Flavopiridol to Treat Relapsed Mantle Cell Lymphoma or Diffuse Large B-Cell Lymphoma
| Status: | Completed |
|---|---|
| Conditions: | Lymphoma |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/1/2018 |
| Start Date: | November 27, 2006 |
| End Date: | October 18, 2012 |
A Phase I/II Study of Flavopiridol in Relapsed or Refractory Mantle Cell Lymphoma (MCL) and Diffuse Large B-Cell Lymphoma (DLBCL)
Background:
Mantle cell lymphoma (MCL) and diffuse large B-cell lymphoma (DLBCL) are aggressive subtypes
of non-Hodgkin lymphoma.
Flavopiridol is an investigational drug that works differently from standard chemotherapy and
may target abnormalities in MCL and DLBCL cells, such as a protein excess that prevents tumor
cells from dying.
A challenge in developing flavopiridol for treatment has been determining its optimal dosing
schedule. The schedule used for this study is effective in a type of leukemia called chronic
lymphocytic leukemia (CLL) and may benefit patients with MCL and DLBCL also.
Objectives:
To determine the highest dose of flavopiridol that can be given safely to patients with
relapsed MCL and DLBCL at the dosing schedule detailed below
To assess the response of the tumor to flavopiridol given at the test dosing schedule
Eligibility:
Patients 18 years of age and older with relapsed MCL or DLBCL
Design:
Flavopiridol is given at four different dose levels, starting with the lowest dose for the
first group of three to six patients and increasing with subsequent groups, depending on side
effects at the preceding dose. The drug is given weekly for 4 weeks followed by a 2-week
break (one cycle) for up to six cycles. It is given through a vein as a 30-minute infusion
followed by a 4-hour infusion.
Patients undergo the following procedures for research studies and to evaluate the effect of
treatment on the tumor:
- Blood tests
- Lymph node, bone marrow and tumor biopsies
- Lymphapheresis to collect blood cells for research
- Disease staging with imaging studies (computed tomography (CT), positron emission
tomography (PET) and/or magnetic resonance imaging (MRI) after every 2 cycles
Mantle cell lymphoma (MCL) and diffuse large B-cell lymphoma (DLBCL) are aggressive subtypes
of non-Hodgkin lymphoma.
Flavopiridol is an investigational drug that works differently from standard chemotherapy and
may target abnormalities in MCL and DLBCL cells, such as a protein excess that prevents tumor
cells from dying.
A challenge in developing flavopiridol for treatment has been determining its optimal dosing
schedule. The schedule used for this study is effective in a type of leukemia called chronic
lymphocytic leukemia (CLL) and may benefit patients with MCL and DLBCL also.
Objectives:
To determine the highest dose of flavopiridol that can be given safely to patients with
relapsed MCL and DLBCL at the dosing schedule detailed below
To assess the response of the tumor to flavopiridol given at the test dosing schedule
Eligibility:
Patients 18 years of age and older with relapsed MCL or DLBCL
Design:
Flavopiridol is given at four different dose levels, starting with the lowest dose for the
first group of three to six patients and increasing with subsequent groups, depending on side
effects at the preceding dose. The drug is given weekly for 4 weeks followed by a 2-week
break (one cycle) for up to six cycles. It is given through a vein as a 30-minute infusion
followed by a 4-hour infusion.
Patients undergo the following procedures for research studies and to evaluate the effect of
treatment on the tumor:
- Blood tests
- Lymph node, bone marrow and tumor biopsies
- Lymphapheresis to collect blood cells for research
- Disease staging with imaging studies (computed tomography (CT), positron emission
tomography (PET) and/or magnetic resonance imaging (MRI) after every 2 cycles
Background:
Flavopiridol is a synthetic N-methylpiperidinyl, chlorophenyl flavone compound that targets a
number of different cellular pathways and processes.
It works through several different mechanisms that include inhibition of cyclin dependent
kinases and the cyclin D-1 complex which is over-expressed in mantle cell lymphoma.
Flavopiridol also has demonstrated activity in activated B-like diffuse large B-cell lymphoma
cell lines.
One of the great challenges in developing flavopiridol and applying it clinically has been
determining its optimal dosing schedule. Following several different dosing schedules, one
strategy that has been very promising in chronic lymphocytic leukemia (CLL) is the
application of so-called hybrid schedules of the drug (an infusion for an intermediate time
following a bolus dose).
Objectives:
Assess the toxicity and safety of administration of this hybrid schedule.
Assess the response rate of the hybrid schedule of flavopiridol in relapsed mantle cell
lymphoma (MCL) and diffuse large B-cell lymphoma (DLBCL).
Eligibility:
Relapsed MCL or DLBCL.
Eastern Cooperative Oncology Group (ECOG) performance status(P.S.) less than or equal to 2.
Age greater than or equal to 18 years.
Human immunodeficiency virus (HIV) serology negative
Design:
Phase I/II.
Phase I portion consists of 3-4 dose levels of 3-6 patients each.
Administer weekly times 4 and then 2 weeks off (1 cycle). Restage after every 2 cycles.
Continue if complete response (CR), partial response (PR) or stable disease (SD) for up to 6
cycles. Dose reductions for toxicity will be addressed in the protocol.
Phase II portion of the study will be a Simon optimal two-stage design: designed to rule out
20% response rate (p0=0.20) in favor of a 45% response rate (p1=0.45).
The maximum sample size to be accrued for this study will be 71 patients.
Flavopiridol is a synthetic N-methylpiperidinyl, chlorophenyl flavone compound that targets a
number of different cellular pathways and processes.
It works through several different mechanisms that include inhibition of cyclin dependent
kinases and the cyclin D-1 complex which is over-expressed in mantle cell lymphoma.
Flavopiridol also has demonstrated activity in activated B-like diffuse large B-cell lymphoma
cell lines.
One of the great challenges in developing flavopiridol and applying it clinically has been
determining its optimal dosing schedule. Following several different dosing schedules, one
strategy that has been very promising in chronic lymphocytic leukemia (CLL) is the
application of so-called hybrid schedules of the drug (an infusion for an intermediate time
following a bolus dose).
Objectives:
Assess the toxicity and safety of administration of this hybrid schedule.
Assess the response rate of the hybrid schedule of flavopiridol in relapsed mantle cell
lymphoma (MCL) and diffuse large B-cell lymphoma (DLBCL).
Eligibility:
Relapsed MCL or DLBCL.
Eastern Cooperative Oncology Group (ECOG) performance status(P.S.) less than or equal to 2.
Age greater than or equal to 18 years.
Human immunodeficiency virus (HIV) serology negative
Design:
Phase I/II.
Phase I portion consists of 3-4 dose levels of 3-6 patients each.
Administer weekly times 4 and then 2 weeks off (1 cycle). Restage after every 2 cycles.
Continue if complete response (CR), partial response (PR) or stable disease (SD) for up to 6
cycles. Dose reductions for toxicity will be addressed in the protocol.
Phase II portion of the study will be a Simon optimal two-stage design: designed to rule out
20% response rate (p0=0.20) in favor of a 45% response rate (p1=0.45).
The maximum sample size to be accrued for this study will be 71 patients.
- ELIGIBILITY CRITERIA:
Previously treated mantle cell lymphoma or diffuse large B-cell lymphoma (to include
mediastinal (thymic) large B-cell lymphoma; transformed large B-cell lymphoma; follicular
grade IIIB large B-cell lymphoma; intravascular large B-cell lymphoma).
Confirmed pathological diagnosis at the National Cancer Institute, National Institutes of
Health (NIH).
Recurrent measurable disease (measurable disease in 2 dimensions or leukemic disease which
can be quantified and followed).
Prior anthracycline-based treatment for patients with diffuse large B-cell lymphoma
(DLBCL).
Age greater than 18 years.
Eastern Cooperative Oncology Group (ECOG) performance 2 or better.
Major organ function: absolute neutrophil count (ANC) greater than 1000/mcL, Platelet
greater than 50,000/mcL, Creatinine less than 1.5 mg/dL or creatinine clearance greater
than 60 mL/min; serum glutamic pyruvic transaminase (SGPT) less than 5 x upper limit of
normal; bilirubin less than 2 mg/dL (total) except less than 5 mg/dL in patients with
Gilbert's syndrome as defined by greater than 80% unconjugated. ANC and platelet
requirements must be met independent of transfusion.
Informed consent and willingness to use contraception by both men and women.
Both male and female patients must be willing to use adequate contraception (to include
effective barrier methods of contraception) or to completely abstain from heterosexual
intercourse while on protocol treatment.
EXCLUSION CRITERIA:
Pregnant or nursing because of an unknown potential for teratogenic or abortifacient
effects.
Human immunodeficiency virus (HIV) serology negative. HIV positive patients receiving
combination anti-retroviral therapy are excluded from the study because of possible
pharmacokinetic interactions with flavopiridol. Additionally, the biology of HIV associated
DLBCL's is often quite different from HIV negative disease due to involvement of Epstein
Barr virus (EBV).
Hepatitis B surface antigen negative.
Active central nervous system (CNS) lymphoma. These patients have a poor prognosis and
because they frequently develop progressive neurological dysfunction that would confound
the evaluation of neurological and other adverse events.
History of inflammatory bowel disease unless this has been inactive for a period of 2 or
more years.
Recovery from toxicity of prior therapy to a grade 1 or less.
Systemic cytotoxic or experimental treatments within 4 weeks of treatment.
White blood cell (WBC) greater than 100,000 cells/mcL.
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
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