Lenalidomide Plus Rituximab for Recurrent/Refractory CNS and Intraocular Lymphoma

NCT01542918 | Completed Phase 1 DMC FDA Drug

• 2 other identifiers: 112530NCI-2013-00056
• Study Type: interventional
• Target: 14
• Locations: 1 country
• Sites: 1

Brief Summary

This is a Phase I study, which means that the goal is to see if the study treatment is safe. The purpose of this study is to test the safety of Lenalidomide at different dose levels, and to test the safety of Lenalidomide alone or in combination with Rituximab (also known as Rituxan®).

Conditions

Recurrent/Refractory CNS; Intraocular Lymphoma

Keywords

Recurrent; Refractory; CNS; Intraocular; Lymphoma

Outcome Measures

Primary Outcomes (1)

• To establish the maximal tolerated dose (MTD) of Lenalidomide in patients with recurrent CNS NHL and intraocular NHL

  Participants will be followed for the duration of treatment, an expected average of 4 months.

Secondary Outcomes (5)

• To define the extent of cerebrospinal fluid (CSF) penetration of lenalidomide.

  Participants will have CSF withdrawn every 4 weeks while on treatment. Average study participation is approximately 4 months.

• To assess the clinical efficacy Lenalidomide monotherapy as measured by cytologic, neurologic, radiographic, and ocular (for patients with intraocular lymphoma) response criteria.

  Participants will have weekly evaluations at clinic visits for the duration of treatment. Average study participation is approximately 4 months.

• To define the immunological effects of lenalidomide using flow-cytometry CSF as well as genomic markers of recurrent/refractory CNS lymphoma.

  Participants will have CSF withdrawn every 4 weeks while on treatment. Average study participation is approximately 4 months.

• To assess the clinical efficacy of combined intraventricular plus systemic rituximab administration in combination with lenalidomide as measured by cytologic, neurologic, and radiographic response criteria.

  Participants will have weekly evaluations at clinic visits for the duration of treatment. Average study participation is approximately 4 months.

• To determine a potential impact of intravenous rituximab administration on the rate of rituximab clearance from the CSF after intraventricular rituximab administration.

  Participants will have CSF withdrawn every 4 weeks while on treatment. Average study participation is approximately 4 months.

Study Arms (1)

Study intervention

EXPERIMENTAL

Lenalidomide Plus Rituximab

Drug: Lenalidomide; Drug: Rituximab

Interventions

Lenalidomide DRUG

Formulation of Dosage forms: 5 mg, 10 mg, 15 mg and 25 mg capsules. Dosage: 10 mg - 30 mg (Treatment 1 and Treatment 2) Route of administration: Oral

Also known as: Revlimid

Study intervention

Rituximab DRUG

Formulation of Dosage forms: 100 mg/IO mL and 500 mg/50 mL solution in a single-use vial Dosage: 375 mg/m2, intravenous (Treatment 2, Cycle 1 only); 25 mg intraventricular injection (Treatment 2, all cycles) Route of administration: Intravenous (Treatment 2, Cycle 1 only); Intraventricular injection (Treatment 2, all cycles)

Also known as: Rituxan, MabThera

Study intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Ability to give written informed consent and willingness to comply with the requirements of the protocol
• Age eighteen years or older
• Tumors must be CD20+ on prior pathologic analysis
• All prospective participants must have an Ommaya reservoir (or equivalent ventricular access device) inserted as part of their standard clinical care prior to initiation of study treatment.
• No concurrent methotrexate, thiotepa, cytarabine, or investigational agents
• Absolute neutrophil count (ANC) \> 1,500 (growth factors permitted)
• Platelets \>50,000 (platelet transfusion allowed)
• Total bilirubin \</= 1.5 x upper limit of normal (ULN)
• aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase (SGOT)) and alanine aminotransferase (ALT) (serum glutamic-pyruvic transaminase (SGPT)) \</= 3 x ULN.
• Stable dose of glucocorticoids pre-therapy. If patients are receiving dexamethasone, the dose of dexamethasone should not increase during the 96 hours prior to initiation of therapy.
• Renal function assessed by calculated creatinine clearance. Patients must have calculated creatinine clearance (CrCl) \>/= 60ml/min by Cockcroft-Gault formula or 24 hour urine demonstrating CrCl \>/= 60ml/min .
• Females of childbearing potential (FCBPs)† must have a negative serum or urine pregnancy test with a sensitivity of at least 25 Milli-International Units per millilitre (mIU/mL) within 10 - 14 days and again within 24 hours prior to receiving lenalidomide for Cycle 1 and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBPs must also agree to ongoing pregnancy testing and for 28 days after receiving their last dose of lenalidomide.
• Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy.
• Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to aspirin may use warfarin or low molecular weight heparin).
• All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.

You may not qualify if:

• Intraventricular chemotherapy or radiation therapy within 4 days of starting treatment
• Intravenous rituximab within 30 days of starting treatment
• Persistent neurotoxicity from intraventricular methotrexate, cytarabine, thiotepa
• Anticipated survival of less than 1 month
• Pregnant women and women of child-bearing potential who are not using an effective method of birth control.
• Known hypersensitivity to thalidomide or lenalidomide
• The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
• Known seropositive for or active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV). Patients who are seropositive because of hepatitis B virus vaccine are eligible.
• Contraindication to aspirin. If unable to take aspirin, contraindication to warfarin or low molecular weight heparin.

Sponsors & Collaborators

• James Rubenstein: lead
• Celgene: collaborator
• Genentech, Inc.: collaborator

Study Sites (1)

University of California, San Francisco

San Francisco, California, 94143, United States

Location

Related Publications (1)

• Rubenstein JL, Geng H, Fraser EJ, Formaker P, Chen L, Sharma J, Killea P, Choi K, Ventura J, Kurhanewicz J, Lowell C, Hwang J, Treseler P, Sneed PK, Li J, Wang X, Chen N, Gangoiti J, Munster PN, Damato B. Phase 1 investigation of lenalidomide/rituximab plus outcomes of lenalidomide maintenance in relapsed CNS lymphoma. Blood Adv. 2018 Jul 10;2(13):1595-1607. doi: 10.1182/bloodadvances.2017014845.

  PMID: 29986852 DERIVED

MeSH Terms

Conditions

Recurrence; Intraocular Lymphoma; Lymphoma

Interventions

Lenalidomide; Rituximab

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Neoplasms by Histologic Type; Neoplasms; Eye Neoplasms; Neoplasms by Site; Lymphoproliferative Disorders; Lymphatic Diseases; Hemic and Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases

Intervention Hierarchy (Ancestors)

Phthalimides; Phthalic Acids; Acids, Carbocyclic; Carboxylic Acids; Organic Chemicals; Piperidones; Piperidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Isoindoles; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Antibodies, Monoclonal, Murine-Derived; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins

Study Officials

• James Rubenstein, MD, PhD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Associate Professor in Residence

Study Record Dates

• First Submitted: February 27, 2012
• First Posted: March 2, 2012
• Study Start: December 17, 2012
• Primary Completion: April 7, 2016
• Study Completion: August 30, 2016
• Last Updated: August 11, 2020

Record last verified: 2020-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)