Bendamustine Hydrochloride and Rituximab With or Without Bortezomib Followed by Rituximab With or Without Lenalidomide in Treating Patients With High-Risk Stage II, Stage III, or Stage IV Follicular Lymphoma
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| ClinicalTrials.gov Identifier: NCT01216683 |
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Recruitment Status :
Active, not recruiting
First Posted : October 7, 2010
Last Update Posted : October 28, 2020
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RATIONALE: Drugs used in chemotherapy, such as bendamustine hydrochloride, 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. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Biological therapies, such as lenalidomide, may stimulate the immune system in different ways and stop cancer cells from growing. It is not yet known whether giving bendamustine hydrochloride and rituximab together alone is more effective than giving bendamustine hydrochloride and rituximab together with bortezomib or lenalidomide in treating follicular lymphoma.
PURPOSE: This randomized phase II trial is studying giving bendamustine hydrochloride and rituximab together with or without bortezomib followed by rituximab with or without lenalidomide to see how well they work in treating patients with high-risk stage II, stage III, or stage IV follicular lymphoma.
| Condition or disease | Intervention/treatment | Phase |
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| Lymphoma | Biological: rituximab Drug: bendamustine hydrochloride Drug: bortezomib Drug: lenalidomide | Phase 2 |
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| Study Type : | Interventional (Clinical Trial) |
| Estimated Enrollment : | 250 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A 3-Arm Randomized Phase II Trial of Bendamustine-Rituximab (BR) Followed by Rituximab vs Bortezomib-BR (BVR) Followed by Rituximab vs BR Followed by Lenalidomide/Rituximab in High Risk Follicular Lymphoma |
| Actual Study Start Date : | December 13, 2010 |
| Actual Primary Completion Date : | December 2, 2019 |
| Estimated Study Completion Date : | May 8, 2030 |
| Arm | Intervention/treatment |
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Experimental: Arm I
Patients receive rituximab IV on day 1 and bendamustine hydrochloride IV over 1 hour on days 1 and 2. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Beginning 4 weeks after the completion of induction therapy, patients receive rituximab IV on day 1. Treatment repeats every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.
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Biological: rituximab
Given IV Drug: bendamustine hydrochloride Given IV |
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Experimental: Arm II
Patients receive rituximab IV on day 1, bortezomib IV on days 1, 4, 8, and 11, and bendamustine hydrochloride IV over 1 hour on days 1 and 4. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Beginning 4 weeks after the completion of induction therapy, patients receive rituximab as in arm I.
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Biological: rituximab
Given IV Drug: bendamustine hydrochloride Given IV Drug: bortezomib Given IV |
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Experimental: Arm III
Patients receive rituximab IV on day 1 and bendamustine hydrochloride IV over 1 hour on days 1 and 2. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Immediately after completing induction therapy, patients receive oral lenalidomide on days 1-21. Treatment repeats every 28 days for 13 courses in the absence of disease progression or unacceptable toxicity. Beginning 4 weeks after the completion of induction therapy, patients receive rituximab IV on day 1. Treatment repeats every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.
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Biological: rituximab
Given IV Drug: bendamustine hydrochloride Given IV Drug: lenalidomide Given orally |
- Complete remission (CR) rate after induction therapy
- 1-year post-induction disease-free survival rate
- Progression-free survival at 3 years
- Overall survival at 5 years
- Effect of continuation therapy in converting partial response or stable disease from induction into CR
- Association of the original FLIPI-1 score with the recently reported FLIPI-2 score
- Relationship between FLIPI-2 score and outcome
- Overall health-related quality of life and disease-related symptoms as assessed by the FACT-Lymphoma subscale (FACTLym)
- Treatment-related symptoms as assessed by the 13-item FACT-Fatigue scale and the 11-item FACT/GOG-Neurotoxicity scale
- Disease-related symptoms and distress as assessed by the patient self-report assessment
- Number of co-morbidities as assessed by the Cumulative Illness Rating Scale (CIRS) at 2 years
- Relationship between CIRS score and outcome
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| Ages Eligible for Study: | 18 Years to 120 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
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Histologically confirmed (biopsy-proven) diagnosis of follicular B-cell non-Hodgkin lymphoma with no evidence of transformation to large cell histology
- Patients having both diffuse and follicular architectural elements are eligible if the histology is predominantly follicular (i.e., ≥ 50% of the cross-sectional area) and there is no evidence of transformation to a large cell histology
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Diagnostic confirmation (i.e., core needle or excisional lymph node biopsy) required if the interval since tissue diagnosis of low-grade malignant lymphoma is > 24 months
- Bone marrow biopsy alone not acceptable
- Stage II, III, or IV AND grade 1, 2, or 3a disease
