Rituximab and Combination Chemotherapy in Treating Patients With Newly Diagnosed Primary CNS Lymphoma
RATIONALE: Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Giving rituximab with combination chemotherapy may kill more cancer cells.
PURPOSE: This phase II trial is studying how well rituximab given with combination chemotherapy works in treating patients with newly diagnosed primary CNS lymphoma.
Drug: leucovorin calcium
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Intensive Chemotherapy And Immunotherapy In Patients With Newly Diagnosed Primary CNS Lymphoma|
- Response after remission induction [ Time Frame: 4 months ] [ Designated as safety issue: No ]
- Relapse-free survival [ Time Frame: After CR until relapse or progression ] [ Designated as safety issue: No ]
- Toxicity [ Time Frame: When the first 6, 10, 20, 30 or 45 pts have tox data ] [ Designated as safety issue: Yes ]
- Neurologic function [ Time Frame: diagnosis, 1, 4, 12, & 36 mon post Tx initiation ] [ Designated as safety issue: No ]
- Overall Survival & molecular markers [ Time Frame: 2 years and 4 years ] [ Designated as safety issue: No ]
|Study Start Date:||October 2004|
|Estimated Study Completion Date:||November 2012|
|Primary Completion Date:||January 2010 (Final data collection date for primary outcome measure)|
Experimental: Intensive Combination Chemo & Immunotherapy
Standard cancer therapies in investigational combination for treatment of newly diagnosed primary CNS lymphoma.
5 mcg/kg subQ injection daily Day 14 until ANC > or = 500 uL for 2 days or 1500 uL for 1 day (Cycle 6)
Other Name: G-CSFBiological: rituximab
375 mg/sq m IV infusion (max rate of 400 mg/hr) on Days 3, 10, 17, & 24 of Cycle 1 nad Days 3 & 10 of Cycle 2Drug: cytarabine
2 g/sq m IV infusion over 2 hours q 12 hrs x 8 doses Days 1-4 of Cycle 6Drug: etoposide
5 mg/kg IV infusion over 12 hrs q 12 hrs x 8 doses Days 1-4 of Cycle 6Drug: leucovorin calcium
100 mg/sq m IV infusion q 6 hrs starting 24 hrs after ea MTX dose until serum MTX < or = 0.05uM Cycles 1-5.Drug: methotrexate
8 g/sq m IV infusion over 4 hrs Days 1 & 15 Cycles 1, 2, & 3; Day 15 Cycle 4 and Day 1 Cycle 5.Drug: temozolomide
150 mg/sq m PO Days 7-11 Cycles 1-5.
- Determine the complete response rate after remission induction therapy with the combination of high-dose methotrexate (HDMTX), temozolomide, and rituximab at 4 months.
- Determine the safety and feasibility of consolidation therapy comprising cytarabine and etoposide administered after induction therapy in these patients.
- Determine the percentage of patients who achieve durable (complete and partial) remission when treated with this regimen.
- Determine relapse-free survival after complete response in patients treated with this regimen.
- Correlate molecular markers with outcome in patients treated with this regimen.
- Determine the effects of this regimen on neurological function in these patients.
OUTLINE: This is a multicenter study.
Induction Chemotherapy: All induction therapy courses repeat every 28 days.
- Courses 1-3: Patients receive high-dose methotrexate IV over 4 hours on days 1 and 15, leucovorin calcium IV or orally every 6 hours beginning on days 2 and 16 and continuing until blood levels of methotrexate are in a safe range, and oral temozolomide on days 7-11. Patients also receive rituximab* IV on days 3, 10, 17, and 24 of course 1 and days 3 and 10 of course 2 (total of 6 doses).
NOTE: *Patients diagnosed with T-cell primary CNS lymphoma do not receive rituximab.
Course 4: Patients receive oral temozolomide on days 7-11, high-dose methotrexate IV over 4 hours on day 15, and leucovorin calcium IV or orally every 6 hours beginning on day 16 and continuing until blood levels of methotrexate are in a safe range. Patients achieving a complete response or a complete response unconfirmed proceed to consolidation therapy.
