Lenalidomide Plus Rituxan for Untreated Mantle Cell Lymphoma
Study Details
Study Description
Brief Summary
This is a phase II, multicenter study to determine the efficacy and safety of first-line lenalidomide plus rituximab therapy in patients with mantle cell lymphoma who have received no prior systemic therapy.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 2 |
Detailed Description
Induction Phase (week 1 - 48):
-
Lenalidomide will be given at 20 mg/day for days 1-21 of a 28-day cycle for 12 cycles. If no excess toxicity is observed the dose will be increased to 25 mg/day.
-
Rituximab will be administered at 375 mg/m2 per dose for a total of 9 doses. The first 4 doses will be administered weekly starting on day 1 of lenalidomide (e.g. days 1, 8, 15 and 22). Subsequent rituximab doses will be administered for one dose each at weeks 12, 20, 28, 36 and 44.
Maintenance Phase (week 49 - progression of disease):
-
Lenalidomide will be given at 15 mg/day for days 1-21 of a 28-day cycle.
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Rituximab at 375 mg/m2 per dose will be administered for one dose every 8 weeks, starting at week 52.
Response Assessment
-
Year 1-2: Conventional restaging CT scan (or MRI) with IV contrast every 3 months from cycle 1 day 1 of the study.
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Year 3 onwards: Conventional restaging CT scan (or MRI) with IV contrast every 6 months until progression.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: all patients Induction Phase (week 1 - 48): Lenalidomide will be given at 20 mg/day for days 1-21 of a 28-day cycle for 12 cycles. If no excess toxicity is observed the dose will be increased to 25 mg/day. Rituximab will be administered at 375 mg/m2 per dose for a total of 9 doses. The first 4 doses will be administered weekly starting on day 1 of lenalidomide (e.g. days 1, 8, 15 and 22). Subsequent rituximab doses will be administered for one dose each at weeks 12, 20, 28, 36 and 44. Maintenance Phase (week 49 - progression of disease): Lenalidomide will be given at 15 mg/day for days 1-21 of a 28-day cycle. Rituximab at 375 mg/m2 per dose will be administered for one dose every 8 weeks, starting at week 52. |
Drug: lenalidomide
Induction phase: 20 mg/day for days 1-21 of a 28-day cycle for 12 cycles. If no excess toxicity is observed the dose will be increased to 25 mg/day.
Maintenance phase: Lenalidomide will be given at 15 mg/day for days 1-21 of a 28-day cycle.
Other Names:
Biological: rituximab
Induction phase: Rituximab will be administered at 375 mg/m2 per dose for a total of 9 doses. The first 4 doses will be administered weekly starting on day 1 of lenalidomide (e.g. days 1, 8, 15 and 22). Subsequent rituximab doses will be administered for one dose each at weeks 12, 20, 28, 36 and 44.
Maintenance phase: Rituximab at 375 mg/m2 per dose will be administered for one dose every 8 weeks, starting at week 52.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Overall Response Rate [30 months]
The primary endpoint of overall response rate will be estimated and a 95% confidence interval will be estimated via binomial proportions.
Secondary Outcome Measures
- Progression-free Survival [10 years]
PFS will be defined as the time from first treatment day until objective or symptomatic progression or death.
- Overall Survival [10 years]
Overall survival will be defined as the time from first treatment day until death.
- Time to Next Treatment [10 years]
Median amount of time (in months) from start of study treatment to next treatment
- Safety as Measured by Number of Subjects Who Experience an Adverse Event While on Study Treatment [10 years]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Understand and voluntarily sign an informed consent form.
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Age > = 18 years at the time of signing the informed consent form.
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Able to adhere to the study visit schedule and other protocol requirements.
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Histologically confirmed diagnosis of mantle cell Non-Hodgkin's Lymphoma with cyclin D1 overexpression by immunohistochemistry, and a characteristic immunophenotypic profile with CD5(+), CD23(-), CD20(+), and CD10(-). In tumor tissues with negative cyclin D1, evidence of cyclin D2 or D3 overexpression by immunohistochemistry will be acceptable.
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No prior systemic therapy for lymphoma including chemotherapy or immunotherapy. Patients may have received involved-field radiation therapy which has been discontinued at least 4 weeks prior to treatment in this study.
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Patient has measurable disease as defined by a tumor mass > 1.5 cm in one dimension.
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Low and intermediate-risk disease as defined by MIPI score.
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Subject who the investigator considers that chemotherapy is not indicated.
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ECOG performance status of < = 2 at study entry.
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Laboratory test results within these ranges:
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Absolute neutrophil count > = 1000 /mm³
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Platelet count > = 75,000 /mm³
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Calculated creatinine clearance ≥ 30 ml/min by Cockcroft-Gault formula • Total bilirubin < = 2 x ULN
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AST (SGOT) and ALT (SGPT) < = 3 x ULN.
