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Clofarabine for Relapsed or Refractory T-Cell or B-Cell Non-Hodgkin Lymphoma (NHL)

Primary Purpose

Lymphoma, B-Cell, Lymphoma, Non-Hodgkin

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CLOFARABINE
Sponsored by
Oncology Specialists, S.C.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lymphoma, B-Cell focused on measuring B-Cell NHL

Eligibility Criteria

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

Inclusion Criteria: Adult patients who are at least 18 years old with histology confirmed diffuse large cell B-cell NHL who have failed prior systemic chemotherapy with or without monoclonal antibody-based therapies. Measurable disease determined by Ct or PET scans or bone marrow involvement, defined as lesions that can be accurately measured in two dimensions by CT or PET scan with the longest diameter accurately as greater than or equal to 1.0 cm or palpable lesions with both diameters greater than or equal to 2.0 cm. PET scan measurable disease is defined based on SUV value as determined by nuclear medicine evaluation. Eastern Cooperative Oncology Group (ECOG) performance status of 0,1,or 2. Life expectancy greater than 12 weeks. Laboratory values obtained less than or equal to 14 days prior to registration: Absolute neutrophil count (ANC) greater than or equal to 1500. White blood cell (WBC) count greater than 3.0. Platelets greater than or equal to 100. Hemoglobin (HG) greater than 9.0 g/dL. Total bilirubin less than or equal to 2.0 mg/dL. Aspartate transaminase (AST)/alanine transaminase (ALT) less than or equal to 3 times the upper limit of normal (ULN). Higher values are acceptable if it is deemed that they are related to liver involvement with NHL. Serum creatinine less than or equal to 2.0 mg/dL. Cardiac function on pretreatment MUGA scan or echocardiogram that is considered normal by institutional standards. Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide valid informed consent. Female patients of childbearing potential must have a negative serum pregnancy test within 2 weeks prior to enrollment. Male and female patients must use an effective contraceptive method during the study and for a minium of 6 months after study treatment. Exclusion Criteria: Previously untreated NHL. Received previous treatment with clofarabine. History of T-cell lymphoma. Bulky disease (ie, any single mass greater than 10 cm or circulating malignant cells greater than or equal to 24,000 cells/ul. Patients with known AIDS-related or HIV-positive lymphoma. Autologous bone marrow or stem cell transplant within 3 months of study entry. History of allogeneic bone marrow transplant or organ transplant. Prior radiotherapy to the only site of measurable disease. Any medical condition that requires chronic use of oral high-dose corticosteroids. ( in excess of 1 mg/kg/day). Autoimmune thrombocytopenia. Use if investigational agents within 30 days or any anticancer therapy within 3 weeks before study entry. The patient must have recovered from all acute toxicities from any previous therapy. Patients with an active, uncontrolled systemic infection considered to be opportunistic, life threatening, or clinically significant at the time of treatment or with a known or suspected fungal infection (ie, patients of parenteral antifungal therapy). HIV-positive status. Active secondary malignancy. Pregnant or lactating patients. Any significant concurrent disease, illness , or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow-up, or interpretation of study results. Patients with active or untreated central nervous lymphoma (CNS) lymphoma.

Sites / Locations

  • Oncology Specialists, SC

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

1

Arm Description

Clofarabine 4 mg/m^2 days 1-5 of every cycle for a maximum of 6 cycles.

Outcomes

Primary Outcome Measures

Phase I Maximum Tolerated Dose
Maximum Tolerated Dose for Clofarabine. Cohorts of 3 patients each will receive doses of clofarabine increased in increments as follows: 4, 6, 8, 10, 12,…etc mg/m2/day for 5 days. The dose level immediately below the MTD will be used to treat patients in the Phase II part of the study. Starting dose of 4 mg/m2.
Phase II Overall Response
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Secondary Outcome Measures

Toxicity
Number of Participants with Toxicity

Full Information

First Posted
September 8, 2005
Last Updated
October 24, 2017
Sponsor
Oncology Specialists, S.C.
Collaborators
Genzyme, a Sanofi Company
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1. Study Identification

Unique Protocol Identification Number
NCT00156013
Brief Title
Clofarabine for Relapsed or Refractory T-Cell or B-Cell Non-Hodgkin Lymphoma (NHL)
Official Title
A Phase I/II Open-label Study of Clofarabine in Patients With Relapsed or Refractory Diffuse Large Cell B-Cell NHL
Study Type
Interventional

2. Study Status

Record Verification Date
October 2017
Overall Recruitment Status
Completed
Study Start Date
September 2005 (undefined)
Primary Completion Date
April 2010 (Actual)
Study Completion Date
April 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Oncology Specialists, S.C.
Collaborators
Genzyme, a Sanofi Company

