Active, not recruiting
Phase 2
Rituximab, Bendamustine Hydrochloride, and Bortezomib Followed by Rituximab and Lenalidomide in Treating Older Patients With Previously Untreated Mantle Cell Lymphoma
Condition(s) studied
LymphomaMantle Cell Lymphoma
Investigational drug(s) / intervention(s)
rituximabBendamustinebortezomiblenalidomide
rituximab: Given IV
Bendamustine: Given IV
bortezomib: Given IV or SC
lenalidomide: Given PO
Study summary
RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some find cancer cells and help kill them or carry cancer-killing substances to them. Others interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as bendamustine hydrochloride, also work in different ways to kill cancer cells or stop them from dividing. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Lenalidomide may stop the growth of mantle cell lymphoma by blocking blood flow to the cancer. It is not yet known whether giving rituximab together with bendamustine and bortezomib is more effective than rituximab and bendamustine, followed by rituximab alone or with lenalidomide in treating mantle cell lymphoma.
PURPOSE: This randomized phase II trial studies rituximab, bortezomib, bendamustine, and lenalidomide in treating previously untreated older patients with mantle cell lymphoma.
Eligibility
Step 1 (Induction) Inclusion Criteria:
* Mantle Cell Lymphoma International Prognostic Index (MIPI) score must be calculated and entered in OPEN
* Histologically confirmed untreated mantle cell lymphoma (MCL), with documented cyclin D1 by immunohistochemical stains and/or t(11;14) by cytogenetics or fluorescence in situ hybridization (FISH)
* Patients must have at least one objective measurable disease parameter
* Negative pregnancy test
* Women of childbearing potential and sexually active males use an accepted and effective method of contraception
* ECOG performance status 0-2
* Absolute neutrophil count (ANC) ≥ 1,500/mcL (1.5 x 10\^9/L)
* Platelets ≥ 100,000/mcL (100 x 10\^9/L)
* Aspartate transaminase (AST)/alanine transaminase (ALT) ≤ 2 times upper limit of normal (ULN)
* Bilirubin ≤ 2 times ULN
* Calculated creatinine clearance by Cockroft-Gault formula ≥ 30 mL/min
* Patient agrees that if randomized to Arms C or D, and proceeding onto Arms G or H, they must register into the mandatory RevAssist program, and be willing and able to comply with the requirements of RevAssist. Patients must have no medical contra-indications to, and be willing to take, DVT prophylaxis as all patients registering to the lenalidomide/rituximab Arms G and H will be required to have deep vein thrombosis (DVT) prophylaxis. Patients randomized to Arms G or H who have a history of a thrombotic vascular event will be required to have full anticoagulation, therapeutic doses of low molecular weight heparin or warfarin to maintain an INR between 2.0 - 3.0, or any other accepted full anticoagulation regimen (e.g. direct thrombin inhibitors or Factor Xa inhibitors) with appropriate monitoring for that agent. Patients on Arms G and H without a history of a thromboembolic event are required to take a daily aspirin (81 mg or 325 mg) for DVT prophylaxis. Patients who are unable to tolerate aspirin should receive low molecular weight heparin therapy or warfarin treatment or another accepted full anticoagulation regimen. Ways to minimize risk of DVT should be discussed with patients, including, but not limited to, avoiding smoking, minimizing prothrombotic hormone replacement, avoiding prolonged periods of inactivity (e.g. uninterrupted long car or plane trips).
* HIV-positive patients are not excluded but, to enroll, must meet all of the below criteria:
* HIV is sensitive to antiretroviral therapy
* Must be willing to take effective antiretroviral therapy, if indicated
* CD4 count at screening \>= 300 cells/mm³
* 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 until at least 2 months following the completion of therapy or until the CD4 cells recover to over 250 cells/mm³, whichever occurs later
Step 1 (Induction) Exclusion Criteria:
* Women (sexually mature female) must not be pregnant or breast-feeding
* Evidence of prior malignancy except adequately treated non-melanoma skin cancer, in situ cervical carcinoma, low grade prostate carcinoma (Gleason grade ≤ 6) managed with observation that has been stable for at least 6 months, or any malignancy treated with curative intent continuously disease free for \>=3 years so as not to interfere with interpretation of radiographic response
* Prior therapy for MCL, except: \< 2 weeks of steroid therapy for symptom control or local radiation therapy for symptom control if there is measurable disease outside the radiation portal. Patients may be on chronic steroids for non-malignant disease if on a stable dose equivalent to ≤ 20 mg prednisone per day.