- Consolidation therapy I (course 5): Beginning 4 weeks after the start of course 4, patients receive high-dose methotrexate IV over 4 hours on day 1, leucovorin calcium IV or orally every 6 hours beginning on day 2 and continuing until blood levels of methotrexate are in a safe range, and oral temozolomide on days 7-11.
- Consolidation therapy II (course 6): Beginning 3-5 weeks after the start of course 5, patients receive cytarabine IV over 2 hours twice daily and etoposide IV over 12 hours twice daily on days 1-4 and filgrastim (G-CSF) or sargramostim (GM-CSF) subcutaneously beginning on day 14 and continuing until blood counts recover.
Treatment continues in the absence of disease progression.
After completion of study treatment, patients are followed periodically for 3 years.
PROJECTED ACCRUAL: A total of 27-45 patients will be accrued for this study within 2-3 years.
Hide Study Locations
|United States, California|
|UCSF Helen Diller Family Comprehensive Cancer Center|
|San Francisco, California, United States, 94115|
|United States, Delaware|
|Tunnell Cancer Center at Beebe Medical Center|
|Lewes, Delaware, United States, 19958|
|CCOP - Christiana Care Health Services|
|Newark, Delaware, United States, 19713|
|United States, Illinois|
|University of Chicago Cancer Research Center|
|Chicago, Illinois, United States, 60637-1470|
|United States, Indiana|
|Fort Wayne Medical Oncology and Hematology|
|Fort Wayne, Indiana, United States, 46845|
|United States, Iowa|
|Hematology Oncology Associates of the Quad Cities|
|Bettendorf, Iowa, United States, 52722|
|United States, Kansas|
|Menorah Medical Center|
|Overland Park, Kansas, United States, 66209|
|Saint Luke's Hospital - South|
|Overland Park, Kansas, United States, 66213|
|Shawnee Mission Medical Center|
|Shawnee Mission, Kansas, United States, 66204|
|United States, Maryland|
|Union Hospital Cancer Program at Union Hospital|
|Elkton MD, Maryland, United States, 21921|
|United States, Minnesota|
|Masonic Cancer Center at University of Minnesota|
|Minneapolis, Minnesota, United States, 55455|
|United States, Missouri|
|Research Medical Center|
|Kansas City, Missouri, United States, 64132|
|Parvin Radiation Oncology|
|Kansas City, Missouri, United States, 64116|
|North Kansas City Hospital|
|Kansas City, Missouri, United States, 64116|
|CCOP - Kansas City|
|Kansas City, Missouri, United States, 64131|
|Truman Medical Center - Hospital Hill|
|Kansas City, Missouri, United States, 64108|
|St. Joseph Medical Center|
|Kansas City, Missouri, United States, 64114|
|Saint Luke's Cancer Institute at Saint Luke's Hospital|
|Kansas City, Missouri, United States, 64111|
|Saint Luke's East - Lee's Summit|
|Lee's Summit, Missouri, United States, 64086|
|Liberty, Missouri, United States, 64068|
|Heartland Regional Medical Center|
|Saint Joseph, Missouri, United States, 64506|
|United States, New Jersey|
|Cancer Institute of New Jersey at Cooper - Voorhees|
|Voorhees, New Jersey, United States, 08043|
|United States, New York|
|Stony Brook University Cancer Center|
|Stony Brook, New York, United States, 11794-9446|
|SUNY Upstate Medical University Hospital|
|Syracuse, New York, United States, 13210|
|United States, Ohio|
|Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center|
|Columbus, Ohio, United States, 43210-1240|
|United States, Rhode Island|
|Providence, Rhode Island, United States, 02906|
|Rhode Island Hospital Comprehensive Cancer Center|
|Providence, Rhode Island, United States, 02903|
|United States, Vermont|
|Berlin, Vermont, United States, 05602|
|Fletcher Allen Health Care - University Health Center Campus|
|Burlington, Vermont, United States, 05401|
|United States, Virginia|
|Danville Regional Medical Center|
|Danville, Virginia, United States, 24541|
|Study Chair:||James L. Rubenstein, MD, PhD||University of California, San Francisco|