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Rituximab, Cyclophosphamide, Bortezomib, and Dexamethasone in Treating Patients With Relapsed or Refractory Low-Grade Follicular Lymphoma, Waldenstrom Macroglobulinemia, or Mantle Cell Lymphoma
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), January 2009
First Received: July 8, 2008   Last Updated: March 19, 2009   History of Changes
Sponsors and Collaborators: Mayo Clinic Scottsdale
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00711828
  Purpose

RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cyclophosphamide and dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving rituximab and bortezomib together with combination chemotherapy may kill more cancer cells.

PURPOSE: This phase II trial is studying how well giving rituximab and cyclophosphamide together with bortezomib and dexamethasone works in treating patients with relapsed or refractory low-grade follicular lymphoma, Waldenstrom macroglobulinemia, or mantle cell lymphoma.


Condition Intervention Phase
Lymphoma
Biological: rituximab
Drug: bortezomib
Drug: cyclophosphamide
Drug: dexamethasone
Other: questionnaire administration
Procedure: quality-of-life assessment
Phase II

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Cancer Lymphoma
Drug Information available for: Dexamethasone Cyclophosphamide Dexamethasone acetate Doxiproct plus Rituximab Bortezomib Dexamethasone Sodium Phosphate
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: A Phase 2 Clinical Trial of Rituximab, Cyclophosphamide, Bortezomib (VELCADE®), and Dexamethasone (R-CyBor-D) in Relapsed Low Grade and Mantle Cell Lymphoma

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

Primary Outcome Measures:
  • Proportion of responses (complete response or partial response) [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]
  • Progression-free survival [ Designated as safety issue: No ]
  • Duration of response [ Designated as safety issue: No ]
  • Time to treatment failure [ Designated as safety issue: No ]
  • Adverse events [ Designated as safety issue: Yes ]

Estimated Enrollment: 36
Study Start Date: October 2008
Estimated Primary Completion Date: July 2013 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • To assess tumor response in patients with relapsed or refractory low-grade follicular lymphoma (grade I or II), mantle cell lymphoma, or lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia) treated with rituximab, cyclophosphamide, bortezomib, and dexamethasone.

Secondary

  • To evaluate overall survival, progression-free survival, duration of response, and time to treatment failure in patients treated with this regimen.
  • To describe the adverse event profile (as assessed by NCI CTCAE version 3.0) of this regimen in these patients.
  • To evaluate the quality of life, in terms of patient-reported neurotoxicity, in patients treated with this regimen.

OUTLINE: Patients receive rituximab IV on day 1, bortezomib IV on days 1, 4, 8, and 11, and oral cyclophosphamide and oral dexamethasone on days 1, 8, 15, and 22. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

Patients complete a quality of life questionnaire (FACT/GOG neurotoxicity questionnaire, version 4.0) at baseline, on day 1 of courses 3, 6, and 9, and at the completion of study treatment.

After completion of study treatment, patients are followed every 3-6 months for up to 5 years.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed relapsed or refractory follicular lymphoma (grade I or II), mantle cell lymphoma (MCL), or lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia [WM])

    • MCL confirmed by cyclin D1 staining or fluorescent in situ hybridization [t(11;14)]
  • Measurable disease, defined as lymph nodes ≥ 2.0 cm in at least one dimension by CT scan, PET/CT scan, or MRI

    • Patients with WM without lymphadenopathy must have > 10% lymphocytes, lymphoplasmacytic cells, or plasma cells on a bone marrow aspirate/biopsy AND quantitative IgM ≥ 400 mg/dL

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy > 3 months
  • ANC ≥ 1,200/mm^3
  • Platelet count ≥ 75,000/mm^3
  • Hemoglobin ≥ 8.0 g/dL
  • Total bilirubin ≤ 1.5 times upper limit of normal (ULN) OR direct bilirubin ≤ 2.0 mg/dL
  • Alkaline phosphatase ≤ 3 times ULN
  • AST ≤ 3 times ULN
  • Creatinine ≤ 1.5 times ULN
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No comorbid systemic illness or other severe concurrent disease that, in the judgment of the investigator, would exclude the patient from participating in this study or would interfere significantly with the proper assessment of safety and adverse events of the prescribed study regimen
  • No known HIV positivity
  • No concurrent uncontrolled illness including, but not limited to, any of the following:

    • Ongoing or active infection
    • Symptomatic congestive heart failure
    • Unstable or uncontrolled angina pectoris
    • Cardiac arrhythmias, including severe uncontrolled ventricular arrhythmias
    • Psychiatric illness/social situation that would preclude compliance with study requirements
  • No hypersensitivity to bortezomib, boron, or mannitol
  • No myocardial infarction within the past 6 months
  • No NYHA class III-IV heart failure
  • No evidence of acute ischemia by ECG
  • No active conduction system abnormalities
  • No other malignancy within the past 3 years, except for the following:

    • Completely resected basal cell or squamous cell carcinoma of the skin
    • In situ malignancy
    • Curatively treated prostate cancer deemed to be at low risk

PRIOR CONCURRENT THERAPY:

  • More than 14 days since prior investigational drugs
  • At least 4 weeks since prior anticancer therapy, including radiotherapy, hormonal therapy, or surgery
  • No other concurrent investigational agents as treatment for the primary malignancy
  • No concurrent therapy for other malignancies, except hormonal therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00711828

Locations
United States, Arizona
Mayo Clinic Scottsdale Recruiting
Scottsdale, Arizona, United States, 85259-5499
Contact: Clinical Trials Office - All Mayo Clinic Locations     507-538-7623        
Sponsors and Collaborators
Mayo Clinic Scottsdale
Investigators
Principal Investigator: Craig B. Reeder, MD Mayo Clinic Scottsdale
  More Information

Additional Information:
No publications provided

Responsible Party: Mayo Clinic Scottsdale ( Craig B. Reeder )
Study ID Numbers: CDR0000600003, MAYO-MC0883, MAYO-X05259
Study First Received: July 8, 2008
Last Updated: March 19, 2009
ClinicalTrials.gov Identifier: NCT00711828     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent grade 1 follicular lymphoma
recurrent grade 2 follicular lymphoma
recurrent mantle cell lymphoma
Waldenstrom macroglobulinemia

Study placed in the following topic categories:
Anti-Inflammatory Agents
Dexamethasone
Immunologic Factors
Blood Protein Disorders
Hormone Antagonists
Lymphoma, Mantle-Cell
Hormones, Hormone Substitutes, and Hormone Antagonists
Lymphoma, Follicular
Antiemetics
Paraproteinemias
Mantle Cell Lymphoma
Cyclophosphamide
Hemostatic Disorders
Hormones
Follicular Lymphoma
Hemorrhagic Disorders
Alkylating Agents
Lymphoma
Dexamethasone acetate
Immunoproliferative Disorders
Antineoplastic Agents, Hormonal
Hematologic Diseases
Rituximab
Blood Coagulation Disorders
Bortezomib
Vascular Diseases
Glucocorticoids
Immunosuppressive Agents
Recurrence
Protease Inhibitors

Additional relevant MeSH terms:
Anti-Inflammatory Agents
Dexamethasone
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Blood Protein Disorders
Lymphoma, Mantle-Cell
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Lymphoma, Follicular
Antiemetics
Paraproteinemias
Cyclophosphamide
Hemostatic Disorders
Hormones
Hemorrhagic Disorders
Therapeutic Uses
Cardiovascular Diseases
Alkylating Agents
Lymphoma
Dexamethasone acetate
Immunoproliferative Disorders
Neoplasms by Histologic Type
Antineoplastic Agents, Hormonal
Immune System Diseases
Hematologic Diseases
Rituximab
Bortezomib
Gastrointestinal Agents
Vascular Diseases

ClinicalTrials.gov processed this record on May 07, 2009