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Combination Therapy With Carfilzomib, Romidepsin, Lenalidomide in Patients With Relapsed or Refractory B- and T-cell Lymphomas

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ClinicalTrials.gov Identifier: NCT02341014
Recruitment Status : Active, not recruiting
First Posted : January 19, 2015
Last Update Posted : February 6, 2019
Sponsor:
Collaborator:
University of Nebraska
Information provided by (Responsible Party):
Memorial Sloan Kettering Cancer Center

Brief Summary:
This is an open label phase Ib/IIa study of patients with relapsed/refractory B- and T-cell lymphomas who are treated with carfilzomib, lenalidomide and romidepsin in a 3+3 design. The phase IIa portion of the study will involve a dose expansion at the MTD to better characterize the efficacy and to inform further disease specific studies.

Condition or disease Intervention/treatment Phase
T-cell Lymphomas Relapsed or Refractory Drug: Carfilzomib Drug: Romidepsin Drug: Lenalidomide Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 31 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase Ib/IIa Study of Combination Therapy With Carfilzomib, Romidepsin, Lenalidomide in Patients With Relapsed or Refractory B- and T-cell Lymphomas
Actual Study Start Date : January 2015
Estimated Primary Completion Date : January 2020
Estimated Study Completion Date : January 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lymphoma

Arm Intervention/treatment
Experimental: Carfilzomib, Romidepsin, Lenalidomide
All patients will be treated with romidepsin administered intravenously on days 1 and 8 of a 21-day cycle. Lenalidomide will be taken orally daily for days 1-14 of a 21-day cycle. The carfilzomib will be given weekly on days 1, and 8 of a 21-day cycle. Once a MTD is determined this dosing level will be used for the phase IIa portion. Cycles will be continued as above until the patient's wishes to be removed from the study, unacceptable toxicity develops, disease progression, treating physician recommends removal, or termination of study occurs.
Drug: Carfilzomib
The initial dose of carfilzomib (cycle 1, day 1) given to any patient regardless of dose level must be 20mg/m2 . All subsequent doses of carfilzomib will be based on the patient's dose level.

Drug: Romidepsin
Drug: Lenalidomide



Primary Outcome Measures :
  1. MTD (phase Ib) [ Time Frame: 1 year ]
    Determine the MTD by NCI-CTCAE v4.0.


Secondary Outcome Measures :
  1. overall response rate (orr) [ Time Frame: 1 year ]
    will be summarized using proportions and confidence intervals will be provided. ORR will be calculated based on the best response at any time during the course of treatment on this protocol.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Pathologically confirmed B- or T-cell lymphomas at the enrolling institution, including stage ≥ Ib CTCL, which has relapsed or progressed after at least one systemic therapy.
  • Hodgkin lymphoma is allowed and will be classified as a B-cell lymphoma in the phase IIA portion.
  • Age ≥ 18,
  • Previous systemic anti-cancer therapy must have been discontinued at least 3 weeks prior to treatment and adverse effects must have resolved to ≤Grade 1 or baseline. In the phase IIa portion, in progressing subjects, a 2 week washout may be allowed after discussion with the MSK Principal Investigator.
  • Previous radiation, hormonal therapy, and/or surgery must have been discontinued or completed at least 2 weeks prior to treatment in this study and adverse effects must have resolved. Lymph node or other diagnostic biopsies within 2 weeks are not considered exclusionary.
  • ECOG ≤ 2
  • Meet the following laboratory criteria:
  • Absolute neutrophil count 1.0/mm³,
  • Platelet count 80 K/μ (in the Phase II portion, if thrombocytopenia is due to bone marrow involvement platelet count must be 50 K/μL),
  • Phase Ib subjects must have calculated creatinine clearance 50ml/min by Cockcroft-Gault formula, phase IIa subjects must have calculated creatinine clearance ≥ 40ml4/min by Cockcroft-Gault formula.
  • Total bilirubin 1.5 x upper limit of normal (ULN); AST (SGOT) and ALT (SGPT) 3 x ULN
  • Measurable disease for phase IIa portion only.
  • Lymphoma (includes CTCL patients who are without evidence of the disease in the skin): CT or PET/CT by modified Cheson criteria with incorporation of PET.
  • CTCL: mSWAT >0, or absolute Sezary count ≥ 1000 cells/μL.
  • All study participants must be registered into the mandatory Revlimid REMS ® program, and be willing and able to comply with the requirements of the REMS ® program.
  • Short course systemic corticosteroids for disease control, improvement of performance status or non-cancer indication (< 7 days) must have been discontinued at least 6 days prior to study treatment. Stable ongoing corticosteroid use (≥ 30 days) up to an equivalent dose of 15 mg of prednisone is permissible.
  • Topical steroids that have been used for > 3 weeks may be continued (CTCL only).
  • Women of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. See Appendix A: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods.
  • A female of reproductive potential is a sexually mature female who:
  • has not undergone a hysterectomy or bilateral oophorectomy; or 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).

