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Romidepsin Plus Oral 5-Azacitidine in Relapsed/Refractory Lymphoid Malignancies

Primary Purpose

Lymphoid Malignancies, Lymphoma, Hodgkin Lymphoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Romidepsin
Oral 5-Azacitidine
Sponsored by
Columbia University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lymphoid Malignancies focused on measuring Lymphoid Malignancies, Lymphoma, Hodgkin Lymphoma, Non-hodgkin Lymphoma, Follicular Lymphoma, Diffuse Large B-Cell Lymphoma, Anaplastic Large Cell Lymphoma, Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma, Mantle Cell Lymphoma, Marginal Zone Lymphoma, Burkitt Lymphoma, Waldenstrom Macroglobulinemia, Peripheral T-cell Lymphoma, Cutaneous T-cell Lymphoma

Eligibility Criteria

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

Inclusion Criteria:

  • Phase I: Histologically confirmed relapsed or refractory non-Hodgkin lymphoma or Hodgkin lymphoma (WHO criteria), with no accepted curative options.
  • Phase II: Relapsed or refractory T-cell lymphoma, including patients with central nervous system (CNS) involvement or lymphomatous meningitis are allowed on study.
  • Relapsed or refractory disease following frontline chemotherapy. No upper limit for the number of prior therapies. Patients may have relapsed after prior autologous or allogeneic stem cell transplant.
  • Evaluable Disease in the Phase I, and measurable disease for the Phase II.
  • Age > or = 18 years.
  • Eastern Cooperative Oncology Group (ECOG) performance status < or = 2.
  • Patients must have adequate organ and marrow function.
  • Negative urine or serum pregnancy test for females of childbearing potential.
  • All females of childbearing potential must use an effective barrier method of contraception during the treatment period and for at least 1 month thereafter. Male subjects should use a barrier method of contraception during the treatment period and for at least 3 months thereafter.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Prior Therapy

    • Exposure to chemotherapy or radiotherapy within 2 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 2 weeks earlier.
    • Systemic steroids that have not been stabilized ( ≥ 5 days) to the equivalent of ≤10 mg/day prednisone prior to the start of the study drugs.
    • No other concurrent investigational agents are allowed.
  • History of allergic reactions to Oral 5-azacitidine or Romidepsin.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Pregnant women.
  • Nursing women.
  • Active concurrent malignancy (except non-melanoma skin cancer or carcinoma in situ of the cervix). If there is a history of prior malignancy, the patient must be disease-free for ≥ 3 years.
  • Patients known to be Human Immunodeficiency Virus (HIV)-positive.
  • Patients with active hepatitis A, hepatitis B, or hepatitis C infection.
  • Concomitant use of CYP3A4 inhibitors.
  • Any known cardiac abnormalities.

Sites / Locations

  • Columbia University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

R/O: Level -1

R/O: Level 1

R/O: Level 2

R/O: Level 3

R/O: Level 4

R/O: Level 5

R/O: Level 6

Arm Description

Oral 5-Azacitidine 100 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Day 8), cycle length (28 days)

Oral 5-Azacitidine 100 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)

Oral 5-Azacitidine 200 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)

Oral 5-Azacitidine 300 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)

Oral 5-Azacitidine 300 mg (Days 1-14) Romidepsin (14 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)

Oral 5-Azacitidine 300 mg (Days 1-14) Romidepsin (14 mg/m2 rounded to 14 mg/m2, Days 8, 15 and 22), cycle length (35 days)

Oral 5-Azacitidine 300 mg (Days 1-21) Romidepsin (14 mg/m2 rounded to 14 mg/m2, Days 8, 15 and 22), cycle length (35 days)

Outcomes

Primary Outcome Measures

Phase I: Maximum tolerated dose (MTD) of the combination of oral 5-azacitidine & romidepsin
Phase I: Number of dose limiting toxicities (DLTs) of the combination of oral 5-azacitidine & romidepsin
Phase I: Number of toxicities experienced by patients with the combination of oral 5-azacitidine and romidepsin
Phase II: Overall response rate (ORR) (complete + partial response) of the combination of oral 5-azacitidine and romidepsin in patients with relapsed/refractory T-Cell Lymphoma

Secondary Outcome Measures

Phase I: Maximum number of cycles received
Pending
Phase I: Number of dose delays at the maximally tolerated dose (MTD)
Pending
Phase I: Number of dose reductions at the maximally tolerated dose (MTD)
Pending
Phase I: Overall response rate (ORR) of the study population
Pending
Phase I & II: Progression free survival (PFS) of the study population
Pending
Phase I & II: Duration of response (DOR) of the study population
Phase II: Prevalence of overall survival of the patients with T-cell lymphoma on study
Data analysis ongoing
Phase II: Positive response to clinical outcome indicating potential pre-treatment biomarkers by relating correlative sample data to clinical data on each patient.
Data analysis ongoing

Full Information

First Posted
November 20, 2013
Last Updated
January 5, 2021
Sponsor
Columbia University
Collaborators
Celgene
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1. Study Identification

