Aprepitant's Effect on Drug Metabolism in Multi-Day Combination (CHOP/R-CHOP) Chemotherapy Regimen in Lymphoma Patients

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ClinicalTrials.gov Identifier: NCT00651755

Recruitment Status : Completed

First Posted : April 3, 2008

Results First Posted : July 2, 2013

Last Update Posted : July 2, 2013

Sponsor:

Collaborator:

Merck Sharp & Dohme Corp.

Information provided by (Responsible Party):

M.D. Anderson Cancer Center

Study Description

Brief Summary:

The goal of this clinical research study is to learn the effect of combining aprepitant with CHOP or R-CHOP in patients with Non-Hodgkin's Lymphoma (NHL) that is either newly diagnosed or has come back. Researchers also want to see if aprepitant can help to prevent nausea and/or vomiting that may be caused by chemotherapy treatment with CHOP or R-CHOP, in these patients. CHOP consists of four drugs - Cyclophosphamide (also called Cytoxan/Neosar), Doxorubicin (or Adriamycin), Vincristine (Oncovin) and Prednisolone while R-CHOP includes Rituximab and CHOP.

Condition or disease	Intervention/treatment	Phase
Lymphoma	Drug: Aprepitant Drug: Cyclophosphamide Drug: Doxorubicin Drug: Vincristine Drug: Prednisone Drug: Rituximab Drug: Ondansetron	Not Applicable

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Detailed Description:

The Study Drugs:

Aprepitant is designed to block the natural substance in the brain that causes nausea and vomiting. This may help to prevent and/or control nausea and vomiting caused by cancer chemotherapy treatment.

CHOP and R-CHOP are commonly used chemotherapy regimens for treating NHL.

In the blood, aprepitant may increase or decrease the drug levels of cyclophosphamide, vincristine, and/or prednisone (which are part of the CHOP and R-CHOP regimens), but this is not known for certain. This study is designed to help researchers learn the effect of combining aprepitant with CHOP and R-CHOP.

Study Groups:

If you are found to be eligible to take part in this study, you will be randomly assigned (as in the toss of a coin) to 1 of 2 groups. There is an equal chance of being assigned to either group.

Standard Chemotherapy Administration:

Both CHOP and R-CHOP typically have 21-day "cycles" but can vary from every 14 to 28 days. You will receive CHOP or R-CHOP according to the schedule prescribed by your doctor. You will also receive standard medications for preventing nausea and vomiting. You will sign a separate consent form that will describe these treatments in detail, along with their risks.

Aprepitant Administration:

Aprepitant is taken by mouth, with or without food.

Group 1 will take aprepitant on Days 1, 2, and 3 of Study Cycle 1 only. Group 2 will take aprepitant on Days 1, 2, and 3 of Study Cycle 2 only.

Study Diary:

Prior to each study cycle, you will be given a study diary to use throughout the study. Once a day, you will record any side effects you may have experienced. You should bring your study diary to every study visit so the study staff can review it.

Study Visits:

Prior to each study cycle, you will have a study visit with the following tests/procedures performed:

Your medical history will be recorded.
You will have a physical exam, including measurement of vital signs and weight.
You will have a performance status evaluation.
You will fill out the same questionnaire you did at screening, about any nausea and vomiting you may be experiencing.
You will be asked about any other medications you may be taking. Be sure to tell the study doctor about all medications (including vitamins, herbal products, and nutritional supplements), because some medications/substances will cause side effects when taken at the same time as aprepitant.
The study staff will review your study diary.

Pharmacokinetic Testing:

You will have additional blood samples drawn for pharmacokinetic (PK) testing of cyclophosphamide, vincristine, and prednisone levels. PK testing measures the amount of the drug in the body at different time points. These PK blood draws will be about 2 tablespoons each.

On Days 1 and 2 of Study Cycles 1 and 2, blood will be drawn for PK testing at the following times: before taking prednisone, 30 minutes after the start of the cyclophosphamide infusion, and at 60 minutes, 75 minutes, 90 minutes, and 2, 4, 6, 8, and 24 hours after the start of the cyclophosphamide infusion.

Other Blood Tests:

At least twice a week during Study Cycles 1 and 2, blood (about 1 teaspoon) will be drawn for routine tests.

Aprepitant may increase the blood sugar during the first few days the drug is taken. Because of this, on Day 1 of Study Cycle 1, you will be given a glucometer (a machine to check your blood sugar). You will use the glucometer at home during the study (or in the hospital if you are admitted there for chemotherapy). You will be given instructions on how to use it, and what to be looking for. On Days 1-6 of Study Cycle 1, you will give yourself a "fingerstick" blood sugar test once a day (before breakfast). You will take a "fingerstick" blood sugar test before you receive each dose of aprepitant.

Length of Study:

You may receive up to 2 cycles of chemotherapy, including 1 cycle of aprepitant. If intolerable side effects occur or the disease gets worse, you will be taken off study early.

End-of-Study Visit:

At 30 days after your last dose of aprepitant, you will return for an end-of-study visit. At this visit, you will have the same tests/procedures performed that you did at the other study visits. You will return the glucometer to the study staff.

This is an investigational study. The CHOP and R-CHOP regimens are commercially available and FDA approved for use in NHL.

Aprepitant is commercially available and FDA approved (when used in combination with other nausea medication, such as ondansetron) for the prevention of nausea and vomiting that may be caused by chemotherapy. However, this study is considered experimental because researchers want to find out how aprepitant may affect the drug levels of cyclophosphamide, vincristine, and prednisone in the blood. (Cyclophosphamide, vincristine, and prednisone are part of the CHOP and R-CHOP regimens.) The use of aprepitant is authorized for this experimental purpose.

Up to 18 patients will take part in this study. All will be enrolled at M. D. Anderson.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	23 participants
Allocation:	Randomized
Intervention Model:	Crossover Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Evaluation of Aprepitant's Effect on Drug Metabolism in Multi-Day Combination (CHOP/R-CHOP) Chemotherapy Regimen in Patients With Non-Hodgkin's Lymphoma
Study Start Date :	March 2008
Actual Primary Completion Date :	September 2011
Actual Study Completion Date :	September 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lymphoma

Drug Information available for: Aprepitant

Genetic and Rare Diseases Information Center resources: Lymphosarcoma

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Experimental: Aprepitant + CHOP/R-CHOP Aprepitant 125 mg oral (PO) Day 1 of Cycle 1 followed by 80 mg PO Daily Days 2-3 with CHOP (steroid in CHOP) or R-CHOP plus Rituximab 375 mg/m^2 intravenous Day 1. CHOP or R-CHOP chemotherapy: (1) bolus or 48-hour infusion CHOP [cyclophosphamide 750 mg/m^2 IV Day 1, doxorubicin 25 mg/m^2/day IV given bolus or over 48 hours continuous infusion Days 1-2, vincristine 2 mg IV Day 1, prednisone PO 100 mg * 5 days]; or (2) Bolus or 48-hour infusion R-CHOP [Rituximab 375 mg/m^2 on Day 1 + CHOP as above]. [For patients receiving R-CHOP, CHOP may be administered starting on Day 2 at the discretion of the treating physician]	Drug: Aprepitant 125 mg By Mouth (PO) On Day 1, followed by 80 mg PO Daily On Days 2-3. Other Names: Emend L754030 MK869 Drug: Cyclophosphamide 750 mg/m^2 By Vein On Day 1 Other Names: Cytoxan Neosar Drug: Doxorubicin 25 mg/m^2 By Vein Over 48 Hours On Days 1-2 Other Names: AD Hydroxydaunomycin hydrochloride Drug: Vincristine 2 mg By Vein On Day 1 Drug: Prednisone 100 mg PO for 5 Days Drug: Rituximab 375 mg/m^2 By Vein On Day 1. Other Name: Rituxan
Experimental: Standard of Care (Control) + CHOP/R-CHOP Anti-emetics, Ondansetron 8 mg daily for 2 days, plus steroids in CHOP or R-CHOP regimen.	Drug: Cyclophosphamide 750 mg/m^2 By Vein On Day 1 Other Names: Cytoxan Neosar Drug: Doxorubicin 25 mg/m^2 By Vein Over 48 Hours On Days 1-2 Other Names: AD Hydroxydaunomycin hydrochloride Drug: Vincristine 2 mg By Vein On Day 1 Drug: Prednisone 100 mg PO for 5 Days Drug: Rituximab 375 mg/m^2 By Vein On Day 1. Other Name: Rituxan Drug: Ondansetron 8 mg daily for 2 days

Arm

Intervention/treatment

Experimental: Aprepitant + CHOP/R-CHOP

Aprepitant 125 mg oral (PO) Day 1 of Cycle 1 followed by 80 mg PO Daily Days 2-3 with CHOP (steroid in CHOP) or R-CHOP plus Rituximab 375 mg/m^2 intravenous Day 1. CHOP or R-CHOP chemotherapy: (1) bolus or 48-hour infusion CHOP [cyclophosphamide 750 mg/m^2 IV Day 1, doxorubicin 25 mg/m^2/day IV given bolus or over 48 hours continuous infusion Days 1-2, vincristine 2 mg IV Day 1, prednisone PO 100 mg * 5 days]; or (2) Bolus or 48-hour infusion R-CHOP [Rituximab 375 mg/m^2 on Day 1 + CHOP as above]. [For patients receiving R-CHOP, CHOP may be administered starting on Day 2 at the discretion of the treating physician]

Drug: Aprepitant

125 mg By Mouth (PO) On Day 1, followed by 80 mg PO Daily On Days 2-3.

