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Bortezomib and Rituximab in Treating Patients With Non-Hodgkin's Lymphoma

Primary Purpose

Lymphoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
bortezomib + rituximab
Sponsored by
Jonsson Comprehensive Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lymphoma focused on measuring recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, recurrent marginal zone lymphoma, splenic marginal zone lymphoma

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Diagnosis of indolent B-cell non-Hodgkin's lymphoma of 1 of the following subtypes: Follicular (grade 1, 2, or 3) Marginal zone (extranodal, nodal, or splenic) CD20-positive disease Relapsed or progressive disease after prior anti-neoplastic therapy, as indicated by 1 of the following: New lesions Objective evidence of progression of existing lesions Complete response ≥ 6 months in duration after prior rituximab therapy* NOTE: *For patients who were previously treated with a regimen that included rituximab At least 1 measurable lymph node mass > 1.5 cm in 2 perpendicular dimensions that has not been irradiated OR that has progressed since prior radiotherapy No active CNS lymphoma PATIENT CHARACTERISTICS: Age 18 and over Performance status Karnofsky 50-100% OR ECOG 0-2 Life expectancy Not specified Hematopoietic Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 50,000/mm^3 Hepatic AST and ALT ≤ 3 times upper limit of normal (ULN) Bilirubin ≤ 2 times ULN Renal Creatinine ≤ 2 mg/dL OR Creatinine clearance ≥ 30 mL/min Immunologic No known anaphylaxis or immunoglobulin E-mediated hypersensitivity to murine proteins or to any component of rituximab, including polysorbate 80 and sodium citrate dihydrate No active systemic infection requiring treatment No history of allergic reaction attributable to compounds containing boron or mannitol Other No peripheral neuropathy or neuropathic pain ≥ grade 2 No other malignancy within the past 5 years except completely resected basal cell or squamous cell skin cancer or an in situ malignancy Previously diagnosed prostate cancer allowed provided the following criteria are met: T1-2a, N0, M0 disease AND Gleason score ≤ 7 AND prostate specific antigen (PSA) ≤ 10 ng/mL before initial therapy Treated with definitive curative therapy (i.e., prostatectomy or radiotherapy) within the past 2 years No clinical evidence of prostate cancer AND undetectable PSA (for prostatectomy patients) or PSA < 1 ng/mL (for patients who did not undergo prostatectomy) No serious medical or psychiatric illness that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics More than 10 weeks since prior radioimmunoconjugates or toxin immunoconjugates (e.g., ibritumomab tiuxetan or iodine I 131 tositumomab) More than 4 weeks since prior rituximab, alemtuzumab, or other unconjugated therapeutic antibody No concurrent prophylactic bone marrow growth factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF], or epoetin alfa) during course 1 of study therapy Chemotherapy More than 6 weeks since prior nitrosoureas No concurrent cisplatin Endocrine therapy No concurrent corticosteroids (e.g., dexamethasone) except prednisone ≤ 15 mg/day or equivalent for adrenal insufficiency Radiotherapy See Disease Characteristics See Biologic therapy More than 3 weeks since prior radiotherapy No concurrent radiotherapy Surgery More than 2 weeks since prior major surgery Other Recovered from all prior therapy No prior bortezomib More than 3 weeks since prior antineoplastic therapy More than 3 weeks since prior experimental therapy No other concurrent antineoplastic therapy No other concurrent investigational agents Concurrent participation in a non-treatment study allowed provided it does not interfere with participation in this study

Sites / Locations

  • Jonsson Comprehensive Cancer Center at UCLA

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

bortezomib + rituximab

Arm Description

Arm I: Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11. Patients also receive rituximab IV on days 1, 8, and 15 of course 1 only and on day 1 of course 2 only. Treatment with repeats every 21 days for up to 5 courses in the absence of disease progression or unacceptable toxicity. Arm II: Patients receive bortezomib IV over 3-5 seconds on days 1, 8, 15 and 22. Patients also receive rituximab IV on days 1, 8, 15, and 22 of course 1 only. Treatment repeats every 35 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients in either arm may crossover to the other arm if treatment is found to be ineffective.

