Phase 2 Study of Bexxar in Relapsed/Refractory DLCL

• ClinicalTrials.gov Identifier: NCT00490009
• Recruitment Status: Completed
• First Posted: June 22, 2007
• Results First Posted: February 28, 2017
• Last Update Posted: March 30, 2017
• Sponsor: Susan Knox
• Collaborators: Corixa Corporation; GlaxoSmithKline
• Information provided by (Responsible Party): Susan Knox, Stanford University

Study Description

Brief Summary:

The purpose of this study is to obtain safety and efficacy data using Bexxar in patients with relapsed/refractory diffuse large cell Non-Hodgkin's lymphoma (DLCL).

Condition or disease	Intervention/treatment	Phase
Lymphoma	Drug: Bexxar; Drug: Acetaminophen; Drug: Diphenhydramine; Drug: Potassium Iodide (KI)	Phase 2

Detailed Description:

There is a lack of efficacious treatment options for patients with relapsed/refractory diffuse large cell Non-Hodgkin's lymphoma (DLCL) who are not appropriate candidates for stem cell transplantation. DLCL is a relatively radiosensitive disease and patients with DLCL have been reported to respond to anti-CD20 monoclonal antibody (MAB) therapy. Therefore, radioimmunotherapy targeting CD20 is a rational and promising therapeutic approach for this patient population.

This study evaluated if Bexxar is safe and efficacious for diffuse large cell Non-Hodgkin's lymphoma.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 9 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase 2 Study of Bexxar in Relapsed/Refractory Diffuse Large Cell Lymphoma (DLCL)
• Study Start Date: September 2004
• Actual Primary Completion Date: April 2010
• Actual Study Completion Date: June 2013

Arms and Interventions

Arm

Intervention/treatment

Experimental: Bexxar + Total Body Irradiation (TBI); Bexxar will be administered with pre-medications acetaminophen, diphenhydramine, and potassium iodide (KI).

Drug: Bexxar; Bexxar is a radioimmunotherapeutic drug, an antibody that specifically attaches to the CD20 antigen, which is present on the surfaces of B cells and B cell lymphoma cells. The radioactive isotope then gives off radiation, which kills the cells. Bexxar will be administered to provide the following patient-specific radiotherapy: Platelet count of 150,000/mm³ = 75 cGy; Platelet count ≥ 100,000/mm³ but < 150,000/mm³ = 65 cGy; Other Names: Tositumomab; iodine-131 tositumomab; I-131 tositumomab; Drug: Acetaminophen; As premedication 30 to 60 minutes before antibody infusion; 650 mg, oral. Used to as to relieve pain; Other Name: Tylenol; Drug: Diphenhydramine; As premedication 30 to 60 minutes before antibody infusion; 50 mg, oral. Used to prevent inflammation or allergic reactions; Other Name: Benadryl; Drug: Potassium Iodide (KI); Administered to prevent thyroid blockage 130 mg orally 3 times a day,; Other Names: Saturated solution potassium iodine (SSKI); Lugol's solution

Outcome Measures

Primary Outcome Measures :

1. Clinical Response Rate [ Time Frame: 6 years ]
   Clinical response rate for all participants, reported as the sum of the numbers of patients achieving complete response (CR, complete disappearance of all lesions); functional CR (fCR, minimal residual disease but clear of disease by positron emission tomography (PET)-scan); or partial response (PR, ≥ decrease in size of lesions and negative for active disease by PET-scan). Progressive disease (PD, advancing cancer) or stable disease (not CR, fCR, or PD) not included as Clinical Response.

Secondary Outcome Measures :

1. Time to Progression (TTP) [ Time Frame: 1.5 months; 3 months; 6 months; or Not Progressed ]
   Time of disease progression reported as the number of subjects experiencing disease progression at the time point of progression.
2. Overall Survival (OS) Rate [ Time Frame: 6 years ]
   Overall survival reported as the percentage of participants (less lost-to-follow-up) surviving at 6 years.

Eligibility Criteria

• Ages Eligible for Study: 19 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Histologically-confirmed, diffuse large cell lymphoma (DLCL), CD20+ B-cell non-Hodgkin lymphoma (NHL) who have relapsed after chemotherapy or are chemotherapy resistant, without prior history of low grade NHL. The patient must have failed at least one chemotherapy regimen containing an anthracycline or equivalent chemotherapeutic agent.
• No anticancer treatment for three weeks prior to the treatment dose of Bexxar (6 weeks if Rituximab, nitrosourea or Mitomycin C)
• Fully recovered from all toxicities associated with prior surgery, radiation, chemotherapy or immunotherapy
• An Institutional Review Board (IRB)-approved signed informed consent
• Age 19 years or older
• Prestudy Karnofsky Performance Status of ≥ 70%
• Absolute neutrophil count (ANC) ≥ 1,500/mm³
• Platelet count ≥ 100,000/mm³
• Hct > 30%
• Hgb > 9.0 gm%
• Bilirubin ≤ 2.0
• Creatinine ≤ 2.0
• Bone marrow involvement with lymphoma less than 25% (bilateral bone marrow) within 6 weeks of enrollment
• Acceptable birth control method for men and women
• Female patients who are not pregnant
• Not lactating

Exclusion Criteria:

• Prior myeloablative therapies with bone marrow transplantation or peripheral stem cell rescue
• Platelet count < 100,000/mm³
• Hypocellular bone marrow (≤ 15% cellularity)
• Marked reduction in bone marrow precursors of one or more cell lines
• History of failed stem cell collection
• Prior treatment with Fludarabine
• Prior radioimmunotherapy
• Presence of central nervous system (CNS) lymphoma
• Patients with known HIV or AIDS-related lymphoma
• Patients with evidence of myelodysplasia on bone marrow biopsy
• Patients who have received prior external beam radiation therapy to more than 25% of active bone marrow
• Patients who have received filgrastim or sargramostim therapy within 3 weeks prior to treatment
• Pregnant
• Lactating
• Presence of human anti-mouse antibody (HAMA) reactivity in patients with prior exposure to murine antibodies or proteins
• Serious nonmalignant disease or infection, which, in the opinion of the investigator, would compromise other protocol objectives
• Another primary malignancy (other than squamous cell and basal cell carcinoma of the skin, in situ carcinoma of the cervix, or treated prostate cancer with stable prostate specific antigen levels) for which the patients has not been disease-free for at least 3 years
• Major surgery, other than diagnostic surgery, within 4 weeks
• Patients with pleural effusion

Contacts and Locations

Locations

United States, California

Stanford University School of Medicine

Stanford, California, United States, 94305

Sponsors and Collaborators

Susan Knox

Corixa Corporation

GlaxoSmithKline

Investigators

• Principal Investigator: Susan J Knox; Stanford University

More Information

• Responsible Party: Susan Knox, Associate Professor, Stanford University
• ClinicalTrials.gov Identifier: NCT00490009
• Other Study ID Numbers: IRB-10275; LYMNHL0019 ( Other Identifier: OnCore ); 30978 ( Other Identifier: Stanford SPO )
• First Posted: June 22, 2007
• Results First Posted: February 28, 2017
• Last Update Posted: March 30, 2017
• Last Verified: February 2017

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Additional relevant MeSH terms:

Lymphoma; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases; Acetaminophen; Iodine; Diphenhydramine; Promethazine; Cadexomer iodine; Tositumomab I-131; Lugol's solution; Pharmaceutical Solutions; Analgesics, Non-Narcotic; Analgesics; Sensory System Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs; Antipyretics; Anti-Infective Agents, Local; Anti-Infective Agents; Trace Elements; Micronutrients; Sleep Aids, Pharmaceutical; Hypnotics and Sedatives; Central Nervous System Depressants; Anesthetics, Local; Anesthetics