Unique Protocol Identification Number
NCT01998035
Brief Title
Romidepsin Plus Oral 5-Azacitidine in Relapsed/Refractory Lymphoid Malignancies
Official Title
Phase I/IIa Study of the Oral 5-Azacitidine in Combination With the Histone Deacetylase Inhibitor Romidepsin for the Treatment of Patients With Relapsed and Refractory Lymphoid Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Terminated
Why Stopped
PI left institution
Study Start Date
November 2013 (undefined)
Primary Completion Date
January 6, 2020 (Actual)
Study Completion Date
January 6, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Columbia University
Collaborators
Celgene

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is an open label, phase I/IIa, 3 x 3 dose escalation study with an initial phase I followed by a disease focused phase II. The primary objective of the phase I is to determine the maximum tolerated dose (MTD) and dose limiting toxicity (DLT) of the combinations of oral 5-azacitidine and romidepsin in patients with lymphoma. The safety and toxicity of this combination will be evaluated throughout the entire study. If the combination of oral 5-azacitidine and romidepsin is found to be feasible and an MTD is established, the phase II part of the study will be initiated. Phase II will consist of a 2 stage design of the combination of oral 5-azacitidine and romidepsin for patients with relapsed or refractory T-cell lymphomas.
Detailed Description
Subjects will receive oral 5-azacitidine and romidepsin, administered as follows: oral 5-azacitidine from Days 1-14 (Dose cohorts -1 to 5) or Days 1-21 (Dose cohort 6); and romidepsin administered intravenously on Days 8 (Dose cohorts 1-4) of a 28 day cycle, and Day 22 (Dose cohorts 5 and 6) of a 35 day cycle. Cohorts of 3 patients will be enrolled sequentially as outlined in the dose escalation scheme. Once the MTD is reached the Phase II part of the protocol will be initiated in patients with T-Cell Lymphoma.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoid Malignancies, Lymphoma, Hodgkin Lymphoma, Non-hodgkin Lymphoma
Keywords
Lymphoid Malignancies, Lymphoma, Hodgkin Lymphoma, Non-hodgkin Lymphoma, Follicular Lymphoma, Diffuse Large B-Cell Lymphoma, Anaplastic Large Cell Lymphoma, Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma, Mantle Cell Lymphoma, Marginal Zone Lymphoma, Burkitt Lymphoma, Waldenstrom Macroglobulinemia, Peripheral T-cell Lymphoma, Cutaneous T-cell Lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
52 (Actual)

8. Arms, Groups, and Interventions

Arm Title
R/O: Level -1
Arm Type
Experimental
Arm Description
Oral 5-Azacitidine 100 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Day 8), cycle length (28 days)
Arm Title
R/O: Level 1
Arm Type
Experimental
Arm Description
Oral 5-Azacitidine 100 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)
Arm Title
R/O: Level 2
Arm Type
Experimental
Arm Description
Oral 5-Azacitidine 200 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)
Arm Title
R/O: Level 3
Arm Type
Experimental
Arm Description
Oral 5-Azacitidine 300 mg (Days 1-14) Romidepsin (10 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)
Arm Title
R/O: Level 4
Arm Type
Experimental
Arm Description
Oral 5-Azacitidine 300 mg (Days 1-14) Romidepsin (14 mg/m2 rounded to 14 mg/m2, Days 8 and 15), cycle length (28 days)
Arm Title
R/O: Level 5
Arm Type
Experimental
Arm Description
Oral 5-Azacitidine 300 mg (Days 1-14) Romidepsin (14 mg/m2 rounded to 14 mg/m2, Days 8, 15 and 22), cycle length (35 days)
Arm Title
R/O: Level 6
Arm Type
Experimental
Arm Description
Oral 5-Azacitidine 300 mg (Days 1-21) Romidepsin (14 mg/m2 rounded to 14 mg/m2, Days 8, 15 and 22), cycle length (35 days)
Intervention Type
Drug
Intervention Name(s)
Romidepsin
Other Intervention Name(s)
Istodax
Intervention Description
Romidepsin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Romidepsin is classified as a "Histone Deacetylase Inhibitor". Dose escalation (10, 14 mg/m2)
Intervention Type
Drug
Intervention Name(s)
Oral 5-Azacitidine
Other Intervention Name(s)
5-AC
Intervention Description
A pyrimidine nucleoside analogue of cytidine with antineoplastic activity. Dose escalation (100, 200, 300 mg)
Primary Outcome Measure Information:
Title
Phase I: Maximum tolerated dose (MTD) of the combination of oral 5-azacitidine & romidepsin
Time Frame
up to 1.5 years
Title
Phase I: Number of dose limiting toxicities (DLTs) of the combination of oral 5-azacitidine & romidepsin
Time Frame
up to 1 year
Title
Phase I: Number of toxicities experienced by patients with the combination of oral 5-azacitidine and romidepsin
Time Frame
Up to 1.5 years
Title
Phase II: Overall response rate (ORR) (complete + partial response) of the combination of oral 5-azacitidine and romidepsin in patients with relapsed/refractory T-Cell Lymphoma
Time Frame
Up to 3 years
Secondary Outcome Measure Information:
Title
Phase I: Maximum number of cycles received
Description
Pending
Time Frame
Up to 1.5 years
Title
Phase I: Number of dose delays at the maximally tolerated dose (MTD)
Description
Pending
Time Frame
Up to 1.5 years
Title
Phase I: Number of dose reductions at the maximally tolerated dose (MTD)
Description
Pending
Time Frame
Up to 1.5 years
Title
Phase I: Overall response rate (ORR) of the study population
Description
Pending
Time Frame
Up to 1.5 years
Title
Phase I & II: Progression free survival (PFS) of the study population
Description
Pending
Time Frame
Up to 1.5 years
Title
Phase I & II: Duration of response (DOR) of the study population
Time Frame
Up to 1.5 years
Title
Phase II: Prevalence of overall survival of the patients with T-cell lymphoma on study
Description
Data analysis ongoing
Time Frame
Up to 1.5 years
Title
Phase II: Positive response to clinical outcome indicating potential pre-treatment biomarkers by relating correlative sample data to clinical data on each patient.
Description
Data analysis ongoing
Time Frame
Up to 1.5 years
Other Pre-specified Outcome Measures:
Title
Phase I & II: Prevalence of pharmacodynamic markers of drug effect indicated in optional paired tissue biopsies
Description
Samples taken from baseline and post treatment timepoints will be compared to try to identify pharmacodynamic markers of drug effect.
Time Frame
Up to 1.5 years
Title
Phase I: Concentration time curve (AUC) for the combination of oral 5-azacitidine & romidepsin in cycle 1
Description
Samples will be drawn at various timepoints and run in aggregate during the course of the study.
Time Frame
Up to 1.5 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Phase I: Histologically confirmed relapsed or refractory non-Hodgkin lymphoma or Hodgkin lymphoma (WHO criteria), with no accepted curative options. Phase II: Relapsed or refractory T-cell lymphoma, including patients with central nervous system (CNS) involvement or lymphomatous meningitis are allowed on study. Relapsed or refractory disease following frontline chemotherapy. No upper limit for the number of prior therapies. Patients may have relapsed after prior autologous or allogeneic stem cell transplant. Evaluable Disease in the Phase I, and measurable disease for the Phase II. Age > or = 18 years. Eastern Cooperative Oncology Group (ECOG) performance status < or = 2. Patients must have adequate organ and marrow function. Negative urine or serum pregnancy test for females of childbearing potential. All females of childbearing potential must use an effective barrier method of contraception during the treatment period and for at least 1 month thereafter. Male subjects should use a barrier method of contraception during the treatment period and for at least 3 months thereafter. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Prior Therapy Exposure to chemotherapy or radiotherapy within 2 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 2 weeks earlier. Systemic steroids that have not been stabilized ( ≥ 5 days) to the equivalent of ≤10 mg/day prednisone prior to the start of the study drugs. No other concurrent investigational agents are allowed. History of allergic reactions to Oral 5-azacitidine or Romidepsin. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Pregnant women. Nursing women. Active concurrent malignancy (except non-melanoma skin cancer or carcinoma in situ of the cervix). If there is a history of prior malignancy, the patient must be disease-free for ≥ 3 years. Patients known to be Human Immunodeficiency Virus (HIV)-positive. Patients with active hepatitis A, hepatitis B, or hepatitis C infection. Concomitant use of CYP3A4 inhibitors. Any known cardiac abnormalities.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Owen A. O'Connor, MD, Ph.D.
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10019
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33171487
Citation
Falchi L, Ma H, Klein S, Lue JK, Montanari F, Marchi E, Deng C, Kim HA, Rada A, Jacob AT, Kinahan C, Francescone MM, Soderquist CR, Park DC, Bhagat G, Nandakumar R, Menezes D, Scotto L, Sokol L, Shustov AR, O'Connor OA. Combined oral 5-azacytidine and romidepsin are highly effective in patients with PTCL: a multicenter phase 2 study. Blood. 2021 Apr 22;137(16):2161-2170. doi: 10.1182/blood.2020009004. Erratum In: Blood. 2022 Mar 10;139(10):1600.
Results Reference
derived
PubMed Identifier
31471376
Citation
O'Connor OA, Falchi L, Lue JK, Marchi E, Kinahan C, Sawas A, Deng C, Montanari F, Amengual JE, Kim HA, Rada AM, Khan K, Jacob AT, Malanga M, Francescone MM, Nandakumar R, Soderquist CR, Park DC, Bhagat G, Cheng B, Risueno A, Menezes D, Shustov AR, Sokol L, Scotto L. Oral 5-azacytidine and romidepsin exhibit marked activity in patients with PTCL: a multicenter phase 1 study. Blood. 2019 Oct 24;134(17):1395-1405. doi: 10.1182/blood.2019001285.
Results Reference
derived

Learn more about this trial

Romidepsin Plus Oral 5-Azacitidine in Relapsed/Refractory Lymphoid Malignancies

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