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Imexon for Relapsed Follicular and Aggressive Lymphomas (ULYM11011)

Primary Purpose

Follicular Lymphoma, Small Lymphocytic Lymphoma, Marginal Zone Lymphoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Imexon
Sponsored by
University of Rochester
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Follicular Lymphoma focused on measuring Non Hodgkin's Lymphoma, Lymphoma, Low Grade, Lymphoma, Intermediate Grade, Lymphoma, High Grade, Lymphoma, B Cell

Eligibility Criteria

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

Inclusion Criteria:

  1. Diagnosis:

    Group 1: Histologically confirmed indolent NHL, including follicular (any grade), small lymphocytic lymphoma, marginal zone lymphoma and lymphoplasmacytic lymphomaGroup 2: histologically confirmed diffuse large B-cell, mantle cell, Burkitt, Burkitt-like, and diffuse large B-cell transformed from indolent non-Hodgkin's lymphoma.

  2. Prior treatment:

    Group 1: (indolent histologies): Patients must have demonstrated relapsed or refractory disease to 1 prior treatment regimen. The maximum number of prior regimens used for treatment is not specified.

    Group 2: (aggressive histologies): Patients must have demonstrated relapsed or refractory disease to at least 1 prior treatment regimen. In the case of de novo diffuse large B-cell lymphoma, prior treatment must include R-CHOP or R-CHOP-like therapy, as well as second line autologous stem cell transplantation unless the patient is not eligible. The maximum number of prior regimens is not specified.

  3. At least one target lesion, measurable by radiographic methods according to the 2007 Revised Response Criteria for Malignant Lymphoma.
  4. ECOG Performance Status 0-2.
  5. No clinical or laboratory evidence of central nervous system disease.
  6. Adult (age 18 years or older).
  7. Projected life expectancy >4 months.
  8. If female, neither pregnant (negative pregnancy test required at screening) nor lactating.
  9. If of child-bearing potential, must be able to use and agree to use medically acceptable contraception for the duration of the study. For female subjects who are neither post-menopausal nor surgically sterilized, this includes oral or injectable hormonal methods, barrier methods such as an intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence. Male subjects must also agree to use an acceptable method for contraception for the duration of the study.
  10. No major infection or serious uncontrolled concomitant disease. Fully recovered from any major surgery.
  11. No evidence of other concurrent active malignancy.
  12. At least 4 weeks since any prior cancer chemotherapy (2 weeks for corticosteroids), antibody therapy, or radiotherapy.
  13. Prior radiotherapy to less than an estimated 25% of the bone marrow. In addition, the target lesion(s) must not have been previously irradiated.
  14. Clinical laboratory values within the following limits:

    1. Hgb >/=10.0 g/dL
    2. Absolute neutrophil count ANC >/=1,500/mm3
    3. Platelets >/=75,000/mm3
    4. Serum creatinine </=2.0 times upper limit of normal
    5. Serum bilirubin </=2.0 times upper limit of normal
    6. Serum AST and ALT </=3 times upper limit of normal
  15. G6PD level >/= lower limit of normal
  16. Able and willing to render informed consent and to follow protocol requirements.

Exclusion Criteria:

  1. Diagnosis of lymphoma based on fine needle aspirate.
  2. Curative therapy is indicated or possible.
  3. Absence of a measurable target lesion, or the only target lesion was previously irradiated.
  4. Symptoms, exam findings, or laboratory findings to suggest central nervous system disease involvement.
  5. Age < 18 years
  6. Projected life expectancy <4 months.
  7. Pregnant or lactating.
  8. Unable or unwilling to use medically acceptable contraception, if of childbearing potential.
  9. Evidence of major infection or other serious uncontrolled concomitant illness. Not fully recovered from prior major surgery.
  10. Evidence of other active malignancy.
  11. Prior radiotherapy, antibody therapy, or cancer chemotherapy within 4 weeks before start of treatment (2 weeks for corticosteroids). Prior radiotherapy to >25% of the bone marrow.
  12. Clinical laboratory values outside of permitted ranges.
  13. Respiratory insufficiency requiring oxygen therapy; angina at rest, or myocardial infarction in previous 3 months; history of life threatening ventricular arrhythmia; uncompensated CHF or NYHA Grade 3 or 4 cardiac disease.
  14. Unable or unwilling to give informed consent and to follow protocol requirements.
  15. Failure to meet any of the eligibility criteria.

Sites / Locations

  • Arizona Cancer Center, University of Arizona
  • University of Rochester Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Imexon

Arm Description

Subjects will be treated on Days 1-5 of 21-day treatment cycles for up to one year. Following pre-treatment with anti-emetics Amplimexon will be given by intravenous infusion over 60 minutes.

Outcomes

Primary Outcome Measures

Overall Response Rate of of Participants to Imexon in the Treatment of Relapsed/Refractory Indolent and Aggressive Lymphomas
CT, PET, or MRI scans for the assessment of objective tumor responses were performed at baseline, after cycle 2, and every 3 cycles thereafter until disease progression. Standard response criteria from the International Harmonization Project on Lymphoma were used for classification of objective tumor responses. Response was defined as PR (Regression of measuable disease and no new sites) if >= 50% decrease in sum of the product of the diameters of up to 6 largest dominant masses; no increase in size of other nodes (a) [18F]fluorodeoxyglucose (FDG)-avid or PET prior to therapy; one or more (PET) positive at previously involved site (b) Variably FDG-avid or PET negative; regression on CT.

Secondary Outcome Measures

Median Time to Progression Free Survival in Participants With Relapsed/Refractory Indolent and Aggressive Lymphomas
Measured from start of treatment until disease progression or death from any cause.

Full Information

First Posted
March 10, 2011
Last Updated
December 4, 2015
Sponsor
University of Rochester
Collaborators
University of Arizona
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1. Study Identification

Unique Protocol Identification Number
NCT01314014
Brief Title
Imexon for Relapsed Follicular and Aggressive Lymphomas
Acronym
ULYM11011
Official Title
A Phase II Study of Amplimexon® (Imexon for Injection) for the Treatment of Previously Treated Follicular and Aggressive Lymphoma in Adults
Study Type
Interventional

2. Study Status

Record Verification Date
December 2015
Overall Recruitment Status
Completed
Study Start Date
May 2011 (undefined)
Primary Completion Date
March 2013 (Actual)
Study Completion Date
August 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Rochester
Collaborators
University of Arizona

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine whether Amplimexon (imexon for injection) is effective in the treatment of indolent and aggressive lymphomas that have progressed after treatment with standard therapies.
Detailed Description
A phase II exploratory trial of imexon in lymphoma is justified by: (1) the observation of clinical activity (partial response to the drug observed in phase I testing in a subject with refractory indolent lymphoma); (2) the finding that imexon prevents the development of human immunoblastic lymphoma in SCID mice; (3) the finding that lymphoma cell lines are killed by readily achievable doses; and (4) translational studies implicating the importance of the redox state of the cancer cell. The dose and schedule chosen (1000 mg/m2 daily X 5 days every 3 weeks) is based on tolerability and subject acceptance in prior AmpliMed phase I studies. The planned correlative studies should help to identify potential biomarkers for response to imexon and provide further insight into potential mechanisms of imexon action hypothesized from results of prior laboratory studies.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Follicular Lymphoma, Small Lymphocytic Lymphoma, Marginal Zone Lymphoma, Lymphoplasmacytic Lymphoma, Diffuse Large B Cell Lymphoma, Mantle Cell Lymphoma, Burkitt's Lymphoma
Keywords
Non Hodgkin's Lymphoma, Lymphoma, Low Grade, Lymphoma, Intermediate Grade, Lymphoma, High Grade, Lymphoma, B Cell

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Imexon
Arm Type
Experimental
Arm Description
Subjects will be treated on Days 1-5 of 21-day treatment cycles for up to one year. Following pre-treatment with anti-emetics Amplimexon will be given by intravenous infusion over 60 minutes.
Intervention Type
Drug
Intervention Name(s)
Imexon
Other Intervention Name(s)
Amplimexon (imexon for injection)
Intervention Description
Amplimexon will be administered daily on Days 1-5 of 21-day treatment cycles as an intravenous infusion over a time course of 60 minutes. Subjects will receive 17 cycles of therapy for a total of one year on treatment. The Amplimexon starting dose for each subject in this study is 1000 mg/m² on each treatment day. Dose may be reduced by 25% for toxicity; after 2 dose reductions, subjects must be withdrawn from treatment.
Primary Outcome Measure Information:
Title
Overall Response Rate of of Participants to Imexon in the Treatment of Relapsed/Refractory Indolent and Aggressive Lymphomas
Description
CT, PET, or MRI scans for the assessment of objective tumor responses were performed at baseline, after cycle 2, and every 3 cycles thereafter until disease progression. Standard response criteria from the International Harmonization Project on Lymphoma were used for classification of objective tumor responses. Response was defined as PR (Regression of measuable disease and no new sites) if >= 50% decrease in sum of the product of the diameters of up to 6 largest dominant masses; no increase in size of other nodes (a) [18F]fluorodeoxyglucose (FDG)-avid or PET prior to therapy; one or more (PET) positive at previously involved site (b) Variably FDG-avid or PET negative; regression on CT.
Time Frame
One year
Secondary Outcome Measure Information:
Title
Median Time to Progression Free Survival in Participants With Relapsed/Refractory Indolent and Aggressive Lymphomas
Description
Measured from start of treatment until disease progression or death from any cause.
Time Frame
up to 25 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis: Group 1: Histologically confirmed indolent NHL, including follicular (any grade), small lymphocytic lymphoma, marginal zone lymphoma and lymphoplasmacytic lymphomaGroup 2: histologically confirmed diffuse large B-cell, mantle cell, Burkitt, Burkitt-like, and diffuse large B-cell transformed from indolent non-Hodgkin's lymphoma. Prior treatment: Group 1: (indolent histologies): Patients must have demonstrated relapsed or refractory disease to 1 prior treatment regimen. The maximum number of prior regimens used for treatment is not specified. Group 2: (aggressive histologies): Patients must have demonstrated relapsed or refractory disease to at least 1 prior treatment regimen. In the case of de novo diffuse large B-cell lymphoma, prior treatment must include R-CHOP or R-CHOP-like therapy, as well as second line autologous stem cell transplantation unless the patient is not eligible. The maximum number of prior regimens is not specified. At least one target lesion, measurable by radiographic methods according to the 2007 Revised Response Criteria for Malignant Lymphoma. ECOG Performance Status 0-2. No clinical or laboratory evidence of central nervous system disease. Adult (age 18 years or older). Projected life expectancy >4 months. If female, neither pregnant (negative pregnancy test required at screening) nor lactating. If of child-bearing potential, must be able to use and agree to use medically acceptable contraception for the duration of the study. For female subjects who are neither post-menopausal nor surgically sterilized, this includes oral or injectable hormonal methods, barrier methods such as an intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence. Male subjects must also agree to use an acceptable method for contraception for the duration of the study. No major infection or serious uncontrolled concomitant disease. Fully recovered from any major surgery. No evidence of other concurrent active malignancy. At least 4 weeks since any prior cancer chemotherapy (2 weeks for corticosteroids), antibody therapy, or radiotherapy. Prior radiotherapy to less than an estimated 25% of the bone marrow. In addition, the target lesion(s) must not have been previously irradiated. Clinical laboratory values within the following limits: Hgb >/=10.0 g/dL Absolute neutrophil count ANC >/=1,500/mm3 Platelets >/=75,000/mm3 Serum creatinine </=2.0 times upper limit of normal Serum bilirubin </=2.0 times upper limit of normal Serum AST and ALT </=3 times upper limit of normal G6PD level >/= lower limit of normal Able and willing to render informed consent and to follow protocol requirements. Exclusion Criteria: Diagnosis of lymphoma based on fine needle aspirate. Curative therapy is indicated or possible. Absence of a measurable target lesion, or the only target lesion was previously irradiated. Symptoms, exam findings, or laboratory findings to suggest central nervous system disease involvement. Age < 18 years Projected life expectancy <4 months. Pregnant or lactating. Unable or unwilling to use medically acceptable contraception, if of childbearing potential. Evidence of major infection or other serious uncontrolled concomitant illness. Not fully recovered from prior major surgery. Evidence of other active malignancy. Prior radiotherapy, antibody therapy, or cancer chemotherapy within 4 weeks before start of treatment (2 weeks for corticosteroids). Prior radiotherapy to >25% of the bone marrow. Clinical laboratory values outside of permitted ranges. Respiratory insufficiency requiring oxygen therapy; angina at rest, or myocardial infarction in previous 3 months; history of life threatening ventricular arrhythmia; uncompensated CHF or NYHA Grade 3 or 4 cardiac disease. Unable or unwilling to give informed consent and to follow protocol requirements. Failure to meet any of the eligibility criteria.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul M Barr, MD
Organizational Affiliation
University of Rochester
Official's Role
Principal Investigator
Facility Information:
Facility Name
Arizona Cancer Center, University of Arizona
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
University of Rochester Medical Center
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
17242396
Citation
Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, Coiffier B, Fisher RI, Hagenbeek A, Zucca E, Rosen ST, Stroobants S, Lister TA, Hoppe RT, Dreyling M, Tobinai K, Vose JM, Connors JM, Federico M, Diehl V; International Harmonization Project on Lymphoma. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007 Feb 10;25(5):579-86. doi: 10.1200/JCO.2006.09.2403. Epub 2007 Jan 22.
Results Reference
result
PubMed Identifier
25016003
Citation
Barr PM, Miller TP, Friedberg JW, Peterson DR, Baran AM, Herr M, Spier CM, Cui H, Roe DJ, Persky DO, Casulo C, Littleton J, Schwartz M, Puvvada S, Landowski TH, Rimsza LM, Dorr RT, Fisher RI, Bernstein SH, Briehl MM. Phase 2 study of imexon, a prooxidant molecule, in relapsed and refractory B-cell non-Hodgkin lymphoma. Blood. 2014 Aug 21;124(8):1259-65. doi: 10.1182/blood-2014-04-570044. Epub 2014 Jul 11.
Results Reference
derived

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Imexon for Relapsed Follicular and Aggressive Lymphomas

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