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Lenalidomide in Relapsed or Refractory Classical Hodgkin Lymphoma

Primary Purpose

Hodgkin Disease

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Lenalidomide
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hodgkin Disease focused on measuring Hodgkin Lymphoma, Lenalidomide, Anti-neoplastic agents, Thalidomide

Eligibility Criteria

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

Inclusion Criteria:

  • Histologically documented classical Hodgkin lymphoma that is recurrent or refractory to standard chemotherapy.
  • Patients must have relapsed or progressed after at least one prior systemic cytotoxic chemotherapy; prior autologous or allogeneic stem cell transplantation is allowed.
  • Measurable disease must be present either on physical examination or imaging studies (CT, MRI, PET/CT). Any tumor mass greater or equal to 1 cm is acceptable.
  • Age > 18 years old.
  • ECOG performance status of less than or equal to 2 at study entry
  • Adequate hematologic, renal, hepatic function as defined by:

    • Absolute neutrophil count greater than or equal to 1000 / uL
    • Platelets greater than or equal to 50,000 / uL
    • Serum creatinine less than or equal to 1.5X institution upper limit of normal (ULN)
    • Total bilirubin less than or equal to 2.0 mg/dL
    • AST (SGOT) and ALT (SGPT) less than or equal to 3 x ULN (if not attributed to cHL)
  • Disease free of prior malignancies for greater than or equal to 5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast.
  • Understand and voluntarily sign an informed consent form.
  • Able to adhere to the study visit schedule and other protocol requirements
  • Females of childbearing potential (FCBP)† must agree to use two reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse during the following time periods related to this study: 1) for at least 28 days before starting study drug; 2) while participating in the study; and 3) for at least 28 days after discontinuation from the study. The two methods of reliable contraception must include one highly effective method (i.e. intrauterine device (IUD), hormonal [birth control pills, injections, or implants], tubal ligation, partner's vasectomy) and one additional effective (barrier) method (i.e. latex condom, diaphragm, cervical cap). FCBP must be referred to a qualified provider of contraceptive methods if needed.
  • FCBP must have two negative serum or urine pregnancy tests (sensitivity of at least 50 mIU/mL) prior to starting study drug. The first pregnancy test must be performed within 10-14 days prior to the start of study drug and the second pregnancy test must be performed within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days as required by RevAssist) and 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. The subject may not receive study drug until the Investigator has verified that the results of these pregnancy tests are negative.
  • Men must agree to use a latex condom during sexual contact with females of childbearing potential while participating in the study and for at least 28 days following discontinuation from the study even if he has undergone a successful vasectomy.
  • All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure.
  • Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA may use warfarin or low molecular weight
  • All study participants must be registered into the mandatory RevAssist program, and be willing and able to comply with the requirements of RevAssist.

Exclusion Criteria:

  • Patients who are candidates for high dose chemotherapy and stem cell transplantation and have not yet undergone stem cell transplantation should not be enrolled.
  • Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  • Any condition, including the presence of laboratory abnormalities.
  • Use of any other anti-cancer drug or therapy, including experimental, within 30 days of enrollment.
  • Known hypersensitivity to thalidomide.
  • The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
  • Any prior use of lenalidomide.
  • Known positive for HIV or infectious hepatitis, type A, B or C.
  • Pregnant or breastfeeding females.
  • Concurrent use of other anti-cancer agents or treatments.

Sites / Locations

  • Washington University
  • Hackensack University Medical Center
  • Wake Forest University Medical School
  • Ohio State University
  • Medical College of Wisconsin

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Cohort 1 - Lenalidomide daily on days 1-21

Cohort 2 - Lenalidomide daily on days 1-28

Arm Description

The first group of participants will be assigned to Cohort 1 and if no unacceptable toxicities occur in Cohort 1 then the second group of participants will be assigned to Cohort 2 Lenalidomide 25 mg per day PO daily on days 1-21 of a 28 day cycle.

The first group of participants will be assigned to Cohort 1 and if no unacceptable toxicities occur in Cohort 1 then the second group of participants will be assigned to Cohort 2 Lenalidomide 25 mg per day PO daily on days 1-28 of a 28 day cycle.

