]
    11
    61.1%
    2. Secondary Outcome
    Title Progression-free Survival Rate
    Description Progression is defined by the Revised International Workshop Response Criteria (2007) (see reference in protocol section).
    Time Frame 6 months

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Panobinostat/Rituximab
    Arm/Group Description Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.
    Measure Participants 18
    Number (90% Confidence Interval) [percentage of participants]
    6
    33.3%
    3. Secondary Outcome
    Title Toxicities
    Description Evaluate safety of this combination in relapsed/refractory DLBCL patients Grade 1 = mild, Grade 2 = moderate, Grade 3 = severe, Grade 4 = life-threatening
    Time Frame 1 year

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Panobinostat/Rituximab
    Arm/Group Description Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.
    Measure Participants 18
    Grade 1
    5
    27.8%
    Grade 2
    1
    5.6%
    Grade 3
    1
    5.6%
    Grade 4
    7
    38.9%
    Did not have any
    4
    22.2%
    Grade 1
    7
    38.9%
    Grade 2
    1
    5.6%
    Grade 3
    3
    16.7%
    Grade 4
    0
    0%
    Did not have any
    7
    38.9%
    Grade 1
    3
    16.7%
    Grade 2
    3
    16.7%
    Grade 3
    4
    22.2%
    Grade 4
    0
    0%
    Did not have any
    8
    44.4%
    Grade 1
    5
    27.8%
    Grade 2
    1
    5.6%
    Grade 3
    2
    11.1%
    Grade 4
    0
    0%
    Did not have any
    10
    55.6%
    Grade 1
    5
    27.8%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    13
    72.2%
    Grade 1
    0
    0%
    Grade 2
    1
    5.6%
    Grade 3
    3
    16.7%
    Grade 4
    1
    5.6%
    Did not have any
    13
    72.2%
    Grade 1
    4
    22.2%
    Grade 2
    1
    5.6%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    13
    72.2%
    Grade 1
    2
    11.1%
    Grade 2
    2
    11.1%
    Grade 3
    0
    0%
    Grade 4
    1
    5.6%
    Did not have any
    13
    72.2%
    Grade 1
    0
    0%
    Grade 2
    1
    5.6%
    Grade 3
    2
    11.1%
    Grade 4
    1
    5.6%
    Did not have any
    14
    77.8%
    Grade 1
    4
    22.2%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    14
    77.8%
    Grade 1
    4
    22.2%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    14
    77.8%
    Grade 1
    3
    16.7%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    15
    83.3%
    Grade 1
    3
    16.7%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    15
    83.3%
    Grade 1
    3
    16.7%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    15
    83.3%
    Grade 1
    0
    0%
    Grade 2
    0
    0%
    Grade 3
    2
    11.1%
    Grade 4
    1
    5.6%
    Did not have any
    15
    83.3%
    Grade 1
    3
    16.7%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    15
    83.3%
    Grade 1
    0
    0%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    2
    11.1%
    Did not have any
    16
    88.9%
    Grade 1
    2
    11.1%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    16
    88.9%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    0
    0%
    Grade 2
    1
    5.6%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    0
    0%
    Grade 2
    0
    0%
    Grade 3
    1
    5.6%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    0
    0%
    Grade 2
    1
    5.6%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    1
    5.6%
    Grade 2
    0
    0%
    Grade 3
    0
    0%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%
    Grade 1
    0
    0%
    Grade 2
    0
    0%
    Grade 3
    1
    5.6%
    Grade 4
    0
    0%
    Did not have any
    17
    94.4%