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Disease free of prior malignancies for > = 5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, carcinoma "in situ" of the cervix or breast, or localized prostate cancer.
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All subjects must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.
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Subjects of reproductive potential agree to use birth control throughout their participation in this study, and for three months following study termination.
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Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days and again within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days). FCBP must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. See Appendix: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods.
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Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA may use warfarin or low molecular weight heparin).
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Asymptomatic carriers of hepatitis B virus can be considered for study if they agree to and comply with close monitoring and suppressive therapy with lamivudine during treatment and for additional six months after coming off study.
Exclusion Criteria:
-
Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
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Pregnant or breast feeding females.
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Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
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Use of any other experimental drug or therapy within 28 days of baseline.
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Patient on corticosteroids within two weeks prior to study entry, except for prednisone < = 10 mg/day or equivalent for purposes other than treating MCL.
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Known hypersensitivity to thalidomide.
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Any prior use of lenalidomide.
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Known seropositive for or active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV). Patients who are seropositive because of hepatitis B virus vaccine are eligible.
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Known central nervous system (CNS) involvement by lymphoma.
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Patient at high risk for deep vein thrombosis not willing to take DVT prophylaxis.
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Patient has had major surgery within the last 3 weeks
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Moffitt Cancer Center | Tampa | Florida | United States | 33612 |
2 | University of Chicago | Chicago | Illinois | United States | 60637 |
3 | Weill Cornell Medical College | New York | New York | United States | 10065 |
4 | University of Pennsylvania | Philadelphia | Pennsylvania | United States | 19104 |
Sponsors and Collaborators
- Weill Medical College of Cornell University
- Celgene
Investigators
- Principal Investigator: Jia Ruan, MD, PhD, Weill Medical College of Cornell University
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 1103011566
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail |
Arm/Group Title | All Patients |
---|---|
Arm/Group Description | Study Treatment Arm |
Period Title: Induction Phase (Week 1- 48) | |
STARTED | 38 |
COMPLETED | 27 |
NOT COMPLETED | 11 |
Period Title: Induction Phase (Week 1- 48) | |
STARTED | 27 |
COMPLETED | 4 |
NOT COMPLETED | 23 |
Baseline Characteristics
Arm/Group Title | All Patients |
---|---|
Arm/Group Description | Study Treatment Arm |
Overall Participants | 38 |
Age (years) [Median (Full Range) ] | |
Median (Full Range) [years] |
65
|
Sex: Female, Male (Count of Participants) | |
Female |
11
28.9%
|
Male |
27
71.1%
|
Outcome Measures
Title | Overall Response Rate |
---|---|
Description | The primary endpoint of overall response rate will be estimated and a 95% confidence interval will be estimated via binomial proportions. |
Time Frame | 30 months |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | All Patients |
---|---|
Arm/Group Description | Study Treatment Arm |
Measure Participants | 33 |
Number (95% Confidence Interval) [percentage of patients] |
92
|
Title | Progression-free Survival |
---|---|
Description | PFS will be defined as the time from first treatment day until objective or symptomatic progression or death. |
