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Study Examining the Combination of Lenalidomide and Azacitidine for Relapsed/Refractory CLL and SLL

This study has been terminated.
(anticipated results not seen and population not seen)
Sponsor:
Collaborator:
Celgene Corporation
Information provided by (Responsible Party):
Hackensack University Medical Center
ClinicalTrials.gov Identifier:
NCT01241786
First received: November 15, 2010
Last updated: November 7, 2012
Last verified: November 2012
  Purpose

To determine the response to the combination of azacitidine + lenalidomide in patients with relapsed/refractory CLL and SLL

Hypothesize - lenalidomide's activity in combination with azacitidine may further enhance its activity and the durability of treatment response.


Condition Intervention Phase
Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)
Drug: Revlimid
Drug: Azacitidine
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II, Single Arm Study Examining the Combination of Lenalidomide and Azacitidine (RA-CLL) for the Treatment of Relapsed/Refractory Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

Resource links provided by NLM:


Further study details as provided by Hackensack University Medical Center:

Primary Outcome Measures:
  • The primary objective of this study is to estimate the rate of response, using International Working Group response criteria, to the combination of azacitidine + lenalidomide in patients with relapsed/refractory CLL and small lymphocytic lymphoma (SLL). [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • 1. Assess for treatment related toxicity following administration of lenalidomide/ azacitidine. [ Designated as safety issue: Yes ]
  • 2. Estimate the progression free survival and overall survival of patients treated with the combination of lenalidomide and azacitidine [ Designated as safety issue: Yes ]
  • 3. Bank tumor samples for planned correlative analyses to identify epigenetically silenced, clinically relevant genes in CLL. [ Designated as safety issue: Yes ]

Estimated Enrollment: 28
Study Start Date: July 2010
Study Completion Date: October 2011
Primary Completion Date: October 2011 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Revlimid
    Lenalidomide PO daily Day 1-21. For patients with baseline calculated creatinine clearance ≥ 30 ml/min and < 60 ml/min the starting dose is 5 mg every other day (odd numbered days during Days 1-21). For patients with baseline calculated creatinine clearance ≥ 60 ml/min the starting dose is 5 mg daily on Days 1-21).
    Other Name: Lenalidomide
    Drug: Azacitidine
    Azacitidine 75 mg/m2 IV or SC D 1-5
    Other Name: Vidaza
Detailed Description:

A promising and untested combination in CLL is the combination of lenalidomide with the DNA methyltransferase inhibitor azacitidine. The combination of lenalidomide and azacitidine is novel to CLL, but has been tested in a phase I clinical trial involving patients with MDS and has been found to be safe with promising activity in that disease. Studying the activity of this combination in CLL may allow us to shift the CLL treatment paradigm from cytotoxic chemo-immunotherapies therapies towards an epigenetic-immunomodulatory approach and offers the unique opportunity to further understand the complex biology of this disease, mechanisms of resistance and its interaction with its microenvironment.

  Eligibility

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

Inclusion Criteria:

  1. Patients must be age ≥ 18.
  2. Patients must have an ECOG PS ≤ 2.
  3. Patients must understand and voluntarily sign informed consent.
  4. Able to adhere to the study visit schedule and other protocol requirements.
  5. Patients must carry the diagnosis of B-CLL/SLL as per WHO diagnostic criteria.
  6. SLL/CLL must be defined as relapsed or refractory disease as defined by the NCI-sponsored IWG criteria.

    • Relapsed CLL/SLL: Relapse is defined as a patient who has previously achieved CR or PR, but after a period of 6 or more months, demonstrates evidence of disease progression.
    • Refractory CLL/SLL: Refractory disease is defined as treatment failure or disease progression within 6 months to the last antileukemic therapy.
  7. Patients must have received and failed at least one purine-based treatment regimen (ie. FCR, FR, PCR, Fludarabine) or alemtuzumab-based regimen or bendamustine-based regimen prior to study enrollment.
  8. Serum bilirubin levels <1.5 times the upper limit of the normal range for the laboratory (ULN). Higher levels are acceptable if these can be attributed to active hemolysis, ineffective erythropoiesis or Gilbert's disease.
  9. Serum glutamic-oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamic-pyruvic transaminase (SGPT) (alanine aminotransferase [ALT]) levels <2 x ULN. (or <5 x ULN if hepatic metastases are present)
  10. Subjects must have calculated creatinine clearance ≥ 30ml/min by Cockcroft-Gault formula. See section below, "Dosing Regimen", regarding lenalidomide dose adjustment for calculated creatinine clearance > 30ml/min and < 60ml/min
  11. Absolute neutrophil count > 1.0 x 109 / L
  12. Platelet count > 50x 109 / L (unless bone marrow is heavily infiltrated with underlying disease (50% or more)
  13. Disease free of prior malignancies for > 5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "insitu" of the cervix or breast.
  14. All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.
  15. Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA may use warfarin or low molecular weight heparin).
  16. Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours prior to prescribing lenalidomide (prescriptions must be filled within 7 days) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. See Appendix: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods.

    -

Exclusion Criteria:

Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.

2. Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.

3. Patients must be lenalidomide / azacitidine naïve prior to study enrollment. 4. Patient's must not carry a diagnosis of HIV, Hepatitis B or Hepatitis C. Patients who are seropositive because of hepatitis B virus vaccine are eligible.

5. Patients must not have received chemotherapy, immunotherapy or any experimental study drug for CLL or SLL at least 4 weeks prior to study enrollment and initiation of treatment.

6. Patients with history of B-CLL and the development of prolymphocytic leukemia or Richter's transformation.

7. Known or suspected hypersensitivity to azacitidine, mannitol, thalidomide or lenalidomide.

8. Pregnant or breast feeding females. Lactating females must agree not to breast feed while taking lenalidomide.

9. Evidence of laboratory TLS by Cairo-Bishop Definition of Tumor Lysis Syndrome. Subjects may be enrolled upon correction of electrolyte abnormalities.

10. Patients with advanced malignant hepatic tumors. 11. Concurrent use of other anti-cancer agents or treatments. 12. Uncontrolled systemic fungal, bacterial, or viral infection (defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics or other treatment);

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  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01241786

Locations
United States, New Jersey
Hackensack University Medical Center
Hackensack, New Jersey, United States, 07601
Sponsors and Collaborators
Hackensack University Medical Center
Celgene Corporation
Investigators
Principal Investigator: Anthony Mato, MD Hackensack University Medical Center
  More Information

No publications provided

Responsible Party: Hackensack University Medical Center
ClinicalTrials.gov Identifier: NCT01241786     History of Changes
Other Study ID Numbers: VZ-CLL-PI-0146
Study First Received: November 15, 2010
Last Updated: November 7, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by Hackensack University Medical Center:
chronic lymphocytic leukemia (CLL)
small lymphocytic lymphoma (SLL)

Additional relevant MeSH terms:
Leukemia
Leukemia, Lymphocytic, Chronic, B-Cell
Leukemia, Lymphoid
Lymphoma
Immune System Diseases
Immunoproliferative Disorders
Leukemia, B-Cell
Lymphatic Diseases
Lymphoproliferative Disorders
Neoplasms
Neoplasms by Histologic Type
Azacitidine
Lenalidomide
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Enzyme Inhibitors
Growth Inhibitors
Growth Substances
Immunologic Factors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses

ClinicalTrials.gov processed this record on November 24, 2014