Clinical Trial to Evaluate R-COMP Versus R-CHOP in Newly Diagnosed Patients With Non-localised Diffuse Large B-cell Lymphoma (DLBCL)/Follicular Lymphoma Grade IIIb
Primary Purpose
Lymphoma
Status
Unknown status
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
RCOMP
RCHOP
Sponsored by
About this trial
This is an interventional treatment trial for Lymphoma focused on measuring Follicular lymphoma, large B-cell lymphoma
Eligibility Criteria
Inclusion Criteria:
- ≥60 years of age
- Histological confirmed DLBCL/follicular lymphoma grade IIIb by WHO classification, with any IPI (International Prognostic Index)
- Newly diagnosed, with no previous treatment
- Non-localised stage, i.e. lymphoma that does not fit into a single radiotherapy field (including clinical stage IA with large tumour mass until stage IV) with at least one measurable lesion
- ECOG performance status 0 to 2
- Present appropriate haematologic, liver (ALT or AST < 2.5 ULN ? upper limit of normal) and renal functions (creatinine < 2.5 ULN) , unless changes are secondary to lymphoma
- LVEF at rest ? 55%, with no documented history of congestive heart failure (CHF), serious arrhythmia or acute myocardial infarction
Exclusion Criteria:
- Clinical stage I without large tumour mass or clinical stage IIA with fewer than three affected areas (stage-IIB patients are considered suitable, regardless of the number of affected areas)
- CNS infiltration
- Transformed lymphoma, although with no previous treatment, as well as other histological subtypes such as mantle cell lymphoma, peripheral T-cell lymphoma and its variants and post-transplant lymphoproliferative syndrome
- Clinically significant secondary cardiovascular disease
- Signs of any severe, acute or chronic and active infection
- Concurrent malignancy or history of other neoplasia except basal cell carcinoma (BCC) and cervical or breast carcinoma in situ (CIN)
- Patients with positive results in the HBV, HIV or HCV RNA tests
- Any previous treatment for DLBCL/follicular lymphoma grade IIIb
Sites / Locations
- Hospital Universitario de Alava
- Hospital Clínico Universitario Lozano Blesa
- Hospital de Cabueñes
- Hospital Universitari Germans Trias i Pujol
- ICO- Hospital Duran i Reynals
- Hospital Universitario Marqués de Valdecilla
- Hospital Universitario de Salamanca
- Hospital Clínico Universitario de Valladolid
- Hospital Fundación de Alcorcón
- Hospital del Mar
- Hospital General Universitario Gregorio Marañón
- Hospital Universitario Infanta Leonor
- Hospital Universitario 12 de Octubre
- Hospital Clínico Universitario Virgen de la Arrixaca
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
RCOMP
RCHOP
Arm Description
R-COMP Regimen: Day 1: Rituximab 375 mg/m2; Myocet® 50 mg/m2; cyclophosphamide 750 mg/m2; vincristine 1.4 mg/m2 (maximum 2 mg); prednisone 60 mg/m2 Days 2-5: Prednisone, 60 mg/m2 Administered every 21 days × 6 cycles
R-CHOP Regimen: Day 1: Rituximab 375 mg/m2; Doxorubicin 50 mg/m2; cyclophosphamide 750 mg/m2; vincristine 1.4 mg/m2 (maximum 2 mg); prednisone 60 mg/m2 Days 2-5: Prednisone, 60 mg/m2 Administered every 21 days × 6 cycles
Outcomes
Primary Outcome Measures
Subclinical cardiac toxicity
Subclinical cardiac toxicity determined by the percentage of measurings experiencing a decrease in LEVF determined by echocardiography with final LEVF <55% at day 135
Subclinical cardiac toxicity
Subclinical cardiac toxicity determined by the percentage of measurings experiencing a decrease in LEVF determined by echocardiography with final LEVF <55% at day 225
Secondary Outcome Measures
Survival
Event free survial, progression free survival and overall survival at 2 and 5 years.
Response rate
Overall response rates and complete responses evaluated by the International Harmonization Project for response criteria in lymphoma
Cardiac/cardiovascular toxicity
Rate of cardiac/cardiovascular toxicity according to the CTC criteria (version 4.0) of the National Cancer Institute (NCI) during the treatment and during 5 years
Toxicity (except cardiac)
No cardiotoxicity according to the CTC criteria (version 4.0) of the NCI during 24 months
Cardiac biomarkers
Cardiotoxicity determined by elevated values of troponin and NT-proBNP and decreased values of LEVF determined during 12 months
Full Information
NCT ID
NCT02012088
First Posted
November 11, 2013
Last Updated
January 8, 2020
Sponsor
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea
1. Study Identification
Unique Protocol Identification Number
NCT02012088
Brief Title
Clinical Trial to Evaluate R-COMP Versus R-CHOP in Newly Diagnosed Patients With Non-localised Diffuse Large B-cell Lymphoma (DLBCL)/Follicular Lymphoma Grade IIIb
Official Title
Phase II, Randomised, Multicentre Study With Two Treatment Arms (R-COMP Versus R-CHOP) in Newly Diagnosed Elderly Patients (≥60 Years) With Non-localised Diffuse Large B-cell Lymphoma (DLBCL)/Follicular Lymphoma Grade IIIb.
Study Type
Interventional
2. Study Status
Record Verification Date
January 2020
Overall Recruitment Status
Unknown status
Study Start Date
October 11, 2013 (Actual)
Primary Completion Date
October 2016 (Actual)
Study Completion Date
August 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The Phase II study proposed here assesses the hypothesis that replacing doxorubicin by Myocet® in the R-CHOP regimen would yield comparable antitumour efficacy with a lower cardiotoxicity for first-line treatment in elderly patients with non-localised DLBCL/Follicular lymphoma grade IIIb
Detailed Description
Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of non-Hodgkin's lymphoma (NHL). This is an aggressive lymphoma, with an incidence in Western countries estimated at 5-6 cases/100,000 inhabitants/year that increases with age.
Treatment for patients with DLBCL is currently based on immunochemotherapy, of which the R-CHOP regimen, which includes cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) in combination with the anti-CD20 monoclonal antibody rituximab and is administered every 21 days for a total of 6-8 cycles, is the most commonly used.
Cardiotoxicity is one of the undesirable effects that limit the use of anthracyclines, such as doxorubicin, as part of the CHOP regimen, which is caused by the formation of complexes between ferric ions and the anthracycline within the myocyte. Because of their oxidative properties, these complexes are toxic and produce highly reactive free radicals that damage the lipid membrane and lead to the cell death of myocytes. Several studies have linked the onset of cardiotoxicity with old age, high cumulative doses of doxorubicin, cardiovascular risk factors and previous heart disease, among others. Anthracycline-induced cardiotoxicity is cumulative and irreversible. Moreover, left ventricular dysfunction is an important late effect in patients with aggressive NHL who survive long term and, according to some studies, have received doxorubicin at doses higher than 200 mg/m². Cardiotoxicity may be silent or subclinical, which is usually detected as a decrease in left ventricular ejection fraction (LVEF), or clinical, with varying degrees of congestive heart failure (CHF). Depending on the symptoms, cardiotoxicity also differs between acute, subacute, late or chronic. The first is manifested at an early stage, usually as arrhythmia, transient ECG changes or pericarditis, among others, is usually reversible, is not detrimental to the continuation of treatment and is not associated with subacute and late toxicity.
Chronic cardiotoxicity could be early or late. Early-onset cardiotoxicity occurs within 1 year after anthracycline treatment and late-onset cardiotoxicity occurs more than 1 year after completion of anthracycline treatment. In the latter two, cardiotoxicity is associated with the lesion of cardiomyocytes and is therefore considered irreversible. The incidence of cardiotoxicity varies among different studies, depending on patient follow-up or the definition of cardiotoxicity used (acute, subacute or late).
In addition to clinical findings, the determination of LVEF or, more recently, the use of biomarkers, are the most commonly used methods to diagnose and assess cardiotoxicity. Regarding the identification of biomarkers, troponin I and N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) are the most commonly used and investigated in the context of clinical studies. The advantages of using biomarkers include their minimally invasive identification, which is less expensive than echocardiography, and, unlike radionuclide ventriculography, they avoid irradiation of the patient. Furthermore, the interpretation of their results does not depend on the observer's experience, thus avoiding interobserver variability. Several studies have shown the role of troponins as indicators of early anthracycline-induced cardiotoxicity or other chemotherapeutic agents, which are able to predict impaired ventricular function and higher incidence of cardiac events in patients with elevated values of this marker compared with patients with normal troponin values. Regarding the use of brain natriuretic peptides such as NT-proBNP, several studies have shown a correlation between persistently high values of this biomarker and impaired heart function parameters, in particular LVEF.
Myocet® (non-pegylated liposomal doxorubicin) is one of the several strategies developed to reduce cardiotoxicity and maintain the therapeutic efficacy of the R-CHOP regimen. Non-pegylated liposomal doxorubicin has shown a similar efficacy and less cardiotoxicity than conventional doxorubicin in the treatment of women with metastatic breast cancer. In addition, several studies in patients with NHL have shown similar response rates with regimens containing non-pegylated liposomal doxorubicin to those obtained in historical controls with conventional doxorubicin, with a low incidence of clinical and subclinical cardiovascular events. The treatment is relatively well tolerated, while myelosuppression is its most important toxicity.
Most of these phase I and II studies (with or without rituximab), which assessed Myocet® in combination with cyclophosphamide; vincristine and prednisone, showed that it is an active treatment in newly diagnosed patients with aggressive NHL.
100% of the data registered on CRFs will be source data verified. eCRDs will be used in order to register the data. Nine monitoring visits per site will be performed.
First monitoring vistit will be performed when the first patient is included Second monitoring visit willb be performed when the third patient is included Third monitoring visit will be perforemd when the fifth patient is included Fourth monitoring visit will be performed then the last patient finish study treatment One monitoring visit per year will be performed during follow-up phase.
CRO (Dynamic) Standard Operating Procedures will be used to manage the clinical trial.
Sample size of the study is based on the hypothesis of a LEVF decrease <55% in the 15% of patients assigned to R-CHOP treatment group and 5% of patients assigned to R-COMP treatment group.
Categorical variables were show by absolute and relative frequencies, including the confidence interval of 95%.
For the description of the continuous variables will be use the mean, standard deviation, median, mode, minimum and maximum, including the total number of valid values.
In the case of compare subgroups of patients, will be use for quantitative variables parametric tests or nonparametric as characteristics of the variables under study. For qualitative variables will be use Chi-square test.
Statistical analysis was planned with the SAS statistical package version 9.1 or later.
Two interim analysis will be performed when the last patient peforms the end of treatment visit and when the last patient performd the 24 months follow-up visit.
Final analysis will be performed at the end of the study.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma
Keywords
Follicular lymphoma, large B-cell lymphoma
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
91 (Actual)
8. Arms, Groups, and Interventions
Arm Title
RCOMP
Arm Type
Experimental
Arm Description
R-COMP Regimen:
Day 1: Rituximab 375 mg/m2; Myocet® 50 mg/m2; cyclophosphamide 750 mg/m2; vincristine 1.4 mg/m2 (maximum 2 mg); prednisone 60 mg/m2 Days 2-5: Prednisone, 60 mg/m2 Administered every 21 days × 6 cycles
Arm Title
RCHOP
Arm Type
Active Comparator
Arm Description
R-CHOP Regimen:
Day 1: Rituximab 375 mg/m2; Doxorubicin 50 mg/m2; cyclophosphamide 750 mg/m2; vincristine 1.4 mg/m2 (maximum 2 mg); prednisone 60 mg/m2 Days 2-5: Prednisone, 60 mg/m2 Administered every 21 days × 6 cycles
Intervention Type
Drug
Intervention Name(s)
RCOMP
Other Intervention Name(s)
Rituximab, Myocet, Cyclophosphamide, Vincristine, Prednisone
Intervention Description
Day 1: Rituximab 375 mg/m2; Myocet® 50 mg/m2; cyclophosphamide 750 mg/m2; vincristine 1.4 mg/m2 (maximum 2 mg); prednisone 60 mg/m2 Days 2-5: Prednisone, 60 mg/m2 Administered every 21 days × 6 cycles
Intervention Type
Drug
Intervention Name(s)
RCHOP
Other Intervention Name(s)
Rituximab, Doxorubicin, Cyclophosphamide, Vincristine, Prednisone 60 mg/m2
Intervention Description
Day 1: Rituximab 375 mg/m2; Doxorubicin 50 mg/m2; cyclophosphamide 750 mg/m2; vincristine 1.4 mg/m2 (maximum 2 mg); prednisone 60 mg/m2 Days 2-5: Prednisone, 60 mg/m2 Administered every 21 days × 6 cycles
Primary Outcome Measure Information:
Title
Subclinical cardiac toxicity
Description
Subclinical cardiac toxicity determined by the percentage of measurings experiencing a decrease in LEVF determined by echocardiography with final LEVF <55% at day 135
Time Frame
Day 135
Title
Subclinical cardiac toxicity
Description
Subclinical cardiac toxicity determined by the percentage of measurings experiencing a decrease in LEVF determined by echocardiography with final LEVF <55% at day 225
Time Frame
Day 225
Secondary Outcome Measure Information:
Title
Survival
Description
Event free survial, progression free survival and overall survival at 2 and 5 years.
Time Frame
2 and 5 years
Title
Response rate
Description
Overall response rates and complete responses evaluated by the International Harmonization Project for response criteria in lymphoma
Time Frame
Day 135
Title
Cardiac/cardiovascular toxicity
Description
Rate of cardiac/cardiovascular toxicity according to the CTC criteria (version 4.0) of the National Cancer Institute (NCI) during the treatment and during 5 years
Time Frame
During 5 years
Title
Toxicity (except cardiac)
Description
No cardiotoxicity according to the CTC criteria (version 4.0) of the NCI during 24 months
Time Frame
During 2 years
Title
Cardiac biomarkers
Description
Cardiotoxicity determined by elevated values of troponin and NT-proBNP and decreased values of LEVF determined during 12 months
Time Frame
During 12 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
≥60 years of age
Histological confirmed DLBCL/follicular lymphoma grade IIIb by WHO classification, with any IPI (International Prognostic Index)
Newly diagnosed, with no previous treatment
Non-localised stage, i.e. lymphoma that does not fit into a single radiotherapy field (including clinical stage IA with large tumour mass until stage IV) with at least one measurable lesion
ECOG performance status 0 to 2
Present appropriate haematologic, liver (ALT or AST < 2.5 ULN ? upper limit of normal) and renal functions (creatinine < 2.5 ULN) , unless changes are secondary to lymphoma
LVEF at rest ? 55%, with no documented history of congestive heart failure (CHF), serious arrhythmia or acute myocardial infarction
Exclusion Criteria:
Clinical stage I without large tumour mass or clinical stage IIA with fewer than three affected areas (stage-IIB patients are considered suitable, regardless of the number of affected areas)
CNS infiltration
Transformed lymphoma, although with no previous treatment, as well as other histological subtypes such as mantle cell lymphoma, peripheral T-cell lymphoma and its variants and post-transplant lymphoproliferative syndrome
Clinically significant secondary cardiovascular disease
Signs of any severe, acute or chronic and active infection
Concurrent malignancy or history of other neoplasia except basal cell carcinoma (BCC) and cervical or breast carcinoma in situ (CIN)
Patients with positive results in the HBV, HIV or HCV RNA tests
Any previous treatment for DLBCL/follicular lymphoma grade IIIb
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dr. Alejandro Martin
Organizational Affiliation
University of Salamanca
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Dr. Juan Manuel Sancho
Organizational Affiliation
Germans Trias i Pujol Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Dr. Francisco Gual
Organizational Affiliation
Germans Trias i Pujol Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Universitario de Alava
City
Vitoria
State/Province
Alava
Country
Spain
Facility Name
Hospital Clínico Universitario Lozano Blesa
City
Zaragoza
State/Province
Aragón
ZIP/Postal Code
50009
Country
Spain
Facility Name
Hospital de Cabueñes
City
GIjón
State/Province
Asturas
ZIP/Postal Code
33203
Country
Spain
Facility Name
Hospital Universitari Germans Trias i Pujol
City
Badalona
State/Province
Barcelona
ZIP/Postal Code
08916
Country
Spain
Facility Name
ICO- Hospital Duran i Reynals
City
L´Hospitalet de Llobregat
State/Province
Barcelona
ZIP/Postal Code
08908
Country
Spain
Facility Name
Hospital Universitario Marqués de Valdecilla
City
Santander
State/Province
Cantabria
ZIP/Postal Code
39008
Country
Spain
Facility Name
Hospital Universitario de Salamanca
City
Salamanca
State/Province
Castilla Y Leon
ZIP/Postal Code
37007
Country
Spain
Facility Name
Hospital Clínico Universitario de Valladolid
City
Valladolid
State/Province
Castilla Y Leon
ZIP/Postal Code
47005
Country
Spain
Facility Name
Hospital Fundación de Alcorcón
City
Alcorcón
State/Province
Madrid
ZIP/Postal Code
28922
Country
Spain
Facility Name
Hospital del Mar
City
Barcelona
ZIP/Postal Code
08003
Country
Spain
Facility Name
Hospital General Universitario Gregorio Marañón
City
Madrid
ZIP/Postal Code
28007
Country
Spain
Facility Name
Hospital Universitario Infanta Leonor
City
Madrid
ZIP/Postal Code
28031
Country
Spain
Facility Name
Hospital Universitario 12 de Octubre
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Facility Name
Hospital Clínico Universitario Virgen de la Arrixaca
City
Murcia
ZIP/Postal Code
30120
Country
Spain
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
background
PubMed Identifier
17654614
Citation
Rigacci L, Mappa S, Nassi L, Alterini R, Carrai V, Bernardi F, Bosi A. Liposome-encapsulated doxorubicin in combination with cyclophosphamide, vincristine, prednisone and rituximab in patients with lymphoma and concurrent cardiac diseases or pre-treated with anthracyclines. Hematol Oncol. 2007 Dec;25(4):198-203. doi: 10.1002/hon.827.
Results Reference
result
PubMed Identifier
20007997
Citation
Luminari S, Montanini A, Caballero D, Bologna S, Notter M, Dyer MJS, Chiappella A, Briones J, Petrini M, Barbato A, Kayitalire L, Federico M. Nonpegylated liposomal doxorubicin (MyocetTM) combination (R-COMP) chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL): results from the phase II EUR018 trial. Ann Oncol. 2010 Jul;21(7):1492-1499. doi: 10.1093/annonc/mdp544. Epub 2009 Dec 11.
Results Reference
result
PubMed Identifier
15226333
Citation
Levine AM, Tulpule A, Espina B, Sherrod A, Boswell WD, Lieberman RD, Nathwani BN, Welles L. Liposome-encapsulated doxorubicin in combination with standard agents (cyclophosphamide, vincristine, prednisone) in patients with newly diagnosed AIDS-related non-Hodgkin's lymphoma: results of therapy and correlates of response. J Clin Oncol. 2004 Jul 1;22(13):2662-70. doi: 10.1200/JCO.2004.10.093.
Results Reference
result
PubMed Identifier
15148277
Citation
Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G, Civelli M, Peccatori F, Martinelli G, Fiorentini C, Cipolla CM. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation. 2004 Jun 8;109(22):2749-54. doi: 10.1161/01.CIR.0000130926.51766.CC. Epub 2004 May 17.
Results Reference
result
PubMed Identifier
20728699
Citation
Cardinale D, Sandri MT. Role of biomarkers in chemotherapy-induced cardiotoxicity. Prog Cardiovasc Dis. 2010 Sep-Oct;53(2):121-9. doi: 10.1016/j.pcad.2010.04.002.
Results Reference
result
PubMed Identifier
21892906
Citation
Cardinale D, Salvatici M, Sandri MT. Role of biomarkers in cardioncology. Clin Chem Lab Med. 2011 Sep 6;49(12):1937-48. doi: 10.1515/CCLM.2011.692.
Results Reference
result
PubMed Identifier
33492774
Citation
Sancho JM, Fernandez-Alvarez R, Gual-Capllonch F, Gonzalez-Garcia E, Grande C, Gutierrez N, Penarrubia MJ, Batlle-Lopez A, Gonzalez-Barca E, Guinea JM, Gimeno E, Penalver FJ, Fuertes M, Bastos M, Hernandez-Rivas JA, Moraleda JM, Garcia O, Sorigue M, Martin A. R-COMP versus R-CHOP as first-line therapy for diffuse large B-cell lymphoma in patients >/=60 years: Results of a randomized phase 2 study from the Spanish GELTAMO group. Cancer Med. 2021 Feb;10(4):1314-1326. doi: 10.1002/cam4.3730. Epub 2021 Jan 25.
Results Reference
derived
Links:
URL
http://www.geltamo.com/
Description
Sponsor web page
Learn more about this trial
Clinical Trial to Evaluate R-COMP Versus R-CHOP in Newly Diagnosed Patients With Non-localised Diffuse Large B-cell Lymphoma (DLBCL)/Follicular Lymphoma Grade IIIb
We'll reach out to this number within 24 hrs