Clinical Trials /

Rituximab Hyaluronidase in Combination With Chemotherapy in Treating Aggressive B-cell Lymphoma in Uganda

NCT03864419

Description:

This phase I trial studies how well rituximab hyaluronidase and combination chemotherapy work in treating patients in Uganda with Burkitt lymphoma, diffuse large B-cell lymphoma, or Kaposi sarcoma herpesvirus associated multicentric Castleman disease. Rituximab hyaluronidase is a combination of rituximab and hyaluronidase. Rituximab binds to a molecule called CD20, which is found on B cells (a type of white blood cell) and some types of cancer cells. This may help the immune system kill cancer cells. Hyaluronidase allows rituximab to be given by injection under the skin. Giving rituximab and hyaluronidase by injection under the skin is faster than giving rituximab alone by infusion into the blood. Drugs used in chemotherapy, such as cyclophosphamide, vincristine, methotrexate, etoposide, doxorubicin, and prednisone work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. While rituximab has a clear survival benefit in patients within developed countries, differences in supportive care and infectious co-morbidities require special attention. Giving rituximab hyaluronidase alone or in combination with chemotherapy may work better in treating patients with Burkitt lymphoma, diffuse large B-cell lymphoma, or Kaposi sarcoma herpesvirus associated multicentric Castleman disease compared to chemotherapy alone in Uganda.

Related Conditions:
  • Burkitt Lymphoma
  • Diffuse Large B-Cell Lymphoma
  • Multicentric Angiofollicular Lymphoid Hyperplasia
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Rituximab Hyaluronidase in Combination With Chemotherapy in Treating Aggressive B-cell Lymphoma in Uganda
  • Official Title: A Phase I Study of Subcutaneous Rituximab Hyaluronidase Combined With Local Standard-of-Care Chemotherapy for the Treatment of Burkitt Lymphoma, Diffuse Large B-Cell Lymphoma or as Monotherapy for Kaposi Sarcoma Herpesvirus Associated Multicentric Castleman Disease in Pediatrics and Adults in Uganda

Clinical Trial IDs

  • ORG STUDY ID: RG1001799
  • SECONDARY ID: U028
  • SECONDARY ID: NCI-2019-01493
  • SECONDARY ID: P30CA015704
  • SECONDARY ID: 10040
  • NCT ID: NCT03864419

Conditions

  • Burkitt Lymphoma
  • KSHV-associated Multicentric Castleman Disease
  • Diffuse Large B-Cell Lymphoma

Interventions

DrugSynonymsArms
Rituximab and Hyaluronidase HumanRituxan Hycela, Rituximab Plus Hyaluronidase, Rituximab/Hyaluronidase, Rituximab/Hyaluronidase HumanCohort I (pediatric BL)
CyclophosphamideCycloblastin, Cycloblastine, Cyclophospham, Cyclophosphamid monohydrate, Carloxan, Ciclofosfamida, Ciclofosfamide, CicloxalCohort I (pediatric BL)
VincristineLEUROCRISTINE, VCR, VincrystineCohort I (pediatric BL)
MethotrexateAbitrexate, Alpha-Methopterin, Amethopterin, Brimexate, Emthexat, Emtexate, Methotrexate LPF, Methylaminopterin, MethotrexatumCohort I (pediatric BL)
DoxorubicinHydroxyl Daunorubicin, HydroxyldaunorubicinCohort II (DLBCL)
Doxorubicin HydrochlorideAdriamycine, Adriblastina, Doxolem, Doxorubicin.HClCohort II (DLBCL)
PrednisoneDeltacortene, Decorton, Decortisyl, DeCortin, Deltacortisone, EconosoneCohort II (DLBCL)
EtoposideDemethyl Epipodophyllotoxin Ethylidine Glucoside, EPEG, VepesidCohort II (DLBCL)
RituximabBI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, Rituxan, Rituximab ABBS, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar JHL1101, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SIBP-02, rituximab biosimilar TQB2303, RTXM83, TruximaCohort I (pediatric BL)

