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Trial record 1 of 43 for:    cutaneous sclerosis
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Imatinib and Rituximab in Treating Cutaneous Sclerosis in Patients With Chronic Graft-Versus-Host Disease

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Lee, Stephanie, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
ClinicalTrials.gov Identifier:
NCT01309997
First received: March 1, 2011
Last updated: July 29, 2014
Last verified: July 2014

March 1, 2011
July 29, 2014
March 2011
March 2015   (final data collection date for primary outcome measure)
Significant clinical response [ Time Frame: 3 and 6 months ] [ Designated as safety issue: No ]
Assessed by decline in an affected area's skin score as measured with the Vienna Skin Scale (from 4 to 2, 3 to 1, or 2 to 0) without a concurrent increase of two or more points in another area OR by an increase in the range of motion of the shoulders, elbows or wrists by two points (in a 1-7 scale) or of the ankles by one point (in a 1 to 4 scale) without a concurrent worsening in another area.
Significant clinical response in sclerosis [ Time Frame: At 6 months after enrollment and treatment with one of the two agents ] [ Designated as safety issue: No ]
  1. decline in the skin score from baseline, measured by the Vienna Skin Scale, from 4 to 2, 3 to 1 OR 2 to 0, in any affected area, without an increase by two or more points in other areas compared to baseline.

    OR

  2. increase in the range of motion by two points in a 1-7 (1 = poor and 7= full mobility) scale for the shoulders, elbows or wrists or by one point in a 1 to 4 scale (ankles) from baseline without worsening in any area (2 points for shoulders, elbows or wrists; 1 point for ankles) (photos diagram detailed in the protocol).
Complete list of historical versions of study NCT01309997 on ClinicalTrials.gov Archive Site
  • Proportion of patients achieving a greater than or equal to 50% reduction in the daily corticosteroid dose [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Cumulative incidence of treatment failure [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Defined as discontinuation of randomized treatment due to chronic GVHD progression or treatment intolerance or no significant clinical response in sclerosis.
  • Number of patients achieving improvement in cutaneous sclerosis [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Assessed by decrease of >= 0.2 units in the Scleroderma Health Assessment Questionnaire (SHAQ).
  • Correlation of blood and skin biomarker profile with each therapeutic agent and clinical response [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Proportion of subjects with any percentage decline in any grade of sclerosis without increase in percentage of higher grades of sclerosis in other areas on the Vienna skin scale [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Decrease in the daily corticosteroid dose [ Time Frame: After 6 months ] [ Designated as safety issue: No ]
    Corticosteroid dose <= 50% from the baseline dose
  • Cumulative incidence of treatment failure [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    1. Discontinuation of randomized treatment due to chronic GVHD progression or treatment intolerance within 6 months after enrollment, OR
    2. less than a significant clinical response in sclerosis (as defined above) at 6 months compared to baseline
  • Improvement in scleroderma by patient-self assessment [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Decrease in the SHAQ score by >= 0.2 units
  • Changes in biomarker profiles between the two arms of the study, and between responders and non-responders [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    PDGF antibodies and B cell markers (blood and skin) and collagen expression and phospho-protein immunohistochemistry and gene profiling for PDGFR in the skin will be evaluated.
Not Provided
Not Provided
 
Imatinib and Rituximab in Treating Cutaneous Sclerosis in Patients With Chronic Graft-Versus-Host Disease
A Randomized Phase II Study of Imatinib and Rituximab for Cutaneous Sclerosis After Allogeneic Hematopoietic Cell Transplantation

This randomized phase II trial is evaluating how well imatinib mesylate works compared to rituximab in treating cutaneous sclerosis in patients with chronic graft- versus-host disease (GVHD). Both imatinib and rituximab have been reported to decrease skin thickening and improve skin and joint flexibility in people with cutaneous sclerosis due to chronic GVHD.

PRIMARY OBJECTIVES:

I. To determine the best clinical response rate of cutaneous sclerosis (skin and/or fascial thickening) after 6 months of initial therapy with either imatinib (imatinib mesylate) or rituximab.

SECONDARY OBJECTIVES:

I. To determine the best response at either the 3 or 6 month assessment.

II. To determine the response rate at the 3 month assessment.

III. To determine the proportion of subjects who are able to taper corticosteroid after 6 months of imatinib or rituximab therapy.

IV. To determine the incidence of treatment failure to initial treatment with either imatinib or rituximab.

V. To evaluate if the Scleroderma Health Assessment Questionnaire (SHAQ) findings correlate with severity of cutaneous sclerosis clinical findings and response to study treatment.

VI. To correlate the detection of antibody against platelet derived growth factor receptor alpha (PDGFR A) with clinical response.

VII. To correlate change in B cell relevant parameters from baseline to 6 months or early crossover (antibody levels, skin collagen expression, B cell subsets) with therapeutic agent and best clinical response while on initial treatment.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive imatinib mesylate by mouth (PO) once daily (QD) for 6 months in the absence of progression of sclerosis or unacceptable toxicity. Subjects with a significant clinical response will continue to receive study drug for an additional 6 months.

