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Bortezomib and Vorinostat as Maintenance Therapy After Autologous Stem Cell Transplant for Non-Hodgkin Lymphoma
This study is currently recruiting participants.
Verified December 2011 by Fred Hutchinson Cancer Research Center

First Received on October 7, 2009.   Last Updated on December 7, 2011   History of Changes
Sponsor: Fred Hutchinson Cancer Research Center
Information provided by: Fred Hutchinson Cancer Research Center
ClinicalTrials.gov Identifier: NCT00992446
  Purpose

RATIONALE: Bortezomib and vorinostat in the laboratory may stop the growth of lymphoma cells and make them more likely to die. Giving bortezomib together with vorinostat after an autologous stem cell transplant may thus kill any lymphoma cells that remain after transplant.

PURPOSE: This phase II trial is studying the side effects and how well bortezomib and vorinostat work in treating patients with non-Hodgkin lymphoma after an autologous stem cell transplant.


Condition Intervention Phase
Anaplastic Large Cell Lymphoma
Contiguous Stage II Adult Diffuse Large Cell Lymphoma
Contiguous Stage II Adult Diffuse Mixed Cell Lymphoma
Contiguous Stage II Adult Diffuse Small Cleaved Cell Lymphoma
Contiguous Stage II Grade 1 Follicular Lymphoma
Contiguous Stage II Grade 2 Follicular Lymphoma
Contiguous Stage II Grade 3 Follicular Lymphoma
Contiguous Stage II Mantle Cell Lymphoma
Grade 1 Follicular Lymphoma
Grade 2 Follicular Lymphoma
Grade 3 Follicular Lymphoma
Nodal Marginal Zone B-cell Lymphoma
Noncontiguous Stage II Adult Diffuse Mixed Cell Lymphoma
Noncontiguous Stage II Adult Diffuse Small Cleaved Cell Lymphoma
Noncontiguous Stage II Grade 1 Follicular Lymphoma
Noncontiguous Stage II Grade 2 Follicular Lymphoma
Noncontiguous Stage II Grade 3 Follicular Lymphoma
Noncontiguous Stage II Mantle Cell Lymphoma
Recurrent Adult Diffuse Large Cell Lymphoma
Recurrent Adult Diffuse Mixed Cell Lymphoma
Recurrent Adult Diffuse Small Cleaved Cell Lymphoma
Recurrent Adult T-cell Leukemia/Lymphoma
Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma
Recurrent Grade 1 Follicular Lymphoma
Recurrent Grade 2 Follicular Lymphoma
Recurrent Grade 3 Follicular Lymphoma
Recurrent Mantle Cell Lymphoma
Recurrent Mycosis Fungoides/Sezary Syndrome
Stage I Adult Diffuse Large Cell Lymphoma
Stage I Adult Diffuse Mixed Cell Lymphoma
Stage I Adult Diffuse Small Cleaved Cell Lymphoma
Stage I Adult T-cell Leukemia/Lymphoma
Stage I Cutaneous T-cell Non-Hodgkin Lymphoma
Stage I Grade 1 Follicular Lymphoma
Stage I Grade 2 Follicular Lymphoma
Stage I Grade 3 Follicular Lymphoma
Stage I Mantle Cell Lymphoma
Stage I Mycosis Fungoides/Sezary Syndrome
Stage II Adult T-cell Leukemia/Lymphoma
Stage II Cutaneous T-cell Non-Hodgkin Lymphoma
Stage II Mycosis Fungoides/Sezary Syndrome
Stage III Adult Diffuse Large Cell Lymphoma
Stage III Adult Diffuse Mixed Cell Lymphoma
Stage III Adult Diffuse Small Cleaved Cell Lymphoma
Stage III Adult T-cell Leukemia/Lymphoma
Stage III Cutaneous T-cell Non-Hodgkin Lymphoma
Stage III Grade 1 Follicular Lymphoma
Stage III Grade 2 Follicular Lymphoma
Stage III Grade 3 Follicular Lymphoma
Stage III Mantle Cell Lymphoma
Stage III Mycosis Fungoides/Sezary Syndrome
Stage IV Adult Diffuse Large Cell Lymphoma
Stage IV Adult Diffuse Mixed Cell Lymphoma
Stage IV Adult Diffuse Small Cleaved Cell Lymphoma
Stage IV Adult T-cell Leukemia/Lymphoma
Stage IV Cutaneous T-cell Non-Hodgkin Lymphoma
Stage IV Grade 1 Follicular Lymphoma
Stage IV Grade 2 Follicular Lymphoma
Stage IV Grade 3 Follicular Lymphoma
Stage IV Mantle Cell Lymphoma
Stage IV Mycosis Fungoides/Sezary Syndrome
Drug: rituximab
Drug: carmustine
Drug: cytarabine
Drug: etoposide
Drug: melphalan
Drug: bortezomib
Drug: vorinostat
Procedure: autologous hematopoietic stem cell transplantation
Phase II

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Bortezomib and Vorinostat as Maintenance Therapy After Autologous Transplant for Non-Hodgkin's Lymphoma Using R-BEAM or BEAM Conditioning Transplant Regimen

