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Novel Targeted Drugs Combined With R-ICE Regimen in Relapsed and Refractory Diffuse Large B-cell Lymphoma (R-ICE+X)

Primary Purpose

Diffuse Large B Cell Lymphoma

Status
Recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Zanubrutinib plus R-ICE
Decitabine plus R-ICE
Chidamide plus R-ICE
Tofacitinib plus R-ICE
Pomalidomide plus R-ICE
Sponsored by
Ruijin Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diffuse Large B Cell Lymphoma focused on measuring Diffuse Large B Cell Lymphoma, R-ICE+X

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • DLBCL was confirmed by histology according to world Health Organization (WHO) disease classification (excluding primary central lymphoma and HIV-associated lymphoma);
  • There are evaluable lesions detected by PET/CT;
  • Life expectancy of more than 3 months;
  • Prior treatment with sufficient first-line anti-lymphoma therapy, no remission within 90 days of the last administration, or disease progression after sufficient first-line anti-lymphoma therapy, and no current anti-lymphoma therapy (≥2 weeks since the last anti-lymphoma therapy). Patients were allowed to receive hormone drugs or rituximab at least 1 week after enrollment for symptom control reasons;
  • 18≤ age ≤75 years old, male and female;
  • ECOG 0-2 points;
  • No serious organic lesions in the main organs, meeting the requirements of the following laboratory examination indicators (conducted within 7 days before treatment) :

    ① Absolute value of neutrophil count ≥1500/mm3; Platelet count ≥75,000/mm3

    ② Total bilirubin ≤2× upper limit of normal value (ULN)

    ③ Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (serum glutamate pyruvate aminotransferase [SGPT]) ≤3× upper limit of normal value (ULN)

    ④ the creatinine clearance rate was ≥60ml/min

    ⑤ No cardiac dysfunction

  • If the subject is of reproductive age and requires effective contraception, he/she agrees to comply with all contraceptive requirements: 1) there are fertile women have to decide, at the same time take two reliable contraceptive methods (a kind of high efficient contraceptives - tubal ligation, intrauterine contraceptive device, hormone (birth control pills, needle, patch, vaginal ring or implants) or partner vasectomy, another effective birth control method -- men or synthetic rubber condom, diaphragm or cervical cap). 2) Unless hysterectomy, effective contraception is required even if there is a history of infertility;
  • Fertile men must always use rubber or synthetic condoms when having sexual contact with fertile women during the use of this product and within 28 days of discontinuation of this product, even if they have successfully vasectomy; The subjects knew the characteristics of the disease, voluntarily joined the study, received treatment and follow-up, and the informed consent was signed by the subjects themselves or their guardians and impartial witnesses.

Exclusion Criteria:

  • Pregnant or lactating women (lactating women must agree not to breastfeed while taking pomadomide);
  • Known hepatitis B (HBV), hepatitis C (HCV) infection (HBV infection refers to HBV-DNA > detectable limit); And other acquired, congenital immune deficiency disorders, including but not limited to HIV-infected persons;
  • Subjects with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) within the past 12 months;
  • Bone marrow failure, defined as ANC<1500/mm3 or platelet <75,000/mm3, unless hematologic changes are thought to be associated with lymphomas infiltrating the bone marrow;
  • Clinically significant heart disease, including unstable angina, acute myocardial infarction 6 months before enrollment, congestive heart failure (NYHA) heart function grade III or IV; Or left ventricular ejection fraction <50%;
  • Lymphoma with central nervous system (CNS) involvement;
  • Those who are known to be allergic to the test drug ingredients;
  • Those who have received grade II or above surgery within three weeks before treatment;
  • Patients who have received organ transplants;
  • Has been diagnosed with or is being treated for malignancy other than lymphoma, except for:

    ① They have received therapeutic treatment and have not had known active disease malignancy for ≥5 years prior to enrollment;

    ② Basal cell carcinoma of the skin (except melanoma) without signs of disease after adequate treatment;

    ③ Cervical carcinoma in situ without signs of disease after adequate treatment.

  • With severe infection;
  • Substance abuse, medical, psychological, or social conditions that may interfere with the subjects' participation in the study or evaluation of the study results; The researchers deemed unsuitable for the group.

Sites / Locations

  • Ruijin HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

R-ICE+X

Arm Description

Outcomes

Primary Outcome Measures

Complete response rate after 3 cycle chemotherapy
Percentage of participants with complete response was determined on the basis of investigator assessments according to 2014 Lugano criteria.

Secondary Outcome Measures

2 year overall survival
Overall survival was defined as the time from the date of randomization to the date of death from any cause.
2 year progression free survival
Progression-free survival was defined as the time from the date of randomization until the date of the first documented day of disease progression or relapse, using 2014 Lugano criteria, or death from any cause, whichever occurred first.
Objective remission rate after 3 cycle chemotherapy
Percentage of participants with complete response or partial response was determined on the basis of investigator assessments according to 2014 Lugano criteria.
Chemotherapy-related adverse reactions
Any harmful reaction that occurs during the treatment of a disease according to the normal usage and dosage of a drug, which is unrelated to the purpose of treatment.

