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Study of MK 2206 in Patients With Relapsed or Refractory Diffuse Large B Cell Lymphoma (AKTIL)

Primary Purpose

Diffuse Large B Cell Lymphoma

Status
Terminated
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
MK2206
Sponsored by
Centre Leon Berard
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diffuse Large B Cell Lymphoma focused on measuring Diffuse Large B cell Lymphoma, AKT, MK 2206, objective response rate, progression free survival, overall survival, safety

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with histologically confirmed diffuse large B-Cell lymphomas.
  • Patients must have measurable disease.
  • Subjects must have received at least two prior treatment lines.There is no maximal limit on the number of prior therapies

    • Prior treatment must include CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) -like chemotherapy in combination with rituximab. Rituximab used alone is not considered as a separate regimen.
    • Prior treatment could include high dose chemotherapy with autologous stem-cell transplantation if patients had progressed ≥ 3 months after this treatment.
    • Salvage treatment, mobilization chemotherapy, high-dose chemotherapy and planned post-transplant therapy should be considered as one regimen
    • Relapsed or refractory patients who are candidate to high-dose chemotherapy and autologous or allogenic stem cell transplantation are not eligible.
  • Patients must have discontinued all prior therapies for at least 5 times the t1/2 of prior anti-cancer therapies before study entry.
  • Male or female patients, age ≥ 18 years.
  • Life expectancy greater than 4 months.
  • ECOG performance status ≤2.
  • Patients must have normal organ and marrow function as defined below:

    • Absolute neutrophil count ≥ 1.5 x 109/L,
    • Platelet count ≥ 100 x 109/L or ≥75 x 109/L if the bone marrow is involved,
    • AST/ALT ≤ 2.5 x upper limit of normal (ULN) (or ≤ 5.0 x ULN if liver metastasis) direct bilirubin ≤ 1.5ULN
    • Calculated creatinine clearance (Cockcroft-Gault formula) of ≥ 50mL/min
  • Patients must agree to use adequate double contraception
  • Patients must be able to swallow whole tablets.
  • Cardiovascular baseline QTcF≤ 450 msec (male) or QTcF≤470msec (female).
  • Signed written informed consent document.
  • Patients with French Social Security in compliance with the French law relating to biomedical research.

Exclusion Criteria:

  • Tumor tissue sample not available for pathological review.
  • Patients with others than Diffuse large B-Cell Lymphoma histology.
  • Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study.
  • Patients who have not recovered from adverse events grade > 1 due to agents administered more than 4 weeks earlier.
  • Patients who are receiving any other investigational agents.
  • Patients with known CNS involvement should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the compliance to the study protocol.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to MK-2206 tablets.
  • Patients with uncontrolled hyperglycemia
  • Patients with 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 and breastfeeding women are excluded from this study.
  • HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with MK-2206.
  • Patients with malabsorption syndrome or other condition that would interfere with intestinal absorption.
  • Patients with clinically important history of liver disease, including viral or other hepatitis or cirrhosis.
  • Prior history of malignancies other than lymphoma (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast) unless the subject has been free of the disease for ≥ 3 years.
  • Uncontrolled hypertension with resting SBP>140 or resting DBP>90mm Hg

Sites / Locations

  • Institut Bergonié
  • Centre Henri Mondor
  • CHRU
  • Centre Leon Berard
  • Institut Paoli Calmettes
  • CHU St Eloi
  • CHU
  • CHU de Nantes
  • Hôpital Saint-Louis
  • Hôpital Necker
  • Centre Hospitalier LYON SUD
  • Centre Henri Becquerel
  • Institut Gustave Roussy

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

MK2206

Arm Description

Treatment is started the day after registration (day 1)until progression according to Cheson international response criteria or documented toxicity.

Outcomes

Primary Outcome Measures

evaluation of the antitumor activity of MK-2206 in terms of objective response rate (ORR).
the objective response rate (ORR) is measured as per 2007 Cheson international response criteria.

Secondary Outcome Measures

safety profile
safety profile is characterized by type, frequency and seriousness of the toxicities showed by patients and graded using CTCAE-V04.
overall survival
progression-free survival
duration of response
evaluation of the antitumor activity of MK-2206 in terms of objective response rate (ORR).
the objective response rate (ORR) is measured as per 1999 Cheson international response criteria.

Full Information

First Posted
October 28, 2011
Last Updated
July 9, 2014
Sponsor
Centre Leon Berard
Collaborators
National Cancer Institute, France
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1. Study Identification

Unique Protocol Identification Number
NCT01466868
Brief Title
Study of MK 2206 in Patients With Relapsed or Refractory Diffuse Large B Cell Lymphoma
Acronym
AKTIL
Official Title
A Phase II Study of MK 2206 in Patients With Relapsed or Refractory Diffuse Large B Cell Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2014
Overall Recruitment Status
Terminated
Why Stopped
Regarding the comments of the iDSMB, the sponsor decided to stop the inclusions
Study Start Date
November 2011 (undefined)
Primary Completion Date
September 2013 (Actual)
Study Completion Date
June 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre Leon Berard
Collaborators
National Cancer Institute, France

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the antitumor efficacy and the safety of MK 2206 in patients with relapsed or refractory diffuse large B cell lymphoma.
Detailed Description
Diffuse Large B-cell Lymphoma (DLBCL) is the most frequent subtype of Non-Hodgkin lymphoma (NHL) around the world, in all age groups. DLBCL is a curable disease and combination of monoclonal antibody against CD20 (rituximab) with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen have improved the prognosis of patients with a 20% increase of the cure rate. For the remaining patients who are not in complete response and/or who relapse after first line therapy, the possibility of cure is dramatically reduced. As PI3K/AKT/mTOR pathway regulates the expression of cyclin D1, c-Myc and Stat3 proteins, which are involved in the pathogenesis of DLBCL HL), this signalling axis is an emerging therapeutic target for treatment of DLBCL. One study has shown that the level of p-Akt is an adverse prognostic feature in DLBCL and is found in 52% of tumors samples from DLBCL patients. Given the fact that AKT is overactivated in about to 52% of DLBCL and is considered as a poor prognosis factor, we postulate that targeting AKT in DLBCL may be an interesting therapeutic strategy. MK-2206 is an orally selective allosteric inhibitor of AKT developed by MERCK currently highlighted as a promising therapeutic option for cancer patients and under clinical development in several Phase 1 trials. Therefore, we propose to conduct a Phase II study using a two-stage Simon's design with objective response rate (ORR) as the primary endpoint.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diffuse Large B Cell Lymphoma
Keywords
Diffuse Large B cell Lymphoma, AKT, MK 2206, objective response rate, progression free survival, overall survival, safety

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
MK2206
Arm Type
Experimental
Arm Description
Treatment is started the day after registration (day 1)until progression according to Cheson international response criteria or documented toxicity.
Intervention Type
Drug
Intervention Name(s)
MK2206
Intervention Description
Treatment will be administered orally once weekly, 2 hours before or after a meal, at day 1, 8, 15, 22 over a 28 day cycle period. The starting dose level is 200 mg. 2 dose reduction are allowed (135 mg and 90 mg)in case of documented toxicity according to the specific algorithms.
Primary Outcome Measure Information:
Title
evaluation of the antitumor activity of MK-2206 in terms of objective response rate (ORR).
Description
the objective response rate (ORR) is measured as per 2007 Cheson international response criteria.
Time Frame
4 months after the first day of treatment.
Secondary Outcome Measure Information:
Title
safety profile
Description
safety profile is characterized by type, frequency and seriousness of the toxicities showed by patients and graded using CTCAE-V04.
Time Frame
during the treatment and up to 3.5 years from the first inclusion
Title
overall survival
Time Frame
from the date of inclusion to the date of death from any cause (up to 3.5 years from the first inclusion)
Title
progression-free survival
Time Frame
from the date of inclusion to the date of event defined as the first documented disease progression or death from any cause (up to 3.5 years from the first inclusion)
Title
duration of response
Time Frame
from the time of first documented response (complete response or partial response) until the first documented disease progression or death due to underlying cancer (up to 3.5 years from the first inclusion)
Title
evaluation of the antitumor activity of MK-2206 in terms of objective response rate (ORR).
Description
the objective response rate (ORR) is measured as per 1999 Cheson international response criteria.
Time Frame
4 months after the first day of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with histologically confirmed diffuse large B-Cell lymphomas. Patients must have measurable disease. Subjects must have received at least two prior treatment lines.There is no maximal limit on the number of prior therapies Prior treatment must include CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) -like chemotherapy in combination with rituximab. Rituximab used alone is not considered as a separate regimen. Prior treatment could include high dose chemotherapy with autologous stem-cell transplantation if patients had progressed ≥ 3 months after this treatment. Salvage treatment, mobilization chemotherapy, high-dose chemotherapy and planned post-transplant therapy should be considered as one regimen Relapsed or refractory patients who are candidate to high-dose chemotherapy and autologous or allogenic stem cell transplantation are not eligible. Patients must have discontinued all prior therapies for at least 5 times the t1/2 of prior anti-cancer therapies before study entry. Male or female patients, age ≥ 18 years. Life expectancy greater than 4 months. ECOG performance status ≤2. Patients must have normal organ and marrow function as defined below: Absolute neutrophil count ≥ 1.5 x 109/L, Platelet count ≥ 100 x 109/L or ≥75 x 109/L if the bone marrow is involved, AST/ALT ≤ 2.5 x upper limit of normal (ULN) (or ≤ 5.0 x ULN if liver metastasis) direct bilirubin ≤ 1.5ULN Calculated creatinine clearance (Cockcroft-Gault formula) of ≥ 50mL/min Patients must agree to use adequate double contraception Patients must be able to swallow whole tablets. Cardiovascular baseline QTcF≤ 450 msec (male) or QTcF≤470msec (female). Signed written informed consent document. Patients with French Social Security in compliance with the French law relating to biomedical research. Exclusion Criteria: Tumor tissue sample not available for pathological review. Patients with others than Diffuse large B-Cell Lymphoma histology. Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study. Patients who have not recovered from adverse events grade > 1 due to agents administered more than 4 weeks earlier. Patients who are receiving any other investigational agents. Patients with known CNS involvement should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the compliance to the study protocol. History of allergic reactions attributed to compounds of similar chemical or biologic composition to MK-2206 tablets. Patients with uncontrolled hyperglycemia Patients with 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 and breastfeeding women are excluded from this study. HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with MK-2206. Patients with malabsorption syndrome or other condition that would interfere with intestinal absorption. Patients with clinically important history of liver disease, including viral or other hepatitis or cirrhosis. Prior history of malignancies other than lymphoma (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast) unless the subject has been free of the disease for ≥ 3 years. Uncontrolled hypertension with resting SBP>140 or resting DBP>90mm Hg
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hervé Ghesquières, MD
Organizational Affiliation
Centre Leon Berard, Lyon, France
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Philippe Cassier, MD
Organizational Affiliation
Centre Leon Berard
Official's Role
Principal Investigator
Facility Information:
Facility Name
Institut Bergonié
City
Bordeaux
ZIP/Postal Code
33000
Country
France
Facility Name
Centre Henri Mondor
City
Créteil
Country
France
Facility Name
CHRU
City
Lille
Country
France
Facility Name
Centre Leon Berard
City
Lyon
Country
France
Facility Name
Institut Paoli Calmettes
City
Marseille
ZIP/Postal Code
13000
Country
France
Facility Name
CHU St Eloi
City
Montpellier
Country
France
Facility Name
CHU
City
Nancy
Country
France
Facility Name
CHU de Nantes
City
Nantes
Country
France
Facility Name
Hôpital Saint-Louis
City
Paris
ZIP/Postal Code
75010
Country
France
Facility Name
Hôpital Necker
City
Paris
ZIP/Postal Code
75014
Country
France
Facility Name
Centre Hospitalier LYON SUD
City
Pierre Bénite
Country
France
Facility Name
Centre Henri Becquerel
City
Rouen
Country
France
Facility Name
Institut Gustave Roussy
City
Villejuif
Country
France

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Study of MK 2206 in Patients With Relapsed or Refractory Diffuse Large B Cell Lymphoma

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