Lymphoma, Follicular
Conditions
Brief summary
This protocol is designed to assess the efficacy and safety of inotuzumab ozogamicin given with rituximab compared to a defined investigator's choice therapy. Subjects will be randomized to one of these two arms of the study.
Detailed description
On January 14th 2009, enrollment in the study was discontinued because of poor enrollment and because it was unlikely that the study would meet the estimated enrollment of approximately 978 subjects. The decision was not prompted by the identification of any safety signals in this or other studies. Active treatment and follow-up of the already enrolled subjects was continued. On July, 22th 2010 , the study was amended to shorten the long-term follow-up to one year after active treatment.
Interventions
IV administration, 1.8mg/m² on day 2 of each cycle every 28 days, for up to 8 cycles.
IV administration, 375 mg/m² on day 1 of each cycle every 28 days, for up to 8 cycles.
intravenous cyclophosphamide at a dose of 750 mg/m2 on day 1
intravenous vincristine at a dose of 1.4 mg/m2 (not to exceed 2 mg) on day 1
oral prednisone/prednisolone at a dose of 40 mg/m2 on days 1 through 5
mitoxantrone 10 mg/m2 intravenous on day 2
fludarabine 25 mg/m2 intravenous on days 2 through 4
oral dexamethasone 20 mg/day on days 1-5
Sponsors
Study design
Eligibility
Inclusion criteria
* Subjects with a diagnosis of CD20 and CD22-positive, follicular lymphoma, who have received 1 or 2 prior regimens, at least 1 of which should have contained administration of rituximab (either as a single agent or in combination). * Age 18 years or older. * ECOG performance status \<= 2. * ANC \>= 1.5 x 10\^9/L (1500/mL) and platelets \>= 75 x 10\^9/L (75,000/mL), serum creatinine \<= 1.5 x ULN and urine protein to creatinine ratio of \<= 0.5, total bilirubin \<= 1.5 x ULN, AST and ALT \<= 2.5 x ULN. * At least 1 measurable disease lesion that is \>= 1.5 cm x 1.5 cm by CT or MRI, in an area of no prior radiation therapy, or documented progression in an area that was previously irradiated.
Exclusion criteria
* Subjects with clinical evidence of transformation to a more aggressive subtype of lymphoma or grade 3b follicular lymphoma. * Subjects whose disease is rituximab refractory, meaning that they did not have a CR or PR, or that they experienced disease progression within 6 months from the initiation of the rituximab or rituximab containing treatment regimen administered immediately preceding study enrollment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Baseline until disease progression or death or up to 1 year after last dose of study drug | PFS was defined as the time from randomization to disease progression or death due to any cause, whichever occurred first, censored at the last tumor evaluation date. PFS calculated as (Months) = (first event date minus randomization date plus 1) divided by 30.44. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Objective Response (OR) | Baseline, every 6 to 12 weeks during treatment period, end of treatment (EOT) (42 days after last dose), every 12 weeks during follow-up for up to 1 year after the last dose of study drug | OR was based on assessment of complete response(CR),unconfirmed CR(Cru),partial response(PR) as per International Response Criteria for Non-Hodgkin's Lymphoma.Confirmed response=response persists on repeat imaging at least 4 weeks after initial response.CR=complete disappearance of all detectable clinical/radiographic evidence of disease,lymph nodes regressed to normal size \[at least 1.5 centimeter(cm) or less\],spleen regressed,not palpable on physical examination,bone marrow infiltrate cleared on repeat aspiration/biopsy.PR=at least 50 percent (%) decrease in sum of product diameters of 6 greatest dominant nodes,no increase in other nodes,liver/spleen,no new sites of disease. CRu=residual lymph node greater than 1.5 cm in transverse diameter that has regressed more than 75% in product diameter.Individual nodes previously confluent,regressed more than 75% in product diameters.Indeterminate bone marrow (increased number/size of lymph aggregates without cytologic/architectural atypia). |
| Overall Survival Probability at Months 6, 12 and 24 | Baseline up to Month 6, 12, 24 | Overall survival was defined as the time from randomization to death due to any cause, censoring at the date of last contact or the end of the study. Participants who withdrew or lost to follow-up from study without having death documented were censored at the date of last contact. Kaplan-Meier estimates of the probability of survival at 6, 12 and 24 months was used to estimate the survival function. |
| Pharmacokinetics of Inotuzumab Ozogamicin in Combination With Rituximab | 0, 1, 168 hours on Cycle 1, 2; 0, 1, 2, 168 hours on Cycle 3, 4 | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings | Baseline up to 42 days post-treatment | Assessments of QT interval was performed only in rituximab + inotuzumab ozogamicinin group. QT interval corrected using Fridericia's formula (QTcF) and Bazett's formula (QTcB) was analyzed as per common terminology criteria for adverse events (CTCAE) version 3.0, where Grade 1 = mild AE, Grade 2 = moderate AE, Grade 3 = severe AE, Grade 4 = life-threatening or disabling AE, Grade 5 = death related to AE. Number of participants with change in CTCAE grading at post-baseline time point compared to the baseline were presented. The post-baseline value was defined as the maximum grade after the first dose date on or before the end of treatment. |
| Number of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs) | Baseline up to 42 days post-treatment | AE=any untoward medical occurrence in participant who received study drug without regard to possibility of causal relationship. Grade 3 (Severe) events=unacceptable or intolerable events, significantly interrupting usual daily activity, require systemic drug therapy/other treatment. Grade 4 (Life-threatening) events caused participant to be in imminent danger of death. TEAE=between first dose of study drug and up to 42 days after last dose that were absent before treatment or that worsened relative to pretreatment state. |
| Number of Participants With Clinically Significant Change From Baseline in Laboratory Findings | Baseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years) | Criteria for laboratory test abnormality: Blood Chemistry (alkaline phosphatase \[greater than{\>}5\*upper limit of normal {ULN}, calcium \[less than {\<}1.75 millimole per liter {mmol/L}, creatinine \[\>3\*ULN\], glucose \[\>13.9 mmol/L\], phosphorous \[\<0.6 mmol/L\], potassium \[\<3 mmol/L\], aspartate transaminase \[\>5.0\*ULN\], total bilirubin \[\>3\*ULN\]), Coagulation (international normalized ratio \[\>2\*ULN\]), Hematology (hemoglobin \[\<80 grams/Liter\], lymphocytes \[\<0.5\*10\^9/L\], absolute neutrophil count \[\<1\*10\^9/L\], platelet count \[\<50\*10\^9/L\], WBC \[\<2.0\*10\^9/L\]). |
| Number of Participants With Clinically Significant Change From Baseline in Vital Signs | Baseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years) | Criteria for determining significant change from baseline in vital signs abnormalities: heart rate value of \<40 beats per minute and value \>150 beats per minute, systolic blood pressure (SBP) of \<80 or \>210 millimeter of mercury (mmHg), diastolic blood pressure (DBP) of \<40 or \>130 mmHg, temperature \<32 or \>40 degree centigrade, and body weight\>=10% increase or decrease of body weight in kilogram (kg). |
Countries
Argentina, Belgium, Canada, Hong Kong, India, Italy, Mexico, Poland, Portugal, Russia, South Africa, South Korea, Spain, United States
Participant flow
Recruitment details
Enrollment of participants started on 15 November 2007 and completed on 16 January 2009. The trial was terminated (07 April 2011) due to poor accrual of 29 out of 978 planned participants.
Participants by arm
| Arm | Count |
|---|---|
| Rituximab + Inotuzumab Ozogamicin Participants received intravenous infusion of rituximab 375 milligram per square meter (mg/m\^2) of body surface area (BSA) on Day 1 followed by intravenous infusion of inotuzumab ozogamicin (CMC-544) 1.8 mg/m\^2 of BSA on Day 2 for each cycle up to 8 cycles. Each cycle was of 28 days. | 15 |
| Control Regimens R-CVP + R-FND Participants received either regimen containing intravenous infusion of rituximab 375 mg/m\^2 of BSA along with intravenous infusion of cyclophosphamide 750 mg/m\^2 of BSA and vincristine 1.4 mg/m\^2 of BSA on Day 1 followed by oral prednisone/prednisolone 40 mg/m\^2 of BSA on Days 1 through 5 for up to 8 cycles (R-CVP); or regimen containing intravenous infusion of rituximab 375 mg/m\^2 of BSA on Day 1 followed by intravenous infusion of novantrone (mitoxantrone) 10 mg/m\^2 of BSA on Day 2, intravenous infusion of fludarabine 25 mg/m\^2 of BSA on Days 2 through 4, and oral dexamethasone 20 mg once daily on Days 1 through 5 for up to 8 cycles (R-FND). Each regimen cycle was of 21 days. | 14 |
| Total | 29 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 2 | 4 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | Other | 0 | 1 |
| Overall Study | Withdrawal by Subject | 0 | 1 |
Baseline characteristics
| Characteristic | Rituximab + Inotuzumab Ozogamicin | Control Regimens R-CVP + R-FND | Total |
|---|---|---|---|
| Age, Continuous | 62.3 years STANDARD_DEVIATION 11.4 | 60.9 years STANDARD_DEVIATION 12.4 | 61.7 years STANDARD_DEVIATION 11.7 |
| Sex: Female, Male Female | 9 Participants | 6 Participants | 15 Participants |
| Sex: Female, Male Male | 6 Participants | 8 Participants | 14 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 15 / 15 | 13 / 13 |
| serious Total, serious adverse events | 6 / 15 | 6 / 13 |
Outcome results
Progression-Free Survival (PFS)
PFS was defined as the time from randomization to disease progression or death due to any cause, whichever occurred first, censored at the last tumor evaluation date. PFS calculated as (Months) = (first event date minus randomization date plus 1) divided by 30.44.
