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Interleukin-12 and Interleukin-2 in Treating Patients With Mycosis Fungoides

Primary Purpose

Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma, Recurrent Mycosis Fungoides/Sezary Syndrome, Stage I Cutaneous T-cell Non-Hodgkin Lymphoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
aldesleukin
recombinant interleukin-12
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histologically confirmed mycosis fungoides Stage Ib-IV At least 5% of total blood mononuclear cells must be CD8-positive lymphocytes No CNS disease Performance status - Karnofsky 70-100% At least 6 months WBC ≥ 3,000/mm^3 but ≤ 40,000/mm^3 Absolute neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 10 g/dL (transfusion or epoetin alfa allowed) Bilirubin ≤ 1.5 times upper limit of normal (ULN) AST and ALT ≤ 2 times ULN Creatinine ≤ 1.5 times ULN Creatinine clearance ≥ 60 mL/min EKG normal No known cardiac and peripheral vascular disease No cardiac arrhythmias requiring medical treatment Chest x-ray normal No history of or clinically significant autoimmune disease (e.g., rheumatoid arthritis), autoimmune hemolytic anemia, or positive Coombs' test No HTLV-I or HTLV-II-associated disease HIV negative Antinuclear antibody negative Rheumatoid factor negative No serious concurrent infection requiring IV antibiotics No clinically significant gastrointestinal bleeding No uncontrolled peptic ulcer disease No history of inflammatory bowel disease Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No history of peripheral neuropathy No other major illness that would substantially increase the patient's risk Prior interferon allowed Prior denileukin diftitox allowed No prior interleukin (IL)-2 or IL-12 No prior anti-T-cell monoclonal antibody therapy No other concurrent biologic therapy Prior topical imidazole mustard or carmustine allowed Prior bexarotene allowed Prior oral methotrexate allowed At least 3 weeks since prior topical chemotherapy At least 8 weeks since prior treatment with any single chemotherapeutic agent (12 weeks for multiple chemotherapeutic agents) Treatment must not have included steroids No prior systemic chemotherapy No prior fludarabine, pentostatin, or cladribine No concurrent systemic chemotherapy At least 3 weeks since prior topical or systemic steroids more potent than 1% hydrocortisone No concurrent systemic corticosteroids No concurrent low-potency steroid creams No concurrent radiotherapy Not specified At least 3 weeks since prior psoralen-ultraviolet-light (PUVA) or ultraviolet B (UVB) At least 3 weeks since prior retinoids At least 3 weeks since prior investigational drugs Prior photopheresis allowed No other concurrent investigational therapy

Sites / Locations

  • Abramson Cancer Center of The University of Pennsylvania

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (aldesleukin, recombinant interleukin-12)

Arm Description

Patients receive IL-12 SC twice weekly for 24 weeks. Disease is assessed at 13 weeks. Patients who do not have progressive disease also receive IL-2 SC 3 consecutive days a week during weeks 13-24. Patients with progressive disease at week 13 receive IL-2 SC at a fixed dose during weeks 13-24. Patients with responding disease after week 24 may continue to receive IL-2 and IL-12 for another 12 weeks. Cohorts of 3-6 patients receive escalating doses of IL-2 until the MTD is determined. The MTD is defined as the dose at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. The RD is the dose preceding the MTD. Additional patients are treated at the RD.

Outcomes

Primary Outcome Measures

Clinical response rate defined as the percentage of patients who achieve complete or partial response (Phase I)
Refractory disease defined as a patient who initially shows clinical improvement in the early weeks of treatment and then exhibits a response plateau for >= 30 days or exhibits progression of their disease (Phase I)
Logistic regression may be employed to explore the relationships between clinical response or refractory disease and baseline patient features.
Improved clinical response defined as a patient who had refractory or persistent disease and who subsequently had a >= 25% clinical improvement for >= 30 days during aldesleukin and recombinant interleukin-12 therapy (Phase II)
Toxicities graded using National Cancer Institute (NCI) Common Toxicity Criteria Version 2.0 (Phase I)

Secondary Outcome Measures

Dose-limiting toxicity (DLT) is defined as any grade 3 or higher hematologic or non-hematologic toxicity (Phase II)
Maximum tolerated dose (MTD), defined as the dose level at which at least 2 of 3 patients or at least 2 of 6 patients experience DLT, graded according to the NCI CTC v2.0 (Phase II)
Recommended dose (RD), defined as the dose level at which 0/6 or 1/6 patients experience DLT and at least 2 patients treated at a higher dose level experience DLT (Phase II)
Interferon gamma production
Compared between the two groups by two independent samples t-test or nonparametric Mann-Whitney test, as appropriate.
Infiltration of skin lesions by CD8+ cells
Induction of apoptosis in infiltrating tumor cells in the skin

