Patient case: 72-year-old male with melanoma; genetic feature: TP53 loss of function

Clinical trial: EL625 in Persistent Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

Summary: The purpose of this research study is to see if the investigational drug EL625, when combined with traditional chemotherapy (rituximab, fludarabine, and cyclophosphamide), is effective in Persistent Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

Detailed description: Chronic lymphocytic leukemia (CLL) and small B-cell lymphocytic lymphoma (SLL) are thought to be different manifestations of the same disease. Treatment options for CLL/SLL range from a watch and wait approach to bone marrow transplant. Currently there is no consensus on the best treatment regimen and new approaches to treatment are needed.
  EL625 is a 20-mer antisense molecule which binds to a coding region of exon 10 in p53 RNA transcripts. It can bind to both mutant and wild type p53. p53 is involved in regulating apoptosis and DNA repair in cells. When genetic damage occurs p53 is upregulated. As the expression of p53 increases in normal cells they are more likely to undergo apoptosis rather than cell cycle arrest and DNA repair. However in malignant cells, for a given level of DNA damage they are more likely to undergo cell cycle arrest and repair rather than apoptosis. Because EL625 is theorized to increase response to chemotherapy, we propose adding EL625 to a combination of fludarabine, cyclophosphamide and rituximab.

Eligibility: Inclusion Criteria:
  -  Patients with a diagnosis of CLL/SLL who have received at least one prior treatment regimen and have persistent disease (i.e. any evidence of active disease). Patients with a chromosome 17 abnormality or a p53 mutation of any type may be enrolled without having received prior treatment.
  -  Patients must be 18 years of age or older.
  -  Patient has an estimated or measured creatinine clearance ≥30 ml/min at study enrollment.
  -  AST, ALT, total bilirubin < than 2.5 times the upper limit of normal.
  -  WBC > 1.5; ANC >500; Plt >50,000 unless documented as due to disease
  -  ECOG performance status of 0-2.
  -  Voluntary written informed consent before performance of any study-related procedure not part of normal medical care.
  -  Female subject is either post-menopausal or surgically sterilized or willing to use an acceptable method of birth control (i.e., a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for 2 weeks after administration of the study drug.
  -  Male subject agrees to use an acceptable method for contraception for the duration of the study therapy and for 2 weeks after administration of study drug.
  Exclusion Criteria:
  -  Female who is pregnant or lactating.
  -  Serious medical or psychiatric illness likely to interfere with participation in this clinical study.
  -  Patients with another malignancy within the last three years (from documentation of remission) other than basal or squamous cell skin cancer, resected early stage prostate cancer not requiring systemic treatment or CIS of the cervix or fully treated early stage prostate cancer.
  -  Significant cardiac or vascular events within 6 months: acute MI, unstable angina, severe peripheral vascular disease (ischemic pain at rest class 3 or worse, non-healing ulcers/wounds, congestive heart failure (NYHA class ≥ 2), uncontrolled cardiac arrhythmias, and disseminated intravascular coagulation.
  -  Patients who are unable to refrain from taking acetaminophen
  -  Investigational agent within 14 days of enrolling on the study.
  -  Patients unable or unwilling to refrain from antioxidants including vitamin A, vitamin C, vitamin E, lycopene, lutein, grape seed extract, pycnogenol, green tea extract, and the like.
  -  Patients who have received a prior allogenic stem cell transplant and have at least 2.5% donor cells still evident on engraftment studies.

Relevance to patient case: not relevant