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| Sponsor: | University of California, San Diego |
|---|---|
| Collaborator: |
Bristol-Myers Squibb |
| Information provided by: | University of California, San Diego |
| ClinicalTrials.gov Identifier: | NCT00949988 |
Purpose
This is an open-label phase I/II study that will investigate the combination of dasatinib and rituximab therapy in patients with relapsed/refractory CLL. In phase I, eligible subjects will take either 100 mg or 140 mg of dasatinib daily along with rituximab on day 1 of each cycle for 6 cycles. In phase II, eligible subjects will all receive the same dose of dasatinib, as established in the phase I portion, along with rituximab on day 1 of each cycle for 6 cycles.
The investigators hypothesize that the combination of dasatinib and rituximab will demonstrate efficacy in the treatment of patients with relapsed/refractory CLL.
| Condition | Intervention | Phase |
|---|---|---|
|
Chronic Lymphocytic Leukemia |
Drug: Dasatinib and Rituximab |
Phase I Phase II |
| Study Type: | Interventional |
| Study Design: | Allocation: Non-Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Phase I/II Study of Dasatinib and Rituximab for Relapsed/Refractory Chronic Lymphocytic Leukemia |
Phase II:
To determine the efficacy of D+R treatment in patients with relapsed/refractory CLL as measured by complete and partial response rates
| Estimated Enrollment: | 28 |
| Study Start Date: | May 2009 |
| Estimated Primary Completion Date: | June 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Dasatinib - 100 mg (Phase I)
Dasatinib - 100 mg (Phase I)
|
Drug: Dasatinib and Rituximab
In Phase I, subjects will be enrolled into a "3+3" dose escalation scheme with two dasatinib cohort doses of 70 mg QD and 100 mg QD to be given continuously during each 28-day cycle. All subjects will also receive rituximab 500 mg/m2 on day 1 of each cycle (375 mg/m2 on day 1 of cycle 1 only). There will be a pre-phase for each dose cohort when subjects will receive single-agent dasatinib from days -7 to -1 to allow for PK and PD assessment. Cohorts will be assessed for dose-limiting toxicities for two cycles before accrual of additional
|
|
Active Comparator: Dasatinib - 70 mg (Phase I)
Dasatinib - 70 mg (Phase I)
|
Drug: Dasatinib and Rituximab
In Phase I, subjects will be enrolled into a "3+3" dose escalation scheme with two dasatinib cohort doses of 70 mg QD and 100 mg QD to be given continuously during each 28-day cycle. All subjects will also receive rituximab 500 mg/m2 on day 1 of each cycle (375 mg/m2 on day 1 of cycle 1 only). There will be a pre-phase for each dose cohort when subjects will receive single-agent dasatinib from days -7 to -1 to allow for PK and PD assessment. Cohorts will be assessed for dose-limiting toxicities for two cycles before accrual of additional
|
In phase I, patients will be enrolled in a standard "3+3" dose escalation scheme with two dasatinib cohort doses of 100 mg QD and 140 mg QD x 28 days/cycle with rituximab 500 mg/m2 on day 1 of each cycle (375 mg/m2 on day 1 of cycle 1 only). During the first cycle of each dose cohort patients will receive dasatinib on days -7 to 0 to allow for pharmacokinetic and pharmacodynamic analysis of single agent dasatinib dosing. Cohorts will be assessed for DLTs during the first 2 cycles. Treatment will continue for 6 cycles or until intolerable toxicity or disease progression. It is estimated that accrual of 3-6 patients will be completed in 4-6 months depending on DLTs observed.
The dasatinib dose established in phase I will move forward to the phase II setting. If there are no DLTs, the phase II dose will be chosen based on PD parameters. Dasatinib will be administered for 28 days/cycle with rituximab 500 mg/m2 on day 1 of each cycle (375 mg/m2 on day 1 of cycle 1 only) for 6 cycles or until intolerable toxicity or disease progression. For this portion of the study, up to an additional 22 patients will be enrolled over a 6-month period for a total of 28 patients at the chosen dose level.
For both, phase I and II, patients will complete up to six cycles of D+R therapy and endpoints will be evaluated 8 weeks after treatment. Patients will be followed until disease progression, study withdrawal or death. Patients with a PR or CR will be eligible to remain on dasatinib alone.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
INCLUSION CRITERIA:
Confirmed immunohistological diagnosis of B-cell CLL and Rai Stage III or IV disease, or stage 0-II disease that meets NCIWG criteria for active disease as indicated by any one of the following disease-related symptoms:
Adequate organ function:
EXCLUSION CRITERIA:
Concurrent medical condition which may increase the risk of toxicity, including:
Uncontrolled or significant cardiovascular disease, including:
History of significant bleeding disorder unrelated to CLL, including:
Past or current malignancy, except for:
Use of Prohibited Concomitant Medications
Subjects requiring any of the following prohibited therapies should not be enrolled:
CYP3A4 Inhibitors: Dasatinib is a CYP3A4 substrate. Concomitant use of dasatinib and drugs that inhibit CYP3A4 (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir, atazanavir, indinavir, nefazodone, nelfinavir, saquinavir, telithromycin) may increase exposure to dasatinib and should be avoided.
In patients receiving treatment with dasatinib, close monitoring for toxicity and a dasatinib dose reduction should be considered if systemic administration of a potent CYP3A4 inhibitor cannot be avoided.
-Drugs that may decrease dasatinib plasma concentration: CYP3A4 Inducers: Drugs that induce CYP3A4 activity may decrease dasatinib plasma concentrations. In patients in whom CYP3A4 inducers (eg, dexamethasone, phenytoin, carbamazepine, rifampicin, phenobarbital) are indicated, alternative agents with less enzyme induction potential should be used. If dasatinib must be administered with a CYP3A4 inducer, a dose increase in dasatinib should be considered and approved by the principal investigator.
-Drugs that may have their plasma concentration altered by dasatinib: CYP3A4 Substrates: CYP3A4 substrates known to have a narrow therapeutic index such as alfentanil, astemizole, terfenadine, cisapride, cyclosporine, fentanyl, pimozide, quinidine, sirolimus, tacrolimus, or ergot alkaloids (ergotamine, dihydroergotamine) should be administered with caution in patients receiving dasatinib.
May decrease dasatinib plasma concentrations unpredictably. Patients receiving dasatinib should not take St. John's wort.
Subjects enrolled in this study should not take or begin to take concomitant medications known to prolong the QT interval. If such medications are already being taken by the patient before study starts, a wash-out period of ≥ 7days is required prior to starting dasatinib. Medications known to prolong the QT interval and/or are generally accepted to have a risk of causing Torsades de Pointes ventricular arrhythmia are (see http://www.qtdrugs.org/medical-pros/drug-lists/drug-lists.htm):
Cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone, halofantrine, levomethadyl, pentamidine, sparfloxacin, lidoflazine Should the Investigator believe that beginning therapy with a potentially QT prolonging medication (other than the ones explicitly prohibited) is vital to an individual subject's care, the Investigator must check that the subject's prior on-therapy ECG has not shown a QTcF ≥ 450 msec or an increase in QTc ≥ 60 msec over the baseline value.
Subjects enrolled in this study should not take concomitant medications that durably inhibit platelet function. For such medications, a wash-out period of ≥ 7days is required prior to starting dasatinib. (Agents that inhibit platelet function transiently or inhibit coagulation by other mechanisms are restricted.)
Medications that directly and durably inhibit platelet function include:
Medications that directly and durably inhibit anticoagulation include:
Women who are pregnant (including having a positive pregnancy test) or breastfeeding, or unable/unwilling to practice an acceptable method to avoid pregnancy for the entire study period and for at least 4 weeks after cessation of study drug, or men who are sexual partners thereof.
Contacts and Locations| United States, California | |
| University of California San Diego Moores Cancer Center | |
| La Jolla, California, United States, 92093 | |
| Principal Investigator: | Januario Castro, M.D. | Associate Clinical Professor, Blood and Bone Marrow Transplant Division |
| Principal Investigator: | Thomas J Kipps, M.D., Ph.D. | Professor of Medicine, Evelyn and Edwin Tasch Chair in Cancer Research in the UCSD School of Medicine |
More Information
| Responsible Party: | Dr. Januario Castro, M.D./Associate Clinical Professor, Blood and Bone Marrow Transplant Division), University of California, San Diego Moores Cancer Center |
| ClinicalTrials.gov Identifier: | NCT00949988 History of Changes |
| Other Study ID Numbers: | UCSD 110054 - Prev 080422 |
| Study First Received: | July 28, 2009 |
| Last Updated: | May 2, 2011 |
| Health Authority: | United States: Institutional Review Board |
|
Chronic Lymphocytic Leukemia CLL Dasatinib |
Rituximab Relapsed Refractory |
|
Leukemia Leukemia, Lymphocytic, Chronic, B-Cell Leukemia, Lymphoid Neoplasms by Histologic Type Neoplasms Leukemia, B-Cell Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Rituximab |
Dasatinib Immunologic Factors Physiological Effects of Drugs Pharmacologic Actions Antirheumatic Agents Therapeutic Uses Antineoplastic Agents Protein Kinase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |