Bortezomib, Rituximab, and Dexamethasone With or Without Temsirolimus in Treating Patients With Untreated or Relapsed Waldenstrom Macroglobulinemia or Relapsed or Refractory Mantle Cell or Follicular Lymphoma

This study is currently recruiting participants.
Verified November 2013 by National Cancer Institute (NCI)
Sponsor:
Information provided by (Responsible Party):
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT01381692
First received: June 23, 2011
Last updated: November 18, 2013
Last verified: November 2013
  Purpose

This randomized phase I/II trial studies the side effects and the best dose of temsirolimus when given together with bortezomib, rituximab, and dexamethasone and to see how well they work compared to bortezomib, rituximab, and dexamethasone alone in treating patients with untreated or relapsed Waldenstrom macroglobulinemia or relapsed or refractory mantle cell or follicular lymphoma. Bortezomib and temsirolimus may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Bortezomib may also stop the growth of cancer cells by blocking blood flow to the tumor. Monoclonal antibodies, such as rituximab, can block cancer growth in difference 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. Drugs used in chemotherapy, such as dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It is not yet known whether bortezomib, rituximab, and dexamethasone are more effective with temsirolimus in treating non-Hodgkin lymphoma.


Condition Intervention Phase
Cognitive/Functional Effects
Fatigue
Neurotoxicity
Recurrent Grade 1 Follicular Lymphoma
Recurrent Grade 2 Follicular Lymphoma
Recurrent Grade 3 Follicular Lymphoma
Recurrent Mantle Cell Lymphoma
Recurrent Marginal Zone Lymphoma
Recurrent Small Lymphocytic Lymphoma
Therapy-related Toxicity
Waldenström Macroglobulinemia
Drug: temsirolimus
Biological: rituximab
Drug: bortezomib
Drug: dexamethasone
Other: laboratory biomarker analysis
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomized Phase I/II Study of Bortezomib, Rituximab, Dexamethasone and Temsirolimus in Patients With Relapsed Waldenstrom's Macroglobulinemia and Relapsed/Refractory Mantle Cell, Follicular, Marginal Zone or Small Lymphocytic Lymphomas (Phase I), and Untreated/Relapsed Waldenstrom's Macroglobulinemia (Phase II)

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • MTD and recommended phase II dose of temsirolimus in combination with bortezomib, rituximab, and dexamethasone (Phase I) [ Time Frame: Up to 6 courses ] [ Designated as safety issue: Yes ]
    Dose-limiting toxicity (DLT) is based on the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0).

  • Progression-free survival (PFS) of patients treated with temsirolimus in combination with bortezomib, rituximab, and dexamethasone (Phase II) [ Time Frame: Time from randomization until disease progression or death of any cause, assessed up to 10 years ] [ Designated as safety issue: No ]
    PFS distributions will be estimated using the method of Kaplan and Meier. The primary analysis of PFS will be performed using a stratified log-rank test with an approximate overall one-sided alpha = 0.15.


Secondary Outcome Measures:
  • Response rates and duration of response (Phase II) [ Time Frame: Up to 10 years ] [ Designated as safety issue: No ]
    Major/Objective Response (OR) is defined as achieving partial response or better by the end of protocol treatment. Minor Response (MR) is defined as achieving minor response or better by the end of protocol treatment.

  • Time to disease progression (Phase II) [ Time Frame: From registration to first observed progression or censored at date of last disease assessment without progression, assessed up to 10 years ] [ Designated as safety issue: No ]
  • Duration of response (Phase II) [ Time Frame: From first observation of a response (minimal response or better) to the time of disease progression, with deaths due to causes other than progression censored, assessed up to 10 years ] [ Designated as safety issue: No ]
  • Time to next therapy (Phase II) [ Time Frame: From the end of treatment to the initiation of next therapy, censored at date last known alive without initiation of next therapy, assessed up to 10 years ] [ Designated as safety issue: No ]
  • Overall survival of patients (Phase II) [ Time Frame: From date of study entry until date of death, assessed up to 10 years ] [ Designated as safety issue: No ]
  • Change in the FACT-Fatigue Trial Outcome Index (TOI) score between the two treatment arms [ Time Frame: Baseline to 3 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 144
Study Start Date: July 2011
Estimated Primary Completion Date: June 2020 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm I (rituximab, bortezomib, dexamethasone)
Patients receive rituximab IV over 30-60 minutes on days 1, 8, 15, and 22 (of courses 1 and 4 only) and bortezomib IV and dexamethasone PO on days 1, 8, and 15. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity.
Biological: rituximab
Given IV
Other Names:
  • IDEC-C2B8
  • IDEC-C2B8 monoclonal antibody
  • Mabthera
  • MOAB IDEC-C2B8
  • Rituxan
Drug: bortezomib
Given IV
Other Names:
  • LDP 341
  • MLN341
  • VELCADE
Drug: dexamethasone
Given PO
Other Names:
  • Aeroseb-Dex
  • Decaderm
  • Decadron
  • DM
  • DXM
Other: laboratory biomarker analysis
Correlative studies
Experimental: Arm II (temsirolimus, rituximab, bortezomib, dexamethasone)
Patients receive temsirolimus IV over 30-60 minutes on days 1, 8, 15, and 22 and rituximab, bortezomib, and dexamethasone as in arm I. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity.
Drug: temsirolimus
Given IV
Other Names:
  • CCI-779
  • cell cycle inhibitor 779
  • Torisel
Biological: rituximab
Given IV
Other Names:
  • IDEC-C2B8
  • IDEC-C2B8 monoclonal antibody
  • Mabthera
  • MOAB IDEC-C2B8
  • Rituxan
Drug: bortezomib
Given IV
Other Names:
  • LDP 341
  • MLN341
  • VELCADE
Drug: dexamethasone
Given PO
Other Names:
  • Aeroseb-Dex
  • Decaderm
  • Decadron
  • DM
  • DXM
Other: laboratory biomarker analysis
Correlative studies

  Hide Detailed Description

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine the maximum tolerated dose (MTD) of temsirolimus in combination with bortezomib, rituximab, dexamethasone in patients with relapsed Waldenstrom's Macroglobulinemia and relapsed/refractory mantle cell, follicular, marginal zone or small lymphocytic lymphoma. (Phase I) II. To evaluate whether the addition of temsirolimus to the regimen of bortezomib, rituximab, dexamethasone improves progression-free survival in patients with previously untreated or relapsed Waldenstrom's Macroglobulinemia. (Phase II)

SECONDARY OBJECTIVES:

I. To define and describe the toxicities of temsirolimus in combination with bortezomib, rituximab, and dexamethasone. (Phase I) II. To evaluate time to progression of bortezomib, rituximab, dexamethasone +/- temsirolimus in patients. (Phase II) III. To evaluate major and minor response by 6 cycles of therapy of bortezomib, rituximab, dexamethasone +/- temsirolimus. (Phase II) IV. To evaluate time to response and duration of response of bortezomib, rituximab, dexamethasone +/- temsirolimus. (Phase II) V. To evaluate toxicity of bortezomib, rituximab, dexamethasone +/- temsirolimus. (Phase II) VI. To evaluate time to next therapy of bortezomib, rituximab, dexamethasone +/- temsirolimus. (Phase II) VII. To evaluate overall survival of bortezomib, rituximab, dexamethasone +/- temsirolimus. (Phase II) VIII. To describe treatment-related fatigue, physical and functional well-being during and after treatment. (Phase II) IX. To compare the change in treatment related fatigue, physical and functional well-being over 6 cycles of bortezomib, rituximab, dexamethasone +/- temsirolimus. (Quality of Life) X. To prospectively assess health-related quality of life longitudinally (pre-treatment to 3 year follow-up assessment) among trial participants. (Quality of Life) XI. To describe treatment-related peripheral neuropathy associated with bortezomib neurotoxicity. (Quality of Life)

OUTLINE: This is a multicenter, phase I, dose-escalation study of temsirolimus followed by a phase II study.

PHASE I: Patients receive temsirolimus intravenously (IV) over 30-60 minutes on days 1, 8, 15, and 22; rituximab IV over 30-60 minutes on days 1, 8, 15, and 22 (of courses 1 and 4 only); and bortezomib IV and dexamethasone orally (PO) on days 1, 8, and 15. Courses repeat every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

PHASE II: Patients are stratified according to disease status (previously untreated vs relapsed) and by the International Prognostic Scoring System for Waldenstrom macroglobulinemia staging (stage I or II vs stage III). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive rituximab IV over 30-60 minutes on days 1, 8, 15, and 22 (of courses 1 and 4 only) and bortezomib IV and dexamethasone PO on days 1, 8, and 15. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive temsirolimus IV over 30-60 minutes on days 1, 8, 15, and 22 and rituximab, bortezomib, and dexamethasone as in arm I. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity.

Patients complete the Functional Assessment of Cancer Therapy (FACT) Physical well-being scale, the Functional well-being scale, and the FACT-Fatigue scale at baseline and periodically during study.

After completion of study therapy, patients are followed up every 3 months for 2 years, every 6 months for 5 years, and then yearly for 5 years.

  Eligibility

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

Inclusion Criteria:

  • Histologically proven diagnosis
  • For phase I portion (Arm A, B, C and D), patients must have of one of the following:

    • Relapsed Waldenstrom's macroglobulinemia
    • Relapsed/refractory mantle cell lymphoma; previous treatment with at least one standard regimen and no longer responsive to that regimen
    • Relapsed/refractory follicular lymphoma; previous treatment with at least one standard regimen and no longer responsive to that regimen
    • Relapsed/refractory marginal zone lymphoma; previous treatment with at least one standard regimen and no longer responsive to that regimen
    • Relapsed/refractory small lymphocytic lymphoma; previous treatment with at least one standard regimen and no longer responsive to that regimen
  • For phase II portion (Arm E and F), patients must have a diagnosis of symptomatic Waldenstrom's macroglobulinemia, either untreated or relapsed, confirmed by the presence of all of the following:

    • Bone marrow lymphoplasmacytosis with

      • >= 10% lymphoplasmatic cells (measured within 28 days prior to registration) OR
      • Aggregates or sheets of one of the following: lymphocytes, plasma cells or lymphoplasmacytic cells on the bone marrow biopsy (measured within 28 days prior to registration)
    • Measurable disease defined as a quantitative immunoglobulin M (IgM) monoclonal protein of >= 1000 mg/dL obtained within 28 days prior to registration
    • Cluster of differentiation 20 (CD20) positive bone marrow or lymph node by immunohistochemistry or flow cytometry obtained within 28 days prior to registration
    • Lymph node biopsy must be done =< 28 days prior to registration if used as an eligibility criterion for study entry
    • Serum protein electrophoresis (SPEP) is required to be performed within 28 days prior to registration
  • Additional requirements for Waldenstrom's macroglobulinemia (WM) patients (phase I and II):
  • In addition to measurable disease, patients must have symptomatic disease defined by one or more of the following:

    • Laboratory studies defining eligibility (hemoglobin [Hgb], platelet count, viscosity) must have been obtained within 28 days prior to registration; if more than one test was obtained, the most recent one will be utilized
    • Hemoglobin =< 11 g/dL
    • Hyperviscosity syndrome or measured viscosity level of >= 4 centipoise

      • NOTE: For these patients it is strongly recommended that they undergo therapeutic plasmapheresis prior to initiation of therapy
    • Platelet count < 100,000/mm^3
    • Symptomatic lymphadenopathy, splenomegaly, or hepatomegaly
    • Constitutional symptoms including fever, night sweats, or unexplained weight loss (at least 10% of body weight in < 6 months)
    • Symptomatic cryoglobulinemia
  • Additional requirements for WM patients (phase I):

    • Patients must have received previous treatment with at least one standard regimen and are no longer responsive to that regimen
    • If last regimen is with rituximab there must have been at least 6 months since last rituximab dose, and if without rituximab there must have been at least 3 months since last regimen
  • Additional requirements for WM patients (phase II):

    • For previously treated patients, no more than 4 prior regimens are allowed
    • If last regimen is with rituximab there must have been at least 6 months since last rituximab dose, and if without rituximab there must have been at least 3 months since last regimen
  • Patients must not be receiving concurrent steroids > 10mg prednisone (or equivalent) per day
  • Prior irradiation is allowed if >= 28 days prior to registration have elapsed since the date of last treatment
  • Fasting serum cholesterol =< 300 mg/dL OR =< 7.75 mmol/L AND fasting triglycerides =< 2.5 x institutional upper limit of normal (ULN), within 28 days prior to registration

