Clinical Trials /

Brentuximab Vedotin and Lenalidomide in Treating Patients With Stage IB-IVB Relapsed or Refractory T-Cell Lymphoma

NCT03409432

Description:

This phase II trial studies how well brentuximab vedotin and lenalidomide work in treating patients with stage IB-IVB T-cell lymphoma that have come back or do not respond to treatment. Monoclonal antibodies, such as brentuximab vedotin, may interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as lenalidomide, 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 brentuximab vedotin and lenalidomide may work better in treating patients with T-cell lymphoma.

Related Conditions:
  • Lymphomatoid Papulosis
  • Primary Cutaneous Anaplastic Large Cell Lymphoma
  • Primary Cutaneous T Cell Non-Hodgkin Lymphoma
  • Transformed Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Brentuximab Vedotin and Lenalidomide in Treating Patients With Stage IB-IVB Relapsed or Refractory T-Cell Lymphoma
  • Official Title: A Phase II Study of Brentuximab Vedotin and Lenalidomide in Relapsed and Refractory T-Cell Lymphomas

Clinical Trial IDs

  • ORG STUDY ID: OSU-17204
  • SECONDARY ID: NCI-2017-02221
  • SECONDARY ID: OSU-17204
  • SECONDARY ID: P30CA016058
  • NCT ID: NCT03409432

Conditions

  • Lymphomatoid Papulosis
  • Primary Cutaneous Anaplastic Large Cell Lymphoma
  • Recurrent Primary Cutaneous T-Cell Non-Hodgkin Lymphoma
  • Recurrent T-Cell Non-Hodgkin Lymphoma
  • Refractory Primary Cutaneous T-Cell Non-Hodgkin Lymphoma
  • Stage I Cutaneous T-Cell Non-Hodgkin Lymphoma
  • Stage II Cutaneous T-Cell Non-Hodgkin Lymphoma
  • Stage III Cutaneous T-Cell Non-Hodgkin Lymphoma
  • Stage IV Cutaneous T-Cell Non-Hodgkin Lymphoma

Interventions

DrugSynonymsArms
Brentuximab VedotinADC SGN-35, Adcetris, Anti-CD30 Antibody-Drug Conjugate SGN-35, Anti-CD30 Monoclonal Antibody-MMAE SGN-35, Anti-CD30 Monoclonal Antibody-Monomethylauristatin E SGN-35, cAC10-vcMMAE, SGN-35Treatment (brentuximab vedotin, lenalidomide)
LenalidomideCC-5013, CC5013, CDC 501, RevlimidTreatment (brentuximab vedotin, lenalidomide)

Purpose

This phase II trial studies how well brentuximab vedotin and lenalidomide work in treating patients with stage IB-IVB T-cell lymphoma that have come back or do not respond to treatment. Monoclonal antibodies, such as brentuximab vedotin, may interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as lenalidomide, 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 brentuximab vedotin and lenalidomide may work better in treating patients with T-cell lymphoma.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the overall response rate (ORR) of the combination of brentuximab vedotin
      (BV) and lenalidomide in patients with relapsed or refractory cutaneous T-cell lymphoma
      (CTCL)/peripheral T-cell lymphoma (PTCL).

      SECONDARY OBJECTIVES:

      I. To estimate the duration of response and 2 year progression-free survival (PFS) and
      overall survival (OS) associated with the combination of brentuximab vedotin (BV) and
      lenalidomide in patients with relapsed or refractory CTCL/PTCL.

      II. To define the qualitative and quantitative toxicities of the combination of brentuximab
      vedotin (BV) and lenalidomide in patients with relapsed or refractory CTCL/PTCL.

      TERTIARY OBJECTIVES:

      I. To correlate between the expression of CD30 in neoplastic cells by immunohistochemistry
      (IHC) and overall response rate (ORR) of the combination of brentuximab vedotin (BV) and
      lenalidomide in patients with relapsed or refractory CTCL/PTCL.

      II. To determine T-cell and natural killer (NK) cell subset numbers, phenotype, and
      functional status in relapsed or refractory (rel/ref) CTCL/PTCL patients, and whether the
      combination of brentuximab vedotin and lenalidomide alters these parameters during therapy.

      III. To determine changes in plasma cytokine levels and other biomarkers in this patient
      population during therapy with the combination of brentuximab vedotin and lenalidomide.

      OUTLINE:

      Patients receive brentuximab vedotin intravenously (IV) over 30 minutes on day 1 and
      lenalidomide orally (PO) once daily (QD) on day 1-21. Treatment repeats every 21 days for up
      to 16 courses in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up every 3 months for 2 years.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (brentuximab vedotin, lenalidomide)ExperimentalPatients receive brentuximab vedotin IV over 30 minutes on day 1 and lenalidomide PO QD on day 1-21. Treatment repeats every 21 days for up to 16 courses in the absence of disease progression or unacceptable toxicity.
  • Brentuximab Vedotin
  • Lenalidomide

Eligibility Criteria

        Inclusion Criteria:

          -  Able to understand and voluntarily sign an informed consent form

          -  Able to adhere to the study visit schedule and other protocol requirements

          -  Biopsy-proven, measurable, stage IB-IVB relapsed or refractory cutaneous T-cell
             lymphoma after 2 lines of skin-directed therapy or one prior line of systemic therapy

               -  (Note: extracorporeal photopheresis will be considered a systemic therapy for
                  this study)

          -  Patients with large cell transformation of cutaneous T cell lymphoma are eligible

          -  Patients with advanced stage non-mycosis fungoides (MF) CTCL are eligible including,
             but not limited to, advanced stage lymphomatoid papulosis (LyP) or primary cutaneous
             anaplastic large cell lymphoma (pcALCL)

          -  Patients with systemic T cell lymphoma of any stage and any subtypes; patient must
             have had at least one standard chemotherapy and measurable disease at the time of
             enrollment; bidimensional measurable disease of at least 1.5 cm in the greatest
             transverse diameter as documented by computed tomography (CT) or positron emission
             tomography (PET)/CT

          -  Patients with systemic T cell lymphomas who relapsed after autologous transplant are
             eligible

          -  Prior treatment with brentuximab vedotin is allowed provided the patient did not
             progress on BV or within 30 days of last dose of BV; patients must be at least 3
             months from the last dose of BV

          -  CD30 staining is to be performed on fresh biopsy or archival formalin-fixed
             paraffin-embedded (FFPE) tissue however CD30 positivity is not required for
             eligibility

          -  All cancer therapy, including radiation, topical steroid, and chemotherapy must have
             been discontinued at least 1 week or 3 half-lives whichever is the longest prior to
             treatment in this study; the only exceptions are participants who are symptomatic from
             their skin lesions and have been on corticosteroids for prolonged periods of time (>
             60 days) without change may continue use of either systemic steroids (equivalent to <
             10 mg per day of prednisone) or topical steroids are eligible for this study if the
             frequency and dosage steroids has not changed for 60 days prior to the study; these
             participants should continue on the same dose of systemic/topical steroid throughout
             the study period unless they achieve a complete response at which time steroids can be
             discontinued; patients are allowed to continue any medications with known activity in
             T cell lymphomas at the pre-enrollment doses for conditions other than T cell
             lymphomas (ie, steroids for sarcoidosis), as long as there is evidence of T cell
             lymphoma progression while patients were on these agents

          -  Eastern Cooperative Oncology Group (ECOG) performance status of =< 2 at study entry

          -  Absolute neutrophil count >= 1000/mm^3

          -  Platelet count >= 50,000/mm^3

          -  Total bilirubin =< 2 x upper limit of normal (ULN)

          -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and
             alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3 x
             ULN

          -  AST (SGOT) and ALT (SGPT) =< 5 x ULN in patients with documented hepatic involvement
             by lymphoma

          -  Calculated creatinine clearance >= 60 ml/min (by the Cockcroft-Gault equation)

          -  Disease free of prior malignancies for >= 5 years with exception of currently treated
             basal cell, squamous cell carcinoma of the skin, or carcinoma in situ of the cervix or
             breast; patients with early stage of prostate cancer under clinical surveillance
             without therapy are eligible

          -  Negative serum pregnancy test at the time of enrollment for females of childbearing
             potential

          -  Women of childbearing potential must follow pregnancy testing requirements as outlined
             in the Revlimid Risk Evaluation and Mitigation Strategy (REMS) program material; this
             is defined as either commit to continued abstinence from heterosexual intercourse or
             begin TWO acceptable methods of contraception (one highly effective method and one
             additional effective method (AT THE SAME TIME) at least 28 days prior to the start of
             lenalidomide, for the duration of study participation, and for 28 days following the
             last doses of brentuximab vedotin and lenalidomide; women of childbearing potential
             must also agree to ongoing pregnancy testing; men must agree to use a latex condom
             during sexual contact with a woman of childbearing potential even if they have had a
             successful vasectomy; all patients must be counseled at a minimum of every 28 days
             about pregnancy precautions and risks of fetal exposure; should a woman become
             pregnant or suspect she is pregnant while participating in this study, she must inform
             her treating physician immediately

          -  All study participants must be registered into the mandatory Revlimid REMS program and
             be willing to comply with its requirements; per standard Revlimid REMS program
             requirements, all physicians who prescribe lenalidomide for research subjects enrolled
             into this trial, must be registered in, and must comply with, all requirements of the
             Revlimid REMS program

          -  Life expectancy > 30 days

        Exclusion Criteria:

          -  Patients with active central nervous system (CNS) involvement with lymphoma are not
             eligible

          -  Patients with pre-existing grade >= 3 peripheral neuropathy

          -  Patients with known human immunodeficiency virus (HIV) infection or are not eligible

          -  Patients who had solid organ transplants are not eligible

          -  Evidence of active hepatitis B infection, based on positive surface antigen or
             hepatitis B deoxyribonucleic acid (DNA) polymerase chain reaction (PCR), or active
             hepatitis C infection; patients who are hepatitis B core antibody positive must take
             prophylaxis with lamivudine or equivalent and be willing to undergo monthly hepatitis
             B DNA PCR testing

          -  Present or history of progressive multifocal leukoencephalopathy (PML)

          -  Prior allogeneic stem cell transplant is not permitted

          -  Unable to swallow capsules or 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 likely to interfere with the delivery, absorption, or metabolism of
             lenalidomide

          -  Patients may take steroids for disease control up to 24 hours prior to study
             enrollment; topical steroids are allowed for CTCL patients as described in inclusion
             criteria above

          -  Any illness, medical condition or organ system dysfunction which, in the
             investigator?s opinion, could compromise the subject?s safety, interfere with the
             absorption or metabolism of lenalidomide, or put the study outcomes at undue risk

          -  A cardiovascular disability status of New York Heart Association class >= 2

          -  History of severe allergic reactions to humanized monoclonal antibodies

          -  History of other malignancy that could affect compliance with the protocol or
             interpretation of results; patients with a history of curatively treated basal or
             squamous cell carcinoma or stage 1 melanoma of the skin or in situ carcinoma of the
             cervix are eligible; individuals in documented remission without treatment for 2 years
             prior to enrollment may be included at the discretion of the investigator; patients
             with early stage of prostate cancer under clinical surveillance without therapy are
             eligible

          -  Known hypersensitivity to any of the study drugs or analogs

          -  Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection
             (excluding fungal infections of nail beds) at study enrollment, or any major episode
             of infection requiring treatment with IV antibiotics or hospitalization (relating to
             the completion of the course of antibiotics) within 4 weeks prior study therapy

          -  Clinically significant history of liver disease, including viral or other hepatitis,
             current alcohol abuse, or cirrhosis

          -  Receipt of live-virus vaccines within 28 days prior to the initiation of study
             treatment or need for live-virus vaccines at any time during study treatment

          -  Recent major surgery (within 6 weeks prior to the start of study treatment) other than
             for diagnosis

          -  Receiving immunosuppressive therapy

          -  Refractory to prior therapy with brentuximab vedotin (evidence of progression within
             30 days of the last dose)

          -  Prior therapy with lenalidomide

          -  Pregnant or lactating, or intending to become pregnant during the study
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall response rate
Time Frame:Up to 2 years
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Incidence of adverse events according to National Cancer Institute Common Toxicity Criteria for Adverse Events (CTCAE) version 4.0
Time Frame:Up to 30 days after last day of study treatment
Safety Issue:
Description:
Measure:Overall survival (OS)
Time Frame:From start of study treatment to date of death due to any cause, assessed up to 2 years
Safety Issue:
Description:Kaplan-Meier method will be used to estimate OS.
Measure:Progression free survival (PFS)
Time Frame:From start of study treatment to first documentation of tumor progression (including radiographic and clinical progression) or to death due to any cause, whichever comes first, assessed up to 2 years
Safety Issue:
Description:Kaplan-Meier method will be used to estimate PFS.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Basem William, MD

Last Updated

March 19, 2018