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Must meet criteria for High Tumor Burden (higher risk) as defined by either the Groupe D'Etude des Lymphomes Follicularies (GELF) criteria OR the follicular lymphoma international prognostic index (FLIPI) as defined below:
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Patient must meet ≥ 1 of the following GELF criteria:
- Nodal or extranodal mass ≥ 7 cm
- At least 3 nodal masses > 3.0 cm in diameter
- Systemic symptoms due to lymphoma or B symptoms
- Splenomegaly with spleen > 16 cm by CT scan
- Evidence of compression syndrome (e.g., ureteral, orbital, gastrointestinal) or pleural or peritoneal serous effusion due to lymphoma (irrespective of cell content)
- Leukemic presentation (≥ 5.0 x 10^9/L malignant circulating follicular cells)
- Cytopenias (polymorphonuclear leukocytes < 1.0 X 10^9/L, hemoglobin < 10 g/dL, and/or platelets < 100 x 10^9/L)
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Patient must have a FLIPI-1 score of 3, 4, or 5 (1 point per criterion below):
- Age ≥ 60 years
- Stage III-IV disease
- Hemoglobin level < 12 g/dL
- > 4 nodal areas
- Serum LDH level above normal
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At least 1 objective measurable disease parameter
- Baseline measurements and evaluations (PET and CT) obtained within 6 weeks of randomization
- Measurable disease in the liver is required if the liver is the only site of lymphoma
PATIENT CHARACTERISTICS:
- See Disease Characteristics
- ECOG performance status 0-2
- ANC ≥ 1,500/mm³ (includes neutrophils and bands)
- Platelet count ≥ 100,000/mm³
- Creatinine ≤ 2.0 mg/dL
- AST and ALT ≤ 5 x upper limit of normal (ULN)
- Alkaline phosphatase ≤ 5 x ULN
- Total bilirubin ≤ 1.5 x ULN (patients with known Gilbert disease should contact the study PI)
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use 2 effective methods (1 highly effective and 1 additional effective method) of contraception ≥ 28 days before, during, and for ≥ 28 days after completing study treatment
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HIV-positive patients must meet all of the following criteria:
- HIV is sensitive to antiretroviral therapy
- Must be willing to take effective antiretroviral therapy if indicated
- No history of CD4 < 300 cells/mm³ prior to or at the time of lymphoma diagnosis
- No history of AIDS-defining conditions
- If on antiretroviral therapy, must not be taking zidovudine or stavudine
- Must be willing to take prophylaxis for Pneumocystis jiroveci pneumonia (PCP) during therapy and ≥ 2 months following completion of study therapy or until the CD4 cells recover to over 250 cells/mm³
- No recent history of malignancy except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient has been disease-free for ≥ 2 years
- No active, uncontrolled infections (afebrile for > 48 hours off antibiotics)
- No ≥ grade 2 neuropathy
- No myocardial infarction within the past 6 months
- No NYHA class III-IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities
- No serious medical or psychiatric illness likely to interfere with participation in this clinical study
- No known hypersensitivity to boron or mannitol
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No chronic carriers of hepatitis B virus (HBV) with positive hepatitis surface antigen (HBsAg +)
- Patients with a prior history of HBV infection, but immune, with only IgG hepatitis core antibody positive (HBcAb+), must receive antiviral prophylaxis (e.g., lamivudine 100 mg po daily) for ≥ 1 week prior to course 1 and throughout induction and continuation therapy and for ≥ 12 months after the last rituximab dose
- Must register into the mandatory RevAssist® program and be willing and able to comply with the requirements of RevAssist® (for patients randomized to arm III)
PRIOR CONCURRENT THERAPY:
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No prior chemotherapy, radiotherapy, or immunotherapy for lymphoma
- Prednisone or other corticosteroids used for non-lymphomatous conditions will not be considered as prior chemotherapy
- A prior/recent short course (< 2 weeks) of steroids for symptom relief of lymphoma-related symptoms is allowed
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01216683
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| Principal Investigator: | Andrew M. Evens, DO, MS | Robert H. Lurie Cancer Center |
| Responsible Party: | Eastern Cooperative Oncology Group |
| ClinicalTrials.gov Identifier: | NCT01216683 |
| Other Study ID Numbers: |
E2408 E2408 ( Other Identifier: ECOG-ACRIN ) NCI-2011-02644 ( Other Identifier: NCI ) CDR0000683312 ( Other Identifier: NCI ) |
| First Posted: | October 7, 2010 Key Record Dates |
| Last Update Posted: | October 28, 2020 |
| Last Verified: | October 2020 |
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contiguous stage II grade 1 follicular lymphoma contiguous stage II grade 2 follicular lymphoma contiguous stage II grade 3 follicular lymphoma noncontiguous stage II grade 1 follicular lymphoma noncontiguous stage II grade 2 follicular lymphoma noncontiguous stage II grade 3 follicular lymphoma |
stage III grade 1 follicular lymphoma stage III grade 2 follicular lymphoma stage III grade 3 follicular lymphoma stage IV grade 1 follicular lymphoma stage IV grade 2 follicular lymphoma stage IV grade 3 follicular lymphoma |
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Lymphoma Lymphoma, Follicular Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Lymphoma, Non-Hodgkin Rituximab Lenalidomide Bortezomib Bendamustine Hydrochloride |
Antineoplastic Agents, Immunological Antineoplastic Agents Immunologic Factors Physiological Effects of Drugs Antirheumatic Agents Angiogenesis Inhibitors Angiogenesis Modulating Agents Growth Substances Growth Inhibitors Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action |