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Radiolabeled Monoclonal Antibody Plus Rituximab With and Without Filgrastim and Interleukin-11 in Treating Patients With Relapsed or Refractory Non-Hodgkin's Lymphoma
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), January 2009
First Received: March 3, 2001   Last Updated: March 11, 2009   History of Changes
Sponsors and Collaborators: Mayo Clinic
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00012298
  Purpose

RATIONALE: Radiolabeled monoclonal antibodies can locate cancer cells and deliver cancer-killing substances to them without harming normal cells.

Biological therapies such as filgrastim and interleukin-11 use different ways to stimulate the immune system and stop cancer cells from growing.

PURPOSE: Phase I/II trial to study the effectiveness of combining radiolabeled monoclonal antibody therapy and rituximab with and without filgrastim and interleukin-11 in treating patients who have relapsed or refractory non-Hodgkin's lymphoma.


Condition Intervention Phase
Lymphoma
Biological: filgrastim
Biological: recombinant interleukin-11
Biological: rituximab
Radiation: yttrium Y 90 ibritumomab tiuxetan
Phase I
Phase II

MedlinePlus related topics: Cancer Lymphoma Radiation Therapy
Drug Information available for: Filgrastim Oprelvekin Rituximab Ibritumomab tiuxetan
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: Phase I Study of Two Sequential Doses of IDEC-Y2B8 in Patients With Relapsed Low Grade and Follicular Non-Hodgkin's Lymphoma

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Maximum tolerated dose (Phase I) [ Designated as safety issue: Yes ]
  • Toxicity (Phase I) [ Designated as safety issue: Yes ]
  • Proportion of patients who receive 2 sequential doses of Y2B8 immunotherapy and are progression-free at 3 years (Phase II) [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Association between the amount of tumor radiation indicated by the In2B8 scan and tumor response (Phase I) [ Designated as safety issue: No ]
  • Association between In2B8 scan and positron emission tomography scan results (Phase I) [ Designated as safety issue: No ]
  • Appearance of tumor and normal organ images on the second In2B8 scan (Phase I) [ Designated as safety issue: No ]
  • Survival (Phase II) [ Designated as safety issue: No ]
  • Time to disease progression (Phase II) [ Designated as safety issue: No ]
  • Tumor response rate (Phase II) [ Designated as safety issue: No ]

Estimated Enrollment: 73
Study Start Date: April 2001
Estimated Primary Completion Date: December 2011 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

  • Determine the maximum tolerated dose (MTD) of yttrium Y 90 ibritumomab tiuxetan (IDEC-^90Y2B8) administered with rituximab with and without filgrastim (G-CSF) and interleukin-11 (IL-11) in patients with relapsed low-grade or follicular CD20+ non-Hodgkin's lymphoma. (Phase I)
  • Determine the toxicity of this regimen in these patients.
  • Determine the response rate in patients treated with this regimen.
  • Compare tumor and normal organ dosimetry with positron emission tomography and computerized tomography scans, subsequent tumor response, and normal organ toxicity by utilizing indium In 111 ibritumomab tiuxetan radioimmunoconjugate scans before each IDEC-^90Y2B8 dose in these patients. (Phase I)
  • Determine the immune response to this regimen, in terms of human anti-mouse and human anti-chimeric antibody formation, in these patients. (Phase I)
  • Determine whether G-CSF and IL-11 can ameliorate the effect of the MTD of IDEC-^90Y2B8 on bone marrow function in these patients. (Phase I)
  • Determine progression-free survival at 3 years. (Phase II)

OUTLINE: This is a phase I dose-escalation study of yttrium Y 90 ibritumomab tiuxetan (IDEC-^90Y2B8) followed by a phase II open-label study.

  • Phase I: Patients receive rituximab IV on days 1 and 8, indium In 111 ibritumomab tiuxetan IV over 10 minutes on day 1 (for radioimaging), and IDEC-^90Y2B8 IV over 10 minutes on day 8. Treatment repeats 24-36 weeks later for a total of 2 courses in the absence of disease progression or unacceptable toxicity. Once the maximum tolerated dose (MTD) of IDEC-^90Y2B8 is determined, patients also receive filgrastim (G-CSF) subcutaneously (SC) daily beginning when absolute neutrophil count is less than 1,500/mm^3 and continuing until blood counts recover. Patients also receive interleukin-11 (IL-11) SC beginning when platelet count is less than 75,000/mm^3 and continuing until blood counts recover. Patients undergo PBSC transplantation only if marrow recovery is inadequate. Cohorts of 3-6 patients receive escalating doses of IDEC-^90Y2B8 until the MTD is determined. The MTD is defined as the dose preceding that at which at least 2 of 6 patients experience dose-limiting toxicity.

Once the MTD is determined, additional patients are accrued to determine the MTD of this radioimmunotherapy with the addition of the prophylactic cytokines, G-CSF and IL-11.

  • Phase II: Patients receive rituximab, indium In 111 ibritumomab tiuxetan, and IDEC-^90Y2B8 IV as determined at the MTD in phase I. Treatment repeats 24-36 weeks later for a total of 2 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months for 1 year, every 4 months for 1 year, every 6 months for 1 year, and then annually for 2 years.

PROJECTED ACCRUAL: A total of 73 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically proven relapsed or refractory low-grade or follicular CD20+ non-Hodgkin's lymphoma, including 1 of the following:

    • Small lymphocytic lymphoma
    • Lymphoplasmacytoid lymphoma
    • Follicular center lymphoma (grades I, II, and III)
    • Extranodal marginal zone B-cell lymphoma
    • Nodal marginal zone B-cell lymphoma
    • Splenic marginal zone B-cell lymphoma (monocytoid B-cell lymphoma)
  • Bidimensionally measurable disease with at least 1 lesion ≥ 2 cm in the greatest diameter
  • Less than 25% bone marrow involvement of cellular marrow with lymphoma by bilateral bone marrow aspirate and biopsy
  • No CNS lymphoma
  • No myelodysplastic syndromes or marrow chromosomal changes suggesting myelodysplasia
  • No HIV or AIDS-related lymphoma
  • No pleural effusion or ascites with lymphoma cells NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma.

However, this protocol uses the former terminology.

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • ECOG 0-2

Life expectancy:

  • Not specified

Hematopoietic:

  • Absolute neutrophil count ≥ 1,500/mm^3
  • Platelet count ≥ 150,000/mm^3
  • Total lymphocyte count < 5,000/mm^3 for patients with small lymphocytic lymphoma

Hepatic:

  • Bilirubin ≤ 2 mg/dL

Renal:

  • Creatinine ≤ 2 mg/dL

Other:

  • No active infection
  • No other serious non-malignant disease that would preclude study participation
  • No other active primary malignancy
  • No known human anti-mouse or human anti-chimeric antibody
  • No prior skin rash (e.g., Stevens-Johnson's syndrome or toxic epidermal necrolysis) from rituximab therapy
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • No prior radioimmunotherapy, including yttrium Y 90 ibritumomab tiuxetan or iodine I 131 monoclonal antibody tositumomab or Lym-1
  • No prior myeloablative therapy with autologous or allogeneic bone marrow transplantation or peripheral blood stem cell support

Chemotherapy:

  • See Biologic therapy

Endocrine therapy:

  • No concurrent corticosteroid therapy except prednisone (or an equivalent) for adrenal failure or < 20 mg of prednisone daily

Radiotherapy:

  • No prior external beam radiotherapy to > 25% of active bone marrow

Surgery:

  • More than 4 weeks since prior surgery other than diagnostic surgery

Other:

  • No other concurrent myelosuppressive antineoplastic agents
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00012298

Locations
United States, Minnesota
Mayo Clinic Cancer Center Recruiting
Rochester, Minnesota, United States, 55905
Contact: Clinical Trials Office - All Mayo Clinic Locations     507-538-7623        
Sponsors and Collaborators
Mayo Clinic
Investigators
Study Chair: Thomas E. Witzig, MD Mayo Clinic
Investigator: Gregory Wiseman, MD Mayo Clinic
  More Information

Additional Information:
No publications provided

Responsible Party: Mayo Clinic Cancer Center ( Thomas E. Witzig )
Study ID Numbers: CDR0000068503, MAYO-MC998C, NCI-312
Study First Received: March 3, 2001
Last Updated: March 11, 2009
ClinicalTrials.gov Identifier: NCT00012298     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent grade 1 follicular lymphoma
recurrent grade 2 follicular lymphoma
recurrent grade 3 follicular lymphoma
Waldenstrom macroglobulinemia
recurrent marginal zone lymphoma
recurrent small lymphocytic lymphoma
extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
nodal marginal zone B-cell lymphoma
splenic marginal zone lymphoma

Study placed in the following topic categories:
Immunoproliferative Disorders
Immunologic Factors
Rituximab
Lymphoma, Follicular
Lymphoma, B-Cell, Marginal Zone
Follicular Lymphoma
Recurrence
Antibodies, Monoclonal
Lymphoma, B-Cell
Lymphoma, Small Cleaved-cell, Diffuse
Lymphatic Diseases
Antibodies
Chronic Lymphocytic Leukemia
Waldenstrom Macroglobulinemia
Oprelvekin
B-cell Lymphomas
Leukemia, Lymphocytic, Chronic, B-Cell
Antirheumatic Agents
Leukemia, B-cell, Chronic
Lymphoma, Non-Hodgkin
Lymphoproliferative Disorders
Lymphoma
Immunoglobulins

Additional relevant MeSH terms:
Neoplasms by Histologic Type
Immunoproliferative Disorders
Immunologic Factors
Immune System Diseases
Rituximab
Antineoplastic Agents
Physiological Effects of Drugs
Lymphoma, Follicular
Pharmacologic Actions
Antibodies, Monoclonal
Lymphatic Diseases
Neoplasms
Oprelvekin
Therapeutic Uses
Antirheumatic Agents
Lymphoma, Non-Hodgkin
Lymphoproliferative Disorders
Lymphoma

ClinicalTrials.gov processed this record on May 06, 2009