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A Pilot Study of Oral Vorinostat Plus Oral Eltrombopag Support in Patients With Lymphoma (VEIL) (VEIL)

Primary Purpose

Follicular Lymphoma, Marginal Zone Lymphoma, Mantle Cell Lymphoma

Status
Terminated
Phase
Phase 2
Locations
Australia
Study Type
Interventional
Intervention
Eltrombopag and Vorinostat
Sponsored by
Peter MacCallum Cancer Centre, Australia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Follicular Lymphoma focused on measuring Follicular lymphoma, Marginal zone lymphoma, Mantle cell lymphoma, thrombocytopenia, eltrombopag, vorinostat, lymphoma

Eligibility Criteria

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

Inclusion Criteria:

  • Age 18years or older
  • T-cell lymphoma involving the skin or patients with relapsed/refractory follicular lymphoma (FL), marginal zone lymphoma (MZL), or mantle cell lymphoma (MCL). Disease must have been confirmed by previous histology and must be measurable
  • For patients with cutaneous T-cell lymphoma: At least 2 prior systemic therapies (including 1 month of therapy with systemic steroids >25mg alternating days of prednisolone or equivalent, or total skin electron-beam radiotherapy). For patients with B cell lymphoma, prior exposure to a chemotherapy regimen is required, unless the patient is deemed to be unfit for conventional chemo-therapeutic regimens.
  • Adequate haematological function: ANC ≥ 1.0x109/L
  • Adequate renal function (serum creatinine clearance calculated as CrCl ≥30mL/min (perform 24hr urine creatinine clearance if serum creatinine is >1.5xULN);electrolyte levels ≥ LLN (i.e.: potassium, total calcium [corrected for serum albumin], magnesium and phosphorus) or correctable with supplements)
  • Adequate hepatic function:AST and ALT ≤ 2.5 x ULN (or ≤ 5.0 x ULN if liver infiltration;Serum bilirubin ≤ 1.5 x ULN
  • Life expectancy ≥ 12 weeks
  • Written informed consent obtained prior to any study specific screening procedures
  • ECOG performance status grade 0-2
  • Ability to comply with adequate contraception in patients of childbearing potential.
  • Females of childbearing potential must have had a negative urine pregnancy test at screening and agree to use a medically reliable method of preventing conception throughout the study and for 30 days following the date of last dose.
  • Males with a female partner of childbearing potential must agree to use a medically reliable method of preventing conception throughout the study and for 30 days following the date of last dose.
  • Mentally competent and is able to understand the information given and provide informed consent.

Exclusion Criteria:

  • Known uncontrolled medical conditions which may compromise participation in this study including but not limited to:Poorly controlled congestive heart failure: ejection fraction <30% measured in past 6 months) or NYHA class IV;Unstable angina or an ischaemic cardiac event requiring hospital admission in the previous 12 months.
  • Concomitant use of another HDAC inhibitor, including sodium valproate.
  • GI disease that may significantly alter the absorption of eltrombopag
  • Subjects known to be seropositive for HIV, Hepatitis B or Hepatitis C.
  • Current participation in other trials or studies of medical therapeutic interventions.
  • Known pro-thrombotic condition as defined by a history ≥1 unprovoked deep venous thrombosis or pulmonary embolism, or any DVT/PE with a procoagulant condition screen suggesting the presence of a procoagulant condition (prothrombin gene mutation homozygosity, factor V Leiden homozygosity, antithrombin deficiency, lupus anticoagulant syndrome).
  • History of ischaemic neurological event (TIA or stroke) within the preceding 2 years.
  • Active or uncontrolled infection, other than cutaneous infection.
  • Prior diagnosis of cancer that was:more than 5 years prior to current diagnosis with subsequent evidence of disease recurrence or estimated clinical expectation of recurrence is greater than 10% within next 2 years;within 5 years of current diagnosis with the exception of successfully treated basal cell or squamous cell skin carcinoma, carcinoma in situ of the cervix or localised cancer treated curatively with local therapy only
  • Use of another anti-cancer treatment within 21 days of starting vorinostat, with the exception of steroids, interferon or oral methotrexate which have been at a stable dose for at least 4 weeks prior to day 1.

Sites / Locations

  • Peter MacCallum Cancer Centre

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Eltrombopag and vorinostat combination therapy

Arm Description

Daily oral intake of 400mg vorinostat if necessary with combination therapy eltrombopag commencing at 50mg per day increasing to a maximum of 200mg per day

Outcomes

Primary Outcome Measures

The occurrence of all grade III/IV adverse events (haematological and non haematological) during vorinostat and eltrombopag combination therapy
The period of observation for the primary endpoint is defined as the observation for 6 cycles of eligible patients who have commencement eltrombopag following commencement of vorinostat.