Resource links provided by NLM:


Further study details as provided by Fred Hutchinson Cancer Research Center:

Primary Outcome Measures:
  • Toxicity [ Time Frame: One year ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Time to disease progression [ Time Frame: Three years ] [ Designated as safety issue: No ]
  • Event-free survival [ Time Frame: Three years ] [ Designated as safety issue: No ]
  • Overall survival [ Time Frame: Three years ] [ Designated as safety issue: No ]
  • Ability to complete planned therapy [ Time Frame: Three years ] [ Designated as safety issue: No ]

Estimated Enrollment: 20
Study Start Date: December 2009
Estimated Primary Completion Date: November 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm I
All patients receive BEAM as conditioning regimen for transplant. Only patients with CD20+ lymphoma also receive rituximab IV on days -19 and -12. Patients undergo autologous stem cell transplantation on day 0. Patients then receive bortezomib 1.3 mg/m2 IV on days 2 and 8 and oral vorinostat once daily on days 1-14 per 28 day cycle. Vorinostat therapy begins at dose of 200 mg orally daily d1-14 per 28 day cycles for total of 3 cycles. If tolerated, then Vorinostat increased to 300 mg po daily d1-14 for 2 cycles and then if tolerated, increase to 400 mg orally daily d1-14 for 7 cycles. . Treatment with bortezomib and vorinostat repeats for 12 courses in the absence of disease progression or unacceptable toxicity.
Drug: rituximab
Given IV
Other Names:
  • C2B8 Monoclonal Antibody
  • IDEC-C2B8
  • IDEC-C2B8 monoclonal antibody
  • Mabthera
  • MOAB IDEC-C2B8
  • Rituxan
Drug: carmustine
Given IV
Other Names:
  • BCNU
  • Becenum
  • Becenun
  • BiCNU
  • bis(chloroethyl) nitrosourea
  • bis-chloronitrosourea
Drug: cytarabine
Given IV
Other Names:
  • ARA-C
  • ARA-cell
  • arabinofuranosylcytosine
  • arabinosylcytosine
  • Cytosar-U
  • cytosine arabinoside
Drug: etoposide
Given IV
Other Names:
  • Demethyl Epipodophyllotoxin Ethylidine Glucoside
  • EPEG
  • epipodophyllotoxin
  • VePesid
  • VP-16
  • VP-16-213
Drug: melphalan
Given IV
Other Names:
  • Alkeran
  • CB-3025
  • L-PAM
  • L-phenylalanine mustard
  • L-Sarcolysin
  • Melfalan
Drug: bortezomib
Given IV
Other Names:
  • LDP 341
  • MLN341
  • PS-341
  • VELCADE
Drug: vorinostat
Given orally
Other Names:
  • L-001079038
  • SAHA
  • suberoylanilide hydroxamic acid
  • Zolinza
Procedure: autologous hematopoietic stem cell transplantation
Undergo transplantation

Detailed Description:

PRIMARY OBJECTIVES:

I. Assess toxicities of combining vorinostat and bortezomib as maintenance therapy after ASCT for NHL.

SECONDARY OBJECTIVES:

I. Ability to complete planned therapy. II. Time to disease progression and event-free survival. III. Overall survival.

OUTLINE:

All patients receive carmustine IV over 3 hours on day -7; cytarabine IV twice daily over 3 hours and etoposide IV twice daily over 2 hours on days -6 to -3; and melphalan IV over 30 minutes on day -2. Only patients with CD20+ lymphoma receive additional rituximab IV on days -19 and -12. Patients undergo autologous stem cell transplantation on day 0. Patients then receive bortezomib IV on days 2 and 8 and oral vorinostat once daily on days 1-14 of 28-day cycle. Treatment with bortezomib and vorinostat repeats for total of 12 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed for at least 2 years.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion

Inclusion Criteria for Transplant:

  • Diagnosis of non-Hodgkin's lymphoma, transformed B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, diffuse large B-cell or T-cell lymphoma, and deemed a candidate for autologous transplant
  • Signed informed consent
  • Male patient agrees to use an adequate method of contraception for the duration of the study
  • Renal: Creatinine clearance (calculated creatinine clearance is permitted) > 40 mL/min
  • Pulmonary: DLCO, FEV1, and FVC >= 50% of predicted (corrected for hemoglobin)
  • Hepatic: Bilirubin =< 2.0 mg/dL (except for isolated hyperbilirubinemia attributed to Gilbert syndrome) and ALT and AST =< 3x the upper limit of normal
  • Cardiac: American Heart Association Class I: Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. Additionally, patients > 60 years of age must have a left ventricular ejection fraction of at least >= 40% demonstrated by MUGA or Echo
  • Autologous graft with a minimum of >= 3.0 x 10^6 CD34+ cells/kg (not CD34 selected)
  • Female patients of childbearing potential has a negative serum pregnancy test beta-hCG
  • Female patient is either post menopausal, free from menses for >= 2 years, surgically sterilized, or willing to use 2 adequate barrier methods of contraception to prevent pregnancy or agrees to abstain from heterosexual activity throughout the study

Inclusion Criteria for Maintenance Therapy:

  • 30-120 days post ASCT for non-Hodgkin's lymphoma: CrCL >= 40 mL/min; PLT >= 75,000, and ANC >= 1500 cells/mm3 for 5 days after recovery from ASCT nadir; TB =< 2.0 (unless history of Gilbert's disease), AST/ALT =< 2.5 x ULN

Exclusion

Exclusion Criteria for Transplant:

  • Karnofsky performance score < 70%
  • Uncontrolled bacterial, viral, or fungal infection (currently taking medication and with progression or no clinical improvement)
  • Pregnant or breastfeeding
  • Fertile men and women unwilling to use contraceptive techniques from the time of transplant until one month post maintenance therapy
  • Prior autologous or allogeneic HSCT
  • Patients with evidence of MDS/AML or abnormal cytogenetics analysis indicative of MDS on the pre-transplant bone marrow examination
  • Prolonged QTC on EKG
  • Poorly-controlled DM
  • Prior history of HIV positivity or known history of hepatitis B or C
  • Previous history of hypersensitivity to Bortezomib, boron, or mannitol; known hypersensitivity to the components of study drug or its analogs
  • Require therapeutic anticoagulation treatment, especially with coumadin
  • Patient who has had chemotherapy, radiotherapy, or biological therapy, within 30 days (42 days for nitrosoureas or mitomycin C) or who has not recovered from adverse events due to agents administered more than 30 days earlier
  • Patient is currently participating or has participated in a study with an investigational compound or devise within 30 days of initial dosing with study drug(s)
  • History of CNS disease
  • Patient had prior treatment with an HDAC inhibitor (e.g., romidespin (Depsipeptide), NSC-630176, MS 275, LAQ-824, belinostat (PXD-101), LBH589, MGCD0103, CRA024781, etc)
  • Patients who have received compounds with HDAC inhibitor-like activity, such as valproic acid, as anti-tumor therapy should not enroll in this study; patients who have received such compounds for other indications (e.g., valproic acid for epilepsy) may enroll after a 30-day washout period
  • Symptomatic ascites or pleural effusions
  • Patient has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial
  • Patient is, at the time of signing informed consent, a regular user of any illicit drugs, substance abuse or had a recent history (within the last year) of drug or alcohol abuse
  • Patient with a history of a prior malignancy with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma or an in situ malignancy; adequately treated localized prostate carcinoma with PSA < 1.0; or who has undergone potentially curative therapy with no evidence of disease for five years, and/or who is deemed at low risk for recurrence by his/her treating physician
  • Patient has a history or current evidence of any condition, therapy, or lab abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study or is not in the best interest of the patient to participate
  • Patient has a history of a gastrointestinal surgery or other procedures that might, in the opinion of the investigator, interfere with the absorption or swallowing of the study drugs

Exclusion Criteria for Maintenance Therapy:

  • MI with ASCT or developed dilated cardiomyopathy with ASCT
  • Untreated systemic infection
  • K and Mg < normal limits of adequate supplementation
  • >= grade 2 peripheral neuropathy within 14 days before beginning maintenance therapy
  • Any other non-study investigational agent; radiation therapy will not be allowed
  • Prolonged QTC
  • Poorly controlled DM
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00992446

Locations
United States, Washington
Fred Hutchinson Cancer Research Center Recruiting
Seattle, Washington, United States, 98109
Contact: Leona A. Holmberg     206-667-6447        
Principal Investigator: Leona A. Holmberg            
Sponsors and Collaborators
Fred Hutchinson Cancer Research Center
Investigators
Principal Investigator: Leona Holmberg Fred Hutchinson Cancer Research Center
  More Information

No publications provided

Responsible Party: Holmberg, Leona, Fred Hutchinson Cancer Research Center
ClinicalTrials.gov Identifier: NCT00992446     History of Changes
Other Study ID Numbers: 2292.00, NCI-2009-01302
Study First Received: October 7, 2009
Last Updated: December 7, 2011
Health Authority: United States: Institutional Review Board

Keywords provided by Fred Hutchinson Cancer Research Center:
Autologous Stem cell transplant, NHL, maintenance therapy

Additional relevant MeSH terms:
Leukemia
Leukemia, T-Cell
Leukemia-Lymphoma, Adult T-Cell
Lymphoma
Lymphoma, Follicular
Lymphoma, Large B-Cell, Diffuse
Lymphoma, Non-Hodgkin
Mycoses
Mycosis Fungoides
Sezary Syndrome
Lymphoma, B-Cell
Lymphoma, T-Cell
Lymphoma, T-Cell, Cutaneous
Lymphoma, Large-Cell, Anaplastic
Lymphoma, B-Cell, Marginal Zone
Lymphoma, Mantle-Cell
Neoplasms by Histologic Type
Neoplasms
Leukemia, Lymphoid
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Antibodies
Antibodies, Monoclonal
Cytarabine
Melphalan
Rituximab
Carmustine
Vorinostat

ClinicalTrials.gov processed this record on February 09, 2012