Clinical trial NCT00823719: Phase II Study of Ofatumumab Plus Ifosfamide, Carboplatin, Etoposide (ICE) or Dexamethasone, Cytarabine, Cisplatin (DHAP) Chemotherapy Regimen in Relapsed/ Refractory Diffuse Large B Cell Lymphoma (DLBCL)
Official title: A Single Arm, Safety and Efficacy Study of Ofatumumab in Combination With ICE or DHAP Chemotherapy in Relapsed or Refractory Aggressive Lymphoma Prior to Autologous Stem Cell Transplantation
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Lymphoma, Large-Cell, Diffuse
Keywords: Salvage chemotherapy
relapsed
grade 3B follicular lymphoma
efficacy
safety
DHAP
ofatumumab
refractory
Non-Hodgkin's Lymphoma
Diffuse Large B Cell Lymphoma (DLBCL)
Oncology
ICE
Transformed follicular lymphoma
Lead sponsor: GlaxoSmithKline
Sponsor class: INDUSTRY
First posted: 2009-01-16
Enrollment: 61
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to evaluate the safety and efficacy of ofatumumab used in combination with ifosfamide, carboplatin, etoposide (ICE) or dexamethasone, cytarabine, cisplatin (DHAP) salvage chemotherapy regimens in subjects with relapsed or refractory diffuse large B cell lymphoma (DLBCL) who are eligible for autologous stem cell transplant.

Detailed description: Rituximab combined with anthracycline based chemotherapy is the most common first-line treatment for subjects with diffuse large B cell lymphoma (DLBCL). Subjects requiring second-line therapy will most often receive rituximab in combination with salvage chemotherapy as an induction therapy prior to autologous stem cell transplant. With rituximab being in first-line therapy, the response rates for subjects receiving rituximab plus salvage chemotherapy has significantly decreased. Treatment with ofatumumab may be able to overcome the resistance to rituximab in the second-line setting and offer improved response rates. The objective of this study is to evaluate the overall response rate of ofatumumab in combination with ICE or DHAP chemotherapy prior to autologous stem cell transplant. Additional objectives are to evaluate the complete response rate, ability to mobilize cluster of differentiation (CD)34+ cells, progression-free survival (PFS) and overall survival.

Eligibility criteria: Inclusion Criteria:

* Subjects with CD20 positive aggressive non-Hodgkin's lymphoma (NHL) including DLBCL, transformed follicular lymphoma (FL) \& grade 3b FL.

Refractory to, or relapsed following, first-line treatment with rituximab combined with anthracycline- or anthracenedione-based chemotherapy as defined by the protocol.

* Computed tomography (CT) with involvement of 2 or more clearly demarcated lesions with a long axis \> 1.5 centimeters (cm) and short axis ≥ 1.0 cm or 1 clearly demarcated lesion with a long axis \>2.0 cm and short axis ≥1.0 cm.
* Baseline \[18F\] fluorodeoxyglucose (FDG)-positron emission tomography (PET) scans must demonstrate positive lesions compatible with CT defined anatomical tumor sites.
* Age 18 yrs or older.
* Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.
* Eligible for high dose chemotherapy and autologous stem cell transplant (ASCT).
* Resolution of toxicities from first-line therapy to a grade that in the opinion of the investigator does not contraindicate study participation.
* Signed written informed consent.

Exclusion Criteria:

* Previous cancer therapy for lymphoma, with the exception of required rituximab/ anthracycline- or anthracenedione-based chemotherapy, monotherapy rituximab prior to first-line therapy and / or as a maintenance therapy, or limited field radiotherapy (as defined by the protocol).
* Any anti-cancer therapy, except limited field radiotherapy, within 2 weeks prior to start of study therapy.
* Chronic Glucocorticoid use (limited acute use is allowed and defined by the protocol).
* History of significant cerebrovascular disease.
* Abnormal/ inadequate white blood cell (WBC) count, liver, and kidney function.
* Clinically significant cardiac disease, active or chronic infections, serious significant diseases, other cancer within last 5 years.
* Known or suspected hypersensitivity to study treatments.
* Prior treatment with anti-CD20 monoclonal antibodies, at any time, or treated with other monoclonal antibodies within 3 months prior to start of study therapy, with the exception of rituximab in both instances.
* Inability to comply with the protocol activities.
* Pregnant or lactating women or female patients of child-bearing potential (or male patients with such partners) not willing to use adequate contraception during and up to 1 year following dosing completion.

Primary outcomes:
measure: Number of Participants With Overall Response (OR), as Assessed by the Investigator
timeFrame: From Day 14 (Study Day 56) to Day 21 (approximately Study Day 63) of treatment Cycle 3, or earlier in the case of early withdrawal or missing response assessment for Cycle 3
Secondary outcomes:
measure: Number of Participants With CR, as Assessed by the Investigator
timeFrame: From Day 14 (Study Day 56) to Day 21 (approximately Study Day 63) of treatment Cycle 3, or earlier in the case of early withdrawal or missing response assessment for Cycle 3
measure: Number of Participants With the Ability to Mobilize at Least 2 Million Cluster of Differentiation (CD)34+ Cells Per Kilogram (kg) From Peripheral Blood
timeFrame: During treatment Cycle 2 (Study Days 22-42) and/or Cycle 3 (Study Days 43-63)
measure: Progression-free Survival (PFS)
timeFrame: From Day 14 (Study Day 56) to Day 21 (approximately Study Day 63) of treatment Cycle 3, or earlier in the case of early withdrawal or missing response assessment for Cycle 3
measure: Overall Survival
timeFrame: From Day 14 (Study Day 56) to Day 21 (approximately Study Day 63) of treatment Cycle 3, or earlier in the case of early withdrawal or missing response assessment for Cycle 3
measure: Area Under the Concentration-time Curve From Time Zero to Infinity, AUC(0-inf), of Ofatumumab at the First Infusion (Cycle 1, Day 1) and the Last Infusion (Cycle 3)
timeFrame: Cycle 1 Day 1 (Study Day 1; up to 1 week) and Cycle 3 (Study Day 43; up to 6 weeks)
measure: Area Under the Concentration-time Curve During the Dosing Interval (AUC(0-tau)) of Ofatumumab at the Last Infusion (Cycle 3)
timeFrame: Cycle 3 (Study Day 43; 3 weeks)
measure: Clearance (CL) of Ofatumumab
timeFrame: Study Day 1 up to Study Day 85 (up to 12 weeks)
measure: Maximum Plasma Concentration (Cmax) of Ofatumumab at the First Infusion (Cycle 1 Day 1), Second Infusion (Cycle 1 Day 8), and Last Infusion (Cycle 3)
timeFrame: Cycle 1 Day 1 (Study Day 1; up to 48 hours), Cycle 1 Day 8 (Study Day 8; up to 24 hours), Cycle 3 (Study Day 43; up to 48 hours)
measure: Trough Plasma Concentration (Ctrough) of Ofatumumab Prior to Second Infusion (Cycle 1 Day 8), Third Infusion (Cycle 2), and Last Infusion (Cycle 3)
timeFrame: Cycle 1 Day 8 (Study Day 8; up to 8 hours prior to infusion start), Cycle 2 (Study Day 22; up to 7 hours prior to infusion start), Cycle 3 (Study Day 43; up to 6 hours prior to infusion start)
measure: Terminal Phase Half-life (t1/2) of Ofatumumab
timeFrame: Study Day 1 up to Study Day 85 (up to 12 weeks)
measure: Volume of Distribution at Steady State (Vss) of Ofatumumab
timeFrame: Study Day 1 up to Study Day 85 (up to 12 weeks)
measure: Number of Participants Who Were Positive and Negative for Human Anti-human Antibodies (HAHA) at the Indicated Time Points
timeFrame: Study Day 1 up to approximately Study Day 63
measure: Number of Participants With the Indicated Adverse Events (AEs) Associated With Neutropenia
timeFrame: Study Day 1 to approximately Study Day 63
measure: Number of Participants With the Indicated AEs Associated With Decreased Hemoglobin Counts
timeFrame: Study Day 1 to approximately Study Day 63
measure: Number of Participants With the Indicated AEs Associated With Decreased Platelet Counts
timeFrame: Study Day 1 to approximately Study Day 63
Other outcomes:
Locations:
Study officials:
affiliation: GlaxoSmithKline
name: GSK Clinical Trials
role: STUDY_DIRECTOR
References:
citation: Matasar MJ, Czuczman MS, Rodriguez MA, Fennessy M, Shea TC, Spitzer G, Lossos IS, Kharfan-Dabaja MA, Joyce R, Fayad L, Henkel K, Liao Q, Edvardsen K, Jewell RC, Fecteau D, Singh RP, Lisby S, Moskowitz CH. Ofatumumab in combination with ICE or DHAP chemotherapy in relapsed or refractory intermediate grade B-cell lymphoma. Blood. 2013 Jul 25;122(4):499-506. doi: 10.1182/blood-2012-12-472027. Epub 2013 May 21.