NM-IL-12 (rHuIL-12) In Relapsed/Refractory Diffuse Large B- Cell Lymphoma (DLBCL) Undergoing Salvage Chemotherapy
Primary Purpose
Lymphoma, Large B-Cell, Diffuse (DLBCL)
Status
Unknown status
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
NM-IL-12
Sponsored by
About this trial
This is an interventional treatment trial for Lymphoma, Large B-Cell, Diffuse (DLBCL) focused on measuring Relapsed, Refractory, DLBCL, Chemotherapy
Eligibility Criteria
Inclusion Criteria:
- Diagnosis of relapsed/refractory diffuse large B- cell lymphoma (DLBCL) within 28 days prior to enrollment
- PET/CT evaluation performed within 28 days prior to enrollment demonstrates measurable disease
- Age >18 years
- Eligible for intensive salvage chemotherapy with R-ICE, R-DHAP
- Patient received first line of chemotherapy when DLBCL was initially diagnosed and did not receive any further chemotherapy until enrollment in this study
- All treatment-related toxicities from prior chemotherapy resolved to grade ≤ 1or resolved to grade 2 only if deemed clinically not significant and approved by the Sponsor
- ECOG performance status ≤ 2
Adequate organ function obtained within 28 days prior to enrollment:
- Absolute neutrophil count ≥ 1,000/μL
- Platelet count ≥ 50,000/μL
- Total bilirubin ≤ 1.5x institutional upper limit of normal (IULN)
- AST and ALT ≤ 2x IULN
- Creatinine ≤ 2x IULN
- Creatinine clearance ≥ 45 mL/min/1.73m2 for participants with creatinine levels above IULN
- Albumin ≥ 2.5 g/dL
- Prothrombin time (PT) and PTT 80% to 120% of institutional normal range
- Women of childbearing potential must have a negative serum pregnancy test and must agree to use effective contraception, defined as intrauterine devices, double barrier method (condom plus spermicide or diaphragm) or abstain from sexual intercourse during the study
- Male subjects must be willing to use an appropriate method of contraception (e.g., condoms) or abstain from sexual intercourse and inform any sexual partners that they must also use a reliable method of contraception (e.g., birth control pills) during the study
- Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests and other study procedures
- Ability to understand and willingness to sign a written informed consent document
Exclusion Criteria:
- Uncontrolled infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose of the first cycle of the chemotherapy regimen. Infections controlled on concurrent antimicrobial agents are acceptable, and antimicrobial prophylaxis per institutional guidelines are acceptable. Patient needs to be clinically stable as defined as being afebrile and hemodynamically stable for 24-48 hours prior to study enrollment
- Known active hepatitis B or C infections, known human immunodeficiency virus (HIV) infection or known to be positive for HCV RNA or HBsAg (HBV surface antigen)
- History of or active central nervous system (CNS) involvement by lymphoma
- Prior or concomitant malignancy in the past 5 years that is currently active and likely to interfere with the patient's treatment for DLBCL or that is likely to increase the patient's morbidity or mortality
- Concomitant illness associated with a likely survival of < 1 year
- Any life-threatening illness, medical condition or organ system dysfunction that, in the investigator's opinion, could compromise the patient's safety, or put the study outcomes at undue risk
- Prior chemotherapy or radiation therapy (unless related to NHL / DLBCL treatment) within the last 5 years
- Cytotoxic drug therapy within 21 days prior to enrollment
- Unresolved toxicity from previous anticancer therapy (unless resolved to grade ≤ 1or resolved to grade 2 only if deemed clinically not significant and approved by the Sponsor) or incomplete recovery from surgery
- Major surgery (excluding that for diagnosis) within 28 days of enrollment
Unstable cardiovascular function defined as:
- Symptomatic ischemia
- Uncontrolled clinically significant conduction abnormalities (i.e., ventricular tachycardia on anti-arrhythmic agents are excluded; first degree AV block or asymptomatic left anterior fascicular block [LAFB]/right bundle branch block [RBBB] will not be excluded), or
- Congestive heart failure NYHA Class ≥ 3, or myocardial infarction within 3 months prior to enrollment
- Cerebrovascular event (transient ischemic attack or stroke) within the last 12 months.
