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Rituximab Maintenance Versus Observation After First-line Immunochemotherapy by FCR in Older Patients With Chronic Lymphocytic Leukemia (LLC2007SA)

This study has been completed.
Sponsor:
Collaborators:
Roche Pharma AG
French Innovative Leukemia Organisation
Information provided by (Responsible Party):
University Hospital, Tours
ClinicalTrials.gov Identifier:
NCT00645606
First received: March 26, 2008
Last updated: July 27, 2017
Last verified: July 2017
  Purpose

RATIONALE: Classical chemotherapy does not cure advanced chronic lymphocytic leukemia (CLL) despite new drugs. Rituximab is a monoclonal antibody directed against CD20 surface antigen on B lymphocytes and leads to apoptosis of CD20 positive B lymphocytes. The highest response rate yet published in the treatment of first-line CLL has been obtained by the association of fludarabine, cyclophosphamide and rituximab (FCR). Now, the question is whether this response can be improved, as some trials showed that eradication of minimal residual disease (MRD) in CLL is associated with a longer treatment-free and overall survival. Maintenance therapy using rituximab has been recently approved as a means of prolonging remission in patients with indolent non Hodgkin's lymphoma. Maintenance therapy with rituximab could be of interest in treatment of MRD in CLL and prolonging remission and survival times.

PURPOSE: The overall purpose of the study is to determine the value of immunotherapy maintenance with single agent rituximab in comparison with no further treatment (observation ) for previously untreated chronic lymphocytic leukaemia in elderly (>65 years) patients who respond to induction immunochemotherapy with FCR.


Condition Intervention Phase
Leukemia Biological: Rituximab Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Single-agent Rituximab as Maintenance Treatment Versus Observation After Combined Induction Immunochemotherapy With Fludarabine, Cyclophosphamide and Rituximab in Patients Older Than 65 Years With Previously Untreated Chronic Lymphocytic Leukemia: a Phase III Trial of FILO

Resource links provided by NLM:


Further study details as provided by University Hospital, Tours:

Primary Outcome Measures:
  • Progression-free survival [ Time Frame: randomization until disease progression or death ]
    Progression-free survival is defined as the time from randomization to the first occurrence of disease progression, relapse or death from any cause; using iwCLL criteria


Secondary Outcome Measures:
  • Event-free survival [ Time Frame: randomization until disease progression, death, new CLL treatment, and secondary cancer ]
    Event-free survival is defined as the time from randomization to the occurrence of one of the following events, whichever occurs first: disease progression or relapse, death from any cause, initiation of any new anti-CLL therapy, and secondary malignancy

  • Disease-free survival [ Time Frame: first documented CR until relapse ]
    Disease-free survival is defined as the time from first documented CR to relapse

  • Overall survival [ Time Frame: randomization until death ]
    Overall survival is defined as the time from randomization to death from any cause

  • Time to next treatment [ Time Frame: randomization until new CLL treatment ]
    Time to next treatment is defined as the time from randomization to initiation of a new CLL-related treatment

  • Overall response rate [ Time Frame: baseline up to approximately 66 months ]
    Overall response rate is defined by the percentage of participants with an overall response; CR or PR according to NCI criteria and CR, CRi or PR according to iwCLL

  • Phenotypic response rate [ Time Frame: randomization up to approximately 60 months ]
    Phenotypic response rate is defined by the percentage of participants with minimal residual disease negativity as measured by six-colour flow cytometry with a sensitivity of 0.7 x 10-5. MRD is considered as undetectable when the positivity criteria, defined as the presence of at least 20 CLL cells, is not reached

  • Rates of treatment-related adverse events [ Time Frame: safety since baseline ]
    Rate of treatment-related adverse events (plus adverse events of particular interest) is defined as the percentage of participants with adverse events assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 3.0 and version 2.0. for hematological toxicity

  • Pharmacokinetics of rituximab [ Time Frame: baseline up to approximately 36 months ]
    Pharmacokinetics of rituximab during induction and rituximab maintenance

  • Quality of life [ Time Frame: baseline up to approximately 30 months ]
    Change from baseline in EORTC Quality of Life Questionnaire Core 30


Enrollment: 542
Study Start Date: December 2007
Study Completion Date: July 2017
Primary Completion Date: February 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: Observation
Observation every 8 weeks during 2 years
Experimental: rituximab arm
rituximab :500 mg/m² every 8 weeks during 2 years
Biological: Rituximab
rituximab :500 mg/m² every 8 weeks during 2 years
Other Name: Mabthera

Detailed Description:

OBJECTIVES:

Primary

  • To demonstrate superiority, in terms of 3-year progression-free survival (PFS), of rituximab maintenance over observation in patients who are in complete or partial response (CR or PR) after induction therapy comprising fludarabine, cyclophosphamide, and rituximab.

Secondary

  • To determine event-free survival, disease-free survival, overall survival, and time to next treatment, all from time of randomization.
  • To determine overall response rate (CR and PR) according to NCI and iwCLL criteria
  • To assess the rate of phenotypic response (minimal residual disease).
  • To assess duration of phenotypic and NCI and iwCLL clinical responses.
  • To determine response rates and time-related parameters in biological subgroups.
  • To determine rates of treatment-related adverse events.
  • To evaluate CD4/CD8 counts, immunoglobulin levels, and incidence of Coombs-positive hemolytic anemia.
  • To study pharmacokinetics of rituximab during induction and maintenance.
  • To evaluate the prognostic impact of the immunoglobulin FcγRIIIA genotype.
  • To assess quality of life.
  • To study pharmacoeconomics.

OUTLINE: This is a multicenter study. Randomization is stratified according to response to induction therapy (complete response [CR] vs partial response [PR]), IGHV mutational status, and 11q deletion.

Patients receive rituximab IV on days 1 and 14 of courses 1-2 and on day 1 of courses 3 and 4. Patients also receive oral fludarabine and oral cyclophosphamide once daily on days 2-4 of course 1 and on days 1-3 of courses 2-4. Courses are administered every 28 days. Patients achieving CR or PR are randomized 1:1 to maintenance arm or observation arm.

  • Arm A: Patients receive rituximab IV every 2 months in the absence of disease progression or unacceptable toxicity for a maximum duration of 24 months (12 infusions).
  • Arm B: Patients undergo observation only.

After completion of study therapy, patients are followed every 3 months for 1 year and then every 6 months for 2 years.

  Eligibility

Ages Eligible for Study:   65 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria

  • B-CLL
  • Matutes score 4 or 5
  • Binet stages B or C
  • Age > 65 years old
  • No previous treatment of CLL by chemotherapy, radiotherapy or immunotherapy, except glucocorticoids < 1 month
  • Patient's written informed consent
  • Life expectancy > 6 months

Exclusion criteria

  • Binet stage A
  • ECOG performance status 2 or more
  • Presence of a 17p deletion by FISH (> 10% positive cores)
  • Clinically significant auto-immune cytopenia, Coombs-positive hemolytic anemia as judged by the treating physician
  • Patients with a history of another malignancy in complete remission less than 5 years, except basal cell skin cancer or tumor treated curatively by surgery
  • Concomitant disease requiring prolonged use of corticosteroids (> 1 month)
  • Any severe co-morbidities such as NYHA Class III or IV heart failure, myocardial infarction within 6 months, unstable angina, ventricular tachyarrhythmias requiring ongoing treatment, severe uncontrolled myocardiopathy, uncontrolled hypertension, severe chronic obstructive pulmonary disease with hypoxemia, or uncontrolled diabetes mellitus.
  • CIRS (Cumulative Illness rating Scale) > 6
  • Known hypersensitivity to murine proteins or to any of the study drugs or to their components
  • Transformation into an aggressive B-cell malignancy (e.g. diffuse large cell lymphoma, Hodgkin lymphoma) or prolymphocytic leukemia
  • Active bacterial, viral or fungal infection
  • Seropositivity HIV, hepatitis C or hepatitis B (unless clearly due to vaccination)
  • Total bilirubin, alkaline phosphatases and aminotransferases > 2 x ULN
  • Creatinine clearance < 60 ml/min calculated according to the formula of Cockcroft and Gault
  • Any coexisting medical or psychological condition that would preclude participation to the required study procedures
  • Patient with mental deficiency preventing proper understanding of the requirements of treatment

Inclusion criteria at randomization

  • Patients having received the full induction phase with 4 FC and 6 rituximab courses (with/without dose adjustments as per protocol)
  • Complete or partial response according to NCI and iwCLL criteria at the end of induction phase
  • Recovery from FCR toxicities
  • Patient willingness to continue on protocol
  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: NCT00645606

Locations
France
French Innovative leukemia Organization
TOURS Cedex, France, 37044
Sponsors and Collaborators
University Hospital, Tours
Roche Pharma AG
French Innovative Leukemia Organisation
Investigators
Principal Investigator: Caroline Dartigeas, MD Hématologie et Thérapie Cellulaire Hôpital Bretonneau CHU Tours FRANCE
Principal Investigator: Eric VAN DEN NESTE, MD PhD Département d'hématologie Cliniques Universitaires Saint Luc BRUSSELS BELGIUM
  More Information

Responsible Party: University Hospital, Tours
ClinicalTrials.gov Identifier: NCT00645606     History of Changes
Other Study ID Numbers: CDR0000589684
CHRUT-LLC-2007-SA ( Other Identifier: CHU Tours )
CHRUT-PHRN05-CD ( Other Identifier: CHU Tours )
INCA-RECF0497 ( Other Identifier: INCA )
2007-001015-28 ( EudraCT Number )
Study First Received: March 26, 2008
Last Updated: July 27, 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by University Hospital, Tours:
B-cell chronic lymphocytic leukemia
Maintenance in first-line treatment
Elderly patients

Additional relevant MeSH terms:
Leukemia
Leukemia, Lymphoid
Leukemia, Lymphocytic, Chronic, B-Cell
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Leukemia, B-Cell
Rituximab
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents

ClinicalTrials.gov processed this record on September 20, 2017