Ipilimumab and Rituximab In Treating Patients With Relapsed or Refractory B-Cell Lymphoma
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Purpose
This partially randomized phase I trial studies the side effects and best dose of ipilimumab when given together with rituximab in treating patients with relapsed or refractory B-cell lymphoma. Monoclonal antibodies, such as ipilimumab and rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them
| Condition | Intervention | Phase |
|---|---|---|
|
B-cell Chronic Lymphocytic Leukemia Cutaneous B-cell Non-Hodgkin Lymphoma Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue Intraocular Lymphoma Nodal Marginal Zone B-cell Lymphoma Recurrent Adult Burkitt Lymphoma Recurrent Adult Diffuse Large Cell Lymphoma Recurrent Adult Diffuse Mixed Cell Lymphoma Recurrent Adult Diffuse Small Cleaved Cell Lymphoma Recurrent Adult Grade III Lymphomatoid Granulomatosis Recurrent Adult Hodgkin Lymphoma Recurrent Adult Immunoblastic Large Cell Lymphoma Recurrent Adult Lymphoblastic Lymphoma Recurrent Grade 1 Follicular Lymphoma Recurrent Grade 2 Follicular Lymphoma Recurrent Grade 3 Follicular Lymphoma Recurrent Mantle Cell Lymphoma Recurrent Marginal Zone Lymphoma Recurrent Small Lymphocytic Lymphoma Refractory Hairy Cell Leukemia Small Intestine Lymphoma Splenic Marginal Zone Lymphoma Testicular Lymphoma Waldenström Macroglobulinemia |
Biological: ipilimumab Biological: rituximab Other: laboratory biomarker analysis |
Phase 1 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Phase I Study of Ipilimumab in Combination With Rituximab in Patients With Relapsed/Refractory CD20+ B-Cell Lymphoma |
- Toxicities according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4 ( v4) [ Time Frame: Up to 12 months ] [ Designated as safety issue: Yes ]Tables will be created to summarize the toxicities and side effects by dose, course, organ and severity.
- Immune response as measured by the frequency of activated T-cells, absolute lymphocyte count, antibody dependent cell-mediated cytotoxicity (ADCC), and kinetics and magnitude of B-cell depletion [ Time Frame: Baseline, days 8 and 15, and weeks 9, 12, and 14 ] [ Designated as safety issue: No ]Regression methods (adapted for repeated measures) will be used to describe the changes over time. In addition to summarizing the changes over time within each arm, these regression models will contain contrasts to compare the two arms in terms of changes.
- Clinical anti-tumor response (complete response [CR] and partial response [PR] as per International workshop lymphoma response criteria [Cheson 2007]) [ Time Frame: Up to 12 months ] [ Designated as safety issue: No ]
- Progression-free survival [ Time Frame: From when the patient started treatment to the time the patient is first recorded as having disease relapse/progression, or to the date of death if the patient dies due to causes other than disease progression, assessed up to 12 months ] [ Designated as safety issue: No ]Progression-free survival will be summarized using Kaplan-Meier plots.
| Estimated Enrollment: | 38 |
| Study Start Date: | November 2012 |
| Estimated Primary Completion Date: | April 2015 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Arm A (ipilimumab and rituximab)
Patients receive rituximab IV over 2-6 hours once weekly in weeks 1-4 and ipilimumab IV over 90 minutes once weekly in weeks 1, 4, 7, and 10. Patients then receive ipilimumab IV over 90 minutes and rituximab IV over 2-6 hours once every 12 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.
|
Biological: ipilimumab
Given IV
Other Names:
Biological: rituximab
Given IV
Other Names:
Other: laboratory biomarker analysis
Correlative studies
|
|
Experimental: Arm B (ipilimumab and rituximab)
Patients receive rituximab IV over 2-6 hours once weekly in weeks 1-4 and ipilimumab IV over 90 minutes once weekly in weeks 3, 6, 9, and 12. Patients then receive ipilimumab IV over 90 minutes and rituximab IV over 2-6 hours once every 12 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.
|
Biological: ipilimumab
Given IV
Other Names:
Biological: rituximab
Given IV
Other Names:
Other: laboratory biomarker analysis
Correlative studies
|
Detailed Description:
PRIMARY OBJECTIVES:
I. To determine a recommended phase II dose for ipilimumab in combination with rituximab.
SECONDARY OBJECTIVES:
I. To obtain preliminary information on the effect of adding ipilimumab to rituximab in regard to: immune response; clinical anti-tumor response/overall remission rate (ORR) (complete remission + partial remission); progression free survival (PFS).
OUTLINE: This is a dose-escalation study of ipilimumab followed by a randomized study.
PART I:
INDUCTION: Patients receive ipilimumab intravenously (IV) over 90 minutes once every 3 weeks for 12 weeks and rituximab IV over 2-6 hours once weekly for 4 weeks.
MAINTENANCE: Patients receive ipilimumab IV over 90 minutes and rituximab IV over 2-6 hours once every 12 weeks for up to 1 year.
PART II: Patients are randomized to 1 of 2 treatment arms. ARM A: Patients receive rituximab IV over 2-6 hours once weekly in weeks 1-4 and ipilimumab IV over 90 minutes once weekly in weeks 1, 4, 7, and 10. Patients then receive ipilimumab IV over 90 minutes and rituximab IV over 2-6 hours once every 12 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive rituximab IV over 2-6 hours once weekly in weeks 1-4 and ipilimumab IV over 90 minutes once weekly in weeks 3, 6, 9, and 12. Patients then receive ipilimumab IV over 90 minutes and rituximab IV over 2-6 hours once every 12 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 12 months.
Eligibility| Ages Eligible for Study: | 19 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Previously treated, histologically confirmed CD20+ B cell lymphoma; bone marrow biopsies as the sole means of diagnosis are not acceptable, but they may be submitted in conjunction with nodal biopsies or extra nodal biopsies; fine needle aspirates are not acceptable
- All patients must be informed of the investigative nature of the clinical trial and give written informed consent in accordance with institutional and federal guidelines
- Able to adhere to the study visit schedule and other protocol requirements
- Karnofsky >= 70%
- Life expectancy expected to be greater than 3 months
- Leukocytes > 3,000/mcL
- Absolute neutrophil count > 1,000/mcL
- Platelets > 50,000/mcL
- Total bilirubin < 2.0
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) < 2.5 x institutional upper limit of normal
- Serum creatinine =< 1.5 x upper limit of normal or calculated creatinine clearance > 50 ml/min/1.73 M^2 by the modified Cockcroft and Gault Formula or creatinine clearance > 50 mL/min obtained from a 24-hour urine collection
- At least one measurable lesion according to International workshop lymphoma response criteria (Cheson 2007); there must be measurable lymphadenopathy to follow with serial exam and/or imaging
- All previous cancer therapy, including radiation, hormonal therapy and surgery, must have been discontinued at least 4 weeks prior to treatment in this study
- Patients must have evidence of progression of disease during or after last treatment
- Submission of original biopsy for review and verification by Participating Center hematopathologist
- Disease free of prior malignancies for >= 3 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast
Exclusion Criteria:
- Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
- Patients with a history of prior treatment with ipilimumab
- Patients with a history of prior treatment with an anti-PD 1 antibody, CD137 agonist or other immune activating therapy such as anti-CD 40 antibody are excluded unless 5 half-lives of the agent (minimum of 8 weeks) have intervened since the therapy; patients who have received prior vaccine therapy are eligible
- Patients who are receiving any other investigational agents
- Autoimmune disease: patients with a history of inflammatory bowel disease, including ulcerative colitis and Crohn's disease, are excluded from this study, as are patients with a history of symptomatic disease (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [e.g., Wegener's Granulomatosis]); central nervous system (CNS) or motor neuropathy considered of autoimmune origin (e.g. Guillain-Barre Syndrome and Myasthenia Gravis, multiple sclerosis)
- Patients with known immune impairment who may be unable to respond to anti-cytotoxic T-lymphocyte antigen 4 (CTLA 4) antibody
- Patients with known brain metastases are excluded
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to rituximab
- Patients on systemic corticosteroids (except for patients on stable doses of hormone replacement therapy such as hydrocortisone), or other immunosuppressants (e.g., infliximab, mycophenolate mofetil) are excluded
- 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
- Patients with chronic human immunodeficiency virus (HIV), hepatitis B or hepatitis C infections are excluded
- Pregnant women are excluded from this study
- HIV-positive patients on combination antiretroviral therapy are ineligible
- Rituximab within three months
Contacts and Locations| United States, California | |
| City of Hope | Recruiting |
| Duarte, California, United States, 91010 | |
| Contact: Joseph M. Tuscano 916-734-3089 joseph.tuscano@ucdmc.ucdavis.edu | |
| Principal Investigator: Joseph M. Tuscano | |
| UC Davis Comprehensive Cancer Center | Recruiting |
| Sacramento, California, United States, 95817 | |
| Contact: Joseph M. Tuscano 916-734-3771 joseph.tuscano@ucdmc.ucdavis.edu | |
| Principal Investigator: Joseph M. Tuscano | |
| United States, Pennsylvania | |
| Penn State Hershey Children's Hospital | Recruiting |
| Hershey, Pennsylvania, United States, 17033 | |
| Contact: Mark H. Kirschbaum 717-531-7782 mkirschbaum@hmc.psu.edu | |
| Principal Investigator: Mark H. Kirschbaum | |
| Principal Investigator: | Joseph Tuscano | Beckman Research Institute |
More Information
No publications provided
| Responsible Party: | National Cancer Institute (NCI) |
| ClinicalTrials.gov Identifier: | NCT01729806 History of Changes |
| Other Study ID Numbers: | NCI-2012-02213, PHI-69, U01CA062505 |
| Study First Received: | November 14, 2012 |
| Last Updated: | February 6, 2013 |
| Health Authority: | United States: Food and Drug Administration |
Additional relevant MeSH terms:
|
Burkitt Lymphoma Lymphoma Lymphoma, Follicular Lymphoma, Non-Hodgkin Lymphoma, B-Cell Lymphoma, Large B-Cell, Diffuse Lymphoma, Large-Cell, Immunoblastic Precursor Cell Lymphoblastic Leukemia-Lymphoma Lymphoma, B-Cell, Marginal Zone Lymphoma, Extranodal NK-T-Cell Lymphoma, Mantle-Cell Lymphoma, T-Cell Rituximab Hodgkin Disease Leukemia |
Leukemia, Lymphocytic, Chronic, B-Cell Leukemia, Hairy Cell Leukemia, Lymphoid Lymphomatoid Granulomatosis Waldenstrom Macroglobulinemia Epstein-Barr Virus Infections Herpesviridae Infections DNA Virus Infections Virus Diseases Tumor Virus Infections Neoplasms by Histologic Type Neoplasms Neoplasms, Experimental Lymphoproliferative Disorders Lymphatic Diseases |
ClinicalTrials.gov processed this record on May 19, 2013