Description:
This study is an open label, multicenter phase 2 study. The primary objective of the study is
to determine the efficacy of brentuximab vedotin in patients treated by gemcitabine for
relapsed or refractory peripheral T-cell lymphoma in term of overall response rate assessed
after 4 cycles of treatment according to the international response criteria for malignant
lymphoma (Lugano Classification 2014 - CT-Based Response).
Title
- Brief Title: Study of Brentuximab Vedotin in Patients With R/R PTCL Treated With Gemcitabine
- Official Title: A Phase II Study of Brentuximab Vedotin in Patients With Relapsed or Refractory Peripheral T-cell Lymphoma Treated With Gemcitabine Followed by Brentuximab Vedotin Maintenance
Clinical Trial IDs
- ORG STUDY ID:
TOTAL
- NCT ID:
NCT03496779
Conditions
- Refractory Peripheral T-Cell Lymphoma
- Relapsed Peripheral T-Cell Lymphoma
Interventions
Drug | Synonyms | Arms |
---|
Brentuximab Vedotin - induction | Adcetris | Experimental |
Gemcitabine | Gemzar | Experimental |
Brentuximab Vedotin - maintenance | Adcetris | Experimental |
Purpose
This study is an open label, multicenter phase 2 study. The primary objective of the study is
to determine the efficacy of brentuximab vedotin in patients treated by gemcitabine for
relapsed or refractory peripheral T-cell lymphoma in term of overall response rate assessed
after 4 cycles of treatment according to the international response criteria for malignant
lymphoma (Lugano Classification 2014 - CT-Based Response).
Detailed Description
Currently, there is no standard treatment for patients with recurrent or refractory
peripheral T-cell lymphoma who relapse after a first line of cyclophosphamide,
hydroxydaunomycin, oncovin, and prednisone (CHOP) treatment.
Chemotherapies such as gemcitabine are used as monotherapy but the results alone are
insufficient. In addition, there is no approved monotherapy in the European Union, with the
exception of brentuximab vedotin in refractory or recurrent large systemic anaplastic
lymphomas.
Stem cell transplantation may be an option for patients who respond to a second line of
treatment or a subsequent line of treatment, but conditions for being eligible for
transplantation, including long-term remission, are infrequent.
Brentuximab vedotin (BV) is a targeted treatment directed against a protein, cluster of
differentiation antigen 30 (CD30), present on the surface of lymphoma cells. It allows
chemotherapy to enter directly into the lymphoma cell. The CD30 protein is variably expressed
in patients with relapsed or refractory T-cell lymphoma; about 50% of patients have
significant expression.
Data from clinical studies with brentuximab vedotin suggest that the addition of this
treatment to gemcitabine may be more successful than gemcitabine alone.
The main hypothesis is a 15% increase in responder patients after 4 cycles of treatment with
brentuximab vedotin and gemcitabine. The main objective of the study is therefore to
determine the overall response rate after 4 cycles of treatment according to the criteria of
Lugano 2014 (response based on CT-scan).
The secondary objectives will focus on the efficacy of brentuximab vedotin: complete response
rate, response time for responder patients, time to failure of treatment, time to next
treatment and overall survival, efficacy of brentuximab vedotin maintenance: survival
progression-free, response time, overall survival, overall response rate based on positron
emission tomography (PET)-scan and brentuximab vedotin toxicity in patients treated with
gemcitabine and in maintenance therapy.
The duration of the study is estimated to be 4.5 years including follow-up with an estimated
recruitment period of 1.5 years. 70 patients will be enrolled.
Trial Arms
Name | Type | Description | Interventions |
---|
Experimental | Experimental | Patients treated with gemcitabine will receive Brentuximab Vedotin-induction for 4 cycles of induction.
Patients who will obtain partial or complete response and who will be eligible for transplant will receive autologous or allogeneic stem cell transplantation.
Patients who will obtain partial or complete response and who will not be eligible for transplant will receive maintenance therapy with Brentuximab Vedotin-maintenance every 3 weeks for 12 infusions. | - Brentuximab Vedotin - induction
- Gemcitabine
- Brentuximab Vedotin - maintenance
|
Eligibility Criteria
Inclusion Criteria:
- Males and females of 18 years to 80 years of age;
- Understand and voluntarily sign an informed consent document prior to any study
related assessment or procedure;
- Patients able to adhere to the study visit schedule and protocol requirements;
- Patients with histologically proven, CD30 positive (at least 5% of cells according to
local examination) peripheral T-cell lymphoma (PTCL) according to the 2016 World
Health Organization (WHO) classification for whom gemcitabine treatment is expected. A
biopsy at relapse is highly recommended;
- Patients who have evidence of relapsed disease after at least one line (and no more
than three lines) of treatment or who were refractory to a first or subsequent line of
treatment;
- Patients with Ann Arbor stage I - IV;
- Patients with Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 2;
- Patients with at least one measurable disease, i.e. one nodal or extra-nodal lesion of
1.5 cm or more;
- Negative pregnancy test for females of childbearing potential (FCBP);
- Female patients of child bearing potential must use an effective method of birth
control (i.e. hormonal contraceptive, intrauterine device, diaphragm with spermicide,
condom with spermicide or abstinence) during treatment period and 6 months thereafter.
- Males must use an effective method of birth control during treatment period and 6
months thereafter.
Exclusion Criteria:
- Any significant medical condition or laboratory abnormality unrelated to PTCL, or
psychiatric illness that would prevent the patient from participating in the study and
from signing the informed consent form;
- Any condition that confounds the ability to interpret data from the study;
- Other types of lymphomas, e.g. B-cell lymphoma;
- Central nervous system and/or meningeal involvement by PTCL;
- Signs or symptoms of Progressive Multifocal Leukoencephalopathy;
- Preexistent peripheral neuropathy ≥ grade 2, whatever the cause;
- Contraindication to any drug contained in the chemotherapy regimen;
- Known hypersensitivity to recombinant proteins, murine proteins, or to any excipient
contained in the drug formulation of brentuximab vedotin;
- Subjects with HIV or HTLV1 positivity;
- Subjects with active hepatitis B or C. Chronic carriers of hepatitis B without
hepatitis B virus (HBV) DNA positive blood are eligible. Subjects with non-active
hepatitis C (with normal transaminases) are eligible;
- Chronic or acute, clinically significant, untreated bacterial, viral or fungal
infection;
- Any of the following laboratory abnormalities:
1. Absolute neutrophil count (ANC) < 1500 cells/mm3 (1.5 x 109/L);
2. Platelet count <75,000/mm3 (75 x 109/L);
3. Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 3.0 x
upper limit of normal (ULN). AST or ALT may be elevated up to 5 x ULN if their
elevation can be ascribed to the presence of hematologic/solid tumor in the
liver;
4. Serum total bilirubin > 1.5 x ULN;
5. Serum lipase level > 2 x ULN;
6. Serum creatinine > 2.0 mg/dL and/or creatinine clearance or calculated creatinine
clearance < 40 mL/minute;
7. Hemoglobin < 8g/dL;
- Active malignancies other than PTCL requiring systemic treatment;
- Previous treatment with brentuximab vedotin;
- Previous treatment with gemcitabine;
- Pregnant or lactating females or women of childbearing potential not willing to use an
adequate method of birth control for the duration of the study;
- Known history of any of the following cardiovascular conditions:
1. Myocardial infarction within 2 years of enrollment
2. New York Heart Association (NYHA) Class III or IV heart failure
3. 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
4. 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;
- Diagnosed or treated for another malignancy within 3 years before the first dose or
previously diagnosed with another malignancy and have evidence of residual disease.
Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not
excluded if they have undergone complete resection.
Maximum Eligible Age: | 80 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall Response Rate (ORR) |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | rate of patient in Complete/Partial response according to the international response criteria for malignant lymphoma (Lugano Classification 2014 - CT-Based Response). |
Secondary Outcome Measures
Measure: | Progression-Free Survival (PFS) |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | % of patient who did not progressed according to the international response criteria for malignant lymphoma (Lugano Classification 2014 - CT-Based Response). |
Measure: | Progression-Free Survival (PFS) |
Time Frame: | 4.5 years |
Safety Issue: | |
Description: | % of patient who did not progressed according to the international response criteria for malignant lymphoma (Lugano Classification 2014 - CT-Based Response). |
Measure: | Complete Response Rate (CRR) |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | rate of patient in Complete Response (CR)according to the international response criteria for malignant lymphoma (Lugano Classification 2014 - CT-Based Response). |
Measure: | Duration of Response (DoR) |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | duration between the Complete/Partial Response and the Progression according to the international response criteria for malignant lymphoma (Lugano Classification 2014 - CT-Based Response) = duration between the Complete/Partial Response and the Progression |
Measure: | Duration of Response (DoR) |
Time Frame: | 4.5 years |
Safety Issue: | |
Description: | duration between the Complete/Partial Response and the Progression according to the international response criteria for malignant lymphoma (Lugano Classification 2014 - CT-Based Response) = duration between the Complete/Partial Response and the Progression |
Measure: | Time to Treatment Failure (TTF) |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | duration between the inclusion and the premature end of treatment |
Measure: | Time to next treatment |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | Duration between the end of the studied treatment and the beginning of a new one after progression |
Measure: | Overall Survival (OS) |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | % of patient still alive |
Measure: | Overall Survival (OS) |
Time Frame: | 4.5 years |
Safety Issue: | |
Description: | % of patient still alive |
Measure: | Overall response rate |
Time Frame: | 4.5 years |
Safety Issue: | |
Description: | rate of patient in Complete/Partial response according to the international response criteria for malignant lymphoma (Lugano Classification 2014 - CT-Based Response). |
Measure: | Number of Serious Adverse Events (SAE) during the induction period |
Time Frame: | 16 weeks = 4 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | |
Measure: | Number of Serious Adverse Events (SAE) during the maintenance period |
Time Frame: | 36 weeks = 12 cycles or permanent treatment discontinuation |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | The Lymphoma Academic Research Organisation |
Trial Keywords
- Brentuximab Vedotin
- T-cell lymphoma
Last Updated
August 7, 2020