Adult Lymphocyte Depletion Hodgkin Lymphoma, Adult Lymphocyte Predominant Hodgkin Lymphoma, Adult Mixed Cellularity Hodgkin Lymphoma, Adult Nodular Sclerosis Hodgkin Lymphoma, Recurrent Adult Hodgkin Lymphoma
Conditions
Brief summary
This randomized phase II trial studies the side effects and how well giving monoclonal antibody SGN-30 together with combination chemotherapy works in treating patients with Hodgkin lymphoma that has returned after a period of improvement or did not respond to previous treatment. Monoclonal antibodies, such as SGN-30, may interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as gemcitabine hydrochloride, vinorelbine tartrate, and pegylated liposomal doxorubicin hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving monoclonal antibody SGN-30 together with combination chemotherapy may kill more cancer cells and shrink tumors.
Detailed description
PRIMARY OBJECTIVES: I. To determine the complete and partial response rates following treatment with the anti-cluster of differentiation (CD) 30 antibody, SGN-30 (monoclonal antibody SGN-30), and gemcitabine (gemcitabine hydrochloride), vinorelbine (vinorelbine tartrate), and pegylated liposomal doxorubicin (pegylated liposomal doxorubicin hydrochloride) (GVD) in patients with relapsed or refractory Hodgkin lymphoma (HL). II. To assess time to progression and overall survival in patients treated with SGN-30 and GVD in patients with relapsed or refractory Hodgkin lymphoma (HL). III. To evaluate the toxicity of SGN-30 in combination with GVD in patients with relapsed and refractory HL. SECONDARY OBJECTIVES: I. To determine the pharmacokinetic profile of SGN-30 when combined with GVD chemotherapy. II. To correlate soluble (s) CD30 levels with response to treatment. III. To determine the incidence of human anti-chimeric antibodies (HACA) formation following repetitive SGN-30 dosing. IV. To correlate Fc gamma receptor polymorphisms with response to treatment. OUTLINE: Part 1 (closed to accrual as of 5/18/2007): Patients receive monoclonal antibody SGN-30 intravenously (IV) over 2 hours, vinorelbine tartrate IV over 6-10 minutes, gemcitabine hydrochloride IV over 30 minutes, and pegylated doxorubicin hydrochloride liposome IV over 90 minutes on days 1 and 8. Treatment repeats every 21 days until 10 out of 16 patients complete 1 course in the absence of unacceptable toxicity. Subsequent patients receive treatment on part 2. Part 2: Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive monoclonal antibody SGN-30 IV over 2 hours, vinorelbine tartrate IV over 6-10 minutes, gemcitabine hydrochloride IV over 30 minutes, and pegylated doxorubicin hydrochloride liposome IV over 90 minutes on days 1 and 8. Arm II (closed to accrual as of 12/4/07): Patients receive placebo IV over 2 hours, vinorelbine tartrate IV over 6-10 minutes, gemcitabine hydrochloride IV over 30 minutes, and pegylated doxorubicin hydrochloride liposome IV over 90 minutes on days 1 and 8. Treatment in both arms repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. NOTE: Treatment with SGN-30/placebo was stopped on 4/12/2007 due to pulmonary toxicity. After completion of study treatment, patients are followed up periodically for up to 10 years.
Interventions
BIOLOGICALmonoclonal antibody SGN-30
Given IV
OTHERplacebo
Given IV
DRUGvinorelbine tartrate
Given IV
DRUGpegylated liposomal doxorubicin hydrochloride
Given IV
DRUGgemcitabine hydrochloride
Given IV
OTHERlaboratory biomarker analysis
Correlative studies
OTHERpharmacological study
Correlative studies
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically documented CD30-positive classical Hodgkin lymphoma according to the World Health Organization (WHO) classification of lymphoid malignancies that is recurrent or refractory after at least one prior therapy * Note: Patients with nodular lymphocyte predominant HL are not eligible; all other subtypes including nodular sclerosis, lymphocyte-depleted, lymphocyte rich, and mixed cellularity HL may be enrolled * Core needle biopsies are acceptable if they contain adequate tissue for primary diagnosis and immunophenotyping; bone marrow biopsies as the sole means of diagnosis are not acceptable, but they may be submitted in conjunction with nodal biopsies; fine needle aspirates are not acceptable; if the original diagnostic specimen is not available, specimens obtained at relapse may be submitted; if multiple specimens are available, please submit the most recent; failure to submit pathology specimens within 60 days of patient registration will be considered a major protocol violation * Patients must have relapsed or refractory disease after at least one prior therapy, with at least a 3 week interval from the completion of the most recent chemotherapy or radiotherapy regimen; recovery to =\< grade 1 from all toxicities related to the prior treatments is required; patients