- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03432741
Direct Tumor Microinjection and FDG-PET in Testing Drug Sensitivity in Patients With Relapsed or Refractory Non-Hodgkin Lymphoma, Hodgkin Lymphoma, or Stage IV Breast Cancer
Pilot Safety and Feasibility Study of an In Vivo Sensitivity Screen Using a Direct Tumor Microinjection Technique and FDG-PET
Study Overview
Status
Conditions
- Recurrent Hodgkin Lymphoma
- Refractory Hodgkin Lymphoma
- Recurrent Non-Hodgkin Lymphoma
- Refractory Non-Hodgkin Lymphoma
- Recurrent Breast Carcinoma
- Recurrent Mycosis Fungoides
- Recurrent Primary Cutaneous T-Cell Non-Hodgkin Lymphoma
- Stage IV Breast Cancer AJCC v6 and v7
- Breast Adenocarcinoma
- Metastatic Breast Carcinoma
- Refractory Breast Carcinoma
- Refractory Mycosis Fungoides
- Refractory Primary Cutaneous T-Cell Non-Hodgkin Lymphoma
- Refractory Nodal Marginal Zone Lymphoma
Intervention / Treatment
- Other: Laboratory Biomarker Analysis
- Drug: Belinostat
- Drug: Carfilzomib
- Drug: Copanlisib Hydrochloride
- Biological: Daratumumab
- Drug: Fludeoxyglucose F-18
- Drug: Gemcitabine Hydrochloride
- Biological: Nivolumab
- Biological: Obinutuzumab
- Biological: Pembrolizumab
- Procedure: Positron Emission Tomography
- Biological: Rituximab
- Drug: Romidepsin
- Other: Saline
- Biological: Trastuzumab
Detailed Description
PRIMARY OBJECTIVE:
I. To assess the safety of in vivo in host drug sensitivity testing in patients with breast cancer and patients with lymphoma (nodal, extranodal masses, or cutaneous lesions).
SECONDARY OBJECTIVES:
I. To assess the feasibility of in vivo in host drug sensitivity testing in this patient population.
II. To identify targeted therapies with potential activity in relapsed lymphoma and metastatic breast cancer.
III. To evaluate the adverse event profile within each patient population.
CORRELATIVE OBJECTIVES:
I. To assess for apoptosis in response to intratumoral injection using known biomarkers (e.g., by morphology, Ki-67, caspace-3 assay as a marker of early apoptosis).
II. To evaluate intratumoral biomarkers, intratumoral cell populations, and distribution, identify potential biomarkers that correlate with response to therapy based on individual therapies.
OUTLINE:
Patients undergo FDG-PET and receive saline intralesionally on day 1. Patients also receive up to five additional injections of gemcitabine hydrochloride, romidepsin, belinostat, carfilzomib, copanlisib hydrochloride, nivolumab, trastuzumab, daratumumab, obinutuzumab, pembrolizumab, or rituximab intralesionally per investigator on day 1. Beginning 5 days later, patients with nodal/extranodal mass undergo restaging FDG-PET and biopsy (if clinically feasible). Within 3-7 days, patients with cutaneous disease undergo restaging photography and biopsy.
After completion of study treatment, patients are followed up at 3 months.
Study Type
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Locations
-
-
Minnesota
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Rochester, Minnesota, United States, 55905
- Mayo Clinic in Rochester
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age >= 18 years
Histologically proven of relapsed or refractory
- Non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HL) nodal or extranodal mass OR
- Cutaneous T-cell lymphoma (CTCL) including mycosis fungoides (MF), as well as transformed MF OR
Breast adenocarcinoma with nodal or cutaneous metastases (stage 4)
- NOTE: Patients must be refractory to or intolerant of existing therapy(ies) known to provide clinical benefit for their condition
- NOTE: The patient must not be a candidate for any curative therapy or any known life-prolonging therapy
Cohort I: For nodal/extranodal mass, presence of lesions that are amenable for injections as determined by interventional radiology
- NOTE: Nodal or extranodal mass must be palpable and easily accessible; masses such as mediastinum, retroperitoneum, within solid organs, spinal sites, central nervous system (CNS) sites, etc., are NOT allowed
Measurable disease:
- For nodal or extranodal disease (lymphoma or breast): must have at least 2 lesions that are >= 20 mm (2.0 cm) in the longest diameter by physical exam and/or on cross-sectional imaging and measurable in two perpendicular dimensions per computed tomography PET-computed tomography (CT); For Cohort I, the lesions must be amenable to intralesional injections as determined by interventional radiology (including tumors that can be safely accessed using imaging guidance and treated with minimal risk to adjacent structures)
- For cutaneous lesions (lymphoma or breast): at least two visible, non-infected skin lesions that are greater than 1 cm and are amenable to intralesional injection as determined by investigator
- Candidate for further therapy and able to wait 7 days prior to start of next systemic therapy
- Absolute neutrophil count (ANC) >= 1000/mm^3 (obtained =< 14 days prior to registration)
- Platelet count >= 50,000/mm^3 (obtained =< 14 days prior to registration)
- International normalized ratio (INR)/prothrombin time (PT) =< 1.5 (obtained =< 14 days prior to registration)
- Negative serum or urine pregnancy test done =< 7 days prior to registration, for persons of childbearing potential only
- Provide written informed consent
- Willing to return to enrolling institution for follow-up
- Willing to provide tissue samples for correlative research purposes
Exclusion Criteria:
Any of the following:
- Pregnant persons
- Nursing persons
- Persons of childbearing potential who are unwilling to employ adequate contraception
- Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
- Systemic corticosteroids between pre-PET and post-PET evaluation and biopsy
Prohibited treatments and or therapies
- Autologous stem cell transplant (ASCT) =< 12 weeks prior to registration
- Prior chemotherapy =< 2 weeks prior to registration
- Prior treatment with nitrosureas =< 4 weeks prior to registration
- Therapeutic anticancer antibodies =< 2 weeks prior to registration
- Radio- or toxin immunoconjugates =< 4 weeks prior to registration
- Radiation therapy to the injected area =< 2 weeks prior to registration
- Major surgery =< 2 weeks prior to registration
- Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
Requires anticoagulation that cannot be discontinued prior to biopsy
- Note: Exception if able to hold antiplatelet agents 7 days prior to the injections and biopsy
- NOTE: Low molecular weight heparin (LMWH) will be allowed for bridging if on warfarin
- NOTE: Heparin for line patency without detectable lab abnormalities for coagulation will be allowed
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 (FDG-PET, direct tumor microinjection)
Patients undergo FDG-PET and receive saline intralesionally on day 1.
