Description:
Trial Design:
This clinical trial is a phase III multicenter, randomized, double blind and controlled with
placebo trial and with two arms designed to assess the efficiency and toxicity of the scheme
Lenalidomide versus observation in a series of 60 patients with low risk myelodysplastic
syndrome associated to 5q deletion with anemia (Hb≤12g/dL) but without the need of
transfusion. Patients are randomized in the study in a 2:1 ratio. They will receive treatment
for 104 weeks until progression of the disease, which implies that the patient suffering from
anemia due to myelodysplastic syndrome requires transfusion of at least 2 UCH/56 days (2
months) with a minimum follow up of 112 days (4 months), or unacceptable toxicity.
Disease:
Low risk myelodysplastic syndrome associated to the loss of 5q without transfusion
requirements.
Total number of patients:
In total 60 patients will be included, 40 assigned to the treatment branch and 20 to the
placebo branch.
Calendar:
First patient first visit: February 2010, and Last patient last visit expected in February
2016. (Recruitment was initially expected to take place over a period of 24 months and was
expected to be finished in February 2012, but due to low rate of recruitment it was extended
until the population sample is included in the trial).
Title
- Brief Title: Study of REVLIMID (Lenalidomide) Versus Placebo in Patients With Low Risk Myelodysplastic Syndrome
- Official Title: Multicenter, Randomized, Double-blind, Phase III Study of REVLIMID (Lenalidomide) Versus Placebo in Patients With Low Risk Myelodysplastic Syndrome (Low and Intermediate-1 IPSS) With Alteration in 5q- and Anemia Without the Need of Transfusion.
Clinical Trial IDs
- ORG STUDY ID:
SINTRA-REV
- SECONDARY ID:
2009-013619-36
- NCT ID:
NCT01243476
Conditions
Interventions
| Drug | Synonyms | Arms |
|---|
| Lenalidomide | Revlimid 5 mg | lenalidomide |
Purpose
Trial Design:
This clinical trial is a phase III multicenter, randomized, double blind and controlled with
placebo trial and with two arms designed to assess the efficiency and toxicity of the scheme
Lenalidomide versus observation in a series of 60 patients with low risk myelodysplastic
syndrome associated to 5q deletion with anemia (Hb≤12g/dL) but without the need of
transfusion. Patients are randomized in the study in a 2:1 ratio. They will receive treatment
for 104 weeks until progression of the disease, which implies that the patient suffering from
anemia due to myelodysplastic syndrome requires transfusion of at least 2 UCH/56 days (2
months) with a minimum follow up of 112 days (4 months), or unacceptable toxicity.
Disease:
Low risk myelodysplastic syndrome associated to the loss of 5q without transfusion
requirements.
Total number of patients:
In total 60 patients will be included, 40 assigned to the treatment branch and 20 to the
placebo branch.
Calendar:
First patient first visit: February 2010, and Last patient last visit expected in February
2016. (Recruitment was initially expected to take place over a period of 24 months and was
expected to be finished in February 2012, but due to low rate of recruitment it was extended
until the population sample is included in the trial).
Detailed Description
General summary of myelodysplastic syndrome with alteration in 5q. Myelodysplastic syndromes
(MDS) are a very heterogenic group of diseases characterized by the presence of morphologic
features of dyshemopoiesis in bone marrow (BM) and in peripheral blood (PB), which is
translated into an inefficient hematopoiesis. This will lead to the concomitant development
of peripheral cytopenias which will be the cause of complications in these patients and, in
most cases, the cause of death. In addition, these patients have an increased risk of
developing acute leukemia, and this risk increases with the progression of the disease.MDS
represents an incurable disease with standard treatments with a quite variable survival mean
ranging from 3 months to 15 years depending on the number of blasts, the number of cytopenias
and the type of cytogenetic disorders2. The sole curative treatment of the MDS is the
allogenic transplant of hematopoietic progenitors but this option is only available for a 5%
of the patients with MDS.
Lenalidomide, initially known as CC-5013, is an analogue of the immunomodulator Drug
Thalidomide (Thalidomid®; Pharmion Corp., Boulder, CO, USA), which was the first drug with
anti-angiogenic and immunomodulator properties investigated in MDS. Lenalidomide has, as well
as thalidomide, a broad array of potential activities against dysplastic cells, not fully
known, among which we find immunomodulator and non-immunomodulator properties
(anti-angiogenic effect, anti-proliferative and pro-apoptotic). The greater advantage of
Lenalidomide in comparison with thalidomide is that the former is between 50 and 2000 times
stronger tan thalidomide in what respects to its immunomodulator effects. And moreover, the
toxic profile of Lenalidomide seems lower than that of its analogue; Thalidomide.
There is no treatment indication on the present times for patients with low risk MDS
associated to the loss of 5q without transfusion dependent anemia. The results with
Lenalidomide are highly promising for patients with low risk MDS associated to the loss of 5q
when (it has so been tested) there is red blood cells transfusion dependent anemia. In this
sense, the proposal consists on being able to state that treatment with Lenalidomide can be
efficient from diagnose preventing CH transfusions with an acceptable toxicity.
In this sense, the present study has the intention to treat early patients with low-risk MDS
associated to the loss of 5q with a view to prevent CH transfusion. Therefore, we could
extend in these patients the time until CH transfusion and even assess the possibility of
eradicating the disease at a cytogenetic/morphologic level. In the present trial and given
the characteristics of the patients, we have chosen the option of supplying Lenalidomide at a
dose of 5mg/day. The option of considering a lower dose to the one currently considered as
"standard" (10mg/day) is to reduce toxicity, mainly hematologic, in patients who do not
receive treatment normally. A dose with lower toxicity has been chosen which has revealed
itself efficient.
Main efficiency objective:
•To assess if treatment with Revlimid (Lenalidomide) extends the period until the progression
to myelodysplastic syndrome del(5q) considered as transfusion independent, documented
verification that the patient suffering from anemia due to MDS requires transfusion of at
least 2 UCH/56 days (2 months) with a minimum follow up of 112 days (4 months). Revlimid will
be compared to the current standard treatment for patients with low risk myelodysplastic
syndrome associated with the loss of 5qwithout transfusion dependent anemia, which is the
therapeutic abstention and monitoring until its progression.
Secondary efficiency objectives:
- Erythroid response according to the Criteria of the myelodysplastic syndrome
International Work Team 2006).
- Duration of the red blood cells transfusion independency (defined as the number of days
elapsed between the randomization and the first transfusion after this period free of
transfusions).
- Change of hemoglobin concentration (Hb) in relation to baseline levels of patients who
show erythroid response.
- Variation in platelets absolute count in relation to baseline levels.
- Variation in neutrophils absolute count in relation to baseline levels.
- Cytogenetic response according to the Criteria of the myelodysplastic syndrome
International Work Team.
- Bone marrow response according to the Criteria of the myelodysplastic syndrome
International Work Team.
- To assess the safety and tolerance of the Lenalidomide scheme, measured according to the
incidence of clinical and laboratory toxicity.
- Global survival, Event Free Survival and Rate of Transformation to Acute Leukemia.
- Time from diagnose to transfusion independence.
Main safety objective:
Safety (type, frequency and severity [Criteria of normal terminology of adverse reactions of
the National Cancer Institute (NCI CTCAE) version 3.0] of adverse reactions (AR)and list of
the AR with Lenalidomide.
Trial Arms
| Name | Type | Description | Interventions |
|---|
| lenalidomide | Experimental | Experimental treatment branch with Lenalidomide 5 mg/day (oral use) | |
| placebo | Placebo Comparator | Placebo branch (oral use) | |
Eligibility Criteria
Inclusion Criteria:
1. - The patient must, in the investigator's opinion, be able to comply with all the
clinical trial requirements.
2. - The patient must voluntarily sign the informed consent form before undergoing any
test of the trial that is not part of the normal patient care, and patient must be
aware that he/she can withdraw from the trial at any time, without it ever affecting
their future healthcare.
3. - Age > 18 years.
4. - The patient must be diagnosed with low risk MDS (low and intermediate-1 IPSS)
associated with 5q deletion, either as an isolated abnormality or accompanied by other
additional cytogenetic abnormalities.
5. - MDS Del(5q) with transfusion-independent anaemia (Hb ≤ 12 g/dL), and documented
confirmation that no packed red blood cells transfusion due to the patient's
underlying condition (MDS) has been received.
6. - The patient must have an ECOG performance status of ≤ 2.
7. - The patient must be able to comply with the scheduled study visits.
8. - Female patient with childbearing potential must*:
- Understands the teratogenic risk of the study drug.
- Commits herself to use two forms of effective birth control continuously, and is
able to use them correctly, for the 4 weeks prior to starting treatment with the
study drug, as well as during treatment with the study drug (including periods of
dose interruption), and for up to 4 weeks after finishing treatment with the
study drug, even if amenorrhoeic. This always applies, except in women who commit
to continued complete sexual abstinence, as confirmed on a monthly basis.
- The patient must understand that even if she is amenorrhoeic she must follow all
the advice on effective contraception.
- The patient must understand the possible consequences of pregnancy and the need
to attend a healthcare service urgently in case there is a risk of pregnancy.
- Agree to undergo a pregnancy test with a minimum sensitivity of 25 mIU/mL, under
medical supervision, on the day of the study visit or during the 3 days prior to
this visit, after using effective birth control for at least 4 weeks. This
requirement also applies to women with childbearing potential who practice
complete and continued sexual abstinence. The test must confirm that the patient
is not pregnant at the time the treatment is initiated.
- Agree to undergo a pregnancy test, under medical supervision, weekly for he first
28 days of treatment, and subsequently every 4 weeks, including a pregnancy test
4 weeks after finishing the study treatment, except in case of confirmed tubal
ligation. This pregnancy test will be performed on the day of the study visit or
during the 3 days prior to it. This requirement also applies to women with
childbearing potential who practice complete and continued sexual abstinence.
9. - All male patients must:
- Commit himself to the use of condoms throughout all the treatment with the study
drug, including all periods of dose interruption, and up to one week after
finishing the treatment if their partner is a woman with childbearing potential
and does not use birth control methods.
- Commit himself to not donate semen during treatment with the study drug and up to
one week after finishing the treatment.
10. - All patients must:
- Refrain from donating blood while receiving treatment with the study drug and
during the week following the end of the treatment.
- Refrain from sharing the study drug with others, and return all unused study drug
to the investigator or pharmacist.
Exclusion Criteria:
1. - Any organic disease or psychiatric disorder which makes it impossible for the
patient to sign or understand the informed consent.
2. - Having received any treatment for MDS.
3. - Del(5q) MDS with transfusion-dependent anaemia, and documented confirmation that the
patient has received any pRBC transfusion due to the underlying condition (MDS).
4. - Pregnant or breast-feeding women.
5. - Any of the following laboratory abnormalities:
- Absolute neutrophil count < 500/mm3
- Platelet count < 25,000/mm3
- Serum GOT or GPT > 3 times the upper limit of normal values.
- Total serum bilirubin > 2 times the upper limit of normal values.
6. - Previous history of other malignancies other than MDS (except for basal cell or
squamous cell skin carcinoma, or carcinoma in situ of the cervix or breast), unless
the patient has been free of disease for more than 5 years.
7. - Known hypersensitivity to or a history of uncontrollable side effects to
lenalidomide.
8. - Major surgery within the 4 weeks prior to the inclusion in the trial.
9. - The patient has received any investigational agent in the 30 days prior to
inclusion.
| Maximum Eligible Age: | N/A |
| Minimum Eligible Age: | 18 Years |
| Eligible Gender: | All |
| Healthy Volunteers: | No |
Primary Outcome Measures
| Measure: | Period until the progression of myelodysplastic syndrome |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | To assess if treatment with Revlimid (Lenalidomide) extends the period until the progression to MDS of(5q) considered as transfusion independent, documented verification that the patient suffering from anemia due to MDS requires transfusion of at least 2 UCH/56 days (2 months) with a minimum follow up of 112 days (4 months). Revlimid will be compared to the current standard treatment for patients with low risk MDS associated with the loss of 5q without transfusion dependent anemia, which is the therapeutic abstention and monitoring until its progression. |
Secondary Outcome Measures
| Measure: | Erythroid response |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Erythroid response according to the Criteria of the MDS International Work Team. |
| Measure: | Duration of the red blood cells transfusion independency |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Red blood cells transfusion independency,defined as the number of days elapsed between the randomization and the first transfusion after this period free of transfusions. |
| Measure: | Change of the hemoglobin concentration (Hb) in relation to baseline levels |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Change of the hemoglobin concentration (Hb) in relation to baseline levels of patients who show erythroid response. |
| Measure: | Variation in platelets and neutrophils absolute count in relation to baseline levels |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Variation in platelets and neutrophils absolute count in relation to baseline levels |
| Measure: | Cytogenetic response |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Cytogenetic response according to the Criteria of the MDS International Work Team. |
| Measure: | Bone marrow response |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Bone marrow response according to the Criteria of the MDS International Work Team. |
| Measure: | Global survival, Event Free Survival and Rate of Transformation to Acute Leukemia. |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Global survival, Event Free Survival and Rate of Transformation to Acute Leukemia |
| Measure: | Time from diagnose to transfusion independence. |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Time from diagnose to transfusion independence |
| Measure: | Safety( type, frequency and severity of adverse events and relationship to lenalidomide |
| Time Frame: | 6 years (study treatment and follow up) |
| Safety Issue: | |
| Description: | Safety (type, frequency and severity [Criteria of normal terminology of adverse reactions of the National Cancer Institute (NCI CTCAE) version 3.0] of adverse reactions (AR)and list of the AR with Lenalidomide. |
Details
| Phase: | Phase 3 |
| Primary Purpose: | Interventional |
| Overall Status: | Active, not recruiting |
| Lead Sponsor: | Fundación General de la Universidad de Salamanca |
Trial Keywords
- myelodysplastic syndrome
- 5q deletion
- anemia
- lenalidomide
- red blood cells transfusion
Last Updated
February 25, 2020