* CNS involvement
* History of AIDS-defining conditions
* Grade 2 or greater peripheral neuropathy.
* NYHA Class III or IV heart failure, uncontrolled angina severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia
* Hypersensitivity to bortezomib, boron or mannitol
* A serious medical or psychiatric illness likely to interfere with study participation
* Participating in any other therapeutic clinical trial or taking any other experimental medications within 14 days prior to registration.
Step 2 (Maintenance) Inclusion Criteria:
* ECOG performance status between 0-2
* Complete response, partial response or stable disease after Step 1
* ANC \>= 1000 cells/mm3 (1.0 x 10\^9/L)
* Platelets \>= 75,000 cells/mm3 (75 x 10\^9/L)
* AST/ALT \<= 2 x upper limit of normal (ULN)
* Total bilirubin \<= 2 x upper limit of normal (ULN) or, if total elevated, direct bilirubin \<= 2 x upper limit of normal (ULN)
* Calculated creatinine clearance by Cockroft-Gault formula \>= 30 ml/min
* Patient agrees that if randomized to Arms C or D, and proceeding onto Arms G or H, they must register into the mandatory REMS program, and be willing and able to comply with the requirements of REMS.
* Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of Cycle 1 of lenalidomide.
* Females of childbearing potential (FCBP)\* with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on lenalidomide therapy (including breaks in therapy); at discontinuation of lenalidomide and at Day 28 post the last dose of lenalidomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on lenalidomide therapy (including breaks in therapy), at discontinuation of lenalidomide and at Day 14 and Day 28 post the last dose of lenalidomide (see Appendix VI: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
* Females of childbearing potential (FCBP)\* must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10 - 14 days and again within 24 hours prior to starting Cycle 1 of lenalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure.
* A female of childbearing potential is any sexually mature female, regardless of sexual orientation of 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 (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).
* Females of childbearing potential (FCBP) must agree to use two reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse during the following time periods related to this study/lenaliomide: 1) for at least 28 days before starting lenalidomide; 2) while participating in the study including interruptions in therapy; and 3) for at least 28 days after discontinuation/stopping lenalidomide. The two methods of reliable contraception must include one highly effective method (i.e. intrauterine device (IUD), hormonal \[birth control pills, injections, or implants\], tubal ligation, partner's vasectomy) and one additional effective (barrier) method (i.e. latex condom, diaphragm, cervical cap). FCBP must be referred to a qualified provider of contraceptive methods if needed.
* Women must agree to abstain from donating blood during study participation and for at least 28 days after discontinuation from protocol treatment.
* Males must agree to abstain from donating blood, semen, or sperm during study participation and for at least 28 days after discontinuation from protocol treatment. All males, regardless of whether they have undergone a successful vasectomy, must agree to use a latex condom during sexual contact with a female of childbearing potential, or to practice complete abstinence from heterosexual intercourse with any female of childbearing potential during all cycles of study treatment and for at least 28 days following discontinuation of protocol treatment
* Patients must have no medical contra-indications to, and be willing to take, DVT prophylaxis as all patients registering to the lenalidomide/rituximab Arms G and H will be required to have deep vein thrombosis (DVT) prophylaxis. Patients randomized to Arms G or H who have full anticoagulation, a history of a thrombotic vascular event will be required to have therapeutic doses of low molecular weight heparin or warfarin to maintain an INR between 2.0 - 3.0, or any other accepted full anticoagulation regimen (e.g. direct thrombin inhibitors or Factor Xa inhibitors) with appropriate monitoring for that agent. Patients on Arms G and H without a history of a thromboembolic event are required to take a daily aspirin (81 mg or 325 mg) for DVT prophylaxis. Patients who are unable to tolerate aspirin should receive low molecular weight heparin therapy or warfarin treatment or another accepted full anticoagulation regimen. Ways to minimize risk of DVT should be discussed with patients, including, but not limited to, avoiding smoking, minimizing pro-thrombotic hormone replacement, avoiding prolonged periods of inactivity (e.g. uninterrupted long car or plane trips).
Primary outcome measure(s)
- Progression-free Survival (PFS) for Induction Phase — Assessed at baseline, every 3 months for 2.5 years, every 6 months up to 10 years from end of treatment, and then annually up to 10 years and 6 months
PFS is defined as time from randomization to lymphoma progression or death. Progression is defined as:
* Appearance of any new lesion \>1.5 cm in any axis during or at the end of therapy
* \>=50% increase from nadir in the sum of products of the diameters (SPD) of any previously involved nodes or extranodal masses, or in a single involved node or extranodal mass, or the size of other lesions.
* \>=50% increase in the longest diameter of any single previously identified node or extranodal mass more than 1 cm in its short axis.
* Lesions should be PET positive if observed in a typical FDG-avid lymphoma or the lesion was PET positive before therapy unless the lesion is too small to be detected with current PET systems
- Progression-free Survival (PFS) for Maintenance Phase (Step 2) — Assessed at registration to step 2, cycles 6, 12, 18, treatment completion, then every 3 months for 2.5 years, every 6 months up to 10 years from end of treatment, and then annually up to 10 years and 6 months
PFS is defined as time from Step 2 registration to lymphoma progression or death. Progression is defined as:
* Appearance of any new lesion \>1.5 cm in any axis during or at the end of therapy
* \>=50% increase from nadir in the sum of products of the diameters (SPD) of any previously involved nodes or extranodal masses, or in a single involved node or extranodal mass, or the size of other lesions.
* \>=50% increase in the longest diameter of any single previously identified node or extranodal mass more than 1 cm in its short axis.
* Lesions should be PET positive if observed in a typical FDG-avid lymphoma or the lesion was PET positive before therapy unless the lesion is too small to be detected with current PET systems
Trial sites (418)
| Facility | City | Region | Status |
| Alaska Breast Care and Surgery LLC |
Anchorage |
Alaska |
|
| Alaska Women's Cancer Care |
Anchorage |
Alaska |
|
| Anchorage Oncology Centre |
Anchorage |
Alaska |
|
| Katmai Oncology Group |
Anchorage |
Alaska |
|
| Providence Alaska Medical Center |
Anchorage |
Alaska |
|
| Kaiser Permanente-Deer Valley Medical Center |
Antioch |
California |
|
| Kaiser Permanente, Fremont |
Fremont |
California |
|
| Kaiser Permanente |
Fresno |
California |
|
| Los Angeles County-USC Medical Center |
Los Angeles |
California |
|
| USC / Norris Comprehensive Cancer Center |
Los Angeles |
California |
|
| Kaiser Permanente-Modesto |
Modesto |
California |
|
| Kaiser Permanente-Oakland |
Oakland |
California |
|
| Kaiser Permanente-Redwood City |
Redwood City |
California |
|
| Kaiser Permanente-Richmond |
Richmond |
California |
|
| Kaiser Permanente-Roseville |
Roseville |
California |
|
| Kaiser Permanente-South Sacramento |
Sacramento |
California |
|
| Kaiser Permanente - Sacramento |
Sacramento |
California |
|
| Kaiser Permanente-San Francisco |
San Francisco |
California |
|
| Kaiser Permanente-Santa Teresa-San Jose |
San Jose |
California |
|
| Kaiser Permanente San Leandro |
San Leandro |
California |
|
| Kaiser Permanente-San Rafael |
San Rafael |
California |
|
| Kaiser Permanente Medical Center - Santa Clara |
Santa Clara |
California |
|
| Kaiser Permanente-Santa Rosa |
Santa Rosa |
California |
|
| Kaiser Permanente-South San Francisco |
South San Francisco |
California |
|
| Stanford University Hospitals and Clinics |
Stanford |
California |
|
| Kaiser Permanente-Stockton |
Stockton |
California |
|
| Kaiser Permanente Medical Center-Vacaville |
Vacaville |
California |
|
| Kaiser Permanente-Vallejo |
Vallejo |
California |
|
| Kaiser Permanente-Walnut Creek |
Walnut Creek |
California |
|
| Rocky Mountain Cancer Centers-Aurora |
Aurora |
Colorado |
|
| The Medical Center of Aurora |
Aurora |
Colorado |
|
| Boulder Community Hospital |
Boulder |
Colorado |
|
| Rocky Mountain Cancer Centers-Boulder |
Boulder |
Colorado |
|
| Penrose-Saint Francis Healthcare |
Colorado Springs |
Colorado |
|
| Rocky Mountain Cancer Centers-Penrose |
Colorado Springs |
Colorado |
|
| Kaiser Permanente-Franklin |
Denver |
Colorado |
|
| Porter Adventist Hospital |
Denver |
Colorado |
|
| Exempla Saint Joseph Hospital |
Denver |
Colorado |
|
| Presbyterian - Saint Lukes Medical Center - Health One |
Denver |
Colorado |
|
| Rocky Mountain Cancer Centers-Midtown |
Denver |
Colorado |
|
+ 378 more sites — see the full list on the official registry below.