A Phase I/II Trial of VR-CHOP in Lymphoma Patients

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Millennium Pharmaceuticals, Inc.
Information provided by (Responsible Party):
Christopher R. Flowers, Emory University
ClinicalTrials.gov Identifier:
NCT00634179
First received: February 11, 2008
Last updated: March 14, 2014
Last verified: March 2014
  Purpose

This is an open-label (doctors and patients know which drug will be given), single center, phase 1/2 clinical trial, which is now continuing to enroll patients in the phase 2 portion of the trial. The primary objective is to determine whether VR-CHOP provides benefit to patients with previously untreated indolent non-Hodgkin's lymphomas (NHL).


Condition Intervention Phase
Lymphoma, B-Cell
Follicular Lymphoma
Drug: rituximab, cyclophosphamide, doxorubicin, vincristine, bortezomib, prednisone
Phase 1
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I/II Trial of VR-CHOP for Patients With Untreated Follicular Lymphoma and Other Low Grade B-Cell Lymphomas

Resource links provided by NLM:


Further study details as provided by Emory University:

Primary Outcome Measures:
  • To identify the maximal tolerated doses of bortezomib and vincristine when used in combination of bortezomib, rituximab and the CHOP chemotherapy regimen [ Time Frame: Cycle 1 for MTD, following completion of therapy for CR ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • An estimate of the overall response rate (ORR)(complete response [CR] + CR unconfirmed [CRu] + partial response [PR] to VR-CHOP according to IWRC criteria [ Time Frame: Following completion of therapy ] [ Designated as safety issue: No ]

Enrollment: 37
Study Start Date: February 2008
Estimated Study Completion Date: February 2015
Estimated Primary Completion Date: March 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
This is an open-label, single-center, prospective phase 1/2 clinical trial with a dose escalation and de-escalation schema for bortezomib and vincristine to identify the maximum tolerated doses (MTD) of bortezomib and vincristine when used in the VR-CHOP regimen. In phase 2, the trial will evaluate the efficacy and safety of the MTD combination of VELCADE and rituximab-CHOP. At the start of phase 1, treatment consisted of rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, vincristine 1.4 mg/m2 given on day 1, bortezomib 1.3 mg/m2 given on days 1 and 8, and prednisone 100 mg/day given orally on days 1-5. Dose titration occured in phase 1 to a maximum bortezomib dose of 1.6 mg/m2 given on days 1 and 8. The phase 1 portion of the trial determined that patients enrolled in phase 2 should start treatment at a bortezomib dose of 1.6 mg/m2 given on days 1 and 8 and a vincristine dose of 1.4 mg/m2 (capped at 1.5 mg).
Drug: rituximab, cyclophosphamide, doxorubicin, vincristine, bortezomib, prednisone
rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, vincristine 1.4 mg/m2 (capped at 1.5 mg maximum) given on day 1, bortezomib 1.6 mg/m2 given on days 1 and 8, and prednisone 100 mg/day given orally on days 1-5.
Other Name: Velcade, R-CHOP, VR-CHOP, BR-CHOP,CHOP-R

Detailed Description:

This study will assess whether adding bortezomib (Velcade) to R-CHOP (in a new combination called VR-CHOP) can further improve outcomes in patients with indolent NHL who have not previously received treatment.

Patients who are eligible to take part in the study will receive VR-CHOP at the doses of Velcade and vincristine established in phase 1. Patients will receive VR-CHOP for up to 8 cycles of treatment (each of 21 days duration). During treatment, patients will be assessed for their response to therapy and for possible side effects. All patients will go on to receive maintenance therapy after completion of their initial treatment as designed by the protocol.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

• Tissue diagnosis of a previously untreated, CD20+, B-Cell Non-Hodgkin Lymphoma.

For the Phase 1 trial: Patients with any of the following diagnoses are eligible:

  • Follicular Lymphomas (Grade 1, 2, 3a, 3b)
  • Small Lymphocytic Lymphoma
  • Marginal Zone Lymphomas

For the Phase 2 trial: Patients with any of the following diagnoses are eligible:

  • Follicular Lymphomas (Grade 1, 2, 3a)
  • Small Lymphocytic Lymphoma
  • Marginal Zone Lymphomas
  • Patients with follicular or other low-grade lymphoma must have an indication for treatment based on modified GELF criteria or a FLIPI score ≥3
  • Indications for treatment based on modified GELF criteria include any one of the following:
  • B symptoms or other lymphoma-related symptoms
  • Involvement of 3 nodal sites, each with a diameter of 3 cm
  • Any nodal or extranodal tumor mass with a diameter of 7 cm
  • Splenomegaly
  • Pleural effusions or peritoneal ascites
  • Cytopenias (leukocytes < 1.0 x 10 /L and/or platelets < 100 x 10 /L)
  • Leukemia (> 5.0 x 10 /L circulating malignant cells)
  • Indications for treatment based on FLIPI criteria include any three of the following:
  • Age ≥60 years
  • Ann Arbor stage III or IV
  • Hemoglobin level <120 g/L
  • Number of nodal areas involved >4
  • Serum LDH level >normal
  • Only chemotherapy-naïve subjects are eligible. Subjects may have received prednisone (< 2 months of therapy) or radiation ≤ 2 sites of therapy.
  • Voluntary written informed consent and HIPAA Authorization before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.
  • Female subject is either post-menopausal or surgically sterilized or willing to use an acceptable method of birth control (i.e., a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study.
  • Female patients of child bearing potential must have a negative beta-HCG test.
  • Male subject agrees to use an acceptable method for contraception for the duration of the study.
  • ≥18 years of age at the time of registration
  • Patients must have adequate renal function as demonstrated by a serum creatinine < 1.5 mg/dl unless felt to be secondary to lymphoma
  • Must have an ALT/AST ≤ 3.5 the upper limit of normal and a total bilirubin ≤2.0 mg/dL unless secondary to lymphoma.
  • Must have a cardiac left ventricular ejection fraction ≥50%.
  • At least 1 measurable tumor mass (greater than 1.5 cm in the longest dimension and greater than 1.0 cm in the short axis)
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤2.
  • Life expectancy of greater than one year.

Exclusion Criteria:

  • Subject with primary or secondary CNS lymphoma (current or previously treated) will not be eligible.
  • A history of unrelated (non-lymphomatous) neoplasm within the past 10 years other than non-melanoma skin cancer or in-situ cervix cancer. Subjects with a prior diagnosis of malignancy more than 10 years may be entered into the study at the discretion of the Principal Investigator.
  • Serious medical or psychiatric illness likely to interfere with participation in this clinical study.
  • Patient has received other investigational drugs with 14 days before enrollment.
  • Patient has hypersensitivity to boron or mannitol.
  • Female subject is pregnant or breast-feeding. Chemotherapeutic agents are known to have teratogenic effects on developing embryos and to cause chromosomal damage to gametes. These agents also cause bone marrow suppression and can be excreted in milk. Confirmation that the subject is not pregnant must be established by a negative serum β-human chorionic gonadotropin (β-hCG)pregnancy test result obtained during screening. Pregnancy testing is not required for post-menopausal or surgically sterilized women.
  • Patient has ≥Grade 2 peripheral neuropathy within 14 days before enrollment.
  • Myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) Class III or IV heart failure (see section 8.4), uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Prior to study entry, any ECG abnormality at Screening has to be documented by the investigator as not medically relevant.
  • Patient has a platelet count of < 10 x 1010/L (unless due to bone marrow involvement with lymphoma documented within 14 days before enrollment).
  • Patient has an absolute neutrophil count of <1.0 x 109/L (unless due to bone marrow involvement with lymphoma documented within 14 days before enrollment).
  • Patient has a calculated or measured creatinine clearance of <20 mL/minute within 14 days before enrollment.
  • Presence of antibodies to HIV.
  • Subject unwilling to give informed consent.
  • Failure to meet any of the eligibility criteria in Section 3.2.1.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00634179

Locations
United States, Georgia
Emory University Winship Cancer Institute
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
Millennium Pharmaceuticals, Inc.
Investigators
Principal Investigator: Christopher Flowers, MD Emory University
  More Information

No publications provided

Responsible Party: Christopher R. Flowers, Principal Investigator, Emory University
ClinicalTrials.gov Identifier: NCT00634179     History of Changes
Other Study ID Numbers: IRB00002996
Study First Received: February 11, 2008
Last Updated: March 14, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Emory University:
Lymphoma

Additional relevant MeSH terms:
Lymphoma
Lymphoma, Follicular
Lymphoma, B-Cell
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Cyclophosphamide
Rituximab
Bortezomib
Doxorubicin
Prednisone
Vincristine
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antibiotics, Antineoplastic
Glucocorticoids
Hormones

ClinicalTrials.gov processed this record on July 22, 2014