A Phase I/II Study to Investigate the Use of VORAXAZE™ As Intended Intervention in Patients with CNSL

NCT04841434 | Completed Phase 1 DMC

• 1 other identifier: CNS-Lymphoma-Vorax-1
• Study Type: interventional
• Target: 18
• Locations: 1 country
• Sites: 1

Brief Summary

This phase I-II trial is intented to demonstrate tolerability (i.e. absence of severe non-hematological toxicity) and efficacy of intended intervention with repeated doses of Voraxaze, in addition to leucovorin (LV), in patients with renal impairment or renal failure during previous HD-MTX therapy. Patients will receive up to 6 cycles of HD-MTX treatment with 14 days between cycles (a maximum delay of 28 days is permitted in order to allow time for a patient to recover from the previous cycle).

Conditions

CNS Lymphoma

Keywords

impaired renal function

Outcome Measures

Primary Outcomes (2)

• Tolerability of Voraxaze

  absence of severe non-hematological toxicity

  1 year

• Efficacy of Voraxaze

  immediate and sustained reduction in plasma MTX concentration

  1 year

Secondary Outcomes (3)

• Dose Limiting Toxicities (DLTs)

  1 year

• Anti-glucarpidase antibodies

  at screening, prior to the MTX infusion at each treatment cycle and on day 28 of the last cycle

• MTX toxicities

  1 year

Study Arms (1)

Dose escalation

EXPERIMENTAL

Patients will receive up to 6 cycles of HD-MTX Treatment Dose escalation will be performed using three dose levels of MTX: 3.0 g/m2, 3.5 g/m2, 4.0 g/m2

Drug: Voraxaze Injectable Product

Interventions

Voraxaze Injectable Product DRUG

High-dose Methotrexat Infusion: MTX is given at a dose according to the allocated dose level cohort as a 4-hour IV infusion. HD-MTX cycles (up to 6) should be repeated every 14 days, provided that the patient has recovered (i.e., hematopoietic reconstitution) between cycles. A delay of up to 28 days between cycles is permitted in order to allow patients to recover from the preceding dose of MTX. In patients with a decline of the GFR to \<40 mL/min, or in the case of decreased GFR, the decrease is \>50% compared with the pretreatment value, treatment will be terminated. At the start of Cycle 3 the dose of MTX can be escalated to the next level if MTX has been well-tolerated according to the criteria described under dose escalation. Voraxaze: 2000 Units in patients weighing ≤100kg and at least 20 Units per kg body weight in patients weighing \>100kg is given in each HD-MTX cycle as a slow IV injection at 24 hours (+/- 2 hours) after the start of HD-MTX infusion.

Also known as: High-dose Methotrexat Infusion

Dose escalation

Eligibility Criteria

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

You may qualify if:

• Primary or secondary CNSL (PCNSL or SCNSL) confirmed by histology or cytology.
• Renal insufficiency defined as a glomerular filtration rate (GFR, assessed by CKD-EPI or MDRD equation) of 40-80 mL/min or patients with a GFR \>80mL/min who have experienced renal failure, defined as doubling of the serum creatinine compared to the baseline value during a previous HD-MTX treatment.
• Age ≥ 18 years (male or female).
• Life expectancy \>3 months.
• Adequate organ function (i.e., bone marrow, liver, lungs) allowing intensive chemotherapy with MTX.
• Adequate clinical pathology values:
• Absolute neutrophil count ≥1.0 x 109/L, hemoglobin ≥9mg/dL (transfusion allowed), platelets ≥100 x 109/L.
• Total bilirubin ≤1.5x the upper limit of normal except for patients with known Gilbert syndrome.
• Alanine amino-transferase (ALT) and aspartate amino-transferase (AST) ≤2x the upper limit of normal.
• Alkaline phosphatase ≤2x the upper limit of normal.
• Prothrombin time within the normal range for the institution.
• Signed informed consent by the patient or legal representative prior to start of any study specific procedure.
• Females of childbearing potential and males must be willing and able to use an adequate method of contraception to avoid pregnancy for the duration of the study in such a manner that the risk of pregnancy is minimized. Acceptable contraceptives include intra-uterine devices (IUDs), hormonal contraceptives (oral, depot, patch or injectable) and double barrier methods such as condoms or diaphragms with spermicidal gel or foam.

You may not qualify if:

• Ongoing or expected need for therapy with drugs interfering with MTX-clearance (i.e., beta-lactam antibiotics, NSAIDs, probenicid, salicylates, sulphonamides) or other nephrotoxic drugs.
• Prior brain radiotherapy within 28 days of first dose of the study drug.
• Concurrent illness interfering with hydration (i.e., relevant congestive heart failure, SIADH syndrome).
• Relevant third space (i.e., pleural effusion, ascites, extended edema) precluding HD-MTX treatment.
• Obesity (body mass index \>30 kg/m2).
• Uncontrolled diabetes.
• Active hepatitis.
• HIV-infection.
• Pregnant or lactating woman.
• Participation in any other clinical trial either 1 month prior to or during this study.
• Previous intolerance to any of the drugs used in this study (i.e., MTX, LV)

Sponsors & Collaborators

• Charite University, Berlin, Germany: lead

Study Sites (1)

Charité Campus Benjamin Franklin (CBF)

Berlin, 12200, Germany

Location

MeSH Terms

Conditions

Renal Insufficiency

Condition Hierarchy (Ancestors)

Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PD Dr. med.

Model Details: Dose escalation will be performed using three dose levels of MTX.

Study Record Dates

• First Submitted: April 8, 2021
• First Posted: April 12, 2021
• Study Start: June 1, 2021
• Primary Completion: December 1, 2024
• Study Completion: December 1, 2024
• Last Updated: January 6, 2025

Record last verified: 2025-01

Locations

DE (1)