Cutaneous T-cell Lymphoma
Conditions
Keywords
romidepsin
Brief summary
GPI-04-0001 was a Phase II, non-randomized, open label, single arm study that was conducted at approximately 30 sites, primarily in the United States, Europe and Russia. It assessed the efficacy, safety, and tolerability of romidepsin as a treatment for cutaneous T-cell lymphoma (CTCL). Study patients (pts) received romidepsin in a dose of 14 mg/m\^2 intravenously over 4 hours on Days 1, 8 and 15 of each 28-day cycle. The duration of study treatment was 6 cycles although pts who showed an objective response or stable disease could continue to receive therapy, at the discretion of the investigator, until disease progression or another withdrawal criterion was met.
Detailed description
Responses were evaluated according to a composite assessment (Objective Primary Disease Response Evaluation Criteria \[OPDREC\]) that included cutaneous manifestations of disease, lymph node involvement, and circulating malignant T-cells (Sézary cells). Skin involvement was measured using a weighted body surface area skin assessment tool (WBSA/SWAT) or an erythroderma score, depending upon the pt's disease. Disease response was assessed by the Investigators and an Independent Response Review Committee (IRRC) with the IRRC assessment considered supportive of the Investigator's evaluations using the following criteria: Complete Response (CR): * Complete resolution of skin patches, skin plaques, and skin tumors, or erythroderma * No evidence of abnormal lymph nodes * Absence of circulating Sézary cells. * No evidence of new tumors (cutaneous or non-cutaneous) * Findings confirmed by skin biopsy Clinical complete response (CCR): \- Same as CR but without skin biopsy Partial Response (PR): * ≥50% improvement in the summation of (change in Skin + change in Lymph Node + change in Peripheral Blood) with * At least \>30% improvement in Skin and * No worsening in Lymph Node or Sézary cells. * No evidence of new tumors (cutaneous/non-cutaneous) Stable Disease (SD): * Not enough improvement or worsening in the summation of (change in Skin + change in Lymph Node + change in Peripheral Blood to qualify as PR or PD * No evidence of new tumors (cutaneous/non-cutaneous) SD90: \- SD90 was defined as documented evidence of SD for at least 90 Days Duration Progressive Disease (PD): * Evidence of new tumor (cutaneous or non-cutaneous), OR * \>25% worsening in the summation of (change in Skin + change in Lymph Node + change in Peripheral Blood) with \>15% worsening in change in Skin.
Interventions
DRUGromidepsin (depsipeptide, FK228)
Study patients received romidepsin at a dose of 14 mg/m\^2 intravenously over 4 hours on Days 1, 8 and 15 of each 28-day cycle. The duration of study treatment was 6 cycles although patients who showed an objective response or stable disease could continue to receive therapy, at the discretion of the investigator, until disease progression or another withdrawal criterion was met.
Sponsors
Celgene Corporation
Celgene
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients had to fulfill all of the following criteria to be eligible for study participation: * Males or non-pregnant females aged 18 or over. * Histologically confirmed diagnosis of CTCL, including mycosis fungoides and Sézary syndrome. * Patients with CTCL stages II-A, II-B, III, and IV-A only. * Patients with CTCL stage IB who had relapsed following previous therapy and where, in the investigator's opinion, the potential benefit of treatment with romidepsin outweighed the possible risks. * Patients who had failed standardized skin-directed therapy and had had at least one course of systemic therapy, such as interferon, Ontak®, chemotherapy or Targretin®, etc., which they were deemed to have failed. * Anticipated life expectancy greater than six months. * Written informed consent to participate in the study.
