Study of Bexxar <Tositumomab> Combined With External Beam Radiation Therapy

Study of Bexxar <Tositumomab> Combined With External Beam Radiation Therapy for Patients With Relapsed, Bulky Non-Hodgkin's Lymphoma

The purpose of the study is to assess the response rate of patients with relapsed or refractory low-grade or transformed low-grade, CD20-positive, B-cell non-Hodgkin's lymphoma to Iodine-131 (I-131) tositumomab (Bexxar) therapy plus local palliative radiation therapy (XRT).

Study Overview

• Status: Terminated
• Conditions: Lymphoma, Non-Hodgkin
• Intervention / Treatment: Drug: Bexxar (tositumomab); Procedure: External beam radiotherapy (XRT); Drug: Potassium Iodide (KI)

Detailed Description

Response will be assessed on the basis of the presence or absence of measurable lesion ≥ 1.4 x 1.4 cm (operationally defined as ≥ 2.0 cm2) by radiographic evaluation OR ≥ 1.0 cm in greatest diameter detected by palpation on physical exam

• Study Type: Interventional
• Enrollment (Actual): 8
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • Stanford, California, United States, 94305
      • Stanford University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 17 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

INCLUSION CRITERIA

• Histologically confirmed low grade CD20+ B cell non-Hodgkin lymphoma (NHL) patients who have relapsed after chemotherapy or are chemotherapy resistant and have one or more sites of disease measuring more than 5 cm.
• The patients must have failed at least one chemotherapy regimen
• No anticancer treatment for three weeks prior to study initiation (six weeks if Rituximab, nitrosourea or Mitomycin C)
• Fully recovered from all toxicities associated with prior surgery, radiation, chemotherapy or immunotherapy
• An institutional review board- (IRB)-approved signed informed consent
• Age 19 years or older
• Expected survival of at least 6 months
• Prestudy Performance Status of 0, 1 or 2 according to the World Health Organization (WHO)
• Absolute neutrophil count (ANC) of at least 1,500/mm³
• Platelet count at least 100,000/mm³
• Hct > 30%
• Hgb > 9.0 gm
• Bilirubin ≤ 2.0
• Creatinine ≤ 2.0
• Bone marrow involvement with lymphoma less than 25% (bilateral bone marrow) within 6 weeks of enrollment
• Acceptable birth control method for men and women

EXCLUSION CRITERIA

• Disease progression within 3 months of last chemotherapy
• Prior myeloablative therapies with bone marrow transplantation or peripheral stem cell rescue
• Platelet count less than 100,000/mm³
• Hypocellular bone marrow (≤ 15% cellularity)
• Marked reduction in bone marrow precursors of one or more cell lines
• History of failed stem cell collection
• Prior treatment with fludarabine
• Prior radioimmunotherapy
• Presence of central nervous system (CNS) lymphoma
• HIV or AIDS-related lymphoma
• Evidence of myelodysplasia on bone marrow biopsy
• Abnormal bone marrow cytogenetics
• Patients who have received prior external beam radiation therapy to more than 25% of active bone marrow
• Patients who have received filgrastim
• Sargramostim therapy within 3 weeks prior to treatment
• Presence of human anti-mouse antibody (HAMA) reactivity in patients with prior exposure to murine antibodies or proteins
• Serious nonmalignant disease or infection, which, in the opinion of the investigator and/or sponsor, would compromise other protocol objectives
• Another primary malignancy (other than squamous cell and basal cell cancer of the skin, in situ carcinoma of the cervix, or treated prostate cancer with stable prostate-specific antigen, PSA) for which the patients has not been disease free for at least 3 years
• Major surgery, other than diagnostic surgery within 4 weeks
• Pleural effusion
• Pregnant
• Lactating

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: Tositumomab + XRT + KI; Tositumomab + external beam radiotherapy (XRT) + potassium iodide (KI)

Drug: Bexxar (tositumomab); Tositumomab is a CD20-directed radiotherapeutic (131-iodine) monoclonal antibody indicated for the treatment of patients with CD20-positive, relapsed or refractory, low-grade, follicular, or transformed non-Hodgkin's lymphoma who have progressed during or after rituximab therapy, including patients with rituximab-refractory non-Hodgkin's lymphoma. Tositumomab (standard regimen) will be administered at whole body exposure of 75 cGy.; Other Names: 131-iodine tositumomab; Procedure: External beam radiotherapy (XRT); Patient-specific XRT will begin within 24 hours of administration of the therapeutic dose of tositumomab. Subjects will receive local XRT to bulky sites of disease measuring at least 5 cm in at least one dimension. The size and number of fields to be treated will determined by the investigators, but will encompass the patient's most symptomatic/threatening site(s) of disease and not cumulatively include more than 25% of the active bone marrow. Subjects will be treated with the 2 x 2 Gy regimen (2 daily fractions of 2 Gy). Sites of disease previously-irradiated with 30 to 40 Gy will not be treated on this study.; Other Names: Radiotherapy (RT); Drug: Potassium Iodide (KI); Potassium iodide (KI) will be administered as: Saturated solution potassium iodide (SSKI) 4 drops orally 3-times-a-day,; Lugol's solution 20 drops orally 3-times-a-day, OR; KI tablets 130 mg orally once per day KI treatment will start at least 24 hours prior to tositumomab, and continue daily for 14 days following the last dose of tositumomab; Other Names: Lugol's solution; Saturated Solution Potassium Iodide (SSKI); Potassium iodide tablets

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Complete Response (CR) Rate	Participants assessed for by the following Complete Response (CR) criteria CR or Functional CR; No evidence of disease and symptoms; Any macroscopic nodules detected in any organs no longer present.; Any palpable lymph node is normal and greatest diameter is < 1.0 cm.; The enlarged organs decreased in size and not palpable; The bone marrow biopsy and aspirate are negative for disease; Negative for disease by PET-scan (functional CR) CR Unconfirmed (CRu) criteria; No evidence of disease and symptoms; Any lymph node mass > 1.0 cm^2 diameter has regressed is size by more than 75%.; No macroscopic nodules in any organs; Any palpable lymph node is normal and greatest diameter is < 1.0 cm.; The bone marrow biopsy and aspirate are negative for disease; The bone marrow biopsy may have increased number or size of lymphoid aggregates without cytologic or architectural atypia	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Response Rate (ORR)	ORR is assessed as the sum of the overall rates of; CR confirmed by positron emission tomography (PET); CR not confirmed by PET, and; Partial response (PR) negative for progression by PET	12 weeks
Time-to-Progression (TTP)		2 years

Collaborators and Investigators

• Sponsor: Stanford University
• Collaborators: GlaxoSmithKline
• Investigators: Principal Investigator: Susan J Knox, Stanford University

Study record dates

Study Major Dates

• Study Start: January 1, 2007
• Primary Completion (Actual): June 1, 2011
• Study Completion (Actual): July 1, 2013

Study Registration Dates

• First Submitted: June 20, 2007
• First Submitted That Met QC Criteria: June 20, 2007
• First Posted (Estimate): June 22, 2007

Study Record Updates

• Last Update Posted (Actual): March 29, 2017
• Last Update Submitted That Met QC Criteria: February 9, 2017
• Last Verified: February 1, 2017

More Information

Terms related to this study

• 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; Anti-Infective Agents, Local; Anti-Infective Agents; Trace Elements; Micronutrients; Hemostatics; Coagulants; Iodine; Pharmaceutical Solutions; Lugol's solution
• Other Study ID Numbers: IRB-07479; 97437 (Other Identifier: Stanford University Alternate IRB Approval Number); LYMNHL0046 (Other Identifier: OnCore)