Lenalidomide (Revlimid®, CC-5013) in Subjects With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma

A Phase II, Multicenter, Single-Arm, Open-Label Study to Evaluate the Safety and Efficacy of Single-Agent Lenalidomide (Revlimid®, CC-5013) in Participants With Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma

Participants who qualify will receive lenalidomide daily on days 1-21 of every 28 day cycle. Treatment will continue for up to 52 weeks or until disease progression; participants who achieve a complete response (CR) will receive an additional 2 cycles of treatment prior to discontinuation. Participants will be followed for progression free survival following discontinuation from the treatment phase

Study Overview

• Status: Completed
• Conditions: Non-Hodgkins Lymphoma
• Intervention / Treatment: Drug: Lenalidomide

Detailed Description

Participants who qualified for enrollment into the study entered the treatment phase and received single-agent lenalidomide 25 mg once daily on Days 1 to 21 of every 28-day cycle. The treatment phase began on Day 1 of Cycle 1. Study visits were scheduled to occur every 28 days to coincide with the beginning of a new cycle. The start date of a new cycle was delayed if adverse events (AEs) occurred, in which case the visit date for the start of the following cycle was scheduled 28 days after the actual start date of the delayed cycle. Efficacy and safety assessments, including complete blood counts (CBCs) were performed at least every 2 weeks during Cycles 1 to 4 of the treatment phase. Participants continued in the treatment phase of the study for up to 52 weeks or until disease progression developed, lenalidomide treatment was discontinued for any reason, or the study was terminated.

• Study Type: Interventional
• Enrollment (Actual): 43
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • Burnaby, British Columbia, Canada, V5H 4K7
      • BC Community Oncology Trialist
    • North Vancouver, British Columbia, Canada, V7L 2P9
      • BC Community Oncology
  • Ontario
    • London, Ontario, Canada, N6A 5W9
      • London Regional Cancer Program
  • Saskatchewan
    • Saskatoon, Saskatchewan, Canada, S7N 4H4
      • University of Saskatchewan
• United States
  • Arizona
    • Scottsdale, Arizona, United States, 85259
      • Mayo Clinic Scottsdale
  • California
    • Berkeley, California, United States, 94704
      • Alta Bates Cancer Center
    • Fountain Valley, California, United States, 92708
      • Pacific Coast Hematology/Oncology Medical Group, Onc.
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Rush University Medical Center
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Harvard University
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic
  • Nebraska
    • Omaha, Nebraska, United States, 68198-6805
      • University of Nebraska
  • New York
    • Bronx, New York, United States, 10466
      • New York Medical Center, MBCCOP
  • Ohio
    • Middletown, Ohio, United States, 45042
      • Signal Point Hematology/Oncology
  • Washington
    • Seattle, Washington, United States, 98104
      • Swedish Cancer Institute
  • Wisconsin
    • La Crosse, Wisconsin, United States, 54601
      • Gunderson Clinic, Ltd.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Understand and voluntarily sign an informed consent form.
2. Age greater than or equal to 18 years at the time of signing the informed consent form
3. Able to adhere to the study visit schedule and other protocol requirements
4. Biopsy-proven non-Hodgkin's lymphoma (NHL)

5. Indolent lymphoma the following histologies are acceptable:

   1. Follicular center lymphoma, grades 1, 2,
   2. Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type,
   3. Nodal marginal zone B-cell lymphoma
   4. Splenic marginal zone B-cell lymphoma,
   5. Small lymphocytic lymphoma,
   6. Lymphoplasmacytoid lymphoma
6. Relapsed or refractory to previous therapy for lymphoma. Participants must have received at least one prior treatment regimen such as radiation, immunotherapy, chemotherapy, OR radioimmunotherapy, and be ineligible or unwilling to undergo an autologous stem cell transplant. There is no limit on the number of prior therapies
7. Participants must have measurable disease on cross sectional imaging that is at least 2 cm in the longest diameter
8. Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1 or 2
9. Females of childbearing potential (FCBP) must agree to use two reliable forms of contraception or to practice complete abstinence from heterosexual intercourse during the following periods 1) for at least 28 days before starting study drug; 2) while participating in the study; and 3) for at least 28 days after discontinuation from the study. 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.

Exclusion Criteria:

1. Any of the following laboratory abnormalities

   1. Absolute neutrophil count (ANC) <1,500 cells/mm^3 (1.5 x 10^9/L)
   2. Platelet count <100,000/mm^3 (100 x 10^9/L)
   3. Serum creatinine >2.5 mg/dL (221 mmol/L)
   4. Serum glutamic-oxaloacetic transaminase/ aspartate aminotransferase (SGOT/AST) or serum glutamic:pyruvic transaminase/alanine aminotransferase (SGPT/ALT) >5.0 x upper limit of normal (ULN)
   5. Serum total bilirubin >2.0 mg/dL (34 mmol/L)
2. Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
3. All participants with Central Nervous System (CNS) disease with the exception of those subjects whose CNS disease has been treated with chemotherapy, radiotherapy or surgery and remains asymptomatic, with no active CNS disease, as shown by lumbar puncture, Computed Tomography or Magnetic resonance imaging (CT scan or MRI), for at least 6 months.
4. Prior history of malignancies other than NHL (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast) unless the subject has been free of the disease for > or equal to 1 year.
5. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
6. Known positive for Human Immunodeficiency Virus (HIV).
7. Pregnant or lactating females.
8. Prior ≥ grade 3 (National Cancer Institute-Common Terminology Criteria for Adverse Events [NCI CTCAE]) allergic reaction/hypersensitivity to thalidomide.
9. Prior ≥ grade 3 rash or any desquamating (blistering) rash while taking thalidomide.
10. Prior use of lenalidomide.
11. Use of any standard or experimental anti-cancer drug therapy within 28 days of day 1 of study drug therapy.
12. Known active Hepatitis C.