Time Frame | 10 years |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title |
---|
Arm/Group Description |
Title | Overall Survival |
---|---|
Description | Overall survival will be defined as the time from first treatment day until death. |
Time Frame | 10 years |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title |
---|
Arm/Group Description |
Title | Time to Next Treatment |
---|---|
Description | Median amount of time (in months) from start of study treatment to next treatment |
Time Frame | 10 years |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title |
---|
Arm/Group Description |
Title | Safety as Measured by Number of Subjects Who Experience an Adverse Event While on Study Treatment |
---|---|
Description | |
Time Frame | 10 years |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title |
---|
Arm/Group Description |
Adverse Events
Time Frame | ||
---|---|---|
Adverse Event Reporting Description | ||
Arm/Group Title | All Patients | |
Arm/Group Description | Study Treatment Arm | |
All Cause Mortality |
||
All Patients | ||
Affected / at Risk (%) | # Events | |
Total | / (NaN) | |
Serious Adverse Events |
||
All Patients | ||
Affected / at Risk (%) | # Events | |
Total | 11/38 (28.9%) | |
Blood and lymphatic system disorders | ||
Tumor Flare | 2/38 (5.3%) | 2 |
Blood Bilirubin Increase | 1/38 (2.6%) | 1 |
Cardiac disorders | ||
Ventricular Fibrillation | 1/38 (2.6%) | 1 |
Gastrointestinal disorders | ||
Cholangitis | 1/38 (2.6%) | 1 |
General disorders | ||
Fever | 1/38 (2.6%) | 1 |
Pneumonia | 2/38 (5.3%) | 2 |
Shortness of Breath | 1/38 (2.6%) | 1 |
Hepatobiliary disorders | ||
Cholecystitis | 1/38 (2.6%) | 1 |
Injury, poisoning and procedural complications | ||
Hip Fracture | 1/38 (2.6%) | 1 |
Infusion Reaction | 1/38 (2.6%) | 1 |
Skin and subcutaneous tissue disorders | ||
Basal Cell Carcinoma | 1/38 (2.6%) | 1 |
Melanoma | 1/38 (2.6%) | 1 |
Merkel Cell Carcinoma | 1/38 (2.6%) | 1 |
Pruritic Rash | 1/38 (2.6%) | 1 |
Other (Not Including Serious) Adverse Events |
||
All Patients | ||
Affected / at Risk (%) | # Events | |
Total | 31/38 (81.6%) | |
Blood and lymphatic system disorders | ||
Thrombocytopenia | 15/38 (39.5%) | |
Leukopenia | 23/38 (60.5%) | |
Neutropenia | 28/38 (73.7%) | |
Blood Bilirubin Increased | 9/38 (23.7%) | |
Anemia | 23/38 (60.5%) | |
Neutropenic Fever | 2/38 (5.3%) | |
Tumor Flare | 13/38 (34.2%) | |
Cardiac disorders | ||
Hypertension | 6/38 (15.8%) | |
Endocrine disorders | ||
Hypothyroidism | 6/38 (15.8%) | |
Hyperthyroidism | 3/38 (7.9%) | |
Gastrointestinal disorders | ||
Constipation | 17/38 (44.7%) | |
Diarrhea | 21/38 (55.3%) | |
General disorders | ||
Nausea | 12/38 (31.6%) | |
Vomit | 5/38 (13.2%) | |
Fever | 22/38 (57.9%) | |
Fatigue | 28/38 (73.7%) | |
Night Sweats | 9/38 (23.7%) | |
Dyspnea | 11/38 (28.9%) | |
Sore Throat | 9/38 (23.7%) | |
Cough | 21/38 (55.3%) | |
Abdominal Pain | 9/38 (23.7%) | |
Head Pain/Headache/Migraine | 10/38 (26.3%) | |
Rigors | 4/38 (10.5%) | |
Edema | 16/38 (42.1%) | |
Chills | 5/38 (13.2%) | |
Serum Sickness | 3/38 (7.9%) | |
Hepatobiliary disorders | ||
Elevated Alanine Aminotransferase | 13/38 (34.2%) | |
Elevated Aspartate Aminotransferase | 11/38 (28.9%) | |
Elevated Alkaline Phosphatase | 9/38 (23.7%) | |
Metabolism and nutrition disorders | ||
Anorexia | 11/38 (28.9%) | |
Hypoalbuminemia | 13/38 (34.2%) | |
Hyperalbuminemia | 13/38 (34.2%) | |
Hypocalcemia | 17/38 (44.7%) | |
Hyponatremia | 12/38 (31.6%) | |
Hypomagnesemia | 9/38 (23.7%) | |
Hyperkalemia | 3/38 (7.9%) | |
Hypoglycemia | 13/38 (34.2%) | |
Hyperglycemia | 19/38 (50%) | |
Musculoskeletal and connective tissue disorders | ||
Arthralgia | 10/38 (26.3%) | |
Myalgia | 7/38 (18.4%) | |
Cramping | 6/38 (15.8%) | |
Gout Flares | 4/38 (10.5%) | |
Nervous system disorders | ||
Dysgeusia | 7/38 (18.4%) | |
Dizziness | 8/38 (21.1%) | |
Neuropathy | 6/38 (15.8%) | |
Tinnitus | 5/38 (13.2%) | |
Product Issues | ||
Infusion Related Reaction | 13/38 (34.2%) | |
Renal and urinary disorders | ||
Urinary tract Infection | 7/38 (18.4%) | |
Elevated Creatinine | 8/38 (21.1%) | |
Respiratory, thoracic and mediastinal disorders | ||
Upper Respiratory Infection | 15/38 (39.5%) | |
Pneumonia | 3/38 (7.9%) | |
Bronchial Infection/ Lung Infection | 5/38 (13.2%) | |
Skin and subcutaneous tissue disorders | ||
Nasal Congestion | 12/38 (31.6%) | |
Macro Papular | 25/38 (65.8%) |
Limitations/Caveats
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 | Jia Ruan M.D, Ph.D |
---|---|
Organization | Weill Cornell Medicine |
Phone | 646.962.2064 |
amr2017@med.cornell.edu |
- 1103011566