who have previously received a stem cell transplant are permitted to enroll on this study * Prior treatment with an anti-CD30 antibody, gemcitabine, vinorelbine, or pegylated liposomal doxorubicin is not permitted * No uncontrolled angina, no myocardial infarction (MI) within 6 months of study entry, and no New York Heart Association (NYHA) class II or greater congestive heart failure (CHF) * Baseline left ventricular ejection fraction (LVEF) by multi gated acquisition scan (MUGA) or echocardiogram (ECHO) must be \>= 45% * Eastern Cooperative Oncology Group (ECOG) performance status 0-2 * Measurable disease must be present on either physical examination or imaging studies; evaluable or non-measurable disease alone is not acceptable * Measurable disease is defined as any lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as \>= 10 mm * Non-measurable disease includes all other lesions, including small lesions (\< 10 mm) and truly non-measurable lesions * Lesions that are considered non-measurable include the following: * Bone lesions (lesions, if present, should be noted) * Bone marrow involvement (if present, this should be noted) * Ascites * Pleural/pericardial effusion * Lymphangitis cutis/pulmonis * Pregnant or nursing women may not be enrolled; women of childbearing potential must have a negative serum or urine pregnancy test prior to registration; women and men of reproductive potential should agree to use an effective means of birth control * Corrected diffusion capacity of carbon monoxide (DLCO) \>= 50% * Absolute neutrophil count (ANC) \>= 1,200/uL * Platelet count \>= 100,000/uL * Creatinine =\< 2.0 mg/dL * Bilirubin =\< 2.0 mg/dL * Absent a history of Gilbert's disease * Aspartate aminotransferase (AST) =\< 2.0 x upper limits of normal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Overall Response (OR) | Up to 10 years | The number of participants who respond (complete or partial) to treatment. Response was defined using the revised criteria for malignant lymphoma. Complete response (CR): complete disappearance of all detectable disease; partial response (PR): \>= 50% reduction in sum of the product of diameters of indicator lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Event Free Survival (EFS) | Up to 10 years | Event free survival is the time from trial entry until progression, death, or termination of treatment due to nonresponse. Patients who went on to receive a stem cell transplant (SCT) were not censored from the EFS survival at the time of transplant and were only considered failures at the time of relapse or death from any cause. The median EFS with 95% confidence interval (CI) was estimated using the Kaplan Meier method. |
| Overall Survival (OS) At 1 Year | 1 year | Percentage of patients who were alive at 1 year. The 1-year survival rate was estimated using the Kaplan Meier method. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Peak Serum Level of Monoclonal Antibody SGN-30 | Up to day 21 of course 6 | Record the highest serum level of monoclonal antibody SGN-30 achieved. |
| sCD30 Levels | Up to day 21 of course 6 | A 2-sided t-test with alpha = 0.05 will be used to compare sCD30 levels between responders (OR) and non-responders groups. |
| Fc Gamma Receptor Polymorphisms | Baseline | Fisher's exact test with 2-sided alpha = 0.05 will be used to compare the response probabilities in patients with V/V (valine expression), V/F (heterozygous), and F/F (homozygous for phenylalanine) for each of Fc gamma RIIIa a |
Countries
United States
Participant flow
Recruitment details
From April 2006 to December 2007 10 institutions recruited 30 participants to this trial.
Participants by arm
| Arm | Count |
|---|---|
| Arm I (SGN-30, Chemotherapy) Participants receive one of the following regimens every cycle depending on history of prior stem cell transplant. Cycle is 21 days.
No prior stem cell transplant:
SGN-30: 12 mg/kg IV days 1 & 8, vinorelbine: 20 mg/m\^2 IV days 1 & 8, gemcitabine: 1000 mg/m\^2 IV days 1 & 8, pegylated doxorubicin HCl liposome: 15 mg IV days 1 & 8.
Prior stem cell transplant SGN-30: 12 mg/kg IV days 1 & 8, vinorelbine: 15 mg/m\^2 IV days 1 & 8, gemcitabine: 800 mg/m\^2 IV days 1 & 8, pegylated doxorubicin HCl liposome: 10 mg IV days 1 & 8.
monoclonal antibody SGN-30: Given IV
vinorelbine tartrate: Given IV
pegylated liposomal doxorubicin hydrochloride: Given IV
gemcitabine hydrochloride: Given IV
laboratory biomarker analysis: Correlative studies
pharmacological study: Correlative studies | 23 |
| Arm II (Placebo, Chemotherapy) Participants receive one of the following regimens every cycle depending on history of prior stem cell transplant. Cycle is 21 days.
No prior stem cell transplant:
SGN-30: 12 mg/kg IV days 1 & 8, vinorelbine: 20 mg/m\^2 IV days 1 & 8, gemcitabine: 1000 mg/m\^2 IV days 1 & 8, pegylated doxorubicin HCl liposome: 15 mg IV days 1 & 8.
