- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00787969
Rituximab, Cladribine, and Temsirolimus in Treating Patients With Newly Diagnosed Mantle Cell Lymphoma
Phase I/II Trial of Rituximab, Cladribine, and Temsirolimus (RCT) Therapy in Newly Diagnosed Mantle Cell Lymphoma (MCL)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To assess the efficacy and safety of the combination of rituximab, cladribine, and temsirolimus for newly diagnosed mantle cell lymphoma.
II. To determine the maximum tolerated dose (MTD) of temsirolimus combined with a fixed dose and schedule of rituximab and cladribine. (Phase I) III. To assess the efficacy of the combination of rituximab, cladribine, and temsirolimus for newly diagnosed mantle cell lymphoma with the proportion of complete responses as the primary endpoint. (Phase II)
SECONDARY OBJECTIVES:
I. To assess other measures of efficacy of the regimen including progression free survival, duration of response, and overall survival.
II. To assess the toxicity profile of the combination of rituximab, cladribine, and temsirolimus.
III. To assess efficacy using traditional lymphoma parameters and absolute lymphocyte count.
IV. To assess metabolic markers (hyperglycemia, hyperlipidemia) as markers of mammalian target of rapamycin (mTOR) inhibition using the glucose and lipid measurements being performed in the clinical laboratory as part of routine care.
V. To correlate response with serum free light chains, single nucleotide polymorphisms (SNPs) in host immune genes, vitamin D metabolites, and phosphatidylinositide 3-kinase (PI3K) pathway member expression.
VI. As part of ongoing research for North Central Cancer Treatment Group (NCCTG) lymphoma studies, paraffin-embedded tissue blocks/slides and blood products will be banked for future studies.
OUTLINE: This is a phase I, dose-escalation study of temsirolimus followed by a phase II study.
Patients receive rituximab intravenously (IV) on day 1 and cladribine IV over 2 hours on days 1-5. Patients then receive temsirolimus IV over 30 minutes on days 1, 8, 15, and 22. Patients also receive filgrastim subcutaneously (SC) on days 6-15 or pegfilgrastim SC on day 6. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 4 months for 3 years.
Study Type
Enrollment (Anticipated)
Phase
- Phase 1
Contacts and Locations
Study Locations
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Arizona
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Scottsdale, Arizona, United States, 85259-5499
- Mayo Clinic Scottsdale
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Illinois
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Bloomington, Illinois, United States, 61701
- Illinois CancerCare - Bloomington
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Bloomington, Illinois, United States, 61701
- St. Joseph Medical Center
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Canton, Illinois, United States, 61520
- Illinois CancerCare - Canton
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Canton, Illinois, United States, 61520
- Graham Hospital
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Carthage, Illinois, United States, 62321
- Memorial Hospital
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Carthage, Illinois, United States, 62321
- Illinois CancerCare - Carthage
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Eureka, Illinois, United States, 61530
- Illinois CancerCare - Eureka
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Eureka, Illinois, United States, 61530
- Eureka Community Hospital
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Galesburg, Illinois, United States, 61401
- Illinois CancerCare - Galesburg
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Galesburg, Illinois, United States, 61401
- Galesburg Clinic, PC
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Havana, Illinois, United States, 62644
- Mason District Hospital
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Havana, Illinois, United States, 62644
- Illinois CancerCare - Havana
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Kewanee, Illinois, United States, 61443
- Illinois CancerCare - Kewanee Clinic
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Macomb, Illinois, United States, 61455
- Illinois CancerCare - Macomb
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Macomb, Illinois, United States, 61455
- McDonough District Hospital
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Monmouth, Illinois, United States, 61462
- Illinois CancerCare - Monmouth
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Monmouth, Illinois, United States, 61462
- OSF Holy Family Medical Center
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Normal, Illinois, United States, 61761
- BroMenn Regional Medical Center
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Normal, Illinois, United States, 61761
- Community Cancer Center
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Normal, Illinois, United States, 61761
- Illinois CancerCare - Community Cancer Center
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Ottawa, Illinois, United States, 61350
- Community Hospital of Ottawa
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Ottawa, Illinois, United States, 61350
- Oncology Hematology Associates of Central Illinois, PC - Ottawa
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Pekin, Illinois, United States, 61554
- Cancer Treatment Center at Pekin Hospital
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Pekin, Illinois, United States, 61603
- Illinois CancerCare - Pekin
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Peoria, Illinois, United States, 61636
- Methodist Medical Center of Illinois
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Peoria, Illinois, United States, 61614
- Proctor Hospital
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Peoria, Illinois, United States, 61637
- OSF St. Francis Medical Center
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Peoria, Illinois, United States, 61615
- CCOP - Illinois Oncology Research Association
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Peoria, Illinois, United States, 61615
- Oncology Hematology Associates of Central Illinois, PC - Peoria
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Peru, Illinois, United States, 61354
- Illinois CancerCare - Peru
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Peru, Illinois, United States, 61354
- Illinois Valley Community Hospital
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Princeton, Illinois, United States, 61356
- Perry Memorial Hospital
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Princeton, Illinois, United States, 61356
- Illinois CancerCare - Princeton
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Spring Valley, Illinois, United States, 61362
- Illinois CancerCare - Spring Valley
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Indiana
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Elkhart, Indiana, United States, 46515
- Elkhart General Hospital
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Elkhart, Indiana, United States, 46514-2098
- Elkhart Clinic, LLC
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Elkhart, Indiana, United States, 46514
- Michiana Hematology-Oncology, PC - Elkhart
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Kokomo, Indiana, United States, 46904
- Howard Community Hospital
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La Porte, Indiana, United States, 46350
- Center for Cancer Therapy at LaPorte Hospital and Health Services
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Mishawaka, Indiana, United States, 46545-1470
- Michiana Hematology-Oncology, PC - South Bend
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Mishawaka, Indiana, United States, 46545-1470
- Saint Joseph Regional Medical Center
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Plymouth, Indiana, United States, 46563
- Michiana Hematology Oncology PC - Plymouth
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South Bend, Indiana, United States, 46601
- Memorial Hospital of South Bend
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South Bend, Indiana, United States, 46601
- CCOP - Northern Indiana CR Consortium
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Westville, Indiana, United States, 46391
- Michiana Hematology Oncology PC - La Porte
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Iowa
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Ames, Iowa, United States, 50010
- McFarland Clinic, PC
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Cedar Rapids, Iowa, United States, 52403
- Cedar Rapids Oncology Associates
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Cedar Rapids, Iowa, United States, 52403
- Mercy Regional Cancer Center at Mercy Medical Center
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Clive, Iowa, United States, 50325
- Medical Oncology and Hematology Associates - West Des Moines
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Des Moines, Iowa, United States, 50309
- CCOP - Iowa Oncology Research Association
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Des Moines, Iowa, United States, 50309
- John Stoddard Cancer Center at Iowa Methodist Medical Center
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Des Moines, Iowa, United States, 50309
- Medical Oncology and Hematology Associates at John Stoddard Cancer Center
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Des Moines, Iowa, United States, 50314
- Medical Oncology and Hematology Associates at Mercy Cancer Center
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Des Moines, Iowa, United States, 50314
- Mercy Cancer Center at Mercy Medical Center - Des Moines
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Des Moines, Iowa, United States, 50316
- John Stoddard Cancer Center at Iowa Lutheran Hospital
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Mason City, Iowa, United States, 50401
- Mercy Cancer Center at Mercy Medical Center - North Iowa
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Sioux City, Iowa, United States, 51101
- Siouxland Hematology-Oncology Associates, LLP
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Sioux City, Iowa, United States, 51102
- Mercy Medical Center - Sioux City
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Sioux City, Iowa, United States, 51104
- St. Luke's Regional Medical Center
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Kansas
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Chanute, Kansas, United States, 66720
- Cancer Center of Kansas, PA - Chanute
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Dodge City, Kansas, United States, 67801
- Cancer Center of Kansas, PA - Dodge City
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El Dorado, Kansas, United States, 67042
- Cancer Center of Kansas, PA - El Dorado
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Fort Scott, Kansas, United States, 66701
- Cancer Center of Kansas - Fort Scott
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Independence, Kansas, United States, 67301
- Cancer Center of Kansas-Independence
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Kingman, Kansas, United States, 67068
- Cancer Center of Kansas, PA - Kingman
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Lawrence, Kansas, United States, 66044
- Lawrence Memorial Hospital
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Liberal, Kansas, United States, 67901
- Cancer Center of Kansas, PA - Liberal
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Newton, Kansas, United States, 67114
