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Ofatumumab Added to Dexamethasone in Subjects With Relapsed or Refractory Chronic Lymphocytic Leukemia

Primary Purpose

Chronic Lymphocytic Leukemia

Status
Completed
Phase
Phase 2
Locations
Czech Republic
Study Type
Interventional
Intervention
ofatumumab plus dexamethasone
Sponsored by
Brno University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Lymphocytic Leukemia focused on measuring Chronic Lymphocytic Leukemia, Refractory, Relapse, Ofatumumab, Dexamethasone

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female previously treated patients with B-cell CLL requiring therapy according to the revised NCI criteria (including CLL patients with immune-mediated hemolysis or thrombocytopenia).
  • Flow cytometry confirmation of CLL immunophenotype with CD5, CD19, CD20, CD23, CD79b, and surface Ig at screening.
  • Disease recurrence (or refractory disease) after at least one fludarabine-containing regimen, or after at least two previous chemotherapy regimens without fludarabine; and/or poor marrow reserve not allowing chemotherapy administration (Absolute Neutrophil Count < 1.0 x 109/L and/or Absolute Platelet Count < 50 x 109/L).
  • Age ≥ 18 years old.
  • Signed written informed consent.
  • Life expectancy > 3 months.
  • ECOG performance status ≤ 2.
  • CT scan performed.

Exclusion Criteria:

  • Active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment).
  • Treatment with any known non-marketed drug substance or experimental therapy within 5 terminal half lives or 4 weeks prior to enrollment, whichever is longer, or currently participating in any other interventional clinical study.
  • Other past or current malignancy. Subjects who have been free of malignancy for at least 5 years, or have a history of completely resected non-melanoma skin cancer, or successfully treated in situ carcinoma are eligible.
  • Prior treatment with anti-CD20 monoclonal antibody or alemtuzumab within 3 months prior to start of therapy.
  • Chronic or current infectious disease requiring systemic antibiotics, antifungal, or antiviral treatment such as, but not limited to, chronic renal infection, chronic chest infection with bronchiectasis, tuberculosis and active Hepatitis C.
  • History of significant cerebrovascular disease in the past 6 months or ongoing event with active symptoms or sequelae.
  • Known HIV positive.
  • Clinically significant cardiac disease including unstable angina, acute myocardial infarction within six months prior to randomization, congestive heart failure (NYHA III-IV), and arrhythmia unless controlled by therapy, with the exception of extra systoles or minor conduction abnormalities.
  • Significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, gastrointestinal, endocrine, pulmonary, neurological, cerebral or psychiatric disease which in the opinion of the investigator may represent a risk for the patient.
  • Positive serology for Hepatitis B (HBV) defined as a positive test for HBsAg. In addition, if negative for HBsAg but HBcAb positive (regardless of HBsAb status), a HBV DNA test will be performed and if positive the subject will be excluded. See section 10.3.2.1 Hepatitis B screening.
  • Positive serology for hepatitis C (HCV) defined as a positive test for anti-HCVAb, in which case reflexively perform a HCV RIBA immunoblot assay on the same sample to confirm the result
  • Screening laboratory values:

    • creatinine > 2.0 times upper normal limit
    • total bilirubin >1.5 times upper normal limit (unless due to CLL involvement of liver or a known history of Gilbert's disease)
    • ALT > 2.5 times upper normal limit (unless due to disease involvement of liver)
    • alkaline phosphatase > 2.5 times upper normal limit (unless due to disease involvement of the liver or bone marrow)
  • Pregnant or lactating women. Women of childbearing potential must have a negative pregnancy test at screening.
  • Women of childbearing potential, including women whose last menstrual period was less than one year prior to screening, unable or unwilling to use adequate contraception from study start to one year after the last dose of protocol therapy.
  • Male subjects unable or unwilling to use adequate contraception methods from study start to one year after the last dose of protocol therapy.

Sites / Locations

  • University Hospital Brno, Department of Internal Medicine - Hematology and Oncology
  • University Hospital Hradec Králové, Department of clinical hematology
  • University Hospital Královské Vinohrady, Department of clinical hematology
  • Charles University in Prague and General University Hospital in Prague, 1st Department of medicine - Department of hematology

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ofatumumab plus dexamethasone

Arm Description

Outcomes

Primary Outcome Measures

Overall response rate (complete remission - CR, CRi; partial remission - PR)
The response (CR, CRi, PR rates) will be assessed at the end of therapy of every patient according to international guideline.

Secondary Outcome Measures

Safety profile of the combination of ofatumumab and dexamethasone
Safety of the treatment will be evaluated by: adverse events, laboratory tests, vital signs, electrocardiogram and performance status. The safety analysis population will include all subjects who receive at least one dose/infusion and a baseline safety assessment.
Time dependent parameters: progression-free survival (PFS); overall survival (OS).
PFS and OS will be summarized using Kaplan-Meier plots. Median and the corresponding 95% CI (using Greenwood's formula) will be provided as appropriate. In addition these will be compared with the corresponding plots of a previous study R-dex using one sample log-rank test as described in Finkelstein et al. (J Nat Cancer Inst, 2003).

Full Information

First Posted
March 7, 2011
Last Updated
February 1, 2015
Sponsor
Brno University Hospital
Collaborators
University Hospital Hradec Kralove, Faculty Hospital Kralovske Vinohrady, General Teaching Hospital, Prague
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1. Study Identification

Unique Protocol Identification Number
NCT01310101
Brief Title
Ofatumumab Added to Dexamethasone in Subjects With Relapsed or Refractory Chronic Lymphocytic Leukemia
Official Title
Ofatumumab Added to Dexamethasone in Subjects With Relapsed or Refractory Chronic Lymphocytic Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
February 2015
Overall Recruitment Status
Completed
Study Start Date
April 2011 (undefined)
Primary Completion Date
February 2015 (Actual)
Study Completion Date
February 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Brno University Hospital
Collaborators
University Hospital Hradec Kralove, Faculty Hospital Kralovske Vinohrady, General Teaching Hospital, Prague

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The rationale of the study is to explore the safety and efficacy of ofatumumab in combination with dexamethasone (O-dex regimen) in patients with refractory/relapsed CLL. Moreover, the hypothesis is that this approach will be able to achieve at least the same response rates compared with R-dex regimens (historical controls; manuscript submitted to Leukemia), while maintaining lower toxicity profile.
Detailed Description
This is an open-label, multi-center, non-randomized, phase II study to evaluate the safety and efficacy of ofatumumab added to dexamethasone in subjects with relapsed or refractory chronic lymphocytic leukemia. The treatment will be given for a minimum of 3 cycles, until the best response, or up to a maximum of 6 cycles. After completion of the treatment phase in all patients, survival and disease status assessments will be performed in 1 month post treatment, and then every 2 months for 3 years. The patient will be followed-up in the study for 3 years if there is no progression. Dose and schedule Cycle 1: Ofatumumab: 300 mg as an i.v. infusion on day 1 of the cycle Ofatumumab: 2000 mg as an i.v. infusion on days 8, 15, 22; Dexamethasone: 40 mg/day p.o., days 1-4 and 15-18; Cycles 2 to 6 (cycles every 28 days): Ofatumumab: 1000 mg i.v. infusion on day 1, 8, 15 and 22 of the cycle; Dexamethasone: 40 mg/day p.o., days 1-4 and 15-18. Response will be assessed according to the IWCLL guidelines. The investigator assessment of response and progression will be considered primary for all endpoints described in the study. Safety of the treatment will be evaluated by: adverse events, laboratory tests, vital signs, electrocardiogram and performance status. Study Endpoints Primary Endpoint: Overall response rate (CR, CRi, PR rates) Secondary Endpoints: Toxicity, tolerability, adverse events (these events will be assessed by investigator and by the independent reviewers at the key time-points) Overall survival Progression-free survival Time to response and duration of response Time to progression and time to next therapy Other/Exploratory Endpoints: Exploratory molecular genetic, immunophenotypic, cytogenetic and pharmacologic markers

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Lymphocytic Leukemia
Keywords
Chronic Lymphocytic Leukemia, Refractory, Relapse, Ofatumumab, Dexamethasone

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Ofatumumab plus dexamethasone
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
ofatumumab plus dexamethasone
Intervention Description
Dose and schedule Cycle 1: Ofatumumab: 300 mg as an i.v. infusion on day 1 of the cycle; Ofatumumab: 2000 mg as an i.v. infusion on days 8, 15, 22; Dexamethasone: 40 mg/day p.o., days 1-4 and 15-18 Cycles 2 to 6 (cycles every 28 days): Ofatumumab: 1000 mg i.v. infusion on day 1, 8, 15 and 22 of the cycle; Dexamethasone: 40 mg/day p.o., days 1-4 and 15-18
Primary Outcome Measure Information:
Title
Overall response rate (complete remission - CR, CRi; partial remission - PR)
Description
The response (CR, CRi, PR rates) will be assessed at the end of therapy of every patient according to international guideline.
Time Frame
Up to Week 24
Secondary Outcome Measure Information:
Title
Safety profile of the combination of ofatumumab and dexamethasone
Description
Safety of the treatment will be evaluated by: adverse events, laboratory tests, vital signs, electrocardiogram and performance status. The safety analysis population will include all subjects who receive at least one dose/infusion and a baseline safety assessment.
Time Frame
Up to Week 24
Title
Time dependent parameters: progression-free survival (PFS); overall survival (OS).
Description
PFS and OS will be summarized using Kaplan-Meier plots. Median and the corresponding 95% CI (using Greenwood's formula) will be provided as appropriate. In addition these will be compared with the corresponding plots of a previous study R-dex using one sample log-rank test as described in Finkelstein et al. (J Nat Cancer Inst, 2003).
Time Frame
Year 3 after treatment completion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female previously treated patients with B-cell CLL requiring therapy according to the revised NCI criteria (including CLL patients with immune-mediated hemolysis or thrombocytopenia). Flow cytometry confirmation of CLL immunophenotype with CD5, CD19, CD20, CD23, CD79b, and surface Ig at screening. Disease recurrence (or refractory disease) after at least one fludarabine-containing regimen, or after at least two previous chemotherapy regimens without fludarabine; and/or poor marrow reserve not allowing chemotherapy administration (Absolute Neutrophil Count < 1.0 x 109/L and/or Absolute Platelet Count < 50 x 109/L). Age ≥ 18 years old. Signed written informed consent. Life expectancy > 3 months. ECOG performance status ≤ 2. CT scan performed. Exclusion Criteria: Active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment). Treatment with any known non-marketed drug substance or experimental therapy within 5 terminal half lives or 4 weeks prior to enrollment, whichever is longer, or currently participating in any other interventional clinical study. Other past or current malignancy. Subjects who have been free of malignancy for at least 5 years, or have a history of completely resected non-melanoma skin cancer, or successfully treated in situ carcinoma are eligible. Prior treatment with anti-CD20 monoclonal antibody or alemtuzumab within 3 months prior to start of therapy. Chronic or current infectious disease requiring systemic antibiotics, antifungal, or antiviral treatment such as, but not limited to, chronic renal infection, chronic chest infection with bronchiectasis, tuberculosis and active Hepatitis C. History of significant cerebrovascular disease in the past 6 months or ongoing event with active symptoms or sequelae. Known HIV positive. Clinically significant cardiac disease including unstable angina, acute myocardial infarction within six months prior to randomization, congestive heart failure (NYHA III-IV), and arrhythmia unless controlled by therapy, with the exception of extra systoles or minor conduction abnormalities. Significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, gastrointestinal, endocrine, pulmonary, neurological, cerebral or psychiatric disease which in the opinion of the investigator may represent a risk for the patient. Positive serology for Hepatitis B (HBV) defined as a positive test for HBsAg. In addition, if negative for HBsAg but HBcAb positive (regardless of HBsAb status), a HBV DNA test will be performed and if positive the subject will be excluded. See section 10.3.2.1 Hepatitis B screening. Positive serology for hepatitis C (HCV) defined as a positive test for anti-HCVAb, in which case reflexively perform a HCV RIBA immunoblot assay on the same sample to confirm the result Screening laboratory values: creatinine > 2.0 times upper normal limit total bilirubin >1.5 times upper normal limit (unless due to CLL involvement of liver or a known history of Gilbert's disease) ALT > 2.5 times upper normal limit (unless due to disease involvement of liver) alkaline phosphatase > 2.5 times upper normal limit (unless due to disease involvement of the liver or bone marrow) Pregnant or lactating women. Women of childbearing potential must have a negative pregnancy test at screening. Women of childbearing potential, including women whose last menstrual period was less than one year prior to screening, unable or unwilling to use adequate contraception from study start to one year after the last dose of protocol therapy. Male subjects unable or unwilling to use adequate contraception methods from study start to one year after the last dose of protocol therapy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jiří Mayer, Prof., M.D.
Organizational Affiliation
University Hospital Brno, Department of Internal Medicine - Hematology and Oncology
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Michael Doubek, A.Prof.,M.D.
Organizational Affiliation
University Hospital Brno, Department of Internal Medicine - Hematology and Oncology
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Lukáš Smolej, M.D., Ph.D.
Organizational Affiliation
University Hospital Hradec Králové, Department of clinical hematology
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Tomáš Kozák, Doc.,M.D.
Organizational Affiliation
University Hospital Královské Vinohrady, Department of clinical hematology
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Petra Obrtlíková, M.D., Ph.D.
Organizational Affiliation
Charles University in Prague and General University Hospital in Prague, 1st Department of medicine - Department of hematology
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Brno, Department of Internal Medicine - Hematology and Oncology
City
Brno
ZIP/Postal Code
62500
Country
Czech Republic
Facility Name
University Hospital Hradec Králové, Department of clinical hematology
City
Hradec Králové
ZIP/Postal Code
50005
Country
Czech Republic
Facility Name
University Hospital Královské Vinohrady, Department of clinical hematology
City
Prague
ZIP/Postal Code
10034
Country
Czech Republic
Facility Name
Charles University in Prague and General University Hospital in Prague, 1st Department of medicine - Department of hematology
City
Prague
ZIP/Postal Code
12808
Country
Czech Republic

12. IPD Sharing Statement

Citations:
PubMed Identifier
25645263
Citation
Doubek M, Brychtova Y, Panovska A, Sebejova L, Stehlikova O, Chovancova J, Malcikova J, Smardova J, Plevova K, Volfova P, Trbusek M, Mraz M, Bakesova D, Trizuljak J, Hadrabova M, Obrtlikova P, Karban J, Smolej L, Oltova A, Jelinkova E, Pospisilova S, Mayer J. Ofatumumab added to dexamethasone in patients with relapsed or refractory chronic lymphocytic leukemia: Results from a phase II study. Am J Hematol. 2015 May;90(5):417-21. doi: 10.1002/ajh.23964. Epub 2015 Apr 1.
Results Reference
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Ofatumumab Added to Dexamethasone in Subjects With Relapsed or Refractory Chronic Lymphocytic Leukemia

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