Full Information

First Posted
January 10, 2022
Last Updated
December 21, 2022
Sponsor
Ruijin Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05348213
Brief Title
Novel Targeted Drugs Combined With R-ICE Regimen in Relapsed and Refractory Diffuse Large B-cell Lymphoma
Acronym
R-ICE+X
Official Title
Clinical Study of Efficacy and Safety of Novel Targeted Drugs Combined With R-ICE Regimen in the Treatment of Relapsed and Refractory Diffuse Large B-cell Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
May 16, 2022 (Actual)
Primary Completion Date
June 1, 2024 (Anticipated)
Study Completion Date
June 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ruijin Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A single-center, open, single-arm clinical study of the efficacy and safety of a novel targeted agent in combination with R-ICE in the treatment of relapsed and refractory diffuse Large B-cell lymphoma.
Detailed Description
Refractory recurrence of patients with diffuse large B cell lymphoma inclusion/exclusion standard subjects in a signed written informed consent, according to the results of genotyping, divided the patients into MCD, TP53, BN2, EZB, ST2, NOS, N1, a total of 7 kinds of types. New targeted drugs were added based on typing results: Etoposide for MCD and BN2, Decitabine for TP53, Chidamide for EZB, Tofacitinib for ST2, and pomalidomide for N1 and NOS. Patients with stable disease (SD) and disease progression (PD) were withdrawn from the trial. Patients with partial response (PR) and complete response (CR) were treated for another course of treatment. After 3 courses of treatment, PET-CT was used to evaluate the efficacy. Patients with CR/PR, aged ≤65 years, qualified and willing for transplantation, were treated with autologous hematopoietic stem cell transplantation (ASCT); Patients who did not meet the above requirements or failed to collect autologous hematopoietic stem cells were placed on new targeted drug maintenance therapy for up to 12 months; If patients were evaluated as SD and PD after 3 cycles, they were dropped out of the trial and treated with other regiments. New targeted drugs combined with R-ICE and ASCT were evaluated every 3 months in the first year and every 6 months in the second and third years after treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diffuse Large B Cell Lymphoma
Keywords
Diffuse Large B Cell Lymphoma, R-ICE+X

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
R-ICE+X
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Zanubrutinib plus R-ICE
Intervention Description
Zanubrutinib 160mg/bid PO D1-21 Rituximab 375mg/m2 IV D0 Ifosfamide 1500mg/m2 IV D1-3 Carboplatin AUC×[GFR(ml/min) + 25] mg/d,AUC=5 IV D2 Etoposide 100 mg/m2 IV D1-3
Intervention Type
Drug
Intervention Name(s)
Decitabine plus R-ICE
Intervention Description
Decitabine 10mg/m2 IV D1-5 Rituximab 375mg/m2 IV D0 Ifosfamide 1500mg/m2 IV D1-3 Carboplatin AUC×[GFR(ml/min) + 25] mg/d,AUC=5 IV D2 Etoposide 100 mg/m2 IV D1-3
Intervention Type
Drug
Intervention Name(s)
Chidamide plus R-ICE
Intervention Description
Chidamide 20mg/d PO D1、4、8、11 Rituximab 375mg/m2 IV D0 Ifosfamide 1500mg/m2 IV D1-3 Carboplatin AUC×[GFR(ml/min) + 25] mg/d,AUC=5 IV D2 Etoposide 100 mg/m2 IV D1-3
Intervention Type
Drug
Intervention Name(s)
Tofacitinib plus R-ICE
Intervention Description
Tofacitinib 5mg/bid PO D1-10 Rituximab 375mg/m2 IV D0 Ifosfamide 1500mg/m2 IV D1-3 Carboplatin AUC×[GFR(ml/min) + 25] mg/d,AUC=5 IV D2 Etoposide 100 mg/m2 IV D1-3
Intervention Type
Drug
Intervention Name(s)
Pomalidomide plus R-ICE
Intervention Description
Pomalidomide 4mg/d PO D1-10 Rituximab 375mg/m2 IV D0 Ifosfamide 1500mg/m2 IV D1-3 Carboplatin AUC×[GFR(ml/min) + 25] mg/d,AUC=5 IV D2 Etoposide 100 mg/m2 IV D1-3
Primary Outcome Measure Information:
Title
Complete response rate after 3 cycle chemotherapy
Description
Percentage of participants with complete response was determined on the basis of investigator assessments according to 2014 Lugano criteria.
Time Frame
At the end of cycle 3 (each cycle is 21 days)
Secondary Outcome Measure Information:
Title
2 year overall survival
Description
Overall survival was defined as the time from the date of randomization to the date of death from any cause.
Time Frame
Baseline up to data cut-off (up to approximately 2 years)
Title
2 year progression free survival
Description
Progression-free survival was defined as the time from the date of randomization until the date of the first documented day of disease progression or relapse, using 2014 Lugano criteria, or death from any cause, whichever occurred first.
Time Frame
Baseline up to data cut-off (up to approximately 2 years)
Title
Objective remission rate after 3 cycle chemotherapy
Description
Percentage of participants with complete response or partial response was determined on the basis of investigator assessments according to 2014 Lugano criteria.
Time Frame
At the end of cycle 3 (each cycle is 21 days)
Title
Chemotherapy-related adverse reactions
Description
Any harmful reaction that occurs during the treatment of a disease according to the normal usage and dosage of a drug, which is unrelated to the purpose of treatment.
Time Frame
At the end of cycle 3 (each cycle is 21 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: DLBCL was confirmed by histology according to world Health Organization (WHO) disease classification (excluding primary central lymphoma and HIV-associated lymphoma); There are evaluable lesions detected by PET/CT; Life expectancy of more than 3 months; Prior treatment with sufficient first-line anti-lymphoma therapy, no remission within 90 days of the last administration, or disease progression after sufficient first-line anti-lymphoma therapy, and no current anti-lymphoma therapy (≥2 weeks since the last anti-lymphoma therapy). Patients were allowed to receive hormone drugs or rituximab at least 1 week after enrollment for symptom control reasons; 18≤ age ≤75 years old, male and female; ECOG 0-2 points; No serious organic lesions in the main organs, meeting the requirements of the following laboratory examination indicators (conducted within 7 days before treatment) : ① Absolute value of neutrophil count ≥1500/mm3; Platelet count ≥75,000/mm3 ② Total bilirubin ≤2× upper limit of normal value (ULN) ③ Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (serum glutamate pyruvate aminotransferase [SGPT]) ≤3× upper limit of normal value (ULN) ④ the creatinine clearance rate was ≥60ml/min ⑤ No cardiac dysfunction If the subject is of reproductive age and requires effective contraception, he/she agrees to comply with all contraceptive requirements: 1) there are fertile women have to decide, at the same time take two reliable contraceptive methods (a kind of high efficient contraceptives - tubal ligation, intrauterine contraceptive device, hormone (birth control pills, needle, patch, vaginal ring or implants) or partner vasectomy, another effective birth control method -- men or synthetic rubber condom, diaphragm or cervical cap). 2) Unless hysterectomy, effective contraception is required even if there is a history of infertility; Fertile men must always use rubber or synthetic condoms when having sexual contact with fertile women during the use of this product and within 28 days of discontinuation of this product, even if they have successfully vasectomy; The subjects knew the characteristics of the disease, voluntarily joined the study, received treatment and follow-up, and the informed consent was signed by the subjects themselves or their guardians and impartial witnesses. Exclusion Criteria: Pregnant or lactating women (lactating women must agree not to breastfeed while taking pomadomide); Known hepatitis B (HBV), hepatitis C (HCV) infection (HBV infection refers to HBV-DNA > detectable limit); And other acquired, congenital immune deficiency disorders, including but not limited to HIV-infected persons; Subjects with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) within the past 12 months; Bone marrow failure, defined as ANC<1500/mm3 or platelet <75,000/mm3, unless hematologic changes are thought to be associated with lymphomas infiltrating the bone marrow; Clinically significant heart disease, including unstable angina, acute myocardial infarction 6 months before enrollment, congestive heart failure (NYHA) heart function grade III or IV; Or left ventricular ejection fraction <50%; Lymphoma with central nervous system (CNS) involvement; Those who are known to be allergic to the test drug ingredients; Those who have received grade II or above surgery within three weeks before treatment; Patients who have received organ transplants; Has been diagnosed with or is being treated for malignancy other than lymphoma, except for: ① They have received therapeutic treatment and have not had known active disease malignancy for ≥5 years prior to enrollment; ② Basal cell carcinoma of the skin (except melanoma) without signs of disease after adequate treatment; ③ Cervical carcinoma in situ without signs of disease after adequate treatment. With severe infection; Substance abuse, medical, psychological, or social conditions that may interfere with the subjects' participation in the study or evaluation of the study results; The researchers deemed unsuitable for the group.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
ZHAO weili
Phone
64370045
Email
zwl_trial@163.com
First Name & Middle Initial & Last Name or Official Title & Degree
XU pengpeng
Phone
64370045
Email
pengpeng_xu@126.com
Facility Information:
Facility Name
Ruijin Hospital
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200020
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Weili ZHAO
Phone
+862164370045
Ext
610707
Email
zwl_trial@163.com

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Novel Targeted Drugs Combined With R-ICE Regimen in Relapsed and Refractory Diffuse Large B-cell Lymphoma

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