- Cancer Center of Kansas, PA - Newton
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Parsons, Kansas, United States, 67357
- Cancer Center of Kansas, PA - Parsons
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Pratt, Kansas, United States, 67124
- Cancer Center of Kansas, PA - Pratt
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Salina, Kansas, United States, 67401
- Cancer Center of Kansas, PA - Salina
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Wellington, Kansas, United States, 67152
- Cancer Center of Kansas, PA - Wellington
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Wichita, Kansas, United States, 67208
- Cancer Center of Kansas, PA - Medical Arts Tower
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Wichita, Kansas, United States, 67214
- Cancer Center of Kansas, PA - Wichita
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Wichita, Kansas, United States, 67214
- CCOP - Wichita
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Wichita, Kansas, United States, 67214
- Via Christi Cancer Center at Via Christi Regional Medical Center
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Wichita, Kansas, United States, 67208
- Associates in Womens Health, PA - North Review
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Winfield, Kansas, United States, 67156
- Cancer Center of Kansas, PA - Winfield
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Michigan
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Battle Creek, Michigan, United States, 49017
- Battle Creek Health System Cancer Care Center
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Big Rapids, Michigan, United States, 49307
- Mecosta County Medical Center
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Escanaba, Michigan, United States, 49431
- Green Bay Oncology, Limited - Escanaba
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Grand Rapids, Michigan, United States, 49503
- Butterworth Hospital at Spectrum Health
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Grand Rapids, Michigan, United States, 49503
- CCOP - Grand Rapids
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Grand Rapids, Michigan, United States, 49503
- Lacks Cancer Center at Saint Mary's Health Care
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Iron Mountain, Michigan, United States, 49801
- Dickinson County Healthcare System
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Muskegon, Michigan, United States, 49443
- Mercy General Health Partners
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Niles, Michigan, United States, 49120
- Michiana Hematology Oncology PC - Niles
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Saint Joseph, Michigan, United States, 49085
- Lakeside Cancer Specialists, PLLC
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Saint Joseph, Michigan, United States, 49085
- Lakeland Regional Cancer Care Center - St. Joseph
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Traverse City, Michigan, United States, 49684
- Munson Medical Center
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Wyoming, Michigan, United States, 49519
- Metro Health Hospital
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Minnesota
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Burnsville, Minnesota, United States, 55337
- Fairview Ridges Hospital
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Coon Rapids, Minnesota, United States, 55433
- Mercy and Unity Cancer Center at Mercy Hospital
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Duluth, Minnesota, United States, 55805
- CCOP - Duluth
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Duluth, Minnesota, United States, 55805-1983
- Duluth Clinic Cancer Center - Duluth
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Duluth, Minnesota, United States, 55805
- Miller - Dwan Medical Center
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Edina, Minnesota, United States, 55435
- Fairview Southdale Hospital
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Fridley, Minnesota, United States, 55432
- Mercy and Unity Cancer Center at Unity Hospital
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Hutchinson, Minnesota, United States, 55350
- Hutchinson Area Health Care
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Maplewood, Minnesota, United States, 55109
- Minnesota Oncology Hematology, PA - Maplewood
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Maplewood, Minnesota, United States, 55109
- HealthEast Cancer Care at St. John's Hospital
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Minneapolis, Minnesota, United States, 55407
- Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
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Minneapolis, Minnesota, United States, 55415
- Hennepin County Medical Center - Minneapolis
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Robbinsdale, Minnesota, United States, 55422-2900
- Humphrey Cancer Center at North Memorial Outpatient Center
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Rochester, Minnesota, United States, 55905
- Mayo Clinic Cancer Center
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Saint Louis Park, Minnesota, United States, 55416
- CCOP - Metro-Minnesota
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Saint Louis Park, Minnesota, United States, 55416
- Park Nicollet Cancer Center
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Saint Paul, Minnesota, United States, 55102
- United Hospital
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Saint Paul, Minnesota, United States, 55101
- Regions Hospital Cancer Care Center
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Shakopee, Minnesota, United States, 55379
- St. Francis Cancer Center at St. Francis Medical Center
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Stillwater, Minnesota, United States, 55082
- Lakeview Hospital
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Waconia, Minnesota, United States, 55387
- Ridgeview Medical Center
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Willmar, Minnesota, United States, 56201
- Willmar Cancer Center at Rice Memorial Hospital
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Woodbury, Minnesota, United States, 55125
- Minnesota Oncology Hematology, PA - Woodbury
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Montana
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Billings, Montana, United States, 59101
- CCOP - Montana Cancer Consortium
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Billings, Montana, United States, 59101
- St. Vincent Healthcare Cancer Care Services
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Billings, Montana, United States, 59107-7000
- Billings Clinic - Downtown
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Billings, Montana, United States, 59102
- Hematology-Oncology Centers of the Northern Rockies - Billings
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Bozeman, Montana, United States, 59715
- Bozeman Deaconess Cancer Center
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Butte, Montana, United States, 59701
- St. James Healthcare Cancer Care
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Great Falls, Montana, United States, 59405
- Great Falls Clinic - Main Facility
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Great Falls, Montana, United States, 59405
- Sletten Cancer Institute at Benefis Healthcare
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Havre, Montana, United States, 59501
- Northern Montana Hospital
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Helena, Montana, United States, 59601
- St. Peter's Hospital
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Kalispell, Montana, United States, 59901
- Kalispell Regional Medical Center
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Kalispell, Montana, United States, 59901
- Glacier Oncology, PLLC
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Kalispell, Montana, United States, 59901
- Kalispell Medical Oncology at KRMC
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Missoula, Montana, United States, 59807
- Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
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North Dakota
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Bismarck, North Dakota, United States, 58501
- Bismarck Cancer Center
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Bismarck, North Dakota, United States, 58501
- Medcenter One Hospital Cancer Care Center
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Bismarck, North Dakota, United States, 58501
- Mid Dakota Clinic, PC
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Bismarck, North Dakota, United States, 58502
- St. Alexius Medical Center Cancer Center
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South Dakota
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Rapid City, South Dakota, United States, 57701
- Rapid City Regional Hospital
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Wisconsin
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Green Bay, Wisconsin, United States, 54307-3508
- St. Vincent Hospital Regional Cancer Center
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Green Bay, Wisconsin, United States, 54301-3526
- Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
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Green Bay, Wisconsin, United States, 54303
- Green Bay Oncology, Limited at St. Mary's Hospital
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Green Bay, Wisconsin, United States, 54303
- St. Mary's Hospital Medical Center - Green Bay
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Manitowoc, Wisconsin, United States, 54221-1450
- Holy Family Memorial Medical Center Cancer Care Center
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Marinette, Wisconsin, United States, 54143
- Bay Area Cancer Care Center at Bay Area Medical Center
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Oconto Falls, Wisconsin, United States, 54154
- Green Bay Oncology, Limited - Oconto Falls
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Sheboygan, Wisconsin, United States, 53081
- St. Nicholas Hospital
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Sturgeon Bay, Wisconsin, United States, 54235
- Green Bay Oncology, Limited - Sturgeon Bay
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Wyoming
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Sheridan, Wyoming, United States, 82801
- Welch Cancer Center at Sheridan Memorial Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Histologically confirmed mantle cell lymphoma (MCL); the diagnosis must be confirmed by NCCTG pre-registration pathology review by Dr. Paul Kurtin or his designate; it is recommended that the biopsy be an excisional biopsy, but adequate core-needle biopsies will be accepted as long as they are considered adequate for registration by Dr. Kurtin or his designate; the tumor must be cyclin D-1 positive by immunohistochemistry or have evidence of a t(11;14) translocation by fluorescence based in situ hybridization (FISH) or cytogenetics
Measurable or assessable disease, defined as at least one of the following:
- A lymph node or tumor mass that is >= 2.0 cm in at least one dimension by positron emission tomography (PET)/computed tomography (CT), CT, magnetic resonance imaging (MRI), or plain radiograph imaging
- Splenic enlargement may be used as a measurable parameter if the spleen is palpable >= 3 cm below the left costal margin
- Diffuse infiltration of an organ such as the stomach, bone marrow, peripheral blood, liver, lungs, or bowel by lymphoma without a discrete mass would constitute assessable, but not measurable, disease
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0, 1, 2, or 3
- Life expectancy >= 12 weeks
- Absolute neutrophil count (ANC) >= 1,500/mm³
- Platelet count (PLT) >= 100,000/mm³
- Serum creatinine =< 2.0 mg/dL
- Serum total bilirubin (or direct bilirubin if total is abnormal) =< institutional upper limit of normal (ULN) with or without secondary liver involvement
- Serum glutamic oxaloacetic transaminase (SGOT) =< 3 x institutional ULN (exception: if there is liver involvement, SGOT must be =< 5 x institutional ULN)
- Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only
- Willingness to return to NCCTG enrolling institution for follow-up
- Willingness to provide the blood specimens as required by the protocol
- Willingness to provide tissue specimens as required by the protocol
- Willing to return to NCCTG enrolling institution for follow-up
- Willing to provide blood and tissue specimens as required by the protocol
- Willing to abstain from eating grapefruit or drinking grapefruit juice
- Willingness to abstain from eating grapefruit or drinking grapefruit juice for the duration of the study
Exclusion Criteria
- Any prior therapy for mantle cell non-Hodgkin lymphoma including radiation therapy; exception: patient may have undergone a splenectomy for diagnosis, cytopenia, or systematic splenomegaly
- Active or uncontrolled infection
Any of the following cardiac conditions:
- Uncontrolled high blood pressure
- Unstable angina
- Active congestive heart failure
- Myocardial infarction =< 6 months
- Serious uncontrolled cardiac arrhythmia
- Known central nervous system (CNS) involvement
Any of the following:
- Pregnant women or women of reproductive ability who are unwilling to use effective contraception while taking the drug and for 12 months after stopping treatment
- Nursing women
- Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking the drug and for 12 months after stopping treatment
- Medical or psychiatric conditions which, in the opinion of the investigator, make the patient a poor risk for participation
- Known to be human immunodeficiency virus (HIV) positive; HIV testing is not required but should be done if clinically indicated; HIV-positive patients receiving combination anti-retroviral therapy are excluded from the study
- Concurrent malignancy =< 5 years ago; exceptions: carcinoma in situ of the cervix, resected basal cell or squamous cell carcinomas of the skin, or prostate cancer that is in remission following a radical retropubic prostatectomy or radiation therapy; if there is a history of prior malignancy, they must not be receiving other specific treatment (other than hormonal therapy) for their cancer
- Known hypersensitivity to rituximab or its components, or to murine proteins
- Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
- Prior treatment with an mTOR inhibitor
- Autologous or allogeneic stem cell transplant planned as part of initial therapy
- Receiving enzyme-inducing antiepileptic drugs (enzyme inducing anti-epileptic drugs [EIAEDs]; e.g., phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, phenobarbital, or primidone); any other potent cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) inducer such as rifampin, glucocorticoids at greater than adrenal replacement levels, or St. John's wort; or receiving strong CYP3A4 inhibitors * Note: if these agents are discontinued, temsirolimus therapy can begin >= 7 days after discontinuation of such agent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Treatment (rituximab, cladribine, temsirolimus)
Patients receive rituximab IV on day 1 and cladribine IV over 2 hours on days 1-5.
Patients then receive temsirolimus IV over 30 minutes on days 1, 8, 15, and 22. Patients also receive filgrastim SC on days 6-15 or pegfilgrastim SC on day 6.
Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
|
Give IV
Give IV
Give IV
Give SC
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Number of dose limiting toxicity incidents as per National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v) 3.0 (Phase I)
Time Frame: 28 days
|
28 days
|
|
Proportion of complete tumor responses defined as complete remission (CR) as the objective status (Phase II)
Time Frame: Up to 5 years
|
Up to 5 years
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Overall survival
Time Frame: up to 5 years
|
up to 5 years
|
|
Survival time
Time Frame: Up to 5 years
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Up to 5 years
|
|
Progression-free survival (PFS)
Time Frame: up to 5 years
|
up to 5 years
|
|
Time to disease progression
Time Frame: up to 5 years
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up to 5 years
|
|
Duration of response, defined as date at which the patient's objective status is first noted to be either a CR or partial remission to the date progression is documented
Time Frame: Up to 5 years
|
Up to 5 years
|
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Frequency and severity of adverse events assessed by CTCAE v3.0
Time Frame: Up to 5 years
|
Up to 5 years
|
Collaborators and Investigators
Collaborators
Investigators
- Study Chair: David J. Inwards, MD, Mayo Clinic
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Lymphatic Diseases
- Immunoproliferative Disorders
- Lymphoma, Non-Hodgkin
- Lymphoma
- Lymphoma, Mantle-Cell
- Physiological Effects of Drugs
- Anti-Infective Agents
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Immunological
- Anti-Bacterial Agents
- Antibiotics, Antineoplastic
- Antifungal Agents
- Rituximab
- Sirolimus
- Cladribine
Other Study ID Numbers
- NCCTG-N078D
- NCI-2009-00669 (Registry Identifier: CTRP (Clinical Trials Reporting System))
- CDR0000619329 (Registry Identifier: PDQ (Physician Data Query))
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.