Clinical Trials /

Belinostat Therapy With Zidovudine for Adult T-Cell Leukemia-Lymphoma

NCT02737046

Description:

The investigators propose to use Belinostat in combination with AZT as consolidation therapy for the treatment of ATLL.

Related Conditions:
  • Adult T-Cell Leukemia/Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Belinostat Therapy With Zidovudine for Adult T-Cell Leukemia-Lymphoma
  • Official Title: A Phase II Trial of Belinostat as Consolidation Therapy With Zidovudine for Adult T-Cell Leukemia-Lymphoma

Clinical Trial IDs

  • ORG STUDY ID: 20150567
  • NCT ID: NCT02737046

Conditions

  • Adult T-cell Leukemia-Lymphoma
  • ATLL

Interventions

DrugSynonymsArms
BelinostatPXD101, Beleodaq®Belinostat + Zidovudine
ZidovudineAZTBelinostat + Zidovudine
Interferon-Alfa-2bIFN-α-2bBelinostat + Zidovudine
Pegylated Interferon-Alfa-2bPEG-IFN-α-2bBelinostat + Zidovudine

Purpose

The investigators propose to use Belinostat in combination with AZT as consolidation therapy for the treatment of ATLL.

Trial Arms

NameTypeDescriptionInterventions
Belinostat + ZidovudineExperimentalBelinostat + Zidovudine (AZT) in combination as consolidation therapy, followed by standard zidovudine (AZT)-based maintenance therapy with optional Interferon-Alfa-2b (IFNalfa-2b) or Pegylated Interferon-Alfa-2b (PEG-IFN-alfa-2b)
  • Belinostat
  • Zidovudine
  • Interferon-Alfa-2b
  • Pegylated Interferon-Alfa-2b

Eligibility Criteria

        Inclusion Criteria:

          1. Histologically or cytologically documented adult T-cell leukemia/lymphoma (ATLL) with
             the following characteristics:

               -  Any stage of disease,

               -  Aggressive types (for definition of ATLL subtypes see Appendix H),

               -  Documented presence of ATLL cells in peripheral blood by either morphology,
                  histology, flow cytometry or gene rearrangement studies.

          2. One of the following:

               -  Received prior AZT/IFNα therapy for ≥ 2 weeks and achieved at least partial
                  hematological response defined as > 50% reduction in absolute lymphocyte count)
                  without evidence of new disease lesions or disease progression (defined as 50%
                  increase in measurable disease from nadir as in section 14.5 if imaging is
                  performed) at the time of enrollment. OR;

               -  Received chemotherapy for ≥ 2 weeks prior, followed by at least a partial
                  hematologic response ((defined as > 50% reduction in absolute lymphocyte count),
                  and without evidence of new disease lesions or disease progression (defined as
                  50% increase in absolute lymphocyte count or measurable disease from nadir as
                  specified in section 14.5 if imaging is performed) at the time of enrollment. OR;

               -  Received high-dose steroids (prednisone, methylprednisolone, or dexamethasone)
                  followed by at least a stable partial hematologic response without evidence of
                  new disease lesions or disease progression (defined as 50% increase in absolute
                  lymphocyte count or measurable disease from nadir as specified in section 14.5 if
                  imaging is performed) within 2 weeks of enrollment.

          3. Presence of residual ATLL in peripheral blood either by morphology, histology, flow
             cytometry or gene rearrangement studies (T-cell clonality) during screening prior to
             enrollment.

          4. Documented Human T-cell lymphotropic virus type 1 (HTLV-1) infection: Documentation
             may be serologic assay (ELISA) confirmed by Western blot or polymerase chain reaction
             (PCR).

          5. Measurable or evaluable disease, including presence of molecular disease as evidence
             by T-cell clonality detected by gene rearrangement studies.

          6. 18 years of age or older.

          7. Karnofsky performance status (KPS) ≥ 50% or Eastern Cooperative Oncology Group (ECOG)
             performance status ≤ 3

          8. Patients must have adequate end organ and bone marrow function as defined below:

               -  absolute neutrophil count (ANC) ≥ 1,000 cells/mm3 [Exception: Unless cytopenias
                  are secondary to ATLL]

               -  platelets (PLT) ≥ 50,000 cells/mm3 [Exception: Unless cytopenias are secondary to
                  ATLL]

               -  Adequate hepatic function:

                    -  transaminase ≤ 2.5 the institutional upper limit of normal (ULN),

                    -  total bilirubin ≤ 1.5 x the institutional upper limit of normal (ULN),
                       [Exception: Unless secondary to hepatic infiltration with lymphoma. If the
                       elevated bilirubin is felt to be secondary to Indinavir or Atazavinir
                       therapy (or anti-HIV medications), patients will be allowed to enroll.]