Purpose

This phase I trial studies how well rituximab hyaluronidase and combination chemotherapy work in treating patients in Uganda with Burkitt lymphoma, diffuse large B-cell lymphoma, or Kaposi sarcoma herpesvirus associated multicentric Castleman disease. Rituximab hyaluronidase is a combination of rituximab and hyaluronidase. Rituximab binds to a molecule called CD20, which is found on B cells (a type of white blood cell) and some types of cancer cells. This may help the immune system kill cancer cells. Hyaluronidase allows rituximab to be given by injection under the skin. Giving rituximab and hyaluronidase by injection under the skin is faster than giving rituximab alone by infusion into the blood. Drugs used in chemotherapy, such as cyclophosphamide, vincristine, methotrexate, etoposide, doxorubicin, and prednisone work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. While rituximab has a clear survival benefit in patients within developed countries, differences in supportive care and infectious co-morbidities require special attention. Giving rituximab hyaluronidase alone or in combination with chemotherapy may work better in treating patients with Burkitt lymphoma, diffuse large B-cell lymphoma, or Kaposi sarcoma herpesvirus associated multicentric Castleman disease compared to chemotherapy alone in Uganda.

Detailed Description

      OUTLINE:

      Open-label Phase I study characterizing the safety, tolerability, and activity of
      subcutaneous rituximab hyaluronidase (sqR) alone (KSHV-MCD), or combined with local standard
      of care chemotherapy (BL or DLBCL), in 2 age-based cohorts of patients:

        1. Cohort 1: Age >= 15

        2. Cohort 2: Age: 2-14

      sqR dose for Cohort 1 (adults) will be 1400 mg (flat dose); sqR dose for Cohort 2
      (pediatrics) will depend on patient weight: >= 35 kg: 1400 mg, < 35 kg: 700 mg. For all
      participants, sqR will be administered with local standard of care chemotherapy (BL, DLBCL)
      or alone (KSHV-MCD), and supportive care.

      Each cohort comprises two Therapy Groups. Therapy Group 1: up to 6 participants and will
      receive the first cycle of rituximab IV, and subsequent cycles as flat-dose sqR. Therapy
      Group 2: up to 12 participants and will receive flat-dose sqR for all cycles.

      Disease-specific chemotherapy to be administered with rituximab hyaluronidase include:

      PEDIATRIC BURKITT LYMPHOMA (BL): cyclophosphamide, vincristine and prednisone followed by 6
      cycles of cyclophosphamide, vincristine, and methotrexate (COP-COM).

      DLBCL: 6 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone PO on days 1-5
      of cycle 1 (CHOP).

      ADULT BL: 6 cycles modified dose: etoposide, doxorubicin, vincristine, cyclophosphamide and
      prednisone PO on days 1-5 (adjusted EPOCH).

      KSHV-MCD: Rituximab or rituximab hyaluronidase SC on days 1, 8, 15, and 22.

      After completion of study treatment, patients are followed up at 30 days, 3, 6, 9 and 12
      months.
    

Trial Arms

NameTypeDescriptionInterventions
Cohort I (pediatric BL)ExperimentalPatients receive cyclophosphamide IV and vincristine IV on day 1, and prednisone IV or PO on days 1-7 in the absence of disease progression or unacceptable toxicity. Patients then receive rituximab IV or rituximab hyaluronidase SC, cyclophosphamide IV, vincristine IV, and methotrexate IV on day 1. Cycles repeat every 14 days for 6 cycles in the absence of disease progression or unacceptable toxicity.
  • Rituximab and Hyaluronidase Human
  • Cyclophosphamide
  • Vincristine
  • Methotrexate
  • Rituximab
Cohort II (DLBCL)ExperimentalPatients receive rituximab IV or rituximab and hyaluronidase human SC, cyclophosphamide IV, doxorubicin IV, and vincristine IV on day 1, and prednisone PO on days 1-5 of cycle 1. Cycles repeat every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity.
  • Rituximab and Hyaluronidase Human
  • Cyclophosphamide
  • Vincristine
  • Doxorubicin
  • Doxorubicin Hydrochloride
  • Prednisone
  • Etoposide
  • Rituximab
Cohort III (Adult BL)ExperimentalPatients receive rituximab IV or rituximab and hyaluronidase human SC in day 1, etoposide IV, doxorubicin IV, and vincristine IV on days 1-4. Patients also receive cyclophosphamide IV on day 5 and prednisone PO on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity.
  • Rituximab and Hyaluronidase Human
  • Cyclophosphamide
  • Vincristine
  • Doxorubicin
  • Doxorubicin Hydrochloride
  • Prednisone
  • Rituximab
Cohort IV (MCD)ExperimentalPatients receive rituximab IV or rituximab and hyaluronidase human SC on days 1, 8, 15, and 22 in the absence of disease progression or unacceptable toxicity.
  • Rituximab and Hyaluronidase Human
  • Rituximab

Eligibility Criteria

        Inclusion Criteria:

          -  Histology and immunohistochemistry (CD20+) confirmed Burkitt lymphoma (BL), diffuse
             large B-cell lymphoma (DLBCL), or histology confirmed KSHV-associated multicentric
             Castleman disease with elevated blood KSHV viral load

          -  Cohort 1: Age should be equal to or greater than 15

          -  Cohort 2: Age: 2-15

          -  Measurable disease

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2

          -  Able to provide informed consent (adults) or assent (children < 18 years) in English
             or Luganda

          -  Human immunodeficiency virus (HIV)-infected patients eligible if meet the following
             criteria:

               -  CD4+ T-cell count > 200 cells/uL

               -  HIV treatable with effective antiretroviral therapy that does not include agents
                  with known significant drug-drug interactions with accompanying chemotherapy
                  (ritonavir and cobicistat contraindicated)

        Exclusion Criteria:

          -  Previous therapy for lymphoma or KSHV-multicentric Castleman disease (MCD)

          -  History of hypersensitivity to rituximab

          -  Pregnant or nursing women. Men or women may not participate unless they have agreed to
             use effective contraception during treatment and for 12 months following completion of
             therapy

          -  Inadequate organ function, unless attributed to lymphoma or KSHV-MCD

          -  Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) > 2.5 times upper
             limit of normal

          -  Creatinine > 2 times upper limit than normal or calculated creatinine clearance < 60
             mL/min

          -  New York Heart Association (NYHA) cardiac failure class III or IV

          -  Patients with clinically significant anemia-hemoglobin less than 10 g/dL

          -  Central nervous system (CNS) masses consistent with lymphoma or untreated infection;
             leptomeningeal disease will not be excluded

          -  Patients with malignancy within 5 years, other than resected local skin cancer or
             limited Kaposi sarcoma (KS) (no known pulmonary KS)

          -  Patients with evidence of active infections including malaria and hepatitis B
             (participants with hepatitis B virus [HBV] controlled on antivirals will not be
             excluded)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:2 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of treatment-emergent adverse events
Time Frame:Up to 12 months
Safety Issue:
Description:Common Terminology Criteria for Adverse Events version 5.0 including unanticipated problems and grade 3-5 adverse events (AEs) at least probably related to subcutaneous rituximab hyaluronidase (sqR) administration.

Secondary Outcome Measures

Measure:Number of participants achieving a repose of complete response (CR)
Time Frame:1 year
Safety Issue:
Description:Response Evaluation Criteria in Solid Tumors (RECIST) criteria CR: complete disappearance of all target lesions.
Measure:Overall survival
Time Frame:1 year
Safety Issue:
Description:Kaplan-Meier estimate
Measure:Progression-free survival
Time Frame:1 year
Safety Issue:
Description:Kaplan-Meier estimate
Measure:Disease-free survival
Time Frame:1 year
Safety Issue:
Description:Kaplan-Meier estimate

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Fred Hutchinson Cancer Research Center

Last Updated

February 25, 2021