Description:
This is a phase II study using risk and response-adapted therapy for low, intermediate and
high risk classical Hodgkin lymphoma. Chemotherapy regimens will be based on risk group
assignment. Low-risk and intermediate- risk patients will be treated with bendamustine,
etoposide, Adriamycin® (doxorubicin), bleomycin, Oncovin® (vincristine), vinblastine, and
prednisone (BEABOVP) chemotherapy. High-risk patients will receive Adcetris® (brentuximab
vedotin), etoposide, prednisone and Adriamycin® (doxorubicin) (AEPA) and cyclophosphamide,
Adcetris® (brentuximab vedotin), prednisone and Dacarbazine® (DTIC) (CAPDac) chemotherapy.
Residual node radiotherapy will be given at the end of all chemotherapy only to involved
nodes that do not have an adequate response (AR) after 2 cycles of therapy for all risk
groups.
Title
- Brief Title: Pediatric Classical Hodgkin Lymphoma Consortium Study: cHOD17
- Official Title: Pediatric Classical Hodgkin Lymphoma Consortium Study: cHOD17
Clinical Trial IDs
- ORG STUDY ID:
cHOD17
- SECONDARY ID:
NCI-2018-02924
- NCT ID:
NCT03755804
Conditions
Interventions
Drug | Synonyms | Arms |
---|
bendamustine | TREANDA (R) | Intermediate-Risk |
Etoposide | VP-16, Vepeside | High-Risk |
Doxorubicin | Adriamycin (R) | High-Risk |
Bleomycin | Blenoxane (R) | Intermediate-Risk |
Vincristine | Oncovin (R) | Intermediate-Risk |
Vinblastine | Velban (R) | Intermediate-Risk |
Prednisone | Prednisolone | High-Risk |
Filgrastim | Neupogen (R) | High-Risk |
Brentuximab Vedotin | Adcetris | High-Risk |
Cyclophosphamide | Cytoxan (R) | High-Risk |
DTIC | DACARBAZINE (R), Dimethyl Triazeno Imidazole Carboximide | High-Risk |
Purpose
This is a phase II study using risk and response-adapted therapy for low, intermediate and
high risk classical Hodgkin lymphoma. Chemotherapy regimens will be based on risk group
assignment. Low-risk and intermediate- risk patients will be treated with bendamustine,
etoposide, Adriamycin® (doxorubicin), bleomycin, Oncovin® (vincristine), vinblastine, and
prednisone (BEABOVP) chemotherapy. High-risk patients will receive Adcetris® (brentuximab
vedotin), etoposide, prednisone and Adriamycin® (doxorubicin) (AEPA) and cyclophosphamide,
Adcetris® (brentuximab vedotin), prednisone and Dacarbazine® (DTIC) (CAPDac) chemotherapy.
Residual node radiotherapy will be given at the end of all chemotherapy only to involved
nodes that do not have an adequate response (AR) after 2 cycles of therapy for all risk
groups.
Detailed Description
PRIMARY OBJECTIVES
- To evaluate the efficacy (adequate response) after 2 cycles of BEABOVP (bendamustine
substitution for mechlorethamine in the original Stanford V chemotherapy backbone) in
low-risk and intermediate-risk patients with classical Hodgkin lymphoma (cHL).
- To estimate the event-free survival in high-risk patients with classical Hodgkin
lymphoma (cHL).
SECONDARY OBJECTIVES
- To describe the acute hematologic and infectious toxicities of BEABOVP (bendamustine
substitution for mechlorethamine in the original Stanford V chemotherapy backbone) in
patients with low-risk and intermediate- risk cHL as they relate to transfusion
requirements, hematopoietic growth factor support, episodes of febrile neutropenia and
hospitalizations, according to the NCI Common Terminology Criteria for Adverse Events
(CTCAE), version 5.0.
- To describe the acute hematologic, neuropathic, and infectious toxicities of AEPA/CAPDac
in patients with high-risk cHL as they relate to transfusion requirements, hematopoietic
growth factor support, episodes of grade 3 and 4 sensory or motor neuropathy, episodes
of febrile neutropenia and hospitalizations, according to the NCI Common Terminology
Criteria for Adverse Events (CTCAE), version 5.0.
- To evaluate patterns of failure in irradiated and non-irradiated patients.
- To estimate the EFS functions of LR and IR patients, and compare with those in
previously published studies.
- To estimate the response rate in HR patients and compare with historical and literature
rates.
- To compare response rates in LR and IR patients with historical and literature rates.
- To compare the EFS function of HR patients with that in previously published studies.
EXPLORATORY OBJECTIVES
- To evaluate the plasma pharmacokinetics of bendamustine along with predictors of its
variability when used as part of BEABOVP regimen for pediatric cHL patients
- To explore the patterns and dynamics of T-cell clonality in classical Hodgkin lymphoma
- To explore the association between TARC, total metabolic tumor volume, stage, risk group
and treatment response.
- To establish next generation sequencing of ctDNA as a reliable method of non-invasively
profiling tumor-associated mutations in pediatric patients with HL.
- To determine if kinetics of ctDNA in patients with pediatric HL during treatment are
predictive of outcome.
- To obtain baseline testing by St. Jude Lifetime Study (SJLIFE) to allow for enhanced
survivorship follow-up:
- Neurologic testing
- Neurocognitive testing
- Quantitative brain imaging
- Polysomnography
- Cardiovascular testing (valvular testing, arterial elasticity, carotid-femoral
pulse wave velocity, orthostatic hypotension, heart rate variability
- Neuropathy screening
- Changes in body mass index composition during therapy
Low-risk and Intermediate-risk: Low-risk patients will receive 2 cycles of BEABOVP and
Intermediate-risk patients will receive 3 cycles of BEABOVP.
BEABOVP regimen: Patients will receive bendamustine day 1, etoposide day 15, Adriamycin®
(doxorubicin) days 1 and 15, bleomycin days 8 and 22, Oncovin® (vincristine) days 8 and 22,
vinblastine days 1 and 15, and prednisone two or three times per day every other day of each
cycle for a total of 14 days of steroids.
High-risk patients will receive 2 cycles of AEPA and 4 cycles of CAPDac.
AEPA regimen: Patients will receive Adcedris® (brentuximab vedotin) days 1, 8 and 15,
etoposide days 1 to 5, prednisone two or three times daily days 1 to 15 and Adriamycin®
(doxorubicin) days 1 and 15.
CAPDac regimen: Patients will receive cyclophosphamide days 1 and 8, Adcetris® (brentuximab
vedotin) days 1 and 8, prednisone two or three times daily days 1 to 15 and Dacarbazine®
(DTIC) days 1 to 3.
Residual node radiotherapy will be given at the end of all chemotherapy only to involved
nodes that do not have an AR after 2 cycles of therapy for all risk groups.
Steroids will be omitted after 2 cycles for any IR or HR patient with an AR after 2 cycles of
therapy.
Trial Arms
Name | Type | Description | Interventions |
---|
Low-Risk | Experimental | Participants receive 2 cycles of BEABOVP: bendamustine, etoposide, Adriamycin® (doxorubicin), bleomycin, Oncovin® (vincristine), vinblastine and prednisone. Filgrastim may be given as clinically indicated. Dexrazoxane may be given at the discretion of the treating investigator. Residual node radiotherapy will be given at the end of all chemotherapy only to involved nodes that do not have an AR after 2 cycles of therapy. Quality of Life measurements will be done. | - bendamustine
- Etoposide
- Doxorubicin
- Bleomycin
- Vincristine
- Vinblastine
- Prednisone
- Filgrastim
|
Intermediate-Risk | Experimental | Participants receive 3 cycles of BEABOVP: bendamustine, etoposide, Adriamycin® (doxorubicin), bleomycin, Oncovin® (vincristine), vinblastine and prednisone. For patients with an AR after 2 cycles of therapy, steroids will be omitted from their subsequent cycles of therapy. Filgrastim may be given as clinically indicated. Dexrazoxane may be given at the discretion of the treating investigator. Residual node radiotherapy will be given at the end of all chemotherapy only to involved nodes that do not have an AR after 2 cycles of therapy. Quality of Life measurements will be done. | - bendamustine
- Etoposide
- Doxorubicin
- Bleomycin
- Vincristine
- Vinblastine
- Prednisone
- Filgrastim
|
High-Risk | Experimental | Participants receive 2 cycles of AEPA: Adcedris® (brentuximab vedotin), etoposide, prednisone and Adriamycin® (doxorubicin) and 4 cycles of CAPDac: cyclophosphamide, Adcetris® (brentuximab vedotin), prednisone and Dacarbazine® (DTIC). For patients with an AR after 2 cycles of therapy, steroids will be omitted from their subsequent cycles of therapy. Filgrastim may be given as clinically indicated. Dexrazoxane may be given at the discretion of the treating investigator. Residual node radiotherapy will be given at the end of all chemotherapy only to involved nodes that do not have an AR after 2 cycles of therapy. Quality of Life measurements will be done. | - Etoposide
- Doxorubicin
- Prednisone
- Filgrastim
- Brentuximab Vedotin
- Cyclophosphamide
- DTIC
|
Eligibility Criteria
Inclusion Criteria:
- Histologically confirmed, previously untreated CD30+ classical HL. (Participants are
still eligible if they received limited emergent RT or steroid therapy - maximum of 7
days if within the last month or as approved by PI).
- Age ≤ 21 years at the time of diagnosis (i.e., participants are eligible until their
22nd birthday) for low-risk and intermediate-risk
- Age ≤ 25 years at the time of diagnosis (i.e., participants are eligible until their
26th birthday) for high-risk
- All Ann Arbor stages.
- Low-Risk: IA, IIA (excluding patients with "E" lesions or mediastinal bulk)
- Intermediate-Risk: IA or IIA with "E" lesions or bulky mediastinal adenopathy
(mediastinal mass to thoracic cavity ratio 33% or greater by chest radiograph)
and IB, IIIA.
- High-Risk: IIB, IIIB, IV
- Adequate renal function based on GFR ≥ 70 ml/min/1.73m2 OR serum creatinine adjusted
for age and gender as follows: Age 1 to < 2 years: maximum serum creatinine 0.6 mg/dL
for males and 0.6 mg/dL for females, Age 2 to < 6 years: maximum serum creatinine 0.8
mg/dL for males and 0.8 mg/dL for females, Age 6 to < 10 years: maximum serum
creatinine 1 mg/dL for males and 1 mg/dL for females, Age 10 to < 13 years: maximum
serum creatinine 1.2 mg/dL for males and 1.2 mg/dL for females, Age 13 to < 16 years:
maximum serum creatinine 1.5 mg/dL for males and 1.4 mg/dL for females, Age ≥16 years:
maximum serum creatinine 1.7 mg/dL for males and 1.4 mg/dL for females
- Adequate hepatic function (total bilirubin ≤ 1.5 x ULN for age, and AST/ALT ≤ 2.5 x
ULN for age).
- Adequate hematologic criteria at baseline, unless secondary to Hodgkin disease
diagnosis
- Absolute neutrophil count (ANC) ≥1000/µL
- Platelets ≥ 75,000/µL
- Adequate cardiac function defined as shortening fraction of ≥ 27% by echocardiogram or
MUGA, unless decreased function is due to large mediastinal mass or effusion related
to HL.
- Adequate pulmonary function defined as no evidence of dyspnea at rest, no exercise
intolerance, and a pulse oximetry > 92% on room air unless secondary to a large
mediastinal mass or effusion related to HL.
- Female participant who is post-menarchal must have a negative urine or serum pregnancy
test.
- Female or male participant of reproductive potential must agree to use an effective
contraceptive method throughout duration of study treatment.
Exclusion Criteria:
- CD30 negative HL.
- Has received prior therapy for Hodgkin lymphoma
- Inadequate organ function
- High-risk participants with a history of ≥ grade 2 peripheral neuropathy or any active
neurologic disease that would impede the ability to assess neurologic toxicities.
- Inability or unwillingness of research participant or legal guardian / representative
to give written informed consent.
Maximum Eligible Age: | 25 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Response rate of adequate response |
Time Frame: | after the first 2 cycles of chemotherapy (at approximately 2 months after enrollment |
Safety Issue: | |
Description: | The 70 evaluable low-risk patients enrolled will be evaluated for this objective. |
Secondary Outcome Measures
Measure: | Number of adverse events in low-risk and intermediate-risk patients |
Time Frame: | From enrollment to end of therapy (approximately 8 months |
Safety Issue: | |
Description: | According to the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 |
Measure: | Number of adverse events in high-risk patients |
Time Frame: | From enrollment to end of therapy (approximately 8 months |
Safety Issue: | |
Description: | According to the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 |
Measure: | Local failure rate |
Time Frame: | From start of therapy to 2 years after completion of therapy (up to 3 years after study enrollment |
Safety Issue: | |
Description: | Local failure rate in irradiated and non-irradiated patients |
Measure: | Event-free survival |
Time Frame: | From start of therapy to 2 years after completion of therapy (up to 3 years after study enrollment |
Safety Issue: | |
Description: | Time to event defined as relapse, progression or death. The EFS for the low-risk patients and intermediate-risk patients are compared to those in HOD08 and HOD05, respectively. |
Measure: | Response rate |
Time Frame: | after the first 2 cycles of chemotherapy (at approximately 2 months after enrollment |
Safety Issue: | |
Description: | Response rate of adequate response after 2 cycles of AEPA in the high-risk patients with FDG-PET compared to that after 2 cycles of AEPA in HLHR13. |
Measure: | Response rate |
Time Frame: | after the first 2 cycles of chemotherapy (at approximately 2 months after enrollment |
Safety Issue: | |
Description: | Response rate of adequate response after 2 cycles of BEABOVP in the low-risk and high-risk patients with FDG-PET compared to those after 2 cycles of STANFORD V chemotherapy in HOD08 and HOD05, respectively. |
Measure: | Event-free survival |
Time Frame: | From start of therapy to 2 years after completion of therapy (up to 3 years after study enrollment |
Safety Issue: | |
Description: | Time to event defined as relapse, progression or death. The EFS for the high-risk patients is compared to those in HLHR13. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | St. Jude Children's Research Hospital |
Trial Keywords
- Hodgkin Lymphoma
- Pediatric Cancer
- Frontline Therapy
- Response Adapted Therapy
- Risk Adapted Therapy
Last Updated
March 15, 2021