Time frame: Baseline until disease progression or death or up to 1 year after last dose of study drug
Population: Intent-to-treat population included all participants who were randomized in to the study.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Rituximab + Inotuzumab Ozogamicin | Progression-Free Survival (PFS) | NA months |
| Control Regimens R-CVP + R-FND | Progression-Free Survival (PFS) | 16.4 months |
Overall Survival Probability at Months 6, 12 and 24
Overall survival was defined as the time from randomization to death due to any cause, censoring at the date of last contact or the end of the study. Participants who withdrew or lost to follow-up from study without having death documented were censored at the date of last contact. Kaplan-Meier estimates of the probability of survival at 6, 12 and 24 months was used to estimate the survival function.
Time frame: Baseline up to Month 6, 12, 24
Population: Intent-to-treat population included all participants who were randomized in to the study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rituximab + Inotuzumab Ozogamicin | Overall Survival Probability at Months 6, 12 and 24 | Overall Survival: Baseline up to Month 6 | 100.0 percent chance of survival |
| Rituximab + Inotuzumab Ozogamicin | Overall Survival Probability at Months 6, 12 and 24 | Overall Survival: Baseline up to Month 12 | 86.7 percent chance of survival |
| Rituximab + Inotuzumab Ozogamicin | Overall Survival Probability at Months 6, 12 and 24 | Overall Survival: Baseline up to Month 24 | 86.7 percent chance of survival |
| Control Regimens R-CVP + R-FND | Overall Survival Probability at Months 6, 12 and 24 | Overall Survival: Baseline up to Month 6 | 92.3 percent chance of survival |
| Control Regimens R-CVP + R-FND | Overall Survival Probability at Months 6, 12 and 24 | Overall Survival: Baseline up to Month 12 | 83.9 percent chance of survival |
| Control Regimens R-CVP + R-FND | Overall Survival Probability at Months 6, 12 and 24 | Overall Survival: Baseline up to Month 24 | 67.1 percent chance of survival |
Percentage of Participants With Objective Response (OR)
OR was based on assessment of complete response(CR),unconfirmed CR(Cru),partial response(PR) as per International Response Criteria for Non-Hodgkin's Lymphoma.Confirmed response=response persists on repeat imaging at least 4 weeks after initial response.CR=complete disappearance of all detectable clinical/radiographic evidence of disease,lymph nodes regressed to normal size \[at least 1.5 centimeter(cm) or less\],spleen regressed,not palpable on physical examination,bone marrow infiltrate cleared on repeat aspiration/biopsy.PR=at least 50 percent (%) decrease in sum of product diameters of 6 greatest dominant nodes,no increase in other nodes,liver/spleen,no new sites of disease. CRu=residual lymph node greater than 1.5 cm in transverse diameter that has regressed more than 75% in product diameter.Individual nodes previously confluent,regressed more than 75% in product diameters.Indeterminate bone marrow (increased number/size of lymph aggregates without cytologic/architectural atypia).
Time frame: Baseline, every 6 to 12 weeks during treatment period, end of treatment (EOT) (42 days after last dose), every 12 weeks during follow-up for up to 1 year after the last dose of study drug
Population: Intent-to-treat population included all participants who were randomized in to the study.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Rituximab + Inotuzumab Ozogamicin | Percentage of Participants With Objective Response (OR) | 93.3 percentage of participants |
| Control Regimens R-CVP + R-FND | Percentage of Participants With Objective Response (OR) | 64.3 percentage of participants |
Pharmacokinetics of Inotuzumab Ozogamicin in Combination With Rituximab
Time frame: 0, 1, 168 hours on Cycle 1, 2; 0, 1, 2, 168 hours on Cycle 3, 4
Population: Data for this outcome measurement was not collected since pharmacokinetic parameters were not analyzed in this study due to very few number of participants with PK samples.
