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Pentamidine + Salvage Chemo for Relapsed/Refractory Classical Hodgkin Lymphoma

Primary Purpose

Hodgkin Lymphoma, Refractory Hodgkin Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Pentamidine
Sponsored by
Reinhold Munker
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hodgkin Lymphoma focused on measuring Pentamidine, Salvage Chemotherapy

Eligibility Criteria

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

Inclusion Criteria:

  • Age 18 years old or older
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤2
  • Subjects with histologically confirmed relapse or refractory cHL who had received a front-line anthracycline-containing regimen.
  • Subjects must have at least one measurable lesion >1.5cm as defined by the lymphoma response criteria.
  • Subjects must have recovered from their last prior chemotherapy; if they have received an investigational agent, at least 5 half-lives must have expired to assure clearance of prior therapy.
  • Prior radiation should have been completed at least 4 weeks prior to study Day 1.
  • Toxicities related to prior therapy must have returned to Grade 1 or less except for alopecia. Peripheral neuropathy must be grade 2 or less.
  • Adequate bone marrow function defined as: 1) Absolute neutrophil count ≥ 1000/µl and 2) Platelet count ≥ 50,000/µl
  • Adequate organ function: 1) Creatinine Clearance (CrCl) >60 mL/min and 2) Aspartate Aminotransferase (AST) ≤ 3 upper limit normal (ULN), and Alanine Aminotransferase (ALT) ≤3 ULN, and Bilirubin ≤ 1.5 ULN (Unless they have Gillbert's disease)
  • Ability to comply with the treatment, evaluations and required study follow-up.

Exclusion Criteria:

  • Subjects with central nervous system involvement.
  • Subjects with concomitant second malignancy (except adequately treated non-melanoma skin cancer, ductal carcinoma in-situ, superficial bladder cancer, prostate cancer or in situ cervical cancer) are excluded unless a complete remission was achieved at least 3 years prior to study entry and no additional therapy is required or anticipated.
  • A serious uncontrolled medical disorder or active infection which impairs the ability of the subject to receive protocol therapy or whose control is jeopardized by the complication of this therapy.
  • Prior organ allograft or allogeneic bone marrow transplantation.
  • Positive for HIV (1/2) or known acquired immunodeficiency syndrome.
  • Positive for hepatitis B Surface Ag, or antibody to hepatitis B core ag, or hepatitis C antibody or hepatitis C RNA in serum.
  • Ejection fraction less than 45% in subjects with prior anthracycline therapy (measurement of ejection fraction is mandatory).
  • Corrected QT interval (QTc) prolongation of more than 500.
  • Women of reproductive age who are unwilling or unable to use an acceptable method to minimize the risk of pregnancy for the entire study period and for at least 18 weeks after the last dose of pentamidine.
  • Women who are pregnant or breast-feeding.
  • Women with a positive pregnancy test (serum assay) on enrollment or prior to pentamidine administration.
  • Sexually active men not using birth control if their partners are women of reproductive age.
  • Prisoner or subjects who are involuntarily incarcerated.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to pentamidine and/or ifosfamide, carboplatin and etoposide.
  • No investigational or commercial agents or therapies other than those specified by the protocol may be administered with the intent to treat the patient's malignancy.

Sites / Locations

  • University of Kentucky Markey Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Pentamidine + ICE

Arm Description

Pentamidine, Ifosfamide, Carboplatin, and Etoposide (ICE) by IV Infusion.

Outcomes

Primary Outcome Measures

Maximum tolerated dose (MTD)
Dose limiting toxicity (DLT) for hematological and non-hematological toxicities will be graded using National Cancer Institute (NCI) CTCAE Version 5.0

Secondary Outcome Measures

Determine Efficacy: best overall response
Individual best overall response at 5 and 16 weeks from enrollment, patients will be categorized as either a responder (complete response, partial response) versus nonresponders (stable disease, progressive disease).
Define the Duration of Response
Duration of response as defined starting from the first occurrence of response until disease progression or death.
Identify Immunohistochemistry Biomarkers
Immunohistochemistry staining of paraffin fixed tissue sample and peripheral blood will be done to assess the ability of pentamidine to inhibit its pharmacological target through PRL-3 expression.
Polymerase Chair Reaction (PCR) analysis of Biomarkers
Digital PCR analysis of paraffin fixed tissue sample and peripheral blood will be done to assess PRL-3 expression and compare to the immunohistochemistry staining to determine the ideal testing modality for PRL-3 in cHL.
Identify Phosphorylation Biomarkers
Pentamidine concentration/protein phosphorylation will be measured in PBMC and plasma samples collected throughout treatment.
Identify sCD30 and TARC Biomarkers
Biomarkers: ELISA testing will be used to assess levels of sCD30 and TARC in serum samples collected prior to initiation of therapy and subsequent cycles.

Full Information

First Posted
October 26, 2018
Last Updated
July 6, 2021
Sponsor
Reinhold Munker
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1. Study Identification

Unique Protocol Identification Number
NCT03730363
Brief Title
Pentamidine + Salvage Chemo for Relapsed/Refractory Classical Hodgkin Lymphoma
Official Title
A Phase I Study of Pentamidine in Combination With Salvage Chemotherapy for Relapsed/Refractory Classical Hodgkin Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Completed
Study Start Date
December 19, 2018 (Actual)
Primary Completion Date
May 23, 2019 (Actual)
Study Completion Date
May 23, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Reinhold Munker

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Primary Objective: To evaluate dose limiting toxicity and to determine the recommended phase 2 dose (RP2D) of pentamidine in combination with salvage chemotherapy with ifosfamide, carboplatin and etoposide (ICE) on a 3-weeks schedule in relapsed/refractory classical Hodgkin lymphoma (cHL). Secondary Objective: To estimate the overall best treatment response at 5- and 16-weeks from study enrollment. Although the clinical benefit of these drugs in combination has not been established, offering this treatment may provide a therapeutic benefit. The patients will be carefully monitored for tumor response and symptom relief, in addition to safety and tolerability. To estimate the duration of response to the proposed combined therapy. To measure the protein of regenerating liver-3 (PRL-3) level of expression in patients at time of relapse. To measure circulating biomarkers of response (soluble CD30 (sCD30), and thymus and activation-related chemokine (TARC)) in serum samples collected throughout treatment and inhibition of (pSTAT, pAKT) in peripheral blood mononucleated cells (PBMC). Exploratory Objective: To measure cell-free messenger RNA (cfmRNA) in peripheral blood. To measure cell-free DNA in peripheral blood
Detailed Description
The primary objective of this Phase I study is to determine the maximum tolerated dose (MTD) of Pentamidine. A two-stage continual reassessment method (CRM) will be employed to determine dose escalation levels and the maximum tolerated dose (MTD) of Pentamidine. Specifically, a modified two-stage CRM will be employed with 2 patients per cohort at each dose level. The trial starts with an escalation design from the lowest dose (2 mg/kg) with a traditional 2+2 dose escalation method. After occurrence of the first DLT, dose assignment will be determined by the CRM (2 patients/per cohort) using empirical model with restrictions to avoid dose-skipping and escalation immediately after a toxicity outcome. A maximum of 12 patients will be enrolled into the trial during the escalation phase. Once the MTD is reached, an additional 4 patients will be treated at this dose. Thus, 6 or more patients will be treated at the MTD. The target DLT rate is 33% and the investigators choose to use 0.10, 0.20 and 0.33 as prior toxicity distribution. CRM simulations indicate optimal performance of this design with high dose recommendation probabilities (at least 48%) and more patients allocated to the correct dose

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hodgkin Lymphoma, Refractory Hodgkin Lymphoma
Keywords
Pentamidine, Salvage Chemotherapy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Pentamidine + ICE
Arm Type
Experimental
Arm Description
Pentamidine, Ifosfamide, Carboplatin, and Etoposide (ICE) by IV Infusion.
Intervention Type
Drug
Intervention Name(s)
Pentamidine
Intervention Description
Pentamidine will be administered as an IV infusion on treatment day 1-3 of a 21-day cycle 3 cycles using 2, 3, and 4 mg/kg dose escalation schedules. Non-investigational agents will be administered as follows: Ifosfamide 5000 mg/m2, Carboplatin 5 area under curve (AUC), and Etoposide 100 mg/mg2.
Primary Outcome Measure Information:
Title
Maximum tolerated dose (MTD)
Description
Dose limiting toxicity (DLT) for hematological and non-hematological toxicities will be graded using National Cancer Institute (NCI) CTCAE Version 5.0
Time Frame
Up to 21 days
Secondary Outcome Measure Information:
Title
Determine Efficacy: best overall response
Description
Individual best overall response at 5 and 16 weeks from enrollment, patients will be categorized as either a responder (complete response, partial response) versus nonresponders (stable disease, progressive disease).
Time Frame
Up to 112 days
Title
Define the Duration of Response
Description
Duration of response as defined starting from the first occurrence of response until disease progression or death.
Time Frame
Up to 112 days
Title
Identify Immunohistochemistry Biomarkers
Description
Immunohistochemistry staining of paraffin fixed tissue sample and peripheral blood will be done to assess the ability of pentamidine to inhibit its pharmacological target through PRL-3 expression.
Time Frame
Up to 112 days
Title
Polymerase Chair Reaction (PCR) analysis of Biomarkers
Description
Digital PCR analysis of paraffin fixed tissue sample and peripheral blood will be done to assess PRL-3 expression and compare to the immunohistochemistry staining to determine the ideal testing modality for PRL-3 in cHL.
Time Frame
Up to 112 days
Title
Identify Phosphorylation Biomarkers
Description
Pentamidine concentration/protein phosphorylation will be measured in PBMC and plasma samples collected throughout treatment.
Time Frame
Up to 112 days
Title
Identify sCD30 and TARC Biomarkers
Description
Biomarkers: ELISA testing will be used to assess levels of sCD30 and TARC in serum samples collected prior to initiation of therapy and subsequent cycles.
Time Frame
Up to 112 days
Other Pre-specified Outcome Measures:
Title
Measure cfmRNA Biomarkers
Description
Digital PCR analysis of the peripheral blood plasma will be used to measure cfmRNA during therapy
Time Frame
Up to 112 days
Title
Measure Circulating-free DNA (cfDNA) Biomarkers
Description
digital PCR analysis of the peripheral blood plasma will be used to measure cfDNA during therapy.
Time Frame
Up to 112 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 years old or older Eastern Cooperative Oncology Group (ECOG) performance status ≤2 Subjects with histologically confirmed relapse or refractory cHL who had received a front-line anthracycline-containing regimen. Subjects must have at least one measurable lesion >1.5cm as defined by the lymphoma response criteria. Subjects must have recovered from their last prior chemotherapy; if they have received an investigational agent, at least 5 half-lives must have expired to assure clearance of prior therapy. Prior radiation should have been completed at least 4 weeks prior to study Day 1. Toxicities related to prior therapy must have returned to Grade 1 or less except for alopecia. Peripheral neuropathy must be grade 2 or less. Adequate bone marrow function defined as: 1) Absolute neutrophil count ≥ 1000/µl and 2) Platelet count ≥ 50,000/µl Adequate organ function: 1) Creatinine Clearance (CrCl) >60 mL/min and 2) Aspartate Aminotransferase (AST) ≤ 3 upper limit normal (ULN), and Alanine Aminotransferase (ALT) ≤3 ULN, and Bilirubin ≤ 1.5 ULN (Unless they have Gillbert's disease) Ability to comply with the treatment, evaluations and required study follow-up. Exclusion Criteria: Subjects with central nervous system involvement. Subjects with concomitant second malignancy (except adequately treated non-melanoma skin cancer, ductal carcinoma in-situ, superficial bladder cancer, prostate cancer or in situ cervical cancer) are excluded unless a complete remission was achieved at least 3 years prior to study entry and no additional therapy is required or anticipated. A serious uncontrolled medical disorder or active infection which impairs the ability of the subject to receive protocol therapy or whose control is jeopardized by the complication of this therapy. Prior organ allograft or allogeneic bone marrow transplantation. Positive for HIV (1/2) or known acquired immunodeficiency syndrome. Positive for hepatitis B Surface Ag, or antibody to hepatitis B core ag, or hepatitis C antibody or hepatitis C RNA in serum. Ejection fraction less than 45% in subjects with prior anthracycline therapy (measurement of ejection fraction is mandatory). Corrected QT interval (QTc) prolongation of more than 500. Women of reproductive age who are unwilling or unable to use an acceptable method to minimize the risk of pregnancy for the entire study period and for at least 18 weeks after the last dose of pentamidine. Women who are pregnant or breast-feeding. Women with a positive pregnancy test (serum assay) on enrollment or prior to pentamidine administration. Sexually active men not using birth control if their partners are women of reproductive age. Prisoner or subjects who are involuntarily incarcerated. History of allergic reactions attributed to compounds of similar chemical or biologic composition to pentamidine and/or ifosfamide, carboplatin and etoposide. No investigational or commercial agents or therapies other than those specified by the protocol may be administered with the intent to treat the patient's malignancy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hayder Saeed, MD
Organizational Affiliation
Lucille P. Markey Cancer Center at University of Kentucky
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Kentucky Markey Cancer Center
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40536
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Pentamidine + Salvage Chemo for Relapsed/Refractory Classical Hodgkin Lymphoma

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