Conditions: Lymphoma
Keywords: diffuse large b cell lymphoma
Allocation: NA | Intervention model: SINGLE_GROUP
Enrollment: 17
Healthy volunteers: no

Brief summary:
This will be a phase I/II study of 5-azacitidine in combination with vorinostat in patients with relapsed or refractory DLBCL. Combination therapy with methyltransferase inhibitors and histone deacetylase inhibitors is highly synergistic in DLBCL cells, and both classes of drugs can also synergize powerfully with standard anti-lymphoma chemotheraputics such as doxorubicin in pre-clinical studies. We hypothesize that azacytidine + vorinostat combination therapy will be safe and effective in selected patients with relapsed or refractory DLBCL. We also hypothesize that patients demonstrating objective responses to this combination therapy display specific epigenetic signatures, and that a biomarker or gene classifier can be generated which will identify those patients likely to respond.

Detailed description:
Eligible subjects will have biopsy proven relapsed or refractory DLBCL, have preserved hematologic and other organ function, and have either progressed following or be inappropriate candidates for autologous stem cell transplantation.

Patients will be treated with 5-azacitidine via subcutaneous administration and vorinostat orally at four different dose levels as described below:

* Dose level 1: azacitidine 55 mg/m2 on days 1-5 and oral vorinostat at 300 mg BID on Days 1-7.
* Dose level 2: azacitidine 75 mg/m2 on days 1-5 and oral vorinostat at 200 mg BID on Days 1-7.
* Dose level 3: azacitidine 55 mg/m2 on days 1-5 and oral vorinostat at 300 mg BID on Days 1-14.
* Dose level 4: azacitidine 75 mg/m2 on days 1-5 and oral vorinostat at 200 mg BID on Days 1-14.

Each cycle will be of 28 days and patients will be treated for up to 6 cycles.

Up to 8 patients will be enrolled at each dose level. If at any time 2 patients in a given cohort experience DLT, enrollment to that level will be discontinued.

Efficacy will be assessed by standard radiographic and other criteria at baseline and at the end of treatment to determine ORR. Patients will be followed for 2 years or until disease progression.

Tumor samples will be obtained for correlative studies at baseline through core needle or surgical biopsy, with an additional biopsy performed on day 15 of cycle 1 as a pharmacodynamic endpoint.

Arms:
arm 1: None

Interventions: intervention 1: azacytidine intervention 2: vorinostat
Intervention descriptions: intervention 1: * Dose level 1: azacitidine 55 mg/m2 on days 1-5
* Dose level 2: azacitidine 75 mg/m2 on days 1-5
* Dose level 3: azacitidine 55 mg/m2 on days 1-5
* Dose level 4: azacitidine 75 mg/m2 on days 1-5

Each cycle = 28 days. Subjects may receive up to 6 cycles. intervention 2: * Dose level 1: oral vorinostat at 300 mg BID on Days 1-7.
* Dose level 2: oral vorinostat at 200 mg BID on Days 1-7.
* Dose level 3: oral vorinostat at 300 mg BID on Days 1-14.
* Dose level 4: oral vorinostat at 200 mg BID on Days 1-14.

Each cycle = 28 days. Subjects receive up to 6 cycles.

Protocol document: