Description:
This study will gain information about a rare disorder called KSHV-associated multicentric
Castleman s disease (MCD). KSHV, a virus, causes several kinds of cancer, including some
forms of MCD. KSHV stands for the Kaposi s sarcoma herpes virus, also called human herpes
virus-8, or HHV-8. Researchers want to understand the biology of KSHV-MCD to identify how
this disease causes illness and to find ways to treat it. There is no standard therapy
effective for all cases of KSHV-MCD. The disease is often fatal, and about half the people
who have it die within 2 years of diagnosis.
Participants ages 18 and older may be eligible for this study. Participation entails more
drawing of blood and having repeated tumor biopsies than if patients received treatment in a
non-research setting. Researchers would like to learn more about the relationship of KSHV and
Castleman s disease symptoms, and they want to obtain at least three biopsies in this study.
There are some side effects of experimental therapy that participants may take for KSHV-MCD.
Zidovudine, or Retrovir , is used at a high dose. It is given orally or through a vein, four
times daily, for 7 days or longer. Zidovudine can cause nausea, vomiting, decreased bone
marrow function, and decreased blood counts. Combined with valganciclovir, or Valcyte , it is
likely to be more toxic to bone marrow. Valganciclovir can cause problems with bone marrow
function, leading to low blood counts, sterility, and defects in a fetus. Combined with
zidovudine, valganciclovir may cause more toxicity to the bone marrow. It is given twice
daily for 7 days or longer. Bortezomib, or Velcade , is given for a few seconds by a rapid
push through a needle into the vein. It is given twice weekly for four doses and then stopped
for 1 week. Bortezomib can sometimes cause low blood pressure; it also can cause
gastrointestinal problems and a low blood platelet count. Rituximab and liposomal doxorubicin
are drugs given by a catheter into a vein. Interferon-alpha is given by injection into the
skin. Those drugs are not experimental, but their use in Castleman s disease is experimental.
Some participants may be treated with a combination of chemotherapy followed by
interferon-alpha. Interferon-alpha is infected into the skin by a needle. The natural form of
interferon is produced by the body and helps to control viral infections. KSHV decreases the
effect of the body s interferon, and the researchers want to see if giving higher doses of
interferon will help to control KSHV infection.
A positron emission tomography (PET) scan, for research purposes only, may be done up to
three times a year. A radioactive sugar molecule called fluorodeoxyglucose, or FDG, is used.
It is believed that activated lymphocytes that may be found in participants disease might use
more FDG because these cells burn more glucose fuel.
This study may or may not have a direct benefit for participants. However, detailed
assessments made throughout the study may provide information to help the doctors treat
KSHV-MCD better.
Title
- Brief Title: Virotherapy and Natural History Study of KHSV-Associated Multricentric Castleman s Disease With Correlates of Disease Activity
- Official Title: Targeted Oncolytic Virotherapy and Natural History Study of KSHV-Associated Multicentric Castleman's Disease With Laboratory and Clinical Correlates of Disease Activity
Clinical Trial IDs
- ORG STUDY ID:
040275
- SECONDARY ID:
04-C-0275
- NCT ID:
NCT00092222
- NCT ALIAS:
NCT00099073
Conditions
- Lymphoproliferative Disorder
- HHV-8
- Malignancy
- HIV
Interventions
| Drug | Synonyms | Arms |
|---|
| Etoposide | | Active Treatment 2 |
| Interferon-alpha | | Active Treatment 4 |
| Rituximab | | Active Treatment 2 |
| Zidovudine | | Active Treament 3 |
| Liposomal Doxorubicin | | Active Treatment 4 |
| Bortezomib | | Active Treament 3 |
| Valganciclovir | | Active Treament 3 |
| Doxorubicin | | Active Treatment 2 |
| Vincristine | | Active Treatment 2 |
| Cyclophosphamide | | Active Treatment 2 |
| Filgrastim (G-CSF) | | Active Treatment 2 |
| Prednisone | | Active Treatment 2 |
| Sirolimus | | Active Treatment 1 |
Purpose
This study will gain information about a rare disorder called KSHV-associated multicentric
Castleman s disease (MCD). KSHV, a virus, causes several kinds of cancer, including some
forms of MCD. KSHV stands for the Kaposi s sarcoma herpes virus, also called human herpes
virus-8, or HHV-8. Researchers want to understand the biology of KSHV-MCD to identify how
this disease causes illness and to find ways to treat it. There is no standard therapy
effective for all cases of KSHV-MCD. The disease is often fatal, and about half the people
who have it die within 2 years of diagnosis.
Participants ages 18 and older may be eligible for this study. Participation entails more
drawing of blood and having repeated tumor biopsies than if patients received treatment in a
non-research setting. Researchers would like to learn more about the relationship of KSHV and
Castleman s disease symptoms, and they want to obtain at least three biopsies in this study.
There are some side effects of experimental therapy that participants may take for KSHV-MCD.
Zidovudine, or Retrovir , is used at a high dose. It is given orally or through a vein, four
times daily, for 7 days or longer. Zidovudine can cause nausea, vomiting, decreased bone
marrow function, and decreased blood counts. Combined with valganciclovir, or Valcyte , it is
likely to be more toxic to bone marrow. Valganciclovir can cause problems with bone marrow
function, leading to low blood counts, sterility, and defects in a fetus. Combined with
zidovudine, valganciclovir may cause more toxicity to the bone marrow. It is given twice
daily for 7 days or longer. Bortezomib, or Velcade , is given for a few seconds by a rapid
push through a needle into the vein. It is given twice weekly for four doses and then stopped
for 1 week. Bortezomib can sometimes cause low blood pressure; it also can cause
gastrointestinal problems and a low blood platelet count. Rituximab and liposomal doxorubicin
are drugs given by a catheter into a vein. Interferon-alpha is given by injection into the
skin. Those drugs are not experimental, but their use in Castleman s disease is experimental.
Some participants may be treated with a combination of chemotherapy followed by
interferon-alpha. Interferon-alpha is infected into the skin by a needle. The natural form of
interferon is produced by the body and helps to control viral infections. KSHV decreases the
effect of the body s interferon, and the researchers want to see if giving higher doses of
interferon will help to control KSHV infection.
A positron emission tomography (PET) scan, for research purposes only, may be done up to
three times a year. A radioactive sugar molecule called fluorodeoxyglucose, or FDG, is used.
It is believed that activated lymphocytes that may be found in participants disease might use
more FDG because these cells burn more glucose fuel.
This study may or may not have a direct benefit for participants. However, detailed
assessments made throughout the study may provide information to help the doctors treat
KSHV-MCD better.
Detailed Description
Background:
- Multicentric Castleman's disease (MCD) is a rare but lethal Kaposi's sarcoma-associated
herpesvirus (KSHV) associated lymphoproliferative disorder with a median survival of 2
years. It occurs more often in HIV-infected individuals than those without HIV
infection. The poor prognosis is not fully explained by the underlying HIV, as the
HIV-negative cases appear to have no survival advantage over the HIV-positive cohort.
The disease has no defined standard treatment and has not been prospectively studied in
a comprehensive manner.
- KSHV-MCD may provide a model for the development of targeted oncolytic virotherapy or
other pathogenesis-based approaches to viral-associated malignancies. In KSHV-MCD, viral
encoded tyrosine kinase genes appear to be possible targets to exploit in a virotherapy
approach. Specific viral encoded genes appear to convert zidovudine and ganciclovir (or
valganciclovir) into toxic phosphorylated moieties within the KSHV-infected tumor cells,
to specifically target the KSHV-infected cells thus leading to specific cell death. If
successful, this could have direct therapeutic benefit to participants and also provide
a model for further development of this approach in other tumors.
Objectives
-To study and describe the natural history of KSHV-MCD.
Eligibility
- Age greater than or equal to 18 years
- Biopsy proven KSHV-associated MCD
Design
- Natural History study
- Inclusion of treatment as needed, with guidelines for preliminary investigation of a
variety of specific treatments of interest
- High-dose zidovudine and ganciclovir
- High-dose zidovudine and ganciclovir and bortezomib
- Sirolimus
- Rituximab with liposomal doxorubicin followed by interferon-alpha
- Rituximab with EPOCH chemotherapy
Trial Arms
| Name | Type | Description | Interventions |
|---|
| Active Treament 3 | Active Comparator | Patients not responding to high- dose zidovudine and valganciclovir alone may be treated with botezomib plus high- dose zidovudine and valganciclovir | - Zidovudine
- Bortezomib
- Valganciclovir
|
| Active Treatment 1 | Active Comparator | Single agent sirolimus for patients where targeted oncolytic virotherapy seems suboptimal | |
| Active Treatment 2 | Active Comparator | EPOCH chemotherapy with rituximab may be utilized to rescue such patients, with the intent of stabilizing suchpatients | - Etoposide
- Rituximab
- Doxorubicin
- Vincristine
- Cyclophosphamide
- Filgrastim (G-CSF)
- Prednisone
|
| Active Treatment 4 | Active Comparator | Rituximab with liposomal doxorubicin (R-Dox) followed by consolidation or lmaintenancel therapy with dose escalating interferon-alpha | - Interferon-alpha
- Rituximab
- Liposomal Doxorubicin
|
| Active Treatment 5 | Active Comparator | High dose zidovudin and valganciclovir | |
| Natural History | Active Comparator | Observation Only | |
Eligibility Criteria
- INCLUSION CRITERIA:
Age greater than or equal to 18 years.
Biopsy proven KSHV-associated MCD, confirmed in the Laboratory of Pathology, CCR.
Willing to give informed consent.
EXCLUSION CRITERIA:
Any abnormality that would be scored as NCI CTC Grade IV toxicity that is unrelated to HIV,
its treatment, or to MCD that would preclude protocol treatment and/or observation only.
Presence of another malignancy requiring current treatment that would preclude the use of
all of the study treatments or the ability to monitor the natural history of MCD untreated.
Pregnant women are excluded from this study as certain of the study agents have the
potential for teratogenic effects
Any condition or set of circumstances that in the opinion of the investigators would make
participation in this study unsafe or otherwise inappropriate for a given individual.
| Maximum Eligible Age: | N/A |
| Minimum Eligible Age: | 18 Years |
| Eligible Gender: | All |
| Healthy Volunteers: | No |
Primary Outcome Measures
| Measure: | Describe natural history |
| Time Frame: | Study Closure |
| Safety Issue: | |
| Description: | Response to treatment |
Secondary Outcome Measures
| Measure: | overall survival |
| Time Frame: | Study Closure |
| Safety Issue: | |
| Description: | percentage of patients alive until study closure |
| Measure: | Number of flares |
| Time Frame: | Study closure |
| Safety Issue: | |
| Description: | Quantify the number of flares requiring treatment in patients enrolled in this study |
Details
| Phase: | Phase 2 |
| Primary Purpose: | Interventional |
| Overall Status: | Recruiting |
| Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- HHV-8
- HIV
- Malignancy
- Lymphoproliferation
- Lymph Node Hyperplasia
- Multicentric Castleman DIsease
- MCD
- KSHV-MCD
- KSHV Associated MCD
- HIV Infections
- Herpes Viruses
Last Updated
August 26, 2021