Number of Participants With Clinically Significant Change From Baseline in Laboratory Findings
Criteria for laboratory test abnormality: Blood Chemistry (alkaline phosphatase \[greater than{\>}5\*upper limit of normal {ULN}, calcium \[less than {\<}1.75 millimole per liter {mmol/L}, creatinine \[\>3\*ULN\], glucose \[\>13.9 mmol/L\], phosphorous \[\<0.6 mmol/L\], potassium \[\<3 mmol/L\], aspartate transaminase \[\>5.0\*ULN\], total bilirubin \[\>3\*ULN\]), Coagulation (international normalized ratio \[\>2\*ULN\]), Hematology (hemoglobin \[\<80 grams/Liter\], lymphocytes \[\<0.5\*10\^9/L\], absolute neutrophil count \[\<1\*10\^9/L\], platelet count \[\<50\*10\^9/L\], WBC \[\<2.0\*10\^9/L\]).
Time frame: Baseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years)
Population: Safety population included all participants who received at least 1 dose of a test article (either rituximab + inotuzumab ozogamicin or control regimens R-CVP + R-FND).
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in Laboratory Findings | Disease follow up | 8 participants |
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in Laboratory Findings | Baseline up to 42 days post-treatment | 11 participants |
| Control Regimens R-CVP + R-FND | Number of Participants With Clinically Significant Change From Baseline in Laboratory Findings | Baseline up to 42 days post-treatment | 12 participants |
| Control Regimens R-CVP + R-FND | Number of Participants With Clinically Significant Change From Baseline in Laboratory Findings | Disease follow up | 7 participants |
Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings
Assessments of QT interval was performed only in rituximab + inotuzumab ozogamicinin group. QT interval corrected using Fridericia's formula (QTcF) and Bazett's formula (QTcB) was analyzed as per common terminology criteria for adverse events (CTCAE) version 3.0, where Grade 1 = mild AE, Grade 2 = moderate AE, Grade 3 = severe AE, Grade 4 = life-threatening or disabling AE, Grade 5 = death related to AE. Number of participants with change in CTCAE grading at post-baseline time point compared to the baseline were presented. The post-baseline value was defined as the maximum grade after the first dose date on or before the end of treatment.
Time frame: Baseline up to 42 days post-treatment
Population: Safety population included all participants who received at least 1 dose of a test article. Here 'N' signifies those participants who were evaluable for this outcome measure.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings | QTcB: BL normal, post-BL normal | 4 participants |
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings | QTcB: BL normal, post-BL Grade 1 | 2 participants |
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings | QTcB: BL normal, post-BL Grade 2 | 3 participants |
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings | QTcF: BL normal, post-BL normal | 6 participants |
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings | QTcF: BL normal, post-BL Grade 1 | 3 participants |
Number of Participants With Clinically Significant Change From Baseline in Vital Signs
Criteria for determining significant change from baseline in vital signs abnormalities: heart rate value of \<40 beats per minute and value \>150 beats per minute, systolic blood pressure (SBP) of \<80 or \>210 millimeter of mercury (mmHg), diastolic blood pressure (DBP) of \<40 or \>130 mmHg, temperature \<32 or \>40 degree centigrade, and body weight\>=10% increase or decrease of body weight in kilogram (kg).
Time frame: Baseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years)
Population: Safety population included all participants who received at least 1 dose of a test article (either rituximab + inotuzumab ozogamicin or control regimens R-CVP + R-FND).
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in Vital Signs | Baseline up to 42 days post-treatment | 0 participants |
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Clinically Significant Change From Baseline in Vital Signs | Disease follow up | 3 participants |
| Control Regimens R-CVP + R-FND | Number of Participants With Clinically Significant Change From Baseline in Vital Signs | Baseline up to 42 days post-treatment | 1 participants |
| Control Regimens R-CVP + R-FND | Number of Participants With Clinically Significant Change From Baseline in Vital Signs | Disease follow up | 2 participants |
Number of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs)
AE=any untoward medical occurrence in participant who received study drug without regard to possibility of causal relationship. Grade 3 (Severe) events=unacceptable or intolerable events, significantly interrupting usual daily activity, require systemic drug therapy/other treatment. Grade 4 (Life-threatening) events caused participant to be in imminent danger of death. TEAE=between first dose of study drug and up to 42 days after last dose that were absent before treatment or that worsened relative to pretreatment state.
Time frame: Baseline up to 42 days post-treatment
Population: Safety population included all participants who received at least 1 dose of a test article (either rituximab + inotuzumab ozogamicin or control regimens R-CVP + R-FND).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Rituximab + Inotuzumab Ozogamicin | Number of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs) | 12 participants |
| Control Regimens R-CVP + R-FND | Number of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs) | 13 participants |