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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
Neumedicines Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

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

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

Inclusion Criteria:

  1. Diagnosis of relapsed/refractory diffuse large B- cell lymphoma (DLBCL) within 28 days prior to enrollment
  2. PET/CT evaluation performed within 28 days prior to enrollment demonstrates measurable disease
  3. Age >18 years
  4. Eligible for intensive salvage chemotherapy with R-ICE, R-DHAP
  5. Patient received first line of chemotherapy when DLBCL was initially diagnosed and did not receive any further chemotherapy until enrollment in this study
  6. 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
  7. ECOG performance status ≤ 2
  8. 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
  9. 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
  10. 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
  11. Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests and other study procedures
  12. Ability to understand and willingness to sign a written informed consent document

Exclusion Criteria:

  1. 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
  2. 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)
  3. History of or active central nervous system (CNS) involvement by lymphoma
  4. 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
  5. Concomitant illness associated with a likely survival of < 1 year
  6. 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
  7. Prior chemotherapy or radiation therapy (unless related to NHL / DLBCL treatment) within the last 5 years
  8. Cytotoxic drug therapy within 21 days prior to enrollment
  9. 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
  10. Major surgery (excluding that for diagnosis) within 28 days of enrollment
  11. 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
  12. Cerebrovascular event (transient ischemic attack or stroke) within the last 12 months.
  13. Major bleeding within the last 6 months.
  14. Bleeding involving CNS within the last 12 months.
  15. Use of any investigational agents within 30 days prior to enrollment and for the duration of the study
  16. 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

    First Posted
    September 4, 2015
    Last Updated
    August 2, 2016
    Sponsor
    Neumedicines Inc.
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    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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