Lenalidomide in Relapsed or Refractory Primary-cutaneous Large B-cell Lymphoma Leg-type : Multicentre Prospective Phase II Single Arm Trial of the French Study Group of Cutaneous Lymphoma (REV-LEG)
Primary Purpose
Refractory Primary-cutaneous Large B-cell Lymphoma (Leg-type)
Status
Completed
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Lenalidomide
Sponsored by
About this trial
This is an interventional treatment trial for Refractory Primary-cutaneous Large B-cell Lymphoma (Leg-type) focused on measuring oncodermatology, hematology, cutaneous B cell lymphoma, lenalidomide
Eligibility Criteria
Inclusion Criteria:
- Biopsy-proven Primary cutaneous large B-cell lymphoma leg-type
- Clinically measurable skin involvement (T1-T3) or skin and nodal (N1-N3) involvement measurable by PET-CT, corresponding to :
Relapse after initial complete response (CR) after R-polychemotherapy Or Partial response or stable disease after R-polychemotherapy
- Age > 18 years
- Life expectancy > 3 months
- WHO performance status 0-2
- Skin biopsy performed at the inclusion on a skin tumor : new tumor in case of relapsing PCLBCL-LT or initial skin tumor refractory to the previous treatment
- Signed informed consent for clinical and biological analyses. The Lenalidomide Information Sheet will be given to each patient receiving lenalidomide study therapy. The patient must read this document prior to starting lenalidomide study treatment and each time they receive a new supply of study drug.
- Social security cover
- Conditions of global RPP have to be fulfilled by all the patients
- The Lenalidomide Education and Counseling Guidance Document must be completed and signed by either a trained counselor or the Investigator at the participating clinical center prior to each dispensing of lenalidomide study treatment. A copy of this document must be maintained in the patient records.
Exclusion Criteria:
- Central nervous system involvement (cerebral CT scan is performed at the inclusion)
- One or more of the biological abnormalities :
Neutrophil count < 1,500/mm3 ; Platelet count < 60,000/mm3 ; Transaminases > 5 x upper limit of normal ; Total bilirubin > 2.0 mg/dl (34 µmol/L)/ conjugated bilirubin>0.8 mg/dL, except of haemolytic anemia ; Creatinine clearance < 50 mL /min ( measured or calculated according to the method of Cockcroft-Gault)
- Pregnant or lactating females, potentially childbearing females defined by sexually mature female who: 1) has not undergone a hysterectomy (the surgical removal of the uterus) or bilateral oophorectomy (the surgical removal of both ovaries) or 2) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time during the preceding 24 consecutive months.
- Patients should not receive steroids continuously except for prednisone for tumoral flare treatment
- Uncontrolled infectious and thromboembolic diseases
- Subjects not willing to take deep venous thrombosis prophylaxis
- Prior history of malignancies unless the subject has been free of the disease for ≥5 years. Exceptions include basal cell skin carcinoma, carcinoma in situ of the cervix or of the breast
- Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form
- Known seropositive for or active viral infection with HIV, Hepatitis B and C virus.
- Uncontrolled intercurrent illness including, but not limited to ongoing or active infection requiring parenteral antibiotics, uncontrolled diabetes mellitus as defined by the investigator
- Chronic symptomatic congestive heart failure (III or IV of the NYHA Classification for Heart Disease)
- Unstable angina pectoris, angioplasty or myocardial infarctions within 6 months
- Clinically significant cardiac arrhythmia that is symptomatic or requires treatment, or asymptomatic sustained ventricular tachycardia.
- Prior ≥ Grade 3 allergic reaction/hypersensitivity or desquamative rash while taking thalidomide
- Any standard or experimental anti-cancer drug therapy or radiation within 3 weeks of the initiation of study drug therapy.