    Adverse Events

    Time Frame
    Adverse Event Reporting Description
    Arm/Group Title Panobinostat/Rituximab
    Arm/Group Description single-arm, open-label; Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles. Panobinostat with Rituximab: Panobinostat 40 mg orally 3 x weekly Rituximab 375 mg/m^2 IV days 1,8,15,and 22 of cycle 1, and then on day 1 of subsequent cycles.
    All Cause Mortality
    Panobinostat/Rituximab
    Affected / at Risk (%) # Events
    Total / (NaN)
    Serious Adverse Events
    Panobinostat/Rituximab
    Affected / at Risk (%) # Events
    Total 10/18 (55.6%)
    Blood and lymphatic system disorders
    Anemia 1/18 (5.6%) 1
    Death from disease progression 2/18 (11.1%) 2
    Leukocytopenia 1/18 (5.6%) 1
    Neutropenia 1/18 (5.6%) 1
    Thrombocytopenia 6/18 (33.3%) 6
    Cardiac disorders
    Hypotension 1/18 (5.6%) 1
    General disorders
    Death 3/18 (16.7%) 3
    Headache 1/18 (5.6%) 1
    Pain (back) 1/18 (5.6%) 1
    Infections and infestations
    Right lower extremity cellulitis 1/18 (5.6%) 1
    Metabolism and nutrition disorders
    Hypokalemia 2/18 (11.1%) 2
    Hypophosphatemia 2/18 (11.1%) 2
    Nervous system disorders
    Syncope 1/18 (5.6%) 1
    Respiratory, thoracic and mediastinal disorders
    Dyspnea 1/18 (5.6%) 1
    Shortness of Breath 1/18 (5.6%) 1
    Vascular disorders
    Bilateral Deep Vein Thrombosis 1/18 (5.6%) 1
    Other (Not Including Serious) Adverse Events
    Panobinostat/Rituximab
    Affected / at Risk (%) # Events
    Total 18/18 (100%)
    Blood and lymphatic system disorders
    Anemia 12/18 (66.7%) 29
    Cardiac disorders
    Myocarditis 1/18 (5.6%) 1
    Gastrointestinal disorders
    Diarrhea 8/18 (44.4%) 10
    Nausea 6/18 (33.3%) 7
    Abdominal pain 6/18 (33.3%) 6
    Constipation 4/18 (22.2%) 6
    Dry mouth 1/18 (5.6%) 2
    Dysphagia 1/18 (5.6%) 1
    Flatulence 1/18 (5.6%) 1
    Gastroesophageal reflux 1/18 (5.6%) 1
    Mucositis oral 1/18 (5.6%) 1
    Vomiting 1/18 (5.6%) 1
    General disorders
    Fatigue 13/18 (72.2%) 24
    Edema limbs 4/18 (22.2%) 4
    Pain 2/18 (11.1%) 2
    Edema face 1/18 (5.6%) 1
    Fever 1/18 (5.6%) 1
    General disorders 1/18 (5.6%) 1
    Infusion related reaction 1/18 (5.6%) 1
    Non-cardiac chest pain 1/18 (5.6%) 1
    Hepatobiliary disorders
    Hepatobiliary disorders 1/18 (5.6%) 1
    Infections and infestations
    Urinary tract infection 1/18 (5.6%) 1
    Investigations
    Platelet count decreased 12/18 (66.7%) 30
    Lymphocyte count decrease 7/18 (38.9%) 19
    Neutrophil count decrease 4/18 (22.2%) 15
    White blood cell decrease 3/18 (16.7%) 7
    Alkaline phosphatase increase 3/18 (16.7%) 3
    Creatinine increased 3/18 (16.7%) 3
    Blood bilirubin increase 2/18 (11.1%) 2
    Activated partial thromb 1/18 (5.6%) 1
    Aspartate aminotransfera 1/18 (5.6%) 1
    Investigations - Other 1/18 (5.6%) 1
    Metabolism and nutrition disorders
    Hypophosphatemia 5/18 (27.8%) 7
    Hypocalcemia 5/18 (27.8%) 6
    Anorexia 5/18 (27.8%) 5
    Hypoalbuminemia 5/18 (27.8%) 5
    Hyperglycemia 3/18 (16.7%) 3
    Hypomagnesemia 3/18 (16.7%) 3
    Hypokalemia 2/18 (11.1%) 4
    Dehydration 1/18 (5.6%) 1
    Hypermagnesemia 1/18 (5.6%) 1
    Metabolism and nutrition 1/18 (5.6%) 1
    Musculoskeletal and connective tissue disorders
    Back pain 3/18 (16.7%) 4
    Flank pain 3/18 (16.7%) 3
    Pain in extremity 2/18 (11.1%) 2
    Bone pain 1/18 (5.6%) 2
    Arthralgia 1/18 (5.6%) 1
    Muscle weakness lower limb 1/18 (5.6%) 1
    Muscle weakness upper limb 1/18 (5.6%) 1
    Myalgia 1/18 (5.6%) 1
    Nervous system disorders
    Anxiety 2/18 (11.1%) 2
    Peripheral sensory neuro 2/18 (11.1%) 2
    Dysgeusia 1/18 (5.6%) 1
    Headache 1/18 (5.6%) 1
    Myelitis 1/18 (5.6%) 1
    Nervous system disorders 1/18 (5.6%) 1
    Paresthesia 1/18 (5.6%) 1
    Peripheral motor neuropa 1/18 (5.6%) 1
    Psychiatric disorders
    Insomnia 1/18 (5.6%) 1
    Respiratory, thoracic and mediastinal disorders
    Dyspnea 10/18 (55.6%) 11
    Pleural effusion 1/18 (5.6%) 2
    Epistaxis 1/18 (5.6%) 1
    Hoarseness 1/18 (5.6%) 1
    Sore throat 1/18 (5.6%) 1
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorder 1/18 (5.6%) 2
    Vascular disorders
    Vascular disorders - Oth 2/18 (11.1%) 2
    Hematoma 1/18 (5.6%) 1
    Hypertension 1/18 (5.6%) 1
    Hypotension 1/18 (5.6%) 1
    Thromboembolic event 1/18 (5.6%) 1

    Limitations/Caveats

    [Not Specified]

    More Information

    Certain Agreements

    All Principal Investigators ARE employed by the organization sponsoring the study.

    There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

    Results Point of Contact

    Name/Title Jeremy Abramson, MD
    Organization Massachusetts General Hospital Cancer Center
    Phone 617-724-4000
    Email jabramson@mgh.harvard.edu
    Responsible Party:
    Jeremy Abramson, MD, Director, Lymphoma Program, Massachusetts General Hospital
    ClinicalTrials.gov Identifier:
    NCT01282476
    Other Study ID Numbers:
    • 10-441
    First Posted:
    Jan 25, 2011
    Last Update Posted:
    May 9, 2017
    Last Verified:
    Apr 1, 2017