Clinical Trials /

Testing CC-486 (Oral Azacitidine) Plus the Standard Drug Therapy in Patients 75 Years or Older With Newly Diagnosed Diffuse Large B Cell Lymphoma

NCT04799275

Description:

This phase II/III trial compares the side effects and activity of oral azacitidine in combination with the standard drug therapy (reduced dose rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone [R-miniCHOP]) versus R-miniCHOP alone in treating patients 75 years or older with newly diagnosed diffuse large B cell lymphoma. R-miniCHOP includes a monoclonal antibody (a type of protein), called rituximab, which attaches to the lymphoma cells and may help the immune system kill these cells. R-miniCHOP also includes prednisone which is an anti-inflammatory medication and a combination of 3 chemotherapy drugs, cyclophosphamide, doxorubicin, and vincristine. These 3 chemotherapy drugs, as well as oral azacitidine, 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. Combining oral azacitidine with R-miniCHOP may shrink the cancer or extend the time without disease symptoms coming back or extend patient's survival when compared to R-miniCHOP alone.

Related Conditions:
  • Diffuse Large B-Cell Lymphoma
  • Diffuse Large B-Cell Lymphoma Activated B-Cell Type
  • Diffuse Large B-Cell Lymphoma Associated with Chronic Inflammation
  • Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
  • Double-Hit Lymphoma
  • EBV-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
  • Germinal Center B-Cell-Like Diffuse Large B-Cell Lymphoma
  • Grade 3b Follicular Lymphoma
  • HHV8-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
  • High Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements
  • High Grade B-Cell Lymphoma, Not Otherwise Specified
  • Intravascular Large B-Cell Lymphoma
  • Marginal Zone Lymphoma
  • Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type
  • T-Cell/Histiocyte-Rich Large B-Cell Lymphoma
  • Triple-Hit Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 2/Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Testing CC-486 (Oral Azacitidine) Plus the Standard Drug Therapy in Patients 75 Years or Older With Newly Diagnosed Diffuse Large B Cell Lymphoma
  • Official Title: A Phase II/III Randomized Study of R-MiniCHOP With or Without CC-486 (Oral Azacitidine) in Participants Age 75 Years or Older With Newly Diagnosed Diffuse Large B Cell Lymphoma, Grade IIIB Follicular Lymphoma, Transformed Lymphoma, and High-Grade B-Cell Lymphomas With MYC and BCL2 and/or BCL6 Rearrangements

Clinical Trial IDs

  • ORG STUDY ID: NCI-2020-01256
  • SECONDARY ID: NCI-2020-01256
  • SECONDARY ID: S1918
  • SECONDARY ID: S1918
  • SECONDARY ID: U10CA180888
  • NCT ID: NCT04799275

Conditions

  • Ann Arbor Stage III Diffuse Large B-Cell Lymphoma
  • Ann Arbor Stage IIX (Bulky) Diffuse Large B-Cell Lymphoma
  • Ann Arbor Stage IV Diffuse Large B-Cell Lymphoma
  • Diffuse Large B-Cell Lymphoma Activated B-Cell Type
  • Diffuse Large B-Cell Lymphoma Associated With Chronic Inflammation
  • Diffuse Large B-Cell Lymphoma Germinal Center B-Cell Type
  • Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
  • EBV-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
  • Grade 3b Follicular Lymphoma
  • HHV8-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
  • High Grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangements
  • High Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 Rearrangements
  • High Grade B-Cell Lymphoma With MYC, BCL2, and BCL6 Rearrangements
  • High Grade B-Cell Lymphoma, Not Otherwise Specified
  • Intravascular Large B-Cell Lymphoma
  • Lymphoplasmacytic Lymphoma
  • Nodular Lymphocyte Predominant Hodgkin Lymphoma
  • Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type
  • T-Cell/Histiocyte-Rich Large B-Cell Lymphoma
  • Transformed Follicular Lymphoma to Diffuse Large B-Cell Lymphoma
  • Transformed Marginal Zone Lymphoma to Diffuse Large B-Cell Lymphoma

Interventions

DrugSynonymsArms
Cyclophosphamide(-)-Cyclophosphamide, 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate, Carloxan, Ciclofosfamida, Ciclofosfamide, Cicloxal, Clafen, Claphene, CP monohydrate, CTX, CYCLO-cell, Cycloblastin, Cycloblastine, Cyclophospham, Cyclophosphamid monohydrate, Cyclophosphamide Monohydrate, Cyclophosphamidum, Cyclophosphan, Cyclophosphane, Cyclophosphanum, Cyclostin, Cyclostine, Cytophosphan, Cytophosphane, Cytoxan, Fosfaseron, Genoxal, Genuxal, Ledoxina, Mitoxan, Neosar, Revimmune, Syklofosfamid, WR- 138719Arm I (oral azacitidine, R-miniCHOP)
Doxorubicin Hydrochloride5,12-Naphthacenedione, 10-[(3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, hydrochloride, (8S-cis)- (9CI), ADM, Adriacin, Adriamycin, Adriamycin Hydrochloride, Adriamycin PFS, Adriamycin RDF, ADRIAMYCIN, HYDROCHLORIDE, Adriamycine, Adriblastina, Adriblastine, Adrimedac, Chloridrato de Doxorrubicina, DOX, DOXO-CELL, Doxolem, Doxorubicin HCl, Doxorubicin.HCl, Doxorubin, Farmiblastina, FI 106, FI-106, hydroxydaunorubicin, RubexArm I (oral azacitidine, R-miniCHOP)
Oral AzacitidineCC-486Arm I (oral azacitidine, R-miniCHOP)
Prednisone.delta.1-Cortisone, 1, 2-Dehydrocortisone, Adasone, Cortancyl, Dacortin, DeCortin, Decortisyl, Decorton, Delta 1-Cortisone, Delta-Dome, Deltacortene, Deltacortisone, Deltadehydrocortisone, Deltasone, Deltison, Deltra, Econosone, Lisacort, Meprosona-F, Metacortandracin, Meticorten, Ofisolona, Orasone, Panafcort, Panasol-S, Paracort, Perrigo Prednisone, PRED, Predicor, Predicorten, Prednicen-M, Prednicort, Prednidib, Prednilonga, Predniment, Prednisone Intensol, Prednisonum, Prednitone, Promifen, Rayos, Servisone, SK-PrednisoneArm I (oral azacitidine, R-miniCHOP)
RituximabABP 798, BI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-102, IDEC-C2B8, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, PF-05280586, Rituxan, Rituximab ABBS, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar GB241, Rituximab Biosimilar IBI301, Rituximab Biosimilar JHL1101, Rituximab Biosimilar PF-05280586, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SAIT101, Rituximab Biosimilar SIBP-02, rituximab biosimilar TQB2303, rituximab-abbs, RTXM83, TruximaArm I (oral azacitidine, R-miniCHOP)
Vincristine SulfateKyocristine, Leurocristine Sulfate, Leurocristine, sulfate, Oncovin, Vincasar, Vincosid, Vincrex, Vincristine, sulfateArm I (oral azacitidine, R-miniCHOP)

Purpose

This phase II/III trial compares the side effects and activity of oral azacitidine in combination with the standard drug therapy (reduced dose rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone [R-miniCHOP]) versus R-miniCHOP alone in treating patients 75 years or older with newly diagnosed diffuse large B cell lymphoma. R-miniCHOP includes a monoclonal antibody (a type of protein), called rituximab, which attaches to the lymphoma cells and may help the immune system kill these cells. R-miniCHOP also includes prednisone which is an anti-inflammatory medication and a combination of 3 chemotherapy drugs, cyclophosphamide, doxorubicin, and vincristine. These 3 chemotherapy drugs, as well as oral azacitidine, 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. Combining oral azacitidine with R-miniCHOP may shrink the cancer or extend the time without disease symptoms coming back or extend patient's survival when compared to R-miniCHOP alone.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine if the addition of CC-486 (oral azacitidine) to R-miniCHOP results in excess
      toxicity compared to R-miniCHOP alone that would preclude the combination from being studied
      further. (Safety run-in) II. To determine if the CC-486 + R-miniCHOP regimen should be tested
      further (Phase III) against the control R-miniCHOP alone based on progression-free survival
      (PFS). (Phase II component) III. To compare the overall survival (OS) between CC-486 +
      R-miniCHOP and R-miniCHOP alone. (Phase III component)

      SECONDARY OBJECTIVES:

      I. To assess the feasibility of delivering at least 4 cycles of CC-486 with R-miniCHOP in
      this population.

      II. To assess toxicity for CC-486 + R-miniCHOP and for R-miniCHOP. III. To compare complete
      response rates, as defined by Lugano 2014 classification, between CC-486 + R-miniCHOP and
      R-miniCHOP alone.

      INTEGRATED CORRELATIVE GERIATRIC ASSESSMENTS:

      I. To compare functioning as assessed by the S1918 Comprehensive Geriatric Assessment (S1918
      CGA) between participants treated with CC-486 + R-miniCHOP versus R-miniCHOP alone.

      II. To evaluate if frailty status (fit/unfit versus [vs] frail/superfrail) as assessed by the
      FIL tool is associated with OS.

      III. To evaluate if frailty as measured by the FIL tool correlates with the summary frailty
      index as measured using components of the S1918 CGA.

      BANKING OBJECTIVE:

      I. To bank specimens for future correlative studies.

      OUTLINE:

      Beginning 7 days prior to starting [protocol treatment, all patients receive vincristine
      sulfate intravenously (IV) on day 1, and prednisone orally (PO) daily on days 1-7.

      Patients are then randomized to 1 of 2 arms.

      ARM I: Patients receive CC-486 PO for 7 days prior to cycle 1. Patients then receive CC-486
      PO on days 8-21. Treatment repeats every 21 days for cycles 1-5 in the absence of disease
      progression or unacceptable toxicity. Patients also receive rituximab IV (or subcutaneously
      [SC] for cycles 2-6), cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine
      sulfate IV on day 1, and prednisone PO on days 1-5. Treatment repeats every 21 days for
      cycles 1-6 (6 cycles total) in the absence of disease progression or unacceptable toxicity.

      ARM II: Patients receive rituximab IV (or SC for cycles 2-6), cyclophosphamide IV,
      doxorubicin hydrochloride IV, and vincristine sulfate IV on day 1, and prednisone PO on days
      1-5. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression
      or unacceptable toxicity.

      After completion of study treatment, patients are followed up periodically until 5 years from
      the date of registration.
    

Trial Arms

NameTypeDescriptionInterventions
Arm I (oral azacitidine, R-miniCHOP)ExperimentalPatients receive CC-486 PO for 7 days prior to cycle 1. Patients then receive CC-486 PO on days 8-21. Treatment repeats every 21 days for cycles 1-5 in the absence of disease progression or unacceptable toxicity. Patients also receive rituximab IV (or SC for cycles 2-6), cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine sulfate IV on day 1, and prednisone PO on days 1-5. Treatment repeats every 21 days for cycles 1-6 (6 cycles total) in the absence of disease progression or unacceptable toxicity.
  • Cyclophosphamide
  • Doxorubicin Hydrochloride
  • Oral Azacitidine
  • Prednisone
  • Rituximab
  • Vincristine Sulfate
Arm II (R-miniCHOP)Active ComparatorPatients receive rituximab IV (or SC for cycles 2-6), cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine sulfate IV on day 1, and prednisone PO on days 1-5. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
  • Cyclophosphamide
  • Doxorubicin Hydrochloride
  • Prednisone
  • Rituximab
  • Vincristine Sulfate

Eligibility Criteria

        Inclusion Criteria:

          -  Participants must have histologically or cytologically confirmed diffuse large B-cell
             lymphoma (DLBCL), Ann Arbor stage IIX (bulky), III or IV. Participants with DLBCL
             transformed from follicular lymphoma (FL) or marginal zone lymphoma (MZL, including
             mucosa-associated lymphoid tissue [MALT] lymphomas), lymphoplasmacytic lymphoma (LPL),
             or nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) are eligible. Participants
             with grade IIIB follicular lymphoma (FL) and high-grade B-cell lymphomas with MYC and
             BCL2 and/or BCL6 rearrangements are also eligible. Participants with DLBCL that arose
             from prior chronic lymphocytic leukemia (CLL) (Richter's transformation) are not
             eligible

          -  As defined by the World Health Organization (WHO), eligible lymphoma subtypes include
             the following:

               -  DLBCL, not otherwise specified (NOS)

               -  DLBCL, germinal-center B-cell type (GCB)

               -  DLBCL, activated B-cell type (ABC)

               -  T-cell histiocyte-rich B-cell lymphomas (THRBCL)

               -  Primary cutaneous DLBCL, leg type

               -  Intravascular large B cell lymphoma

               -  EBV+ DLBCL, NOS

               -  DLBCL associated with chronic inflammation

               -  HHV8+ DLBCL, NOS

               -  High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements

               -  High grade B-cell lymphoma, NOS

               -  Follicular lymphoma grade 3b

          -  Staging imaging must have occurred within 28 days prior to registration. Positron
             emission tomography (PET)-computed tomography (CT) baseline scans are strongly
             preferred; diagnostic quality magnetic resonance imaging (MRI), contrast-enhanced CT,
             or contrast-enhanced MRI scans are also acceptable if PET-CT is not feasible at
             baseline. Note: PET-CT will be required at end of treatment (EOT) and progression for
             response assessment. All measurable lesions must be assessed within 28 days prior to
             registration. Tests to assess non-measurable disease must be performed within 42 days
             prior to registration

          -  Participants with known human immunodeficiency virus (HIV)-infection are eligible
             providing they are on effective anti-retroviral therapy and have undetectable viral
             load at their most recent viral load test (must be within 26 weeks prior to
             registration). Participants with known HIV must have a CD4 count checked within 28
             days before starting therapy, but may proceed with therapy regardless of CD4 count

          -  All participants must be screened for chronic hepatitis B virus (HBV) within 28 days
             prior to registration. Participants with known HBV infection (positive serology) must
             also have a HBV viral load performed within 28 days prior to registration, and
             participants must have an undetectable HBV viral load on suppressive therapy within 28
             days prior to registration. Participants found to be HBV carriers during screening are
             eligible and must receive standard of care prophylaxis. Participants with active
             hepatitis B (HBV viral load > 500 IU/mL) within 28 days prior to registration are not
             eligible

          -  Participants with a known history of hepatitis C virus (HCV) infection must have an
             undetectable HCV viral load within in 28 days prior to registration

          -  Participants must have a Zubrod performance status of 0-2

          -  Participants must have adequate renal function, as demonstrated by a creatinine
             clearance, calculated by the Cockcroft and Gault formula, of >= 30 ml/min that was
             obtained within 28 days prior to registration

          -  Aspartate aminotransferase (AST) =< 2.5 x institutional upper limit of normal (IULN),
             alanine aminotransferase (ALT) =< 2.5 x IULN (within 28 days prior to registration)

          -  Total bilirubin =< 2 x institutional upper limit of normal (IULN), unless due to
             Gilbert's disease, hemolysis, or lymphomatous involvement of liver (within 28 days
             prior to registration). Note: If total bilirubin is elevated, and direct bilirubin is
             subsequently performed (within 28 days prior to registration) and resulted to be =< 2
             x IULN, the participant will be considered eligible

          -  Absolute neutrophil count (ANC) >= 1000/mcL (within 28 days prior to registration)

          -  Platelets >= 75,000/mcL (within 28 days prior to registration)

          -  If there is a documented lymphomatous involvement of the bone marrow, bone marrow
             function within 28 days prior to registration, as evidenced by:

               -  ANC >= 500/mcL

               -  Platelets >= 50,000/mcL

          -  Participants must have a left ventricular ejection (LVEF) fraction >= 45% as measured
             by echocardiogram or radionuclide (multigated acquisition scan [MUGA])
             ventriculography within 56 days prior to registration

