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R-MINE+X in Patients With Relapsed/Refractory Diffuse Large B-cell Lymphoma

Primary Purpose

Diffuse Large B-cell Lymphoma

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Rituximab
Mitoxantrone hydrochloride liposome
Isophosphamide
Etoposide
X: Orelabrutinib
X: Chidamide
X: Penpulimab
X: Lenalidomide
Sponsored by
The First Affiliated Hospital with Nanjing Medical University
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 DLBCL, R-MINE+X, Mitoxantrone liposome

Eligibility Criteria

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

Inclusion Criteria: Join the study voluntarily and sign the informed consent; Age ≤ 18 years old ≤75 years old; Expected survival time ≥3 months; Recurrent or refractory diffuse large B-cell lymphoma confirmed by histopathology; Consistent with relapsed or refractory lymphoma: Relapsed lymphoma refers to lymphoma that relapsed after CR obtained from initial chemotherapy. Refractory lymphoma is diagnosed by meeting any of the following criteria: 1) tumor shrinkage < 50% or progression after 4 courses of chemotherapy prescribed by the standard regimen; 2) CR was achieved by standard chemotherapy, but recurrent within half a year; 3) Relapse for two or more times after CR; 4) Recurrence after hematopoietic stem cell transplantation; There must be at least one evaluable or measurable lesion in line with Lugano2014 criteria: lymph node lesion, the length and diameter of detectable lymph node must be greater than 1.5cm; For non-lymph node lesions, the diameter of extrinsic lesions should be > 1.0cm; ECOG score 0-2; Bone marrow function: neutrophil count ≥1.5×10^9/L, platelet count ≥75×10^9/L, hemoglobin ≥80g/L (neutrophil count ≥1.0×10^9/L, platelet count ≥50×10^9/L, hemoglobin ≥75g/L in patients with bone marrow involvement); Liver and kidney function: serum creatinine ≤1.5 times the upper limit of normal value; AST and ALT ≤2.5 times the upper limit of normal value (≤5 times the upper limit of normal value for patients with liver invasion); Total bilirubin ≤1.5 times the upper limit of normal value (≤3 times the upper limit of normal value for patients with liver invasion); Exclusion Criteria: The subject's previous history of antitumor therapy meets one of the following conditions: Previous recipients of mitoxantrone or mitoxantrone liposomes; Prior treatment with doxorubicin or anthracycline with a cumulative dose of doxorubicin > 360 mg/m2 (1 mg of doxorubicin for other anthracyclines); Patients who had received autologous hematopoietic stem cell transplantation or had received allogeneic hematopoietic stem cell transplantation within 100 days of the first medication; Received anti-tumor therapy (including chemotherapy, targeted therapy, hormone therapy, taking anti-tumor active Chinese medicine, etc.) or participated in other clinical trials and received clinical trial drugs within 4 weeks before the first use of the drug in this study; Hypersensitivity to any investigational drug or its components; Uncontrolled systemic diseases (such as advanced infections, uncontrolled hypertension, diabetes, etc.); Cardiac function and disease conform to one of the following conditions: Long QTc syndrome or QTc interval >480 ms; Complete left bundle branch block, complete right bundle branch block with left anterior branch block, second degree type II, or third degree atrioventricular block; severe, uncontrolled arrhythmias requiring medical treatment; New York College of Cardiology Grade ≥ III; A history of acute myocardial infarction, unstable angina pectoris, severely unstable ventricular arrhythmias or any other arrhythmia requiring treatment, a history of clinically severe pericardial disease, or electrocardiographic evidence of acute ischemic or active conduction abnormalities within the 6 months prior to recruitment. Hepatitis B and hepatitis C active infection (hepatitis B virus surface antigen positive and hepatitis B virus DNA more than 1x10^3 copies /mL; HCV RNA over 1x10^3 copies /mL); Human immunodeficiency virus (HIV) infection (HIV antibody positive); Past or present co-existing malignancies (in addition to non-melanoma basal cell carcinoma of the skin, carcinoma in situ of the breast/cervix, and other malignancies that have been effectively controlled without treatment in the past five years); Primary or secondary central nervous system (CNS) lymphoma or history of CNS lymphoma at the time of recruitment; There is significant gastrointestinal disease at the time of screening that may affect drug intake, transport or absorption (e.g. inability to swallow, chronic diarrhea, intestinal obstruction, etc.); Pregnant and lactating women and patients of childbearing age who do not wish to take contraceptive measures; Situations in which other researchers have determined that participation in this study is not appropriate.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    R-MINE+X

    Arm Description

    R-MINE: Rituximab, Isophosphamide, Mitoxantrone hydrochloride liposome, Etoposide X: Orelabrutinib, Chidamide, Penpulimab, Lenalidomide

    Outcomes

    Primary Outcome Measures

    Objective Response Rate(ORR)
    Objective response rate (ORR) after 4 cycles of R-MINE+X chemotherapy

    Secondary Outcome Measures

    Complete remission rate(CRR)
    Complete remission rate(CRR) after 4 cycles of R-MINE+X chemotherapy
    Duration of remission(DOR)
    Time from reaching CR or PR for the first time to disease progression
    Progression-Free-Survival rate
    from date of inclusion to date of progression, relapse, or death from any cause
    Overall survival rate
    from the date of inclusion to date of death, irrespective of cause
    Adverse events (AE)
    The safety of the drug was evaluated by NCI-CTC AE 5.0 standard

    Full Information

    First Posted
    March 2, 2023
    Last Updated
    March 23, 2023
    Sponsor
    The First Affiliated Hospital with Nanjing Medical University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05784987
    Brief Title
    R-MINE+X in Patients With Relapsed/Refractory Diffuse Large B-cell Lymphoma
    Official Title
    An Open, Single-arm, Multi-center Clinical Trial of Molecular Subtype-guided R-MINE+X Regimen in the Treatment of Relapsed/Refractory Diffuse Large B-cell Lymphoma (DLBCL)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    April 15, 2023 (Anticipated)
    Primary Completion Date
    January 1, 2024 (Anticipated)
    Study Completion Date
    January 1, 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    The First Affiliated Hospital with Nanjing Medical University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    Based on the modified R-MINE of mitoxantrone hydrochloride liposome, the corresponding targeted drug (X) was added according to the genotyping detected by second-generation gene sequencing (NGS) to explore the effectiveness and safety of R-MINE+X in the treatment of recurrent/refractory (R/R) diffuse large B-cell lymphoma (DLBCL).
    Detailed Description
    Compared with traditional mitoxantrone, mitoxantrone liposomes can significantly prolong the survival time of patients and reduce the cardiotoxicity and non-hematological toxicity of anthracycline drugs. At present, there are no studies on the efficacy and safety of R-MINE+X regimen based on molecular typing in the treatment of R/R DLBCL. Therefore, based on NGS, R/R DLBCL was divided into different molecular types (MCD subtype, BN2 subtype, EZB subtype, A53 subtype and other subtype), and on this basis, different molecular types of targeted drugs (X: MCD/BN2 subtype - BTK inhibitor, EZB subtype - Chidamide, A53 subtype - PD-1 monoclonal antibody and other type - lenalidomide) were used to treat R/R DLBCL. The main purpose was to observe the effectiveness and safety of the program in R/R DLBCL.

    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
    DLBCL, R-MINE+X, Mitoxantrone liposome

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    60 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    R-MINE+X
    Arm Type
    Experimental
    Arm Description
    R-MINE: Rituximab, Isophosphamide, Mitoxantrone hydrochloride liposome, Etoposide X: Orelabrutinib, Chidamide, Penpulimab, Lenalidomide
    Intervention Type
    Drug
    Intervention Name(s)
    Rituximab
    Intervention Description
    375 mg/m2, d0, Cycle 1~4
    Intervention Type
    Drug
    Intervention Name(s)
    Mitoxantrone hydrochloride liposome
    Intervention Description
    20 mg/m2, d1, Cycle 1~4
    Intervention Type
    Drug
    Intervention Name(s)
    Isophosphamide
    Intervention Description
    1.33 g/m2, d1-3(Rescue with equal dose of mesperidine), Cycle 1~4
    Intervention Type
    Drug
    Intervention Name(s)
    Etoposide
    Intervention Description
    65 mg/m2, d1-3, Cycle 1~4
    Intervention Type
    Drug
    Intervention Name(s)
    X: Orelabrutinib
    Intervention Description
    MCD/BN2 subtype: BTK inhibitor-Orelabrutinib: 150 mg/d, d1-21, Cycle 2~4
    Intervention Type
    Drug
    Intervention Name(s)
    X: Chidamide
    Intervention Description
    EZB subtype: Chidamide: 20 mg/d, d1, d4, d8, d11, Cycle 2~4
    Intervention Type
    Drug
    Intervention Name(s)
    X: Penpulimab
    Intervention Description
    TP53 mutation - X: PD-1 monoclonal antibody - Penpulimab: 200mg/d, d0, Cycle 2~4
    Intervention Type
    Drug
    Intervention Name(s)
    X: Lenalidomide
    Intervention Description
    Other-X: Lenalidomide: 25mg/d, d1-10, Cycle 2~4
    Primary Outcome Measure Information:
    Title
    Objective Response Rate(ORR)
    Description
    Objective response rate (ORR) after 4 cycles of R-MINE+X chemotherapy
    Time Frame
    up to 4 cycles of chemotherapy(each cycle is 21 days)
    Secondary Outcome Measure Information:
    Title
    Complete remission rate(CRR)
    Description
    Complete remission rate(CRR) after 4 cycles of R-MINE+X chemotherapy
    Time Frame
    up to 4 cycles of chemotherapy(each cycle is 21 days)
    Title
    Duration of remission(DOR)
    Description
    Time from reaching CR or PR for the first time to disease progression
    Time Frame
    up to 4 cycles of chemotherapy(each cycle is 21 days)
    Title
    Progression-Free-Survival rate
    Description
    from date of inclusion to date of progression, relapse, or death from any cause
    Time Frame
    1 year
    Title
    Overall survival rate
    Description
    from the date of inclusion to date of death, irrespective of cause
    Time Frame
    1 year
    Title
    Adverse events (AE)
    Description
    The safety of the drug was evaluated by NCI-CTC AE 5.0 standard
    Time Frame
    From the first day of medication to 28 days after the last dose

    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: Join the study voluntarily and sign the informed consent; Age ≤ 18 years old ≤75 years old; Expected survival time ≥3 months; Recurrent or refractory diffuse large B-cell lymphoma confirmed by histopathology; Consistent with relapsed or refractory lymphoma: Relapsed lymphoma refers to lymphoma that relapsed after CR obtained from initial chemotherapy. Refractory lymphoma is diagnosed by meeting any of the following criteria: 1) tumor shrinkage < 50% or progression after 4 courses of chemotherapy prescribed by the standard regimen; 2) CR was achieved by standard chemotherapy, but recurrent within half a year; 3) Relapse for two or more times after CR; 4) Recurrence after hematopoietic stem cell transplantation; There must be at least one evaluable or measurable lesion in line with Lugano2014 criteria: lymph node lesion, the length and diameter of detectable lymph node must be greater than 1.5cm; For non-lymph node lesions, the diameter of extrinsic lesions should be > 1.0cm; ECOG score 0-2; Bone marrow function: neutrophil count ≥1.5×10^9/L, platelet count ≥75×10^9/L, hemoglobin ≥80g/L (neutrophil count ≥1.0×10^9/L, platelet count ≥50×10^9/L, hemoglobin ≥75g/L in patients with bone marrow involvement); Liver and kidney function: serum creatinine ≤1.5 times the upper limit of normal value; AST and ALT ≤2.5 times the upper limit of normal value (≤5 times the upper limit of normal value for patients with liver invasion); Total bilirubin ≤1.5 times the upper limit of normal value (≤3 times the upper limit of normal value for patients with liver invasion); Exclusion Criteria: The subject's previous history of antitumor therapy meets one of the following conditions: Previous recipients of mitoxantrone or mitoxantrone liposomes; Prior treatment with doxorubicin or anthracycline with a cumulative dose of doxorubicin > 360 mg/m2 (1 mg of doxorubicin for other anthracyclines); Patients who had received autologous hematopoietic stem cell transplantation or had received allogeneic hematopoietic stem cell transplantation within 100 days of the first medication; Received anti-tumor therapy (including chemotherapy, targeted therapy, hormone therapy, taking anti-tumor active Chinese medicine, etc.) or participated in other clinical trials and received clinical trial drugs within 4 weeks before the first use of the drug in this study; Hypersensitivity to any investigational drug or its components; Uncontrolled systemic diseases (such as advanced infections, uncontrolled hypertension, diabetes, etc.); Cardiac function and disease conform to one of the following conditions: Long QTc syndrome or QTc interval >480 ms; Complete left bundle branch block, complete right bundle branch block with left anterior branch block, second degree type II, or third degree atrioventricular block; severe, uncontrolled arrhythmias requiring medical treatment; New York College of Cardiology Grade ≥ III; A history of acute myocardial infarction, unstable angina pectoris, severely unstable ventricular arrhythmias or any other arrhythmia requiring treatment, a history of clinically severe pericardial disease, or electrocardiographic evidence of acute ischemic or active conduction abnormalities within the 6 months prior to recruitment. Hepatitis B and hepatitis C active infection (hepatitis B virus surface antigen positive and hepatitis B virus DNA more than 1x10^3 copies /mL; HCV RNA over 1x10^3 copies /mL); Human immunodeficiency virus (HIV) infection (HIV antibody positive); Past or present co-existing malignancies (in addition to non-melanoma basal cell carcinoma of the skin, carcinoma in situ of the breast/cervix, and other malignancies that have been effectively controlled without treatment in the past five years); Primary or secondary central nervous system (CNS) lymphoma or history of CNS lymphoma at the time of recruitment; There is significant gastrointestinal disease at the time of screening that may affect drug intake, transport or absorption (e.g. inability to swallow, chronic diarrhea, intestinal obstruction, etc.); Pregnant and lactating women and patients of childbearing age who do not wish to take contraceptive measures; Situations in which other researchers have determined that participation in this study is not appropriate.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Jinhua Liang, M.D
    Phone
    15952032421
    Email
    1151525490@qq.com
    First Name & Middle Initial & Last Name or Official Title & Degree
    Wei Xu, PhD& MD
    Phone
    862568136034
    Email
    xuwei10000@hotmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Wei Xu, PhD& MD
    Organizational Affiliation
    The first Affiliated Hospital Of Nanjing Medical University(JiangSu Province Hospital)
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    R-MINE+X in Patients With Relapsed/Refractory Diffuse Large B-cell Lymphoma

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