Diffuse Large B-Cell Lymphoma
Conditions
Brief summary
This is a randomized, open-label, active-control, parallel-group, multicenter, multinational Phase 2 Study of the efficacy and safety of VELCADE, Rituximab, Cyclophosphamide, Doxorubicin, and Prednisone (VR-CAP) or Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP) in Patients With Newly Diagnosed Non-Germinal Center B-Cell (non-GCB) Subtype of Diffuse Large B-Cell Lymphoma (DLBCL)
Interventions
VELCADE intravenous on Days 1, 4, 8, and 11 of a 21 day (3 week) cycle for 6 cycles.
Rituximab intravenous on Day 1 of a 21 day (3 week) cycle for 6 cycles
Intravenous on Day 1 of a 21 day (3 week) cycle for 6 cycles
Intravenous on Day 1 of a 21 day (3 week) cycle for 6 cycles
Orally on Day 1 to Day 5 of a 21 day (3 week) cycle for 6 cycles
Intravenous on Day 1 of a 21 day (3 week) cycle for 6 cycles
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female patients 18 years or older. * Newly Diagnosed non-GCB subtype of DLBCL (Stage II, III or IV). * At least 1 measurable site of disease. * Eastern Cooperative Oncology Group (ECOG) performance status 0-2 * Female subjects must be postmenopausal (for at least 6 months), surgically sterile, abstinent, or, if sexually active, be practicing an effective method of birth control before entry and throughout the study; and have a negative pregnancy test at screening. * Male subjects must agree to use a double barrier method of birth control
Exclusion criteria
* Prior treatment with VELCADE. * Prior extended radiotherapy or chemotherapy for lymphoma * More than 150 mg/m2 of prior doxorubicin * Major surgery within 3 weeks of study. * Peripheral neuropathy or neuralgia of Grade 2 or worse. * Active CNS lymphoma * Diagnosed or treated for a malignancy other than NHL, with some exceptions * Pregnant or breast feeding * Active systemic infection * Documented of suspected human immunodeficiency virus (HIV)/AIDS * Uncontrolled or severe cardiovascular disease * Known allergies, hypersensitivity or intolerance to study drugs * Serious medical condition that could interfere with study * Concurrent treatment with another investigational agent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Complete Response (CR) Rate | 6 cycles | Complete response was evaluated by an Independent Radiology Review Committee using available computed tomography (CT) and positron emission tomography (PET) scans collected at Baseline, end of cycle 3, and end of cycle 6 (or end of treatment) based on the Revised Response Criteria for Malignant Lymphoma. 1. Complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy. 2. PET scan was negative. 3. The spleen and/or liver, if enlarged before therapy on the basis of physical examination or CT scan, was not palpable on physical examination and was considered normal size by imaging studies; all splenic and hepatic nodules related to lymphomas disappeared. 4. If bone marrow was involved before treatment, the infiltrate cleared on repeated bone marrow biopsy. 5. No new sites of disease were detected. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Durable Response | Median follow up approx. 12 months | Proportion of subjects who achieved a CR or PR with duration of at least 6 months. Duration of response (CR or PR) was calculated from the date of initial documentation of a response to the date of first documented evidence of disease progression or death due to disease progression. Response was evaluated by an Independent Radiology Review Committee using available computed tomography (CT) and positron emission tomography (PET) scans collected at Baseline, end of cycle 3, end of cycle 6 (or end of treatment) based on the Revised Response Criteria for Malignant Lymphoma. |
| Rate of Durable Complete Response | Median follow up approx 12 months | Proportion of subjects who achieved a CR with duration of at least 6 months |
| Subsequent Anti-lymphoma Therapy Rate at 1-year | 1 year | Kaplan-meier estimate of subsequent anti-lymphoma therapy at 1-year. Time to subsequent anti-lymphoma therapy was measured from the date of randomization to the start date of new treatment. Death due to disease progression prior to subsequent therapy was considered as an event. Otherwise, time to next anti-lymphoma treatment was censored at the date of death or the last date known to be alive. |
| Overall Response Rate | 6 cycles | Overall response = Complete Response (CR) + Partial Response (PR) Response was evaluated by an Independent Radiology Review Committee using available computed tomography (CT) and positron emission tomography (PET) scans collected at Baseline, end of cycle 3, and end of cycle 6 (or end of treatment) based on the Revised Response Criteria for Malignant Lymphoma. Complete Response: see primary endpoint Partial Response: At least a 50% decrease in the sum of the product of the diameters (SPD) of up to 6 of the largest dominant nodes or nodal masses. |
| Overall Survival Rate at 1-year | 1 year | Kaplan-meier estimate of overall survival at 1-year measured from date of randomization. |
| Change in Fatigue and Patient Utility Scores | 18-24 months | — |
| Progression-free Survival (PFS)Rate at 1-year | 1 year | Kaplan-meier estimate of progression-free survival at 1-year. Progression-free survival was defined as the interval between the date of randomization and the date of first documented evidence of disease progression or death. |
Countries
Belgium
Participant flow
Pre-assignment details
164 participants were randomized, three participants did not receive study treatment (2 in the VR-CAP and 1 in the R-CHOP arm) for a total of 161 treated.
Participants by arm
| Arm | Count |
|---|---|
| VR-CAP VELCADE, Rituximab, Cyclophosphamide, Doxorubicin and Prednisone | 84 |
| R-CHOP Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone | 80 |
| Total | 164 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 6 | 2 |
| Overall Study | Death | 1 | 3 |
| Overall Study | drug supply issue | 1 | 0 |
| Overall Study | Lack of Efficacy | 1 | 1 |
| Overall Study | Randomized and Not Treated | 2 | 1 |
| Overall Study | Withdrawal by Subject | 2 | 0 |
Baseline characteristics
| Characteristic | VR-CAP | R-CHOP | Total |
|---|---|---|---|
| Age, Continuous | 56.5 years STANDARD_DEVIATION 15 | 57.8 years STANDARD_DEVIATION 13.83 | 57.2 years STANDARD_DEVIATION 14.41 |
| Region of Enrollment Argentina | 2 participants | 1 participants | 3 participants |
| Region of Enrollment Belgium | 4 participants | 1 participants | 5 participants |
| Region of Enrollment Brazil | 2 participants | 3 participants | 5 participants |
| Region of Enrollment Canada | 3 participants | 3 participants | 6 participants |
| Region of Enrollment Czech Republic | 3 participants | 4 participants | 7 participants |
| Region of Enrollment France | 2 participants | 4 participants | 6 participants |
| Region of Enrollment Germany | 13 participants | 8 participants | 21 participants |
| Region of Enrollment India | 2 participants | 4 participants | 6 participants |
| Region of Enrollment Ireland | 2 participants | 0 participants | 2 participants |
| Region of Enrollment Italy | 2 participants | 6 participants | 8 participants |
| Region of Enrollment Korea, Republic of | 6 participants | 6 participants | 12 participants |
| Region of Enrollment Malaysia | 5 participants | 3 participants | 8 participants |
| Region of Enrollment Mexico | 0 participants | 1 participants | 1 participants |
| Region of Enrollment Portugal | 5 participants | 7 participants | 12 participants |
| Region of Enrollment Russian Federation | 22 participants | 14 participants | 36 participants |
| Region of Enrollment Singapore | 2 participants | 1 participants | 3 participants |
| Region of Enrollment Spain | 5 participants | 2 participants | 7 participants |
| Region of Enrollment Turkey | 4 participants | 12 participants | 16 participants |
| Sex: Female, Male Female | 43 Participants | 33 Participants | 76 Participants |
| Sex: Female, Male Male | 41 Participants | 47 Participants | 88 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 73 / 82 | 72 / 79 |
| serious Total, serious adverse events | 31 / 82 | 27 / 79 |
Outcome results
Complete Response (CR) Rate
Complete response was evaluated by an Independent Radiology Review Committee using available computed tomography (CT) and positron emission tomography (PET) scans collected at Baseline, end of cycle 3, and end of cycle 6 (or end of treatment) based on the Revised Response Criteria for Malignant Lymphoma. 1. Complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy. 2. PET scan was negative. 3. The spleen and/or liver, if enlarged before therapy on the basis of physical examination or CT scan, was not palpable on physical examination and was considered normal size by imaging studies; all splenic and hepatic nodules related to lymphomas disappeared. 4. If bone marrow was involved before treatment, the infiltrate cleared on repeated bone marrow biopsy. 5. No new sites of disease were detected.
Time frame: 6 cycles
Population: All randomized subjects with non-GCB DLBCL who received at least 1 dose of any study drug, had at least 1 measurable lesion at baseline, and had at least 1 post-baseline response assessment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VR-CAP | Complete Response (CR) Rate | 64.5 percentage of participants |
| R-CHOP | Complete Response (CR) Rate | 63.5 percentage of participants |
Change in Fatigue and Patient Utility Scores
Time frame: 18-24 months
Overall Response Rate
Overall response = Complete Response (CR) + Partial Response (PR) Response was evaluated by an Independent Radiology Review Committee using available computed tomography (CT) and positron emission tomography (PET) scans collected at Baseline, end of cycle 3, and end of cycle 6 (or end of treatment) based on the Revised Response Criteria for Malignant Lymphoma. Complete Response: see primary endpoint Partial Response: At least a 50% decrease in the sum of the product of the diameters (SPD) of up to 6 of the largest dominant nodes or nodal masses.
Time frame: 6 cycles
Population: All randomized subjects with non-GCB DLBCL who received at least 1 dose of any study drug, had at least 1 measurable lesion at baseline, and had at least 1 post-baseline response assessment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VR-CAP | Overall Response Rate | 93.4 percentage of participants |
| R-CHOP | Overall Response Rate | 98.6 percentage of participants |
Overall Survival Rate at 1-year
Kaplan-meier estimate of overall survival at 1-year measured from date of randomization.
Time frame: 1 year
Population: Intent to Treat Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VR-CAP | Overall Survival Rate at 1-year | 94.1 percentage of partipants |
| R-CHOP | Overall Survival Rate at 1-year | 84.2 percentage of partipants |
Progression-free Survival (PFS)Rate at 1-year
Kaplan-meier estimate of progression-free survival at 1-year. Progression-free survival was defined as the interval between the date of randomization and the date of first documented evidence of disease progression or death.
Time frame: 1 year
Population: Intent to Treat Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VR-CAP | Progression-free Survival (PFS)Rate at 1-year | 78.9 percentage of partipants |
| R-CHOP | Progression-free Survival (PFS)Rate at 1-year | 83.9 percentage of partipants |
Rate of Durable Complete Response
Proportion of subjects who achieved a CR with duration of at least 6 months
Time frame: Median follow up approx 12 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VR-CAP | Rate of Durable Complete Response | 44.7 percentage of participants |
| R-CHOP | Rate of Durable Complete Response | 47.3 percentage of participants |
Rate of Durable Response
Proportion of subjects who achieved a CR or PR with duration of at least 6 months. Duration of response (CR or PR) was calculated from the date of initial documentation of a response to the date of first documented evidence of disease progression or death due to disease progression. Response was evaluated by an Independent Radiology Review Committee using available computed tomography (CT) and positron emission tomography (PET) scans collected at Baseline, end of cycle 3, end of cycle 6 (or end of treatment) based on the Revised Response Criteria for Malignant Lymphoma.
Time frame: Median follow up approx. 12 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VR-CAP | Rate of Durable Response | 53.9 percentage of participants |
| R-CHOP | Rate of Durable Response | 67.6 percentage of participants |
Subsequent Anti-lymphoma Therapy Rate at 1-year
Kaplan-meier estimate of subsequent anti-lymphoma therapy at 1-year. Time to subsequent anti-lymphoma therapy was measured from the date of randomization to the start date of new treatment. Death due to disease progression prior to subsequent therapy was considered as an event. Otherwise, time to next anti-lymphoma treatment was censored at the date of death or the last date known to be alive.
Time frame: 1 year
Population: Intent to Treat Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VR-CAP | Subsequent Anti-lymphoma Therapy Rate at 1-year | 71.1 percentage of participants |
| R-CHOP | Subsequent Anti-lymphoma Therapy Rate at 1-year | 80.2 percentage of participants |