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LBH589 in Relapsed or Relapsed and Refractory Waldenstrom's Macroglobulinemia

Phase II Trial of LBH589 (Panobinostat) in Relapsed or Relapsed and Refractory Waldenstrom's Macroglobulinemia

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00936611
Enrollment
39
Registered
2009-07-10
Start date
2009-07-31
Completion date
2012-11-30
Last updated
2021-01-28

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Waldenstrom's Macroglobulinemia

Keywords

LBH589, WM, panobinostat, relapsed, waldenstrom, macroglobulinemia

Brief summary

The purpose of this research study is to assess the overall response rate of LBH589 in patients with relapsed or refractory Waldenstrom's Macroglobulinemia. LBH589 is a newly discovered compound that has killed Waldenstrom cells in laboratory studies, however, it is not known if LBH589 will show the same activity in people with Waldenstrom's Macroglobulinemia. This drug has been used in research for the treatment of other types of cancer, such as multiple myeloma.

Detailed description

This phase II study is designed to assess the toxicity profile and the proportion of overall response in patients with relapsed or refractory WM. This will study the effect of single agent LBH589 on response in these patients. Efficacy measures will include both objective clinical measurements and investigator-reported outcomes. Response and time to event analyses will follow the criteria set forth in the International Waldenstrom consortium recommendations. Prior to the start of the study, investigators will assess disease and perform a CT scan of the chest, abdomen and pelvis. Response will be assessed after 2 cycles. If patients have stable disease or response, then they will continue on therapy until progression or unacceptable toxicity, being assessed every cycle until the sixth cycle and then every 3 months. Patients who show progression after 2 cycles will come off therapy and undergo event monitoring every 3 months. All responses will be assessed by M-protein quantification and immunofixation from serum and IgM monoclonal protein level. In addition, BM biopsies will be done at baseline, at the end of cycle 6 and at the end of all therapy. The protocol was amended because of concerns of toxicity to allow a starting dose of 25 mg; 12/36 (33%) patients were enrolled on the 25 mg dose.

Interventions

DRUGLBH589

Sponsors

Brigham and Women's Hospital
CollaboratorOTHER
Novartis
CollaboratorINDUSTRY
Dana-Farber Cancer Institute
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Male or female patients aged 18 years or older * Must have received prior therapy for their WM, any number of prior therapies is allowed * Must have symptomatic relapsed or refractory WM * Measurable monoclonal IgM protein in the blood and presence of lymphoplasmacytic cells in the bone marrow during any previous bone marrow * Laboratory values as described in the protocol * Clinically euthyroid * ECOG Performance Status of 2 or less

Exclusion criteria

* Prior HDAC, DAC, HSP90 inhibitors or valproic acid for the treatment of cancer * Patients who will need valproic acid for any medical condition during the study or within 5 days prior to first LBH589 treatment * Peripheral neuropathy CTCAE grade 2 or higher * Impaired cardiac function or clinically significant cardiac diseases * Impairment of GI function or GI disease that may significantly alter the absorption of LBH589 * Diarrhea \> CTCAE grade 1 * Other concurrent severe and/or uncontrolled medical conditions including abnormal laboratory values, that could cause unacceptable safety risks or compromise compliance with the protocol * Patients using medications that have a relative risk of prolonging the QT interval or inducing torsade de pointes if treatment cannot be discontinued or switched to a different medication prior to starting study drug * Patients who have received targeted agents within 2 weeks or within 5 half-lives of the agent and active metabolites (whichever is longer) and who have not recovered from side effects of those therapies * Patients who have received chemotherapy or rituximab within 3 weeks or less; or radiation therapy to \> 30% of marrow-bearing bone within 2 weeks or less prior to starting study treatment; or who have not yet recovered from side effects of such therapies * Patients who have received corticosteroids 2 weeks or less prior to registration. Patients may be receiving chronic corticosteroids if they are being given for disorders other than than Waldenstrom's Macroglobulinemia * Patients with active bleeding tendency or receiving any treatment with therapeutic doses of sodium warfarin or coumadin derivatives. Low doses of Coumadin to maintain line patency is allowed * Patients who have undergone major surgery 4 weeks or less prior to starting study drug or who have not recovered from side effects of such therapy * Women who are pregnant or breast feeding or women of childbearing potential not using an effective method of birth control * Male patients whose sexual partners are women of childbearing potential not using effective methods of birth control * Patients with prior malignancy within the last 5 years (except for basal or squamous cell carcinoma, or in situ cancer of the cervix) * Patients with known positivity for human immunodeficiency virus (HIV) or hepatitis C; baseline testing for HIV and hepatitis C is not required * Patients with a significant history of non-compliance to medical regimens or unwilling or unable to comply with the instructions given to him/her by the study staff

Design outcomes

Primary

MeasureTime frameDescription
Overall Response RateAssessed after 2nd cycle and then every subsequent cycle for 6 cycles. The median number of completed cycles of therapy was 5 (0- 32). As such observed up to ~32 months.Overall response rate is percentage of participants with complete (CR), very good partial (VGPR), partial (PR), or minimal response (MR) as best response during treatment. CR * Disappearance of monoclonal protein by immunofixation * No histologic evidence of bone marrow involvement * Resolution of any adenopathy/organomegaly (confirmed by CT scan), or signs or symptoms attributable to WM. * Second immunofixation required for confirmation. VGPR -At least 90% reduction of serum monoclonal IgM concentration on protein electrophoresis. PR * At least 50% reduction of serum monoclonal IgM concentration on protein electrophoresis and at least 50% decrease in adenopathy/organomegaly on physical examination or on CT scan. * No new symptoms or signs of active disease. MR * At least 25% but less than 50% reduction of serum monoclonal IgM by protein electrophoresis. * No new symptoms or signs of active disease.

Secondary

MeasureTime frameDescription
Median Progression Free SurvivalAssessed after 2nd cycle and then every subsequent cycle for 6 cycles and then every 3 months. If taken off treatment at cycle 2 for disease progression, assessed every 3 months. The median (range) follow up from treatment start is 7.7 month (0.9 - 29.7).Progression free survival (PFS) is defined as the time from start of treatment to disease progression or death from any cause as estimated by Kaplan Meier methods. Patients who have not progressed and are alive are censored at the date the patient is known to be progression-free.
Median Time to ProgressionAssessed after 2nd cycle and then every subsequent cycle for 6 cycles and then every 3 months. If taken off treatment at cycle 2 for disease progression, assessed every 3 months. The median (range) follow up from treatment start is 7.7 month (0.9 - 29.7).Time to progression (TTP) is defined as the time from start of treatment to progression. Patients who have not progressed are censored at the date the patient is last known to be progression free.
Median Duration of ResponseAssessed after 2nd cycle and then every subsequent cycle for 6 cycles and then every 3 months. If taken off treatment at cycle 2 for disease progression, assessed every 3 months. The median (range) follow up from treatment start is 7.7 month (0.9 - 29.7).Duration of response DR is defined as the time from the date of first response after treatment to the date of disease progression Patients who have died for any cause or are alive without progression are censored at the date the patient is last know to be progression-free. Duration of response DR is defined as the time from the date of first response after treatment to the date of disease progression or death for any cause. Patients who are alive without progression are censored at the date the patient is last know to be progression-free.
Number of Participants With Grade 3 and 4 Treatment-Related ThrombocytopeniaAssessed after 2nd cycle, every subsequent cycle for 6 cycles and then every 3 months. Once off-treatment, adverse events will be assessed for 30 days. The median (range) number of completed cycles of therapy was 5 (0- 32). Therefore, up to ~33 months.Grade 3 thrombocytopenia is defined as having 25,000-50,000 /uL platelets Grade 4 thrombocytopenia is defined as having \< 25,000 /uL platelets
Acetylated Histone H3 and Overall Response AssociationBone marrow biopsies were obtained at the start of treatment (baseline) and after the 6th cycle.Acetylated-histone-H3 levels were obtained through bone marrow biopsies and measured using established methods. This analysis aimed to analyze the association between overall response and percent change of acetylated histone h3 in samples using a paired t-test.

Countries

United States

Participant flow

Recruitment details

From July 2009 to March 2011

Participants by arm

ArmCount
LBH589
30 mg three days a week (Mondays, Wednesdays and Fridays). 1 cycle was 28 days Dose modifications for attributable toxicities allowed for reduction to: * 25 mg, 20 mg three times a week every week * Or 20 mg three times a week every other week. No dose re-escalation was allowed. * The protocol was amended on 6/15/2010 because of concerns of toxicity to allow a starting dose of 25 mg; 12/36 (33%) patients were enrolled on the 25 mg dose. LBH589
36
Total36

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyIneligible for Study Drug3
Overall StudyLost to Follow-up1
Overall StudyNew Systemic Therapy22
Overall StudyProgressive Disease3
Overall StudyStill on Active Therapy7
Overall StudyStill on Follow-up1
Overall StudyWithdrawal by Subject2

Baseline characteristics

CharacteristicLBH589
Age, Continuous61.6 years
International Prognostic Scoring System for Waldenstrom Macroglobulinemia
High
7 Participants
International Prognostic Scoring System for Waldenstrom Macroglobulinemia
Intermediate
14 Participants
International Prognostic Scoring System for Waldenstrom Macroglobulinemia
Low
15 Participants
Lymph Nodes and Hepatocyte Selection Medium Assessment by CT Scan Evidence of Disease
Absent
7 Participants
Lymph Nodes and Hepatocyte Selection Medium Assessment by CT Scan Evidence of Disease
Present
29 Participants
Median Beta 2 Microglobulin3.3 mg/dL
Median Hemoglobin10.7 gm/dL
Median IgM3240 mg/dL
Median M Spike2.06 gm/dL
Median Platelets242 platelets x 10^3 / mL
Percentage of Bone Marrow Involvement70 percentage of marrow
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
0 Participants
Race (NIH/OMB)
Black or African American
0 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants
Race (NIH/OMB)
White
35 Participants
Sex: Female, Male
Female
22 Participants
Sex: Female, Male
Male
14 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
28 / 39
other
Total, other adverse events
36 / 39
serious
Total, serious adverse events
29 / 39

Outcome results

Primary

Overall Response Rate

Overall response rate is percentage of participants with complete (CR), very good partial (VGPR), partial (PR), or minimal response (MR) as best response during treatment. CR * Disappearance of monoclonal protein by immunofixation * No histologic evidence of bone marrow involvement * Resolution of any adenopathy/organomegaly (confirmed by CT scan), or signs or symptoms attributable to WM. * Second immunofixation required for confirmation. VGPR -At least 90% reduction of serum monoclonal IgM concentration on protein electrophoresis. PR * At least 50% reduction of serum monoclonal IgM concentration on protein electrophoresis and at least 50% decrease in adenopathy/organomegaly on physical examination or on CT scan. * No new symptoms or signs of active disease. MR * At least 25% but less than 50% reduction of serum monoclonal IgM by protein electrophoresis. * No new symptoms or signs of active disease.

Time frame: Assessed after 2nd cycle and then every subsequent cycle for 6 cycles. The median number of completed cycles of therapy was 5 (0- 32). As such observed up to ~32 months.

ArmMeasureValue (NUMBER)
LBH589Overall Response Rate47 percentage of participants
Secondary

Acetylated Histone H3 and Overall Response Association

Acetylated-histone-H3 levels were obtained through bone marrow biopsies and measured using established methods. This analysis aimed to analyze the association between overall response and percent change of acetylated histone h3 in samples using a paired t-test.

Time frame: Bone marrow biopsies were obtained at the start of treatment (baseline) and after the 6th cycle.

Population: Only three complete sample (baseline and post-therapy) were ascertained. The difference in percentage of acetylated histone h3 were not large enough to conduct the correlative analysis.

Secondary

Median Duration of Response

Duration of response DR is defined as the time from the date of first response after treatment to the date of disease progression Patients who have died for any cause or are alive without progression are censored at the date the patient is last know to be progression-free. Duration of response DR is defined as the time from the date of first response after treatment to the date of disease progression or death for any cause. Patients who are alive without progression are censored at the date the patient is last know to be progression-free.

Time frame: Assessed after 2nd cycle and then every subsequent cycle for 6 cycles and then every 3 months. If taken off treatment at cycle 2 for disease progression, assessed every 3 months. The median (range) follow up from treatment start is 7.7 month (0.9 - 29.7).

ArmMeasureValue (MEDIAN)
LBH589Median Duration of Response6.9 months
Secondary

Median Progression Free Survival

Progression free survival (PFS) is defined as the time from start of treatment to disease progression or death from any cause as estimated by Kaplan Meier methods. Patients who have not progressed and are alive are censored at the date the patient is known to be progression-free.

Time frame: Assessed after 2nd cycle and then every subsequent cycle for 6 cycles and then every 3 months. If taken off treatment at cycle 2 for disease progression, assessed every 3 months. The median (range) follow up from treatment start is 7.7 month (0.9 - 29.7).

ArmMeasureValue (MEDIAN)
LBH589Median Progression Free Survival6.6 months
Secondary

Median Time to Progression

Time to progression (TTP) is defined as the time from start of treatment to progression. Patients who have not progressed are censored at the date the patient is last known to be progression free.

Time frame: Assessed after 2nd cycle and then every subsequent cycle for 6 cycles and then every 3 months. If taken off treatment at cycle 2 for disease progression, assessed every 3 months. The median (range) follow up from treatment start is 7.7 month (0.9 - 29.7).

ArmMeasureValue (MEDIAN)
LBH589Median Time to Progression6.6 months
Secondary

Number of Participants With Grade 3 and 4 Treatment-Related Thrombocytopenia

Grade 3 thrombocytopenia is defined as having 25,000-50,000 /uL platelets Grade 4 thrombocytopenia is defined as having \< 25,000 /uL platelets

Time frame: Assessed after 2nd cycle, every subsequent cycle for 6 cycles and then every 3 months. Once off-treatment, adverse events will be assessed for 30 days. The median (range) number of completed cycles of therapy was 5 (0- 32). Therefore, up to ~33 months.

ArmMeasureValue (NUMBER)
LBH589Number of Participants With Grade 3 and 4 Treatment-Related Thrombocytopenia24 participants

Source: ClinicalTrials.gov · Data processed: Mar 24, 2026