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Bortezomib, Rituximab, Cyclophosphamide, and Prednisone in Treating Patients With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma

Primary Purpose

Leukemia, Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
rituximab
bortezomib
cyclophosphamide
prednisone
Sponsored by
Memorial Sloan Kettering Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent small lymphocytic lymphoma, recurrent marginal zone lymphoma, Waldenstrom macroglobulinemia, recurrent mantle cell lymphoma, refractory chronic lymphocytic leukemia, B-cell chronic lymphocytic leukemia, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed diagnosis of 1 of the following: Chronic lymphocytic leukemia (CLL) B-cell small lymphocytic leukemia (SLL) Any marginal zone lymphoma Grade 1-3A follicular lymphoma Waldenstrom's macroglobulinemia Mantle cell lymphoma No transformed indolent lymphoma Assessable disease (phase I) Measurable disease (phase I and II), defined as ≥ one lesion that can be accurately measured in ≥ 1 dimension as ≥ 2 cm by conventional techniques OR ≥ 1 cm by spiral CT scan Lymph nodes measuring ≤ 1 cm in the short axis are considered normal Relapsed or refractory disease Must have received at least 1 prior therapeutic regimen but no more than 3 prior conventional cytotoxic therapy regimens No known brain metastases or meningeal disease PATIENT CHARACTERISTICS: Karnofsky performance status > 50% Absolute neutrophil count > 1,000/mcl (more than 500/mcl if known lymphomatous involvement) Platelet count ≥ 50,000/mcl Total bilirubin < 1.5 times upper limit of normal (ULN) (less than 5 mg/dL if known history of Gilbert's disease) AST and ALT ≤ 2.5 times ULN (4 times ULN if liver involvement) Creatinine < 1.5 times ULN OR creatinine clearance > 50 mL/min Patients may have febrile episodes up to 38.5ºC without evidence of active infection Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No New York Heart Association class III or IV congestive heart failure No uncontrolled intercurrent illness, including any of the following: Ongoing or active infection Cerebrovascular accident or transient ischemic attack within 6 months of study entry Unstable angina pectoris Cardiac arrhythmia EKG evidence of acute ischemia Psychiatric illness/social situations that would limit compliance with study requirements No uncontrolled hypertension requiring active manipulation of antihypertensive medications No known or active HIV infection No history of hypersensitivity to bortezomib, boron, or mannitol No peripheral neuropathy > grade 2 No other malignancy within the past 5 years except curatively treated non life-threatening malignancies, such as cutaneous basal cell or squamous cell carcinoma or carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: See Disease Characteristics Recovered from prior therapy Prior stem cell transplantation allowed Preparative cytoreductive and high-dose therapies considered 1 prior therapy At least 4 weeks since prior cytotoxic chemotherapy (6 weeks since prior nitrosoureas or mitomycin C) At least 12 weeks since prior radioimmunotherapy One prior course comprising tositumomab or ibritumomab tiuxetan allowed At least 1 week since prior palliative steroids for NHL No therapeutic monoclonal antibodies (e.g., rituximab, tositumomab, ibritumomab, alemtuzumab, etc.) within 3 months of study entry Patients treated with monoclonal antibodies within 3 months allowed provided disease progressed on this therapy AND no treatment received 7 days prior to study entry Seven days since prior rituximab (for patients enrolled in phase I portion) No major surgery within 4 weeks of study entry No other concurrent investigational agents No other concurrent anticancer therapy

Sites / Locations

  • Winship Cancer Institute of Emory University
  • Memorial Sloan-Kettering at Basking Ridge
  • Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
  • Memorial Sloan-Kettering Cancer Center @ Suffolk
  • Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
  • Memorial Sloan-Kettering Cancer Center
  • Memorial Sloan-Kettering at Mercy Medical Center
  • Memoral Sloan Kettering Cancer Center@Phelps

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm I

Arm II

Arm Description

Patients receive cyclophosphamide IV and rituximab IV on day 1, oral prednisone on days 2-6, and bortezomib IV (at the MTD determined in phase I) on days 2, 5, 9, and 12. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity.

Patients receive cyclophosphamide IV and rituximab IV on day 1, oral prednisone on days 2-6, and bortezomib IV (at the MTD determined in phase I) on days 2 and 8. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose
Maximum tolerated dose of Bortezomib in combination with Rituximab, Cyclophosphamide and Prednisone in Phase I participants

Secondary Outcome Measures

Progression-free Survival
Duration of Response (Mean and Median)
Event-free Survival
Overall Survival
Toxicity of Participants Receiving Bortezomib, Rituximab, Cyclophosphamide, and Prednisone for Treatment of Non-Hodgkin's Lymphoma
Toxicity assessed using NCI-CTC v. 3.0

Full Information

First Posted
February 23, 2006
Last Updated
November 15, 2018
Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
National Cancer Institute (NCI), Rutgers Cancer Institute of New Jersey, Columbia University, Emory University
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1. Study Identification

Unique Protocol Identification Number
NCT00295932
Brief Title
Bortezomib, Rituximab, Cyclophosphamide, and Prednisone in Treating Patients With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma
Official Title
A Phase II Study of the Novel Proteasome Inhibitor Bortezomib in Combination With Rituximab, Cyclophosphamide and Prednisone in Patients With Relapsed/Refractory Indolent B-Cell Lymphoproliferative Disorders and Mantle Cell Lymphoma (MCL)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2018
Overall Recruitment Status
Completed
Study Start Date
December 13, 2005 (Actual)
Primary Completion Date
March 11, 2018 (Actual)
Study Completion Date
March 11, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
National Cancer Institute (NCI), Rutgers Cancer Institute of New Jersey, Columbia University, Emory University

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cyclophosphamide and prednisone, 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 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 cyclophosphamide, prednisone, and rituximab may be an effective treatment for non-Hodgkin's lymphoma. PURPOSE: This randomized phase I/II trial is studying the side effects and best dose of bortezomib when given together with cyclophosphamide, prednisone, and rituximab and to see how well it works in treating patients with relapsed or refractory indolent B-cell non-Hodgkin's lymphoma.
Detailed Description
OBJECTIVES: Primary Determine the maximum tolerated dose of bortezomib when given in combination with rituximab, cyclophosphamide, and prednisone (R-CP) in patients with relapsed or refractory indolent B-cell lymphoproliferative disorders or mantle cell lymphoma. (phase I) Determine the frequency and duration of complete and partial responses in patients treated with two different treatment regimes. (phase II) Secondary Evaluate the progression-free survival, event-free survival, and overall survival of patients treated with this regimen. (phase II) Evaluate the toxicity profile of this regimen. OUTLINE: This is a phase I dose-escalation study of bortezomib followed by a phase II randomized, multicenter study. Patients in phase II are stratified according to disease (mantle cell lymphoma vs indolent B-cell lymphoproliferative disorder vs transformed lymphoma). Phase I: Patients receive cyclophosphamide IV and rituximab IV on day 1, oral prednisone on days 2-6, and bortezomib IV on days 2 and 7. Treatment repeats every 21 days for 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 1 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive cyclophosphamide IV and rituximab IV on day 1, oral prednisone on days 2-6, and bortezomib IV (at the MTD determined in phase I) on days 2, 5, 9, and 12. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity. Arm II: Patients receive cyclophosphamide IV and rituximab IV on day 1, oral prednisone on days 2-6, and bortezomib IV (at the MTD determined in phase I) on days 2 and 8. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed at 1 month, every 4 months for 2 years, and then every 6 months thereafter.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Lymphoma
Keywords
recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent small lymphocytic lymphoma, recurrent marginal zone lymphoma, Waldenstrom macroglobulinemia, recurrent mantle cell lymphoma, refractory chronic lymphocytic leukemia, B-cell chronic lymphocytic leukemia, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
79 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I
Arm Type
Experimental
Arm Description
Patients receive cyclophosphamide IV and rituximab IV on day 1, oral prednisone on days 2-6, and bortezomib IV (at the MTD determined in phase I) on days 2, 5, 9, and 12. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity.
Arm Title
Arm II
Arm Type
Experimental
Arm Description
Patients receive cyclophosphamide IV and rituximab IV on day 1, oral prednisone on days 2-6, and bortezomib IV (at the MTD determined in phase I) on days 2 and 8. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity.
Intervention Type
Biological
Intervention Name(s)
rituximab
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
bortezomib
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
prednisone
Intervention Description
Given orally
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose
Description
Maximum tolerated dose of Bortezomib in combination with Rituximab, Cyclophosphamide and Prednisone in Phase I participants
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Progression-free Survival
Time Frame
2 years
Title
Duration of Response (Mean and Median)
Time Frame
2 years
Title
Event-free Survival
Time Frame
2 years
Title
Overall Survival
Time Frame
2 years
Title
Toxicity of Participants Receiving Bortezomib, Rituximab, Cyclophosphamide, and Prednisone for Treatment of Non-Hodgkin's Lymphoma
Description
Toxicity assessed using NCI-CTC v. 3.0
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed diagnosis of 1 of the following: Chronic lymphocytic leukemia (CLL) B-cell small lymphocytic leukemia (SLL) Any marginal zone lymphoma Grade 1-3A follicular lymphoma Waldenstrom's macroglobulinemia Mantle cell lymphoma No transformed indolent lymphoma Assessable disease (phase I) Measurable disease (phase I and II), defined as ≥ one lesion that can be accurately measured in ≥ 1 dimension as ≥ 2 cm by conventional techniques OR ≥ 1 cm by spiral CT scan Lymph nodes measuring ≤ 1 cm in the short axis are considered normal Relapsed or refractory disease Must have received at least 1 prior therapeutic regimen but no more than 3 prior conventional cytotoxic therapy regimens No known brain metastases or meningeal disease PATIENT CHARACTERISTICS: Karnofsky performance status > 50% Absolute neutrophil count > 1,000/mcl (more than 500/mcl if known lymphomatous involvement) Platelet count ≥ 50,000/mcl Total bilirubin < 1.5 times upper limit of normal (ULN) (less than 5 mg/dL if known history of Gilbert's disease) AST and ALT ≤ 2.5 times ULN (4 times ULN if liver involvement) Creatinine < 1.5 times ULN OR creatinine clearance > 50 mL/min Patients may have febrile episodes up to 38.5ºC without evidence of active infection Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No New York Heart Association class III or IV congestive heart failure No uncontrolled intercurrent illness, including any of the following: Ongoing or active infection Cerebrovascular accident or transient ischemic attack within 6 months of study entry Unstable angina pectoris Cardiac arrhythmia EKG evidence of acute ischemia Psychiatric illness/social situations that would limit compliance with study requirements No uncontrolled hypertension requiring active manipulation of antihypertensive medications No known or active HIV infection No history of hypersensitivity to bortezomib, boron, or mannitol No peripheral neuropathy > grade 2 No other malignancy within the past 5 years except curatively treated non life-threatening malignancies, such as cutaneous basal cell or squamous cell carcinoma or carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: See Disease Characteristics Recovered from prior therapy Prior stem cell transplantation allowed Preparative cytoreductive and high-dose therapies considered 1 prior therapy At least 4 weeks since prior cytotoxic chemotherapy (6 weeks since prior nitrosoureas or mitomycin C) At least 12 weeks since prior radioimmunotherapy One prior course comprising tositumomab or ibritumomab tiuxetan allowed At least 1 week since prior palliative steroids for NHL No therapeutic monoclonal antibodies (e.g., rituximab, tositumomab, ibritumomab, alemtuzumab, etc.) within 3 months of study entry Patients treated with monoclonal antibodies within 3 months allowed provided disease progressed on this therapy AND no treatment received 7 days prior to study entry Seven days since prior rituximab (for patients enrolled in phase I portion) No major surgery within 4 weeks of study entry No other concurrent investigational agents No other concurrent anticancer therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carol Portlock, MD
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Winship Cancer Institute of Emory University
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Memorial Sloan-Kettering at Basking Ridge
City
Basking Ridge
State/Province
New Jersey
ZIP/Postal Code
07920
Country
United States
Facility Name
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08903
Country
United States
Facility Name
Memorial Sloan-Kettering Cancer Center @ Suffolk
City
Commack
State/Province
New York
ZIP/Postal Code
11725
Country
United States
Facility Name
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
Memorial Sloan-Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
Memorial Sloan-Kettering at Mercy Medical Center
City
Rockville Centre
State/Province
New York
Country
United States
Facility Name
Memoral Sloan Kettering Cancer Center@Phelps
City
Sleepy Hollow
State/Province
New York
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21346146
Citation
Gerecitano J, Portlock C, Hamlin P, Moskowitz CH, Noy A, Straus D, Schulman P, Dumitrescu O, Sarasohn D, Pappanicholaou J, Iasonos A, Zhang Z, Mo Q, Horanlli E, Rojas CN, Zelenetz AD, O'Connor OA. Phase I trial of weekly and twice-weekly bortezomib with rituximab, cyclophosphamide, and prednisone in relapsed or refractory non-Hodgkin lymphoma. Clin Cancer Res. 2011 Apr 15;17(8):2493-501. doi: 10.1158/1078-0432.CCR-10-1498. Epub 2011 Feb 23.
Results Reference
result
Links:
URL
http://www.mskcc.org
Description
Memorial Sloan Kettering Cancer Center

Learn more about this trial

Bortezomib, Rituximab, Cyclophosphamide, and Prednisone in Treating Patients With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma

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