Prior stem cell transplant SGN-30: 12 mg/kg IV days 1 & 8, vinorelbine: 15 mg/m\^2 IV days 1 & 8, gemcitabine: 800 mg/m\^2 IV days 1 & 8, pegylated doxorubicin HCl liposome: 10 mg IV days 1 & 8.
placebo: Given IV
vinorelbine tartrate: Given IV
pegylated liposomal doxorubicin hydrochloride: Given IV
gemcitabine hydrochloride: Given IV
laboratory biomarker analysis: Correlative studies
pharmacological study: Correlative studies | 7 |
| Total | 30 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 5 | 1 |
| Overall Study | Death | 2 | 0 |
| Overall Study | Disease progression | 1 | 2 |
| Overall Study | Subsequent non-protocol therapy | 3 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Arm I (SGN-30, Chemotherapy) | Arm II (Placebo, Chemotherapy) | Total |
|---|---|---|---|
| Age, Continuous | 35 years | 38 years | 35 years |
| Prior autologous transplant No | 15 participants | 4 participants | 19 participants |
| Prior autologous transplant Yes | 8 participants | 3 participants | 11 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 1 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 18 Participants | 6 Participants | 24 Participants |
| Region of Enrollment United States | 23 participants | 7 participants | 30 participants |
| Sex: Female, Male Female | 5 Participants | 2 Participants | 7 Participants |
| Sex: Female, Male Male | 18 Participants | 5 Participants | 23 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 21 / 23 | 7 / 7 |
| serious Total, serious adverse events | 9 / 23 | 1 / 7 |
Outcome results
Primary
Number of Participants With Overall Response (OR)
The number of participants who respond (complete or partial) to treatment. Response was defined using the revised criteria for malignant lymphoma. Complete response (CR): complete disappearance of all detectable disease; partial response (PR): \>= 50% reduction in sum of the product of diameters of indicator lesions.
Time frame: Up to 10 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm I (SGN-30, Chemotherapy) | Number of Participants With Overall Response (OR) | 15 participants |
| Arm II (Placebo, Chemotherapy) | Number of Participants With Overall Response (OR) | 4 participants |
Secondary
Event Free Survival (EFS)
Event free survival is the time from trial entry until progression, death, or termination of treatment due to nonresponse. Patients who went on to receive a stem cell transplant (SCT) were not censored from the EFS survival at the time of transplant and were only considered failures at the time of relapse or death from any cause. The median EFS with 95% confidence interval (CI) was estimated using the Kaplan Meier method.
Time frame: Up to 10 years
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm I (SGN-30, Chemotherapy) | Event Free Survival (EFS) | 11.3 months |
| Arm II (Placebo, Chemotherapy) | Event Free Survival (EFS) | 4.1 months |
Secondary
Overall Survival (OS) At 1 Year
Percentage of patients who were alive at 1 year. The 1-year survival rate was estimated using the Kaplan Meier method.
Time frame: 1 year
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm I (SGN-30, Chemotherapy) | Overall Survival (OS) At 1 Year | 86 percentage of participants |
| Arm II (Placebo, Chemotherapy) | Overall Survival (OS) At 1 Year | 30 percentage of participants |
Other Pre-specified
Fc Gamma Receptor Polymorphisms
Fisher's exact test with 2-sided alpha = 0.05 will be used to compare the response probabilities in patients with V/V (valine expression), V/F (heterozygous), and F/F (homozygous for phenylalanine) for each of Fc gamma RIIIa a
Time frame: Baseline
Population: Fc gamma receptor polymorphisms were assessed in 28 participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm I (SGN-30, Chemotherapy) | Fc Gamma Receptor Polymorphisms | V/V | 0 participants |
| Arm I (SGN-30, Chemotherapy) | Fc Gamma Receptor Polymorphisms | F/F | 10 participants |
| Arm I (SGN-30, Chemotherapy) | Fc Gamma Receptor Polymorphisms | F/V | 7 participants |
| Arm II (Placebo, Chemotherapy) | Fc Gamma Receptor Polymorphisms | V/V | 0 participants |
| Arm II (Placebo, Chemotherapy) | Fc Gamma Receptor Polymorphisms | F/F | 6 participants |
| Arm II (Placebo, Chemotherapy) | Fc Gamma Receptor Polymorphisms | F/V | 5 participants |
p-value: 1Fisher Exact
Other Pre-specified
Peak Serum Level of Monoclonal Antibody SGN-30
Record the highest serum level of monoclonal antibody SGN-30 achieved.
Time frame: Up to day 21 of course 6
Population: Data was only available on 10 participants from Arm 1. (No participants from Arm II were evaluable for this endpoint as they did not receive SGN-30 per protocol.)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm I (SGN-30, Chemotherapy) | Peak Serum Level of Monoclonal Antibody SGN-30 | 339 mg/ml |
Other Pre-specified
sCD30 Levels
A 2-sided t-test with alpha = 0.05 will be used to compare sCD30 levels between responders (OR) and non-responders groups.
Time frame: Up to day 21 of course 6
Population: Nine participants submitted pretreatment sCD30 samples.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm I (SGN-30, Chemotherapy) | sCD30 Levels | 174.2 U/ml |
| Arm II (Placebo, Chemotherapy) | sCD30 Levels | 76.5 U/ml |
p-value: 0.06Chi-squared