Exclusion Criteria:

  • Patients who have a standard curative option for their lymphoid malignancy at current state of disease are excluded. For eligibility on this trial, allogeneic stem cell transplantation is not to be considered a standard curative option.
  • Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  • Pregnant females. (Lactating females must agree not to breast feed while taking carfilzomib, lenalidomide or romidepsin).
  • Known hypersensitivity to thalidomide.
  • The development of erythema multiforme if characterized by a desquamating rash while taking thalidomide or similar drugs.
  • Prior use of lenalidomide if discontinued due to toxicity.
  • Prior therapy with romidepsin if discontinued due to toxicity.
  • Prior therapy with carfilzomib if discontinued due to toxicity.
  • Prior therapy with a proteasome inhibitor if discontinued due to toxicity.
  • Concurrent use of other anti-cancer agents or treatments.
  • Known seropositive and requiring anti-viral therapy for human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV).
  • Concurrent malignancy requiring active therapy.
  • Patients with more than one type of lymphoma may be enrolled after discussion with the MSK Principal Investigator.
  • Known central nervous system or meningeal involvement (in the absence of symptoms investigation into central nervous system involvement is not required).
  • The following known cardiac abnormalities:
  • Congenital long QT syndrome.
  • QTc/QTf interval ≥ 480 milliseconds; unless secondary to pacemaker or bundle branch block.
  • Myocardial infarction within 6 months of cycle one, day one (C1D1). Subjects with a history of myocardial infarction between 6 and 12 months prior to C1D1 who are asymptomatic and have had a negative cardiac risk assessment (treadmill stress test, nuclear medicine stress test, or stress echocardiogram) since the event may participate.
  • Other significant ECG abnormalities including 2nd degree atrio-ventricular (AV) block type II, 3rd degree AV block.
  • Symptomatic coronary artery disease (CAD), e.g., angina Canadian Class II-IV (see Appendix B). In any patient in whom there is doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present.
  • An ECG recorded at screening showing evidence of cardiac ischemia (ST depression of ≥2 mm, measured from isoelectric line to the ST segment). If in any doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present.
  • Congestive heart failure (CHF) that meets New York Heart Association (NYHA) Class II to IV definitions (see Appendix C) and/or ejection fraction <45% by, echocardiogram, or cardiac MRI.
  • A known history of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), Torsade de Pointes, or cardiac arrest unless currently addressed with an automatic implantable cardioverter defibrillator (AICD).
  • Hypertrophic cardiomegaly or restrictive cardiomyopathy from prior treatment or other causes.
  • Uncontrolled hypertension, i.e., blood pressure (BP) of ≥170/95; patients who have a history of hypertension controlled by medication must be on a stable dose (for at least one month) and meet all other inclusion criteria.
  • Any cardiac arrhythmia requiring an anti-arrhythmic medication (excluding stable doses of beta-blockers)
  • Patients taking drugs that can cause significant QTc/QTf prolongation unless able to be switched to non-QTc/QTf prolonging medication or on a stable dose without significant QT prolongation (>470 msec).
  • Concomitant use of significant CYP3A4 inhibitors unless able to be switched to a non-CYP3A4 inhibiting medication.
  • Caution should be used when administering study drugs to patients taking medications significantly metabolized by these enzymes refer to (http://medicine.iupui.edu/clinpharm/ddis/clinical-table/ ) for clinically relevant medications. Particular attention should be paid to patients receiving warfarin. Patient should have coagulation parameters monitored regularly, and warfarin dose adjusted accordingly. If these drugs cannot be discontinued or replaced, enrollment may be allowed after discussion with MSK PI.

Information from the National Library of Medicine

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): NCT02341014


Locations
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United States, Nebraska
University of Nebraska Medical Center
Omaha, Nebraska, United States, 68198-7680
United States, New Jersey
Memoral Sloan Kettering Cancer Center
Basking Ridge, New Jersey, United States, 07920
United States, New York
Memorial Sloan Kettering Cancer Center @ Suffolk
Commack, New York, United States, 11725
Memorial Sloan Kettering Westchester
Harrison, New York, United States, 10604
Memorial Sloan Kettering Cancer Center
New York, New York, United States, 10065
Memorial Sloan Kettering at Mercy Medical Center
Rockville Centre, New York, United States, 11570
Sponsors and Collaborators
Memorial Sloan Kettering Cancer Center
University of Nebraska
Investigators
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Principal Investigator: Steven Horwitz, MD Memorial Sloan Kettering Cancer Center

Additional Information:
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Responsible Party: Memorial Sloan Kettering Cancer Center
ClinicalTrials.gov Identifier: NCT02341014     History of Changes
Other Study ID Numbers: 14-179
First Posted: January 19, 2015    Key Record Dates
Last Update Posted: February 6, 2019
Last Verified: February 2019
Keywords provided by Memorial Sloan Kettering Cancer Center:
Carfilzomib
Romidepsin
Lenalidomide
Lymphomas
14-179
Additional relevant MeSH terms:
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Lymphoma, T-Cell
Lenalidomide
Lymphoma
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Romidepsin
Immunologic Factors
Physiological Effects of Drugs
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Antineoplastic Agents
Antibiotics, Antineoplastic