Clinical Trials /

Ibrutinib, Rituximab, and Consolidation Chemotherapy in Treating Young Patients With Newly Diagnosed Mantle Cell Lymphoma

NCT02427620

Description:

This phase II trial studies how well ibrutinib, rituximab, and consolidation chemotherapy consisting of cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, dexamethasone, methotrexate, and cytarabine work in treating young patients with newly diagnosed mantle cell lymphoma. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as rituximab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, dexamethasone, methotrexate, and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more cancer cells. Giving ibrutinib together with rituximab and consolidation chemotherapy may be a better treatment for mantle cell lymphoma.

Related Conditions:
  • Mantle Cell Lymphoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Ibrutinib, Rituximab, and Consolidation Chemotherapy in Treating Young Patients With Newly Diagnosed Mantle Cell Lymphoma
  • Official Title: A Phase II Study of Ibrutinib Plus Rituximab With Hyper-CVAD Consolidation in Newly Diagnosed Young Patients With Mantle Cell Lymphoma: A Window Period for Bioimmunotherapy Before Chemotherapy

Clinical Trial IDs

  • ORG STUDY ID: 2014-0559
  • SECONDARY ID: NCI-2015-00960
  • SECONDARY ID: 2014-0559
  • SECONDARY ID: P30CA016672
  • NCT ID: NCT02427620

Conditions

  • Blastoid Variant Mantle Cell Lymphoma
  • CD20 Positive
  • Mantle Cell Lymphoma
  • Pleomorphic Variant Mantle Cell Lymphoma

Interventions

DrugSynonymsArms
Cyclophosphamide(-)-Cyclophosphamide, 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate, Carloxan, Ciclofosfamida, Ciclofosfamide, Cicloxal, Clafen, Claphene, CP monohydrate, CTX, CYCLO-cell, Cycloblastin, Cycloblastine, Cyclophospham, Cyclophosphamid monohydrate, Cyclophosphamidum, Cyclophosphan, Cyclophosphane, Cyclophosphanum, Cyclostin, Cyclostine, Cytophosphan, Cytophosphane, Cytoxan, Fosfaseron, Genoxal, Genuxal, Ledoxina, Mitoxan, Neosar, Revimmune, Syklofosfamid, WR- 138719Treatment (ibrutinib, rituximab, consolidation chemotherapy)
Cytarabine.beta.-Cytosine arabinoside, 1-.beta.-D-Arabinofuranosyl-4-amino-2(1H)pyrimidinone, 1-.beta.-D-Arabinofuranosylcytosine, 1-Beta-D-arabinofuranosyl-4-amino-2(1H)pyrimidinone, 1-Beta-D-arabinofuranosylcytosine, 1.beta.-D-Arabinofuranosylcytosine, 2(1H)-Pyrimidinone, 4-Amino-1-beta-D-arabinofuranosyl-, 2(1H)-Pyrimidinone, 4-amino-1.beta.-D-arabinofuranosyl-, Alexan, Ara-C, ARA-cell, Arabine, Arabinofuranosylcytosine, Arabinosylcytosine, Aracytidine, Aracytin, Aracytine, Beta-cytosine Arabinoside, CHX-3311, Cytarabinum, Cytarbel, Cytosar, Cytosine Arabinoside, Cytosine-.beta.-arabinoside, Cytosine-beta-arabinoside, Erpalfa, Starasid, Tarabine PFS, U 19920, U-19920, Udicil, WR-28453Treatment (ibrutinib, rituximab, consolidation chemotherapy)
DexamethasoneAacidexam, Adexone, Aknichthol Dexa, Alba-Dex, Alin, Alin Depot, Alin Oftalmico, Amplidermis, Anemul mono, Auricularum, Auxiloson, Baycadron, Baycuten, Baycuten N, Cortidexason, Cortisumman, Decacort, Decadrol, Decadron, Decadron DP, Decalix, Decameth, Decasone R.p., Dectancyl, Dekacort, Deltafluorene, Deronil, Desamethasone, Desameton, Dexa-Mamallet, Dexa-Rhinosan, Dexa-Scheroson, Dexa-sine, Dexacortal, Dexacortin, Dexafarma, Dexafluorene, Dexalocal, Dexamecortin, Dexameth, Dexamethasone Intensol, Dexamethasonum, Dexamonozon, Dexapos, Dexinoral, Dexone, Dinormon, Fluorodelta, Fortecortin, Gammacorten, Hexadecadrol, Hexadrol, Lokalison-F, Loverine, Methylfluorprednisolone, Millicorten, Mymethasone, Orgadrone, Spersadex, TaperDex, Visumetazone, ZoDexTreatment (ibrutinib, rituximab, consolidation chemotherapy)
DoxorubicinAdriablastin, Hydroxydaunomycin, Hydroxyl Daunorubicin, HydroxyldaunorubicinTreatment (ibrutinib, rituximab, consolidation chemotherapy)
Doxorubicin Hydrochloride5,12-Naphthacenedione, 10-[(3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, hydrochloride, (8S-cis)- (9CI), ADM, Adriacin, Adriamycin, Adriamycin Hydrochloride, Adriamycin PFS, Adriamycin RDF, ADRIAMYCIN, HYDROCHLORIDE, Adriamycine, Adriblastina, Adriblastine, Adrimedac, Chloridrato de Doxorrubicina, DOX, DOXO-CELL, Doxolem, Doxorubicin HCl, Doxorubicin.HCl, Doxorubin, Farmiblastina, FI 106, FI-106, hydroxydaunorubicin, RubexTreatment (ibrutinib, rituximab, consolidation chemotherapy)
IbrutinibBTK Inhibitor PCI-32765, CRA-032765, Imbruvica, PCI-32765Treatment (ibrutinib, rituximab, consolidation chemotherapy)
MethotrexateAbitrexate, Alpha-Methopterin, Amethopterin, Brimexate, CL 14377, CL-14377, Emtexate, Emthexat, Emthexate, Farmitrexat, Fauldexato, Folex, Folex PFS, Lantarel, Ledertrexate, Lumexon, Maxtrex, Medsatrexate, Metex, Methoblastin, Methotrexate LPF, Methotrexate Methylaminopterin, Methotrexatum, Metotrexato, Metrotex, Mexate, Mexate-AQ, MTX, Novatrex, Rheumatrex, Texate, Tremetex, Trexeron, Trixilem, WR-19039Treatment (ibrutinib, rituximab, consolidation chemotherapy)
RituximabABP 798, BI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-102, IDEC-C2B8, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, PF-05280586, Rituxan, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar GB241, Rituximab Biosimilar IBI301, Rituximab Biosimilar PF-05280586, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SAIT101, rituximab biosimilar TQB2303, rituximab-abbs, RTXM83, TruximaTreatment (ibrutinib, rituximab, consolidation chemotherapy)
VincristineLEUROCRISTINE, VCR, VincrystineTreatment (ibrutinib, rituximab, consolidation chemotherapy)
Vincristine SulfateKyocristine, Leurocristine sulfate, Leurocristine, sulfate, Oncovin, Vincasar, Vincosid, Vincrex, Vincristine, sulfateTreatment (ibrutinib, rituximab, consolidation chemotherapy)