Outcomes

Primary Outcome Measures

Response rate (complete response [CR], CR-unconfirmed [CRu], and partial response [PR])

Secondary Outcome Measures

Response rate (CR, CRu, and PR) at the first disease response evaluation
Overall CR rate (CR and CRu)
Safety and tolerability

Full Information

First Posted
October 6, 2004
Last Updated
October 3, 2012
Sponsor
Jonsson Comprehensive Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00093769
Brief Title
Bortezomib and Rituximab in Treating Patients With Non-Hodgkin's Lymphoma
Official Title
A Phase II Study of VELCADE With Rituximab in Subjects With Relapsed or Refractory Indolent B-Cell Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2012
Overall Recruitment Status
Completed
Study Start Date
August 2004 (undefined)
Primary Completion Date
August 2005 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

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

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Bortezomib may stop the growth of cancer cells by blocking the enzymes necessary for their growth. Monoclonal antibodies such as rituximab can locate cancer cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Giving bortezomib together with rituximab may kill more cancer cells. PURPOSE: This randomized phase II trial is studying how well giving bortezomib together with rituximab works in treating patients with relapsed or refractory non-Hodgkin's lymphoma.
Detailed Description
OBJECTIVES: Primary Determine the response rate (complete response [CR], CR-unconfirmed [CRu], and partial response [PR]) in patients with relapsed or refractory indolent B-cell non-Hodgkin's lymphoma treated with bortezomib and rituximab. Secondary Determine the response rate (CR, CRu, and PR) at the first disease response evaluation in patients treated with this regimen. Determine the overall CR rate (CR and CRu) in patients treated with this regimen. Determine the time to progression in patients treated with this regimen. Determine the duration of response in patients treated with this regimen. Determine the time to best response in patients treated with this regimen. Determine the safety and tolerability of this regimen in these patients. OUTLINE: This is a randomized, open-label, multicenter study. Patients are stratified according to participating center, Karnofsky performance status (< 70% vs ≥ 70%), lactic dehydrogenase level (normal vs > upper limit of normal), age (18 to 60 years vs > 60 years), and lymphoma subtype (follicular vs marginal zone). Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11. Patients also receive rituximab IV on days 1, 8, and 15 of course 1 only and on day 1 of course 2 only. Treatment with repeats every 21 days for up to 5 courses in the absence of disease progression or unacceptable toxicity. Arm II: Patients receive bortezomib IV over 3-5 seconds on days 1, 8, 15 and 22. Patients also receive rituximab IV on days 1, 8, 15, and 22 of course 1 only. Treatment repeats every 35 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients in either arm may crossover to the other arm if treatment is found to be ineffective. Patients are followed at 30 days and then every 12 weeks thereafter. PROJECTED ACCRUAL: A total of 24-66 patients (12-33 per treatment arm) will be accrued for this study within 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma
Keywords
recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, recurrent marginal zone lymphoma, splenic marginal zone lymphoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
bortezomib + rituximab
Arm Type
Experimental
Arm Description
Arm I: Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11. Patients also receive rituximab IV on days 1, 8, and 15 of course 1 only and on day 1 of course 2 only. Treatment with repeats every 21 days for up to 5 courses in the absence of disease progression or unacceptable toxicity. Arm II: Patients receive bortezomib IV over 3-5 seconds on days 1, 8, 15 and 22. Patients also receive rituximab IV on days 1, 8, 15, and 22 of course 1 only. Treatment repeats every 35 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients in either arm may crossover to the other arm if treatment is found to be ineffective.
Intervention Type
Drug
Intervention Name(s)
bortezomib + rituximab
Intervention Description
Arm I: Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11. Patients also receive rituximab IV on days 1, 8, and 15 of course 1 only and on day 1 of course 2 only. Treatment with repeats every 21 days for up to 5 courses in the absence of disease progression or unacceptable toxicity. Arm II: Patients receive bortezomib IV over 3-5 seconds on days 1, 8, 15 and 22. Patients also receive rituximab IV on days 1, 8, 15, and 22 of course 1 only. Treatment repeats every 35 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients in either arm may crossover to the other arm if treatment is found to be ineffective.