Secondary Outcome Measures

Occurrence of thrombocytopenia (TCP) with vorinostat therapy and response to eltrombopag: platelet, transfusion and bleeding endpoints
Occurrence & severity of thrombocytopenia (TCP), all grades at baseline & during first 6 vorinostat cycles. Occurrence & severity of worsening grade of TCP (relative to day 1 cycle 1 of vorinostat therapy) after cycle 1 day 8. Occurrence & severity of TCP following withdrawal of eltrombopag in patients who had protocol-specified withdrawal of eltrombopag. Occurrence of platelet response, defined as a cycle nadir platelet count showing a 50% improvement in platelet nadir compared to previous cycle & at least an absolute increase of 20x109/L. Occurrence of grade III/IV TCP during vorinostat treatment cycle among patients who experience a platelet nadir ≤25 x109/L, receive eltrombopag & who then achieve a platelet response. Percentage drop in platelet count from day 1 of cycle to nadir & percentage drop in neutrophil count from day 1 of cycle to nadir, for each cycle. Occurrence & severity of clinically significant bleeding events defined as per the WHO bleeding scale.

Full Information

First Posted
December 22, 2011
Last Updated
February 12, 2016
Sponsor
Peter MacCallum Cancer Centre, Australia
Collaborators
GlaxoSmithKline, Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT01500538
Brief Title
A Pilot Study of Oral Vorinostat Plus Oral Eltrombopag Support in Patients With Lymphoma (VEIL)
Acronym
VEIL
Official Title
A Pilot Study of Oral Vorinostat Plus Oral Eltrombopag Support in Patients With Lymphoma (VEIL)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2012
Overall Recruitment Status
Terminated
Why Stopped
Poor recruitment rate
Study Start Date
October 2012 (undefined)
Primary Completion Date
May 2013 (Actual)
Study Completion Date
May 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Peter MacCallum Cancer Centre, Australia
Collaborators
GlaxoSmithKline, Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Vorinostat is a drug (Histone Deacetylase Inhibitor [HDACi]) administered orally that has been approved in United States for the patients with cutaneous Tcell lymphoma (CTCL) who have progressive, persistent or recurrent disease on or following two systemic therapies. In the early period of treatment with vorinostat, some patients may experience low platelet counts. Therefore this study will be examining the combination of these two medications (Vorinostat and eltrombopag) to assess if eltrombopag can overcome the low platelets during treatment with vorinostat. Eltrombopag is a drug administered orally designed to mimic the protein thrombopoietin, which causes the body to make more platelets. Eltrombopag has been registered in Australia and approved overseas to treat patients with chronic ITP (Immune Thrombocytopenia Purpura) a disease where patients destroy their own platelets very rapidly and thus develop low platelet count) but it is not registered and it is not yet known whether eltrombopag can increase platelet counts in patients treated with the HDACi. The aim of this project is to test whether Vorinostat and eltrombopag can be safely combined, and to test whether they are effective in participants with T-cell lymphoma involving the skin or patients with relapsed/refractory follicular lymphoma (FL), marginal zone lymphoma (MZL), or mantle cell lymphoma (MCL) A total of 25 people with Cutaneous T cell lymphoma/ CTCL, marginal zone lymphoma, follicular lymphoma or mantle cell lymphoma will be recruited in this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Follicular Lymphoma, Marginal Zone Lymphoma, Mantle Cell Lymphoma
Keywords
Follicular lymphoma, Marginal zone lymphoma, Mantle cell lymphoma, thrombocytopenia, eltrombopag, vorinostat, 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
1 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Eltrombopag and vorinostat combination therapy
Arm Type
Experimental
Arm Description
Daily oral intake of 400mg vorinostat if necessary with combination therapy eltrombopag commencing at 50mg per day increasing to a maximum of 200mg per day
Intervention Type
Drug
Intervention Name(s)
Eltrombopag and Vorinostat
Other Intervention Name(s)
Revolade (eltrombopag), Zolinza (vorinostat)
Intervention Description
4 week mono-therapy eltrombopag, commencing at 50mg/day, increasing to 200mg. Daily intake of 400mg vorinostat for minimum of 6 cycles, each cycle of 4 weeks, possibly in combination with daily intake eltrombopag commencing at 50mg/day at a maximum dose of 200md/day (150mg/day for subjects of East-Asian ancestry)
Primary Outcome Measure Information:
Title
The occurrence of all grade III/IV adverse events (haematological and non haematological) during vorinostat and eltrombopag combination therapy
Description
The period of observation for the primary endpoint is defined as the observation for 6 cycles of eligible patients who have commencement eltrombopag following commencement of vorinostat.
Time Frame
One year from trial entry
Secondary Outcome Measure Information:
Title
Occurrence of thrombocytopenia (TCP) with vorinostat therapy and response to eltrombopag: platelet, transfusion and bleeding endpoints
Description
Occurrence & severity of thrombocytopenia (TCP), all grades at baseline & during first 6 vorinostat cycles. Occurrence & severity of worsening grade of TCP (relative to day 1 cycle 1 of vorinostat therapy) after cycle 1 day 8. Occurrence & severity of TCP following withdrawal of eltrombopag in patients who had protocol-specified withdrawal of eltrombopag. Occurrence of platelet response, defined as a cycle nadir platelet count showing a 50% improvement in platelet nadir compared to previous cycle & at least an absolute increase of 20x109/L. Occurrence of grade III/IV TCP during vorinostat treatment cycle among patients who experience a platelet nadir ≤25 x109/L, receive eltrombopag & who then achieve a platelet response. Percentage drop in platelet count from day 1 of cycle to nadir & percentage drop in neutrophil count from day 1 of cycle to nadir, for each cycle. Occurrence & severity of clinically significant bleeding events defined as per the WHO bleeding scale.
Time Frame
One year from trial entry

