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A Phase 1/2 Study of Lenalidomide in Combination With Bendamustine in Relapsed and Primary Refractory Hodgkin Lymphoma (LEBEN)

Primary Purpose

Recurrent Adult Hodgkin Lymphoma

Status
Unknown status
Phase
Phase 1
Locations
Italy
Study Type
Interventional
Intervention
Lenalidomide
Bendamustine
Bio-specimen Retention
Sponsored by
Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Adult Hodgkin Lymphoma focused on measuring Hodgkin Lymphoma, Lenalidomide, Bendamustine, Salvage therapy, Palliation

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must have histologically confirmed classical Hodgkin lymphoma (HL).
  • Patients must have failed an autologous stem cell transplant or be ineligible for high-dose therapy due to chemorefractory disease (as defined as <50% response to standard salvage chemotherapy), age or comorbidity.
  • Patients must have at least one target PET-avid bidimensionally measurable lesion,
  • Age >18 years
  • Life expectancy of greater than 3 months
  • ECOG performance status <2
  • Patients must have adequate organ and marrow function as defined below: absolute neutrophil count >1,000/mL; platelets >75,000/mL; total bilirubin < 2.0 mg/dl in the absence of a history of Gilbert's disease (or pattern consistent with Gilbert's disease); however dose reduction is recommended for Bendamustine in patients with 30 - 70 % tumour involvement of the liver and moderately diminished liver function (serum bilirubin 1.2 - 3.0 mg/dl); AST(SGOT)/ALT(SGPT) <3 X institutional upper limit of normal; creatinine within normal institutional limits OR creatinine clearance >50 mL/min/1.73 m2
  • Patients must have echocardiogram or gated blood pool scan (MUGA) with an ejection fraction > or = to 50%
  • If patients have a history of malignancy other than cutaneous basal cell or squamous cell carcinoma, they must be disease-free for ~ 5 years at the time of enrolment
  • Patients must accept contraception measures until 4 weeks after the completion of chemotherapy, and up to 6 months for male patients.
  • Women of child-bearing must have a medically supervised negative pregnancy test even if had been using effective contraception.
  • Patients agree not to share study medication with another person and to return all unused study drug to the investigator
  • Patients or their guardians must be capable to understand and must be willing to sign a written informed consent document.

Exclusion Criteria:

  • Treatment with chemotherapy or external radiotherapy within 6 weeks, or monoclonal antibodies within 8 weeks or radioimmunoconjugates in the previous 12 weeks prior to entering the study
  • Treatment with any other investigational agent
  • Parenchymal brain or leptomeningeal HL involvement
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to the agents used in the study
  • Known HIV positivity or active infectious hepatitis, type A, B, or C
  • Clinically significant cardiac disease (NYHA Class III or IV)
  • Abnormal QTcF interval prolonged (> 459 msec)
  • Known pregnancy or breastfeeding.
  • Jaundice
  • Yellow fever vaccination
  • Medical illness unrelated to HL, which in the opinion of the attending physician and principal investigator will preclude safe administration of lenalidomide and bendamustine
  • Corticoid treatment different from low dose prednisone or methylprednisone (up to 16 mg), used for B symptoms control.
  • Contraindications for receiving prophylaxis against deep vein thrombosis
  • Thromboembolic disease grade 3-4 in the last 6 months
  • More than one month between staging procedures and the start of the treatment
  • Major surgical procedures less than 30 days before the start of treatment

Sites / Locations

  • Hematology Oncology and Stem Cell Transplantation Unit , IRCCS Fondazione "G.Pascale"

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

lenalidomide plus bendamustine

Arm Description

Outcomes

Primary Outcome Measures

Dose finding, as best trade-off between toxicity and efficacy according to the Bayesian phase I/II dose finding method of Thall and Cook
According to the Bayesian phase I/II dose finding method of Thall and Cook,a target efficacy-toxicity trade-off contour has been constructed by fitting a curve to target values of pE (probability ofEfficacy) and pT (probability of Toxicity) of 0.30 and 0.40, respectively and probability cut-offs pE (for Efficacy)and pT (for Toxicity) set at 0.10 and 0.10,respectively.The area underneath the target contour has desirable πE, πT pairs. Up to 36 patients can be treated in cohorts of size 3. The 'best' dose is defined as that giving the largest response-toxicity trade-off.

Secondary Outcome Measures

AE/SAE rate at completion of treatment
Overall Rate Response
Event Free Survival
Time to Progression
Response Duration

Full Information

First Posted
August 3, 2011
Last Updated
August 8, 2015
Sponsor
Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale
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1. Study Identification

Unique Protocol Identification Number
NCT01412307
Brief Title
A Phase 1/2 Study of Lenalidomide in Combination With Bendamustine in Relapsed and Primary Refractory Hodgkin Lymphoma
Acronym
LEBEN
Official Title
A Phase 1/2 Study of Lenalidomide in Combination With Bendamustine (LEBEN) in Relapsed and Primary Refractory Hodgkin Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
August 2015
Overall Recruitment Status
Unknown status
Study Start Date
July 2011 (undefined)
Primary Completion Date
July 2015 (Actual)
Study Completion Date
July 2016 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Management of patients with recurring Hodgkin lymphoma (HL) after stem cell transplantation failure represents a typical unmet medical need prompting active development and validation of new agents and treatment strategies. The LEBEN protocol combines two agents, lenalidomide and bendamustine, framing different targets on both tumor and microenvironmental cells of HL. These agents, while showing a low risk of overlapping extrahematologic toxicities, may hit the proliferation machinery of H-RS cells and/or their progenitors, synergistically inhibit tumor-related angiogenesis and interfere on cytokine-mediate circuitries operating in the microenvironment to support tumor cell survival. A weekly schedule of bendamustine, at 60 mg/m2, is combined with the continuous administration of increasing dose of lenalidomide (10, 15, 20 e 25 mg dose levels in a 28-day cycle). Such schedule of Bendamustine is aimed at enhancing the antiangiogenic and immunomodulatory activity of continuous Lenalidomide, as studies have shown that low and protracted doses of alkylators induce a decrease in microvascular density of tumor tissues and inhibit mobilization and viability of circulating endothelial progenitors. The Bayesian phase 1/2 dose finding method of Thall and Cook was employed. This method chooses doses based-on both response and toxicity, and accounts for the trade-off between these two outcomes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Adult Hodgkin Lymphoma
Keywords
Hodgkin Lymphoma, Lenalidomide, Bendamustine, Salvage therapy, Palliation

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
36 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
lenalidomide plus bendamustine
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Lenalidomide
Other Intervention Name(s)
CC-5013, IMiD-1, Revlimid
Intervention Description
10, 15, 20 or 25 mg orally per cohort day 1-28 in a 28 days cycle
Intervention Type
Drug
Intervention Name(s)
Bendamustine
Other Intervention Name(s)
SDX-105, Ribomustin, Treanda, Cytostasan
Intervention Description
intravenous on days 1, 8 and 15 of each 28-days cycle at fixed dose of 60 mg/m2, as a 30-60 min i.v. infusion
Intervention Type
Other
Intervention Name(s)
Bio-specimen Retention
Intervention Description
Samples with DNA and without DNA
Primary Outcome Measure Information:
Title
Dose finding, as best trade-off between toxicity and efficacy according to the Bayesian phase I/II dose finding method of Thall and Cook
Description
According to the Bayesian phase I/II dose finding method of Thall and Cook,a target efficacy-toxicity trade-off contour has been constructed by fitting a curve to target values of pE (probability ofEfficacy) and pT (probability of Toxicity) of 0.30 and 0.40, respectively and probability cut-offs pE (for Efficacy)and pT (for Toxicity) set at 0.10 and 0.10,respectively.The area underneath the target contour has desirable πE, πT pairs. Up to 36 patients can be treated in cohorts of size 3. The 'best' dose is defined as that giving the largest response-toxicity trade-off.
Time Frame
Evaluation at day +56, i.g. after two cycles.
Secondary Outcome Measure Information:
Title
AE/SAE rate at completion of treatment
Time Frame
After course 6. i.g. about 6 months
Title
Overall Rate Response
Time Frame
After 2, 4 and 6 cycles
Title
Event Free Survival
Time Frame
From the time from study entry to any treatment failure including disease progression, or discontinuation of treatment for any reason
Title
Time to Progression
Time Frame
From entry until documented lymphoma progression or death as a result of lymphoma.
Title
Response Duration
Time Frame
From the time when criteria for response (i.g. CR or PR) are met, for which the event is the first documentation of relapse or progression.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have histologically confirmed classical Hodgkin lymphoma (HL). Patients must have failed an autologous stem cell transplant or be ineligible for high-dose therapy due to chemorefractory disease (as defined as <50% response to standard salvage chemotherapy), age or comorbidity. Patients must have at least one target PET-avid bidimensionally measurable lesion, Age >18 years Life expectancy of greater than 3 months ECOG performance status <2 Patients must have adequate organ and marrow function as defined below: absolute neutrophil count >1,000/mL; platelets >75,000/mL; total bilirubin < 2.0 mg/dl in the absence of a history of Gilbert's disease (or pattern consistent with Gilbert's disease); however dose reduction is recommended for Bendamustine in patients with 30 - 70 % tumour involvement of the liver and moderately diminished liver function (serum bilirubin 1.2 - 3.0 mg/dl); AST(SGOT)/ALT(SGPT) <3 X institutional upper limit of normal; creatinine within normal institutional limits OR creatinine clearance >50 mL/min/1.73 m2 Patients must have echocardiogram or gated blood pool scan (MUGA) with an ejection fraction > or = to 50% If patients have a history of malignancy other than cutaneous basal cell or squamous cell carcinoma, they must be disease-free for ~ 5 years at the time of enrolment Patients must accept contraception measures until 4 weeks after the completion of chemotherapy, and up to 6 months for male patients. Women of child-bearing must have a medically supervised negative pregnancy test even if had been using effective contraception. Patients agree not to share study medication with another person and to return all unused study drug to the investigator Patients or their guardians must be capable to understand and must be willing to sign a written informed consent document. Exclusion Criteria: Treatment with chemotherapy or external radiotherapy within 6 weeks, or monoclonal antibodies within 8 weeks or radioimmunoconjugates in the previous 12 weeks prior to entering the study Treatment with any other investigational agent Parenchymal brain or leptomeningeal HL involvement History of allergic reactions attributed to compounds of similar chemical or biologic composition to the agents used in the study Known HIV positivity or active infectious hepatitis, type A, B, or C Clinically significant cardiac disease (NYHA Class III or IV) Abnormal QTcF interval prolonged (> 459 msec) Known pregnancy or breastfeeding. Jaundice Yellow fever vaccination Medical illness unrelated to HL, which in the opinion of the attending physician and principal investigator will preclude safe administration of lenalidomide and bendamustine Corticoid treatment different from low dose prednisone or methylprednisone (up to 16 mg), used for B symptoms control. Contraindications for receiving prophylaxis against deep vein thrombosis Thromboembolic disease grade 3-4 in the last 6 months More than one month between staging procedures and the start of the treatment Major surgical procedures less than 30 days before the start of treatment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Antonio Pinto, MD
Organizational Affiliation
Hematology Oncology and Stem Cell Transplantation Unit , IRCCS Fondazione "G.Pascale" - Naples, Italy
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Gaetano Corazzelli, MD
Organizational Affiliation
Hematology Oncology and Stem Cell Transplantation Unit , IRCCS Fondazione "G.Pascale" - Naples, Italy
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hematology Oncology and Stem Cell Transplantation Unit , IRCCS Fondazione "G.Pascale"
City
Naples
ZIP/Postal Code
80131
Country
Italy

12. IPD Sharing Statement

Citations:
Citation
http://meetinglibrary.asco.org/content/132091-144
Results Reference
result

Learn more about this trial

A Phase 1/2 Study of Lenalidomide in Combination With Bendamustine in Relapsed and Primary Refractory Hodgkin Lymphoma

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