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Study of Lenalidomide/Rituximab Maintenance for Transplantation Ineligible Patients With PCNSL. (Lemon-C)

Primary Purpose

Primary CNS Lymphoma

Status
Recruiting
Phase
Phase 2
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Rituximab, lenalidomide
Sponsored by
Kim, Seok Jin
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Primary CNS Lymphoma

Eligibility Criteria

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

Inclusion Criteria:

  1. Those who have been diagnosed with histopathological primary central nervous system lymphoma and who have completed standard chemotherapy for induction of remission of primary central nervous system lymphoma have reached a complete or partial response.
  2. Those who are unable to transplant autologous hematopoietic stem cells for the following reasons

    • If you are 65 years of age or older or if you are judged to have a weak systemic condition before receiving high-dose chemotherapy
    • Refusal of autologous hematopoietic stem cell transplantation after high-dose chemotherapy
  3. Adequate laboratory functional values

    • Absolute neutrophil count ≥ 1000/ul
    • Platelet count ≥ 50,000/ul
    • Hemoglobin ≥ 9.0 g/dL
    • Serum calcium ≤ 12.0mg/dL
    • Serum creatinine ≤ 1.5 X UNL
    • AST/ALT ≤ 2.5 X UNL
    • Total bilirubin ≤ 1.5 X UNL
  4. Hepatitis B patients with combination of prophylactic antiviral therapy
  5. ECOG PS 0-2
  6. Those who can take oral medication
  7. Written informed consent under institutional guidelines.
  8. Female patients of child-bearing potential (FCBP) must have two negative pregnancy tests (sensitivity of at least 25 mIU/mL) prior to starting lenalidomide. The first pregnancy test must be performed within 10 to 14 days prior to the start of lenalidomide, and the second pregnancy test must be performed within 24 hours prior to the start of lenalidomide.
  9. Effective method of contraception should be used during and for 28 days following the last dose of the drug

    - FCBP is defined as a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy or 2) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).

  10. Male patients must use an effective barrier method of contraception during study and 28 days following the last dose if sexually active with a FCBP.

Exclusion Criteria:

  1. If autotransplantation is planned after chemotherapy
  2. Active congestive heart failure (New York Heart Association [NYHA] Class III to IV), symptomatic ischemia, or conduction abnormalities uncontrolled by conventional intervention. Myocardial infarction within six months prior to 1st day of 1st cycle.
  3. Acute active infection requiring systemic antibiotics, antiviral (except antiviral therapy directed at hepatitis B) or antifungal agents.
  4. Uncontrolled hepatitis C infection and/or hepatitis B (except for patients with hepatitis B surface antigen [SAg] or core antibody receiving and responding to antiviral therapy directed at hepatitis B: these patients are allowed).
  5. . Known human immunodeficiency (HIV) seropositive
  6. Those who are unable to take oral medication
  7. Patients with a history of malignant tumors other than the target diseases except for the following cases

    • If the tumor has not been treated for at least 5 years or is disease-free
    • Patients at least 1 year after complete resection of basal cell carcinoma / squamous cell carcinoma or successful treatment of cervical epithelial cancer
  8. Adverse reactions within 30 days prior to screening Severe gastrointestinal bleeding exceeding Grade 2 according to the Common Terms Criteria 4.03 version criteria
  9. Occurrence of blood clots or embolism within 6 months before starting screening
  10. Patients with hypersensitivity to THIS DRUG and other ingredients of THIS DRUG (e.g., angioedema, Stevens-Jones syndrome, toxic epidermal necrosis, etc.)
  11. Patients with seizure disorder requiring medication
  12. Female patients who are pregnant or lactating.
  13. Patients with genetic problems such as galactose intolerance, lapp lactase deficiency, or glucose-galactose malabsorption.
  14. Patients with hyperreactivity to rituximab.

Sites / Locations

  • Samsung Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Lenalidomide and Rituximab therapy

Arm Description

The clinical trial drug is administered in one cycle for 28 days and is administered as follows. Drug : Rituximab It will be administered 375 mg/m² IV infusion Day 1. (Rituximab: up to 6 cycles) Drug : Lenalidomide It will be administred 20 mg PO day 1 -21. The medication is taken for up to 2 years, and if there is no recurrence, it is stopped after 2 years , Or stop when disease progression is confirmed during the administration period.