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

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lenalidomide; Participants received single-agent lenalidomide 25 mg orally once daily on Days 1 to 21 of every 28-day cycle for up to 52 weeks or until disease progression developed, lenalidomide treatment was discontinued for any reason, or the study was terminated.	Drug: Lenalidomide; Lenalidomide 25 mg orally once daily on Days 1 to 21 of every 28-day cycle for up to 52 weeks or until disease progression developed; Other Names: CC-5013; Revlimid®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With Response	Response was defined as participants with a complete response (CR), unconfirmed complete response (Cru) or partial response (PR), assessed using the International Workshop Lymphoma Response Criteria (IWLRC) and based on best responses as determined by the investigator. CR: Complete disappearance of all detectable clinical and radiographic evidence of disease, disappearance of any disease-related symptoms, and normalization of biochemical abnormalities. Cru: Criteria for CR above but with 1 or more of the following: A residual lymph node mass > 1.5 cm in greatest transverse diameter that has regressed by more than 75% in the sum of the products of diameters (SPD); Indeterminate bone marrow (increased number or size of aggregates without cytologic or architectural atypia). PR: ≥ 50% decrease in SPD of the 6 largest dominant nodes or nodal masses. No increase in the size of other nodes, liver, or spleen. Splenic and hepatic nodules must regress by at least 50% in the SPD.	From enrollment through study completion. Median duration on study was 4.4 months with a maximum of 32 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With Tumor Control	Tumor control was defined as participants with a complete response, unconfirmed complete response, partial response or stable disease (SD), assessed using the International Workshop Lymphoma Response Criteria (IWLRC) and based on best responses as determined by the investigator. SD was defined as a response less than a PR (see above) but not Progressive Disease (PD). PD was defined as; ≥ 50 % increase from nadir in the SPD of any previously identified abnormal node for partial responders or non-responders.; Appearance of any new lesion during or at the end of therapy.	From enrollment through study completion. Median duration on study was 4.4 months with a maximum of 32 months
The Duration of Response	The duration of response was calculated as the first response assessment demonstrating evidence of at least a partial response to the first documentation of progressive disease (as determined by computed tomography scan) or death due to NHL, whichever occurred first. For participants without documentation of progression, the duration of response was censored at the last date of tumor assessment indicating no progression. Median was based on the Kaplan-Meier estimate.	From enrollment through study completion. Median duration on study was 4.4 months with a maximum of 32 months
Progression Free Survival (PFS)	Progression-free survival was defined as the time from the start of study drug therapy to the first observation of disease progression or death due to any cause, whichever came first. Participants who withdrew for any reason or received another NHL therapy including stem cell transplantation without documented progressive disease were censored on the date of their last adequate response assessment indicating no progression (or last adequate assessment prior to receiving other NHL therapy). Participants who were still active without progressive disease at the time of the data cut-off date were censored on the date of their last adequate response assessment.	From enrollment through study completion. Median duration on study was 4.4 months with a maximum of 32 months
Number of Participants With Adverse Events (AEs)	The Investigator determined the relationship between the administration of study drug and the occurrence of an AE as suspected if the temporal relationship of the adverse event to study drug administration made a causal relationship possible, and other drugs, therapeutic interventions, or underlying conditions did not provide a sufficient explanation for the observed event. The Investigator graded the severity of AEs according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) criteria and the following scale: Grade 1 = Mild; Grade 2 = Moderate; Grade 3 = Severe; Grade 4 = Life threatening; Grade 5 = Death A Serious AE is defined as any AE which results in death, is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or constitutes an important medical event.	From the start of study drug through 30 days after the last dose of study drug. Maximum time on study drug was 13.8 months.

Collaborators and Investigators

• Sponsor: Celgene Corporation
• Collaborators: Prologue Research International

Publications and helpful links

General Publications

• Witzig TE, Wiernik PH, Moore T, Reeder C, Cole C, Justice G, Kaplan H, Voralia M, Pietronigro D, Takeshita K, Ervin-Haynes A, Zeldis JB, Vose JM. Lenalidomide oral monotherapy produces durable responses in relapsed or refractory indolent non-Hodgkin's Lymphoma. J Clin Oncol. 2009 Nov 10;27(32):5404-9. doi: 10.1200/JCO.2008.21.1169. Epub 2009 Oct 5.

Study record dates

Study Major Dates

• Study Start: August 1, 2005
• Primary Completion (Actual): April 1, 2008
• Study Completion (Actual): April 1, 2008

Study Registration Dates

• First Submitted: September 10, 2005
• First Submitted That Met QC Criteria: September 13, 2005
• First Posted (Estimate): September 16, 2005

Study Record Updates

• Last Update Posted (Estimate): November 28, 2013
• Last Update Submitted That Met QC Criteria: November 6, 2013
• Last Verified: November 1, 2013

More Information

Terms related to this study

• Keywords: NHL; Non-Hodgkins Lymphoma; CC5013; celgene; revlimid; cc-5013
• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Lymphoma; Lymphoma, Non-Hodgkin; Physiological Effects of Drugs; Antineoplastic Agents; Immunologic Factors; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Lenalidomide
• Other Study ID Numbers: CC-5013-NHL-001