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Multi-center Trial of Revlimid® and Rituximab, for First-Line Treatment of Chronic Lymphocytic Leukemia (CLL)

Primary Purpose

Chronic Lymphocytic Leukemia, CLL, Untreated

Status
Unknown status
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Lenalidomide and Rituximab
Lenalidomide and Rituximab
Sponsored by
Chronic Lymphocytic Leukemia Research Consortium
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Lymphocytic Leukemia focused on measuring Chronic Lymphocytic Leukemia Research Consortium, Chronic lymphocytic leukemia, CLL, CLL Research Consortium, CRC, Revlimid, lenalidomide, Rituximab, Rituxan, First-line, therapy, untreated, Frontline

Eligibility Criteria

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

Inclusion Criteria:

  1. Diagnosis of chronic lymphocytic leukemia with no history of previous treatments with monoclonal antibodies or chemotherapy.
  2. Subjects must have an indication for treatment as defined by the NCI Working Group Guidelines
  3. Understand and voluntarily sign an informed consent form.
  4. Age ≥18 years at the time of signing the informed consent form.
  5. Able to adhere to the study visit schedule and other protocol requirements.
  6. ECOG performance status of ≤ 2 at study entry (see Appendix A).
  7. Laboratory test results within these ranges: Absolute neutrophil count ≥ 1.0 x 109/L, Platelet count ≥ 50 x 109/L, Serum creatinine ≤ 1.5 mg/dL, Total bilirubin ≤ 1.5 mg/dL, AST & ALT ≤ 2 x ULN
  8. Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of starting lenalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure.
  9. Disease free of prior malignancies for ≥ 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "insitu" of the cervix or breast

Exclusion Criteria:

  1. Previous treatment for CLL with chemotherapy or monoclonal antibodies
  2. Known Hepatitis B Ag positive, Hepatitis C positive patients
  3. Known HIV positive patients
  4. Patients with uncontrolled Autoimmune Hemolytic Anemia (AIHA) or autoimmune thrombocytopenia (ITP).
  5. Inability to provide informed consent.
  6. Concurrent malignancy (excluding basal and squamous cell skin cancers).
  7. Active fungal, bacterial, and/or viral infection.
  8. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  9. Pregnant or breast-feeding females. (Lactating females must agree not to breast feed while taking lenalidomide).
  10. Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
  11. Use of any other experimental drug or therapy within 28 days of baseline.
  12. Known hypersensitivity to thalidomide.
  13. The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
  14. Any prior use of lenalidomide.
  15. Concurrent use of other anti-cancer agents or treatments.
  16. Patients with history of deep venous thrombus or pulmonary embolism. Patients who are at increased risk of thrombosis during treatment with lenalidomide including those taking concurrent erythropoietin, darbepoetin or high-dose corticosteroids are also excluded.
  17. Patients with a history of embolic events (e.g. TIA) from arrhythmia or peripheral arterial disease or of recent MI whether or not treated with anti-platelet drugs

Sites / Locations

  • University of California San DiegoRecruiting
  • Dana-Farber/Harvard Cancer Center at Dana Farber Cancer InstituteRecruiting
  • Long Island Jewish Medical CenterRecruiting
  • Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University
  • M. D. Anderson Cancer Center at University of TexasRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

A

B

Arm Description

Subjects younger than 65 years old.

Subjects aged 65 years and older

Outcomes

Primary Outcome Measures

Efficacy to be assessed by clinical response rate following 3 cycles of treatment and the NCI-CLL working group response rate assessed after completion of all treatment.

Secondary Outcome Measures

Safety - type, frequency, severity, and relationship of adverse events to study treatment
Time To Progression
Evaluate response to lenalidomide in relationship to molecular and genetic prognostic features in CLL; including ZAP-70 status, IgVH gene mutational status, and FISH.
Compare the efficacy and tolerability of the combination of Revlimid and rituximab for patients younger than 65 years, and for those 65 and older. •
Evaluate change in hematological parameters including neutropenia, anemia, and thrombocytopenia following treatment with the combination of Revlimid and rituximab.

Full Information

First Posted
February 26, 2008
Last Updated
September 8, 2010
Sponsor
Chronic Lymphocytic Leukemia Research Consortium
Collaborators
Celgene Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT00628238
Brief Title
Multi-center Trial of Revlimid® and Rituximab, for First-Line Treatment of Chronic Lymphocytic Leukemia (CLL)
Official Title
A Two-Arm, Multi-center Trial of Revlimid® and Rituximab, for First-Line Treatment in Patients With B-cell Chronic Lymphocytic Leukemia (CLL)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2010
Overall Recruitment Status
Unknown status
Study Start Date
February 2008 (undefined)
Primary Completion Date
February 2011 (Anticipated)
Study Completion Date
July 2011 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Chronic Lymphocytic Leukemia Research Consortium
Collaborators
Celgene Corporation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The study is a two-arm, multi-center trial of Revlimid® and Rituximab, for the frontline treatment of patients with Chronic Lymphocytic Leukemia (CLL) designed and conducted by the CLL Research Consortium (CRC). The purpose of this study is to determine the response rate of the combination of Revlimid® and Rituximab in previously untreated CLL patients in two arms- those aged 65 years and above and those younger than 65. Secondary objectives will evaluate the safety of the combination of Revlimid® and Rituximab, response duration, improvement in hematologic parameters, and the significance of the tumor flare reaction. All patients will have assessment of known prognostic factors for CLL as well as novel prognostic factors will be evaluated for predicting response to treatment. Biologic corollary studies are designed to evaluate the mechanism of Revlimid® in CLL and the combination of Revlimid® and Rituximab.
Detailed Description
The CLL Research Consortium (CRC) is conducting a two-arm, multi-center phase II trial of Revlimid® and rituximab for the first-line treatment of patients with CLL. Revlimid® (lenalidomide) a derivative of thalidomide with immune-modulating properties. Revlimid® is FDA approved for treatment of relapsed multiple myeloma and 5q- myelodysplastic syndrome. Revlimid® has promising clinical activity in relapsed CLL in two early clinical trials. However, the mechanism(s) whereby Revlimid® is active in CLL is unknown. Rituximab (Rituxan®) is a protein that binds to CD20 expressed on normal and leukemia B cells. Rituximab is FDA approved for the treatment of lymphoma and is used commonly for the treatment of CLL. The purposes of this study are to evaluate the safety and activity of the combination of Revlimid® and rituximab in CLL, elucidate the mechanism of Revlimid® in CLL, and to assess whether prognostic factors might predict those patients likely to benefit from this therapy in the future. As older patients are commonly under-represented in CLL clinical trials and are less tolerable of frontline therapy that utilizes combinations of fludarabine and cyclophosphamide the trial has two arms; one to specifically assess for the tolerability of the regimen in older subjects. The primary objective of this study is to determine the response rate of the combination of Revlimid® and Rituximab in previously untreated CLL patients in two arms- those aged 65 years and above and those younger than 65. Secondary objectives will evaluate the safety of the combination of Revlimid® and Rituximab, response duration, improvement in hematologic parameters, activity of the combination in high-risk CLL subsets, and the significance of the tumor flare reaction. All patients will have baseline assessment of known CLL prognostic factors including: immunoglobulin variable heavy chain (IgVH) gene mutational status, interphase cytogenetics, intracellular ZAP-70 expression, and CD38 expression through the CRC tissue core. These known prognostic features in CLL together with novel prognostic factors will be evaluated for the ability to predict response to treatment with Revlimid® and the combination of Revlimid® and Rituximab. Extensive biologic corollary studies are designed to evaluate the mechanism of Revlimid® in CLL, the impact of Revlimid® on the CLL microenvironment, and Revlimid®'s impact on and rituximab mediated cytotoxicity. All patients will receive the same treatment. Revlimid® will be started at a low dose and slowly escalated based on patient tolerability. Rituximab will be administered following 21 days of Revlimid® monotherapy. Patients will continue treatment for up to 7 cycles unless there is toxicity or progressive disease. There are three planned response assessments for the subjects: a single agent Revlimid® response assessment prior to the addition of rituximab, after 3 cycles of treatment, and following all the therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Lymphocytic Leukemia, CLL, Untreated, Front-line, First-Line, Initial Therapy
Keywords
Chronic Lymphocytic Leukemia Research Consortium, Chronic lymphocytic leukemia, CLL, CLL Research Consortium, CRC, Revlimid, lenalidomide, Rituximab, Rituxan, First-line, therapy, untreated, Frontline

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
80 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Active Comparator
Arm Description
Subjects younger than 65 years old.
Arm Title
B
Arm Type
Active Comparator
Arm Description
Subjects aged 65 years and older
Intervention Type
Drug
Intervention Name(s)
Lenalidomide and Rituximab
Other Intervention Name(s)
Revlimid, CC-5013, Rituxan
Intervention Description
Lenalidomide starting at a low dose and escalated based on patient tolerability 21 days of every cycle. Rituximab at 375mg/m2 administered following the first 21 days of lenalidomide monotherapy, continued weekly throughout cycle 2, and then every 4 weeks for subsequent cycles. Each patient may receive up to a maximum of 7 cycles of treatment if no progressive disease or significant toxicity.
Intervention Type
Drug
Intervention Name(s)
Lenalidomide and Rituximab
Other Intervention Name(s)
Revlimid, CC-5013, Rituxan
Intervention Description
Lenalidomide starting at a low dose and escalated based on patient tolerability 21 days of every cycle. Rituximab at 375mg/m2 administered following the first 21 days of lenalidomide monotherapy, continued weekly throughout cycle 2, and then every 4 weeks for subsequent cycles. Each patient may receive up to a maximum of 7 cycles of treatment if no progressive disease or significant toxicity.
Primary Outcome Measure Information:
Title
Efficacy to be assessed by clinical response rate following 3 cycles of treatment and the NCI-CLL working group response rate assessed after completion of all treatment.
Time Frame
clinical response assessment after 3 cycles of therapy and 3 months following completion of all therapy for NCI-CLL working group response assessment
Secondary Outcome Measure Information:
Title
Safety - type, frequency, severity, and relationship of adverse events to study treatment
Time Frame
Throughout the study period
Title
Time To Progression
Time Frame
Following therapy until disease progression
Title
Evaluate response to lenalidomide in relationship to molecular and genetic prognostic features in CLL; including ZAP-70 status, IgVH gene mutational status, and FISH.
Time Frame
Following final response assessment
Title
Compare the efficacy and tolerability of the combination of Revlimid and rituximab for patients younger than 65 years, and for those 65 and older. •
Time Frame
following final response assessment
Title
Evaluate change in hematological parameters including neutropenia, anemia, and thrombocytopenia following treatment with the combination of Revlimid and rituximab.
Time Frame
Following final response assessment

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of chronic lymphocytic leukemia with no history of previous treatments with monoclonal antibodies or chemotherapy. Subjects must have an indication for treatment as defined by the NCI Working Group Guidelines Understand and voluntarily sign an informed consent form. Age ≥18 years at the time of signing the informed consent form. Able to adhere to the study visit schedule and other protocol requirements. ECOG performance status of ≤ 2 at study entry (see Appendix A). Laboratory test results within these ranges: Absolute neutrophil count ≥ 1.0 x 109/L, Platelet count ≥ 50 x 109/L, Serum creatinine ≤ 1.5 mg/dL, Total bilirubin ≤ 1.5 mg/dL, AST & ALT ≤ 2 x ULN Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of starting lenalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure. Disease free of prior malignancies for ≥ 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "insitu" of the cervix or breast Exclusion Criteria: Previous treatment for CLL with chemotherapy or monoclonal antibodies Known Hepatitis B Ag positive, Hepatitis C positive patients Known HIV positive patients Patients with uncontrolled Autoimmune Hemolytic Anemia (AIHA) or autoimmune thrombocytopenia (ITP). Inability to provide informed consent. Concurrent malignancy (excluding basal and squamous cell skin cancers). Active fungal, bacterial, and/or viral infection. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form. Pregnant or breast-feeding females. (Lactating females must agree not to breast feed while taking lenalidomide). Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study. Use of any other experimental drug or therapy within 28 days of baseline. Known hypersensitivity to thalidomide. The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs. Any prior use of lenalidomide. Concurrent use of other anti-cancer agents or treatments. Patients with history of deep venous thrombus or pulmonary embolism. Patients who are at increased risk of thrombosis during treatment with lenalidomide including those taking concurrent erythropoietin, darbepoetin or high-dose corticosteroids are also excluded. Patients with a history of embolic events (e.g. TIA) from arrhythmia or peripheral arterial disease or of recent MI whether or not treated with anti-platelet drugs
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Danelle F James, M.D.
Phone
858-822-7894
Email
dfjames@ucsd.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Mary Carpenter
Phone
858-822-5635
Email
mcarpenter@ucsd.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thomas J Kipps, M.D., Ph.D
Organizational Affiliation
Director of the CLL Research Consortium and University of California San Diego
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Danelle F James, M.D.
Organizational Affiliation
CLL Research Consortium and University of California San Diego
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California San Diego
City
La Jolla
State/Province
California
ZIP/Postal Code
92093
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jamie N Gould
Phone
858-822-5364
Email
jngould@ucsd.edu
First Name & Middle Initial & Last Name & Degree
Danelle F James
Phone
858-822-7894
Email
dfjames@ucsd.edu
First Name & Middle Initial & Last Name & Degree
Thomas J Kipps, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Danelle F James, M.D.
Facility Name
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Evgeny Mikler, P.A.
Phone
617-632-4719
First Name & Middle Initial & Last Name & Degree
Clinical Trials Office - Dana-Farber/Harvard Cancer Center
Phone
617-582-8480
First Name & Middle Initial & Last Name & Degree
Jennifer R Brown, M.D.,Ph.D
Facility Name
Long Island Jewish Medical Center
City
New Hyde Park
State/Province
New York
ZIP/Postal Code
11040
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nancy Driscoll, RPA-C
Phone
516-470-4767
Email
Ndriscol@lij.edu
Phone
(516)470-4050
First Name & Middle Initial & Last Name & Degree
Kanti Rai, M.D.
Facility Name
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210-1240
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Clinical Trials Office - OSU Comprehensive Cancer Center
Phone
614-293-4976
Email
osu@emergingmed.com
First Name & Middle Initial & Last Name & Degree
Michael Grever, M.D.
First Name & Middle Initial & Last Name & Degree
John Byrd, M.D.
First Name & Middle Initial & Last Name & Degree
Thomas Lin, M.D.
Facility Name
M. D. Anderson Cancer Center at University of Texas
City
Houston
State/Province
Texas
ZIP/Postal Code
77030-4009
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susan C Smith
Phone
713-745-0553
Email
Susan Smith <scsmith@mdanderson.org>
First Name & Middle Initial & Last Name & Degree
Clinical Trials Office
Phone
713-792-3245
First Name & Middle Initial & Last Name & Degree
William G Wierda, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Michael J Keating, M.D., B.S.

12. IPD Sharing Statement

Citations:
PubMed Identifier
17088571
Citation
Chanan-Khan A, Miller KC, Musial L, Lawrence D, Padmanabhan S, Takeshita K, Porter CW, Goodrich DW, Bernstein ZP, Wallace P, Spaner D, Mohr A, Byrne C, Hernandez-Ilizaliturri F, Chrystal C, Starostik P, Czuczman MS. Clinical efficacy of lenalidomide in patients with relapsed or refractory chronic lymphocytic leukemia: results of a phase II study. J Clin Oncol. 2006 Dec 1;24(34):5343-9. doi: 10.1200/JCO.2005.05.0401. Epub 2006 Nov 6.
Results Reference
background
PubMed Identifier
16750498
Citation
Chanan-Khan A, Porter CW. Immunomodulating drugs for chronic lymphocytic leukaemia. Lancet Oncol. 2006 Jun;7(6):480-8. doi: 10.1016/S1470-2045(06)70723-9.
Results Reference
background
PubMed Identifier
18334676
Citation
Ferrajoli A, Lee BN, Schlette EJ, O'Brien SM, Gao H, Wen S, Wierda WG, Estrov Z, Faderl S, Cohen EN, Li C, Reuben JM, Keating MJ. Lenalidomide induces complete and partial remissions in patients with relapsed and refractory chronic lymphocytic leukemia. Blood. 2008 Jun 1;111(11):5291-7. doi: 10.1182/blood-2007-12-130120. Epub 2008 Mar 11.
Results Reference
background
Links:
URL
http://cllresearch.com/
Description
Website for the CLL Research Consortium
URL
http://cancer.ucsd.edu/
Description
Moore's UCSD Cancer Center

Learn more about this trial

Multi-center Trial of Revlimid® and Rituximab, for First-Line Treatment of Chronic Lymphocytic Leukemia (CLL)

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