Patients also receive up to five additional injections of gemcitabine hydrochloride, romidepsin, belinostat, carfilzomib, copanlisib hydrochloride, nivolumab, trastuzumab, daratumumab, obinutuzumab, pembrolizumab, or rituximab intralesionally per investigator on day 1.
Beginning 5 days later, patients with nodal/extranodal mass undergo restaging FDG-PET and biopsy (if clinically feasible).
Within 3-7 days, patients with cutaneous disease undergo restaging photography and biopsy.
|
Correlative studies
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Undergo FDG-PET
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Undergo FDG-PET
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
Given intralesionally
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of drug sensitivity as measured by injection site skin reaction
Time Frame: Up to 3 months
|
Skin reactions will be assessed using the Cancer Therapy Evaluation Program (CTEP) active version of the Common Terminology Criteria for Adverse Events (CTCAE) and will consist of any grade 3 or higher treatment-related pain, skin or subcutaneous tissue disorders.
Incidence rates of skin reactions will be estimated by the number of patients with reactions divided by the total number of evaluable patients per disease type.
Exact binomial 95% confidence intervals for the true incidence rate will be calculated.
|
Up to 3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility
Time Frame: Up to 3 months
|
For Cohort I (Arms A & B) and Cohort II (Arm D): The study will be determined to be feasible if at least 70% of the enrolled patients complete the injection and response evaluation.
The feasibility rate will be estimated by the number of patients completed divided by the total number of evaluable patients.
Exact binomial 95% confidence intervals for the true feasibility rate will be calculated.
For Cohort II (Arm C): The feasibility rate will be evaluated for the device regarding whether the device will be able to target the affected lymph nodes in at least 50% of the time.
The feasibility rate will be estimated by the number of patients completed divided by the total number of evaluable patients.
Exact binomial 95% confidence intervals for the true feasibility rate will be calculated.
|
Up to 3 months
|
Nodal disease response rate
Time Frame: Up to 5 days post injection
|
Defined as a decrease in standardized uptake value (SUV) uptake by 25% at site of injection.
Will be estimated by the number of injection sites with responses divided by the total number of injected sites.
Exact binomial 95% confidence intervals for the true overall response rate will be calculated.
|
Up to 5 days post injection
|
Cutaneous response rate based upon the modified Severity Weighted Assessment Tool score
Time Frame: Up to 7 days post injection
|
Will be estimated by the number of injection sites with responses divided by the total number of injected sites.
Exact binomial 95% confidence intervals for the true overall response rate will be calculated.
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Up to 7 days post injection
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Incidence of adverse events
Time Frame: Up to 3 months
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Will be evaluated using the CTEP active version of the CTCAE.
The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine patterns.
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Up to 3 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Apoptosis in response to intratumoral injection
Time Frame: Up to 3 months
|
Will assess using morphology (evidence of necrosis), measurement by immunohistochemistry of Ki67 (a marker of cell proliferation) and cleaved Caspace-3.
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Up to 3 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Grzegorz S. Nowakowski, M.D., Mayo Clinic
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Skin Diseases
- Infections
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Lymphatic Diseases
- Immunoproliferative Disorders
- Neoplasms by Site
- Neoplasms, Glandular and Epithelial
- Disease Attributes
- Breast Diseases
- Bacterial Infections and Mycoses
- Lymphoma, B-Cell
- Lymphoma
- Breast Neoplasms
- Carcinoma
- Hodgkin Disease
- Recurrence
- Lymphoma, Non-Hodgkin
- Mycoses
- Lymphoma, B-Cell, Marginal Zone
- Lymphoma, T-Cell
- Lymphoma, T-Cell, Cutaneous
- Mycosis Fungoides
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Antiviral Agents
- Enzyme Inhibitors
- Antirheumatic Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunologic Factors
- Radiopharmaceuticals
- Antibiotics, Antineoplastic
- Immune Checkpoint Inhibitors
- Histone Deacetylase Inhibitors
- Trastuzumab
- Fluorodeoxyglucose F18
- Antibodies
- Nivolumab
- Immunoglobulins
- Daratumumab
- Pembrolizumab
- Rituximab
- Antibodies, Monoclonal
- Antineoplastic Agents, Immunological
- Trastuzumab biosimilar HLX02
- Obinutuzumab
- Romidepsin
- Deoxyglucose
- Belinostat
- Gemcitabine
Other Study ID Numbers
- MC1689 (Other Identifier: Mayo Clinic in Rochester)
- NCI-2018-00149 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
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