ARM II: Patients receive rituximab intravenously (IV) on days 1, 8, 15, and 22 (first cycle). A second cycle of treatment with rituximab is repeated at 3 months for a total of 8 doses of rituximab in the absence of progression of sclerosis or unacceptable toxicity.

Patients with progression, treatment intolerance at any time up to 6 months, or no clinical response at 6 months will crossover to the other treatment arm.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Graft Versus Host Disease
  • Systemic Scleroderma
  • Drug: imatinib mesylate
    Given PO
    Other Names:
    • CGP 57148
    • Gleevec
    • Glivec
  • Biological: rituximab
    Given IV
    Other Names:
    • IDEC-C2B8
    • IDEC-C2B8 monoclonal antibody
    • Mabthera
    • MOAB IDEC-C2B8
    • Rituxan
  • Other: laboratory biomarker analysis
    Correlative studies
  • Other: questionnaire administration
    Ancillary studies
  • Experimental: Arm I (enzyme inhibitor)
    Patients receive imatinib mesylate PO QD for 6 months in the absence of progression of sclerosis or unacceptable toxicity.
    Interventions:
    • Drug: imatinib mesylate
    • Other: laboratory biomarker analysis
    • Other: questionnaire administration
  • Experimental: Arm II (monoclonal antibody)
    Patients receive rituximab IV on days 1, 8, 15, and 22. A second treatment cycle is repeated at 3 months for a total of 8 doses of rituximab in the absence of progression of sclerosis or unacceptable toxicity.
    Interventions:
    • Biological: rituximab
    • Other: laboratory biomarker analysis
    • Other: questionnaire administration
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Active, not recruiting
74
Not Provided
March 2015   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Diagnosis within the past 18 months of cutaneous sclerosis after hematopoietic cell transplant (HCT) with sclerotic skin, morphea, myofascial involvement or joint contractures; must have a score of 2 or greater on the Vienna skin scale in any area, or a range-of-motion (ROM) score of 5 or less at the shoulder, elbow or wrist, or 3 or less at the ankle
  • No medication added for the treatment of graft versus host disease (GVHD) within the past 4 weeks
  • Receiving corticosteroids at a dose greater than required for treatment of adrenal insufficiency, unless the physician documents why steroids are contraindicated
  • Age 2-99 years
  • Karnofsky performance status >= 60% at enrollment
  • All females of childbearing potential must have a negative serum or urine pregnancy test =< 7 days prior to starting study therapy
  • All females of childbearing potential must agree to use a form of Food and Drug Administration (FDA) approved contraception from enrollment to one month after study treatment ends
  • Subject has the ability to understand and willingness to sign a written informed consent document

Exclusion Criteria:

  • Total bilirubin > 1.5x upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 2.5 x ULN
  • Renal insufficiency (serum creatinine > 2.0 mg/dl)
  • Platelets < 30,000/ul or absolute neutrophil count < 1500/ul
  • Known hypersensitivity to rituximab or other anti-B cell antibodies
  • Known imatinib intolerance or allergy
  • Evidence of any active viral, bacterial, or fungal infection that is progressive despite appropriate treatment
  • Hepatitis B surface antigen positive
  • Hepatitis B core antibody positive, unless hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is undetectable
  • Hepatitis C antibody positive, unless hepatitis C virus (HCV) ribonucleic acid (RNA) is undetectable
  • Pregnant, lactating, or planning a pregnancy while in the study
  • Distal leg skin score 3 or higher as the only manifestation of sclerosis
  • Prior treatment of chronic GVHD with imatinib, rituximab, or any other monoclonal B-cell antibody (e.g. ofatumumab)
  • Receipt of imatinib within the previous 6 months for any indication
  • Receipt of any monoclonal B-cell antibody (e.g. rituximab, ofatumumab) within the previous 12 months for any indication
  • Treatment with anti-B-cell cellular therapy (e.g. chimeric antigen-receptor-engineered cells) at any time after transplant
  • Current treatment with extracorporeal photopheresis (ECP) at the time of enrollment
  • History of psychiatric disorder that would interfere with normal participation in this study
  • Inability or unwillingness of subject and/or parent guardian to provide informed consent or comply with study protocol
  • Use of non-FDA approved drugs within 4 weeks of participation
  • Patient with any condition that, in the opinion of the investigator, would interfere with the subject's ability to comply with the study requirements
  • Patients with uncontrolled substance abuse
Both
2 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT01309997
2343.00, NCI-2011-00098, RDCRN 6502, RDCRN 6502, 2343.00, U54CA163438, P30CA015704
Yes
Lee, Stephanie, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Lee, Stephanie
National Cancer Institute (NCI)
Principal Investigator: Stephanie Lee Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Fred Hutchinson Cancer Research Center
July 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP