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Brentuximab Vedotin in Pre-transplant Induction and Consolidation for Relapsed or Refractory Hodgkin Lymphoma

Primary Purpose

CLASSICAL HODGKIN LYMPHOMA

Status
Completed
Phase
Phase 1
Locations
Spain
Study Type
Interventional
Intervention
Brentuximab Vedotin
Etoposide
Soludomerin
Cisplatin
Ara C
Sponsored by
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for CLASSICAL HODGKIN LYMPHOMA focused on measuring CLASSICAL HODGKIN LYMPHOMA, HODGKIN LYMPHOMA, LYMPHOMA, HL

Eligibility Criteria

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

Inclusion Criteria:

Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study

  • Histologically confirmed relapsed or refractory classical HL after first line chemotherapy. CD30 has to be positive
  • Age 18 to 65 years. Patient >65 years old with ECOG ≤1 and absence of comorbidities will be included in the study
  • ECOG ≤2
  • Karnofsky performance status ≥ 60
  • No major organ dysfunction
  • Biopsy at HL relapse or when refractoriness disease is diagnosed must be done prior to BV-ESHAP. If biopsy cannot be performed, tumor biopsy at initial diagnosis of HL must be available to be revised
  • Absence of prior history of other malignant diseases, except:

Basal cell carcinoma of the skin or uterine "in situ" carcinoma adequately treated Any curable neoplasia adequately treated that has achieved complete response and has remained in such status longer than 3 years

  • Female patient is either post-menopausal for at least 1 year before the screening visit or surgically sterile or if of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent through 30 days after the last dose of study drug, or agrees to completely abstain from heterosexual intercourse
  • Male patients, even if surgically sterilized, agree to practice effective barrier contraception during the entire study period and through 6 months after the last dose of study drug, or agrees to completely abstain from heterosexual intercourse
  • Life-expectancy >3 months
  • Platelet count ≥75•109/L (or 20 if due to Bone Marrow [BM] infiltration) absolute neutrophil count ≥1.5•109/L (or 0.5 if due to BM infiltration), and hemoglobin ≥ 8g/dL
  • Total Bilirubin: <1.5 x UNL, unless clearly related to the disease (Gilbert disease will be ruled out from this point)
  • AST and ALT: <3 xUNL except liver infiltration
  • Serum creatinine: < 2.0 mg/dL and/or creatinine clearance or calculated creatinine clearance > 40 mL/minute
  • Serum sodium >130 mmol/L
  • Voluntary written informed consent

Exclusion Criteria:

  • Current 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)
  • Serious medical or psychiatric illness likely to interfere with participation in this clinical study
  • Patients that have been treated previously with anti-CD30 monoclonal antibodies
  • Myocardial infarction within 6 months prior to enrollment. Heart failure NYHA Class III-IV, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Recent evidence (within 6 months) of a left-ventricular ejection fraction <50%
  • Peripheral neuropathy or neuropathic pain grade ≥ 2
  • Known cerebral or meningeal disease, including signs or symptoms of PML
  • Symptomatic neurologic disease compromising normal activities of daily living or requiring medication
  • Known hypersensitivity to recombinant proteins, murine proteins, or to any excipient contained in brentuximab vedotin
  • Pregnant women or in breast-feeding period, or adults in childbearing period not using an effective contraception method
  • Treatment with any known non-marketed drug substance or experimental therapy within the longer of 5 terminal half-lives or 4 weeks prior to enrollment or currently participating in any other interventional clinical study
  • Chronic or current infectious disease requiring systemic antibiotics, antifungal, or antiviral treatment within two weeks prior to first study drug dose
  • History of significant cerebrovascular disease in the past 6 months or ongoing event with active symptoms or sequelae
  • HIV positive
  • Significant concurrent, uncontrolled medical condition which may represent a risk for the patient
  • Positive serology for HBV
  • Positive serology for HCV

Sites / Locations

  • Hospital Universitario Central de Asturias
  • Institut Català d'Oncologia, Hospital Germans Trias i Pujol
  • Institut Català d'Oncologia, Hospital Duran i Reynals
  • Hospital Son Espases
  • Hospital del Mar
  • Hospital Clinic i Provincial de Barcelona
  • Hospital General Universitario Gregorio Marañon
  • Hospital Universitario Ramón y Cajal
  • Hospital Universitario 12 de Octubre
  • Hospital Universitario La Paz
  • Hospital Universitario de Salamanca
  • Hospital Universitario de Canarias
  • Hospital Universitario Virgen del Rocío
  • Hospital Clínico de Valencia

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

BV-ESHAP

Arm Description

- 3 cycles every 21 days: Brentuximab Vedotin, on day 1 (BV will be administered at three different doses 0.9mg/kg, 1.2mg/kg, 1.8mg/kg) Etoposide 40 mg/m2/day, on days 1 to 4 Soludomerin (methylprednisolone) 250 mg/day, on days 1 to 4 Cisplatin 25 mg/m2/day, on days 1 to 4 Ara C (cytarabine) 2 g/m2, on day 5 - A fourth dose of BV will be given 21 days after the third BV dose during the evaluation of response before the transplant. - Autologous peripheral blood stem cell transplant - A fifth dose of BV (1.8mg/kg) will be given on between day 28 and 35 post-transplant, followed by two additional doses (1.8mg/kg) every 3 weeks, to complete a total of 7 BV infusions.

Outcomes

Primary Outcome Measures

Recommended dose
During phase I, defined as the maximum Tolerable Dose of the BV in combination with ESHAP in relapsed/resistant HL patients.
Global response rate prior to ASCT
During phase II, Global response rate after BV-ESHAP as salvage regimen prior to ASCT.
Complete response
Percentage of patients with complete response rate after BV-ESHAP as salvage regimen prior to ASCT.

Secondary Outcome Measures

Toxicity according to the CTC criteria
To determine the toxicity of BV-ESHAP regimen
Stem cell mobilization capacity
To assess the stem cell mobilization capacity of the BV-ESHAP regimen: determine the expanse and effectiveness of the extraction of stem cells from peripheral blood.
Transplant-related mortality (TRM)
Overall Survival (OS)
Percentage of patients alive after first dose of treatment through follow-up
Progression free survival (PFS)
Percentage of patients without progression of disease
Event-Free Survival
Percentage of patients without event
Time to HL Progression
Disease-Free Survival
Response Duration
Length of time between date of evidenced response and progression of disease or death
Lymphoma-Specific Survival
Time to Next Treatment

Full Information

First Posted
August 27, 2014
Last Updated
April 23, 2019
Sponsor
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea
Collaborators
Millennium Pharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02243436
Brief Title
Brentuximab Vedotin in Pre-transplant Induction and Consolidation for Relapsed or Refractory Hodgkin Lymphoma
Official Title
Phase I-II Clinical Trial for the Evaluation of Brentuximab Vedotin Plus Etoposide, Solumoderin (Methylprednisolone), High Dose ARA-C (Cytarabine) and Cisplatin in the Transplant and Post-transplant Management for Relapsed or Refractory Classical Hodgkin Lymphoma Patients
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
November 11, 2014 (Actual)
Primary Completion Date
January 2019 (Actual)
Study Completion Date
January 14, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea
Collaborators
Millennium Pharmaceuticals, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Phase I trial aimed to determine the Maximum Tolerable Dose of the BV in combination with ESHAP in relapsed/resistant Hodgkin Lymphona patients and to evaluate response to treatment with BV-ESHAP as salvage regimen prior to autologous stem cell transplantation.
Detailed Description
Most patients suffering from Hodgkin's lymphoma (HL) can be successfully treated with standard chemo- and/or radiotherapy. However, in patients with refractory disease/relapsing after first line of therapy, conventional-dose chemotherapy regimens induce low remission rates, with long-term disease free survival not higher than 10% of patients. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become the standard treatment for these patients. This treatment approach results in long-term remissions in approximately 40-50% of relapsed patients, and in up to 25-30% of those with primary refractory disease. The possibility of a cure depends on several prognostic factors, however, in almost all series, the strongest prognostic factor has been the disease status before ASCT. Patients with HL who do not achieve complete remission (CR) after induction chemotherapy and those with unresponsive relapse have a very poor prognosis. Therefore, the choice of a very active pre-transplant salvage chemotherapy regimen is extremely important to improve results after ASCT. In addition, this activity should also be combined with a good stem cell mobilizing potential and low toxicity profiled. Several pre-transplant salvage regimens for refractory/relapsed HL are currently used with an overall response (OR) and CR rates ranging from 60% to 88% and from 17% to 49%, respectively. No randomized trial exists comparing the effectiveness of these regimens. ESHAP (Etoposide, Solumoderin (methylprednisolone), Ara-C (Cytarabine) and cisplatin) is one of the most commonly used regimens. ESHAP induces an OR and CR of 73% and 41%, respectively, with 5% toxic deaths. In the present study, a combination of ESHAP plus Brentuximab Vedotin (BV) is proposed as pre-transplant therapy with the aim to improve the CR rate before ASCT. HL is characterized by the presence of CD30-positive Hodgkin Reed-Sternberg cells. The antibody-drug conjugate BV delivers the highly potent antimicrotubule agent monomethyl auristatin E (MMAE) to CD30-positive malignant cells by binding specifically to CD30 on the cell surface and releasing MMAE inside the cell via lysosomal degradation. Binding of MMAE to tubulin results in apoptotic death of the CD30 expressing tumor cell.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
CLASSICAL HODGKIN LYMPHOMA
Keywords
CLASSICAL HODGKIN LYMPHOMA, HODGKIN LYMPHOMA, LYMPHOMA, HL

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
67 (Actual)

8. Arms, Groups, and Interventions

Arm Title
BV-ESHAP
Arm Type
Experimental
Arm Description
- 3 cycles every 21 days: Brentuximab Vedotin, on day 1 (BV will be administered at three different doses 0.9mg/kg, 1.2mg/kg, 1.8mg/kg) Etoposide 40 mg/m2/day, on days 1 to 4 Soludomerin (methylprednisolone) 250 mg/day, on days 1 to 4 Cisplatin 25 mg/m2/day, on days 1 to 4 Ara C (cytarabine) 2 g/m2, on day 5 - A fourth dose of BV will be given 21 days after the third BV dose during the evaluation of response before the transplant. - Autologous peripheral blood stem cell transplant - A fifth dose of BV (1.8mg/kg) will be given on between day 28 and 35 post-transplant, followed by two additional doses (1.8mg/kg) every 3 weeks, to complete a total of 7 BV infusions.
Intervention Type
Drug
Intervention Name(s)
Brentuximab Vedotin
Other Intervention Name(s)
ADCETRIS
Intervention Description
Brentuximab Vedotin, 0.9mg/kg, 1.2mg/kg, 1.8mg/kg, day 1
Intervention Type
Drug
Intervention Name(s)
Etoposide
Intervention Description
Intravenose use, 40mg/m2/day, on days 1 to 4
Intervention Type
Drug
Intervention Name(s)
Soludomerin
Other Intervention Name(s)
Methylprednisolone
Intervention Description
Intravenous use, 250mg/day, on days 1 to 4
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Intervention Description
Intravenous use, 25mg/m2/day, on days 1 to 4
Intervention Type
Drug
Intervention Name(s)
Ara C
Other Intervention Name(s)
Cytarabine
Intervention Description
Intravenous use, 2g/m2, day 5
Primary Outcome Measure Information:
Title
Recommended dose
Description
During phase I, defined as the maximum Tolerable Dose of the BV in combination with ESHAP in relapsed/resistant HL patients.
Time Frame
Day 21 of cycle 1 (3 weeks after start of treatment)
Title
Global response rate prior to ASCT
Description
During phase II, Global response rate after BV-ESHAP as salvage regimen prior to ASCT.
Time Frame
9 weeks (after start of treatment)
Title
Complete response
Description
Percentage of patients with complete response rate after BV-ESHAP as salvage regimen prior to ASCT.
Time Frame
9 weeks (after start of treatment)
Secondary Outcome Measure Information:
Title
Toxicity according to the CTC criteria
Description
To determine the toxicity of BV-ESHAP regimen
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Stem cell mobilization capacity
Description
To assess the stem cell mobilization capacity of the BV-ESHAP regimen: determine the expanse and effectiveness of the extraction of stem cells from peripheral blood.
Time Frame
After first or second cycle of treatment
Title
Transplant-related mortality (TRM)
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Overall Survival (OS)
Description
Percentage of patients alive after first dose of treatment through follow-up
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Progression free survival (PFS)
Description
Percentage of patients without progression of disease
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Event-Free Survival
Description
Percentage of patients without event
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Time to HL Progression
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Disease-Free Survival
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Response Duration
Description
Length of time between date of evidenced response and progression of disease or death
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Lymphoma-Specific Survival
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.
Title
Time to Next Treatment
Time Frame
Prior every cycle, 14th day of first three cycles, at week 12, 16, 19, 22, 25, 31. Every 12 weeks for 2 years and then every 24 week up to 5 years.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study Histologically confirmed relapsed or refractory classical HL after first line chemotherapy. CD30 has to be positive Age 18 to 65 years. Patient >65 years old with ECOG ≤1 and absence of comorbidities will be included in the study ECOG ≤2 Karnofsky performance status ≥ 60 No major organ dysfunction Biopsy at HL relapse or when refractoriness disease is diagnosed must be done prior to BV-ESHAP. If biopsy cannot be performed, tumor biopsy at initial diagnosis of HL must be available to be revised Absence of prior history of other malignant diseases, except: Basal cell carcinoma of the skin or uterine "in situ" carcinoma adequately treated Any curable neoplasia adequately treated that has achieved complete response and has remained in such status longer than 3 years Female patient is either post-menopausal for at least 1 year before the screening visit or surgically sterile or if of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent through 30 days after the last dose of study drug, or agrees to completely abstain from heterosexual intercourse Male patients, even if surgically sterilized, agree to practice effective barrier contraception during the entire study period and through 6 months after the last dose of study drug, or agrees to completely abstain from heterosexual intercourse Life-expectancy >3 months Platelet count ≥75•109/L (or 20 if due to Bone Marrow [BM] infiltration) absolute neutrophil count ≥1.5•109/L (or 0.5 if due to BM infiltration), and hemoglobin ≥ 8g/dL Total Bilirubin: <1.5 x UNL, unless clearly related to the disease (Gilbert disease will be ruled out from this point) AST and ALT: <3 xUNL except liver infiltration Serum creatinine: < 2.0 mg/dL and/or creatinine clearance or calculated creatinine clearance > 40 mL/minute Serum sodium >130 mmol/L Voluntary written informed consent Exclusion Criteria: Current 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) Serious medical or psychiatric illness likely to interfere with participation in this clinical study Patients that have been treated previously with anti-CD30 monoclonal antibodies Myocardial infarction within 6 months prior to enrollment. Heart failure NYHA Class III-IV, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Recent evidence (within 6 months) of a left-ventricular ejection fraction <50% Peripheral neuropathy or neuropathic pain grade ≥ 2 Known cerebral or meningeal disease, including signs or symptoms of PML Symptomatic neurologic disease compromising normal activities of daily living or requiring medication Known hypersensitivity to recombinant proteins, murine proteins, or to any excipient contained in brentuximab vedotin Pregnant women or in breast-feeding period, or adults in childbearing period not using an effective contraception method Treatment with any known non-marketed drug substance or experimental therapy within the longer of 5 terminal half-lives or 4 weeks prior to enrollment or currently participating in any other interventional clinical study Chronic or current infectious disease requiring systemic antibiotics, antifungal, or antiviral treatment within two weeks prior to first study drug dose History of significant cerebrovascular disease in the past 6 months or ongoing event with active symptoms or sequelae HIV positive Significant concurrent, uncontrolled medical condition which may represent a risk for the patient Positive serology for HBV Positive serology for HCV
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ramón García-Sanz, MD
Organizational Affiliation
University of Salamanca
Official's Role
Study Chair
Facility Information:
Facility Name
Hospital Universitario Central de Asturias
City
Oviedo
State/Province
Asturias
ZIP/Postal Code
33006
Country
Spain
Facility Name
Institut Català d'Oncologia, Hospital Germans Trias i Pujol
City
Badalona
State/Province
Barcelona
ZIP/Postal Code
08916
Country
Spain
Facility Name
Institut Català d'Oncologia, Hospital Duran i Reynals
City
L'Hospitalet de Llobregat
State/Province
Barcelona
ZIP/Postal Code
08908
Country
Spain
Facility Name
Hospital Son Espases
City
Palma
State/Province
Islas Baleares
Country
Spain
Facility Name
Hospital del Mar
City
Barcelona
ZIP/Postal Code
08003
Country
Spain
Facility Name
Hospital Clinic i Provincial de Barcelona
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
Hospital General Universitario Gregorio Marañon
City
Madrid
ZIP/Postal Code
28007
Country
Spain
Facility Name
Hospital Universitario Ramón y Cajal
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Hospital Universitario 12 de Octubre
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Facility Name
Hospital Universitario La Paz
City
Madrid
ZIP/Postal Code
28046
Country
Spain
Facility Name
Hospital Universitario de Salamanca
City
Salamanca
ZIP/Postal Code
37007
Country
Spain
Facility Name
Hospital Universitario de Canarias
City
Santa Cruz de Tenerife
ZIP/Postal Code
38320
Country
Spain
Facility Name
Hospital Universitario Virgen del Rocío
City
Sevilla
ZIP/Postal Code
41013
Country
Spain
Facility Name
Hospital Clínico de Valencia
City
Valencia
ZIP/Postal Code
46010
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Brentuximab Vedotin in Pre-transplant Induction and Consolidation for Relapsed or Refractory Hodgkin Lymphoma

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