Outcomes

Primary Outcome Measures

Objective Overall Response Rate (ORR) in Relapsed or Refractory cHL.
Overall response rate = CR + PR Definitions per 2007 Cheson Lymphoma Response Criteria

Secondary Outcome Measures

Safety and Tolerability of Lenalidomide Therapy as Measured by the Number of Participants Who Experience Each Adverse Event (Grade 3 or 4 Adverse Events Only) Refractory cHL.
Adverse events were graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 The higher the grade the worse the adverse event was considered
Cytostatic Overall Response Rate
Cytostatic overall response rate = CR + PR + SD greater than or equal to 6 months Definitions per 2007 Cheson Lymphoma Response Criteria
Participant Response Rate in Relapsed or Refractory cHL.
-Definitions per 2007 Cheson Lymphoma Response Criteria
Time to Progression (TTP).
-Time to progression (TTP) is defined as the time from study entry until documented lymphoma progression or death as a result of lymphoma.
Overall Survival (OS)
Overall survival is defined as the time from entry onto the clinical trial until death as a result of any cause.
Relapse Free Survival (RFS)
Event Free Survival (EFS).
-Event-free survival (time to treatment failure) is measured from the time from study entry to any treatment failure including disease progression, or discontinuation of treatment for any reason (eg, disease progression, toxicity, patient preference, initiation of new treatment without documented progression, or death).
Duration of Response
-Duration of response: defined as the interval from the date of response (CR or PR) is documented to the date of progression, taking as reference the smallest measurements recorded since the treatment started

Full Information

First Posted
October 4, 2007
Last Updated
October 5, 2017
Sponsor
Washington University School of Medicine
Collaborators
Celgene Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT00540007
Brief Title
Lenalidomide in Relapsed or Refractory Classical Hodgkin Lymphoma
Official Title
A Phase II Multicenter Study of Lenalidomide in Relapsed or Refractory Classical Hodgkin Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2017
Overall Recruitment Status
Completed
Study Start Date
September 6, 2007 (Actual)
Primary Completion Date
September 1, 2016 (Actual)
Study Completion Date
September 1, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
Celgene Corporation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine the efficacy of lenalidomide in the treatment of relapsed or refractory classic Hodgkin lymphoma(cHL).
Detailed Description
Hodgkin lymphoma (HL), an uncommon but significant subtype of lymphoma, is divided into classical HL (cHL) and nodular lymphocyte predominant HL (NLPHL). Progress has been made in cHL therapy resulting in 5-year failure free survival rates between 61%-89% even in the setting of advanced stage or bulky disease. Patients who relapse however, have a variable prognosis ranging from a 8-year overall survival rate of less than 8% for patients who never achieve a remission to 54% for patients with a complete remission lasting greater than 12 months. High dose chemotherapy with autologous stem cell support is the standard of care for patients with relapsed cHL but for those that relapse despite aggressive salvage therapy 20 - 50%, with median remission durations of approximately 6 months. Furthermore, a subset of relapsed HL patients may not be candidates for aggressive salvage regimens. These novel salvage therapies are needed for relapsed/refractory cHL, especially agents without serious late toxicities are particularly attractive in this disease. Advances in the understanding of HL pathogenesis and lenalidomide's mechanisms of action provide substantial rationale for evaluating lenalidomide in HL patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hodgkin Disease
Keywords
Hodgkin Lymphoma, Lenalidomide, Anti-neoplastic agents, Thalidomide

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
80 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1 - Lenalidomide daily on days 1-21
Arm Type
Experimental
Arm Description
The first group of participants will be assigned to Cohort 1 and if no unacceptable toxicities occur in Cohort 1 then the second group of participants will be assigned to Cohort 2 Lenalidomide 25 mg per day PO daily on days 1-21 of a 28 day cycle.
Arm Title
Cohort 2 - Lenalidomide daily on days 1-28
Arm Type
Experimental
Arm Description
The first group of participants will be assigned to Cohort 1 and if no unacceptable toxicities occur in Cohort 1 then the second group of participants will be assigned to Cohort 2 Lenalidomide 25 mg per day PO daily on days 1-28 of a 28 day cycle.
Intervention Type
Drug
Intervention Name(s)
Lenalidomide
Other Intervention Name(s)
Revlimid, CC-5013
Primary Outcome Measure Information:
Title
Objective Overall Response Rate (ORR) in Relapsed or Refractory cHL.
Description
Overall response rate = CR + PR Definitions per 2007 Cheson Lymphoma Response Criteria
Time Frame
Through 3.5 years from study entry or until disease progression
Secondary Outcome Measure Information:
Title
Safety and Tolerability of Lenalidomide Therapy as Measured by the Number of Participants Who Experience Each Adverse Event (Grade 3 or 4 Adverse Events Only) Refractory cHL.
Description
Adverse events were graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 The higher the grade the worse the adverse event was considered
Time Frame
30 days following the completion of treatment
Title
Cytostatic Overall Response Rate
Description
Cytostatic overall response rate = CR + PR + SD greater than or equal to 6 months Definitions per 2007 Cheson Lymphoma Response Criteria
Time Frame
From 6 months through 3.5 years after study entry
Title
Participant Response Rate in Relapsed or Refractory cHL.
Description
-Definitions per 2007 Cheson Lymphoma Response Criteria
Time Frame
Through 3.5 years from study entry or until disease progression
Title
Time to Progression (TTP).
Description
-Time to progression (TTP) is defined as the time from study entry until documented lymphoma progression or death as a result of lymphoma.
Time Frame
Through 3.5 years from study entry or until disease progression
Title
Overall Survival (OS)
Description
Overall survival is defined as the time from entry onto the clinical trial until death as a result of any cause.
Time Frame
Through 3.5 years from study entry or until disease progression
Title
Relapse Free Survival (RFS)
Time Frame
Through 3.5 years from study entry or until disease progression
Title
Event Free Survival (EFS).
Description
-Event-free survival (time to treatment failure) is measured from the time from study entry to any treatment failure including disease progression, or discontinuation of treatment for any reason (eg, disease progression, toxicity, patient preference, initiation of new treatment without documented progression, or death).
Time Frame
Through 3.5 years from study entry or until disease progression
Title
Duration of Response
Description
-Duration of response: defined as the interval from the date of response (CR or PR) is documented to the date of progression, taking as reference the smallest measurements recorded since the treatment started
Time Frame
Through 3.5 years from study entry or until disease progression

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically documented classical Hodgkin lymphoma that is recurrent or refractory to standard chemotherapy. Patients must have relapsed or progressed after at least one prior systemic cytotoxic chemotherapy; prior autologous or allogeneic stem cell transplantation is allowed. Measurable disease must be present either on physical examination or imaging studies (CT, MRI, PET/CT). Any tumor mass greater or equal to 1 cm is acceptable. Age > 18 years old. ECOG performance status of less than or equal to 2 at study entry Adequate hematologic, renal, hepatic function as defined by: Absolute neutrophil count greater than or equal to 1000 / uL Platelets greater than or equal to 50,000 / uL Serum creatinine less than or equal to 1.5X institution upper limit of normal (ULN) Total bilirubin less than or equal to 2.0 mg/dL AST (SGOT) and ALT (SGPT) less than or equal to 3 x ULN (if not attributed to cHL) Disease free of prior malignancies for greater than or equal to 5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast. Understand and voluntarily sign an informed consent form. Able to adhere to the study visit schedule and other protocol requirements Females of childbearing potential (FCBP)† must agree to use two reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse during the following time periods related to this study: 1) for at least 28 days before starting study drug; 2) while participating in the study; and 3) for at least 28 days after discontinuation from the study. The two methods of reliable contraception must include one highly effective method (i.e. intrauterine device (IUD), hormonal [birth control pills, injections, or implants], tubal ligation, partner's vasectomy) and one additional effective (barrier) method (i.e. latex condom, diaphragm, cervical cap). FCBP must be referred to a qualified provider of contraceptive methods if needed. FCBP must have two negative serum or urine pregnancy tests (sensitivity of at least 50 mIU/mL) prior to starting study drug. The first pregnancy test must be performed within 10-14 days prior to the start of study drug and the second pregnancy test must be performed within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days as required by RevAssist) and 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. The subject may not receive study drug until the Investigator has verified that the results of these pregnancy tests are negative. Men must agree to use a latex condom during sexual contact with females of childbearing potential while participating in the study and for at least 28 days following discontinuation from the study even if he has undergone a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure. Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA may use warfarin or low molecular weight All study participants must be registered into the mandatory RevAssist program, and be willing and able to comply with the requirements of RevAssist. Exclusion Criteria: Patients who are candidates for high dose chemotherapy and stem cell transplantation and have not yet undergone stem cell transplantation should not be enrolled. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form. Any condition, including the presence of laboratory abnormalities. Use of any other anti-cancer drug or therapy, including experimental, within 30 days of enrollment. Known hypersensitivity to thalidomide. The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs. Any prior use of lenalidomide. Known positive for HIV or infectious hepatitis, type A, B or C. Pregnant or breastfeeding females. Concurrent use of other anti-cancer agents or treatments.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Todd Fehniger, M.D., Ph.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Hackensack University Medical Center
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Facility Name
Wake Forest University Medical School
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Facility Name
Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43221
Country
United States
Facility Name
Medical College of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
15057291
Citation
Bartlett JB, Dredge K, Dalgleish AG. The evolution of thalidomide and its IMiD derivatives as anticancer agents. Nat Rev Cancer. 2004 Apr;4(4):314-22. doi: 10.1038/nrc1323. No abstract available.
Results Reference
background
PubMed Identifier
21937701
Citation
Fehniger TA, Larson S, Trinkaus K, Siegel MJ, Cashen AF, Blum KA, Fenske TS, Hurd DD, Goy A, Schneider SE, Keppel CR, Wagner-Johnston ND, Carson KR, Bartlett NL. A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood. 2011 Nov 10;118(19):5119-25. doi: 10.1182/blood-2011-07-362475. Epub 2011 Sep 21.
Results Reference
derived
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Learn more about this trial

Lenalidomide in Relapsed or Refractory Classical Hodgkin Lymphoma

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