               -  Creatinine clearance (CrCl) ≥ 40 mL/min, [Exception: Unless secondary to renal
                  involvement by lymphoma is suspected.]

          9. Patients who are human immunodeficiency virus positive (HIV+) are also eligible.

         10. Females of childbearing potential (CBP) must have a negative serum pregnancy test
             within one week of enrollment. Women should avoid pregnancy while receiving study
             treatment. Males and females must agree to use adequate birth control during
             participation in this trial and for 3 months after completing therapy.

         11. Patients receiving erythropoietin or Granulocyte-colony stimulating factor (G-CSF)
             from baseline are eligible.

        Exclusion Criteria:

          1. Patients with progressive disease (after previous chemotherapy or AZT/IFNα) at the
             time of enrollment.

          2. Patients with chronic leukemia with favorable features, or smoldering type ATLL.

          3. Patients receiving any other investigational agents within 14 days prior to initiation
             of study therapy. (Exception: Patients actively receiving IFN-alfa-2b,
             PEG-IFN-alfa-2b, or similar forms of IFN-alfa are permitted).

          4. Uncontrolled inter-current illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure (CHF), unstable angina pectoris,
             cardiac arrhythmia, or psychiatric illness/social situations that are likely in the
             judgment of the Investigator(s) to interfere or limit compliance with study
             requirements/treatment.

          5. Pregnant or breast-feeding women.

          6. Known hypersensitivity to histone deacetylases (HDACs), zidovudine, belinostat or any
             component of the formulation(s).

          7. Acute hepatitis or decompensated liver disease unless due to lymphoma. Chronic
             hepatitis will be required to be on prophylactic treatment during the study if
             provided liver function test meet criteria listed above without evidence of cirrhosis
             to be eligible.

          8. Concurrent active malignancies, with the exception of in situ carcinoma of the cervix,
             non-metastatic, non-melanomatous skin cancer, or Kaposi's sarcoma not requiring
             systemic chemotherapy.

          9. Known New York Heart Association (NYHA) Class 3 or 4 heart disease as per Appendix D.

         10. Known ejection fraction < 45% or institutional limit of normal range

         11. Psychological, familial, sociological or geographical conditions likely in the
             judgment of the Investigator(s) to interfere or limit compliance with study
             requirements/treatment.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Proportion of Participants achieving Complete Molecular Response (CMR)
Time Frame:From End of Cycle 3 to End of Maintenance Therapy, Up to 12 Months
Safety Issue:
Description:Proportion of participants achieving Complete Molecular Response after receiving protocol therapy. Complete Molecular Response (CMR) is defined as no evidence of disease at any body sites AND the disappearance of malignant clone(s), as proven by negative T-cell receptor gene rearrangement studies of peripheral blood DNA. Molecular response will be evaluated based upon T-cell clonality studies to be conducted while subjects are on Belinostat, and while subjects are receiving AZT-based maintenance treatment (after Belinostat completion).

Secondary Outcome Measures

Measure:Rate of Participants Achieving Clinical Response
Time Frame:Up to 12 months
Safety Issue:
Description:Rate of participants achieving complete response (CR) or partial response (PR) to protocol therapy. Response is assessed on the basis of clinical, radiologic, molecular and pathologic (i.e. bone marrow) criteria.
Measure:One Year Rate of Failure-Free Survival (FFS)
Time Frame:Up to 24 months
Safety Issue:
Description:Subjects will be evaluated during treatment and by follow-up assessments post-treatment. 1-year FFS is defined as the time from study treatment initiation until documented disease progression, relapse after response or death (by any cause, in the absence of progression). In the failure-free subjects, FFS will be censored at the last documented date of failure-free status.
Measure:One Year Rate of Overall Survival (OS)
Time Frame:Up to 24 months
Safety Issue:
Description:Follow-up for OS post-treatment will occur every 3 months during year 1 post treatment under the proposed study. OS is defined as the elapsed time from study treatment initiation to death or date of censoring. Subjects alive or those lost to follow-up will be censored at the last date known to be alive.
Measure:Proportion of participants exhibiting a cytotoxic T-cell response
Time Frame:Up to 13 months
Safety Issue:
Description:Cytotoxic T-Cell response will be evaluated from serum blood samples, as well as molecular evaluation of ATLL and HTLV-1 clones
Measure:HTLV-1 pro-viral load
Time Frame:Up to 13 months
Safety Issue:
Description:Evaluated from serum blood samples

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:University of Miami

Last Updated

July 8, 2021