Randomised Trial in Waldenstrom's Macroglobulinaemia (R2W)
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Purpose
The purpose of this trial is to assess tolerability and efficacy of the Bortezomib, Cyclophosphamide and Rituximab combination as initial therapy for previously untreated patients with symptomatic Waldenstrom's macroglobulinaemia.
| Condition | Intervention | Phase |
|---|---|---|
|
Waldenstrom's Macroglobulinaemia |
Drug: Bortezomib Drug: Cyclophosphamide Biological: Rituximab Drug: Fludarabine |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Subcutaneous Bortezomib, Cyclophosphamide and Rituximab (BCR) Versus Fludarabine, Cyclophosphamide and Rituximab (FCR) for Initial Therapy of Waldenstrőm's Macroglobulinaemia (WM): a Randomized Phase II Trial |
- Disease response [ Time Frame: 6 months (end of treatment) ] [ Designated as safety issue: No ]Number and percentage of patients who achieve disease response
- Toxicity [ Time Frame: Up to 6 months after treatment start ] [ Designated as safety issue: Yes ]The number and percentage of patients who experience grade 3 or higher adverse event
- Progression free survival [ Time Frame: up to 5 years after treatment start ] [ Designated as safety issue: No ]Time from date of randomisation to the date of first progression, relapse or death from any cause
- Overall survival [ Time Frame: up to 5 years after treatment start ] [ Designated as safety issue: No ]Time form date of randomisation to the date of death from any cause
- Quality of life [ Time Frame: at 3 and 6 months after treatment start ] [ Designated as safety issue: No ]Quality of life will be measured using patient-completed EQ-5D questionnaire
| Estimated Enrollment: | 56 |
| Study Start Date: | January 2013 |
| Estimated Study Completion Date: | July 2021 |
| Estimated Primary Completion Date: | July 2016 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: bortezomib, cyclophosphamide, rituximab
Bortezomib:1.6 mg/m2 s.c; days 1, 8, 15 of each cycle. Cyclophosphamide:250 mg/m2 oral; days 1, 8, 15 of each cycle. Rituximab: 375 mg/m2 i.v. infusion; days 1, 8, 15 and 22 of cycles 2 and 5 only. Cycle repeated every 28 days. After 3 cycles of treatment, patients are reassessed and those with evidence of progression stop trial treatment. All other patients continue with further 3 cycles (to a total of 6) unless a clear clinical contradiction to further treatment exist. |
Drug: Bortezomib
1.6 mg/m2 subcutaneous bortezomib on days1, 8 and 15 of 28 days cycle
Other Name: Velcade
Drug: Cyclophosphamide
Cyclophosphamide:250 mg/sq m, oral, days 1, 8 and 15 of each cycle in the experimental arm. Cyclophosphamide:250 mg/sq m, oral, days 1, 2 and 3 of each cycle in the control arm. Rituximab: 375 mg/m2 i.v. infusion; days 1, 8, 15 and 22 of cycles 2 and 5 only
Other Name: MabThera
|
|
Active Comparator: fludarabine, cyclophosphamide, rituximab
Fludarabine:40 mg/sq m, oral, days 1,2 and 3 of each cycle. Cyclophosphamide:250 mg/sq m; oral, days 1, 2 and 3 of each cycle. Rituximab: 375 mg/sq m i.v. infusion days 1, 8, 15 and 22 of cycles 2 and 5 only. Cycle repeated every 28 days.After 3 cycles of treatment, patients are reassessed and those with evidence of progression stop trial treatment. All other patients continue with further 3 cycles (to a total of 6) unless a clear clinical contradiction to further treatment exist. |
Drug: Cyclophosphamide
Cyclophosphamide:250 mg/sq m, oral, days 1, 8 and 15 of each cycle in the experimental arm. Cyclophosphamide:250 mg/sq m, oral, days 1, 2 and 3 of each cycle in the control arm. Rituximab: 375 mg/m2 i.v. infusion; days 1, 8, 15 and 22 of cycles 2 and 5 only
Other Name: MabThera
Drug: Fludarabine
Fludarabine: 40 mg/sq m, oral, days 1, 2 and 3
|
Detailed Description:
Waldenstrom macroglobulinaemia (WM) is a low grade nonHodgkin lymphoma characterised by bone marrow infiltration and the presence of an abnormal protein in the blood (IgM paraprotein. Most patients require treatment at presentation but there is no agreed standard of first line therapy. Current treatment is unsatisfactory with responses often incomplete and slow to attain, while recurrence is inevitable.
The aim of this study is to find out whether a new combination of Bortezomib (Velcade®), Cyclophosphamide and Rituximab (MabThera), is well tolerated and effective for patients with WM. R2W is a randomised, noncomparative, phase II trial of subcutaneous bortezomib, cyclophosphamide, rituximab (BCR, experimental arm) versus fludarabine, cyclophosphamide, rituximab (FCR, control arm) for initial therapy of WM. This is a two stage trial where six patients will be treated initially with BCR to assess tolerability. If BCR is considered tolerable, a further 50 patients will be randomised between BCR and FCR (2:1) in the second stage of the trial. Patients will receive 3 cycles of treatment and then be reassessed. Those with evidence of progression will stop trial treatment. All other patients will continue with a further 3 cycles (to a total of 6) unless there is a clear clinical contraindication to further treatment.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age ≥ 18 years
- Confirmed diagnosis of WM (according to consensus panel / WHO criteria) with measurable IgM paraprotein
Previously untreated disease at any stage requiring therapy at the discretion of the treating physician. Suggested criteria for initiating treatment include:
- haematological suppression to Hb <10 g/dl, or neutrophils <1.5x109/l or platelets <150x109/l
- clinical evidence of hyperviscosity
- bulky lymphadenopathy and/or bulky splenomegaly
- presence of B symptoms
- No previous chemotherapy (prior plasma exchange and steroids are permissible)
- Performance status grade 0 - 2
- Life expectancy of greater than 6 months
- Informed consent
- Agreed compliance with recommended contraceptive precautions where appropriate
Exclusion Criteria:
- Lymphoplasmacytic lymphoma with no detectable serum IgM paraprotein
- Severe pre-existing neuropathy (> grade 2)
- Autoimmune cytopenias
- Evidence of active Hepatitis B or C infection (patients with evidence of past HepB infection may be eligible - see appendix 6)
- Serological positivity for HIV
- Pregnant or lactating women
- Life expectancy severely limited by other illness
- Renal failure (creatinine clearance <30 ml/min)
- Severe impairment of liver function: alkaline phosphatase/bilirubin >2.5 times upper limit of normal (ULN), ALT/AST >2.5 times ULN not related to lymphoma (patients with Gilbert syndrome are eligible)
- History of allergic reaction to compounds containing boron or mannitol
- Known hypersensitivity to murine compounds.
- Diagnosed or treated for a malignancy other than WM within 5 years before day 1 of Cycle 1 with the exception of complete resection of basal cell carcinoma, squamous cell carcinoma of the skin or any other in situ malignancy
- Active systemic infection requiring treatment
- Concurrent treatment with another investigational agent
- Severe or life-threatening cardiac, pulmonary, neurological, psychiatric or metabolic disease
Contacts and Locations| Contact: R2W Trial Coordinator | +44 207 679 9860 | ctc.r2w@ucl.ac.uk |
| United Kingdom | |
| Birmingham Heartlands Hospital | Not yet recruiting |
| Birmingham, United Kingdom, B9 5SS | |
| Principal Investigator: Guy Pratt | |
| St James University Hospital | Recruiting |
| Leeds, United Kingdom, LS9 7TF | |
| Principal Investigator: Roger Owen | |
| St Bartolomew's Hospital | Recruiting |
| London, United Kingdom, EC1A 7BE | |
| Principal Investigator: Rebecca Auer | |
| University College Hospital | Not yet recruiting |
| London, United Kingdom, NW1 2BU | |
| Principal Investigator: Shirley D'Sa | |
More Information
No publications provided
| Responsible Party: | University College, London |
| ClinicalTrials.gov Identifier: | NCT01592981 History of Changes |
| Other Study ID Numbers: | UCL/11/0353 |
| Study First Received: | May 3, 2012 |
| Last Updated: | March 26, 2013 |
| Health Authority: | United Kingdom: Medicines and Healthcare Products Regulatory Agency |
Keywords provided by University College, London:
|
Waldenstrom's macroglobulinaemia bortezomib cyclophosphamide rituximab |
Additional relevant MeSH terms:
|
Waldenstrom Macroglobulinemia Neoplasms, Plasma Cell Neoplasms by Histologic Type Neoplasms Hemostatic Disorders Vascular Diseases Cardiovascular Diseases Paraproteinemias Blood Protein Disorders Hematologic Diseases Hemorrhagic Disorders Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases |
Cyclophosphamide Fludarabine monophosphate Rituximab Fludarabine Bortezomib 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 |
ClinicalTrials.gov processed this record on May 19, 2013