Tailored Prednisone Reduction in Preventing Hyperglycemia in Participants With B-Cell Non-Hodgkin Lymphoma Receiving Combination Chemotherapy Treatment
A Randomized Phase II Pilot of Tailored Prednisone Reduction Versus Usual Care for the Treatment of Hyperglycemia During R-CHOP Chemotherapy
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To compare the cumulative incidence of hyperglycemia after 3 cycles of treatment between standard or tailored rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate and prednisone (R-CHOP) chemotherapy.
SECONDARY OBJECTIVES:
I. To compare the cumulative incidence of hyperglycemia after 6 cycles of treatment and at 6 months post-treatment between standard or tailored R-CHOP chemotherapy.
II. To compare response rates after 6 cycles of treatment as measured by Cheson's criteria between standard or tailored R-CHOP chemotherapy.
III. To compare cumulative rates of grade III or higher adverse events using Common Terminology Criteria for Adverse Events (CTCAE) criteria between standard or tailored R-CHOP chemotherapy from cycle 1 through cycle 6.
IV. To compare severity of prednisone related adverse events using the Patient Reported Outcome (PRO)-CTCAE form between standard or tailored R-CHOP chemotherapy from cycle 1 through cycle 6.
V. To compare health related quality of life (HRQOL) between standard or tailored R-CHOP chemotherapy at baseline, cycle 4 day 1 and after cycle 6.
EXPLORATORY OBJECTIVES:
I. To evaluate the alternative glucose measures of fasting blood glucose (FBG), hemoglobin A1c (HbA1c), fasting insulin and fructosamine to estimate hyperglycemia.
II. To compare health related quality of life (HRQOL) in those with and without hyperglycemia after 3 cycles, 6 cycles, and 6 months post R-CHOP chemotherapy.
III. To compare glycemic variability between the standard and tailored prednisone arms at day 1 of each cycle IV. To determine the ability of patients in the standard or tailored prednisone R-CHOP groups to complete all six cycles of chemotherapy.
OUTLINE: Participants are randomized to 1 of 2 arms.
ARM I: Participants receive rituximab intravenously (IV), vincristine sulfate IV, doxorubicin hydrochloride IV, and cyclophosphamide IV on day 1. Participants also receive tailored prednisone dose orally (PO) once daily (QD) on days 1-5. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
ARM II: Participants receive rituximab, vincristine sulfate doxorubicin hydrochloride, and cyclophosphamide as in Arm I. Participants also receive usual care prednisone dose PO QD on days 1-5. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, participants are followed up to 5 years.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
North Carolina
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Winston-Salem, North Carolina, United States, 27157
- Wake Forest University Health Sciences
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Diagnosis of B cell non-Hodgkin lymphoma confirmed by World Health Organization (WHO) criteria
- Planned treatment with R-CHOP chemotherapy
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 3
- Life expectancy of greater than 3 months with chemotherapy
- Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
- Ability to understand and the willingness to sign an Institutional Review Board (IRB)-approved informed consent document (either directly or via a legally authorized representative)
Exclusion Criteria:
- Uncontrolled human immunodeficiency virus (HIV), CD4 count < 50
- Diagnosis of primary central nervous system (CNS) lymphoma
- Unable to receive R-CHOP chemotherapy
- History of severe (i.e. anaphylactic) allergic reactions attributed to compounds of similar chemical or biologic composition to glucocorticoids and other component of R-
- Uncontrolled intercurrent illness including, but not limited to ongoing or active infection not controlled with antibiotics, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia that cannot be rate controlled with medications, or psychiatric illness/social situations that would limit compliance with study requirements
- Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with these agents
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Arm I (tailored prednisone dose)
Participants receive rituximab IV, vincristine sulfate IV, doxorubicin hydrochloride IV, and cyclophosphamide IV on day 1.
Participants also receive tailored prednisone dose PO QD on days 1-5.
Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
|
Correlative studies
Ancillary studies
Given IV
Other Names:
Given PO
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Ancillary correlative
Other Names:
|
|
Active Comparator: Arm II (usual care prednisone dose)
Participants receive rituximab, vincristine sulfate doxorubicin hydrochloride, and cyclophosphamide as in Arm I. Participants also receive usual care prednisone dose PO QD on days 1-5.
Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
|
Correlative studies
Ancillary studies
Given IV
Other Names:
Given PO
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Ancillary correlative
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Cumulative incidence of hyperglycemia of standard or tailored rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate and prednisone (R-CHOP)
Time Frame: After course 3 (63 days)
|
Will use the Kaplan Meier method to estimate the cumulative incidence of hyperglycemia, and the log-rank test to compare hyperglycemia incidence by arm after 3 cycles of R-CHOP chemotherapy.
|
After course 3 (63 days)
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Cumulative incidence of hyperglycemia of standard or tailored R-CHOP
Time Frame: Baseline up to 6 months
|
Will use the Kaplan Meier method to estimate the cumulative incidence of hyperglycemia, and the log-rank test to compare hyperglycemia incidence by arm after 6 cycles and after 6 months of R-CHOP chemotherapy.
|
Baseline up to 6 months
|
|
Response rates of standard or tailored R-CHOP as measured by Cheson's criteria
Time Frame: After of course 6 (126 days)
|
Will use a Fisher's exact test to compare response rates after 6 cycles of R-CHOP by arm.
|
After of course 6 (126 days)
|
|
Rates of grade III or higher adverse events using Common Terminology Criteria for Adverse Events (CTCAE) criteria from standard or tailored R-CHOP
Time Frame: Up to 6 months
|
Will compare the rates of the incidence of grade III and higher events by arm of R-CHOP for each cycle using Fisher's exact tests.
|
Up to 6 months
|
|
Severity of prednisone related adverse events using the Patient Reported Outcome (PRO)-CTCAE
Time Frame: Up to course 6 (126 days)
|
Will compare the scoring of PRO-CTCAE assessments by arm of R-CHOP using two group t-tests at each time point of interest.
|
Up to course 6 (126 days)
|
|
Health related quality of life (HRQOL) scores
Time Frame: Up to 6 months
|
Evaluated using the Functional Assessment of Cancer Therapy (FACT)-Lymphoma, FACT Gynecologic Oncology Group-Neurotoxicity additional concerns and Patient-Reported Outcomes Measurement Information System 29.
Will compare the HRQOL measures between arms receiving R-CHOP chemotherapy using two group t-tests at each time point of interest.
|
Up to 6 months
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Fasting blood glucose (FBG) levels
Time Frame: Up to 6 months
|
Will examine glucose variability over time in FBG using linear mixed effects models to model between and with-person variation in glucose.
|
Up to 6 months
|
|
Hemoglobin A1C (HbA1c) levels
Time Frame: Up to 6 months
|
Will examine glucose variability over time in HbA1c using linear mixed effects models to model between and with-person variation in glucose.
|
Up to 6 months
|
|
Fasting insulin
Time Frame: Up to 6 months
|
Will examine glucose variability over time in fasting insulin using linear mixed effects models to model between and with-person variation in glucose.
|
Up to 6 months
|
|
Fructosamine levels
Time Frame: Up to 6 months
|
Will examine glucose variability over time in fructosamine using linear mixed effects models to model between and with-person variation in glucose.
|
Up to 6 months
|
|
HRQOL scores in those with and without hyperglycemia
Time Frame: Up to 6 months
|
Will compare quality of life between the those who are hyperglycemic and those that are not at cycle 3, cycle 6, and 12 months using a mixed model analysis covariance (ANCOVA) with adjustment for baseline quality of life.
|
Up to 6 months
|
|
Glycemic variability
Time Frame: Up to 6 months
|
To compare glycemic variability between the arms, will model variability using mixed effect models of FBG and random blood glucose over time, allowing for differing within-person variance by arm as well as fitting a model with pooled variance and any characteristics that differ between the groups.
Will use likelihood ratio tests to compare if there is greater variability in the tailored versus standard arms by comparing the pooled variance model to the model that allows the within-person variation to vary by arm.
|
Up to 6 months
|
|
Percentage of patients in the standard and tailored prednisone R-CHOP arms who complete all six cycles of chemotherapy
Time Frame: End of course 6 (126 days)
|
Will compare the proportion of participants by arm using Fisher's exact test.
|
End of course 6 (126 days)
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Rakhee Vaidya, Wake Forest University Health Sciences
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
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
Additional Relevant MeSH Terms
- Neoplasms
- Metabolic Diseases
- Immune System Diseases
- Neoplasms by Histologic Type
- Glucose Metabolism Disorders
- Lymphatic Diseases
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Lymphoma
- Lymphoma, B-Cell
- Lymphoma, Non-Hodgkin
- Hyperglycemia
- Antibiotics, Antineoplastic
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Inflammatory Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Enzyme Inhibitors
- Antirheumatic Agents
- Tubulin Modulators
- Antimitotic Agents
- Mitosis Modulators
- Topoisomerase Inhibitors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Antineoplastic Agents, Phytogenic
- Topoisomerase II Inhibitors
- Rituximab
- Antineoplastic Agents, Immunological
- Prednisone
- Cyclophosphamide
- Doxorubicin
- Vincristine
- Antibodies
- Immunoglobulins
- Antibodies, Monoclonal
- Liposomal doxorubicin
- Cortisone
Other Study ID Numbers
Other Study ID Numbers
- IRB00050108
- P30CA012197 (U.S. NIH Grant/Contract)
- NCI-2018-00585 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- CCCWFU 98317 (Other Identifier: Wake Forest University Health Sciences)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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