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This research is being done to develop new treatment for non-hodgkin's lymphoma in subjects whose cancer has returned or resisted treatment with chemotherapy. The investigational drug clofarabine is being used in this study. An investigational drug is one that has not been approved by the United States Food and Drug Administration (FDA).
Detailed Description
The safety profile of clofarabine appears acceptable within the target populations studied to date in the clinical studies, with numerous responses observed in heavily pre-treated patients with relapsed/refractory ALL or AML. Dose escalation of clofarabine in patients with solid tumors and lymphoproliferative disorders has been limited because grade 3 and 4 myelosuppression was considered acceptable in patients with acute leukemia, provided that hematologic recovery occurred within 6 weeks of therapy , and dose escalation has proceeded as high as 40 mg/m2 in this patient population. Furthermore, no responses were observed in a recent trial in which patients with relapsed CLL were treated with clofarabine 2 mg/m2, an indolent B-cell lymphoproliferative disorder indicating that low doses are likely to be ineffective in patients with aggressive NHL. (Personal Communication with ILEX Products, INC.) This Phase I/II study will evaluate escalating doses of clofarabine in patients with relapsed and refractory diffuse large cell B-cell NHL starting at a dose of 4 mg/m2/day for 5 consecutive days and repeated every 28 days for a maximum of 6 cycles. This dosing regimen should be evaluated in this patient population because there is no standard therapy at relapse and grade 3 and 4 myelosuppression is frequently observed with traditional NHL salvage. Additionally, patients will receive granulocyte colony stimulating factors at the discretion of the investigator. Antifungal and antibacterial prophylaxis will be administered to minimize the risk of infection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma, B-Cell, Lymphoma, Non-Hodgkin
Keywords
B-Cell NHL

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
33 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
Clofarabine 4 mg/m^2 days 1-5 of every cycle for a maximum of 6 cycles.
Intervention Type
Drug
Intervention Name(s)
CLOFARABINE
Other Intervention Name(s)
Clolar®
Intervention Description
4 mg/m^2 days 1-5 of every cycle for a maximum of 6 cycles
Primary Outcome Measure Information:
Title
Phase I Maximum Tolerated Dose
Description
Maximum Tolerated Dose for Clofarabine. Cohorts of 3 patients each will receive doses of clofarabine increased in increments as follows: 4, 6, 8, 10, 12,…etc mg/m2/day for 5 days. The dose level immediately below the MTD will be used to treat patients in the Phase II part of the study. Starting dose of 4 mg/m2.
Time Frame
days 1 -28, maximum 6 cycles
Title
Phase II Overall Response
Description
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Time Frame
5 years
Secondary Outcome Measure Information:
Title
Toxicity
Description
Number of Participants with Toxicity
Time Frame
5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult patients who are at least 18 years old with histology confirmed diffuse large cell B-cell NHL who have failed prior systemic chemotherapy with or without monoclonal antibody-based therapies. Measurable disease determined by Ct or PET scans or bone marrow involvement, defined as lesions that can be accurately measured in two dimensions by CT or PET scan with the longest diameter accurately as greater than or equal to 1.0 cm or palpable lesions with both diameters greater than or equal to 2.0 cm. PET scan measurable disease is defined based on SUV value as determined by nuclear medicine evaluation. Eastern Cooperative Oncology Group (ECOG) performance status of 0,1,or 2. Life expectancy greater than 12 weeks. Laboratory values obtained less than or equal to 14 days prior to registration: Absolute neutrophil count (ANC) greater than or equal to 1500. White blood cell (WBC) count greater than 3.0. Platelets greater than or equal to 100. Hemoglobin (HG) greater than 9.0 g/dL. Total bilirubin less than or equal to 2.0 mg/dL. Aspartate transaminase (AST)/alanine transaminase (ALT) less than or equal to 3 times the upper limit of normal (ULN). Higher values are acceptable if it is deemed that they are related to liver involvement with NHL. Serum creatinine less than or equal to 2.0 mg/dL. Cardiac function on pretreatment MUGA scan or echocardiogram that is considered normal by institutional standards. Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide valid informed consent. Female patients of childbearing potential must have a negative serum pregnancy test within 2 weeks prior to enrollment. Male and female patients must use an effective contraceptive method during the study and for a minium of 6 months after study treatment. Exclusion Criteria: Previously untreated NHL. Received previous treatment with clofarabine. History of T-cell lymphoma. Bulky disease (ie, any single mass greater than 10 cm or circulating malignant cells greater than or equal to 24,000 cells/ul. Patients with known AIDS-related or HIV-positive lymphoma. Autologous bone marrow or stem cell transplant within 3 months of study entry. History of allogeneic bone marrow transplant or organ transplant. Prior radiotherapy to the only site of measurable disease. Any medical condition that requires chronic use of oral high-dose corticosteroids. ( in excess of 1 mg/kg/day). Autoimmune thrombocytopenia. Use if investigational agents within 30 days or any anticancer therapy within 3 weeks before study entry. The patient must have recovered from all acute toxicities from any previous therapy. Patients with an active, uncontrolled systemic infection considered to be opportunistic, life threatening, or clinically significant at the time of treatment or with a known or suspected fungal infection (ie, patients of parenteral antifungal therapy). HIV-positive status. Active secondary malignancy. Pregnant or lactating patients. Any significant concurrent disease, illness , or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow-up, or interpretation of study results. Patients with active or untreated central nervous lymphoma (CNS) lymphoma.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Chadi Nabhan, MD
Organizational Affiliation
Oncology Specialists,SC
Official's Role
Principal Investigator
Facility Information:
Facility Name
Oncology Specialists, SC
City
Park Ridge
State/Province
Illinois
ZIP/Postal Code
60068
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21425150
Citation
Nabhan C, Davis N, Bitran JD, Galvez A, Fried W, Tolzien K, Foss S, Dewey WM, Venugopal P. Efficacy and safety of clofarabine in relapsed and/or refractory non-Hodgkin lymphoma, including rituximab-refractory patients. Cancer. 2011 Apr 1;117(7):1490-7. doi: 10.1002/cncr.25603. Epub 2010 Nov 8.
Results Reference
derived

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Clofarabine for Relapsed or Refractory T-Cell or B-Cell Non-Hodgkin Lymphoma (NHL)

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