Outcomes

Primary Outcome Measures

1 year progression free survival
The incidence of tumor progression or death from all causes during the 1-year follow-up period from the first drug administration date.

Secondary Outcome Measures

2-year progression free survival
The incidence of tumor progression or death from all causes during the 2-year follow-up period from the first drug administration date.
Overall survival
The time from the first drug administration to death from any cause.
Overall response
The proportion of patients who achieve complete and partial response.
Toxicity profiles
Clinical and laboratory toxicity/symptomatology will be graded based on the NCIC CTG v4.03. Adverse events not reported in NCIC CTG will be categorized into mild, moderate, severe, and fatal and further classified to CTCAE Grades 1-4.

Full Information

First Posted
November 8, 2020
Last Updated
April 16, 2023
Sponsor
Kim, Seok Jin
Collaborators
Celltrion, Samyang Biopharmaceuticals Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT04627753
Brief Title
Study of Lenalidomide/Rituximab Maintenance for Transplantation Ineligible Patients With PCNSL.
Acronym
Lemon-C
Official Title
Phase II Study of Lenalidomide/Rituximab Maintenance for Transplantation Ineligible Patients With Primary CNS Diffuse Large B-cell Lymphoma (Nickname: Lemon-C Study)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 2, 2020 (Actual)
Primary Completion Date
November 2, 2024 (Anticipated)
Study Completion Date
November 2, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Kim, Seok Jin
Collaborators
Celltrion, Samyang Biopharmaceuticals Corporation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
After standard treatment of primary central nervous system lymphoma (PCNSL), high-dose methotrexate induction therapy, and consolidation therapy, most patients reach complete remission, but within the first 6 months, 35-60% of patients refractory to treatment or experience relapse during the first treatment. The progression-free survival (PFS) period of relapsed patients is 2.2 months (0-29.6 months), and the survival period is reported as 3.5 months (0-29.6 months). After relapse, the majority of patients die within 2-4 months due to neurologic deterioration Consolidation therapy after induction therapy includes whole-brain radiation therapy, high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-SCT), and high-dose chemotherapy alone. However, the median age of the inducing patient is 65 years, and more than half of the patients who are unable to transplant autologous hematopoietic stem cells (auto-SCT) after induction therapy account for more than half. Therefore, we intend to conduct a study to evaluate the efficacy and safety of maintenance therapy for rituximab and lenalidomide as one of the consolidation therapies for patients with primary central nervous system lymphoma (PCNSL).
Detailed Description
-As described, standard treatment for patients with primary central nervous system lymphoma is not yet based on a high level of evidence, and studies on consolidation therapy for elderly patients who cannot transplant this disease are very limited. Based on the Korea National Cancer Incidence Database, about 100 to 150 cases of primary central nervous system lymphoma are diagnosed per year in Korea, and 15 to 30% of them are judged to experience recurrence. Rituximab and lenalidomide (RR) are drugs that are expected to play a role in patients with primary central nervous system lymphoma who have already refractory or relapsed as described above, but there is a big hurdle that the number of patients is limited. Since then, it has not been studied as consolidation therapy in elderly or non-transplantable patients. Therefore, the present investigators attempted to confirm the efficacy and safety of lenalidomide/rituximab maintenance therapy in patients with primary central nervous system lymphoma who received high-dose methotrexate-containing anticancer drug, but could not receive consolidation therapy with autograft.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Primary CNS Lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Lenalidomide and Rituximab therapy
Arm Type
Experimental
Arm Description
The clinical trial drug is administered in one cycle for 28 days and is administered as follows. Drug : Rituximab It will be administered 375 mg/m² IV infusion Day 1. (Rituximab: up to 6 cycles) Drug : Lenalidomide It will be administred 20 mg PO day 1 -21. The medication is taken for up to 2 years, and if there is no recurrence, it is stopped after 2 years , Or stop when disease progression is confirmed during the administration period.
Intervention Type
Drug
Intervention Name(s)
Rituximab, lenalidomide
Other Intervention Name(s)
Truxima Inj, Lenalid
Intervention Description
Maintenance for 2 years
Primary Outcome Measure Information:
Title
1 year progression free survival
Description
The incidence of tumor progression or death from all causes during the 1-year follow-up period from the first drug administration date.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
2-year progression free survival