    • NOTE: In case one or both of these thresholds are exceeded, the patient can only be included after initiation of appropriate lipid lowering medication; patients cannot be enrolled if they do not meet these criteria on or off lipid lowering medication; patients must start lipid lowering medication and cholesterol and triglycerides must be below said levels before study entry
  • Patients must not have had prior exposure to mammalian target of rapamycin (m-TOR) inhibitors (sirolimus, temsirolimus, everolimus)
  • Women must not be pregnant or breast-feeding; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy; a female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
  • Women of childbearing potential and sexually active males must use an accepted and effective method of contraception throughout the study and for 8 weeks following discontinuation of everolimus
  • Patients must have no history of prior malignancy except for adequately treated basal cell or squamous cell skin cancer or in-situ cervical cancer; the patient may also have had other cancer for which the patient was curatively treated with surgery alone and from which the patient has been disease free for >= 5 years
  • Platelets >= 75,000mm^3
  • Neutrophils >= 1,000mm^3
  • Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 2.5 x institutional ULN
  • Direct bilirubin =< 1.5 mg/dL
  • Serum creatinine =< 2.5 mg/dL
  • Patients must be tested for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) within 28 days of registration and will not be eligible if found to be positive
  • Patients must not have any severe and/or uncontrolled medical condition or other conditions that could affect their participation in the study, including, but not restricted to:

    • Symptomatic congestive heart failure of New York Heart Association class III or IV
    • Unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction within 3 months of start of study treatment, serious uncontrolled cardiac arrhythmia or any other clinically significant heart disease
    • Severely impaired lung function as defined as spirometry and diffusing capacity of the lung for carbon monoxide (DLCO) (corrected for Hgb) that is < 50% of the normal predicted value and/or oxygen (O2) saturation < 88% at rest on room air
    • Active (acute or chronic) or uncontrolled severe infections
  • Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of =< 2
  • Patients must not have grade 2 or higher neuropathy
  • Patients must not have concurrent use of angiotensin-converting enzyme (ACE) inhibitors (angioedema), and no concurrent use of strong cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) inducers and inhibitors
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01381692

Locations
United States, Colorado
Presbyterian - Saint Lukes Medical Center - Health One Terminated
Denver, Colorado, United States, 80218
United States, Georgia
Emory University Recruiting
Atlanta, Georgia, United States, 30322
Contact: Leonard T. Heffner    404-778-1868      
Principal Investigator: Leonard T. Heffner         
United States, Minnesota
Mayo Clinic Recruiting
Rochester, Minnesota, United States, 55905
Contact: Stephen M. Ansell    507-538-7623      
Principal Investigator: Stephen M. Ansell         
United States, New Jersey
Hackensack University Medical Center Recruiting
Hackensack, New Jersey, United States, 07601
Contact: David H. Vesole    551-996-8704    dvesole@hackensackumc.org   
Principal Investigator: David H. Vesole         
United States, Pennsylvania
Geisinger Medical Center Terminated
Danville, Pennsylvania, United States, 17822-2001
Abramson Cancer Center of The University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Adam D. Cohen    800-474-9892      
Principal Investigator: Adam D. Cohen         
Fox Chase Cancer Center Recruiting
Philadelphia, Pennsylvania, United States, 19111-2497
Contact: Michael M. Millenson    215-728-4790      
Principal Investigator: Michael M. Millenson         
University of Pennsylvania Medical Center Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Adam D. Cohen    215-615-5853    adam.cohen@uphs.upenn.edu   
Principal Investigator: Adam D. Cohen         
United States, Wisconsin
Gundersen Lutheran Recruiting
La Crosse, Wisconsin, United States, 54601
Contact: Kurt Oettel    608-775-2385    cancerctr@gundluth.org   
Principal Investigator: Kurt Oettel         
Marshfield Clinic Recruiting
Marshfield, Wisconsin, United States, 54449
Contact: Matthias Weiss    800-347-0673      
Principal Investigator: Matthias Weiss         
Marshfield Clinic-Minocqua Center Recruiting
Minocqua, Wisconsin, United States, 54548
Contact: Matthias Weiss    800-347-0673      
Principal Investigator: Matthias Weiss         
Sponsors and Collaborators
Investigators
Principal Investigator: Leonard Heffner Eastern Cooperative Oncology Group
  More Information

No publications provided

Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT01381692     History of Changes
Other Study ID Numbers: NCI-2011-02650, NCI-2011-02650, CDR0000701362, E1A10, E1A10, U10CA021115
Study First Received: June 23, 2011
Last Updated: November 18, 2013
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Fatigue
Leukemia, Lymphocytic, Chronic, B-Cell
Lymphoma
Lymphoma, Follicular
Waldenstrom Macroglobulinemia
Neurotoxicity Syndromes
Lymphoma, B-Cell, Marginal Zone
Lymphoma, Mantle-Cell
Signs and Symptoms
Leukemia, B-Cell
Leukemia, Lymphoid
Leukemia
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Neoplasms, Plasma Cell
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Paraproteinemias
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Nervous System Diseases
Poisoning
Substance-Related Disorders

ClinicalTrials.gov processed this record on April 17, 2014