Try the modernized beta website. Learn more about the modernization effort.
Working… Menu

Everolimus and Bortezomib in Treating Patients With Relapsed or Refractory Lymphoma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00671112
Recruitment Status : Terminated (Treatment ineffective)
First Posted : May 5, 2008
Last Update Posted : October 28, 2015
National Cancer Institute (NCI)
The Leukemia and Lymphoma Society
Information provided by (Responsible Party):
Brian Hill, MD, PhD, Case Comprehensive Cancer Center

Brief Summary:

RATIONALE: Everolimus and bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

PURPOSE: This phase I trial is studying the side effects and best dose of everolimus when given together with bortezomib in treating patients with relapsed or refractory lymphoma.

Condition or disease Intervention/treatment Phase
714leukemia Lymphoma Drug: Bortezomib Drug: Everolimus Phase 1

Detailed Description:



  • Determine the maximum tolerated dose of everolimus (up to 10 mg PO daily) in combination with bortezomib in patients with relapsed/refractory indolent or mantle cell non-Hodgkin's lymphoma (NHL) including cutaneous forms, or relapsed/refractory aggressive NHL ineligible for hematopoetic stem cell transplantation


  • Evaluate the toxicity of this combination.
  • Assess the pharmacokinetics interactions between these agents.
  • Assess the response rate and 6-month progression-free survival in treated patients.
  • Obtain preliminary data to assess associations between tumor characteristics and response to treatment. in those subjects who underwent biopsy prior to study treatment.

OUTLINE: This is a dose-escalation study.

Patients receive bortezomib IV on days 1, 4, 8, and 11. Patients also receive oral everolimus once daily or once every other day on days 1-21 in all courses. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients will undergo blood sample collection on Cycle 1, Day 11 for pharmacokinetic studies. Baseline tumor expression of mTOR and NFkB -related proteins (i.e., pS6K, pAKT, and cREL) and FOXP3 is assessed by immunohistochemistry.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 30 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1 Trial of the Combination of Everolimus (RAD001) and Bortezomib (VELCADE) for Relapsed or Refractory Lymphoma
Study Start Date : June 2008
Actual Primary Completion Date : October 2015

Arm Intervention/treatment
Experimental: Everolimus and Bortezomib
Patients will receive a combination of Everolimus by mouth and Bortezomib intravenously for a 21 day cycle.
Drug: Bortezomib

Patients will be assigned to one of the following dose levels of Bortezomib: 0.7mg/m2, 1.0 mg/m2, or 1.3mg/m2 on days 1,4,8,11 of a 21 day cycle.

The appropriate amount of bortezomib will be drawn from the injection vial and administered as an intravenous (IV) push or sub-cutaneously over 3 to 5 seconds followed by a standard saline flush or through a running IV line.

Other Name: Velcade

Drug: Everolimus
Everolimus 5 mg PO every other day, 5 mg by mouth (PO) daily, or 10 mg PO daily
Other Name: RAD001

Primary Outcome Measures :
  1. Maximum tolerated dose of everolimus in combination with bortezomib [ Time Frame: after 1 course (21 days) ]
    Defined as the highest dose level at which 0 out of 3, or 1 out of 6, subjects experiences dose-limiting toxicity (DLT).

Secondary Outcome Measures :
  1. Frequency counts and percentage of patients experiencing toxicities [ Time Frame: After 1 course (21 days) ]
    Adverse events will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 4.0.

  2. Pharmacokinetics [ Time Frame: after 1 course (21 days) ]
  3. Response rate [ Time Frame: Every 3 courses (9 weeks) for the first 12 courses, after 5th restaging scan every 6 courses (18 weeks) until off study ]
    Response assessment will use response definitions of the International Working Group (2007 guidelines). Estimated with exact 95% confidence intervals.

  4. 6-month progression-free survival [ Time Frame: 6 months ]
  5. Correlation of tumor characteristics with response to treatment [ Time Frame: after one course (21 days) ]
    Exploratory analyses will be done using logistic regression to assess associations between tumor characteristics or biomarkers and response.

Information from the National Library of Medicine

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, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Able to provide voluntary written informed consent, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.
  • Diagnosed with relapsed or refractory NHL, limited to subtypes listed below. The subject must have histologic information of diagnosis according to review at the Cleveland Clinic Foundation, either at initial diagnosis or at any subsequent relapse. (Biopsy is not required at relapse, but is suggested. Biopsy at outside institution, reviewed at the Cleveland Clinic, is acceptable.)

    • "Relapsed or refractory" refers to patients who have received at least 1 prior treatment regimen for lymphoma (which may include prior autologous stem cell transplantation) and have demonstrated evidence of progressive disease by clinical and/or radiographic characteristics.
    • "Indolent lymphoma" is included, and refers to small lymphocytic lymphoma/B-cell chronic lymphocytic leukemia (SLL/CLL); lymphoplasmacytic lymphoma (with or without Waldenstrom's macroglobulinemia); hairy cell leukemia; follicular lymphoma (FL) of any grade; marginal zone B-cell lymphoma; or mantle cell lymphoma.
    • Transformed lymphoma is included if patients are ineligible for (or refuse) hematopoetic stem cell transplant.
    • In addition, cutaneous B and T cell lymphoma are permitted. Cutaneous T cell lymphoma must be refractory to 1 prior systemic therapy (topical therapy, photopheresis, radiation are not considered systemic therapy). Transformed B and T cell cutaneous lymphoma are also permitted.
    • Relapsed/refractory diffuse large B cell lymphoma (DLBCL) is allowed if the patient is not eligible for, or refuses, hematopoetic stem cell transplant.
    • Relapsed/refractory nodal, leukemic, and extranodal T cell lymphomas are eligible. Subtypes eligible include anaplastic large cell lymphoma, angioimmunoblastic T cell lymphoma, PTCL-NOS, nasal or disseminated extranodal T/NK lymphoma, enteropathy-associated T cell lymphoma, hepatosplenic gamma/delta T cell lymphoma, subcutaneous panniculitis-like T cell lymphoma, T-prolymphocytic leukemia, Adult T-cell leukemia/lymphoma, large granular lymphocytic leukemia, aggressive NK leukemia.
    • Plasma cell myeloma and Hodgkin lymphoma are excluded.
  • Prior therapy with bortezomib is allowed. Patients who have received prior bortezomib therapy must have received bortezomib >6 months ago, and must have shown some response. Patients that did not respond to prior bortezomib therapy are not eligible.
  • Measurable disease by one of the following: radiographic criteria (≥2 cm by computed tomography); lymphoma involving peripheral blood with more than 5000 leukemia cells/mm3, or any degree of bone marrow infiltration on bone marrow biopsy. Skin involvement with or without nodal or bone marrow involvement permitted for cutaneous lymphomas is also permitted. (see section 6.0, Measurement of Effect).
  • Eastern Cooperative Group (ECOG) Performance Status of 0-2.
  • Serum bilirubin levels ≤1.5 times the upper limit of the normal (ULN) range for the laboratory. Higher levels are acceptable if these can be attributed to active hemolysis or ineffective erythropoiesis. Serum AST or serum ALT levels must be ≤2.5 x ULN, or ≤5 x ULN for patients with liver involvement by lymphoma.
  • Must have adequate bone marrow function:

    • Absolute neutrophil count (ANC) ≥1,000/uL
    • Platelet count (Plt) ≥ 75,000/uL
    • Hemoglobin (Hgb) ≥ 9.0 g/dL
  • Must have adequate renal function: Creatinine ≤ 1.5 X ULN.
  • Women of childbearing potential (WCBP) must have a negative serum or urine pregnancy test within 7 days of starting study drug. In addition, sexually active WCBP must agree to use adequate contraceptive methods (tubal ligation; intrauterine device; or barrier contraceptive with spermicide) while on study. Oral, implantable, or injectable contraceptives may be affected by cytochrome P450 interactions, and are therefore not considered effective for this study. WCBP must agree to have pregnancy tests every 4 weeks while on study drug. Male subject agrees to use an acceptable method of contraception for the duration of the study.
  • Female patients who:

    • Are postmenopausal for at least 1 year before the Screening visit, OR
    • Are surgically sterile, OR
    • If they are of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent through 30 days after the last dose of study treatment, OR agree to completely abstain from heterosexual intercourse
  • Male patients, even if surgically sterilized (ie, status post-vasectomy), who:

    • Agree to practice effective barrier contraception during the entire study treatment period and through 30 days after the last dose of study treatment, OR
    • Agree to completely abstain from heterosexual intercourse
  • Able to adhere to the study visit schedule and other protocol requirements.

Exclusion Criteria:

  • Prior treatment with any investigational drug, chemotherapy, or monoclonal antibody within the preceding 1 month
  • Chronic treatment with systemic steroids or another immunosuppressive agent.
  • Patients should not receive immunization with attenuated live vaccines during study period.
  • History of allogeneic stem cell transplantation.
  • Any patient with known diabetes mellitus currently requiring insulin therapy, or any patient with preexisting diabetes mellitus in poor control, defined as a hemoglobin A1C (HbA1C) value of over 9% within 4 weeks of starting therapy
  • Fasting serum cholesterol >300 mg/dL OR >7.75 mmol/L or fasting triglycerides > 2.5 x ULN. NOTE: In case one or both of these thresholds are exceeded, the patient can only be included after initiation of appropriate lipid lowering medication.
  • Uncontrolled brain or leptomeningeal metastases, including patients who continue to require glucocorticoids for brain or leptomeningeal metastases.
  • Other malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinomas of the skin, or low-risk prostate cancer after curative therapy.
  • Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:

    • unstable angina pectoris, any history of congestive heart failure, any history of known myocardial infarction, uncontrolled cardiac arrhythmia
    • severely impaired lung function
    • uncontrolled diabetes as defined by fasting serum glucose >1.5x ULN, off medications
    • any active (acute or chronic) or uncontrolled infection/ disorders.
    • nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the treatment with the study therapy
    • liver disease including a known history of viral hepatitis B or C, evidence of cirrhosis, chronic active hepatitis or chronic persistent hepatitis
    • a known history of HIV seropositivity
    • Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of RAD001 (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection)
  • Patients with an active, bleeding diathesis
  • Breast feeding or pregnant females
  • Patients with a known hypersensitivity to everolimus or other rapamycins (sirolimus, temsirolimus) or to its excipients, or to bortezomib, boron, or mannitol
  • History of noncompliance to medical regimens
  • Patients unwilling or unable for any reason (personal, medical, or psychiatric) to comply with the protocol
  • Patients with preexisting peripheral neuropathy grade ≥ 2 will not be eligible
  • Patients taking concomitant medications (chronically or within 1 week of study drug administration) which are strong inhibitors of hepatic metabolism via P450/CY3PA4 isoenzyme will be excluded.
  • Patients who have received hematopoietic growth factors (filgrastim, pegfilgrastim, or sargramostim) within 28 days of first dose of screening.
  • Patient had myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) Class III or IV heart failure, 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 must be documented by the investigator as not medically relevant.

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 identifier (NCT number): NCT00671112

Layout table for location information
United States, Ohio
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Cleveland, Ohio, United States, 44195
Sponsors and Collaborators
Brian Hill, MD, PhD
National Cancer Institute (NCI)
The Leukemia and Lymphoma Society
Layout table for investigator information
Principal Investigator: Brian Hill, MD, PhD Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Layout table for additonal information
Responsible Party: Brian Hill, MD, PhD, Principal Investigator, Case Comprehensive Cancer Center Identifier: NCT00671112    
Other Study ID Numbers: CASE2407
P30CA043703 ( U.S. NIH Grant/Contract )
CASE-2407 ( Other Identifier: Case Comprehensive Cancer Center )
NCI-2010-01386 ( Other Identifier: NCI/CTRP )
First Posted: May 5, 2008    Key Record Dates
Last Update Posted: October 28, 2015
Last Verified: October 2015
Keywords provided by Brian Hill, MD, PhD, Case Comprehensive Cancer Center:
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
Waldenstrom's macroglobulinemia
extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
nodal marginal zone B-cell lymphoma
splenic marginal zone lymphoma
refractory hairy cell leukemia
B-cell chronic lymphocytic leukemia
refractory chronic lymphocytic leukemia
hairy cell leukemia
cutaneous B and T cell lymphoma
transformed lymphoma
transformed B and T cell cutaneous lymphoma
relapsed or refractory diffuse large B cell lymphoma
extranodal T cell lymphomas
anaplastic large cell lymphoma
angioimmunoblastic T cell lymphoma
nasal or disseminated extranodal T/NK lymphoma
enteropathy-associated T cell lymphoma
hepatosplenic gamma/delta T cell lymphoma
subcutaneous panniculitis-like T cell lymphoma
T-prolymphocytic leukemia
adult T-cell leukemia/lymphoma
large granular lymphocytic leukemia
aggressive NK leukemia
Additional relevant MeSH terms:
Layout table for MeSH terms
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs