Clinical Trials /

BV-CHEP Chemotherapy for Adult T-cell Leukemia or Lymphoma

NCT03264131

Description:

Adult T-cell leukemia/lymphoma (ATLL) is a rare form of cancer found mostly among people from the Caribbean islands, Western Africa, Brazil, Iran, and Japan. Most cases of this disease in the United States occur along the East Coast due to emigration from the Caribbean islands. There is currently no standard treatment for ATLL. Research shows that patients who go into first time remission (respond completely or partially to treatment) and have a bone marrow transplant have the best outcomes. Traditional chemotherapy treatments have generally not worked well in patients with ATLL. Additionally, not all patients will be eligible for a bone marrow transplant. The purpose of this study is to see how well individuals with ATLL respond to an investigational cancer treatment. This investigational treatment combines a drug called brentuximab vedotin with a standard chemotherapy treatment made up of cyclophosphamide, doxorubicin, etoposide, and prednisone. This treatment is considered investigational because it is not approved by the United States Food and Drug Administration (FDA) for the treatment of ATLL. Brentuximab vedotin, also known as Adcetris, is approved by the United States Food and Drug Administration (FDA) for treatment of certain types of lymphomas, including peripheral T-cell lymphomas when combined with cyclophosphamide, doxorubicin, and prednisone in patients whose cancer cells express a type of marker called CD30. Brentuximab vedotin is an antibody that also has a chemotherapy drug attached to it. Antibodies are proteins that are part of the immune system. They can stick to and attack specific targets on cancer cells. The antibody part of brentuximab vedotin sticks to a target called cluster of differentiation 30 (CD30) that is located on the outside of the cancer cells. Normal cells have little or no CD30 on their surface. ATLL cancer cells often have a larger amount of CD30 on their surface than normal cells. However, CD30 is found in different amounts on ATLL cancer cells. This study will also test the amount of CD30 found on each participant's cancer cells. Researchers will be looking to see if the response to the study treatment varies based on the amount of CD30 found on the outside participants' cancer cells. In another study, brentuximab vedotin was combined in another study with cyclophosphamide, doxorubicin, and prednisone. The study included patients with various types of T-cell lymphomas. Two of the patients enrolled in that study had ATLL. Both had a complete response (no evidence of disease). The researchers in this study (LCCC 1637) have added etoposide to the combination of brentuximab vedotin with cyclophosphamide, doxorubicin, and prednisone. They predict that the addition of etoposide will improve patient outcomes. Research shows that etoposide helps improve outcomes in patients with certain types of T-cell lymphomas who undergo chemotherapy treatment. This investigational combination of brentuximab vedotin with cyclophosphamide, doxorubicin, etoposide, and prednisone is called BV-CHEP.

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

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: BV-CHEP Chemotherapy for Adult T-cell Leukemia or Lymphoma
  • Official Title: Brentuximab Vedotin With Cyclophosphamide, Doxorubicin, Etoposide, and Prednisone (BV-CHEP) for the Treatment of Adult T-Cell Leukemia/Lymphoma: A Phase II Trial of the Rare Lymphoma Working Group

Clinical Trial IDs

  • ORG STUDY ID: LCCC 1637
  • NCT ID: NCT03264131

Conditions

  • Lymphoma
  • Adult T-Cell Leukemia/Lymphoma
  • Lymphatic Diseases

Interventions

DrugSynonymsArms
Brentuximab VedotinOpen-label, Multicenter, Single-Arm
CHEPOpen-label, Multicenter, Single-Arm

Purpose

Adult T-cell leukemia/lymphoma (ATLL) is a rare form of cancer found mostly among people from the Caribbean islands, Western Africa, Brazil, Iran, and Japan. Most cases of this disease in the United States occur along the East Coast due to emigration from the Caribbean islands. There is currently no standard treatment for ATLL. Research shows that patients who go into first time remission (respond completely or partially to treatment) and have a bone marrow transplant have the best outcomes. Traditional chemotherapy treatments have generally not worked well in patients with ATLL. Additionally, not all patients will be eligible for a bone marrow transplant. The purpose of this study is to see how well individuals with ATLL respond to an investigational cancer treatment. This investigational treatment combines a drug called brentuximab vedotin with a standard chemotherapy treatment made up of cyclophosphamide, doxorubicin, etoposide, and prednisone. This treatment is considered investigational because it is not approved by the United States Food and Drug Administration (FDA) for the treatment of ATLL. Brentuximab vedotin, also known as Adcetris, is approved by the United States Food and Drug Administration (FDA) for treatment of certain types of lymphomas, including peripheral T-cell lymphomas when combined with cyclophosphamide, doxorubicin, and prednisone in patients whose cancer cells express a type of marker called CD30. Brentuximab vedotin is an antibody that also has a chemotherapy drug attached to it. Antibodies are proteins that are part of the immune system. They can stick to and attack specific targets on cancer cells. The antibody part of brentuximab vedotin sticks to a target called cluster of differentiation 30 (CD30) that is located on the outside of the cancer cells. Normal cells have little or no CD30 on their surface. ATLL cancer cells often have a larger amount of CD30 on their surface than normal cells. However, CD30 is found in different amounts on ATLL cancer cells. This study will also test the amount of CD30 found on each participant's cancer cells. Researchers will be looking to see if the response to the study treatment varies based on the amount of CD30 found on the outside participants' cancer cells. In another study, brentuximab vedotin was combined in another study with cyclophosphamide, doxorubicin, and prednisone. The study included patients with various types of T-cell lymphomas. Two of the patients enrolled in that study had ATLL. Both had a complete response (no evidence of disease). The researchers in this study (LCCC 1637) have added etoposide to the combination of brentuximab vedotin with cyclophosphamide, doxorubicin, and prednisone. They predict that the addition of etoposide will improve patient outcomes. Research shows that etoposide helps improve outcomes in patients with certain types of T-cell lymphomas who undergo chemotherapy treatment. This investigational combination of brentuximab vedotin with cyclophosphamide, doxorubicin, etoposide, and prednisone is called BV-CHEP.

Detailed Description

      STUDY OBJECTIVES

      Primary Objective To define the proportion of subjects with CR after 4-6 cycles of
      brentuximab vedotin in combination with cyclophosphamide, doxorubicin, etoposide, and
      prednisone (BV-CHEP) in the treatment of adult T-cell leukemia/lymphoma.

      Secondary Objectives

      To estimate the overall response rate (ORR) with 4-6 cycles of BV-CHEP therapy in patients
      with adult T-cell leukemia/lymphoma.

      To determine progression-free survival (PFS) for BV-CHEP in patients with adult T-cell
      leukemia/lymphoma who received or did not receive BV maintenance.

      To determine duration of response to BV-CHEP in patients with adult T-cell leukemia/lymphoma
      who received or did not receive BV maintenance.

      To determine overall survival (OS) of patients with adult T-cell leukemia/lymphoma treated
      with BV-CHEP who received or did not receive BV maintenance therapy.

      To evaluate the toxicity and tolerability of BV-CHEP and BV maintenance therapy via the
      National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE v4.03).

      *Note: After completion or withdrawal from BV-CHEP therapy, patients will segregate into one
      of the following groups: 1) those who progressed on BV-CHEP; 2) those who completed 4-6
      cycles of BV-CHEP and went on to allogeneic transplant; 3) those who completed 6 cycles of
      BV-CHEP but were CD30 negative and ineligible for maintenance therapy; and 4) those who
      completed 6 cycles of BV-CHEP, were CD30 positive, but continued study treatment on BV in the
      maintenance phase of the study.

      ENDPOINTS

      Primary Endpoint

      Criteria for CR after 4-6 cycles of BV-CHEP will be based on the International Workshop to
      standardize response criteria for malignant lymphomas (ie, Lugano Criteria per Cheson, et al.
      J Clin Oncol. 2014;32(27):3059-68).

      Secondary Endpoints

      Criteria for overall response will be based on the International Workshop to standardize
      response criteria for malignant lymphomas (ie, Lugano Criteria per Cheson, et al. J Clin
      Oncol. 2014;32(27):3059-68).

      PFS is defined as time from D1 of treatment until disease progression (based on Lugano
      criteria) or death from any cause.

      Duration of response is defined as the time from documentation of tumor response per Lugano
      criteria to disease progression

      OS is defined as the time from D1 of treatment until death from any cause

      Toxicity and tolerability of therapy will be assessed via the NCI CTCAE v4.03

      TREATMENT INFORMATION

      Patients will undergo screening to see if they are eligible. If eligible, participants will
      start by receiving 2 cycles of BV-CHEP (cycles 1 and 2). After 2 cycles of BV-CHEP,
      participants will have a positron emission tomography/computed tomography (PET/CT) or a CT
      scan to assess their disease. If the scan shows the cancer has stayed the same or gotten
      better, participants may continue taking BV-CHEP for two more cycles (cycle 3 and 4). If, at
      any time during study treatment, a participant's disease gets worse, the participant will end
      study treatment and other treatment options will be discussed with you.

      If a participant continues on BV-CHEP, at the beginning of cycle 5, the participant will have
      a PET/CT scan. If the cancer has gotten better and the participant is eligible for a bone
      marrow transplant, he/she will have the transplant. If the participant is not eligible for a
      bone marrow transplant and the cancer has stayed the same or gotten better, the participant
      may continue on BV-CHEP for two more cycles (cycles 5 and 6).

      At the end of cycle 6 of BV-CHEP, participants will have another PET/CT scan. If the scan
      shows the cancer has gotten better and the participant is eligible for a bone marrow
      transplant, he/she will have the transplant. If a participant is not eligible for a bone
      marrow transplant and his/her cancer cells did not test positive for CD30, the participant
      will end study treatment. The study doctor will discuss other treatment options that are not
      part of this study with the participant.

      Participants may continue on brentuximab vedotin alone as maintenance therapy if:

        -  They are not eligible for a bone marrow transplant,

        -  Their cancer cells tested positive for CD30, and

        -  Their cancer has not gotten worse after taking BV-CHEP.

      Participants will be removed from BV maintenance therapy if their cancer get worse.

      DURATION OF THERAPY Therapy in LCCC 1637 involves up to 6 cycles of treatment with
      brentuximab vedotin (BV) with a chemotherapy treatment made up of cyclophosphamide,
      doxorubicin, etoposide, and prednisone (CHEP). Each cycle is 21 days long. Participants may
      continue on BV alone as maintenance therapy after 6 cycles of BV-CHEP if they meet the
      requirements outlined above. Each cycles of BV maintenance therapy is 21-day long. BV
      maintenance therapy may continue until a participant's disease progresses.

      DURATION OF FOLLOW-UP PERIOD Participants will be followed for survival for up to 5 years.
      They will also have a PET/CT or CT scan and a blood test every 6 months for 2 years after
      study treatment ends.
    

Trial Arms

NameTypeDescriptionInterventions
Open-label, Multicenter, Single-ArmExperimentalThis is a single-arm intervention where patients will receive concurrent therapy with BV+CHEP [(brentuximab vedotin; 1.8 mg/kg IV, on D1 every 21 days) (cyclophosphamide 750 mg/m^2 on D1; doxorubicin 50 mg/m^2 on D1, etoposide 100 mg/m^2 IV infusion on D1-3; prednisone 100 mg orally once daily on D1-5; cycle length every 21 days)] for 4 to 6 cycles of induction therapy. After 6 cycles of BV + CHEP, responders (CR, PR or SD) who are not eligible for BMT and have CD30-positive ATLL will continue maintenance therapy with BV alone (1.8 mg/kg IV, every 21 days) until disease progression, withdrawal due to toxicity or death.
  • Brentuximab Vedotin
  • CHEP

Eligibility Criteria

        Inclusion Criteria:

        Subjects must meet all of the following inclusion criteria to participate in this study:

          1. Informed consent and HIPAA authorization for release of personal health information
             obtained.

          2. Age ≥ 18 years at the time of consent.

          3. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-2.

          4. Histological confirmation of biopsy-proven peripheral T-cell leukemia/lymphoma
             consistent with ATLL

               -  Included subtypes will be: acute, lymphomatous, and chronic unfavorable. Chronic
                  unfavorable is defined as the chronic variant with at least one of the following:
                  lactate dehydrogenase (LDH)>upper limit of normal (ULN), blood urea nitrogen
                  (BUN)>ULN, Albumin<lower limit of normal (LLN)

               -  Positive human T-lymphotropic virus-1 (HTLV-1) antibody testing with confirmatory
                  testing via Western blot, enzyme-linked immunosorbent assay (ELISA), or molecular
                  testing (PCR).

          5. Documented negative serologic testing for human immunodeficiency virus (HIV).

          6. If positive for HBV exposure or prior infection, can continue to participate in trial
             with prophylactic entecavir (for HBV). If positive for hepatitis c virus (HCV)
             exposure or active infection, can participate in trial with monitoring for liver
             function abnormalities.

          7. Demonstrate adequate organ function as defined below; all screening labs to be
             obtained within three days prior to study treatment.

             System: Renal -Calculated creatinine clearance

             Laboratory Value: ≥ 30 mL/min using the Cockcroft-Gault formula for subjects with
             creatinine levels > 2.0 x institutional ULN

             System: Hepatic - Bilirubin

             Laboratory Value: ≤ 3.0 mg/dL

             System: Hepatic - Aspartate aminotransferase (AST)

             Laboratory Value: ≤ 2.5 × ULN

             System: Hepatic - Alanine aminotransferase (ALT)

             Laboratory Value: ≤ 2.5 × ULN

          8. Females of childbearing potential must have a negative serum pregnancy test within
             three days (72 hours) prior to initiating study treatment. NOTE: Females are
             considered of child bearing potential unless they are surgically sterile (have
             undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they
             are naturally postmenopausal for at least 12 consecutive months.

          9. Females of childbearing potential must be willing to abstain from heterosexual
             activity or to use 2 forms of effective methods of contraception from the time of
             informed consent until 24 weeks (6 months) after treatment discontinuation. The two
             contraception methods can be comprised of two barrier methods, or a barrier method
             plus a hormonal method or an intrauterine device that meets <1% failure rate for
             protection from pregnancy in the product label.

         10. Male patients with female partners must have had a prior vasectomy or agree to use an
             adequate method of contraception (i.e., double barrier method: condom plus spermicidal
             agent) starting with the first dose of study therapy through 24 weeks (6 months) after
             the last dose of study therapy.

         11. As determined by the enrolling physician or protocol designee, willingness and ability
             of the subject to understand and comply with study procedures

         12. Prior Treatment: Previously untreated or has received a maximum of one cycle of any
             combination chemotherapy (e.g. cyclophosphamide, doxorubicin, vincristine, prednisone
             (CHOP), CHOEP, DA-EPOCH, doxorubicin, cyclophosphamide, cytarabine, vincristine,
             methotrexate/Etoposide, ifosfamide, cytarabine, methotrexate (CODOX-M/IVAC),
             HyperCVAD) within 4 weeks of signing the main consent form. Additionally, a patient
             may have taken antiretroviral therapy (e.g. azidothymidine (AZT) and/or IFN) at any
             time prior to study enrollment

         13. CD30 expression determined by flow cytometry or IHC. NOTE: If CD30 testing was
             previously done on the biopsy sample from diagnosis, this information will be
             collected. If CD30 testing was not done, an archival sample from the biopsy used for
             diagnosis will be requested and tested for CD30. CD30 testing will also be done on the
             bone marrow tissue collected from the bone marrow exam. If we are unable to obtain an
             archival sample or if the bone marrow exam is negative, a new biopsy will be performed
             to confirm the diagnosis and test for CD30.

        Exclusion Criteria:

        Subjects who meet any of the following criteria should be excluded from study
        participation:

          1. Pregnant or breastfeeding (NOTE: breast milk cannot be stored for future use while the
             mother is being treated on study).

          2. Has a known additional malignancy that is active and/or progressive requiring
             treatment; exceptions include basal cell or squamous cell skin cancer, in situ
             cervical or bladder cancer, or other cancer for which the subject has been
             disease-free for at least five years.

          3. Previous exposure to brentuximab vedotin (BV).

          4. History of allergic response to BV-CHEP or its components or to any of the required
             prophylactic medications or reasonable alternatives.

          5. Symptomatic cardiac disease including ventricular dysfunction, left ventricular
             ejection fraction < 40%, symptomatic coronary artery disease or symptomatic
             arrhythmias

          6. Subjects with severe hepatic insufficiency Child-Pugh Score > 6

          7. Subjects with severe renal impairment (i.e., creatinine clearance ≤ 30 mL/min; see
             Appendix B - Renal Impairment Guidelines).

          8. Exclude patients with pre-existing neuropathy grade 2 or higher.

          9. Patients receiving prohibited medications listed in the patient handout provided in
             11.4 Appendix D: Prohibited Medications or Those to be used with Caution (ie,
             ketoconazole, itraconazole, ritonavir, macrolide antibiotics, erythromycin phenytoin,
             phenobarbital, carbamazepine, and valproic acid).

         10. Patients with a parenchymal brain lesion thought to be consistent with active lymphoma
             on screening CT/MRI. Of note, patients with cerebrospinal fluid (CSF) involvement
             alone are not excluded.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Proportion of subjects with Complete Response after 4-6 cycles of brentuximab vedotin in combination with cyclophosphamide, doxorubicin, etoposide, and prednisone (BV-CHEP)
Time Frame:18 weeks
Safety Issue:
Description:Criteria for CR after 4-6 cycles of BV-CHEP will be based on the International Workshop to standardize response criteria for malignant lymphomas (i.e. Lugano Criteria).

Secondary Outcome Measures

Measure:Overall response rate (ORR) associated with 4-6 cycles of BV-CHEP therapy in patients with adult T-Cell leukemia/lymphoma.
Time Frame:70 weeks
Safety Issue:
Description:ORR will be evaluated as the rate of complete responses (CR) + partial responses (PR) as defined by the International Workshop to standardize response criteria for malignant lymphomas (i.e. Lugano Criteria). Patients with leukemic component to their disease at baseline will be assessed per Adult T-Cell Leukemia/Lymphoma National Comprehensive Cancer Network (NCCN) guidelines version 2.2017
Measure:Progression-free survival (PFS) for BV-CHEP in patients with adult T-cell leukemia/lymphoma who received or did not receive BV maintenance.
Time Frame:3 years
Safety Issue:
Description:PFS will be assessed from day 1 of treatment until disease progression (based on International Workshop to standardize response criteria for malignant lymphomas (i.e. Lugano Criteria).
Measure:Duration of response to BV-CHEP in patients with adult T-cell leukemia/lymphoma who received or did not receive BV maintenance.
Time Frame:3 years
Safety Issue:
Description:Duration of response is defined as the time from documentation of tumor response per Lugano criteria to disease progression.
Measure:Overall survival (OS) of patients with adult T-cell leukemia/lymphoma treated with BV-CHEP who received or did not receive BV maintenance therapy.
Time Frame:3 years
Safety Issue:
Description:Overall survival is defined as the time from day 1 of treatment until death from any cause.
Measure:Toxicity and tolerability of BV-CHEP and BV maintenance therapy via National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE v4)
Time Frame:70 weeks
Safety Issue:
Description:Toxicity and tolerability of therapy will be assessed via the NCI CTCAE v4.03

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:UNC Lineberger Comprehensive Cancer Center

Trial Keywords

  • Brentuximab Vedotin
  • Adcetris
  • Lymphoma
  • Leukemia
  • CD30

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