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18years or older T-cell lymphoma involving the skin or patients with relapsed/refractory follicular lymphoma (FL), marginal zone lymphoma (MZL), or mantle cell lymphoma (MCL). Disease must have been confirmed by previous histology and must be measurable For patients with cutaneous T-cell lymphoma: At least 2 prior systemic therapies (including 1 month of therapy with systemic steroids >25mg alternating days of prednisolone or equivalent, or total skin electron-beam radiotherapy). For patients with B cell lymphoma, prior exposure to a chemotherapy regimen is required, unless the patient is deemed to be unfit for conventional chemo-therapeutic regimens. Adequate haematological function: ANC ≥ 1.0x109/L Adequate renal function (serum creatinine clearance calculated as CrCl ≥30mL/min (perform 24hr urine creatinine clearance if serum creatinine is >1.5xULN);electrolyte levels ≥ LLN (i.e.: potassium, total calcium [corrected for serum albumin], magnesium and phosphorus) or correctable with supplements) Adequate hepatic function:AST and ALT ≤ 2.5 x ULN (or ≤ 5.0 x ULN if liver infiltration;Serum bilirubin ≤ 1.5 x ULN Life expectancy ≥ 12 weeks Written informed consent obtained prior to any study specific screening procedures ECOG performance status grade 0-2 Ability to comply with adequate contraception in patients of childbearing potential. Females of childbearing potential must have had a negative urine pregnancy test at screening and agree to use a medically reliable method of preventing conception throughout the study and for 30 days following the date of last dose. Males with a female partner of childbearing potential must agree to use a medically reliable method of preventing conception throughout the study and for 30 days following the date of last dose. Mentally competent and is able to understand the information given and provide informed consent. Exclusion Criteria: Known uncontrolled medical conditions which may compromise participation in this study including but not limited to:Poorly controlled congestive heart failure: ejection fraction <30% measured in past 6 months) or NYHA class IV;Unstable angina or an ischaemic cardiac event requiring hospital admission in the previous 12 months. Concomitant use of another HDAC inhibitor, including sodium valproate. GI disease that may significantly alter the absorption of eltrombopag Subjects known to be seropositive for HIV, Hepatitis B or Hepatitis C. Current participation in other trials or studies of medical therapeutic interventions. Known pro-thrombotic condition as defined by a history ≥1 unprovoked deep venous thrombosis or pulmonary embolism, or any DVT/PE with a procoagulant condition screen suggesting the presence of a procoagulant condition (prothrombin gene mutation homozygosity, factor V Leiden homozygosity, antithrombin deficiency, lupus anticoagulant syndrome). History of ischaemic neurological event (TIA or stroke) within the preceding 2 years. Active or uncontrolled infection, other than cutaneous infection. Prior diagnosis of cancer that was:more than 5 years prior to current diagnosis with subsequent evidence of disease recurrence or estimated clinical expectation of recurrence is greater than 10% within next 2 years;within 5 years of current diagnosis with the exception of successfully treated basal cell or squamous cell skin carcinoma, carcinoma in situ of the cervix or localised cancer treated curatively with local therapy only Use of another anti-cancer treatment within 21 days of starting vorinostat, with the exception of steroids, interferon or oral methotrexate which have been at a stable dose for at least 4 weeks prior to day 1.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Dickinson, MBBS (Hons), FRCPA
Organizational Affiliation
Peter MacCallum Cancer Centre, Australia
Official's Role
Principal Investigator
Facility Information:
Facility Name
Peter MacCallum Cancer Centre
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3002
Country
Australia

12. IPD Sharing Statement

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A Pilot Study of Oral Vorinostat Plus Oral Eltrombopag Support in Patients With Lymphoma (VEIL)

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