Methotrexate, Mannitol, Rituximab, and Carboplatin in Treating Patients With Newly Diagnosed Primary Central Nervous System Lymphoma
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| ClinicalTrials.gov Identifier: NCT00293475 |
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Recruitment Status :
Active, not recruiting
First Posted : February 17, 2006
Last Update Posted : September 22, 2021
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Sponsor:
OHSU Knight Cancer Institute
Collaborators:
National Cancer Institute (NCI)
Oregon Health and Science University
Information provided by (Responsible Party):
Edward Neuwelt, OHSU Knight Cancer Institute
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Brief Summary:
This phase I/II trial studies the side effects of methotrexate, mannitol, rituximab, and carboplatin and to see how well they work in treating patients with primary central nervous system lymphoma. Drugs used in chemotherapy, such as methotrexate and carboplatin, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Osmotic blood-brain barrier disruption uses mannitol to open the blood vessels around the brain and allow cancer-killing substances to be carried directly to the brain. Monoclonal antibodies, such as rituximab, may block cancer growth in different ways by targeting certain cells. Giving methotrexate, mannitol, rituximab, and carboplatin together may be an effective treatment for primary central nervous system lymphoma.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Central Nervous System Lymphoma | Drug: Carboplatin Drug: Mannitol Drug: Methotrexate Other: Quality-of-Life Assessment Biological: Rituximab Drug: Sodium Thiosulfate | Phase 1 Phase 2 |
PRIMARY OBJECTIVES:
I. To evaluate the safety and toxicities of a treatment regimen consisting of rituximab (intravenously [IV]) the day prior to methotrexate (intra-arterially [IA]), and carboplatin (IA) in conjunction with blood-brain barrier disruption (BBBD) and delayed sodium thiosulfate (IV).
II. To demonstrate, adding a monoclonal antibody and carboplatin to methotrexate BBBD, that a 45% rate of complete response (CR) within the first 3 months of treatment is achieved, while excluding a CR rate as low as 30%.
SECONDARY OBJECTIVE:
I. To estimate the response rate (counting all CRs), the two-year overall survival and the two-year event-free survival, as baselines for subsequent trials.
OUTLINE:
Patients receive rituximab IV over 5 hours on day 1, mannitol IA, methotrexate IA over 10 minutes, and carboplatin IA over 10 minutes on days 2 and 3. Patients then receive sodium thiosulfate IV over 15 minutes at 4 and 8 hours after carboplatin. Treatment repeats monthly for up to 12 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 2 months, then every 2 months for 2 years, every 6 months for 1 year, and then annually for at least 2 years.
| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 81 participants |
| Allocation: | N/A |
| Intervention Model: | Single Group Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A Phase I/II Study of Patients With Newly Diagnosed Primary Central Nervous System Lymphoma Treated With Methotrexate/BBBD, and Adding Rituximab (an Anti CD-20 Antibody) and Carboplatin, to the Treatment Regimen |
| Actual Study Start Date : | October 14, 2005 |
| Estimated Primary Completion Date : | January 31, 2022 |
| Estimated Study Completion Date : | January 31, 2023 |
Resource links provided by the National Library of Medicine
MedlinePlus related topics:
Lymphoma
| Arm | Intervention/treatment |
|---|---|
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Experimental: Treatment (rituximab, mannitol, methotrexate, carboplatin)
Patients receive rituximab IV over 5 hours on day 1, mannitol IA, methotrexate IA over 10 minutes, and carboplatin IA over 10 minutes on days 2 and 3. Patients then receive sodium thiosulfate IV over 15 minutes at 4 and 8 hours after carboplatin. Treatment repeats monthly for up to 12 courses in the absence of disease progression or unacceptable toxicity.
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Drug: Carboplatin
Given IA
Other Names:
Drug: Mannitol Given IA
Other Names:
Drug: Methotrexate Given IA
Other Names:
Other: Quality-of-Life Assessment Ancillary studies
Other Name: Quality of Life Assessment Biological: Rituximab Given IV
Other Names:
Drug: Sodium Thiosulfate Given IV
Other Names:
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Primary Outcome Measures :
- Incidence of toxicities, assessed using National Cancer Institute Common Toxicity Criteria for Adverse Events version 3.0 (Phase I) [ Time Frame: Within 2 months of completion of study treatment ]
- CR rate (Phase II) [ Time Frame: Within the first 3 months of treatment ]
Secondary Outcome Measures :
- Overall survival [ Time Frame: From entry onto study until death from any cause, assessed at 2 years ]Kaplan-Meier estimates of these survival distributions will be plotted. Descriptive stratifications of these survival distributions by baseline characteristics will be evaluated using the log-rank statistic. If there are multiple predictors of these outcomes, Cox proportional hazard models will be fit to these data to determine which predictors are independent of others in a multi-variable model.
- Event-free survival [ Time Frame: From entry onto study until death or progression of disease, assessed at 2 years ]Kaplan-Meier estimates of these survival distributions will be plotted. Descriptive stratifications of these survival distributions by baseline characteristics will be evaluated using the log-rank statistic. If there are multiple predictors of these outcomes, Cox proportional hazard models will be fit to these data to determine which predictors are independent of others in a multi-variable model.
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| Ages Eligible for Study: | 18 Years to 75 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria:
- Subjects with histopathologic confirmation of intermediate or high-grade primary central nervous system lymphoma (PCNSL) as documented by brain biopsy, or cytology (analysis from cerebral spinal fluid [CSF] or vitrectomy), and cluster of differentiation 20 (CD20) positive; whenever possible, the tumor should be characterized by immunophenotype
- Subjects must be =< 90 days from diagnosis of PCNSL in the brain or spine; time from pathologic diagnosis to initiation of treatment should be specified; subjects with history of only ocular lymphoma are eligible if < 90 days since documented brain parenchymal disease (by imaging or by biopsy)
- Subjects must have an Eastern Cooperative Oncology Group (ECOG) performance score =< 3 (Karnofsky >= 30)
- Hematocrit >= 25% (may be reached by transfusion) (performed within 14 days of registration)
- White blood cell count >= 2.5 x 10^3/mm^3 (performed within 14 days of registration)
- Absolute granulocyte count >= 1.2 x 10^3/mm^3 (performed within 14 days of registration)
- Platelets >= 100 x 10^3/mm^3 (or >= lower limit of institutional normal value) (performed within 14 days of registration)
- Calculated creatinine clearance (Cr Cl) >= 50 ml/min (performed within 14 days of registration); eligible for full dose methotrexate
- Calculated Cr Cl >= 30 ml/min (performed within 14 days of registration); eligible for reduced dose methotrexate
- Bilirubin =< 2.0 x upper limit of institutional normal value (performed within 14 days of registration)
- The subject may have had other systemic chemotherapy for PCNSL during the 90 days since PCNSL diagnosis; prior systemic chemotherapy must have been given at least 4 weeks prior to study entry (6 weeks for nitrosourea agents), with the exceptions of methotrexate and rituximab which may have been given at least 10 days prior; ocular lymphoma treatment may have been given any time prior to study entry; if the subject has undergone treatment for parenchymal disease and the parenchymal disease has progressed on a stable or increasing dose of steroids, the subject is not eligible for enrollment
- Sexually active women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study treatment and for the duration of study treatment; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
- Subjects with a bone marrow biopsy which shows microscopic, low-level involvement of lymphoma are eligible
- Subject with seropositivity for hepatitis B or hepatitis C must be cleared by hepatology service prior to participating in treatment protocol
Exclusion Criteria:
- Prior cranial or spinal radiotherapy
- Subjects with radiographic signs of excessive intra-cranial mass effect with associated rapid neurologic deterioration, and/or spinal block, are unsafe to undergo BBBD chemotherapy and are not eligible
- Uncontrolled (over the last 30 days), clinically significant confounding medical conditions
- Seropositivity for the human immunodeficiency virus
- Systemic lymphoma
- Subjects who have a positive serum human chorionic gonadotropin (hCG), are pregnant or lactating are ineligible
- Known allergy to any of the study agents
- Subjects who are at significant risk for general anesthesia
Information from the National Library of Medicine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00293475
Locations
| United States, Ohio | |
| Good Samaritan Hospital - Cincinnati | |
| Cincinnati, Ohio, United States, 45220 | |
| Cleveland Clinic Foundation | |
| Cleveland, Ohio, United States, 44195 | |
| Ohio State University Comprehensive Cancer Center | |
| Columbus, Ohio, United States, 43210 | |
| United States, Oregon | |
| OHSU Knight Cancer Institute | |
| Portland, Oregon, United States, 97239 | |
Sponsors and Collaborators
OHSU Knight Cancer Institute
National Cancer Institute (NCI)
Oregon Health and Science University
Investigators
| Principal Investigator: | Edward A Neuwelt | OHSU Knight Cancer Institute |
| Responsible Party: | Edward Neuwelt, Principal Investigator, OHSU Knight Cancer Institute |
| ClinicalTrials.gov Identifier: | NCT00293475 |
| Other Study ID Numbers: |
IRB00001012 NCI-2013-00787 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) HEM-08059-LX ( Other Identifier: OHSU Knight Cancer Institute ) CR00022596 ( Other Identifier: OHSU IRB ) MR00041596 ( Other Identifier: OHSU IRB ) MR00045915 ( Other Identifier: OHSU IRB Number ) SOL-05025-LM ( Other Identifier: OHSU Knight Cancer Institute ) SOL-05025-L ( Other Identifier: OHSU Knight Cancer Institute ) IRB00001012 ( Other Identifier: OHSU Knight Cancer Institute ) R01CA137488 ( U.S. NIH Grant/Contract ) |
| First Posted: | February 17, 2006 Key Record Dates |
| Last Update Posted: | September 22, 2021 |
| Last Verified: | September 2021 |
Additional relevant MeSH terms:
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Lymphoma Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Sodium thiosulfate Rituximab Antineoplastic Agents, Immunological Carboplatin Methotrexate Mannitol Antibodies Immunoglobulins |
Antibodies, Monoclonal Antidotes Immunologic Factors Physiological Effects of Drugs Antineoplastic Agents Antirheumatic Agents Abortifacient Agents, Nonsteroidal Abortifacient Agents Reproductive Control Agents Antimetabolites, Antineoplastic Antimetabolites Molecular Mechanisms of Pharmacological Action Dermatologic Agents Enzyme Inhibitors Folic Acid Antagonists |