This study evaluates a fenretinide phospholipid suspension for the treatment of T-cell
non-Hodgkin's lymphoma (NHL).
- All patients must have histologically or cytologically confirmed diagnosis of the
following specific types of T-cell lymphomas (TCL):
1. Cutaneous T-cell lymphoma (CTCL): mycosis fungoides (MF), Sézary Syndrome (SS),
or primary cutaneous CD30+ anaplastic large cell lymphoma (cALCL).
2. Nodal TCL: Peripheral T-cell lymphoma (PTCL) not otherwise specified (NOS),
angioimmunoblastic T-cell lymphoma (AITL), or follicular T-cell lymphoma (FTCL)
as defined in the 2016 revision of the WHO classification of lymphoid
- For standard phase 1a and expanded cohort (1b): Patients must all have at least one
measurable disease site using criteria provided in section 11.
- Relapsed or refractory (R/R) disease, after at least 2 prior systemic drug treatment
regimens (oral bexarotene, interferon, any oral or IV HDAC inhibitor, any oral or IV
chemotherapy drug). For CD30-expressing diseases for which brentuximab vedotin (BV) is
approved, patients should have relapsed or refractory disease to BV or a BV-containing
regimen or have either intolerance or contraindication to BV. For purpose of this
study, total body electron beam radiation is not considered a systemic regimen. There
is no upper limit on prior therapy.
- Refractory disease is defined as lack of objective response (i.e., partial or complete
response) to most recent therapy.
- Relapsed disease is defined as recurrent disease after prior therapy that does not
qualify as refractory disease.
- For primary cutaneous lymphomas, stage IB, II, III and IV according to the TNMB system
are eligible. For primary nodal lymphomas, patients with stages II-IV according to the
Ann Arbor staging system are eligible.
- Minimum of 4 weeks must have elapsed since last systemic treatment or radiation
therapy (or 6 weeks for any nitrosourea-containing regimens), and patients must have
recovered from all toxicity of last treatment.
- Age ≥18 years. Both genders are included. However, women of childbearing potential
must have a negative urine pregnancy test (UPT) and agree to use an effective
contraceptive method for the duration of the study. Lactating women are excluded. Male
patients with significant others of childbearing age should also agree to use barrier
methods of contraception for the duration of therapy
- ECOG performance status 0-1 (Karnofsky ≥60%).
- Life expectancy greater than 6 months.
- Patients must have normal organ and marrow function as defined below:
1. Leukocytes ≥ 3,000/μL
2. Absolute neutrophil count ≥ 1,500/μL
3. Platelets ≥ 100,000/μL
4. Total bilirubin within normal institutional limits. Patients with total bilirubin
≤ 1.5 X upper limit of normal are eligible
5. AST (SGOT) and ALT (SGPT) within institutional upper limit of normal
6. Creatinine clearance ≥60 mL/min/1.73m^2 by the Modification of Diet in Renal
Disease (MDRD) equation
- Triglyceride blood level (fasting) <200mg/dL at time of enrollment (normal: <150mg/dL;
borderline high = 150-199mg/dL; high = 200-499mg/dL; very high = 500mg/dL or higher).
- The effects of ST-001 nanoFenretinide on the developing human fetus are unknown. For
this reason and because of the teratogenic effects of retinoids, women of childbearing
potential and men must agree to use adequate contraception (hormonal or barrier method
of birth control; abstinence) prior to study entry and for the duration of study
participation, as well as for 4 months after completion of ST-001 administration.
Should a woman become pregnant or suspect she is pregnant while she or her partner is
participating in this study, she should inform her treating physician immediately. Men
treated or enrolled on this protocol must also agree to use adequate contraception
prior to enrollment in the study, for the duration of study participation, and 4
months after completion of ST-001administration.
- Ability to understand and the willingness to sign a written informed consent document.
- Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
nitrosoureas or mitomycin C) prior to entering the study or those who have not
recovered from adverse events due to agents administered more than 4 weeks earlier.
- Patients who are receiving any other investigational agents.
- Patients with known or history of central nervous system (CNS) disease are excluded
from this clinical trial because of their poor prognosis and because of concerns
regarding toxicity attribution.
- History of allergic reactions or sensitivity to retinoids or to any excipients of
- Concomitant drug administration.
- Patients who require concurrent treatment with drugs that are strong CYP3A inducers
are excluded from the trial. Patients who have been treated previously with strong
CYP3A inducers may enroll in the trial and receive their first dose of ST-001 only
after four weeks have elapsed since the last dose of the CYP3A inducer. Strong
inducers of human CYP3A include barbiturates, bosentan, carbamazepine, efavirenz,
enzalutamide, etravirine, systemic glucocorticoids, mitotane, modafinil, nevirapine,
oxcarbazepine, phenobarbital, phenytoin, pioglitazone, rifabutin, rifampin,
troglitazone as well as the OTC herbal product St John's Wort
- Patients who require concurrent treatment with drugs that are strong to moderate CYP3A
inhibitors are excluded from the trial, and patients who have been treated previously
with strong CYP3A inhibitors may enroll in the trial and receive their first dose of
ST-001 only after four weeks have elapsed since the last dose of the CYP3A inhibitor.
This group of inhibitors includes certain antivirals (boceprevir, danoprevir,
paritaprevir; elvitegravir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir,
telaprevir, tipranavir; ombitasvir, dasabuvir), macrolide antibiotics (e.g.,
clarithromycin, erythromycin, telithromycin, troleandomycin) and ciprofloxacin,
antifungals (e.g., clotrimazole, fluconazole, ketoconazole, itraconazole, nefazodone,
posaconazole, voriconazole), aprepitant, cimetidine, cobicistat, conivaptan,
crizotinib, cyclosporine, diltiazem, dronedarone, idelalisib, luvoxamine, imatinib,
tofisopam, suboxone and verapamil as well as dietary grapefruit juice and grapefruit
- If patients being treated with ST-001 require the use of drugs that are either strong
inducers of CYP3A or strong to moderate inhibitors of CYP3A to treat a medical
condition, all treatment with ST-001 should be discontinued immediately and no further
treatment with ST-001 will be allowed.
- Use of acetaminophen, cephalosporins and other known hepatotoxic agents is allowed
with caution and close monitoring, due to known or potential interaction with ST-001
and potential increased risk of hepatotoxicity. Because the lists of these agents are
constantly changing, it is important to regularly consult a frequently updated list
such as http://medicine.iupui.edu/clinpharm/ddis/. Medical reference texts such as the
Physicians' Desk Reference may also provide this information.
- As part of the enrollment/informed consent procedures, the patient will be counseled
on the risk of interactions with other agents, and what to do if new medications need
to be prescribed or if the patient is considering a new over-the-counter medicine or
herbal product. Physician investigators should consult the websites listed above for
the most current information regarding drug interactions via CYP3A isozymes.
- Use of vitamin A supplements is prohibited. Standard multivitamin doses are allowed.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure (NY heart classification III/IV),
unstable angina pectoris, cardiac arrhythmia, QTc interval >450 milliseconds on
baseline triplicate ECG, or psychiatric illness/social situations that would limit
compliance with study requirements.
- Pregnant women are excluded from this study because ST-001is a retinoid agent with the
potential for teratogenic or abortifacient effects. Because there is an unknown but
potential risk for adverse events in nursing infants secondary to treatment of the
mother with ST-001, breastfeeding should be discontinued if the mother is treated with
- HIV-positive patients on combination antiretroviral therapy are ineligible because of
the potential for pharmacokinetic interactions with ST-001. Appropriate studies will
be undertaken in patients receiving combination antiretroviral therapy when indicated.
- Patients with any active hepatitis infections.
- Presence of nyctalopia (night blindness), or hemeralopia (defective vision in a bright
light, 'day blindness') at enrollment, or any other retinal, ophthalmological
condition (eg: retinitis pigmentosa, choroidoretinitis and xerophthalmia), and
- Patients who have received prior fenretinide systemic therapy
- Patients with T-cell lymphoma types other than those specified in section 3.1.1 are
not eligible even if they have cutaneous dissemination. Similarly, patients with any
type of natural killer (NK)- or B-cell lymphoma are not eligible regardless of sites
of involvement by disease.