A Feasibility Study of Co-administering Combination Antiretroviral Therapy (cART) and R-EPOCH Chemotherapy for the Management of ARL (CATCH)

September 11, 2013 updated by: Ontario Clinical Oncology Group (OCOG)

Feasibility Study of CO-administering Combination Antiretroviral Therapy (cART) and R-EPOCH Chemotherapy for the Management of Acquired Immunodeficiency Syndrome (AIDS)-Related Lymphoma

No standard regimen currently exists for the treatment of AIDS-related lymphoma. Based on the encouraging NCI results with DA-EPOCH, the US AIDS Malignancy Consortium is currently administering a phase II randomized protocol comparing EPOCH with sequential versus concurrent rituximab (AMC protocol 034). In this AMC trial, the decision to co-administer cART is left to the discretion of the treating physician and the patient. While the AMC phase II study may establish an acceptable chemotherapy regimen suitable for further study in a phase III randomized trial, the results will not address adherence, pharmacokinetic interactions or the role of cART in AIDS-related lymphoma. The contribution of cART to the anti-lymphoma efficacy of any regimen needs to be formally studied. Our proposed trial to demonstrate the feasibility of co-administering cART with chemotherapy would justify the use of combined therapy in future AMC/International phase III protocols.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Study Design & Duration This is a prospective, single-arm, multi-centre, phase II trial of immuno-chemotherapy (rituximab and EPOCH) with mandatory combination antiretroviral therapy for initial treatment of AIDS-related lymphoma. Patients diagnosed with previously-untreated AIDS-related diffuse large B-cell lymphoma will be eligible for this trial. Patients are eligible regardless of whether they have previously been treated with or are naïve to antiretroviral therapy. The total sample size of 18 patients is required to determine the feasibility of co-administering cART and chemotherapy as measured by adequate adherence to the antiretroviral regimen.

Patients will receive EPOCH and rituximab chemotherapy for 6 cycles each given every 21 days. Day 1 of each cycle will consist of an infusion of rituximab followed by the initiation of a 96-hour continuous infusion of etoposide, doxorubicin, and vincristine and oral prednisone. Cyclophosphamide will be administered on Day 5 with initial dose based on initial CD4+ cell count to minimize hematologic toxicity.

Combination antiretroviral therapy will be administered to all patients enrolled in the trial. Patients already responding to their current cART regimen will continue with the same therapy. Otherwise, patients can be initiated on a preferred regimen of tenofovir (TDF), emtricitabine (FTC), and efavirenz (EFV) according to the US Department of Health and Human Services (DHHS) guidelines. Patients initiated on the preferred regimen of TDF/FTC/EFV will start the antiretroviral treatments on Day 7 of the trial, after the first cycle of R-EPOCH is administered. Treatment will subsequently be continued for the duration of the trial and thereafter, according to the discretion of the treating physician.

The primary endpoint for this feasibility study will be medication adherence to cART treatment. "Acceptable adherence" will be defined as the proportion of patients able to complete >90% of all prescribed cART doses during the course of chemotherapy as measured by pill counts. As previously reported, study participants will be asked to bring their pill bottles to clinic prior to each chemotherapy cycle (every three weeks) so that remaining pills can be counted by the participating study nurse/pharmacist. The number of missed doses will be computed from the difference between the actual and expected number of pills remaining in the bottle. Secondary outcomes include the toxicity of the combination therapy, as measured by adverse events graded according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0. CD4+ cell counts and HIV-1 mRNA viral loads will be obtained on all patients at baseline, following recovery from cycles 3 and 6, and every three months thereafter for two years. Secondary outcomes will also include complete and partial lymphoma response rate, progression-free survival, and overall survival, all defined by International Working Group criteria. The pharmacokinetics of etoposide, vincristine and doxorubicin will be studied in the patients initiating the preferred antiretrovirals TDF/3TC/EFV on Day 7 of the protocol (after completion of the first cycle of R-EPOCH). Thus the analysis of PK interactions will be on this subgroup of patients receiving a uniform treatment strategy. Pharmacokinetics will be assessed with the first cycle (when chemotherapy is given alone) and subsequent cycle of R-EPOCH (when chemotherapy is given with cART).

