Bortezomib, Combination Chemotherapy, and Rituximab as First-Line Therapy in Treating Patients With Stage III or Stage IV Follicular Non-Hodgkin's Lymphoma
A Multi-Centre Phase II Trial Investigating the Efficacy and Tolerability of Bortezomib Added to Cyclophosphamide, Vincristine, Prednisone, and Rituximab (BCVP-R) for Patients With Advanced Stage Follicular Non-Hodgkin's Lymphoma Requiring Systemic First-Line Treatment
RATIONALE: Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cyclophosphamide, vincristine, and prednisone, 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. Giving bortezomib together with combination chemotherapy and rituximab may kill more cancer cells.
PURPOSE: This phase II trial is studying the side effects and how well giving bortezomib together with combination chemotherapy and rituximab works when given as first-line therapy in treating patients with stage III or stage IV follicular non-Hodgkin's lymphoma.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
OBJECTIVES:
Primary
- Assess the efficacy of systemic first-line treatment comprising bortezomib, cyclophosphamide, vincristine, prednisone, and rituximab, in terms of complete response rate, in patients with stage III or IV follicular non-Hodgkin's lymphoma.
- Assess the incidence of severe neurotoxicity (defined as grade 3 or 4 neuropathy or neuropathic pain during the first 4 courses of treatment) in patients treated with this regimen.
Secondary
- Assess the overall response rate and response duration in patients treated with this regimen.
- Determine progression-free and overall survival of patients treated with this regimen.
- Evaluate the tolerability and characterize the toxicity profile of this regimen in these patients.
- Assess quality of life, with particular focus on neurotoxicity-related changes, of patients treated with this regimen.
OUTLINE: This is a multicenter, nonrandomized, open-label study.
Patient receive cyclophosphamide IV over 15-45 minutes, vincristine IV over 3-5 seconds and rituximab IV over 1½-6 hours on day 1, oral prednisone daily on days 1-5, and bortezomib IV over 3-5 seconds on days 1 and 8. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity.
Quality of life is assessed at baseline, at the end of each course of treatment, and on day 42 at the post treatment visit.
After completion of study treatment, patients are followed at 3 and 6 weeks and then every 3-6 months thereafter.
PROJECTED ACCRUAL: A total of 90 patients will be accrued for this study.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Alberta
-
Edmonton, Alberta, Canada, T6G 1Z2
- Cross Cancer Institute
-
-
British Columbia
-
Surrey, British Columbia, Canada, V3V 1Z2
- BCCA - Fraser Valley Cancer Centre
-
Vancouver, British Columbia, Canada, V5Z 4E6
- BCCA - Vancouver Cancer Centre
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Victoria, British Columbia, Canada, V8R 6V5
- BCCA - Vancouver Island Cancer Centre
-
-
Manitoba
-
Winnipeg, Manitoba, Canada, R3E 0V9
- CancerCare Manitoba
-
-
New Brunswick
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Moncton, New Brunswick, Canada, E1C 6Z8
- The Moncton Hospital
-
-
Nova Scotia
-
Halifax, Nova Scotia, Canada, B3H 1V7
- QEII Health Sciences Center
-
-
Ontario
-
Greater Sudbury, Ontario, Canada, P3E 5J1
- Regional Cancer Program of the Hopital Regional
-
London, Ontario, Canada, N6A 4L6
- London Regional Cancer Program
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Mississauga, Ontario, Canada, L5M 2N1
- Credit Valley Hospital
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Thunder Bay, Ontario, Canada, P7B 6V4
- Thunder Bay Regional Health Science Centre
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Toronto, Ontario, Canada, M4N 3M5
- Odette Cancer Centre
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Toronto, Ontario, Canada, M5G 2M9
- Univ. Health Network-Princess Margaret Hospital
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Toronto, Ontario, Canada, M9N 1N8
- Humber River Regional Hospital
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Quebec
-
Greenfield Park, Quebec, Canada, J4V 2H1
- Hopital Charles LeMoyne
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Montreal, Quebec, Canada, H2L 4M1
- CHUM - Hopital Notre-Dame
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Montreal, Quebec, Canada, H2W 1S6
- McGill University - Dept. Oncology
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Québec, Quebec, Canada, G1S 4L8
- CHA-Hopital Du St-Sacrement
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Saskatchewan
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Regina, Saskatchewan, Canada, S4T 7T1
- Allan Blair Cancer Centre
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
DISEASE CHARACTERISTICS:
Histologically confirmed follicular non-Hodgkin's lymphoma meeting the following criteria:
- Stage III or IV disease
- Grade 1, 2, or 3 disease requiring systemic first-line treatment
- No transformation to diffuse large cell lymphoma
At least 1 bidimensionally measurable lesion meeting 1 of the following criteria:
- Lymph nodes > 1.5 cm x 1.0 cm by physical exam or CT scan
- Other non-nodal lesion ≥ 1.0 cm x 1.0 cm by MRI or CT scan OR ≥ 1.0 cm x 1.0 cm (e.g., skin lesions or nodules) by physical exam
Must have a medical indication for treatment, as indicated by 1 of the following:
- Presence of constitutional symptoms that are attributed to lymphoma (e.g., B symptoms, including night sweats, fever, weight loss, fatigue, or pain)
- Lymphadenopathy that requires treatment based on presence of associated symptoms, potential threat to organ function (e.g., ureteric compromise from retroperitoneal disease), or degree of enlargement (i.e., > 5 cm)
- Impairment of normal organ function (e.g., impaired hematopoiesis due to marrow involvement by lymphoma or from splenomegaly and hypersplenism)
- Immune-related complications of lymphoma that require therapy
- Rate of disease progression for which observation is deemed inappropriate
- No history of any other lymphoproliferative disorder or evidence of transformation to an aggressive histology lymphoma
- No known CNS involvement by lymphoma
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2
- Life expectancy ≥ 12 weeks
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Platelet count ≥ 75,000/mm^3*
- Absolute neutrophil count ≥ 1,000/mm^3*
- Creatinine ≤ 1.5 times upper limit of normal (ULN)
- Bilirubin ≤ 1.5 times ULN
- AST or ALT ≤ 2.5 times ULN (5 times ULN if liver involvement with lymphoma)
Able (i.e., sufficiently fluent) and willing to complete the quality of life questionnaires in either English or French
- Inability (illiteracy in English or French, loss of sight, or other equivalent reason) to complete the questionnaires will not make the patient ineligible for the study
No history of other malignancies, except for the following:
- Adequately treated nonmelanoma skin cancer
- Curatively treated in situ cancer of the cervix
- Ductal carcinoma in situ of the breast (as long as radiation limitation is not exceeded)
- Other solid tumors curatively treated with no evidence of disease for > 5 years
- No history of allergic reactions attributed to compounds containing boron or mannitol
- No history of an unusual or severe allergic reaction to rituximab or similar agent
- No pre-existing neuropathy ≥ grade 2
- No known HIV infection
No other serious illness or medical condition that would preclude study participation, including any of the following:
- Active, uncontrolled bacterial, fungal, or viral infection
- Significant cardiac dysfunction
- Cardiovascular disease NOTE: *Exceptions will be allowed for values below these thresholds in patients with marrow involvement by lymphoma or lymphoma-related hypersplenism
PRIOR CONCURRENT THERAPY:
- No prior systemic therapy for lymphoma
- No prior bortezomib, cyclophosphamide, or vincristine
At least 4 weeks since prior radiotherapy that involved ≤ 25% of functioning bone marrow and recovered
- Exceptions may be made for low-dose, nonmyelosuppressive radiotherapy or if the irradiated field is not a significant marrow-bearing area
- At least 2 weeks since prior major surgery
- No other concurrent anticancer therapy, investigational agents, corticosteroids (except for physiologic replacement or antiemesis), cytotoxic chemotherapy, or immunotherapy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Bortezomib + BCVP-R
BCVP-R - q 21 days x 4 cycles Bortezomib: 1.3 mg/m2 Days 1 & 8 Cyclophosphamide: 750 mg/m2 IV Day 1 Vincristine: 1.4 mg/m2 IV Day 1 (dose capped at 2 mg) Prednisone: 40 mg/m2 po Days 1-5 Rituximab: 375 mg/m2 IV Day 1
|
375mg/m2 day 1
1.3mg/m2 days 1 & 8
750mg/m2 day 1
40mg/m2 days 1-5
1.4mg/m2 day 1 (dose capped at 2mg)
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Complete response rate
Time Frame: 5 years
|
5 years
|
|
Incidence of severe grade 3 or 4 neurotoxicity or neuropathic pain during the first 4 courses of treatment
Time Frame: 5 years
|
5 years
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Overall survival
Time Frame: 5 years
|
5 years
|
|
Time to progression
Time Frame: 5 years
|
5 years
|
|
Quality of life
Time Frame: 5 years
|
5 years
|
|
Overall response rate
Time Frame: 5 years
|
5 years
|
|
Toxicity
Time Frame: 5 years
|
5 years
|
|
Response duration in patients with observed responses
Time Frame: 5 years
|
5 years
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Chair: Michael R. Crump, MD, FRCPC, Princess Margaret Hospital, Canada
- Study Chair: Laurie Sehn, British Columbia Cancer Agency
Publications and helpful links
General Publications
- Sehn LH, Macdonald DA, Rubin SH, et al.: Tolerability and efficacy of bortezomib added to CVP-R for previously untreated advanced stage follicular fymphoma: interim analysis of a phase II study by the NCIC Clinical Trials Group. [Abstract] Blood 112 (11): A-1576, 2008.
- Sehn LH, MacDonald D, Rubin S, Cantin G, Rubinger M, Lemieux B, Basi S, Imrie K, Gascoyne RD, Sussman J, Chen BE, Djurfeldt M, Shepherd L, Couban S, Crump M. Bortezomib ADDED to R-CVP is safe and effective for previously untreated advanced-stage follicular lymphoma: a phase II study by the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2011 Sep 1;29(25):3396-401. doi: 10.1200/JCO.2010.33.6594. Epub 2011 Aug 1.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms
- Immune System Diseases
- Neoplasms by Histologic Type
- Lymphatic Diseases
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Lymphoma, Non-Hodgkin
- Hemic and Lymphatic Diseases
- Lymphoma
- Lymphoma, Follicular
- Amino Acids, Peptides, and Proteins
- Proteins
- Organic Chemicals
- Heterocyclic Compounds, 1-Ring
- Heterocyclic Compounds
- Heterocyclic Compounds, 2-Ring
- Heterocyclic Compounds, Fused-Ring
- Hydrocarbons
- Alkaloids
- Polycyclic Compounds
- Indoles
- Antibodies, Monoclonal
- Antibodies
- Immunoglobulins
- Immunoproteins
- Blood Proteins
- Serum Globulins
- Globulins
- Inorganic Chemicals
- Pregnadienes
- Pregnanes
- Steroids
- Fused-Ring Compounds
- Phosphoramide Mustards
- Nitrogen Mustard Compounds
- Mustard Compounds
- Hydrocarbons, Halogenated
- Phosphoramides
- Organophosphorus Compounds
- Pregnadienediols
- Vinca Alkaloids
- Secologanin Tryptamine Alkaloids
- Indole Alkaloids
- Indolizidines
- Indolizines
- Antibodies, Monoclonal, Murine-Derived
- Boronic Acids
- Acids, Noncarboxylic
- Acids
- Boron Compounds
- Pyrazines
- Rituximab
- Bortezomib
- Prednisone
- Cyclophosphamide
- Vincristine
Other Study ID Numbers
Other Study ID Numbers
- LY13
- CAN-NCIC-LY13
- CDR0000527275 (Other Identifier: PDQ)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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