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Bendamustine Plus Alemtuzumab for Refractory Chronic Lymphocytic Leukemia (CLL)

Primary Purpose

Recurrent Small Lymphocytic Lymphoma, Refractory Chronic Lymphocytic Leukemia, Stage III Chronic Lymphocytic Leukemia

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Bendamustine Hydrochloride
Alemtuzumab
Sponsored by
Case Comprehensive Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Small Lymphocytic Lymphoma focused on measuring Refractory Chronic Lymphocytic Leukemia, Bendamustine, Alemtuzumab, Phase I, CLL

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Patients with CLL or SLL as defined by the WHO classification system with indications for treatment by National Cancer Institute (NCI) Working Group criteria.
  2. Measurable disease (lymphocytes equal or greater than 5,000/µL, or measurable lymphadenopathy, or bone marrow involvement greater than 30%).
  3. Males and females 18 years of age or older.
  4. Patients must be relapsed or refractory and have been treated with a minimum of one prior purine analog-based chemotherapy regimen (e.g., fludarabine, cladribine, or pentostatin).
  5. All previous cancer therapies, radiation, hormonal therapy and surgery, must have been discontinued at least 28 days prior to the start of treatment. Any cytotoxic chemotherapy must have been discontinued 28 days prior to the start of treatment. Acute toxicities from prior therapy must have resolved to Grade ≤ 1 above baseline.
  6. Normal oxygen saturation with pulse oximetry on room air.
  7. Hemoglobin 9 or greater gm/dL (may be post-transfusion).
  8. Platelet count 50 x103/mL or greater
  9. Total bilirubin less than 2 X ULN, and ALT and AST less than 2 x ULN.
  10. Serum creatinine 2 X ULN or less. In addition, the calculated glomerular filtration rate (GFR) must be > 30cc/min.
  11. ECOG Performance Status 2 or less.
  12. Anticipated survival of at least 3 months.
  13. For men and women of child-producing potential, use of effective contraceptive methods during the study and for one month after discontinuation of treatment.

Exclusion Criteria:

  1. Pregnant or lactating women.
  2. Severe chronic obstructive pulmonary disease with hypoxemia or an uncorrectable pulmonary compromise.
  3. Seizures not controlled by anticonvulsant therapy.
  4. Participation in any investigational drug study within 28 days before study entry.
  5. Patients with second malignancy requiring active treatment.
  6. Active, symptomatic bacterial, fungal, or viral infection including active HIV or viral (A, B, or C) hepatitis.
  7. Clinically significant bleeding event within the last 3 months, unrelated to trauma, or underlying condition that would be expected to result in a bleeding diathesis.
  8. Patients with life- or function-threatening CLL complications (e.g., cord compression, hemolytic crisis, urinary tract obstruction).
  9. Any illness or condition that in the opinion of the investigator may affect safety of treatment or evaluation of any of the study's endpoints.
  10. Systemic treatment for CLL/SLL within 28 days of study entry
  11. Subjects with a history of leukemic meningitis, or signs and symptoms suggestive of leukemic meningitis, must have a negative lumbar puncture within 2 weeks of study entry.

Sites / Locations

  • Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
  • Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bendamustine plus Alemtuzumab

Arm Description

Outcomes

Primary Outcome Measures

Evaluate the safety of the combination of alemtuzumab and bendamustine in patients with advanced CLL
AEs will be graded according to the NCI CTCAE, Version 3.0.

Secondary Outcome Measures

Establish the maximum tolerated dose of alemtuzumab up to the standard dose of 30mg thrice weekly when combined with bendamustine at a standard dose of 70 mg/m2 day 8 and 9 monthly.
Adverse events (AEs) will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), Version 3.0.
Clinical activity and response of the combination of bendamustine hydrochloride and alemtuzumab
Examined by summarizing response overall and by cohort as frequency counts and percentages. Response criteria as described by the National Cancer Institute-sponsored Working Group Guidelines.

Full Information

First Posted
July 24, 2009
Last Updated
August 20, 2013
Sponsor
Case Comprehensive Cancer Center
Collaborators
Cephalon
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1. Study Identification

Unique Protocol Identification Number
NCT00947388
Brief Title
Bendamustine Plus Alemtuzumab for Refractory Chronic Lymphocytic Leukemia (CLL)
Official Title
A Phase I Trial of Bendamustine Plus Alemtuzumab for the Treatment of Fludarabine Refractory Chronic Lymphocytic Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
August 2013
Overall Recruitment Status
Terminated
Why Stopped
No more eligible patients
Study Start Date
November 2008 (undefined)
Primary Completion Date
September 2012 (Actual)
Study Completion Date
March 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Case Comprehensive Cancer Center
Collaborators
Cephalon

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase I trial is studying the side effects and best dose of alemtuzumab when given together with bendamustine hydrochloride in treating patients with relapsed chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) that did not respond to fludarabine phosphate. Drugs used in chemotherapy, such as bendamustine hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as alemtuzumab, can also block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Giving bendamustine hydrochloride together with alemtuzumab may kill more cancer cells.
Detailed Description
PRIMARY OBJECTIVES: I. Evaluate the safety of the combination of alemtuzumab and bendamustine (bendamustine hydrochloride) in patients with advanced CLL. II. Establish the maximum tolerated dose of alemtuzumab up to the standard dose of 30mg thrice weekly when combined with bendamustine at a standard dose of 70 mg/m^2 day 8 and 9 monthly. III. Define a recommended dose for subsequent Phase II studies. IV. Evaluate preliminary evidence of activity as determined by response rates with correlation to EAS flow cytometry. OUTLINE: This is a dose-escalation study of alemtuzumab. Patients receive bendamustine hydrochloride intravenously (IV) over 30-60 minutes on days 8 and 9 for up to 6 courses in the absence of disease progression or unacceptable toxicity and alemtuzumab subcutaneously (SC) on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26. After completion of study treatment, patients are followed every 3 months for 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Small Lymphocytic Lymphoma, Refractory Chronic Lymphocytic Leukemia, Stage III Chronic Lymphocytic Leukemia, Stage III Small Lymphocytic Lymphoma, Stage IV Chronic Lymphocytic Leukemia, Stage IV Small Lymphocytic Lymphoma
Keywords
Refractory Chronic Lymphocytic Leukemia, Bendamustine, Alemtuzumab, Phase I, CLL

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bendamustine plus Alemtuzumab
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Bendamustine Hydrochloride
Other Intervention Name(s)
cytostasan hydrochloride, Ribomustin, SDX-105, Treanda
Intervention Description
Bendamustine 70 mg/m2 IV Day 8 and 9 every 28 days for 6 courses of therapy
Intervention Type
Biological
Intervention Name(s)
Alemtuzumab
Other Intervention Name(s)
anti-CD52 monoclonal antibody, Campath, Campath-1H, MoAb CD52, Monoclonal Antibody Campath-1H, Monoclonal Antibody CD52
Intervention Description
Given subcutaneously (SC)on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26.
Primary Outcome Measure Information:
Title
Evaluate the safety of the combination of alemtuzumab and bendamustine in patients with advanced CLL
Description
AEs will be graded according to the NCI CTCAE, Version 3.0.
Time Frame
up to 1 year
Secondary Outcome Measure Information:
Title
Establish the maximum tolerated dose of alemtuzumab up to the standard dose of 30mg thrice weekly when combined with bendamustine at a standard dose of 70 mg/m2 day 8 and 9 monthly.
Description
Adverse events (AEs) will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), Version 3.0.
Time Frame
up to 12 weeks
Title
Clinical activity and response of the combination of bendamustine hydrochloride and alemtuzumab
Description
Examined by summarizing response overall and by cohort as frequency counts and percentages. Response criteria as described by the National Cancer Institute-sponsored Working Group Guidelines.
Time Frame
up to 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Patients with CLL or SLL as defined by the WHO classification system with indications for treatment by National Cancer Institute (NCI) Working Group criteria. Measurable disease (lymphocytes equal or greater than 5,000/µL, or measurable lymphadenopathy, or bone marrow involvement greater than 30%). Males and females 18 years of age or older. Patients must be relapsed or refractory and have been treated with a minimum of one prior purine analog-based chemotherapy regimen (e.g., fludarabine, cladribine, or pentostatin). All previous cancer therapies, radiation, hormonal therapy and surgery, must have been discontinued at least 28 days prior to the start of treatment. Any cytotoxic chemotherapy must have been discontinued 28 days prior to the start of treatment. Acute toxicities from prior therapy must have resolved to Grade ≤ 1 above baseline. Normal oxygen saturation with pulse oximetry on room air. Hemoglobin 9 or greater gm/dL (may be post-transfusion). Platelet count 50 x103/mL or greater Total bilirubin less than 2 X ULN, and ALT and AST less than 2 x ULN. Serum creatinine 2 X ULN or less. In addition, the calculated glomerular filtration rate (GFR) must be > 30cc/min. ECOG Performance Status 2 or less. Anticipated survival of at least 3 months. For men and women of child-producing potential, use of effective contraceptive methods during the study and for one month after discontinuation of treatment. Exclusion Criteria: Pregnant or lactating women. Severe chronic obstructive pulmonary disease with hypoxemia or an uncorrectable pulmonary compromise. Seizures not controlled by anticonvulsant therapy. Participation in any investigational drug study within 28 days before study entry. Patients with second malignancy requiring active treatment. Active, symptomatic bacterial, fungal, or viral infection including active HIV or viral (A, B, or C) hepatitis. Clinically significant bleeding event within the last 3 months, unrelated to trauma, or underlying condition that would be expected to result in a bleeding diathesis. Patients with life- or function-threatening CLL complications (e.g., cord compression, hemolytic crisis, urinary tract obstruction). Any illness or condition that in the opinion of the investigator may affect safety of treatment or evaluation of any of the study's endpoints. Systemic treatment for CLL/SLL within 28 days of study entry Subjects with a history of leukemic meningitis, or signs and symptoms suggestive of leukemic meningitis, must have a negative lumbar puncture within 2 weeks of study entry.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matt Kalaycio, MD
Organizational Affiliation
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Paolo Caimi, MD
Organizational Affiliation
Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States

12. IPD Sharing Statement

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Bendamustine Plus Alemtuzumab for Refractory Chronic Lymphocytic Leukemia (CLL)

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