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Combination Chemotherapy, Monoclonal Antibody, and Radiation Therapy in Treating Patients With Primary Central Nervous System Lymphoma

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ClinicalTrials.gov Identifier: NCT00068250
Recruitment Status : Completed
First Posted : September 11, 2003
Results First Posted : February 7, 2018
Last Update Posted : February 7, 2018
Sponsor:
Collaborators:
National Cancer Institute (NCI)
NRG Oncology
Information provided by (Responsible Party):
Radiation Therapy Oncology Group

September 10, 2003
September 11, 2003
December 14, 2017
February 7, 2018
February 7, 2018
July 2003
December 2016   (Final data collection date for primary outcome measure)
  • Number of Phase I Participants Experiencing Toxicity [ Time Frame: From start of treatment to 10 weeks if radiation therapy received, to 15 weeks if not. ]
    A dose limiting toxicity (DLT) is defined as any grade 3 or 4 non-hematological toxicity (other than grade 3 nausea/vomiting) or any hematological toxicity resulting in the discontinuation of temozolomide. Toxicity evaluation for this dose escalation includes all toxicities occurring prior to the start of radiation therapy. If the patient did not receive radiation therapy, then toxicity evaluation included all toxicities occurring through week 15. Any grade 5 toxicity would result in immediate suspension of accrual.
  • Phase II: Overall Survival Rate at 2 Years (Including Phase I Patients at Same Dose) [ Time Frame: Analysis occured after all patients have been on study for 2 years. Maximum follow-up at time of analysis was 8.5 years. ]
    Survival time is defined as time from registration to date of death from any cause and is estimated by the Kaplan-Meier method. Patients last known to be alive are censored at the date of last contact. (Please note that this outcome measure is considered the primary endpoint for the Phase II component of the study, but that the patients from Phase I that were treated at the same dose level are included, as indicated in the treatment arm descriptions. )
Not Provided
Complete list of historical versions of study NCT00068250 on ClinicalTrials.gov Archive Site
  • Phase II: Pre-irradiation Chemotherapy Tumor Response Rate (Including Phase I Patients at Same Dose) [ Time Frame: From start of treatment to 10 weeks if RT received, to 15 weeks if not. ]
    Tumor response was centrally reviewed. Complete response: Disappearance of all enhancing tumor, the patient must be off steroid therapy and neurologically stable or improved; partial response: ≥ 50% decrease in enhancing tumor; progressive disease: ≥ 25% increase in a lesion, progressive or newly emergent meningeal or ocular disease. (Please note that this outcome measure is considered a secondary endpoint for the Phase II component of the study, but that the patients from Phase I that were treated at the same dose level are included, as indicated in the treatment arm descriptions. )
  • Phase II: Progression-free Survival (Including Phase I Patients at Same Dose) [ Time Frame: Analysis occured after all patients have been on study for 2 years. Maximum follow-up at time of analysis was 8.5 years. ]
    Progression is defined as greater than 25% increase in enhancing tumor or the appearance of new lesions in the brain, eye, or the appearance of a new positive cerebrospinal fluid (CSF) cytology. The patient may be neurologically stable or worse and on stable or increasing doses of corticosteroid. Progression-free survival time is defined as time from registration to the date of progression, death, or last known follow-up (censored). Progression-free survival rates are estimated using the Kaplan-Meier method. (Please note that this outcome measure is considered a secondary endpoint for the Phase II component of the study, but that the patients from Phase I that were treated at the same dose level are included, as indicated in the treatment arm descriptions. )
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Combination Chemotherapy, Monoclonal Antibody, and Radiation Therapy in Treating Patients With Primary Central Nervous System Lymphoma
Phase I/II Study Of Pre-Irradiation Chemotherapy With Methotrexate, Rituximab, And Temozolomide And Post -Irradiation Temozolomide For Primary Central Nervous System Lymphoma

RATIONALE: Drugs used in chemotherapy such as methotrexate and temozolomide use different ways to stop cancer cells from dividing so they stop growing or die. Monoclonal antibodies such as rituximab can locate cancer cells and either kill them or deliver cancer-killing substances to them without harming normal cells. Radiation therapy uses high-energy x-rays to damage cancer cells. Combining methotrexate, temozolomide, and rituximab with radiation therapy may kill more cancer cells.

