Phase 2 Study of Atorvastatin Safety and Antitumor Effects in Non-Hodgkin's Lymphoma

Atorvastatin has been shown to decrease levels of active oncogenes in preclinical studies
with murine and human lymphoma cell lines, and administration of statins leads to shrinkage
of lymphoma in murine models. Therefore, it may be possible for atorvastatin to decrease
levels of active oncogenes in human lymphomas. Further, upon decrease in levels of active
oncogenes, human lymphomas may regress. Atorvastatin is a commonly prescribed drug for
hypercholesterolemia: targeting the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase
enzyme may also be a way to decrease activation of oncogenes in human lymphoma, with minimal
toxicity. For human low grade non-Hodgkin lymphoma, no curative treatment is available;
therefore new, non-toxic and targeted therapies are sought for this disease.

Inclusion Criteria:

- > 18 years old

- Disease criteria: Confirmed by Stanford Pathology to be one of the following
Non-Hodgkin's Lymphoma (NHL) subtypes:

- Chronic lymphocytic leukemia /small lymphocytic lymphoma (CLL/SLL)

- Extranodal marginal zone B-cell lymphoma

- Nodal marginal zone B-cell lymphoma

- Splenic marginal zone B-cell lymphoma

- Treatment criteria

- Untreated: watchful waiting currently appropriate (includes CLL stage 0) o OR

- Prior treatment: watchful waiting currently appropriate o OR

- Refractory disease

- Staging within 4 weeks prior to enrollment (SLL, marginal zone lymphoma)

- CT chest (date)

- CT abdomen (date)

- CT pelvis (date) OR

- Staging within 4 weeks prior to enrollment (CLL: CT not required)

- Total white blood cell count (WBC) (Value) (date)

- Absolute lymphoma cell count (ALC) (Value) (date)

- Measurable disease (Site) (Size) OR

- CLL (only): elevated absolute lymphoma cell count

- Disease amenable to biopsy (must check at least one):

- Circulating tumor cells

- Positive bone marrow

- Palpable involved site (such as lymph node) measuring > 1.5 cm

- Eastern Cooperative Oncology Group performance status <2 (Karnofsky >60)

- Life expectancy of greater than 3 months

- Patients must have adequate organ and marrow function

- Absolute neutrophil count > 1,000/uL

- Platelets > 30,000/uL

- Total bilirubin within normal institutional limits

- Aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratio < 2.5 x
institutional upper limit of normal

- Creatinine within normal institutional limits OR creatinine clearance > 60
mL/min/1.73 m² for patients with creatinine levels above institutional normal.

- Women of child-bearing 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. Women of child-bearing potential must have
negative BetaHCG at enrollment

Exclusion Criteria:

- Chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C)
prior to entering the study

- Not recovered from adverse events due to agents administered more than four weeks
earlier

- Has stable low grade lymphoma has had rituximab within 3 months Patient with relapsed
or refractory disease has had rituximab within 1 month

- Not recovered from adverse events due to surgery performed 4 weeks earlier

- Receiving any other investigational agent. Known brain metastases

- Taken any statin within the past 6 months prior to enrollment in the trial

- Currently abuses alcohol

- Currently takes cyclosporin or gemfibrozil Patient has a prior history of
rhabdomyolysis

- Has uncontrolled intercurrent illness including, but not limited to ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements.

- Pregnant: Patients are not excluded if they are breastfeeding at the time of
enrollment, but breastfeeding should be discontinued if the mother is treated with
atorvastatin.

- HIV-positive patients receiving combination anti-retroviral therapy