Study administration and data collection will occur under the auspices of the Ontario Clinical Oncology Group (OCOG). OCOG operates from within the Clinical Trials Methodology Group at the Henderson Research Centre in Hamilton and is co-directed by oncologists at the Juravinski Cancer Centre and Toronto Sunnybrook Cancer Centres. OCOG has a well-established research environment to guide the administration of this trial across four unique clinical sites across Canada. The clinical sites for the study include Toronto Sunnybrook Regional Cancer Centre (TSRCC), Princess Margaret Hospital (PMH), St. Michael's Hospital (SMH), and at the St. Paul's Hospital (SPH) in Vancouver. Each clinical site is expected to enroll 1-4 patients per year. An overall accrual rate of 8-10 patients per year is expected. Therefore, it will be possible to register 18 patients within 2 years of study initiation. For the individual patient, the chemotherapy treatment duration is 18 weeks. Following this phase of therapy (18 weeks), individual patients will be followed every 3 months for an additional 2 years.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
6

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • Toronto, Ontario, Canada, M5B 1W8
        • St. Michael's Hospital
      • Toronto, Ontario, Canada, M4N 3M5
        • Odette Cancer Centre

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

14 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. HIV seropositivity
  2. Biopsy diagnosis of a CD20+ diffuse large B-cell lymphoma or variants (including mediastinal (thymic) large B-cell lymphoma and plasmablastic lymphoma), atypical Burkit/Burkitt-like lymphoma, or Burkitt lymphoma diagnosed according to the World Health Organization (WHO) classification
  3. Age 18 years or older

Exclusion Criteria

  1. Performance status ≥3 according to ECOG (Zubrod) scale (see Appendix I)
  2. Known primary central nervous system lymphoma or parenchymal brain involvement with lymphoma
  3. Non-measurable disease by physical examination or radiographic evaluation
  4. Absolute CD4+ cell count <50 cells/mm3 within 3 months prior to trial initiation
  5. Inadequate hepatic function (total bilirubin ≥35 µmol/L, alkaline phosphatase ≥2 xUL normal, AST/ALT ≥2 xUL normal) unless directly attributable to lymphoma or known Hepatitis B or C co-infection.
  6. Inadequate renal function (serum creatinine ≥125µmol/L) unless directly attributable to lymphoma
  7. Inadequate haematological function (haemoglobin ≤85 g/L, absolute neutrophil count ≤1000 cells/mm3, platelet count ≤75,000 cells/mm3) unless directly attributable to lymphoma or autoimmune thrombocytopenia.
  8. Evidence of left ventricular (LV) dysfunction (ejection fraction ≤ 50%) in patients over the age of 60 or in patients with a prior history of hypertension, congestive heart failure, peripheral vascular disease, cerebrovascular disease, coronary artery disease, or cardiac arrhythmia
  9. Pregnant or lactating women who intend to breast-feed during the trial period
  10. Men of reproductive potential and women of childbearing potential who are not using or not willing to use effective contraception
  11. Known intolerance to the prescribed chemotherapy or antiretroviral drugs
  12. Life-expectancy ≤ 3 months
  13. Geographically inaccessible for follow-up

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Other: One
Rituxan with EPOCH and Antiretrovirals
Drug: R-EPOCH and cART
This is a prospective, single-arm, multi-centre, phase II trial of immuno-chemotherapy (rituximab and EPOCH) with mandatory combination antiretroviral therapy for initial treatment of AIDS-related lymphoma.
Other Names:
  • Vepesid
  • Rituxan
  • Cytoxan
  • Truvada
  • Adriamycin
  • Prednisone
  • Sustiva
  • Vincristine

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Time Frame
The primary outcome for this feasibility study will be medication adherence. Acceptable adherence, defined as compliance to ≥90% of all prescribed doses of cART during the course of chemotherapy, will be measured by pill counting and patient self-report
Time Frame: 4 -6 weeks after 6 cycles of R-EPOCH
4 -6 weeks after 6 cycles of R-EPOCH

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Time Frame
Toxicity Lymphoma response Rate Progression -free Survival and Overall Survival Pharmacokinetics
Time Frame: 2 years post completion
2 years post completion

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Ontario Clinical Oncology Group (OCOG)

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Hoffmann-La Roche

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Matthew Cheung, Dr. ., Odette Cancer Centre

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 1, 2008

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2012

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 1, 2013

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 26, 2008

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 26, 2008

First Posted (Estimate)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 27, 2008

Study Record Updates

Last Update Posted (Estimate)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 12, 2013

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 11, 2013

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2013

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • OCOG-2007-CATCH
  • CIHR FRN 79390

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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