- Major bleeding within the last 6 months.
- Bleeding involving CNS within the last 12 months.
- Use of any investigational agents within 30 days prior to enrollment and for the duration of the study
- Pregnancy or lactation -
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
NM-IL-12
Arm Description
NM-IL-12 will be administered subcutaneously
Outcomes
Primary Outcome Measures
Safety and tolerability
General safety: Vital signs (temperature, blood pressure, pulse rate, respiratory rate) and physical examination.
• Toxicity according to the NCI CTCAE (v4.03) for AEs and clinical laboratory profile; AEs will be collected for all patients who received at least one dose of NM-IL-12 and up to one month post last NM-IL-12 dose.
Immunogenicity of NM-IL-12
Immunogenicity of NM-IL-12 will be evaluated by the presence of anti-drug antibody (ADA)
Secondary Outcome Measures
Response rate (Complete Response or Partial Response) as assessed by PET/CT
Comparison will be made between the status before salvage regimen initiation, after the second chemotherapy cycle, and after completion of all salvage chemotherapy cycles. CR and PR will be assessed according to the revised International Working Group Criteria for non-Hodgkin Lymphoma.
Time to neutrophil recovery
Time to neutrophil recovery, as defined by first day of ANC ≥ 500/μL
Time to platelet count recovery
Time to platelet count recovery, as defined by first day of self-sustained platelet count ≥ 20,000/μL
Incidence of systemic infections
Incidence and duration of neutropenic fever
Need for RBC and platelet transfusion
Peak Plasma Concentration (Cmax) of NM-IL-12
Area under the plasma concentration versus time curve (AUC) of NM-IL-12
Peak Plasma Concentration (Cmax) of IFN-g and IP-10
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02544724
Brief Title
NM-IL-12 (rHuIL-12) In Relapsed/Refractory Diffuse Large B- Cell Lymphoma (DLBCL) Undergoing Salvage Chemotherapy
Official Title
Single-Arm, Open-Label Study To Evaluate The Safety, Tolerability And Preliminary Efficacy Of NM-IL-12 (rHuIL-12) In Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma (DLBCL) Undergoing Salvage Chemotherapy
Study Type
Interventional
2. Study Status
Record Verification Date
August 2016
Overall Recruitment Status
Unknown status
Study Start Date
November 2016 (undefined)
Primary Completion Date
August 2017 (Anticipated)
Study Completion Date
December 2017 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Neumedicines Inc.
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
NM-IL-12 is being evaluated as an immunotherapeutic with concomitant hematopoietic regenerating properties for treatment of relapsed/refractory DLBCL, an aggressive type of B-cell non-Hodgkin's lymphoma (NHL). Determination of the maximum tolerated dose (MTD) for NM-IL-12 is not planned in this study, rather, a pre-defined dose of 150 ng/kg will be explored; this dose is based on two safety and tolerability studies of NM-IL-12 in healthy volunteers.
Detailed Description
This is a single-arm, open-label, non-randomized, multi-center study with NM-IL-12 dosed in combination with salvage chemotherapy regimens (R-ICE = rituximab plus ifosfamide-carboplatin-etoposide, R-DHAP = rituximab plus cytosine arabinoside-cisplatin-dexamethasone) for treatment of patients with relapsed/refractory DLBCL.
NM-IL-12 (150 ng/kg) will be administered subcutaneously. Patients will be monitored as routinely practiced; in addition, approximately 1 day after NM-IL-12 injection, patients will have a home visit by a nurse for blood sampling related to pharmacokinetic and pharmacodynamic (PK/PD) evaluation.
Twelve patients are planned to be enrolled into the study; initially 6 patients will be enrolled. The decision to continue and recruit the remaining six patients will be made by Data Safety Monitoring Board (DSMB) after review of relevant safety data, clinical laboratory evaluations, and vital signs collected up to 21 days post enrollment of the last patient in the first treated group. Common Terminology Grades for Adverse Events (CTCAE) guidelines will be used to determine dose-modifying criteria (DMC).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma, Large B-Cell, Diffuse (DLBCL)
Keywords
Relapsed, Refractory, DLBCL, Chemotherapy
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
NM-IL-12
Arm Type
Experimental
Arm Description
NM-IL-12 will be administered subcutaneously
Intervention Type
Biological
Intervention Name(s)
NM-IL-12
Other Intervention Name(s)
rHu-IL12
Intervention Description
Single SC administration of NM-IL-12 will be administered at least 48 hours after completion of the last chemotherapy dose of each cycle
Primary Outcome Measure Information:
Title
Safety and tolerability
Description
General safety: Vital signs (temperature, blood pressure, pulse rate, respiratory rate) and physical examination.
• Toxicity according to the NCI CTCAE (v4.03) for AEs and clinical laboratory profile; AEs will be collected for all patients who received at least one dose of NM-IL-12 and up to one month post last NM-IL-12 dose.
Time Frame
4 months
Title
Immunogenicity of NM-IL-12
Description
Immunogenicity of NM-IL-12 will be evaluated by the presence of anti-drug antibody (ADA)
Time Frame
4 months
Secondary Outcome Measure Information:
Title
Response rate (Complete Response or Partial Response) as assessed by PET/CT
Description
Comparison will be made between the status before salvage regimen initiation, after the second chemotherapy cycle, and after completion of all salvage chemotherapy cycles. CR and PR will be assessed according to the revised International Working Group Criteria for non-Hodgkin Lymphoma.
Time Frame
4 months
Title
Time to neutrophil recovery
Description
Time to neutrophil recovery, as defined by first day of ANC ≥ 500/μL
Time Frame
4 months
Title
Time to platelet count recovery
Description
Time to platelet count recovery, as defined by first day of self-sustained platelet count ≥ 20,000/μL
Time Frame
4 months
Title
Incidence of systemic infections
Time Frame
4 months
Title
Incidence and duration of neutropenic fever
Time Frame
4 months
Title
Need for RBC and platelet transfusion
Time Frame
4 months
Title
Peak Plasma Concentration (Cmax) of NM-IL-12
Time Frame
2 months
Title
Area under the plasma concentration versus time curve (AUC) of NM-IL-12
Time Frame
2 months
Title
Peak Plasma Concentration (Cmax) of IFN-g and IP-10
Time Frame
2 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Diagnosis of relapsed/refractory diffuse large B- cell lymphoma (DLBCL) within 28 days prior to enrollment
PET/CT evaluation performed within 28 days prior to enrollment demonstrates measurable disease
Age >18 years
Eligible for intensive salvage chemotherapy with R-ICE, R-DHAP
Patient received first line of chemotherapy when DLBCL was initially diagnosed and did not receive any further chemotherapy until enrollment in this study
All treatment-related toxicities from prior chemotherapy resolved to grade ≤ 1or resolved to grade 2 only if deemed clinically not significant and approved by the Sponsor
ECOG performance status ≤ 2
Adequate organ function obtained within 28 days prior to enrollment:
Absolute neutrophil count ≥ 1,000/μL
Platelet count ≥ 50,000/μL
Total bilirubin ≤ 1.5x institutional upper limit of normal (IULN)
AST and ALT ≤ 2x IULN
Creatinine ≤ 2x IULN
Creatinine clearance ≥ 45 mL/min/1.73m2 for participants with creatinine levels above IULN
Albumin ≥ 2.5 g/dL
Prothrombin time (PT) and PTT 80% to 120% of institutional normal range
Women of childbearing potential must have a negative serum pregnancy test and must agree to use effective contraception, defined as intrauterine devices, double barrier method (condom plus spermicide or diaphragm) or abstain from sexual intercourse during the study
Male subjects must be willing to use an appropriate method of contraception (e.g., condoms) or abstain from sexual intercourse and inform any sexual partners that they must also use a reliable method of contraception (e.g., birth control pills) during the study
Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests and other study procedures
Ability to understand and willingness to sign a written informed consent document
Exclusion Criteria:
Uncontrolled infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose of the first cycle of the chemotherapy regimen. Infections controlled on concurrent antimicrobial agents are acceptable, and antimicrobial prophylaxis per institutional guidelines are acceptable. Patient needs to be clinically stable as defined as being afebrile and hemodynamically stable for 24-48 hours prior to study enrollment
Known active hepatitis B or C infections, known human immunodeficiency virus (HIV) infection or known to be positive for HCV RNA or HBsAg (HBV surface antigen)
History of or active central nervous system (CNS) involvement by lymphoma
Prior or concomitant malignancy in the past 5 years that is currently active and likely to interfere with the patient's treatment for DLBCL or that is likely to increase the patient's morbidity or mortality
Concomitant illness associated with a likely survival of < 1 year
Any life-threatening illness, medical condition or organ system dysfunction that, in the investigator's opinion, could compromise the patient's safety, or put the study outcomes at undue risk
Prior chemotherapy or radiation therapy (unless related to NHL / DLBCL treatment) within the last 5 years
Cytotoxic drug therapy within 21 days prior to enrollment
Unresolved toxicity from previous anticancer therapy (unless resolved to grade ≤ 1or resolved to grade 2 only if deemed clinically not significant and approved by the Sponsor) or incomplete recovery from surgery
Major surgery (excluding that for diagnosis) within 28 days of enrollment
Unstable cardiovascular function defined as:
Symptomatic ischemia
Uncontrolled clinically significant conduction abnormalities (i.e., ventricular tachycardia on anti-arrhythmic agents are excluded; first degree AV block or asymptomatic left anterior fascicular block [LAFB]/right bundle branch block [RBBB] will not be excluded), or
Congestive heart failure NYHA Class ≥ 3, or myocardial infarction within 3 months prior to enrollment
Cerebrovascular event (transient ischemic attack or stroke) within the last 12 months.
Major bleeding within the last 6 months.
Bleeding involving CNS within the last 12 months.
Use of any investigational agents within 30 days prior to enrollment and for the duration of the study
Pregnancy or lactation -
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lena A Basile, PhD, JD
Phone
626-844-3800
Email
basile@neumedicines.com
First Name & Middle Initial & Last Name or Official Title & Degree
Shawn Jackson, M.Ed.
Phone
626-773-4920
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yossef Kalish, MD
Organizational Affiliation
Hadassah Medical Organization
Official's Role
Principal Investigator
12. IPD Sharing Statement
Citations:
PubMed Identifier
24725395
Citation
Gokhale MS, Vainstein V, Tom J, Thomas S, Lawrence CE, Gluzman-Poltorak Z, Siebers N, Basile LA. Single low-dose rHuIL-12 safely triggers multilineage hematopoietic and immune-mediated effects. Exp Hematol Oncol. 2014 Apr 11;3(1):11. doi: 10.1186/2162-3619-3-11.
Results Reference
background
PubMed Identifier
24852354
Citation
Gluzman-Poltorak Z, Vainstein V, Basile LA. Recombinant interleukin-12, but not granulocyte-colony stimulating factor, improves survival in lethally irradiated nonhuman primates in the absence of supportive care: evidence for the development of a frontline radiation medical countermeasure. Am J Hematol. 2014 Sep;89(9):868-73. doi: 10.1002/ajh.23770. Epub 2014 Jun 19.
Results Reference
background
PubMed Identifier
24708888
Citation
Gluzman-Poltorak Z, Mendonca SR, Vainstein V, Kha H, Basile LA. Randomized comparison of single dose of recombinant human IL-12 versus placebo for restoration of hematopoiesis and improved survival in rhesus monkeys exposed to lethal radiation. J Hematol Oncol. 2014 Apr 6;7:31. doi: 10.1186/1756-8722-7-31.
Results Reference
background
PubMed Identifier
22383962
Citation
Basile LA, Ellefson D, Gluzman-Poltorak Z, Junes-Gill K, Mar V, Mendonca S, Miller JD, Tom J, Trinh A, Gallaher TK. HemaMax, a recombinant human interleukin-12, is a potent mitigator of acute radiation injury in mice and non-human primates. PLoS One. 2012;7(2):e30434. doi: 10.1371/journal.pone.0030434. Epub 2012 Feb 24.
Results Reference
background
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NM-IL-12 (rHuIL-12) In Relapsed/Refractory Diffuse Large B- Cell Lymphoma (DLBCL) Undergoing Salvage Chemotherapy
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