- Participation in another clinical trial
Sites / Locations
- CHU Amiens, Hôpital Sud
- CHU Besançon, Hôpital Saint-Jacques
- AP-HP Hôpital Avicenne
- AP-HP Hôpital Ambroise Paré
- CHU de Clermont-Ferrand, Estaing
- AP-HP Hôpital Henri Mondor
- CHU de Dijon, Le Bocage
- CHU de Grenoble
- CHU de Lille Hôpital Claude Huriez
- Centre Léon Bérard
- AP-HM Hôpital Nord
- CHRU de Montpellier Hôpital Saint-Eloi
- CHU de Nantes, Hôtel Dieu
- CHU de Nice Groupe hospitalier l'Archet
- AP-HP- Hôpital Saint Louis
- AP-HP Groupe hospitalier Cochin
- AP-HP Groupe hospitalier Bichat - Claude Bernard
- AP-HP Hôpital Tenon
- CHU de Bordeaux Hôpital du Haut Lévèque
- CHU Lyon Sud
- CHU de Reims, Hôpital Robert Debré
- CHU de Rouen, Hôpital Charles Nicolle
- CHU de Toulouse Hôpital Larrey
- CHU de Tours- Hôpital Trousseau
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Lenalidomide treatment
Arm Description
Outcomes
Primary Outcome Measures
Overall response rate (complete response CR and partial response PR) at 6 months
Response will be assessed according to clinical and isotopic criteria.
Secondary Outcome Measures
Overall response rate (complete response CR and partial response PR) at 12 months
Response will be assessed according to clinical and isotopic criteria.
Duration of response
Time between the first PR and progression
Progression-free survival
Time between the beginning of the treatment by lenalidomide and progression or death
Overall survival and disease specific survival
Safety : description of adverse events occured including grade based on CTCAE v4.0
Quality of life
Full Information
NCT ID
NCT01556035
First Posted
March 12, 2012
Last Updated
September 22, 2016
Sponsor
University Hospital, Bordeaux
1. Study Identification
Unique Protocol Identification Number
NCT01556035
Brief Title
Lenalidomide in Relapsed or Refractory Primary-cutaneous Large B-cell Lymphoma Leg-type : Multicentre Prospective Phase II Single Arm Trial of the French Study Group of Cutaneous Lymphoma
Acronym
REV-LEG
Official Title
A Multicentre Prospective Phase II Single Arm Trial Evaluating the Benefit of Therapy With Lenalidomide (Revlimid®) in Relapsed or Refractory Primary-cutaneous Large B-cell Lymphoma (Leg-type) After First Line Treatment by Chemotherapy Plus Rituximab for the French Study Group of Cutaneous Lymphoma (GFELC)
Study Type
Interventional
2. Study Status
Record Verification Date
September 2016
Overall Recruitment Status
Completed
Study Start Date
July 2012 (undefined)
Primary Completion Date
March 2015 (Actual)
Study Completion Date
August 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital, Bordeaux
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
In spite of high initial response rate after a first line treatment by R-polychemotherapy, cutaneous but also extra-cutaneous recurrences occur after 2 years in about half of the patients with PCBCL-LT. Thereafter there is no consensus concerning patients care: radiotherapy has only a palliative effect, advanced age often limits using more aggressive chemotherapies and no treatment has demonstrated a prolonged efficacy in these relapsing cases. Therefore new alternatives therapeutic options are needed. Lenalidomide has an antineoplastic pro-apoptotic effect but also immunomodulatory, and antiangiogenic properties. Preliminary results suggest its efficacy in relapsing or refractory diffuse large B-cells lymphomas, especially of nongerminal cells phenotype. By analogy with these results, lenalidomide appears as an attractive candidate in PCLBCL-LT, more specially as it has a manageable toxicity even in advanced age patients.
If the lenalidomide efficacy is confirmed in relapsing PCLBCL-LT, this will plead its evaluation as maintenance therapy after R-chemotherapy in order to avoid recurrences.
Detailed Description
To assess benefit and safety of lenalidomide in patients with refractory or relapsing primary cutaneous large B-cell lymphoma leg type (PCBCL-LT) after a first line treatment by Rituximab and polychemotherapy. The primary endpoint is overall response rate (complete response and partial response) at 6 months. Response will be assessed according to clinical and isotopic criteria.
Optional biological study:
A biological collection (skin and blood samples) will be established. Predictive biological markers of response or of aggressiveness and resistance to the treatment will be investigated on the skin biopsies by phenotypic and genetic analyses. The recent discovery of BLIMP1 inactivation or deletion at 6q21 in activated B-cell like type of diffuse large B-cell systemic lymphoma points to the need of both a global genetic analysis by Array-CGH with Single Nucleotide Polymorphism study and a specific investigations of the status of genes such as CDKN2A, BCL2, BCL6 and BLIMP1 by FISH analysis and/or gene dosage. Xenograft will be performed from skin biopsies in order to develop animal models for PCLBCL-LT.
Lenalidomide stimulates NK cells immunity and enhances anti-tumor responses. It also seems to modify the phenotype of NK cells through a decrease of the expression of Killer cell Immunoglobulin-like Receptors and NKp46. The expression of the NK receptors on blood cells will be analyzed in order to evidence modifications of the phenotypical and functional changes under treatment, and to search for a correlation with the clinical response to the treatment.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Refractory Primary-cutaneous Large B-cell Lymphoma (Leg-type)
Keywords
oncodermatology, hematology, cutaneous B cell lymphoma, lenalidomide
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
19 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Lenalidomide treatment
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Lenalidomide
Intervention Description
Patient orally treated with lenalidomide 25 mg daily for 21 days with 7 days rest of a 28 days cycle.Treatment maintained for 12 months unless progression
Primary Outcome Measure Information:
Title
Overall response rate (complete response CR and partial response PR) at 6 months
Description
Response will be assessed according to clinical and isotopic criteria.
Time Frame
6 months after study treatment start
Secondary Outcome Measure Information:
Title
Overall response rate (complete response CR and partial response PR) at 12 months
Description
Response will be assessed according to clinical and isotopic criteria.
Time Frame
12 months after study treatment start
Title
Duration of response
Description
Time between the first PR and progression
Time Frame
Every 6 months
Title
Progression-free survival
Description
Time between the beginning of the treatment by lenalidomide and progression or death
Time Frame
Every 6 months
Title
Overall survival and disease specific survival
Time Frame
Evrey 6 months
Title
Safety : description of adverse events occured including grade based on CTCAE v4.0
Time Frame
Monthly during treatment duration (up to 12 months)
Title
Quality of life
Time Frame
Every 2 months during treatment duration (up to 12 month)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Biopsy-proven Primary cutaneous large B-cell lymphoma leg-type
Clinically measurable skin involvement (T1-T3) or skin and nodal (N1-N3) involvement measurable by PET-CT, corresponding to :
Relapse after initial complete response (CR) after R-polychemotherapy Or Partial response or stable disease after R-polychemotherapy
Age > 18 years
Life expectancy > 3 months
WHO performance status 0-2
Skin biopsy performed at the inclusion on a skin tumor : new tumor in case of relapsing PCLBCL-LT or initial skin tumor refractory to the previous treatment
Signed informed consent for clinical and biological analyses. The Lenalidomide Information Sheet will be given to each patient receiving lenalidomide study therapy. The patient must read this document prior to starting lenalidomide study treatment and each time they receive a new supply of study drug.
Social security cover
Conditions of global RPP have to be fulfilled by all the patients
The Lenalidomide Education and Counseling Guidance Document must be completed and signed by either a trained counselor or the Investigator at the participating clinical center prior to each dispensing of lenalidomide study treatment. A copy of this document must be maintained in the patient records.
Exclusion Criteria:
Central nervous system involvement (cerebral CT scan is performed at the inclusion)
One or more of the biological abnormalities :
Neutrophil count < 1,500/mm3 ; Platelet count < 60,000/mm3 ; Transaminases > 5 x upper limit of normal ; Total bilirubin > 2.0 mg/dl (34 µmol/L)/ conjugated bilirubin>0.8 mg/dL, except of haemolytic anemia ; Creatinine clearance < 50 mL /min ( measured or calculated according to the method of Cockcroft-Gault)
Pregnant or lactating females, potentially childbearing females defined by sexually mature female who: 1) has not undergone a hysterectomy (the surgical removal of the uterus) or bilateral oophorectomy (the surgical removal of both ovaries) or 2) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time during the preceding 24 consecutive months.
Patients should not receive steroids continuously except for prednisone for tumoral flare treatment
Uncontrolled infectious and thromboembolic diseases
Subjects not willing to take deep venous thrombosis prophylaxis
Prior history of malignancies unless the subject has been free of the disease for ≥5 years. Exceptions include basal cell skin carcinoma, carcinoma in situ of the cervix or of the breast
Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form
Known seropositive for or active viral infection with HIV, Hepatitis B and C virus.
Uncontrolled intercurrent illness including, but not limited to ongoing or active infection requiring parenteral antibiotics, uncontrolled diabetes mellitus as defined by the investigator
Chronic symptomatic congestive heart failure (III or IV of the NYHA Classification for Heart Disease)
Unstable angina pectoris, angioplasty or myocardial infarctions within 6 months
Clinically significant cardiac arrhythmia that is symptomatic or requires treatment, or asymptomatic sustained ventricular tachycardia.
Prior ≥ Grade 3 allergic reaction/hypersensitivity or desquamative rash while taking thalidomide
Any standard or experimental anti-cancer drug therapy or radiation within 3 weeks of the initiation of study drug therapy.
Participation in another clinical trial
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marie BEYLOT-BARRY, MD-PhD
Organizational Affiliation
University Hospital, Bordeaux
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Eric FRISON, MD
Organizational Affiliation
Unité de Soutien Méthodologique à la Recherche clinique et épidémiologique; University Hospital, Bordeaux
Official's Role
Study Chair
Facility Information:
Facility Name
CHU Amiens, Hôpital Sud
City
Amiens
ZIP/Postal Code
80054
Country
France
Facility Name
CHU Besançon, Hôpital Saint-Jacques
City
Besançon
ZIP/Postal Code
25030
Country
France
Facility Name
AP-HP Hôpital Avicenne
City
Bobigny
ZIP/Postal Code
93009
Country
France
Facility Name
AP-HP Hôpital Ambroise Paré
City
Boulogne-billancourt
ZIP/Postal Code
92104
Country
France
Facility Name
CHU de Clermont-Ferrand, Estaing
City
Clermont-ferrand
ZIP/Postal Code
63003
Country
France
Facility Name
AP-HP Hôpital Henri Mondor
City
Creteil
ZIP/Postal Code
94010
Country
France
Facility Name
CHU de Dijon, Le Bocage
City
Dijon
ZIP/Postal Code
21079
Country
France
Facility Name
CHU de Grenoble
City
Grenoble
ZIP/Postal Code
38043
Country
France
Facility Name
CHU de Lille Hôpital Claude Huriez
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
Centre Léon Bérard
City
Lyon
ZIP/Postal Code
69373
Country
France
Facility Name
AP-HM Hôpital Nord
City
Marseille
ZIP/Postal Code
13915
Country
France
Facility Name
CHRU de Montpellier Hôpital Saint-Eloi
City
Montpellier
ZIP/Postal Code
34295
Country
France
Facility Name
CHU de Nantes, Hôtel Dieu
City
Nantes
ZIP/Postal Code
44093
Country
France
Facility Name
CHU de Nice Groupe hospitalier l'Archet
City
Nice
ZIP/Postal Code
06202
Country
France
Facility Name
AP-HP- Hôpital Saint Louis
City
Paris
ZIP/Postal Code
75475
Country
France
Facility Name
AP-HP Groupe hospitalier Cochin
City
Paris
ZIP/Postal Code
75679
Country
France
Facility Name
AP-HP Groupe hospitalier Bichat - Claude Bernard
City
Paris
ZIP/Postal Code
75877
Country
France
Facility Name
AP-HP Hôpital Tenon
City
Paris
ZIP/Postal Code
75970
Country
France
Facility Name
CHU de Bordeaux Hôpital du Haut Lévèque
City
Pessac
ZIP/Postal Code
33604
Country
France
Facility Name
CHU Lyon Sud
City
Pierre Benite
ZIP/Postal Code
69450
Country
France
Facility Name
CHU de Reims, Hôpital Robert Debré
City
Reims
ZIP/Postal Code
51092
Country
France
Facility Name
CHU de Rouen, Hôpital Charles Nicolle
City
Rouen
ZIP/Postal Code
76031
Country
France
Facility Name
CHU de Toulouse Hôpital Larrey
City
Toulouse
ZIP/Postal Code
31059
Country
France
Facility Name
CHU de Tours- Hôpital Trousseau
City
Tours
ZIP/Postal Code
37044
Country
France
12. IPD Sharing Statement
Learn more about this trial
Lenalidomide in Relapsed or Refractory Primary-cutaneous Large B-cell Lymphoma Leg-type : Multicentre Prospective Phase II Single Arm Trial of the French Study Group of Cutaneous Lymphoma
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