Sirolimus as Secondary Therapy in Treating Patients With Chronic Graft-Versus-Host Disease That Did Not Respond to Previous Systemic Treatment - Full Text View

Purpose

RATIONALE: Sirolimus may be effective in treating chronic graft-versus-host disease that has not responded to previous systemic treatment.

PURPOSE: This phase II trial is studying how well sirolimus works as secondary therapy in treating patients with chronic graft-versus-host disease that has not responded to previous systemic treatment.

Condition	Intervention	Phase
Graft Versus Host Disease	Drug: cyclosporine Drug: prednisone Drug: sirolimus Drug: tacrolimus	Phase II

Drug Information available for:

Prednisone Tacrolimus Cyclosporine Cyclosporin Sirolimus Tacrolimus anhydrous

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Supportive Care, Open Label

Official Title:	A Phase II Clinical Trial to Evaluate the Safety and Efficacy of Sirolimus for Secondary Treatment of Chronic Graft-Versus-Host Disease

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:

Benefit

Secondary Outcome Measures:

Safety

Study Start Date:

April 2002

Detailed Description:

OBJECTIVES:

Determine the safety of sirolimus as secondary treatment for patients with chronic graft-versus-host disease who had an inadequate response to prior systemic treatment.
Determine the efficacy of this drug in these patients.

OUTLINE: This is an open-label study.

Patients continue on oral prednisone and oral cyclosporine OR tacrolimus. Patients also receive oral sirolimus once daily. Treatment continues in the absence of disease progression or unacceptable toxicity.

Patients are followed for survival.

PROJECTED ACCRUAL: A total of 39 patients will be accrued for this study within 3 years.

Eligibility

Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

DISEASE CHARACTERISTICS:

Histologically confirmed chronic graft-versus-host disease (GVHD)
- Inadequate response to prior treatment
- Requires secondary systemic therapy as a result of 1 of the following:
  - Clinical progression of signs and symptoms of chronic GVHD in a previously involved organ
  - Development of signs or symptoms of chronic GVHD in a previously uninvolved organ
  - No improvement after 3 months of primary treatment
  - Continued need for at least 1.0 mg/kg/day of prednisone for more than 2 months without qualifying for type of donor, graft, or conditioning regimen
No persistent or recurrent malignancy, including histologically confirmed myeloma or lymphoma
- Patients with bcr/abl detected by polymerase chain reaction assay as the only evidence of persistent chronic myeloid leukemia allowed

PATIENT CHARACTERISTICS:

Age

Any age

Performance status

Not specified

Life expectancy

Not specified

Hematopoietic

Absolute neutrophil count ≥ 1,500/mm^3
Platelet count ≥ 50,000/mm^3

Hepatic

Not specified

Renal

Not specified

Immunologic

No fungal or viral infection without radiographic evidence of improvement during continued appropriate antimicrobial therapy
No cytomegalovirus antigenemia unresponsive to antiviral therapy
No active disseminated varicella-zoster viral infection with persistent non-crusted lesions

Other

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
Able to tolerate oral medicine
No prior hypersensitivity to sirolimus

PRIOR CONCURRENT THERAPY:

Biologic therapy

Not specified

Chemotherapy

Not specified

Endocrine therapy

See Disease Characteristics
Concurrent prednisone allowed

Radiotherapy

Not specified

Surgery

Not specified

Other

No concurrent systemic immunosuppressive medications except cyclosporine or tacrolimus
No concurrent grapefruit juice
No concurrent ketoconazole or voriconazole
No concurrent topical immunosuppressive treatment for chronic GVHD allowed

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00079183

Locations


United States, Washington
	Fred Hutchinson Cancer Research Center
	Seattle, Washington, United States, 98109-1024

Sponsors and Collaborators

Fred Hutchinson Cancer Research Center

National Cancer Institute (NCI)

Investigators


Study Chair:	Paul Carpenter, MD	Fred Hutchinson Cancer Research Center

More Information

Clinical trial summary from the National Cancer Institute's PDQ® database This link exits the ClinicalTrials.gov site

Study ID Numbers:	CDR0000355110, FHCRC-1706.00
First Received:	March 8, 2004
Last Updated:	July 23, 2008
ClinicalTrials.gov Identifier:	NCT00079183
Health Authority:	United States: Federal Government

Keywords provided by National Cancer Institute (NCI):

graft versus host disease

Study placed in the following topic categories:

Sirolimus

Prednisone

Cyclosporine

Clotrimazole

Graft versus host disease

Miconazole

Tioconazole

Neoplasm Metastasis

Graft vs Host Disease

Tacrolimus

Cyclosporins

Homologous wasting disease

Additional relevant MeSH terms:

Anti-Inflammatory Agents

Anti-Infective Agents

Antineoplastic Agents, Hormonal

Immune System Diseases

Molecular Mechanisms of Pharmacological Action

Immunologic Factors

Antineoplastic Agents

Physiological Effects of Drugs

Hormones, Hormone Substitutes, and Hormone Antagonists

Enzyme Inhibitors

Antibiotics, Antineoplastic

Hormones

Immunosuppressive Agents

Glucocorticoids

Pharmacologic Actions

Anti-Bacterial Agents

Antifungal Agents

Therapeutic Uses

Antirheumatic Agents

Dermatologic Agents

ClinicalTrials.gov processed this record on November 20, 2008

Sponsors and Collaborators:	Fred Hutchinson Cancer Research Center National Cancer Institute (NCI)
Information provided by:	National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:	NCT00079183