Exclusion criteria
Patients were ineligible for entry if any of the following criteria were met: * ECOG Performance Status \>1. * Patients who had not received at least 1 course of prior systemic therapy for CTCL. * Visceral involvement i.e. Stage 4B disease (lymphadenopathy was allowed). * Patients with known cardiac abnormalities such as: * Congenital long QT syndrome * QTc (Corrected QT interval on ECG) interval \>480 milliseconds * Any cardiac arrhythmia requiring anti-arrhythmic medication. * Patients who had had a myocardial infarction within 12 months of study entry. * Patients who had a history of coronary artery disease (CAD) e.g. angina Canadian class II to IV. In any patient in whom there was doubt, the patient should have had a stress imaging study and exercise electrocardiogram (ECG) and, if abnormal, angiography to define whether or not CAD was present. * Patients with an ECG recorded at screening showing evidence of cardiac ischaemia (ST depression of \>=2 mm). If in any doubt, the patient should have had a stress imaging study and exercise ECG and, if abnormal, angiography to define whether or not CAD is present. * Patients with congestive heart failure that met New York Heart Association class II to IV definitions and/or ejection fraction \<40% by multiple gated acquisition (MUGA) scan or \<50% by echocardiogram and/or magnetic resonance imaging (MRI) * Patients with a history of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), Torsade de Pointes, or cardiac arrest, unless currently addressed with an automatic implantable cardioverter defibrillator (AICD). * Patients with hypertrophic cardiomegaly or restrictive cardiomyopathy from prior treatment or other causes (if in doubt, see ejection fraction criteria above). * Patients with uncontrolled hypertension, i.e. \>=160/95 mmHg. * Concomitant use of any anti-cancer therapy. * Concomitant use of warfarin (due to a drug interaction). * Concomitant use of any investigational agent. * Use of any investigational agent within 4 weeks of study entry. * Concomitant use of drugs which may cause a prolongation of the QTc interval. * Patients with a potassium level of \<3.5 mmol/L and a magnesium level of \<0.8 mmol/L. * Clinically significant active infection. * Known infection with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C. * Inadequate bone marrow or other organ function, as evidenced by: * unsupported haemoglobin \<9.0 g/dL (transfusions and/or erythropoietin were permitted); * absolute neutrophil count (ANC) \<=1.5 x 10\^9/L; * platelet count \<100 x 10\^9/L; * total bilirubin \>1.25 x upper limit of normal (ULN) for institution, * aspartate transaminase/glutamic oxaloacetic transaminase (AST/SGOT) and alanine transaminase/ glutamic pyruvic transaminase (ALT/SGPT) \>2.0 x ULN, serum creatinine \>2.0 x ULN for age and sex; * Coexistent second malignancy or history of prior malignancy within previous 5 years (excluding basal or squamous cell carcinoma of the skin or cervical epithelial neoplasm \[CIN1, carcinoma in situ\] that had been treated curatively). * Any significant medical or psychiatric condition that might have prevented the patient from complying with all study procedures. * Patients who were pregnant or breast-feeding. All women of child bearing potential were to use an effective method of contraception (either an intrauterine device or a double barrier method using condoms or a diaphragm plus spermicide) during the study and for at least one month after receiving the last dose of romidepsin. Male patients were to use a barrier method of contraception (condoms) during the treatment period and for at least 1 month thereafter. Hormonal methods of contraception such as the contraceptive pill or patch (particularly those containing ethinyl estradiol) were to be avoided due to a potential drug interaction. * Use of topical steroids in the previous 2 weeks or systemic steroids in the previous 4 weeks. * Having previously given consent to participate in this study. * Concomitant use of CYP3A4 inhibitors.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Percent of Patients (Pts) With Objective Disease Response | 6 months | The percent of pts with confirmed Objective Disease Response (confirmed best responses of complete response \[CR\], clinical complete response \[CCR\], or partial response \[PR\]). Responses were evaluated according to a composite assessment (Objective Primary Disease Response Evaluation Criteria - OPDREC). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Objective Disease Response | Up to 10 months | Time to Objective Response was defined as the time in months from first dose date to the first date of objective disease response (later confirmed) and time to CCR was defined as the time in months from first dose date to the first date of CCR (later confirmed). |
| Time to Disease Progression | Up to 10 months; median duration of follow up was 6.1 months | Time To Progression was defined as the duration from the date of the first study drug dose to the date of progression (PD). In this analysis, pts who did not progress were censored at their last evaluation with an OPDREC assessment. |
| Duration of Objective Disease Response | Up to 10 months; median duration of follow up was 5.1 months | Duration of Objective Response was defined as the number of months from the date of the first disease response (clinical complete response \[CCR\], or partial response \[PR\]) (later confirmed) until the date of progression and was determined using Kaplan-Meier product-limit estimates. In this analysis, pts who did not progress were censored as of their last evaluation with an OPDREC assessment. |
| Duration of Objective Disease Control (ODC) | Up to 10 months; median duration of follow up was 6.0 months | For pts with confirmed ODC (pts with CR, CCR, PR, SD90 \[stable disease for 90 days\]) based on OPDREC, duration of ODC was summarized with descriptive statistics, including number of censored observations, and 25th, 50th, 75th percentiles of distribution, based on Kaplan-Meier product limit estimates. For pts with confirmed progressive disease (PD), duration of ODC was calculated from first date of study drug to first date of diagnosis of confirmed PD. For pts without confirmed PD, duration of ODC was calculated from first date of study drug to date of the last visit with any OPDREC data. |
| Percent of Pts With Objective Disease Control | Up to 10 months | The percent of pts with confirmed ODC (CR, CCR, PR and SD90) based on OPDREC was summarized. |
| Decrease in Pruritus Visual Analogue Scale (VAS) Score of ≥30 mm or a Score of 0 for at Least 2 Consecutive Cycles. | Up to 10 months | Pruritus was reported monthly by pts using a 0 (no itching) to 100 (unbearable itching) mm visual analog scale (VAS). Pts were considered to have significant pruritus if the baseline VAS score was ≥ 30 mm. Clinically meaningful reduction in pruritus was defined as a decrease in VAS score of ≥ 30 mm or a score of 0 for at least 2 consecutive cycles. |
Countries
France, Germany, Poland, Russia, United Kingdom, United States
Participant flow
Recruitment details
Patients were enrolled between January 2005 and July 2007. Patients were enrolled at academic centers in the US and Europe that had experience in treating CTCL patients
Pre-assignment details
Eligible patients were required to have failed at least 1 prior systemic therapy, e.g., interferon, chemotherapy, Ontak® (denileukin diftitox), or Targretin® (bexarotene).
Participants by arm
| Arm | Count |
|---|---|
| Romidepsin Regimen was 14 mg/m2 IV over a 4-hour period on Days 1, 8, and 15 of a 28-day cycle. The protocol included 6 cycles of treatment; responding patients and patients who achieved at least Stable Disease (SD) had the option of continuing treatment beyond 6 cycles at the discretion of the Investigator and based on local regulations. | 102 |
| Total | 102 |
Baseline characteristics
| Characteristic | Romidepsin |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 23 Participants |
| Age, Categorical Between 18 and 65 years | 79 Participants |
| Age, Continuous | 57.0 years STANDARD_DEVIATION 11.93 |
| Eastern Cooperative Oncology Group (ECOG) Performance status 0, Fully active, able to carry on all pre-disease | 53 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance status 1, Restricted in physically strenuous activity but | 49 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance status 2, Ambulatory and capable of all selfcare but unab | 0 Participants |
| Region of Enrollment France | 5 participants |
| Region of Enrollment Georgia | 3 participants |
| Region of Enrollment Germany | 6 participants |
| Region of Enrollment Poland | 24 participants |
| Region of Enrollment Russian Federation | 17 participants |
| Region of Enrollment Ukraine | 7 participants |
| Region of Enrollment United Kingdom | 20 participants |
| Region of Enrollment United States | 20 participants |
| Sex: Female, Male Female | 40 Participants |
| Sex: Female, Male Male | 62 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 99 / 102 |
| serious Total, serious adverse events | 23 / 102 |
Outcome results
Primary
The Percent of Patients (Pts) With Objective Disease Response
The percent of pts with confirmed Objective Disease Response (confirmed best responses of complete response \[CR\], clinical complete response \[CCR\], or partial response \[PR\]). Responses were evaluated according to a composite assessment (Objective Primary Disease Response Evaluation Criteria - OPDREC).
Time frame: 6 months
Population: Efficacy analysis based on interim analysis of data for as treated population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Romidepsin | The Percent of Patients (Pts) With Objective Disease Response | 34 Percent of participants |
Secondary
Decrease in Pruritus Visual Analogue Scale (VAS) Score of ≥30 mm or a Score of 0 for at Least 2 Consecutive Cycles.
Pruritus was reported monthly by pts using a 0 (no itching) to 100 (unbearable itching) mm visual analog scale (VAS). Pts were considered to have significant pruritus if the baseline VAS score was ≥ 30 mm. Clinically meaningful reduction in pruritus was defined as a decrease in VAS score of ≥ 30 mm or a score of 0 for at least 2 consecutive cycles.
Time frame: Up to 10 months
Population: Patients meeting definition of moderate to severe pruritus on VAS (i.e., had a VAS of \>=30 mm)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Romidepsin | Decrease in Pruritus Visual Analogue Scale (VAS) Score of ≥30 mm or a Score of 0 for at Least 2 Consecutive Cycles. | 25 participants |
Secondary
Duration of Objective Disease Control (ODC)
For pts with confirmed ODC (pts with CR, CCR, PR, SD90 \[stable disease for 90 days\]) based on OPDREC, duration of ODC was summarized with descriptive statistics, including number of censored observations, and 25th, 50th, 75th percentiles of distribution, based on Kaplan-Meier product limit estimates. For pts with confirmed progressive disease (PD), duration of ODC was calculated from first date of study drug to first date of diagnosis of confirmed PD. For pts without confirmed PD, duration of ODC was calculated from first date of study drug to date of the last visit with any OPDREC data.
Time frame: Up to 10 months; median duration of follow up was 6.0 months
Population: Efficacy analysis based on interim analysis of data for as treated population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Romidepsin | Duration of Objective Disease Control (ODC) | 17.67 Months |
Secondary
Duration of Objective Disease Response
Duration of Objective Response was defined as the number of months from the date of the first disease response (clinical complete response \[CCR\], or partial response \[PR\]) (later confirmed) until the date of progression and was determined using Kaplan-Meier product-limit estimates. In this analysis, pts who did not progress were censored as of their last evaluation with an OPDREC assessment.
Time frame: Up to 10 months; median duration of follow up was 5.1 months
Population: Efficacy analysis based on interim analysis of data for as treated population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Romidepsin | Duration of Objective Disease Response | 14.91 Months |
Secondary
Percent of Pts With Objective Disease Control
The percent of pts with confirmed ODC (CR, CCR, PR and SD90) based on OPDREC was summarized.
Time frame: Up to 10 months
Population: Efficacy analysis based on interim analysis of data for as treated population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Romidepsin | Percent of Pts With Objective Disease Control | 64 Percent of participants |
Secondary
Time to Disease Progression
Time To Progression was defined as the duration from the date of the first study drug dose to the date of progression (PD). In this analysis, pts who did not progress were censored at their last evaluation with an OPDREC assessment.
Time frame: Up to 10 months; median duration of follow up was 6.1 months
Population: Efficacy analysis based on interim analysis of data for as treated population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Romidepsin | Time to Disease Progression | 8.28 Months |
Secondary
Time to Objective Disease Response
Time to Objective Response was defined as the time in months from first dose date to the first date of objective disease response (later confirmed) and time to CCR was defined as the time in months from first dose date to the first date of CCR (later confirmed).
Time frame: Up to 10 months
Population: Efficacy analysis based on interim analysis of data for as treated population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Romidepsin | Time to Objective Disease Response | 1.87 Months |