Oral Hepatitis C Treatment for Indolent Lymphoma (OPTImaL) Study (Optimal)

January 7, 2019 updated by: University of Texas Southwestern Medical Center

There still remains the question if hepatitis C eradication with all oral therapy will lead to a regression or cure of the low grade lymphoma. Thus, the hypothesis of this study is that oral HCV therapy will lead to a high rate of hepatitis C eradication which will correlate with a reduction of the size and extent of low-grade lymphoma. The hypothesis of this study is that subjects with hepatitis C,regardless of genotype, who have low grade lymphoma, when treated for hepatitis C without pegylated interferon will have a regression of low grade non-Hodgkin's lymphoma. In this pilot study we will evaluate the effect of Sofosbuvir/ledipasvir or sofosbuvir/ribavirin based antiviral therapy on the course of a subset of HCV-related low grade B cell non-Hodgkin's lymphoma

Primary Objective This study will assess the safety, as measured by adverse events, in subjects receiving hepatitis C treatment.

Secondary Objective The secondary objective of this study is to assess the rate of overall response of B cell non-Hodgkin's lymphoma defined as either as partial response or complete response according to revised international working group criteria for non-Hodgkin lymphoma.

Primary Endpoint Safety and tolerability of sofosbuvir/ledipasvir or sofosbuvir/ribavirin in subjects with B-cell non-Hodgkin's lymphoma will be assessed by number of adverse events and serious adverse events. In addition, the study will assess the number of subjects who had to stop treatment due to adverse events or serious adverse events. The study will also examine the number of subjects in which treatment for lymphoma had to be given due to clinical progression.

Secondary Endpoints The secondary endpoint(s) of this study is to (1) Assess the rate of overall response of B-cell Non-Hodgkin's lymphoma defined as either as partial response or complete response according to revised international working group criteria for non-Hodgkin lymphoma. (2) Determine the rate of sustained viral response in subjects with low-grade lymphoma.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Detailed Description

Methods and Study Design

The study will plans to enroll approximately 21 subjects over the next 6-12 months for this study.

Subjects with low grade lymphoma with confirmed diagnosis of hepatitis C with a viral load > 1000 will be included in this study. Subjects may be treatment naïve or experienced to hepatitis C therapy, however subjects must be treatment naïve to non-Hodgkin's lymphoma treatment to be included in this study. All subjects will undergo staging studies at the time of study screening which will include a whole body scans and a bone marrow biopsy. In those with a prior bone marrow biopsy, those who had bone marrow involvement and biopsy was <3 months from screening, then an additional biopsy is not needed. If bone marrow biopsy did not show bone marrow involvement, a repeat bone marrow biopsy is needed at screening. If complete data is not available from a prior biopsy, a repeat bone marrow biopsy will need to be done. In addition, patients will have staging of liver disease by serologic markers of liver inflammation, such as aspartate aminotransferase (AST) to platelet ratio (APRI) and FibroTest® or (Fibro Sure®) or FibroScan®. If these methods are inconclusive, then a liver biopsy may be obtained to determine if the patient has cirrhosis. Patients will be treated regardless of stage of fibrosis. The rationale for examining cirrhosis is that these patients may not respond as well and will require further surveillance for hepatocellular cancer every 6 months. Additionally, hepatitis C viral load and genotype will be determined prior to initiation of hepatitis C treatment.

Setting:

This will be a multi- center study conducted at University of Texas Southwestern Medical Center, Cornell Medical Center, and Memorial Sloan Kettering Cancer Center. Each site would be expected to enroll 7 subjects in 6-12 months.

Treatment

Genotype 1:

Treatment Naïve, with or without cirrhosis: sofosbuvir/ledipasvir one pill once a day for 12 weeks.

Treatment experienced, with cirrhosis: sofosbuvir/ledipasvir one pill once a day with weight-based ribavirin for 12 weeks. Weight-based ribavirin refers to use 1200 mg of ribavirin in divided doses for those ≥75 kg and 1000 mg in divided dose for those <75kg.

Treatment experienced with cirrhosis : sofosbuvir/ledipasvir one pill once a day for 24 weeks. This option is for subjects who are unable to take ribavirin.

Genotype 2:

Treatment naïve or experienced without cirrhosis: sofosbuvir 400mg once daily and ribavirin 1000/1200 mg weight-based dosing in divided dose twice a day for 12 weeks.Treatment naïve or experienced with cirrhosis: sofosbuvir 400 mg and weight-based ribavirin for 16 weeks

Genotype 3:

Treatment naïve, non-cirrhotic: sofosbuvir/ledipasvir fixed dose combination combined with weight-based ribavirin for 12 weeks or treatment naïve with cirrhosis: sofosbuvir 400 mg daily with weight-based ribavirin for 24 weeks.

Treatment experienced with cirrhosis will be excluded as the best treatment for this population would require pegylated interferon.

Genotype 4:

Treatment naïve with or without cirrhosis or treatment experienced without cirrhosis: sofosbuvir/Ledipasvir fixed dose combination for 12 weeks.

Treatment experienced with cirrhosis: sofosbuvir/ledipasvir for 24 weeks.

Study Type

Interventional

Enrollment (Actual)

1

Phase

  • Phase 4

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

  • United States
    • New York
      • New York, New York, United States, 10065
        • Memorial Sloan Kettering Cancer Center
      • New York, New York, United States, 10065
        • Cornell Medical Center
    • Texas
      • Dallas, Texas, United States, 75390
        • UT Southwestern Medical Center

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

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Willing and able to provide written informed consent.
  2. Male or female >18 years of age
  3. Serum HCV RNA levels of >1,000 IU per milliliter or higher

  4. HCV treatment experienced or naïve.

    • HCV treatment naïve: No prior exposure to any Interferon, ribavirin, or other approved or experimental HCV-specific directly acting antivirals
    • HCV Treatment-Experienced: Virologic failure after treatment with Pegylated interferon + ribavirin, Non-structural 3/4a (NS3/4A) protease inhibitor plus pegylated interferon + ribavirin, or regimen of sofosbuvir±ribavirin± pegylated interferon regimen.
  5. Chronic Hepatitis C based on the judgment of the investigator
  6. HCV genotype 1, 2, 3, 4
  7. If the patient is determined to be cirrhotic (based on criteria outlined earlier), the patient must have an ultrasound done within 6 months prior to enrollment with no evidence of hepatocellular carcinoma.

  8. Indolent Non-Hodgkin's lymphoma , which may include the following :

    • Nodal Marginal zone lymphoma
    • Extranodal marginal zone lymphoma (MALT)
    • Splenic marginal zone lymphoma

    • Follicular lymphoma Grade 1-3a with low tumor burden*, FLIPI 2 risk category of either low (i.e. no risk factors) or intermediate (1-2 risk factors), and with no B symptoms. B symptoms are defined as:

      • Fever (i.e., temperature >38°C [>100.4°F]) for 3 consecutive days
      • Weight loss exceeding 10% of body weight in 6 months
      • Drenching night sweats
    • Lymphoplasmacytic lymphoma

  9. No prior chemotherapy

    • Low tumor burden is defined as normal lactate dehydrogenase, largest nodal or extranodal mass less than 7 cm, up to three nodal sites containing nodes with a diameter greater than 3 cm, no clinically significant serous effusions detectable by physical examination or positron emission tomography (PET)/CT scan, and spleen enlargement up to 16 cm by CT without any evidence of portal hypertension.
  10. Karnofsky performance status > 70%
  11. Creatinine clearance ≥60 mL/min, as calculated by Cockcroft-Gault equation

  12. If patient will need ribavirin in their regimen then the following inclusion:

    • Hg >12 g/dL for male
    • Hg >11 g/dL for female
  13. All women of child-bearing potential who take ribavirin will need to have a negative urine pregnancy test.

Exclusion Criteria:

  1. Life expectancy < 6 months
  2. Any HCV treatment which uses pegylated interferon
  3. HCV genotype 3 Treatment experienced with cirrhosis
  4. Co-infection with hepatitis B
  5. Prior chemotherapy for lymphoma
  6. Lymphomas of other histologies other than the ones listed in section 3.3 above
  7. Follicular lymphoma with large cell transformation
  8. Decompensated liver disease in which pegylated interferon is contraindicated.
  9. Female who is pregnant or breast feeding and HCV treatment requires use of ribavirin.
  10. Solid organ transplant
  11. Any interferon- containing agent within 8 weeks prior to screening or any prior exposure to HCV-specific antivirals agent(s), other than NS3/ 4A protease inhibitor and sofosbuvir
  12. Known hypersensitivity to ledipasvir, sofosbuvir, or formulation excipients.
  13. On a prohibited medication which cannot be stopped during the duration of HCV treatment.
  14. Female subject who is pregnant or breastfeeding
  15. HIV-infection

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: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: sofosbuvir/ledipasvir
sofosbuvir and ledipasvir fixed dose combination given orally once a day for genotype 1 and 4.
Drug: sofosbuvir/ledipasvir
sofosbuvir ledipasvir fixed dose combination given once a day by mouth
Other Names:
  • Harvoni
Experimental: sofosbuvir and ribavirin
Sofosbuvir 400 mg given orally once a day with weight-base ribavirin of 1200 mg for those >75 kg and 1000 mg for those <75kg given in divided dose twice a day. This intervention is for genotype 2 and 3
Drug: sofosbuvir
sofosbuvir 400 mg given one a daily orally and weight-based ribavirin given twice a day orally
Other Names:
  • sovaldi
Drug: Ribavirin
ribavirin 1200 mg given orally in divided dose for those >75kg and 1000 mg in divided dose for those <75 kg.
Other Names:
  • copegus
  • rebetol
  • ribasphere

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number Subjects Who Experience Adverse Events on HCV Treatment as Assessed by Division of AIDS (DAIDS) Adverse Event (AE) Grading Table Version 2.0.
Time Frame: from drug dispensation until post-treatment week 36
number of subjects who experience treatment-related adverse event on HCV treatment as assessed by DAIDS AE Grading Table version 2.
from drug dispensation until post-treatment week 36

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Subjects Who Have a Change in Lymph Node Size From Baseline After HCV Treatment
Time Frame: from baseline to post-treament week 36
Number of subjects who have a change in the size of lymph node size from baseline
from baseline to post-treament week 36

Collaborators and Investigators

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

Sponsor

University of Texas Southwestern Medical Center

Collaborators

Memorial Sloan Kettering Cancer Center
Weill Medical College of Cornell University

Investigators

  • Principal Investigator: Mamta K. Jain, MD, UT Southwestern Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Actual)

February 25, 2016

Primary Completion (Actual)

June 5, 2017

Study Completion (Actual)

July 18, 2017

Study Registration Dates

First Submitted

November 10, 2015

First Submitted That Met QC Criteria

March 18, 2016

First Posted (Estimate)

March 24, 2016

Study Record Updates

Last Update Posted (Actual)

January 8, 2019

Last Update Submitted That Met QC Criteria

January 7, 2019

Last Verified

January 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 042015-086

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Undecided

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.

Clinical Trials on Liver Disease

Clinical Trials on sofosbuvir/ledipasvir

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Italy

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe