Clinical trial NCT01393756: Revlimid Dose 25 mg in Association With (R-CHOP) in the Treatment Follicular Lymphoma
Official title: A Phase Ib/II Study of Escalating Doses of Revlimid in Association With R-CHOP (R2-CHOP) in the Treatment of B-cell Lymphoma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Follicular Lymphoma
Lead sponsor: The Lymphoma Academic Research Organisation
Sponsor class: OTHER
Collaborators: name: Centre Henri Becquerel
First posted: 2011-07-13
Enrollment: 80
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of the study is to assess the efficacy of the association of Lenalidomide (Revlimid) and R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, vincristine and Prednisone) in a population of patients with follicular lymphoma as measured by the response rate at the end of treatment.


Eligibility criteria: Inclusion Criteria:

* Patients with follicular lymphoma, (WHO) grade 1, 2 or 3a with at least one of the following signs requiring initiation of treatment:

  * Bulky disease according to the GELF criteria: nodal or extra-nodal mass \>7cm in its greater diameter
  * B symptoms
  * Elevated serum (LDH) or beta 2-microglobulin
  * Involvement of at least 3 nodal sites (each \>3cm)
  * Symptomatic spleen enlargement
  * Compressive syndrome
  * Pleural or peritoneal effusion
* Aged from 18 to 70 years
* WHO performance status 0, 1 or 2
* Signed inform consent
* Life expectancy of ≥ 90 days (3 months).
* Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL not more than 3 days from the start of study drug and must either commit to continued abstinence from heterosexual intercourse (and confirmed on a monthly basis) or begin one effective method of birth control, at least four weeks before she starts taking lenalidomide, and maintain that method throughout the entire duration of study drug therapy (including dose interruptions), and for four weeks after the end of study treatment with lenalidomide, even if she has amenorrhea. FCBP must also agree to pregnancy testing at least every three weeks and must be counseled at a minimum of every three weeks about pregnancy precautions and risks of fetal exposure.
* Men must agree not to father a child and agree to use a condom throughout study drug therapy, during any dose interruption, and for one week after cessation of study drug therapy, if their partner is pregnant or of child bearing potential. Men must also agree not to donate semen during study drug therapy and for one week after end of study drug therapy. Men must be counseled at a minimum of every 4 weeks about pregnancy precautions and risks of fetal exposure.
* All subjects must abstain from donating blood while taking study drug therapy and for one week following discontinuation of study drug therapy.
* Agree not to share study drug with another person and to return all unused study drug to the investigator.

  * A female patient is considered to have childbearing potential unless she meets at least one of the following criteria 1) Age ≥ 50 years and naturally amenorrhoeic for ≥ 1 year (amenorrhoea following cancer therapy does not rule out childbearing potential); or 2) Premature ovarian failure confirmed by a specialist gynaecologist or 3) Previous bilateral salpingo-oophorectomy (BSO), or hysterectomy, or 4) XY genotype, turner syndrome, uterine agenesis.

Exclusion Criteria:

* Previous treatment with immunotherapy or chemotherapy:

  * Chlorambucil or Cyclophosphamide per os alone during less than 6 months, if stopped more than one year before inclusion
  * Rituximab alone during less than three months, if stopped more than one year before inclusion
* Previous radiotherapy except if localized to one lymph node area
* Other type of lymphomas: Burkitt, T cell, lymphocytic, CD 20 negative
* Central nervous system or meningeal involvement
* Contraindication to any drug contained in the chemotherapy regimen
* (HIV) disease, active hepatitis B or C
* Any serious active disease or co-morbid medical condition (according to investigator's decision)
* Any of the following laboratory abnormalities.

  * Absolute neutrophil count (ANC) \< 1,500 cells/mm3 (1.5 x 109/L).
  * Platelet count \< 100,000/mm3 (100 x 109/L).
  * Serum (SGOT/AST) or (SGPT/ALT) 5.0 x upper limit of normal (ULN).
  * Serum total bilirubin \> 2.0 mg/dL (34 µmol/L), except in case of hemolytic anemia.
* Calculated creatinine clearance (Cockcroft-Gault formula) of \< 50 mL /min
* Prior history of malignancies other than lymphoma (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast) unless the subject has been free of the disease for ≥ 3 years
* Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
* Pregnant or lactating females.
* Prior ≥ Grade 3 allergic reaction/hypersensitivity to thalidomide.
* Prior ≥ Grade 3 rash or any desquamating (blistering) rash while taking thalidomide.
* Subjects with ≥ Grade 2 neuropathy.
* Prior use of lenalidomide.
* Use of any standard or experimental anti-cancer drug therapy within 28 days of the initiation (Day 1) of study drug therapy.

Primary outcomes:
measure: Complete Response Rate (CR+CRu)
timeFrame: at the end of complete treatment, average of 24 weeks
Secondary outcomes:
measure: Overall survival
timeFrame: from the date of inclusion, average of 6 years
measure: Duration of response
timeFrame: from the date of first documentation of a response, average of 24 weeks
Other outcomes:
Locations:
city: Bordeaux
country: France
facility: Institut Bergonié
city: Bordeaux
country: France
facility: Polyclinique Bordeaux Nord Aquitaine
city: Clermont ferrand
country: France
facility: CHU Estaing
city: Creteil
country: France
facility: Hôpital Henri Mondor
city: Dijon
country: France
facility: CHU de DIJON
city: Lille
country: France
facility: Chru Lille
city: Lyon
country: France
facility: Centre Léon Bérard
city: Marseille
country: France
facility: Institut Paoli Calmettes
city: Metz
country: France
facility: Hôpital Notre Dame de Bon Secours
city: Montpellier
country: France
facility: Hôpital Saint Eloi
city: Nantes
country: France
facility: CHU de NANTES
city: Paris
country: France
facility: Hôpital Saint Antoine
city: Paris
country: France
facility: Hôpital de la Pitié Salpétrière
city: Paris
country: France
facility: Hôpital Necker
city: Paris
country: France
facility: Institut Curie
city: Paris
country: France
facility: Hôpital St Louis
city: Pierre-benite
country: France
facility: Chu Lyon Sud
city: Poitiers
country: France
facility: CHU de Poitiers
city: Reims
country: France
facility: Hôpital Robert Debré
city: Rennes
country: France
facility: Hôpital Pontchaillou
city: Rouen
country: France
facility: Centre Henri BECQUEREL
city: Saint-Cloud
country: France
facility: Hôpital René Huguenin
city: Vandoeuvre-les-nancy
country: France
facility: Chu Brabois
city: Villejuif
country: France
facility: Institut Gustave Roussy
Study officials:
affiliation: Lymphoma Study Association
name: Hervé TILLY, Professeur
role: PRINCIPAL_INVESTIGATOR
References:
citation: Tilly H, Morschhauser F, Casasnovas O, Molina TJ, Feugier P, Gouill SL, Haioun C, Tournilhac O, Bouabdallah R, Gabarre J, Lamy T, Cabecadas J, Becker S, Jardin F, Mounier N, Salles G; Lymphoma Study Association. Lenalidomide in combination with R-CHOP (R2-CHOP) as first-line treatment of patients with high tumour burden follicular lymphoma: a single-arm, open-label, phase 2 study. Lancet Haematol. 2018 Sep;5(9):e403-e410. doi: 10.1016/S2352-3026(18)30131-5.