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Bortezomib and Fludarabine With or Without Rituximab in Treating Patients With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma or Chronic Lymphocytic Leukemia

Primary Purpose

Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue, Hematopoietic/Lymphoid Cancer, Nodal Marginal Zone B-cell Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
bortezomib
fludarabine phosphate
rituximab
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue

Eligibility Criteria

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

Inclusion Criteria: Diagnosis of chronic lymphocytic leukemia (CLL) OR indolent non-Hodgkin's lymphoma (NHL) of any of the following subtypes: Follicular lymphoma: Grade I follicular small cleaved cell; Grade II follicular mixed cell; Grade II follicular large cell; Diffuse small cleaved cell; Small lymphocytic lymphoma; Lymphoplasmacytic lymphoma (Waldenstrom's macroglobulinemia) AND Extranodal marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue [MALT] lymphoma); Nodal marginal zone B-cell lymphoma (monocytoid B-cell lymphoma); Splenic marginal zone lymphoma (splenic lymphoma with villous lymphocytes); Mantle cell lymphoma: No blastic phase mantle cell lymphoma Relapsed or refractory, progressive disease: First, second, or third relapse Measurable disease, meeting 1 of the following criteria: At least 1 unidimensionally measurable lesion at least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan (for NHL patients); OR: Lymphocytosis > 50,000/mm3 OR evidence of progressive bone marrow infiltration failure (e.g., hemoglobin 10 g/dL) OR thrombocytopenia (i.e., platelet count < 100,000/mm3) with > 30% infiltration of bone marrow by leukemia (for CLL patients) No measurable lymphadenopathy (for CLL and Waldenstrom's macroglobulinemia patients) No evidence of CNS lymphoma Performance status: ECOG 0-2 Life expectancy: More than 12 weeks No history of uncontrolled orthostatic hypotension No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception HIV negative No uncontrolled concurrent illness No grade 2 or greater neuropathy No history of allergy or anaphylaxis to mannitol, bortezomib, fludarabine, or boron No ongoing or active infection No psychiatric illness or social situation that would preclude study compliance At least 4 weeks since prior monoclonal antibody (MoAB) therapy: Patients who have received MoAB therapy within the past 3 months must have documented disease progression since receiving this therapy No prior allogeneic stem cell transplantation More than 4 weeks since prior chemotherapy Prior fludarabine allowed At least 1 week since prior steroids At least 3 months since prior radio-immunotherapy More than 4 weeks since prior radiotherapy No prior bortezomib Absolute neutrophil count at least 1,500/mm3 Platelet count at least 75,000/mm3 (greater than 50,000/mm3 if lymphomatous bone marrow involvement is present) Bilirubin no greater than 2.0 mg/dL AST/ALT no greater than 4 times normal Creatinine clearance greater than 40 mL/min No other concurrent investigational agents or treatments for the malignancy No brain metastases OR: Quantitation of IgM paraprotein (for Waldenstrom's macroglobulinemia patients)

Sites / Locations

  • Mercy Medical Center
  • Case Western Reserve University
  • Seidman Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center
  • Southwest General Health Center Ireland Cancer Center
  • UHHS-Chagrin Highlands Medical Center
  • University Suburban Medical Center
  • UHHS-Westlake Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (bortezomib, fludarabine, rituximab)

Arm Description

Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11 and fludarabine IV over 30 minutes on days 1-3 or 1-5. Patients may also receive rituximab IV over 1 hour on day 1. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of bortezomib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

Outcomes

Primary Outcome Measures

Maximum tolerated dose (MTD) assessed by Common Toxicity Criteria version 2.0

Secondary Outcome Measures

Full Information

First Posted
September 10, 2003
Last Updated
September 27, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00068315
Brief Title
Bortezomib and Fludarabine With or Without Rituximab in Treating Patients With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma or Chronic Lymphocytic Leukemia
Official Title
A Phase I Trial of PS-341 and Fludarabine for Relapsed and Refractory Indolent Non-Hodgkin's Lymphoma and Chronic Lymphocytic Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
September 2013
Overall Recruitment Status
Completed
Study Start Date
July 2003 (undefined)
Primary Completion Date
December 2008 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This phase I trial is studying the side effects and best dose of bortezomib when given together with fludarabine with or without rituximab in treating patients with relapsed or refractory indolent non-Hodgkin's lymphoma or chronic lymphocytic leukemia. Bortezomib may stop the growth of cancer cells by blocking the enzymes necessary for cancer cell growth. Drugs used in chemotherapy, such as fludarabine, work in different ways to stop cancer cells from dividing so they stop growing or die. Monoclonal antibodies, such as rituximab, can 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 bortezomib together with fludarabine with or without rituximab may kill more cancer cells.
Detailed Description
OBJECTIVES: I. Determine the safety and toxicity of bortezomib and fludarabine with or without rituximab in patients with relapsed or refractory indolent non-Hodgkin's lymphoma or chronic lymphocytic leukemia. II. Determine the maximum tolerated dose of bortezomib in combination with fludarabine in these patients. III. Determine the biological effect of this regimen on apoptotic markers, cell cycle kinase inhibitors, and DNA repair in these patients. OUTLINE: This is a multicenter, dose-escalation study of bortezomib. Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11 and fludarabine IV over 30 minutes on days 1-3 or 1-5. Patients may also receive rituximab IV over 1 hour on day 1. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of bortezomib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue, Hematopoietic/Lymphoid Cancer, Nodal Marginal Zone B-cell Lymphoma, Recurrent Adult Diffuse Small Cleaved Cell Lymphoma, Recurrent Grade 1 Follicular Lymphoma, Recurrent Grade 2 Follicular Lymphoma, Recurrent Mantle Cell Lymphoma, Recurrent Marginal Zone Lymphoma, Recurrent Small Lymphocytic Lymphoma, Refractory Chronic Lymphocytic Leukemia, Splenic Marginal Zone Lymphoma, Waldenström Macroglobulinemia

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment (bortezomib, fludarabine, rituximab)
Arm Type
Experimental
Arm Description
Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11 and fludarabine IV over 30 minutes on days 1-3 or 1-5. Patients may also receive rituximab IV over 1 hour on day 1. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of bortezomib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
Intervention Type
Drug
Intervention Name(s)
bortezomib
Other Intervention Name(s)
LDP 341, MLN341, VELCADE
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate
Other Intervention Name(s)
2-F-ara-AMP, Beneflur, Fludara
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
rituximab
Other Intervention Name(s)
IDEC-C2B8, IDEC-C2B8 monoclonal antibody, Mabthera, MOAB IDEC-C2B8, Rituxan
Intervention Description
Given IV
Primary Outcome Measure Information:
Title
Maximum tolerated dose (MTD) assessed by Common Toxicity Criteria version 2.0
Time Frame
3 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of chronic lymphocytic leukemia (CLL) OR indolent non-Hodgkin's lymphoma (NHL) of any of the following subtypes: Follicular lymphoma: Grade I follicular small cleaved cell; Grade II follicular mixed cell; Grade II follicular large cell; Diffuse small cleaved cell; Small lymphocytic lymphoma; Lymphoplasmacytic lymphoma (Waldenstrom's macroglobulinemia) AND Extranodal marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue [MALT] lymphoma); Nodal marginal zone B-cell lymphoma (monocytoid B-cell lymphoma); Splenic marginal zone lymphoma (splenic lymphoma with villous lymphocytes); Mantle cell lymphoma: No blastic phase mantle cell lymphoma Relapsed or refractory, progressive disease: First, second, or third relapse Measurable disease, meeting 1 of the following criteria: At least 1 unidimensionally measurable lesion at least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan (for NHL patients); OR: Lymphocytosis > 50,000/mm3 OR evidence of progressive bone marrow infiltration failure (e.g., hemoglobin 10 g/dL) OR thrombocytopenia (i.e., platelet count < 100,000/mm3) with > 30% infiltration of bone marrow by leukemia (for CLL patients) No measurable lymphadenopathy (for CLL and Waldenstrom's macroglobulinemia patients) No evidence of CNS lymphoma Performance status: ECOG 0-2 Life expectancy: More than 12 weeks No history of uncontrolled orthostatic hypotension No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception HIV negative No uncontrolled concurrent illness No grade 2 or greater neuropathy No history of allergy or anaphylaxis to mannitol, bortezomib, fludarabine, or boron No ongoing or active infection No psychiatric illness or social situation that would preclude study compliance At least 4 weeks since prior monoclonal antibody (MoAB) therapy: Patients who have received MoAB therapy within the past 3 months must have documented disease progression since receiving this therapy No prior allogeneic stem cell transplantation More than 4 weeks since prior chemotherapy Prior fludarabine allowed At least 1 week since prior steroids At least 3 months since prior radio-immunotherapy More than 4 weeks since prior radiotherapy No prior bortezomib Absolute neutrophil count at least 1,500/mm3 Platelet count at least 75,000/mm3 (greater than 50,000/mm3 if lymphomatous bone marrow involvement is present) Bilirubin no greater than 2.0 mg/dL AST/ALT no greater than 4 times normal Creatinine clearance greater than 40 mL/min No other concurrent investigational agents or treatments for the malignancy No brain metastases OR: Quantitation of IgM paraprotein (for Waldenstrom's macroglobulinemia patients)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brenda Cooper
Organizational Affiliation
Case Western Reserve University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mercy Medical Center
City
Canton
State/Province
Ohio
ZIP/Postal Code
44708
Country
United States
Facility Name
Case Western Reserve University
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
Seidman Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
Southwest General Health Center Ireland Cancer Center
City
Middleburg Heights
State/Province
Ohio
ZIP/Postal Code
44130
Country
United States
Facility Name
UHHS-Chagrin Highlands Medical Center
City
Orange Village
State/Province
Ohio
ZIP/Postal Code
44122
Country
United States
Facility Name
University Suburban Medical Center
City
South Euclid
State/Province
Ohio
ZIP/Postal Code
44121
Country
United States
Facility Name
UHHS-Westlake Medical Center
City
Westlake
State/Province
Ohio
ZIP/Postal Code
44145
Country
United States

12. IPD Sharing Statement

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Bortezomib and Fludarabine With or Without Rituximab in Treating Patients With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma or Chronic Lymphocytic Leukemia

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