Patient case: 50-year-old male with prostate cancer; genetic feature: ATM deletion

Clinical trial: Revlimid in Transfusion Dependent Patients

Summary: This is a prospective trial of Revlimid for subjects who have a blood cell cancer called myelodysplastic syndrome (MDS). Cells in their marrow make proteins through messages that are carried from the genes. The amount of the message tells researchers if the protein it is going to make is high or low. This is known as expression of genes. The purpose of this study is to conduct a prospective trial testing the idea that expression of specific genes can help to predict which patients will respond to study drug administration with Revlimid (lenalidomide).

Detailed description: The first Revlimid® study reported by List et al included all transfusion dependent MDS patients, but given the early experience which showed a better response in del(5q) patients and those with lower risk disease, more patients belonging to this category were entered on the trial. The subsequent multi-center studies were focused entirely on the low/Int-1 patients who were transfusion dependent. In the present study, we would like to recapitulate the initial study by only treating the transfusion dependent, low and intermediate-1 risk MDS patients without deletion (5q). Since the predictive assay is most applicable for the non-del(5q) patients, and to avoid confusion resulting from an admixture of patients with del(5q) for whom the drug is already FDA approved, we have elected to restrict this clinical trial to only the non-del(5q) patients.
  In the present study, only the non-del(5q) transfusion dependent, low and intermediate-1 risk MDS patients will be treated with single agent Revlimid®. All patients will have their pre-therapy bone marrows studied by gene expression microarray, Luminex bead assay, and real-time PCR.

Eligibility: Inclusion Criteria:
  -  Understand and voluntarily sign an informed consent form.
  -  Age ≥ 21 years at the time of signing the informed consent form.
  -  Able to adhere to the study visit schedule and other protocol requirements.
  -  A confirmed diagnosis (using standard FAB criteria) of a myelodysplastic syndrome with low/Int-1 risk and with a non-del(5q) karyotype must be established.
  -  Patients must have transfusion dependence (at least 2 units within 8 weeks prior to starting therapy).
  -  All transfusion dependent non-del(5q) low/Int-1 risk patients will be eligible for treatment with Revlimid®
  -  Newly diagnosed as well as previously treated patients will be eligible
  -  Patients with primary de novo or secondary MDS will be eligible
  -  All previous cancer therapy, including radiation, hormonal therapy and surgery, must have been discontinued at least 4 weeks prior to treatment in this study.
  -  ECOG performance status of 0-2 at study entry (see Appendix II).
  -  Laboratory test results within these ranges:
  -  Absolute neutrophil count > 250/uL
  -  Platelet count > 30,000/uL
  -  Serum creatinine ≤ 2.0 mg/dL
  -  Total bilirubin ≤ 1.5 mg/dL
  -  AST (SGOT) and ALT (SGPT) ≤ 3 x ULN
  -  BUN ≤ 2 x ULN
  -  Disease free of prior malignancies for ≥ 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast.
  -  All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.
  -  Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of prescribing lenalidomide (prescriptions must be filled within 7 days) 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. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy.
  Exclusion Criteria:
  -  Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  -  Pregnant or breast feeding females. (Lactating females must agree not to breast feed while taking lenalidomide).
  -  Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
  -  Any clinically significant cardiac disease, including congestive heart failure
  -  Liver function studies including SGOT/SGPT > 3 x ULN
  -  Clinically significant renal disease.
  -  Any previous chemotherapy, hematopoietic growth factors, erythropoietin, or cytokines within 4 weeks of starting treatment. Note: prior therapy with G-CSF within 4 weeks is allowed.
  -  Use of any other experimental drug or therapy within 28 days of baseline.
  -  Known hypersensitivity to thalidomide.
  -  The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
  -  Any prior use of lenalidomide. (Patients with prior therapy with thalidomide will be eligible as long as at least 4 weeks have elapsed between end of the drug and accrual on the present trial)
  -  Concurrent use of other anti-cancer agents or treatments.
  -  Known positive for HIV or infectious hepatitis, type B or C.
  -  Life expectancy < 3 months

Relevance to patient case: not relevant