Full Information

First Posted
January 24, 2003
Last Updated
January 15, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00052377
Brief Title
Interleukin-12 and Interleukin-2 in Treating Patients With Mycosis Fungoides
Official Title
A Phase II Open-Label Study Of Recombinant Human Interleukin-12 (NSC 672423) In Mycosis Fungoides (MF) Patients With Cross-Over To Phase I Evaluation Of Escalating Doses Of Interleukin-2 (NSC 373364) Administered With Interleukin-12
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Terminated
Why Stopped
Administratively complete.
Study Start Date
September 2002 (undefined)
Primary Completion Date
June 2005 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
Phase I/II trial to study the effectiveness of combining interleukin-12 with interleukin-2 in treating patients who have mycosis fungoides. Biological therapies, such as interleukin-12 and interleukin-2, use different ways to stimulate the immune system and stop cancer cells from growing. Combining more than one biological therapy may kill more tumor cells
Detailed Description
OBJECTIVES: I. Determine the response rate (complete and partial) in patients with mycosis fungoides treated with interleukin-12 (IL-12). II. Determine the frequency of refractory disease in patients treated with this drug. III. Determine the toxic effects of this drug in these patients. IV. Determine the feasibility and dose-limiting toxic effects (DLT) of interleukin-2 (IL-2) when administered with IL-12 in patients who have not shown disease progression after 12 weeks of IL-12 and in those who have shown disease progression after 12 weeks of IL-12. V. Determine the maximum tolerated dose and recommended dose of IL-2 when administered with IL-12 in these patients. VI. Determine immune and cytokine response over time in patients treated with this regimen. VII. Determine the frequency of improved clinical response in patients treated with this regimen. VIII. Determine the biologic correlates of response, including levels of interferon gamma production, natural killer cell activity, infiltration of skin lesions by CD8-positive cells, lymphocyte IL-12 receptor expression, signal transducers and activators of transcription protein levels and IL-12 signal transduction, and induction of apoptosis in tumor cells in the skin of patients treated with this regimen. OUTLINE: This is an open-label, multicenter, dose-escalation study of interleukin-2 (IL-2). Patients receive interleukin-12 (IL-12) subcutaneously (SC) twice weekly for 24 weeks. Disease is assessed at 13 weeks. Patients who do not have progressive disease also receive IL-2 SC 3 consecutive days a week during weeks 13-24. Patients with progressive disease at week 13 receive IL-2 SC at a fixed dose during weeks 13-24. Patients with responding disease after week 24 may continue to receive IL-2 and IL-12 for another 12 weeks. Cohorts of 3-6 patients receive escalating doses of IL-2 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. The recommended dose (RD) is the dose preceding the MTD. Additional patients are treated at the RD. Patients are followed at 6 months. PROJECTED ACCRUAL: A total of 18-46 patients will be accrued for this study within 28 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma, Recurrent Mycosis Fungoides/Sezary Syndrome, Stage I Cutaneous T-cell Non-Hodgkin Lymphoma, Stage I Mycosis Fungoides/Sezary Syndrome, Stage II Cutaneous T-cell Non-Hodgkin Lymphoma, Stage II Mycosis Fungoides/Sezary Syndrome, Stage III Cutaneous T-cell Non-Hodgkin Lymphoma, Stage III Mycosis Fungoides/Sezary Syndrome, Stage IV Cutaneous T-cell Non-Hodgkin Lymphoma, Stage IV Mycosis Fungoides/Sezary Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
46 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (aldesleukin, recombinant interleukin-12)
Arm Type
Experimental
Arm Description
Patients receive IL-12 SC twice weekly for 24 weeks. Disease is assessed at 13 weeks. Patients who do not have progressive disease also receive IL-2 SC 3 consecutive days a week during weeks 13-24. Patients with progressive disease at week 13 receive IL-2 SC at a fixed dose during weeks 13-24. Patients with responding disease after week 24 may continue to receive IL-2 and IL-12 for another 12 weeks. Cohorts of 3-6 patients receive escalating doses of IL-2 until the MTD is determined. The MTD is defined as the dose at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. The RD is the dose preceding the MTD. Additional patients are treated at the RD.
Intervention Type
Biological
Intervention Name(s)
aldesleukin
Other Intervention Name(s)
IL-2, Proleukin, recombinant human interleukin-2, recombinant interleukin-2
Intervention Description
Given SC
Intervention Type
Biological
Intervention Name(s)
recombinant interleukin-12
Other Intervention Name(s)
cytotoxic lymphocyte maturation factor, IL-12, interleukin-12, natural killer cell stimulatory factor, Ro 24-7472
Intervention Description
Given SC
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Clinical response rate defined as the percentage of patients who achieve complete or partial response (Phase I)
Time Frame
Up to week 13
Title
Refractory disease defined as a patient who initially shows clinical improvement in the early weeks of treatment and then exhibits a response plateau for >= 30 days or exhibits progression of their disease (Phase I)
Description
Logistic regression may be employed to explore the relationships between clinical response or refractory disease and baseline patient features.
Time Frame
Up to week 13
Title
Improved clinical response defined as a patient who had refractory or persistent disease and who subsequently had a >= 25% clinical improvement for >= 30 days during aldesleukin and recombinant interleukin-12 therapy (Phase II)
Time Frame
Up to week 25
Title
Toxicities graded using National Cancer Institute (NCI) Common Toxicity Criteria Version 2.0 (Phase I)
Time Frame
Up to 6 months
Secondary Outcome Measure Information:
Title
Dose-limiting toxicity (DLT) is defined as any grade 3 or higher hematologic or non-hematologic toxicity (Phase II)
Time Frame
Up to week 25
Title
Maximum tolerated dose (MTD), defined as the dose level at which at least 2 of 3 patients or at least 2 of 6 patients experience DLT, graded according to the NCI CTC v2.0 (Phase II)
Time Frame
Up to week 25
Title
Recommended dose (RD), defined as the dose level at which 0/6 or 1/6 patients experience DLT and at least 2 patients treated at a higher dose level experience DLT (Phase II)
Time Frame
Up to week 25
Title
Interferon gamma production
Description
Compared between the two groups by two independent samples t-test or nonparametric Mann-Whitney test, as appropriate.
Time Frame
Up to week 25
Title
Infiltration of skin lesions by CD8+ cells
Time Frame
Up to week 25
Title
Induction of apoptosis in infiltrating tumor cells in the skin
Time Frame
Up to week 26

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed mycosis fungoides Stage Ib-IV At least 5% of total blood mononuclear cells must be CD8-positive lymphocytes No CNS disease Performance status - Karnofsky 70-100% At least 6 months WBC ≥ 3,000/mm^3 but ≤ 40,000/mm^3 Absolute neutrophil count ≥ 1,500/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 10 g/dL (transfusion or epoetin alfa allowed) Bilirubin ≤ 1.5 times upper limit of normal (ULN) AST and ALT ≤ 2 times ULN Creatinine ≤ 1.5 times ULN Creatinine clearance ≥ 60 mL/min EKG normal No known cardiac and peripheral vascular disease No cardiac arrhythmias requiring medical treatment Chest x-ray normal No history of or clinically significant autoimmune disease (e.g., rheumatoid arthritis), autoimmune hemolytic anemia, or positive Coombs' test No HTLV-I or HTLV-II-associated disease HIV negative Antinuclear antibody negative Rheumatoid factor negative No serious concurrent infection requiring IV antibiotics No clinically significant gastrointestinal bleeding No uncontrolled peptic ulcer disease No history of inflammatory bowel disease Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No history of peripheral neuropathy No other major illness that would substantially increase the patient's risk Prior interferon allowed Prior denileukin diftitox allowed No prior interleukin (IL)-2 or IL-12 No prior anti-T-cell monoclonal antibody therapy No other concurrent biologic therapy Prior topical imidazole mustard or carmustine allowed Prior bexarotene allowed Prior oral methotrexate allowed At least 3 weeks since prior topical chemotherapy At least 8 weeks since prior treatment with any single chemotherapeutic agent (12 weeks for multiple chemotherapeutic agents) Treatment must not have included steroids No prior systemic chemotherapy No prior fludarabine, pentostatin, or cladribine No concurrent systemic chemotherapy At least 3 weeks since prior topical or systemic steroids more potent than 1% hydrocortisone No concurrent systemic corticosteroids No concurrent low-potency steroid creams No concurrent radiotherapy Not specified At least 3 weeks since prior psoralen-ultraviolet-light (PUVA) or ultraviolet B (UVB) At least 3 weeks since prior retinoids At least 3 weeks since prior investigational drugs Prior photopheresis allowed No other concurrent investigational therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alain Rook
Organizational Affiliation
Abramson Cancer Center at Penn Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Abramson Cancer Center of The University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States

12. IPD Sharing Statement

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Interleukin-12 and Interleukin-2 in Treating Patients With Mycosis Fungoides

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