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Vinblastine/Prednisone Versus Single Therapy With Cytarabine for Langerhans Cell Histiocytosis (LCH)

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ClinicalTrials.gov Identifier: NCT02670707
Recruitment Status : Recruiting
First Posted : February 2, 2016
Last Update Posted : August 25, 2022
Information provided by (Responsible Party):
Olive Eckstein, Baylor College of Medicine

Brief Summary:

Langerhans Cell Histiocytosis (LCH) is a type of cancer that can damage tissue or cause lesions to form in one or more places in the body. Langerhans cell histiocytosis (LCH) is a cancer that begins in LCH cells (a type of dendritic cell which fights infection). Sometimes there are mutations (changes) in LCH cells as they form. These include mutations of the BRAF gene. These changes may make the LCH cells grow and multiply quickly. This causes LCH cells to build up in certain parts of the body, where they can damage tissue or form lesions.

For most patients with LCH, standard-of-care vinblastine/prednisone are used as front-line therapy while cytarabine therapy has been used as therapy for patients who develop recurrence. No alternate treatment strategy has been developed for frontline therapy in LCH.

The purpose of this research study is to compare previously used vinblastine/prednisone to single therapy with cytarabine for LCH. We will evaluate the utility of an imaging study called a positron emission tomography (PET) scan to more accurately assess areas of LCH involvement not otherwise seen in other imaging studies as well as response to therapy. We also want to identify if genetic and other biomarkers (special proteins in patient's blood and in patient's cancer) relate to the response of patients LCH to study treatment.

Condition or disease Intervention/treatment Phase
Langerhans Cell Histiocytosis Drug: Cytarabine Drug: Vinblastine/prednisone Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 124 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomization of Cytarabine Monotherapy Versus Standard-of-Care Vinblastine/Prednisone for Frontline Treatment of Langerhans Cell Histiocytosis (TXCH LCH0115)
Actual Study Start Date : March 7, 2016
Estimated Primary Completion Date : January 2023
Estimated Study Completion Date : January 2027

Arm Intervention/treatment
Experimental: Cytarabine ("experimental") arm
On this arm, patients will receive single therapy with cytarabine.
Drug: Cytarabine
Cytarabine 100 mg/m^2/day IV for five consecutive days. This five-day cycle will be repeated every 21 days for a total of four cycles for all patients regardless of response. Each new cycle may not begin until absolute neutrophil count (ANC) is ≥ 750/mcL and platelet count is ≥ 75,000/mcL.
Other Name: cytosine arabinoside (ara-C)

Active Comparator: Vinblastine/prednisone ("standard") arm
On this arm, patients will receive standard-of-care therapy with vinblastine and prednisone.
Drug: Vinblastine/prednisone

Vinblastine/Prednisone +/- 6-mercaptopurine based on risk category. Patients with high-risk organ involvement (liver, spleen, hematopoeitic system) will receive 6-mercaptopurine during Continuation Therapy as this is the current standard of care treatment.

Vinblastine 6 mg/m^2/dose IV push weekly for patients ≥ 12 months of age. Vinblastine will be dosed at 3 mg/m^2/dose for patients under 6 months of age, and dosed at 4.5 mg/m^2/dose for patients 6 months of age to 11.99 months of age.

Prednisone (or prednisolone) 20 mg/m2/dose by mouth twice a day

Other Name: Velban/Deltasone

Primary Outcome Measures :
  1. Time to determine 1-year event-free survival (EFS) of patients treated with cytarabine monotherapy for LCH, compared directly with that of standard-of-care vinblastine/prednisone (Events include progression of LCH, relapse, or death). [ Time Frame: up to 60 months ]

    A Kaplan-Meier curve will be used to compare event-free survival between treatment groups. Curves will be compared using the log-rank statistic. Patients will be followed for up to 5 years after one year of therapy. Patients who have not had the event by the 5-year mark will be censored observations. Patients who are lost to follow-up without having an event will be censored at the time of last contact. Statistical significance will be assessed at the 0.05 level.

    A Cox proportional hazards model will also be used to estimate the Hazards Rate for combined events in the Cytarabine group versus standard therapy. A multiple regression model will also be used to estimate the adjusted HRs for genotype and baseline risk of death (high vs. low).

Secondary Outcome Measures :
  1. Durable responses with 2-year and 5-year EFS and OS of the patients treated with cytarabine versus vinblastine/prednisone for LCH. [ Time Frame: 2-years and 5-years post treatment ]
    Overall disease response at each timepoint will be assigned based on the lesion or organ system with worst response. For disease response not defined by the criteria included in the protocol, guidelines established in the RECIST criteria will be used.

  2. Number of toxicities (including psychosis, hypertension, neuropathy, fever, headache) in the patients treated with cytarabine versus vinblastine/prednisone for LCH. [ Time Frame: up to 60 months after completion of therapy ]
    Toxicity will be graded by the NCI Common Toxicity Criteria Version 5.0.

  3. Rate at which patients achieve non-active disease on cytarabine versus vinblastine/prednisone therapy. [ Time Frame: up to 60 months after completion of therapy ]
    RECIST criteria will be used for assessing disease response

  4. Time to eradication of BRAF-V600E cells or other LCH-defining mutation [ Time Frame: within 6-24 weeks of therapy initiation ]
    This will be quantified by quantitative real-time PCR.

  5. Number of patients who have 18-FDG PET/CT positivity in identifying high-risk organ (liver, spleen, or bone marrow) involvement and correlation of PET/CT response with presence of disease activity as well as presence of circulating cells with BRAF-V600E. [ Time Frame: up to 60 months after completion of therapy ]
    For disease response not defined by the criteria included in the protocol, guidelines established in the RECIST criteria will be used.

  6. RECIST criteria and terminology in conjunction with metabolic PET imaging (where applicable) to assess disease response to therapy. [ Time Frame: up to 60 months after completion of therapy ]
    This trial will utilize RECIST criteria for assessing disease response, which uses standard oncology response criteria terminology. Using RECIST terminology, we define response criteria for organs that may not have measurable lesions (i.e. bone marrow) but are clearly critical sites of disease. In addition, definitions of response in terms of metabolic activity from PET scans will also be prospectively analyzed based on prior retrospective radiologic reviews.

  7. Number of risk factors for and time to development of diabetes insipidus and neurodegenerative disease. [ Time Frame: up to 60 months after completion of therapy ]
    Evaluation of CNS+ site involvement at start of therapy, somatic BRAFV600E mutation status and measurable peripheral/marrow levels, ethnicity, age at onset, and extent of disease in predicting risk of neurodegenerative disease and/or pituitary involvement.

  8. Storage of serial samples [ Time Frame: up to 60 months after completion of therapy ]
    To store serial samples (viable WBCs, plasma, tumor, bone marrow, cerebrospinal fluid) for future correlative biology studies.

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Ages Eligible for Study:   up to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patient must have biopsy-confirmed diagnosis of Langerhans cell histiocytosis.
  2. Patient must be between 0-21 years of age.
  3. Patient must have a Karnofsky performance score ≥ 50% or Lansky performance score ≥ 50%.

Exclusion Criteria:

  1. Patient may not have received any prior systemic cytotoxic or other chemotherapies for LCH or any other malignant disorder prior to the initiation of protocol therapy on TXCH LCH0115 with the exception of:

    Steroid pretreatment: Systemic glucocorticosteroids (prednisone, methylprednisone, dexamethasone, etc.) for less than or equal to 120 hours (5 days) in the 7 days prior to initiating protocol therapy or for less than or equal to 336 hours (14 days) in the 28 days before the initiation of protocol therapy does not affect eligibility. The dose of steroid previously given does not affect eligibility. Patients who have only received surgical or radiation therapy, intralesional injection of steroids, inhalational steroids, systemic mineralocorticoids (hydrocortisone), or topical steroids may also be enrolled.

  2. Patient may not have disease limited to a single skin or bone site, with the following exceptions:

    • Central Nervous System (CNS) risk lesions/special site disease: patients with single bone sites that are CNS-risk (sphenoid, mastoid, orbital, zygomatic, ethmoid, maxillary, or temporal bones, the cranial fossa, pituitary gland or neurodegenerative disease) or are "special sites" (odontoid peg, vertebral lesion with intraspinal soft tissue extension) require systemic therapy as standard of care and thus are eligible for the study.
    • Functionally critical lesions: A single lesion not described above which may cause "functionally critical anatomic abnormality" wherein attempts at local therapy (such as surgical curettage or radiation) would cause unacceptable morbidity. These patients may be enrolled with written approval of the Coordinating Center PI or Vice-Chair and documentation of the rationale justifying systemic therapy.
    • Asynchronous multisite LCH presentation: A patient may also have any single site of disease involvement at the time of enrollment if they previously had at least one other site of LCH disease in the past (which may have been treated with local therapy/surgery as described), as long as no systemic therapy was previously given per protocol guidelines.
  3. Patient may not have severe renal disease (creatinine greater than 3 times normal for age OR creatinine clearance < 50 ml/m2/1.73m^2).
  4. Patient may not have severe hepatic disease (direct bilirubin greater than 3 mg/dl OR aspartate aminotransferase (AST) greater than 500 IU/L), unless hepatic injury is due to LCH.
  5. Female patients may not be pregnant or breastfeeding.
  6. Patients of reproductive potential not willing to use an adequate method of birth control for the duration of the study.
  7. Patients who are HIV positive may not be enrolled.

NOTE: Patients excluded for laboratory abnormalities or performance score only may be enrolled on the study with written approval from the Coordinating Center PI or Vice-Chair.

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): NCT02670707

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Contact: Olive Eckstein, MD 832-822-4242 Eckstein@bcm.edu
Contact: Carl E. Allen, MD, PhD 832-826-0860 ceallen@txch.org

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United States, California
Stanford Children's Hospital, Lucile Packard Children's Hospital Recruiting
Palo Alto, California, United States, 94304
Contact: Michael Jeng, MD    650-723-5535    mjeng@stanford.edu   
Contact: Sophia Harrison    (650) 498-2976    sophiah1@stanford.edu   
Rady Children's Hospital - San Diego Recruiting
San Diego, California, United States, 92123
Contact: Jennifer Yu, MD       jyu@rchsd.org   
Contact: Sherri Brandsen    858-966-1700 ext 226235    sbrandsen@rchsd.org   
Principal Investigator: Jennifer Yu, MD         
United States, Minnesota
University of Minnesota/Masonic Cancer Center Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Lucie Turcotte, MD    612-626-2778    turc0023@umn.edu   
Contact: Mollie Koppes    (612) 625-9123    thom1031@umn.edu   
United States, Ohio
Nationwide Children's Hospital Recruiting
Columbus, Ohio, United States, 43205
Contact: Amanda Jacobson-Kelly, MD    614-722-3510    Amanda.Jacobson-Kelly@nationwidechildrens.org   
Contact: Myra Christian-Rancy    (614) 722-3690    Myra.Christian-Rancy@nationwidechildrens.org   
United States, Pennsylvania
Lehigh Valley Health Network- Cedar Crest Recruiting
Allentown, Pennsylvania, United States, 18103
Contact: Daniel Zinn, MD    610-402-9543    Daniel.Zinn@lvhn.org   
Contact: Annmarie Steber    (610) 402-3078    annmarie.steber@lvhn.org   
United States, Texas
Dell Children's Medical Center Recruiting
Austin, Texas, United States, 78723
Contact: Virgina Harrod, MD, PhD    512-628-1900    vlharrod@ascension.org   
Contact: Rhea Robinson    512-628-1902    rmrobinson@ascension.org   
Principal Investigator: Virgina Harrod, MD, PhD         
Cook Children's Health Care System Recruiting
Fort Worth, Texas, United States, 76104
Contact: Anish Ray, MD    682-885-4007    Anish.Ray@cookchildrens.org   
Contact: Heather Downs    (685) 885-3379    Heather.Downs@cookchildrens.org   
Texas Children's Hospital Recruiting
Houston, Texas, United States, 77030
Contact: Olive Eckstein, MD    832-822-4242    Eckstein@bcm.edu   
Vannie Cook Children's Clinic Recruiting
McAllen, Texas, United States, 78503
Contact: Juan C Bernini, MD    956-661-9840    jcbernin@txch.org   
Contact: Jill Hartley    (832) 828-1727    jrhartl1@txch.org   
Children's Hospital of San Antonio Recruiting
San Antonio, Texas, United States, 78207
Contact: Timothy Griffin, MD    210-704-2187    Timothy.Griffin@bcm.edu   
Contact: Bridget Medina    210-704-2894    bridget.medina@christushealth.org   
Principal Investigator: Timothy Griffin, MD         
United States, Virginia
Children's Hospital of The King's Daughters Recruiting
Norfolk, Virginia, United States, 23507
Contact: William Owen, MD    757-668-7243    William.Owen@chkd.org   
Contact: Sabrina Wiggington    757-668-7909    Sabrina.Wigginton@chkd.org   
Principal Investigator: William Owen, MD         
Sponsors and Collaborators
Baylor College of Medicine
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Study Chair: Olive Eckstein, MD Baylor College of Medicine
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Responsible Party: Olive Eckstein, Assistant Professor, Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT02670707    
Other Study ID Numbers: H-37718 TXCH LCH0115
First Posted: February 2, 2016    Key Record Dates
Last Update Posted: August 25, 2022
Last Verified: August 2022
Keywords provided by Olive Eckstein, Baylor College of Medicine:
Langerhans Cell Histiocytosis (LCH)
Additional relevant MeSH terms:
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Histiocytosis, Langerhans-Cell
Lymphatic Diseases
Lung Diseases, Interstitial
Lung Diseases
Respiratory Tract Diseases
Anti-Inflammatory Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antiviral Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Antineoplastic Agents, Phytogenic
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators