Study of Carfilzomib and Vorinostat for Relapsed or Refractory Lymphoma
Study Details
Study Description
Brief Summary
This will be a phase I study of carfilzomib in combination with vorinostat in patients with relapsed/refractory B-cell lymphomas. Combination therapy with proteosome inhibitor PR-171 and HDAC inhibitors is highly synergistic in primary DLBCL cells, and both classes of drugs can also synergize powerfully to induce cell death in bortezomib-resistant cells. The purpose of this study is to see if vorinostat can combine with carfilzomib and to safely find the recommended phase II dose.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 1 |
Detailed Description
Study Drugs:
Vorinostat, a class I/II pan-histone deacetylase inhibitor (HDACI), was the first approved agent og this class on the basis of activity in refractory cutaneous T-cell Lymphoma. Lethal mechanisms include anti-apoptotic protein down-regulation, up-regulation of proapoptotic proteins, induction of ROS, death receptor up-regulation, and disruption of chaperone function and DNA-repair proteins.
Carfilzomib, is a irreversible proteasome inhibitor of the epoxyketone class that exhibits a high level of selectivity for the proteosome. This agent induced a dose- and time-dependent inhibition of proliferation, ultimately leading to apoptosis.
Study Drug Administration:
If you are found to be eligible to take part in this study:
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Vorinostat PO twice daily on Days 1, 2, 3, 8, 9, 10, 15, 16 and 17.
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Daily Carfilzomib 30 minutes infusion on Days 1, 2, 8, 9, 15, 16.
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Administer first daily dose of vorinostat prior to carfilzomib on Days 1, 2, 8, 9, 15, 16
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Cycle repeated every 28 days, up to 13 cycles.
Carfilzomib will be given at 20mg/m2 for days 1 and 2 of cycle 1 only, then escalated to the higher dose indicated in the schema on day 8 of cycle 1 and thereafter. Carfilzomib treatment is to be done early in the morning and have a minimum of a 6 hour observation period after the infusion. For patients with good tolerability to carfilzomib during the first cycle, an observation period of 2 hours is recommended. A minimum of 16 hours should separate doses of carfilzomib, so that the day 1 dose may be given in the afternoon and the day 2 dose in morning during cycle 2 and subsequent cycles for patients who tolerate the drug well.
If two out of 6 patients do not tolerate the initial dose of 20 mg/m2 carfilzomib on days 1 & 2 followed by 27 mg/m2 carfilzomib for subsequent doses and 200 mg/day bid vorinostat, the next patient should be dose reduced to 20 mg/m2 carfilzomib and 100 mg/day bid vorinostat.
Study Visits:
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Baseline within 4 weeks of Cycle 1 Day 1.
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CT or physical exam.
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Bone marrow if needed to follow disease status.
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PET recommended but not required. To document complete response (CR), a PET is REQUIRED.
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Optional research tumor biopsy.
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Peripheral blood obtained for PD prior to initiation of treatment and at 48 hours +/- 6 hours after receiving first dose of Carfilzomib , and at Off Study.
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End of Treatment Restaging will take place 6-8 weeks after completion of treatment and will include an assessment by the physician, labs, and a tumor response evaluation.
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After completion of Restaging exams, Follow up exams will take place every 6 months for 2 years and then annually until disease progression or initiation of another treatment.
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An Off Study visit will take place at the time of disease progression or initiation of another treatment, which will include assessment by the physician,a tumor response evaluation, labs, and a final PD sample, by the patient's consent.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Vorinostat + Carfilzomib
|
Drug: Drug: Carfilzomib
Carfilzomib 30 minutes infusion daily for days 1, 2, 8, 9, 15, 16, Every 28 days. A maximum of 13 cycles will be administered.
Other Names:
Drug: Vorinostat
Vorinostat by mouth twice daily on days 1, 2, 3, 8, 9, 10, 15, 16 and 17. Maximum 13 cycles.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Number of Participants who experience Adverse Events as a Measure of Safety and Tolerability [From date of study entry until the 30 days after the last dose of study treatment.]
Determine the recommended phase II doses for the combination of carfilzomib and vorinostat in patients with relapsed or refractory B cell lymphoma.
Secondary Outcome Measures
- Number of Participants who Respond to Treatment [From the date of completion of first cycle of treatment until the date of best response to treatment, as determined by restaging scans]
Determine response rate to combination of carfilzomib and vorinostat.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Histologically confirmed B-cell lymphomas, excluding CLL (Chronic Lymphocytic Leukemia), that is recurrent or refractory after at least one prior therapy and for which no other potentially curative therapy is available.
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Age ≥ 18 years
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ECOG Performance Status (PS) ≤ 2
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Laboratory parameters
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if SLL, lymphocyte count < 5,000/µL
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Absolute neutrophil count ≥ 1000/µL
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Platelets ≥ 75,000/µL
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Creatinine ≤ 1.5x upper limit of normal or calculated creatinine clearance > 40mL/min
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AST, ALT ≤ 2.5 x upper limit of normal (ULN)
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Bilirubin ≤ 2.0 mg/mL
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Serum potassium ≥ 3.5 mEq/L and serum magnesium ≥ 1.7 mEq/dL (electrolytes may be corrected with supplementation).
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PT < 1.5 x ULN and PTT < 1.2 x ULN (unless receiving therapeutic anticoagulation).
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Patient is, in investigator's opinion, willing and able to comply with the protocol requirements and offers written informed consent.
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Female subject is either post-menopausal or surgically sterilized or willing to use an acceptable method of birth control ( i.e., oral injectable hormonal methods; barrier methods such as intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence)for the duration of the study.
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Male subject agrees to use an acceptable method for contraception for the duration of study.
Exclusion Criteria:
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History of brain metastasis including leptomeningeal metastasis.
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Chemotherapy of radiotherapy within 3 weeks prior to entering the study.
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Prior histone deacetylase inhibitor as cancer treatment.
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Concurrent treatment with other investigational agents or cancer treatment.
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Unable to take oral medications.
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Active ischemic heart disease or congestive heart failure. If there is suspicion of cardiac disease, left ventricular ejection fraction (LVEF) must be ≥ 45%, otherwise study to evaluate EF is not required.
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Persistent blood pressure (BP) of ≥ 160/95 (three separate readings on different days).
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History of allergic reactions attributed to compounds of similar chemical or biological composition to carfilzomib and vorinostat.
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Known clinical significant infection including infection with human immunodeficiency virus (HIV), or active hepatitis B or C, requiring treatment.
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Serious medical or psychiatric illness likely to interfere with patient participation.
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Pregnant or nursing. Confirmation that a woman is not pregnant must be established by a negative serum pregnancy test result obtained at screening.
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Pregnancy testing is not required for post-menopausal or surgically sterilized women.
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No prior allogeneic stem cell transplant.
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Patients scheduled for any type of stem cell transplant within 4 weeks of treatment.
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Patients who have valproic acid for epilepsy can enroll, provided that they stopped drug at least 30 days prior to enrollment and they will be on a stable, effective dose of an alternative anti-seizure medication.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Rochester | Rochester | New York | United States | 14642 |
| 2 | Virginia Commonwealth University Massey Cancer Center | Richmond | Virginia | United States | 23298 |
Sponsors and Collaborators
- University of Rochester
- Massey Cancer Center
Investigators
- Principal Investigator: Jonathan Friedberg, M.D., University of Rochester
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 32833