Description:
The trial assess the maximum tolerated dose of a single-dose of Brentuximab Vedotin added to
standard BeEAM chemotherapy (comprising Bendamustin, Etoposide, Cyclophosphamide and
Melphalan) before autologous stem cell transplantation in CD30+ malignant lymphomas.
Title
- Brief Title: Brentuximab Vedotin and BeEAM High-dose Chemotherapy in Lymphomas
- Official Title: Brentuximab Vedotin and BeEAM High-dose Chemotherapy (B-BeEAM) With Autologous Stem Cell Transplantation for CD30+ Lymphomas, a Phase I/II Study
Clinical Trial IDs
- ORG STUDY ID:
BAL-Trial
- NCT ID:
NCT03187210
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Brentuximab Vedotin | | Arm B (Phase II) |
BeEAM Regimen | | Arm A (Phase II) |
Purpose
The trial assess the maximum tolerated dose of a single-dose of Brentuximab Vedotin added to
standard BeEAM chemotherapy (comprising Bendamustin, Etoposide, Cyclophosphamide and
Melphalan) before autologous stem cell transplantation in CD30+ malignant lymphomas.
Detailed Description
Background and Rationale:
CD30+ lymphomas typically comprise Hodgkin lymphomas and a variety of T-cell non-Hodgkin
lymphoma (T-NHL) entities including angioimmunoblastic T-cell lymphomas (AITL), anaplastic
ALK+ large-cell T-cell lymphomas (ALCL), Sézary-syndrome, peripheral T-NHL NOS and other rare
malignant T-cell lymphoma types.
The prognosis of patients with Hodgkin lymphoma (HL) is excellent for the majority of these
usually young patients; however, HL patients relapsing after autologous stem-cell
transplantation (ASCT) have a rather poor outcome, with approximately only up to 20% of the
patients surviving longer than 5 years. For those in advanced stage Hodgkin's lymphoma
multiple first-line and second-line treatments, including the combination of doxorubicin,
bleomycin, vinblastine, and dacarbazine (ABVD) - internationally, the most widely used
regimen in Hodgkin's lymphoma - is expected to cure about 70-80% of patients. However, in
addition to treatment failures noted for ABVD, the regimen is often associated with
unpredictable bleomycin-induced lung related toxic effects that can be life-threatening.
Although High Dose Chemotherapy (HDCT) with ASCT is a curative strategy for some patients
with relapsing Hodgkin lymphomas, relapse or progression after ASCT is a major limitation of
this procedure. For these reason, the outcome of Hodgkin lymphoma patients relapsing after
ASCT is poor, and novel concepts for such patients is an unmet clinical need.
CD30+ T-NHL generally have a limited prognosis, with a minority of patients being cured after
specific lymphoma treatment. The incorporation of consolidating high-dose chemotherapy with
autologous stem cell transplantation for young fit patients within the first-line treatment
algorithms has improved the prognosis of such patients to some extent. However, the majority
of such patients still ultimately die of their disease. Again, improvement of lymphoma
treatment is an urgent requirement for these patients.
Brentuximab Vedotin (BV; Adcetris®) is an antibody-drug conjugate and is licensed in
Switzerland and the European Medicine Agency region for the single-agent treatment of
relapsed and refractory Hodgkin lymphoma or for relapsed and refractory anaplastic T-cell
lymphoma.
BeEAM high-dose chemotherapy (comprising Bendamustin, Etoposide, Cyclophosphamide and
Melphalan) is the standard conditioning regimen before ASCT for lymphoma patients.
In this trial BV will be used together with BeEAM high-dose chemotherapy according to its
conventional schedule in CD30+ lymphomas as conditioning regimen before ASCT.
Objective:
Phase I: The primary objective of the trial is to assess the maximum tolerated dose of a
single-dose of Brentuximab Vedotin added to standard BeEAM chemotherapy before autologous
stem cell transplantation in CD30+ malignant lymphomas.
Phase II: The main objective of the trial is to assess differences in disease-free survival
between CD30+ lymphoma patients treated with the standard BeEAM high-dose chemotherapy versus
Brentuximab Vedotin together with BeEAM (B-BeEAM) high-dose chemotherapy. We aim to
demonstrate an improvement by 20% of the rate of disease-free survival 1 year after ASCT
(DFS1) from 70% in patients treated with BeEAM alone to 90% in patients treated with the
combination of B-BeEAM.
Study Duration:
Phase I part was planned to last from 3 to 18 months (permitting the enrolment of minimum of
6 patients). The Phase I has been stopped after the RP2D (1.8mg/kg/day) was established with
enrolment of 12 patient in 24 months. The Phase II will stop after the inclusion of 42
evaluable patients.
All patients will be followed up for up to 12 months after end of treatment..
This study will be conducted in compliance with the protocol, the current version of the
Declaration of Helsinki, the ICH-GCP or ISO EN 14155 (as far as applicable) as well as all
national legal and regulatory requirements.
Trial Arms
Name | Type | Description | Interventions |
---|
Dosis finding (Phase I) | Experimental | Brentuximab Vedotin at day -8 together with standard BeEAM (Bendamustine, Cytarabine, Etoposide and Melphalan) chemotherapy at days -7 to -1 followed by reinfusion of autologous stem cells at day 0 | - Brentuximab Vedotin
- BeEAM Regimen
|
Arm A (Phase II) | Active Comparator | BeEAM Regimen:
Bendamustine intravenously once daily on days -7 and -6 at 200 mg/m2/day; Cytarabine (ARA-C) 400 mg/m2/day intravenously once daily from day -5 to day-2; Etoposide 200 mg/m2/day intravenously once daily from day -5 to day -2; and Melphalan 140 mg/m2/day intravenously once on day -1, followed by reinfusion of autologous stem cells at day 0 | |
Arm B (Phase II) | Experimental | Brentuximab Vedotin 1.8 mg/kg at day -8 together with standard BeEAM chemotherapy at days -7 to -1
BeEAM Regimen:
Bendamustine intravenously once daily on days -7 and -6 at 200 mg/m2/day; Cytarabine (ARA-C) 400 mg/m2/day intravenously once daily from day -5 to day-2; etoposide 200 mg/m2/day intravenously once daily from day -5 to day -2; and Melphalan 140 mg/m2/day intravenously once on day -1, followed by reinfusion of autologous stem cells at day 0 | - Brentuximab Vedotin
- BeEAM Regimen
|
Eligibility Criteria
Inclusion Criteria:
- Eligible are all CD30+ malignant lymphoma, meaning lymphoma subtypes such as Hodgkin
lymphomas, angioimmunoblastic T-cell lymphomas (AITL), anaplastic ALK+ T-cell
lymphomas, Sézary-syndrome, but also all other malignant CD30+ lymphoma types.
- Patients must be in first or second remission or second chemosensitive relapse and
patients must be planned to undergo subsequent consolidation with standard high-dose
chemotherapy with autologous stem cell transplantation.
- Patients must be aged 18-75 years, and must have given voluntary written informed
consent.
- Negative pregnancy test (urine or serum) within 14 days prior to registration for all
women of childbearing potential. Patients of childbearing potential must implement two
effective contraceptive measures (hormonal treatment p.o. or i.m., intra uterine
surgical devices, or latex condoms) to avoid pregnancy from the time of signing
informed consent and for additional 12 months. No pregnant or lactating patients are
allowed.
- Male patients, even if surgically sterilized, (i.e., status post vasectomy) agree to
practice effective barrier contraception during the entire study period and through 12
months after the last dose of study drug, or agrees to completely abstain from
heterosexual intercourse.
- Absolute neutrophil count ≥ 1,500/µL unless there is known hematologic/solid tumor
marrow involvement.
- Platelet count ≥ 75,000/ µL unless there is known marrow involvement of the disease.
- Total bilirubin must be < 1.5 x the upper limit of the normal (ULN) unless the
elevation is known to be due to Gilbert syndrome.
- ALT or AST must be < 3 x the upper limit of the normal range. AST and ALT may be
elevated up to 5 times the ULN if their elevation can be reasonably ascribed to the
presence of hematologic/solid tumor in liver.
- Serum creatinine must be < 2.0 mg/dL and/or calculated creatinine clearance > 40
mL/minute (Cockcroft-Gault).
- Hemoglobin must be ≥ 8g/dL.
Exclusion Criteria:
- Patients considered to be not fit for autologous stem cell transplantation (ASCT).
- Patients with other serious medical condition that interfere with the completion of
treatment according to this protocol or that would impair tolerance to therapy or
prolong hematological recovery. Patients with seropositivity for HIV or for Hepatitis
B and C are not excluded from this study if they are otherwise considered fit for
ASCT.
- Symptomatic neurologic disease compromising normal activities of daily living or
requiring medications. Any sensory or motor peripheral neuropathy greater than or
equal to Grade 2.
- Known history of any of the following cardiovascular conditions: Myocardial infarction
within 2 years of registration, New York Heart Association (NYHA) Class III or IV
heart failure (See Appendix 5). Evidence of current uncontrolled cardiovascular
conditions, including cardiac arrhythmias, congestive heart failure (CHF), angina, or
electrocardiographic evidence of acute ischemia or active conduction system
abnormalities, Recent evidence (within 6 months before first dose of study drug) of a
left-ventricular ejection fraction <50%.
- Patients that have not completed any prior treatment chemotherapy and/or other
investigational agents within at least 5 half-lives of last dose of that prior
treatment. Known hypersensitivity to recombinant proteins, murine proteins, or to any
excipient contained in the drug formulation of Brentuximab Vedotin.
- Acute uncontrolled infection.
- Relevant co-existing disease excluding a treatment according to protocol.
- Concurrent malignant disease with the exception of basalioma/spinalioma of the skin,
early-stage cervix carcinoma, or early-stage prostate cancer. • Previous treatment for
other malignancies (not listed above) must have been terminated at least 24 months
before registration and no evidence of active disease must be documented since then.
- Lack of patient cooperation to allow study treatment as outlined in this protocol.
- Pregnant or lactating female patients.
- Major coagulopathy or bleeding disorder.
- Major surgery less than 30 days before start of treatment.
Maximum Eligible Age: | 65 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Phase 1: Dose finding |
Time Frame: | 30 days |
Safety Issue: | |
Description: | to identify the maximum tolerated dose of Brentuximab Vedotin added to standard BeEAM high-dose chemotherapy testing three dose levels. |
Secondary Outcome Measures
Measure: | Phase 1: disease-free survival |
Time Frame: | 12 months |
Safety Issue: | |
Description: | Number of Patient with disease-free survival 12 months after ASCT |
Measure: | Overall survival |
Time Frame: | 12 Months |
Safety Issue: | |
Description: | Number of Patient alive after 12 months |
Measure: | Adverse Events |
Time Frame: | 12 months |
Safety Issue: | |
Description: | Number of Patient experiencing toxicity(Adverse events |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | University Hospital Inselspital, Berne |
Trial Keywords
- CD30+ Lymphoma
- ASCT
- Brentuximab Vedotin
Last Updated
August 5, 2021