Primary Outcome Measure Information:
Title
Response rate (complete response [CR], CR-unconfirmed [CRu], and partial response [PR])
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Response rate (CR, CRu, and PR) at the first disease response evaluation
Time Frame
12 weeks
Title
Overall CR rate (CR and CRu)
Time Frame
12 weeks
Title
Safety and tolerability
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of indolent B-cell non-Hodgkin's lymphoma of 1 of the following subtypes: Follicular (grade 1, 2, or 3) Marginal zone (extranodal, nodal, or splenic) CD20-positive disease Relapsed or progressive disease after prior anti-neoplastic therapy, as indicated by 1 of the following: New lesions Objective evidence of progression of existing lesions Complete response ≥ 6 months in duration after prior rituximab therapy* NOTE: *For patients who were previously treated with a regimen that included rituximab At least 1 measurable lymph node mass > 1.5 cm in 2 perpendicular dimensions that has not been irradiated OR that has progressed since prior radiotherapy No active CNS lymphoma PATIENT CHARACTERISTICS: Age 18 and over Performance status Karnofsky 50-100% OR ECOG 0-2 Life expectancy Not specified Hematopoietic Absolute neutrophil count ≥ 1,000/mm^3 Platelet count ≥ 50,000/mm^3 Hepatic AST and ALT ≤ 3 times upper limit of normal (ULN) Bilirubin ≤ 2 times ULN Renal Creatinine ≤ 2 mg/dL OR Creatinine clearance ≥ 30 mL/min Immunologic No known anaphylaxis or immunoglobulin E-mediated hypersensitivity to murine proteins or to any component of rituximab, including polysorbate 80 and sodium citrate dihydrate No active systemic infection requiring treatment No history of allergic reaction attributable to compounds containing boron or mannitol Other No peripheral neuropathy or neuropathic pain ≥ grade 2 No other malignancy within the past 5 years except completely resected basal cell or squamous cell skin cancer or an in situ malignancy Previously diagnosed prostate cancer allowed provided the following criteria are met: T1-2a, N0, M0 disease AND Gleason score ≤ 7 AND prostate specific antigen (PSA) ≤ 10 ng/mL before initial therapy Treated with definitive curative therapy (i.e., prostatectomy or radiotherapy) within the past 2 years No clinical evidence of prostate cancer AND undetectable PSA (for prostatectomy patients) or PSA < 1 ng/mL (for patients who did not undergo prostatectomy) No serious medical or psychiatric illness that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics More than 10 weeks since prior radioimmunoconjugates or toxin immunoconjugates (e.g., ibritumomab tiuxetan or iodine I 131 tositumomab) More than 4 weeks since prior rituximab, alemtuzumab, or other unconjugated therapeutic antibody No concurrent prophylactic bone marrow growth factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF], or epoetin alfa) during course 1 of study therapy Chemotherapy More than 6 weeks since prior nitrosoureas No concurrent cisplatin Endocrine therapy No concurrent corticosteroids (e.g., dexamethasone) except prednisone ≤ 15 mg/day or equivalent for adrenal insufficiency Radiotherapy See Disease Characteristics See Biologic therapy More than 3 weeks since prior radiotherapy No concurrent radiotherapy Surgery More than 2 weeks since prior major surgery Other Recovered from all prior therapy No prior bortezomib More than 3 weeks since prior antineoplastic therapy More than 3 weeks since prior experimental therapy No other concurrent antineoplastic therapy No other concurrent investigational agents Concurrent participation in a non-treatment study allowed provided it does not interfere with participation in this study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sven De Vos, MD
Organizational Affiliation
Jonsson Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Jonsson Comprehensive Cancer Center at UCLA
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19770386
Citation
de Vos S, Goy A, Dakhil SR, Saleh MN, McLaughlin P, Belt R, Flowers CR, Knapp M, Hart L, Patel-Donnelly D, Glenn M, Gregory SA, Holladay C, Zhang T, Boral AL. Multicenter randomized phase II study of weekly or twice-weekly bortezomib plus rituximab in patients with relapsed or refractory follicular or marginal-zone B-cell lymphoma. J Clin Oncol. 2009 Oct 20;27(30):5023-30. doi: 10.1200/JCO.2008.17.7980. Epub 2009 Sep 21.
Results Reference
result

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Bortezomib and Rituximab in Treating Patients With Non-Hodgkin's Lymphoma

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