Other Names:

Emend
L754030
MK869

Drug: Cyclophosphamide

750 mg/m^2 By Vein On Day 1

Other Names:

Cytoxan
Neosar

Drug: Doxorubicin

25 mg/m^2 By Vein Over 48 Hours On Days 1-2

Other Names:

AD
Hydroxydaunomycin hydrochloride

Drug: Vincristine

2 mg By Vein On Day 1

Drug: Prednisone

100 mg PO for 5 Days

Drug: Rituximab

375 mg/m^2 By Vein On Day 1.

Other Name: Rituxan

Experimental: Standard of Care (Control) + CHOP/R-CHOP

Anti-emetics, Ondansetron 8 mg daily for 2 days, plus steroids in CHOP or R-CHOP regimen.

Drug: Cyclophosphamide

750 mg/m^2 By Vein On Day 1

Other Names:

Cytoxan
Neosar

Drug: Doxorubicin

25 mg/m^2 By Vein Over 48 Hours On Days 1-2

Other Names:

AD
Hydroxydaunomycin hydrochloride

Drug: Vincristine

2 mg By Vein On Day 1

Drug: Prednisone

100 mg PO for 5 Days

Drug: Rituximab

375 mg/m^2 By Vein On Day 1.

Other Name: Rituxan

Drug: Ondansetron

8 mg daily for 2 days

Outcome Measures

Primary Outcome Measures :

Geometric Mean Area Under Curve (AUC) of Analyte, Cyclophosphamide (CP), in Aprepitant Treatment and Control Group [ Time Frame: Time points over 24 hours of cyclophosphamide infusion for both cycles (21 day cycle) ]
Pharmacokinetic (PK) blood sampling to determine the geometric mean AUC of Cyclophosphamide (CP) during & post chemotherapy infusion, baseline, at 30, 60, 75, 90 minutes, and 2 , 4, 6, 8, and 24 hours from start of cyclophosphamide infusion. The absence of PK drug interactions was determined if the 90% Confidence Intervals (CI) of the geometric mean AUC ratio between 2 groups is within 0.80 to 1.25. Measurements reported as concentrate times the time, i.e. micrograms (ug)/milliliters (mL) times hour (hr).
Geometric Mean Area Under Curve (AUC) of Analyte, 2-dechloro-cyclophosphamide(2-deCI-CP), in Aprepitant Treatment and Control Group [ Time Frame: Time points over 24 hours of cyclophosphamide infusion for both cycles (21 day cycle) ]
Pharmacokinetic (PK) blood sampling to determine the geometric mean AUC of 2-deCI-CP, during & post chemotherapy infusion, baseline, at 30, 60, 75, 90 minutes, and 2 , 4, 6, 8, and 24 hours from start of cyclophosphamide infusion. The absence of PK drug interactions was determined if the 90% Confidence Intervals (CI) of the geometric mean AUC ratio between 2 groups is within 0.80 to 1.25. Measurements reported as concentrate times the time, i.e. micrograms (ug)/milliliters (mL) times hour (hr).
Geometric Mean Area Under Curve (AUC) of Analyte, 4-hydroxy-cyclophosphamide (4-OH-CP), in Aprepitant Treatment and Control Group [ Time Frame: Time points over 24 hours of cyclophosphamide infusion for both cycles (21 day cycle) ]
Pharmacokinetic (PK) blood sampling to determine the geometric mean AUC of 4-hydroxy-cyclophosphamide (4-OH-CP), during & post chemotherapy infusion, baseline, at 30, 60, 75, 90 minutes, and 2 , 4, 6, 8, and 24 hours from start of cyclophosphamide infusion. The absence of PK drug interactions was determined if the 90% Confidence Intervals (CI) of the geometric mean AUC ratio between 2 groups is within 0.80 to 1.25. Measurements reported as concentrate times the time, i.e. micrograms (ug)/milliliters (mL) times hour (hr).
Geometric Mean Area Under Curve (AUC) of Analyte, Vincristine (VC), in Aprepitant Treatment and Control Group [ Time Frame: Time points over 24 hours of cyclophosphamide infusion for both cycles (21 day cycle) ]
Pharmacokinetic (PK) blood sampling to determine the geometric mean AUC of VC, during & post chemotherapy infusion, baseline, at 30, 60, 75, 90 minutes, and 2 , 4, 6, 8, and 24 hours from start of cyclophosphamide infusion. The absence of PK drug interactions was determined if the 90% Confidence Intervals (CI) of the geometric mean AUC ratio between 2 groups is within 0.80 to 1.25. Measurements reported as concentrate times the time, i.e. nanograms (ng)/milliliters (mL) times hour (hr).
Geometric Mean Area Under Curve (AUC) of Analyte,Prednisone (PR), in Aprepitant Treatment and Control Group [ Time Frame: Time points over 8 hours of cyclophosphamide infusion for both cycles (21 day cycle) ]
Pharmacokinetic (PK) blood sampling to determine the geometric mean AUC of PR, during & post chemotherapy infusion, baseline, at 30, 60, 75, 90 minutes, and 2 , 4, 6, 8, and 24 hours from start of cyclophosphamide infusion. The absence of PK drug interactions was determined if the 90% Confidence Intervals (CI) of the geometric mean AUC ratio between 2 groups is within 0.80 to 1.25. Measurements reported as concentrate times the time, i.e. nanograms (ng)/milliliters (mL) times hour (hr).
Geometric Mean Area Under Curve (AUC) of Analyte, Prednisolone (PL), in Aprepitant Treatment and Control Group [ Time Frame: Time points over 8 hours of cyclophosphamide infusion for both cycles (21 day cycle) ]
Pharmacokinetic (PK) blood sampling to determine the geometric mean AUC of PL, during & post chemotherapy infusion, baseline, at 30, 60, 75, 90 minutes, and 2 , 4, 6, 8, and 24 hours from start of cyclophosphamide infusion. The absence of PK drug interactions was determined if the 90% Confidence Intervals (CI) of the geometric mean AUC ratio between 2 groups is within 0.80 to 1.25. Measurements reported as concentrate times the time, i.e. nanograms (ng)/milliliters (mL) times hour (hr).

Eligibility Criteria

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

Criteria

Inclusion Criteria:

Newly diagnosed or relapsed lymphoid malignancy.
Patients receiving either:(1) Bolus or 48-hr infusion CHOP (cyclophosphamide 750 mg/m^2 IV Day 1, doxorubicin 25 mg/m^2/day IV given as bolus infusion or over 48 hours continuous infusion Days 1-2, vincristine 2 mg IV Day 1, prednisone PO 100 mg * 5 days) OR (2) Bolus or 48-hr infusion R-CHOP (Rituximab 375mg/m^2 on Day 1+ CHOP as above). (For patients receiving R-CHOP, CHOP may be administered starting on Day 2 at the discretion of the treating physician
Age >/= to 18 years
Adequate organ function defined as serum total bilirubin </= 1.2 mg/dL, serum aspartate aminotransferase or serum glutamate oxaloacetate transaminase (SGOT) </= 60 IU/L, creatinine < 1.5 mg/dL.

Exclusion Criteria:

Evidence of neoplastic central nervous system disease
Patients who are unable to take oral medication (e.g. due to tumor obstruction)
History of Diabetes Mellitus (Diabetes as defined by established diagnosis of diabetes currently receiving medications for the diabetes management and/or a fasting blood glucose of >/= 126 mg/dL.)

Contacts and Locations

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): NCT00651755

Locations

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United States, Texas
UT MD Anderson Cancer Center
Houston, Texas, United States, 77030

Sponsors and Collaborators

M.D. Anderson Cancer Center

Merck Sharp & Dohme Corp.

Investigators

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Principal Investigator:	Saroj Vadhan-Raj, MD	M.D. Anderson Cancer Center

More Information

Additional Information:

MD Anderson Cancer Center This link exits the ClinicalTrials.gov site

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Responsible Party:	M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier:	NCT00651755
Other Study ID Numbers:	2006-1033
First Posted:	April 3, 2008 Key Record Dates
Results First Posted:	July 2, 2013
Last Update Posted:	July 2, 2013
Last Verified:	June 2013

Keywords provided by M.D. Anderson Cancer Center:


Non-Hodgkin's Lymphoma Lymphoma Nausea Cyclophosphamide Cytoxan Neosar Doxorubicin AD Hydroxydaunomycin hydrochloride Vincristine Prednisone	Rituximab Rituxan Aprepitant Emend L754030 MK869 Drug Metabolism CHOP R-CHOP NHL

Additional relevant MeSH terms:

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Lymphoma Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Prednisone Cyclophosphamide Rituximab Doxorubicin Liposomal doxorubicin Vincristine Ondansetron Aprepitant	Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Myeloablative Agonists Antineoplastic Agents, Immunological Antibiotics, Antineoplastic Topoisomerase II Inhibitors Topoisomerase Inhibitors Enzyme Inhibitors Anti-Inflammatory Agents

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