Description
The incidence of tumor progression or death from all causes during the 2-year follow-up period from the first drug administration date.
Time Frame
24 months
Title
Overall survival
Description
The time from the first drug administration to death from any cause.
Time Frame
24 months
Title
Overall response
Description
The proportion of patients who achieve complete and partial response.
Time Frame
24 months
Title
Toxicity profiles
Description
Clinical and laboratory toxicity/symptomatology will be graded based on the NCIC CTG v4.03. Adverse events not reported in NCIC CTG will be categorized into mild, moderate, severe, and fatal and further classified to CTCAE Grades 1-4.
Time Frame
from the date of informed consent signature to 30 days after last drug administration.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Those who have been diagnosed with histopathological primary central nervous system lymphoma and who have completed standard chemotherapy for induction of remission of primary central nervous system lymphoma have reached a complete or partial response. Those who are unable to transplant autologous hematopoietic stem cells for the following reasons If you are 65 years of age or older or if you are judged to have a weak systemic condition before receiving high-dose chemotherapy Refusal of autologous hematopoietic stem cell transplantation after high-dose chemotherapy Adequate laboratory functional values Absolute neutrophil count ≥ 1000/ul Platelet count ≥ 50,000/ul Hemoglobin ≥ 9.0 g/dL Serum calcium ≤ 12.0mg/dL Serum creatinine ≤ 1.5 X UNL AST/ALT ≤ 2.5 X UNL Total bilirubin ≤ 1.5 X UNL Hepatitis B patients with combination of prophylactic antiviral therapy ECOG PS 0-2 Those who can take oral medication Written informed consent under institutional guidelines. Female patients of child-bearing potential (FCBP) must have two negative pregnancy tests (sensitivity of at least 25 mIU/mL) prior to starting lenalidomide. The first pregnancy test must be performed within 10 to 14 days prior to the start of lenalidomide, and the second pregnancy test must be performed within 24 hours prior to the start of lenalidomide. Effective method of contraception should be used during and for 28 days following the last dose of the drug - FCBP is defined as a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy or 2) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months). Male patients must use an effective barrier method of contraception during study and 28 days following the last dose if sexually active with a FCBP. Exclusion Criteria: If autotransplantation is planned after chemotherapy Active congestive heart failure (New York Heart Association [NYHA] Class III to IV), symptomatic ischemia, or conduction abnormalities uncontrolled by conventional intervention. Myocardial infarction within six months prior to 1st day of 1st cycle. Acute active infection requiring systemic antibiotics, antiviral (except antiviral therapy directed at hepatitis B) or antifungal agents. Uncontrolled hepatitis C infection and/or hepatitis B (except for patients with hepatitis B surface antigen [SAg] or core antibody receiving and responding to antiviral therapy directed at hepatitis B: these patients are allowed). . Known human immunodeficiency (HIV) seropositive Those who are unable to take oral medication Patients with a history of malignant tumors other than the target diseases except for the following cases If the tumor has not been treated for at least 5 years or is disease-free Patients at least 1 year after complete resection of basal cell carcinoma / squamous cell carcinoma or successful treatment of cervical epithelial cancer Adverse reactions within 30 days prior to screening Severe gastrointestinal bleeding exceeding Grade 2 according to the Common Terms Criteria 4.03 version criteria Occurrence of blood clots or embolism within 6 months before starting screening Patients with hypersensitivity to THIS DRUG and other ingredients of THIS DRUG (e.g., angioedema, Stevens-Jones syndrome, toxic epidermal necrosis, etc.) Patients with seizure disorder requiring medication Female patients who are pregnant or lactating. Patients with genetic problems such as galactose intolerance, lapp lactase deficiency, or glucose-galactose malabsorption. Patients with hyperreactivity to rituximab.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Seok Jin Kim, MD, PhD
Phone
82-2-3410-1766
Email
kstwoh@skku.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Seok Jin Kim, MD, PhD
Organizational Affiliation
Samsung Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Samsung Medical Center
City
Seoul
ZIP/Postal Code
135710
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Won Seog Kim, MD PhD
Phone
82234106548
Email
wskimsmc@skku.edu
First Name & Middle Initial & Last Name & Degree
Won Seog Kim, MD, PhD
First Name & Middle Initial & Last Name & Degree
Seok Jin Kim, MD, PhD

12. IPD Sharing Statement

Learn more about this trial

Study of Lenalidomide/Rituximab Maintenance for Transplantation Ineligible Patients With PCNSL.

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