PURPOSE: This phase I/II trial is studying the side effects and best dose of temozolomide when given together with methotrexate and rituximab followed by radiation therapy and to see how well they work in treating patients with primary central nervous system lymphoma.

OBJECTIVES:

  • To assess the maximum tolerated dose (MTD) of temozolomide (TMZ) in combination with methotrexate (MTX) and rituximab (RTX) when administered prior to twice daily fractionated whole brain radiation therapy (WBRT) in patients with primary central nervous system lymphoma.
  • To compare the two-year survival rate in patients receiving pre-irradiation chemotherapy, twice daily fractionated whole brain radiation therapy and post-irradiation temozolomide to the reported two-year survival rate of Radiation Therapy Oncology Group (RTOG) trial 93-10. RTOG 9310 does not fall within ClinicalTrials.gov registration/reporting requirements.)
  • To compare the pre-irradiation chemotherapy tumor response rates to the reported rate from RTOG 93-10.
  • To report progression-free survival.
  • To assess acute and long-term neurologic toxicity, and to collect quality of life data for this patient group.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

Interventional
Phase 1
Phase 2
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
  • Brain and Central Nervous System Tumors
  • Lymphoma
  • Drug: rituximab
    375 mg/m2, intravenously three days prior to the first cycle of methotrexate
  • Drug: methotrexate
    Five cycles of methotrexate (MTX) at 3.5 gm/m2 administered every two weeks on weeks 1, 3, 5, 7, and 9 via intravenous infusion over four hours once per cycle. Calcium leucovorin 25 mg orally or intravenously every six hours initiated exactly 24 hours following the start of the MTX infusion. Methotrexate levels to be monitored daily, and calcium leucovorin discontinued when the MTX level is less than 10 micromolar.
  • Drug: temozolomide 100 mg/m^2
    Temozolomide 100 mg/m^2 by mouth per day for five days on weeks 4 and 8.
  • Drug: temozolomide 150 mg/m^2
    Temozolomide 150 mg/m^2 by mouth per day for five days on weeks 4 and 8.
  • Drug: temozolomide 200 mg/m^2
    Temozolomide 200 mg/m^2 per day by mouth for five days on weeks 4 and 8.
  • Radiation: radiation therapy
    Whole brain irradiation (WBRT) during weeks 11, 12, and 13, five days per week (excluding weekends). A daily dose of 2.4 Gy delivered in two fractions of 1.2 Gy each with a minimum inter-fraction interval of 6 hours, with a total dose to brain and meninges of 36 Gy.
    Other Name: radiotherapy
  • Drug: post-radiation therapy temozolomide
    Temozolomide (TMZ) 200 mg/m^2 by mouth per day for 5 days on weeks 14, 18, 22, 26, 30, 34, 38, 42, 46, and 50 for a total of 10 cycles.
  • Experimental: Phase I: Temozolomide 100 mg
    Rituximab, methotrexate, temozolomide 100 mg/m^2, followed by radiation therapy, then post-radiation therapy temozolomide 200 mg/m^2.
    Interventions:
    • Drug: rituximab
    • Drug: methotrexate
    • Drug: temozolomide 100 mg/m^2
    • Radiation: radiation therapy
    • Drug: post-radiation therapy temozolomide
  • Experimental: Phase I: Temozolomide 150 mg
    Rituximab, methotrexate, temozolomide 150 mg/m^2, followed by radiation therapy, then post-radiation therapy temozolomide 200 mg/m^2.
    Interventions:
    • Drug: rituximab
    • Drug: methotrexate
    • Drug: temozolomide 150 mg/m^2
    • Radiation: radiation therapy
    • Drug: post-radiation therapy temozolomide
  • Experimental: Phase I: Temozolomide 200 mg
    Rituximab, methotrexate, temozolomide 200 mg/m^2, followed by radiation therapy, then post-radiation therapy temozolomide 200 mg/m^2.
    Interventions:
    • Drug: rituximab
    • Drug: methotrexate
    • Drug: temozolomide 200 mg/m^2
    • Radiation: radiation therapy
    • Drug: post-radiation therapy temozolomide
  • Experimental: Phase II: Temozolomide 100 mg
    Rituximab, methotrexate, temozolomide 100 mg/m^2, followed by radiation therapy, then post-radiation therapy temozolomide 200 mg/m^2.
    Interventions:
    • Drug: rituximab
    • Drug: methotrexate
    • Drug: temozolomide 100 mg/m^2
    • Radiation: radiation therapy
    • Drug: post-radiation therapy temozolomide
Glass J, Won M, Schultz CJ, Brat D, Bartlett NL, Suh JH, Werner-Wasik M, Fisher BJ, Liepman MK, Augspurger M, Bokstein F, Bovi JA, Solhjem MC, Mehta MP. Phase I and II Study of Induction Chemotherapy With Methotrexate, Rituximab, and Temozolomide, Followed By Whole-Brain Radiotherapy and Postirradiation Temozolomide for Primary CNS Lymphoma: NRG Oncology RTOG 0227. J Clin Oncol. 2016 May 10;34(14):1620-5. doi: 10.1200/JCO.2015.64.8634. Epub 2016 Mar 28.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
60
Not Provided
December 2016
December 2016   (Final data collection date for primary outcome measure)

Inclusion criteria:

  1. Primary central nervous system (CNS) lymphoma [B-cell, Cluster of Differentiation 20 (CD20) antigen positive] based on positive biopsy or cerebrospinal fluid (CSF) or vitreous cytology (in association with measurable intraparenchymal tumor). Cytology must demonstrate lymphoma or have an immunohistochemical diagnosis of malignant lymphocytes with a monoclonal lymphocytic population.
  2. Life expectancy ≥ 8 weeks;
  3. Zubrod performance status of 0-2;
  4. Absolute granulocyte count ≥1500/mm3; platelet count ≥ 100,000/mm3; creatinine clearance ≥ 50, calculated with the Cockcroft-Gault Equation: Cr Clearance = (140-age) x wt (kg)/(Cr[mg/dl]x 72); Bilirubin, serum glutamate oxaloacetate transaminase (SGOT), alkaline phosphatase (AST) ≤ 2 x institutional upper limits of normal;
  5. Patients must sign a study-specific informed consent prior to study entry.
  6. Age ≥ 18

Exclusion criteria:

  1. Evidence of systemic lymphoma;
  2. Prior malignancy (excluding in situ carcinoma of the cervix or non-melanomatous skin cancer)unless disease free for at least five years;
  3. Prior radiotherapy to the brain or head/neck;
  4. Prior chemotherapy;
  5. History of idiopathic sensitivity to any of the drugs to be used;
  6. Active infectious process;
  7. Seropositive for HIV, AIDS, or post-organ transplant;
  8. Pregnant women are ineligible as treatment involves unforeseeable risks to the participant and to the embryo or fetus.
  9. Active hepatitis B.
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
Canada
 
NCT00068250
RTOG-0227
CDR0000301563
Yes
Not Provided
Not Provided
Radiation Therapy Oncology Group
Radiation Therapy Oncology Group
  • National Cancer Institute (NCI)
  • NRG Oncology
Study Chair: Jon Glass, MD Sidney Kimmel Cancer Center at Thomas Jefferson University
Radiation Therapy Oncology Group
February 2018

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP