Bevacizumab and Combination Chemotherapy in Treating Patients With Peripheral T-Cell Lymphoma or Natural Killer Cell Neoplasms

Study Overview
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Brief Summary
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RATIONALE: Monoclonal antibodies, such as bevacizumab, 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. Bevacizumab may also stop the growth of cancer cells by blocking blood flow to the cancer. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving bevacizumab together with combination chemotherapy may kill more cancer cells. PURPOSE: This phase II trial is studying how well giving bevacizumab together with several chemotherapy drugs (combination chemotherapy) works in treating patients with peripheral T-cell lymphoma or natural killer cell neoplasms.

Detailed Description
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OBJECTIVES: Primary Determine the 12-month progression-free survival of patients with peripheral T-cell or natural killer cell neoplasms treated with bevacizumab and combination chemotherapy comprising cyclophosphamide, doxorubicin, vincristine, and prednisone (A-CHOP). Secondary Determine the overall response rate (complete remission [CR, unconfirmed CR, or functional CR] and partial remission) in these patients after courses 3, 6, and 8 of this treatment regimen. Determine the overall survival of patients treated with this regimen. Determine the toxicity of this regimen in these patients. OUTLINE: This is a multicenter study. Patients receive 6-8 cycles of A-CHOP followed by 8 cycles of maintenance bevacizumab (MA), as outlined below. Bevacizumab 15 mg/kg is administered on day 1 over 90 min (first cycle), 60 min (second cycle) and 30 min for the subsequent cycles. CHOP (cyclophosphamide 750 mg/m 2 ; doxorubicin 50 mg/m 2 ; vincristine 1.4 mg/m2 [max. 2 mg]; prednisone 100 mg daily on days 1-5) is administered on day 1 of a 21-day cycle. Radiographic response is assessed after cycles 3, 6 and 8 of ACHOP and after cycle 8 of MA. Patients receive six cycles of ACHOP if they achieve a complete response (CR) after three cycles, eight cycles if they achieve a partial response (PR) after three cycles. Non-responders are removed from the study. ACHOP responders receive maintenance bevacizumab 15 mg/kg every 21 days for eight cycles. After completion of study treatment, patients are followed every 3 months for 2 years, and then every 6 months for up to 5 years. PROJECTED ACCRUAL: A total of 43 patients will be accrued for this study within 22 months. ACTUAL ACCRUAL: 46

Official Title
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Bevacizumab and CHOP (A-CHOP) in Combination for Patients With Peripheral T-Cell or Natural Killer Cell Neoplasms

Conditions
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Lymphoma

Intervention / Treatment
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* Biological: bevacizumab
* Drug: cyclophosphamide
* Drug: doxorubicin
* Drug: prednisone
* Drug: vincristine


Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: Diagnosis of peripheral T-cell or natural killer cell neoplasm Any stage disease allowed HTLV-positive tumors allowed At least one objective measurable disease parameter. Abnormal positron emission tomography scans are not considered evidence of measurable disease unless results are confirmed by CT scan or other appropriate imaging techniques Age 18 and over ECOG Performance status 0-2 Absolute neutrophil count ≥ 1,000/mm^3(500/mm^3 if due to bone marrow involvement with lymphoma) Platelet count ≥ 100,000/mm^3(50,000/mm^3 if due to bone marrow involvement with lymphoma) Bilirubin ≤ 2.0 mg/dL (≤ 3 times upper limit of normal [ULN] if due to hepatic involvement with lymphoma) AST ≤ 2 times ULN (5 times ULN if due to hepatic involvement with lymphoma) PT, INR, and PTT ≤ 1.5 times normal Creatinine ≤ 2.0 mg/dL Urinary protein:creatinine ratio ≤ 1 History of deep venous thrombosis allowed provided patient is on a stable dose of anticoagulants for at least 2 weeks prior to study entry LVEF ≥ 50% History of pulmonary embolism allowed provided patient is on a stable dose of anticoagulants for at least 2 weeks prior to study entry One prior cycle of CHOP for PTCL allowed More than 4 weeks since prior major invasive surgery or open biopsy At least 7 days since prior minor surgery. Peripheral lymph node core biopsy, bone marrow biopsy, fine needle aspiration, skin biopsy, or central line placement are not considered minor surgical procedures More than 7 days since prior and no concurrent anti-platelet drugs (e.g., ticlopidine, clopidogrel, or cilostazol) except aspirin or other nonsteroidal anti-inflammatory drugs Concurrent anticoagulants allowed provided patient is on a stable dose INR must be stable for at least 2 weeks prior to study entry PT/INR and/or PTT must be closely monitored and levels kept within acceptable range for underlying thrombotic disease Concurrent heparin flush for maintenance of central line patency allowed EXCLUSION CRITERIA: Anaplastic lymphoma kinase (ALK)-positive T-cell large cell lymphoma. ALK-negative T-cell large cell lymphoma allowed Cutaneous T-cell lymphoma History of or current radiographic evidence of CNS metastasis, including previously treated, resected, or asymptomatic brain lesions or leptomeningeal involvement Evidence of bleeding diathesis or coagulopathy Cerebrovascular accident within the past 6 months Myocardial infarction within the past 6 months Unstable angina within the past 6 months New York Heart Association class II-IV congestive heart failure Uncontrolled hypertension (i.e., systolic blood pressure [BP] > 150 mm Hg or diastolic BP > 100 mm Hg) Other clinically significant cardiovascular or peripheral vascular disease Abdominal fistula within the past 6 months Gastrointestinal perforation within the past 6 months Intra-abdominal abscess within the past 6 months Concurrent major surgery Pregnant or nursing. Female patients must have negative pregnancy test. Fertile patients must use effective contraception History of active seizures Significant traumatic injury within the past 4 weeks Non-healing ulcer (unless involved with lymphoma) Bone fracture Active infection requiring parenteral antibiotics HIV positivity Other active malignancy within the past 6 months except carcinoma in situ of the cervix or basal cell carcinoma of the skin

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (A-CHOP followed by MA)<br>Patients receive 6-8 cycles of bevacizumab and combination chemotherapy comprising cyclophosphamide, doxorubicin, vincristine, and prednisone (A-CHOP) followed by 8 cycles of maintenance bevacizumab (MA), as outlined below. Bevacizumab 15 mg/kg is administered on day 1 over 90 min (first cycle), 60 min (second cycle) and 30 min for the subsequent cycles. CHOP (cyclophosphamide 750 mg/m 2 ; doxorubicin 50 mg/m 2 ; vincristine 1.4 mg/m2 [max. 2 mg]; prednisone 100 mg daily on days 1-5) is administered on day 1 of a 21-day cycle. Radiographic response is assessed after cycles 3, 6 and 8 of ACHOP and after cycle 8 of MA. Patients receive six cycles of ACHOP if they achieve a complete response (CR) after three cycles, eight cycles if they achieve a partial response (PR) after three cycles. Non-responders are removed from the study. ACHOP responders receive maintenance bevacizumab 15 mg/kg every 21 days for eight cycles. | Biological: bevacizumab<br>* A - CHOP: 15 mg/kg IV infusion once every 21 days for 6-8 cycles. Bevacizumab is to be administered prior to CHOP therapy. Continuous bevacizumab: 15 mg/kg IV infusion once every 21 days. Initial dose should be infused over 90 minutes. If no adverse reactions occur, the second dose should be administered over 60 minutes. Again, if no adverse reactions occur, the third and subsequent doses should be administered over 30 minutes. If infusion-related adverse reactions occur, subsequent infusions should be administered over the shortest period that is well-tolerated. Infusions should be run in via a volumetric infusion device. Do NOT administer as an IV push or bolus.<br>* Other names: Recombinant Humanized Monoclonal Anti-VEGF Antibody.;Drug: cyclophosphamide<br>* IV infusion per institutional guidelines.<br>* Other names: CPM.;Drug: doxorubicin<br>* Intravenously, either as a bolus injection or as a continuous infusion through a central venous line.<br>* Other names: hydroxydaunomycin, ADR.;Drug: prednisone<br>* Prednisone is taken orally.<br>* Other names: Liquid-Pred.;Drug: vincristine<br>* IV push using extravasation precautions.<br>* Other names: LCR.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 12-Month Progression-Free Survival (PFS) | 12-month progression-free survival is defined as the probability of patients remaining alive and progression-free at 12 months from study entry. | Assessed every 3 months the first 2 years from study entry and every 6 months 3-5 years from study entry. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Response Rate | Overall response rate is defined as proportion of patients who achieve complete remission [CR, unconfirmed CR (CRu) or Functional CR] or partial remission. Response is assessed using the criteria from the International Workshop to Standardize Criteria for Non-Hodgkin's Lymphoma (Chesen, 1999). | Assessed after cycle 3, cycle 6, and cycle 8 (if given). | 
| 3-Year Overall Survival | 3-year overall survival is defined as the probability of patients surviving at 3 years from study entry. | Assessed every 3 months the first 2 years from study entry and every 6 months 3-5 years from study entry. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anaplastic large cell lymphoma, stage I adult T-cell leukemia/lymphoma, stage II adult T-cell leukemia/lymphoma, stage III adult T-cell leukemia/lymphoma, stage IV adult T-cell leukemia/lymphoma, peripheral T-cell lymphoma