Purpose

This phase II trial studies how well ibrutinib, rituximab, and consolidation chemotherapy consisting of cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, dexamethasone, methotrexate, and cytarabine work in treating young patients with newly diagnosed mantle cell lymphoma. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as rituximab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, dexamethasone, methotrexate, and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more cancer cells. Giving ibrutinib together with rituximab and consolidation chemotherapy may be a better treatment for mantle cell lymphoma.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To evaluate the response rate of ibrutinib plus rituximab in young newly diagnosed mantle
      cell lymphoma (MCL) including young high-risk patients.

      SECONDARY OBJECTIVES:

      I. To evaluate the progression free survival of ibrutinib plus rituximab with rituximab -
      cyclophosphamide, vincristine (vincristine sulfate), doxorubicin (doxorubicin hydrochloride),
      and dexamethasone (hyper-CVAD) consolidation in newly diagnosed MCL patients and in high-risk
      patients.

      II. To further evaluate the toxicity profile of the ibrutinib/rituximab combination and
      consolidation therapy.

      III. To estimate the rate of complete response (CR) prior to and following consolidation
      therapy.

      IV. To estimate the response duration and overall survival. V. To analyze progression free
      survival in a subgroup of patients presenting with high risk features after receiving an
      additional 2 years of maintenance therapy with rituximab and ibrutinib at doses used in part
      1 of the study, starting after part 2 of the study ends.

      OUTLINE:

      PART I (IBRUTINIB PLUS RITUXIMAB): Patients receive ibrutinib orally (PO) once daily (QD) on
      days 1-28 and rituximab intravenously (IV) over 6-8 hours on days 1, 8, 15, and 22 of cycle 1
      and then over 4 hours on day 1 of cycles 3-12. Treatment repeats every 28 days for up to 12
      cycles in the absence of disease progression or unacceptable toxicity or until patients
      achieve complete response.

      PART II (CONSOLIDATION THERAPY): Patients receive rituximab IV over 6 hours on day 1;
      dexamethasone PO or IV on days 1-4; cyclophosphamide IV over 3 hours twice daily (BID) on
      days 2-4; doxorubicin hydrochloride IV over 15-30 minutes on day 5; and vincristine sulfate
      IV over 15-30 minutes on day 5 of cycles 1, 3, 5, and 7. Patients also receive rituximab IV
      over 6 hours on day 1; methotrexate IV over 24 hours on day 2; and cytarabine IV over 2 hours
      BID on days 3 and 4 of cycles 2, 4, 6, and 8. Treatment repeats every 28 days for up to 8
      cycles in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up every 4 months for 2 years,
      every 6 months for 2 years, and then annually thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (ibrutinib, rituximab, consolidation chemotherapy)ExperimentalPART I (IBRUTINIB PLUS RITUXIMAB): Patients receive ibrutinib PO QD on days 1-28 and rituximab IV over 6-8 hours on days 1, 8, 15, and 22 of cycle 1 and then over 4 hours on day 1 of cycles 3-12. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity or until patients achieve complete response. PART II (CONSOLIDATION THERAPY): Patients receive rituximab IV over 6 hours on day 1; dexamethasone PO or IV on days 1-4; cyclophosphamide IV over 3 hours BID on days 2-4; doxorubicin hydrochloride IV over 15-30 minutes on day 5; and vincristine sulfate IV over 15-30 minutes on day 5 of cycles 1, 3, 5, and 7. Patients also receive rituximab IV over 6 hours on day 1; methotrexate IV over 24 hours on day 2; and cytarabine IV over 2 hours BID on days 3 and 4 of cycles 2, 4, 6, and 8. Treatment repeats every 28 days for up to 8 cycles in the absence of disease progression or unacceptable toxicity.
  • Cyclophosphamide
  • Cytarabine
  • Dexamethasone
  • Doxorubicin
  • Doxorubicin Hydrochloride
  • Ibrutinib
  • Methotrexate
  • Rituximab
  • Vincristine
  • Vincristine Sulfate

Eligibility Criteria

        Inclusion Criteria:

          -  Patient has a confirmed diagnosis of mantle cell lymphoma with CD20 positivity in
             tissue biopsy

          -  Patients with MCL must be symptomatic and need immediate therapy; symptoms and nature
             of MCL include any of the following:

               -  Blastoid variant

               -  Pleomorphic variant

               -  B symptoms

               -  Mantle Cell International Prognostic Score (MIPI) > 3

               -  Ki-67 >= 30%

               -  Bulky tumors > 7 cm or in case of >= 2 tumors, each >= 5 cm in diameter

               -  Disease threatening organ function

               -  Elevated lactate dehydrogenase (LDH)

               -  Peripheral blood white blood cell (PB WBC) > 50,000

               -  Pancytopenia due to bone marrow MCL

               -  Patient's choice due to anxiety

               -  Pain due to lymphoma

               -  Somatic mutations in the TP53, c-MYC or NOTCH genes

               -  Size of spleen >= 20 cm

          -  Patients with mantle cell lymphoma with any of the following will be considered
             "high-risk" for the purpose of this protocol:

               -  Blastoid or pleomorphic histology

               -  Ki-67 index larger than 30%

               -  Bulky tumor of larger than 7 cm or in case of multiple tumors, larger than or
                  equal to 5 cm each in diameter

               -  Somatic mutations in the TP53, c-MYC or NOTCH genes

               -  Size of spleen >= 20 cm

          -  Patient has newly diagnosed disease with no prior therapy

          -  Understand and voluntarily sign an Institutional Review Board (IRB)-approved informed
             consent form

          -  Patients should have bi-dimensional measurable disease using the Cheson criteria
             (measurable disease by computed tomography [CT] scan defined as at least 1 lesion that
             measures >= 1.5 cm in single dimension)

          -  Gastrointestinal or bone marrow or spleen only patients are allowable

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less

          -  An absolute neutrophil count (ANC) > 1,000/mm^3 (patients who have bone marrow
             infiltration by MCL are eligible if their ANC is >= 500/mm^3 [growth factor allowed];
             these patients should be discussed with either the principal investigator [PI] or
             Co-PI of the study for final approval)

          -  Platelet count > 100,000/mm^3 (patients who have bone marrow infiltration by MCL are
             eligible if their platelet level is equal to or > than 20,000/mm^3; these patients
             should be discussed with either the PI or Co-PI of the study for final approval)

          -  Serum bilirubin < 1.5 mg/dl

          -  Creatinine (Cr) clearance >= 30 mL/min

          -  Aspartate transaminase (AST)/serum glutamic oxaloacetic transaminase (SGOT) and
             alanine transaminase (ALT)/serum glutamic-pyruvate transaminase (SGPT) < 2 x upper
             limit of normal or < 5 x upper limit of normal if hepatic metastases are present;
             Gilbert's disease is allowed

          -  Cardiac ejection fraction >= 50% by echocardiogram (ECHO) or multiple gated
             acquisition scan (MUGA)

          -  Disease free of prior malignancies with exception of currently treated basal cell,
             squamous cell carcinoma of the skin, carcinoma "in situ" of the cervix or breast, or
             other malignancies in remission (including prostate cancer patients in remission from
             radiation therapy, surgery or brachytherapy), not actively being treated

          -  Females of childbearing potential (FCBP)* must have a negative serum or urine
             pregnancy test (within 30 days of initiation of protocol therapy) and must be willing
             to use acceptable methods of birth control; men must agree to use a latex condom
             during sexual contact with a female of childbearing potential even if they have had a
             successful vasectomy

               -  A female of childbearing potential is a sexually mature woman who: 1) has not
                  undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
                  postmenopausal for at least 24 consecutive months (i.e., has had menses at any
                  time in the preceding 24 consecutive months)

        Exclusion Criteria:

          -  Any serious medical condition including but not limited to, uncontrolled hypertension,
             uncontrolled diabetes mellitus, active/symptomatic coronary artery disease, chronic
             obstructive pulmonary disease (COPD), renal failure, active hemorrhage, or psychiatric
             illness that, in the investigators opinion places the patient at unacceptable risk and
             would prevent the subject from signing the informed consent form

          -  Pregnant or breast feeding females

          -  Known human immunodeficiency virus (HIV) infection

          -  Patients with active hepatitis B or C infection (not including patients with prior
             hepatitis B vaccination); these patients should be cleared by gastrointestinal (GI)
             consultation for hepatitis B and infectious disease consult for hepatitis C

          -  All patients with central nervous system lymphoma

          -  Significant neuropathy (grades 3 - 4, or grade 2 with pain) within 14 days prior to
             enrollment

          -  Contraindication to any of the required concomitant drugs or supportive treatments or
             intolerance to hydration due to preexisting pulmonary or cardiac impairment including
             pleural effusion requiring thoracentesis or ascites requiring paracentesis unless due
             to lymphoma

          -  Malabsorption syndrome, disease significantly affecting gastrointestinal function, or
             resection of the stomach or small bowel or ulcerative colitis, symptomatic
             inflammatory bowel disease, or partial or complete bowel obstruction, or any other
             gastrointestinal condition that could interfere with the absorption and metabolism of
             ibrutinib

          -  Major surgery within 4 weeks of initiation of therapy; clearance letter from primary
             physician required

          -  Requires anticoagulation with warfarin or equivalent vitamin K antagonist

          -  Requires treatment with strong cytochrome P4503A (CYP3A) inhibitors

          -  Patients with New York Heart Association (NYHA) class III and IV heart failure,
             myocardial infarction in the preceding 6 months, and significant conduction
             abnormalities, including but not limited to 2nd degree atrioventricular block (AV
             block) type II, 3rd degree block, QT prolongation (corrected QT [QTc] > 500
             millisecond [msec]), sick sinus syndrome, ventricular tachycardia, symptomatic
             bradycardia (heart rate < 50 beats per minute [bpm]), hypotension, light headedness
             and syncope; patients with persistent and uncontrolled atrial fibrillation will be
             excluded; the protocol excludes patients who have recently had a stent and by
             recommendation of their cardiologist need to stay on anticoagulants such as warfarin
             or equivalent vitamin K antagonist

          -  Acute infection requiring treatment (IV antibiotics, antivirals, or antifungals)
             within 14 days prior to initiation of study
      
Maximum Eligible Age:65 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall response rate (complete response + partial response)
Time Frame:At 8 weeks
Safety Issue:
Description:Will be monitored using the Bayesian stopping boundaries calculated based on beta-binomial distribution. Logistic regression will be utilized to assess the effect of patient prognostic factors on the response rate.

Secondary Outcome Measures

Measure:Incidence of adverse events
Time Frame:At 4 weeks
Safety Issue:
Description:Will be monitored using the Bayesian stopping boundaries calculated based on beta-binomial distribution. Logistic regression will be utilized to assess the effect of patient prognostic factors on the toxicity rate. Toxicity data by type and severity will be summarized by frequency tables.
Measure:Overall survival
Time Frame:Up to 6 years
Safety Issue:
Description:Will be estimated using the method of Kaplan and Meier. Comparison of time-to-event endpoints by important subgroups will be made using the log-rank test.
Measure:Progression free survival
Time Frame:Up to 6 years
Safety Issue:
Description:Will be estimated using the method of Kaplan and Meier. Comparison of time-to-event endpoints by important subgroups will be made using the log-rank test.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

November 4, 2019