          -  For the duration of the study treatment period and for at least 4 months following the
             last dose of study drug, male participants must agree to use effective contraceptive
             methods during sexual contact with a female of childbearing potential (FCBP) and must
             agree to refrain from semen or sperm donation during the same timeframe. Effective
             contraceptive methods include a history of vasectomy, use of hormonal contraception or
             an intrauterine device (IUD) by the female partner, or use of condoms

               -  A FCBP is a sexually mature woman who: 1) has not undergone a hysterectomy or
                  bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least
                  24 consecutive months (i.e., has had menses at any time in the preceding 24
                  consecutive months)

        Exclusion Criteria:

          -  Participants must not have known lymphomatous involvement of the central nervous
             system (CNS)

          -  Participants must not have active inflammatory bowel disease (such as, Crohn's
             disease, ulcerative colitis), celiac disease (i.e., sprue), prior gastrectomy or upper
             bowel removal, or any other gastrointestinal disorder or defect that would interfere
             with the absorption, distribution, metabolism, or excretion of the study drug and/or
             predispose the subject to an increased risk of gastrointestinal toxicity

          -  Participants must not have received any prior cytotoxic chemotherapy or rituximab for
             treatment of the newly diagnosed DLBCL. Participants who received a short course of
             glucocorticoids (=< 7 days) per the pre-phase are eligible. Inhaled, nasal, and
             topical steroid use is allowed. Prior cytotoxic chemotherapy and/or antibody therapy
             for an indolent lymphoma prior to transformation is allowed

          -  Participants must not have received more than a cumulative of 250 mg/m^2 of prior
             anthracycline therapy (at any time prior to registration)

          -  Participants must not currently be receiving any other investigational agents

          -  Participant must not have a history of allergic reactions attributed to azacitidine,
             mannitol, or other hypomethylating agents

          -  Participants must not have active infection (systemic fungal, bacterial, or viral
             infection) that is not controlled (defined as ongoing signs/symptoms related the
             infection without improvement despite appropriate antibiotics, antiviral therapy,
             and/or other treatment)

          -  Participants must not have active cardiac disease within 26 weeks prior to
             registration, including: symptomatic congestive heart failure (New York Heart
             Association [NYHA] class 4), unstable angina pectoris, hemodynamically unstable
             cardiac arrhythmia, or myocardial infarction

          -  Participants must not have >= grade 2 neuropathy, by Common Terminology Criteria for
             Adverse Events (CTCAE) version (v.) 5.0, within 28 days prior to registration

          -  Participants must not have any other known uncontrolled intercurrent illness
             including, but not limited to ongoing psychiatric illness/social situations that would
             limit compliance with study requirements
      
Maximum Eligible Age:N/A
Minimum Eligible Age:75 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Excess toxicity as a result of adding oral azacitidine (CC-486) to reduced dose rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone (R-miniCHOP) (Safety run-in)
Time Frame:Up to completion of cycle 6
Safety Issue:
Description:Will determine if the addition of CC-486 to R-miniCHOP results in excess toxicity compared to R-miniCHOP alone that would preclude the combination from being studied further.

Secondary Outcome Measures

Measure:Metabolic complete response (CR)
Time Frame:Up to end of cycle 6 or end of treatment
Safety Issue:
Description:Will be defined using 2014 Lugano classification. Fisher's exact test will be used to compare CR rates between the experimental arm of CC-486 + R-miniCHOP and the control arm of R-miniCHOP alone.
Measure:Incidence of adverse events
Time Frame:Until disease progression, assessed up to 5 years
Safety Issue:
Description:Will be assessed using Common Terminology Criteria for Adverse Events version 5. The maximum Grade for each toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns. Treatment-related toxicities between arms will be compared using Fisher's exact test.
Measure:Overall survival (Phase III)
Time Frame:From date of registration to date of death due to any cause, assessed up to 5 years
Safety Issue:
Description:An additional secondary analysis of overall survival of the Phase III comparison will adjust for patients with identified double-hit phenotype in addition to the pre-specified stratification factors. Will also prospectively collect the number of days between diagnostic biopsy and cycle 1 day 1 of therapy for a pre-planned secondary analysis.

Details

Phase:Phase 2/Phase 3
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Last Updated

August 25, 2021