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Study of SyB L-0501 in Combination With Rituximab to Treat Relapsed/Refractory Diffuse Large B-Cell Lymphoma

A Multinational, Multicenter, Open-Label Phase II Study of SyB L-0501 in Combination With Rituximab in Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01118845
Enrollment
63
Registered
2010-05-07
Start date
2010-04-30
Completion date
2011-10-31
Last updated
2013-07-04

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

Conditions

Diffuse, Mantle Cell Lymphoma, Lymphoma, Follicular Lymphoma, Large B-Cell, Diffuse, Lymphoma, Large Cell, Non-Hodgkin's Lymphoma

Keywords

Non-Hodgkin's lymphoma, Lymphoma, Large B-Cell, Diffuse, Mantle cell lymphoma, Lymphoma, Follicular, Lymphoma, Large B-Cell, Diffuse

Brief summary

The purpose of this study is to determine the efficacy of SyB L-0501 in combination with rituximab in patients with relapsed/refractory diffuse large B-cell lymphoma.

Detailed description

Primary Objective is to determine the efficacy, as measured by overall response rate on the basis of Revised Response Criteria for Malignant Lymphoma, of SyB L-0501 at 120 mg/m\^2/day on day2 and 3 in combination with rituximab at 375 mg/m\^2 on day 1 of each 21-day cycle in patients with relapsed/refractory diffuse large B-cell lymphoma.

Interventions

The administration of SyB L-0501 at 120 mg/m\^2/day by intravenous infusion on day 2 and 3 of each 21-day cycle with up to 6 cycles. Dose modifications are permitted from 2nd cycle according to dose reduction schedule. SyB L-0501 60 mg/m\^2, 90 mg/m\^2 or 120 mg/m\^2/day on Day 2 and Day 3 will be followed by 18 days of observation.

DRUGRituximab

The administration of rituximab at 375 mg/m\^2/day by intravenous infusion on day 1 of each 21-day cycle with up to 6 cycles. Dose modifications are not permitted.

Sponsors

SymBio Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
20 Years to 75 Years
Healthy volunteers
No

Inclusion criteria

* Patients with documented Cluster of differentiation 20 (CD20)-positive for lymphoma cells * Patients with measurable lesions * Patients with measurable lesions \>1.5 cm in major axes * Relapsed or refractory after 1 to 3 prior therapeutic treatments for diffuse large B-cell lymphoma. * Patients who are expected to survive for at least 3 months * Patients aged from 20 to 75 years at the time informed consent is obtained * Performance Status (P.S.) of 0 to 1 at initial administration of the study drug * Patients with adequately maintained organ functions * Patients capable of personally giving voluntary informed consent in writing to participate in the study

Exclusion criteria

* Patients who have been without treatment for less than 3 weeks after prior treatment * Patients who can be candidates for autologous peripheral blood stem cell transplantation at the discretion of the investigator. * Patients who received adequate prior treatments and did not respond to any of them. * Patients with central nervous system (CNS) involvement or patients with clinical symptoms suggestive of CNS involvement. * Patients with serious, active infections * Patients with serious complications * Patients with complications or medical history of serious cardiac disease * Patients with serious gastrointestinal symptoms * Patients with malignant pleural effusion, cardiac effusion, or ascites retention * Patients positive for hepatitis B surface (HBs) antigen, hepatitis C virus (HCV) antibody, or HIV antibody * Patients with serious bleeding tendencies * Patients with a fever of 38.0°C or higher * Patients with, or confirmed in the past to have had, interstitial pneumonia, pulmonary fibrosis, or pulmonary emphysema * Patients with active multiple primary cancer or patients with a history of other malignant cancer within the past 5 years, except for basal cell cancer of the skin, squamous cell cancer, or cervical cancer in situ * Patients with, or confirmed in the past to have had, autoimmune hemolytic anemia * Patients who received SyB L-0501 in the past * Patients who received cytokine preparation such as erythropoietin or granulocyte colony-stimulating factor (G-CSF) or blood transfusions within 2 weeks before the examination at registration for this study * Patients who received other investigational products or unapproved medication within 3 months before registration in this study

Design outcomes

Primary

MeasureTime frameDescription
The Overall Response Rate [Complete Response (CR) + Partial Response (PR)] Determined on the Basis of Revised Response Criteria for Malignant Lymphomaup to 30 weeksCR: Disappearance of all evidence of disease. PR: Regression of measurable disease and no new sites. For the criteria for CR, See Outcome measure 2 description. The criteria for PR is as below. Nodal Masses: more than 50% decrease in sum of the product of the perpendicular diameters (SPD) of up to 6 largest dominant masses; no increase in size of other nodes 1. FDG-avid or PET positive prior to therapy; one or more PET positive at previously involved site 2. Variably FDG-avid or PET negative; regression on CT Spleen, Liver: more than 50% decrease in SPD of nodules (for single nodule in greatest transverse diameter); no increase in size of liver or spleen Bone Marrow: Irrelevant if positive prior to therapy; cell type should be specified

Secondary

MeasureTime frameDescription
The Complete Response (CR) Rate Determined on the Basis of Revised Response Criteria for Malignant Lymphomaup to 30 weeksThe criteria for CR is as below Nodal Masses: 1. fluorodeoxy glucose (FDG)-avid or positron emission tomography (PET) positive prior to therapy; mass of any size permitted if PET negative 2. Variably FDG-avid or PET negative; regression to normal size on computed tomography (CT) Spleen, Liver: Not palpable, nodules disappeared Bone Marrow: Infiltrate cleared on repeat biopsy; if indeterminate by morphology, immunohistochemistry should be negative
Progression Free Survival (PFS)up to 30 weeksPFS = day of the first PFS event - day of start of study treatment + 1 The definitions of PFS event are as below. 1. PD according to overall response on the basis of Revised Response Criteria for Malignant Lymphoma PD: Any new lesion or increase by ≥50% of previously involved sites from nadir. Nodal masses; Appearance of a new lesion(s) \>1.5 cm in any axis, ≥50% increase in SPD of more than one node, or ≥50% increase in longest diameter of a previously identified node \>1 cm in short axis. Lesions PET positive if FDG-avid lymphoma or PET positive prior to therapy. Spleen, Liver; ≥50% increase from nadir in the SPD of any previous lesions. Bone marrow; New or recurrent involvement 2. Disease progression during treatment period 3. Disease progression during follow up period 4. Start of treatment of new lesion 5. Occurrence of other multiple malignant tumors 6. Death
The Area Under the Curve (AUC) for Unchanged SyB L-0501 in KoreaPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
Number of Subjects With Adverse Eventup to 30 weeks
Number of Adverse Eventsup to 30 weeks
Number of Subjects With Abnormality (Grade ≥3) in Laboratory Test Valuesup to 30 weeksAbnormalities in laboratory test values in overall study period were analyzed. Severity of abnormalities were evaluated using Common Terminology Criteria for Adverse Events (CTCAE). grade 1 : mild grade 2 : moderate grade 3 : severe grade 4 : life threatening or disabling grade 5 : death related to adverse event
Number of Subjects With Grade ≥3 Physical Examination Findingup to 30 weeks
The Half-life Period (t1/2) of Unchanged SyB L-0501 in KoreaPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
The Maximum Concentration (Cmax) of Unchanged SyB L-0501 in JapanPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
The Maximum Drug Concentration Time (Tmax) of Unchanged SyB L-0501 in JapanPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
The Area Under the Curve (AUC) for Unchanged SyB L-0501 in JapanPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
The Half-life Period (t1/2) of Unchanged SyB L-0501 in JapanPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
The Maximum Concentration (Cmax) of Unchanged SyB L-0501 in KoreaPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
The Maximum Drug Concentration Time (Tmax) of Unchanged SyB L-0501 in KoreaPrior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle
Concomitant Medication Usageup to 30 weeks

Countries

Japan, South Korea

Participant flow

Pre-assignment details

Among the 63 subjects enrolled in the study, 59 subjects received study drug and four subjects were excluded before the first study drug administration. The reasons for exclusion were adverse events and major protocol deviation/violation for two subjects each.

Participants by arm

ArmCount
SyB L-0501
SyB L-0501 was administered in combination with rituximab. SyB L-0501 was administered at 120 mg/m\^2/day by intravenous infusion on day 2 and 3 of each 21-day cycle with up to 6 cycles. Dose modifications are permitted from 2nd cycle according to dose reduction schedule. Rituximab was administered at 375 mg/m\^2/day by intravenous infusion on day 1 of each 21-day cycle with up to 6 cycles. Dose modifications are not permitted.
59
Total59

Baseline characteristics

CharacteristicSyB L-0501
Age Continuous64.2 Year
STANDARD_DEVIATION 9.2
Age, Customized
20-29 years
0.0 Percentage of participants
Age, Customized
30-39 years
1.7 Percentage of participants
Age, Customized
40-49 years
8.5 Percentage of participants
Age, Customized
50-59 years
16.9 Percentage of participants
Age, Customized
60-69 years
39.0 Percentage of participants
Age, Customized
<65 years
37.3 Percentage of participants
Age, Customized
≥65 years
62.7 Percentage of participants
Age, Customized
70-75 years
33.9 Percentage of participants
Body Surface Area(BSA)1.537 m^2
STANDARD_DEVIATION 0.184
Bone marrow involvement
Indeterminate
0.0 Percentage of Participants
Bone marrow involvement
Negative
94.9 Percentage of Participants
Bone marrow involvement
Positive
3.4 Percentage of Participants
Bone marrow involvement
Unknown
1.7 Percentage of Participants
Clinical Stage (Ann Arbor staging)
Stage I
5.1 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage I-E
3.4 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage II
27.1 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage II-E
3.4 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage III
25.4 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage III-E
3.4 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage III-S
6.8 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage III-SE
0.0 Percentage of participants
Clinical Stage (Ann Arbor staging)
Stage IV
25.4 Percentage of participants
Clinical Stage (Ann Arbor staging)
Unknown
0.0 Percentage of participants
Complications of DLBCL
No
6.8 Percentage of participants
Complications of DLBCL
Yes
93.2 Percentage of participants
Diagnosis of Relapsed/Refractory Diffuse Large B-Cell Lymphoma100.0 percentage of participants
Height158.25 cm
STANDARD_DEVIATION 8.59
International Prognostic Index risk category
High-Intermediate (score=3)
23.6 Percentage of Participants
International Prognostic Index risk category
High-Intermediate (score≥3)
30.5 Percentage of Participants
International Prognostic Index risk category
High(score=4-5)
6.8 Percentage of Participants
International Prognostic Index risk category
Low-Intermediate (score=2)
35.6 Percentage of Participants
International Prognostic Index risk category
Low-Intermediate (score<3)
69.5 Percentage of Participants
International Prognostic Index risk category
Low (score=0-1)
33.9 Percentage of Participants
International Prognostic Index risk category
Unknown
0.0 Percentage of Participants
lactate dehydrogenase (LDH)
Elevated
55.9 Percentage of Participants
lactate dehydrogenase (LDH)
Within normal range
44.1 Percentage of Participants
LDH
<240 IU/L
39.0 Percentage of Participants
LDH
≥240 IU/L
61.0 Percentage of Participants
Medical history of diffuse large B-cell lymphoma (DLBCL)
No
40.7 Percentage of participants
Medical history of diffuse large B-cell lymphoma (DLBCL)
Yes
59.3 Percentage of participants
Number of regimens
1
64.4 Percentage of participants
Number of regimens
2
22.0 Percentage of participants
Number of regimens
3
13.6 Percentage of participants
Prior medication/therapy for DLBCL
No
8.5 Percentage of participants
Prior medication/therapy for DLBCL
Yes
91.5 Percentage of participants
Prior medication/therapy for DLBCL (Transplant)
No
86.4 Percentage of participants
Prior medication/therapy for DLBCL (Transplant)
Yes
13.6 Percentage of participants
Prior treatment for DLBCL
No
0.0 Percentage of participants
Prior treatment for DLBCL
Yes
100.0 Percentage of participants
P.S.(performance status)[the Eastern Cooperative Oncology Group (ECOG) criteria]
0
66.1 Percentage of Participants
P.S.(performance status)[the Eastern Cooperative Oncology Group (ECOG) criteria]
1
33.9 Percentage of Participants
Response to prior treatment
Non-Responder
0.0 Percentage of Participants
Response to prior treatment
Responder
100.0 Percentage of Participants
Response to prior treatment
Unknown
0.0 Percentage of Participants
Sex/Gender, Customized
Female
57.6 percentage of participants
Sex/Gender, Customized
Male
42.4 percentage of participants
Site of disease
<2 extranodular sites
93.2 Percentage of Participants
Site of disease
≥4 extranodular sites
6.8 Percentage of Participants
Site of disease
<4 nodular sites
47.5 Percentage of Participants
Site of disease
≥4 nodular sites
52.5 Percentage of Participants
Systemic symptoms (B symptoms) (Ann Arbor staging)
Asymptomatic
86.4 Percentage of participants
Systemic symptoms (B symptoms) (Ann Arbor staging)
Symptomatic
13.6 Percentage of participants
Systemic symptoms (B symptoms) (Ann Arbor staging)
Unknown
0.0 Percentage of participants
Time from prior treatment
<12 months
15.3 Percentage of Participants
Time from prior treatment
≥12 months
49.2 Percentage of Participants
Time from prior treatment
Unknown
0.0 Percentage of Participants
Tumor diameter
<5 cm
71.2 Percentage of Participants
Tumor diameter
≥5 cm
28.8 Percentage of Participants
Tumor diameter
<7 cm
86.4 Percentage of Participants
Tumor diameter
≥7 cm
13.6 Percentage of Participants
Weight57.64 kg
STANDARD_DEVIATION 12.85

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
59 / 59
serious
Total, serious adverse events
14 / 59

Outcome results

Primary

The Overall Response Rate [Complete Response (CR) + Partial Response (PR)] Determined on the Basis of Revised Response Criteria for Malignant Lymphoma

CR: Disappearance of all evidence of disease. PR: Regression of measurable disease and no new sites. For the criteria for CR, See Outcome measure 2 description. The criteria for PR is as below. Nodal Masses: more than 50% decrease in sum of the product of the perpendicular diameters (SPD) of up to 6 largest dominant masses; no increase in size of other nodes 1. FDG-avid or PET positive prior to therapy; one or more PET positive at previously involved site 2. Variably FDG-avid or PET negative; regression on CT Spleen, Liver: more than 50% decrease in SPD of nodules (for single nodule in greatest transverse diameter); no increase in size of liver or spleen Bone Marrow: Irrelevant if positive prior to therapy; cell type should be specified

Time frame: up to 30 weeks

ArmMeasureValue (NUMBER)
SyB L-0501The Overall Response Rate [Complete Response (CR) + Partial Response (PR)] Determined on the Basis of Revised Response Criteria for Malignant Lymphoma62.7 Percentage of Participants
Secondary

Concomitant Medication Usage

Time frame: up to 30 weeks

ArmMeasureGroupValue (NUMBER)
SyB L-0501Concomitant Medication Usageconcomitant medications for adverse events58 Participants
SyB L-0501Concomitant Medication Usageconcomitant medications for complications50 Participants
SyB L-0501Concomitant Medication Usageconcomitant medications for supportive therapy59 Participants
SyB L-0501Concomitant Medication Usageconcomitant medications for other reasons59 Participants
Secondary

Number of Adverse Events

Time frame: up to 30 weeks

ArmMeasureGroupValue (NUMBER)
SyB L-0501Number of Adverse EventsAdverse events1848 Events
SyB L-0501Number of Adverse EventsSerious adverse events23 Events
Secondary

Number of Subjects With Abnormality (Grade ≥3) in Laboratory Test Values

Abnormalities in laboratory test values in overall study period were analyzed. Severity of abnormalities were evaluated using Common Terminology Criteria for Adverse Events (CTCAE). grade 1 : mild grade 2 : moderate grade 3 : severe grade 4 : life threatening or disabling grade 5 : death related to adverse event

Time frame: up to 30 weeks

ArmMeasureGroupValue (NUMBER)
SyB L-0501Number of Subjects With Abnormality (Grade ≥3) in Laboratory Test ValuesSubjects with grade 3 abnormality2 Participants
SyB L-0501Number of Subjects With Abnormality (Grade ≥3) in Laboratory Test ValuesSubjects with grade 4 abnormality54 Participants
Secondary

Number of Subjects With Adverse Event

Time frame: up to 30 weeks

ArmMeasureGroupValue (NUMBER)
SyB L-0501Number of Subjects With Adverse EventSubjects with adverse event59 Participants
SyB L-0501Number of Subjects With Adverse EventSubjects with serious adverse event14 Participants
Secondary

Number of Subjects With Grade ≥3 Physical Examination Finding

Time frame: up to 30 weeks

ArmMeasureGroupValue (NUMBER)
SyB L-0501Number of Subjects With Grade ≥3 Physical Examination FindingSubjects with grade 3 Physical Findings1 Participants
SyB L-0501Number of Subjects With Grade ≥3 Physical Examination FindingSubjects with grade 4 Physical Findings22 Participants
Secondary

Progression Free Survival (PFS)

PFS = day of the first PFS event - day of start of study treatment + 1 The definitions of PFS event are as below. 1. PD according to overall response on the basis of Revised Response Criteria for Malignant Lymphoma PD: Any new lesion or increase by ≥50% of previously involved sites from nadir. Nodal masses; Appearance of a new lesion(s) \>1.5 cm in any axis, ≥50% increase in SPD of more than one node, or ≥50% increase in longest diameter of a previously identified node \>1 cm in short axis. Lesions PET positive if FDG-avid lymphoma or PET positive prior to therapy. Spleen, Liver; ≥50% increase from nadir in the SPD of any previous lesions. Bone marrow; New or recurrent involvement 2. Disease progression during treatment period 3. Disease progression during follow up period 4. Start of treatment of new lesion 5. Occurrence of other multiple malignant tumors 6. Death

Time frame: up to 30 weeks

ArmMeasureValue (MEDIAN)
SyB L-0501Progression Free Survival (PFS)200.0 Days
Secondary

The Area Under the Curve (AUC) for Unchanged SyB L-0501 in Japan

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEAN)Dispersion
SyB L-0501The Area Under the Curve (AUC) for Unchanged SyB L-0501 in Japan10394.39 ng・h/mLStandard Deviation 5368.77
Secondary

The Area Under the Curve (AUC) for Unchanged SyB L-0501 in Korea

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEAN)Dispersion
SyB L-0501The Area Under the Curve (AUC) for Unchanged SyB L-0501 in Korea9218.56 ng・h/mLStandard Deviation 6696.81
Secondary

The Complete Response (CR) Rate Determined on the Basis of Revised Response Criteria for Malignant Lymphoma

The criteria for CR is as below Nodal Masses: 1. fluorodeoxy glucose (FDG)-avid or positron emission tomography (PET) positive prior to therapy; mass of any size permitted if PET negative 2. Variably FDG-avid or PET negative; regression to normal size on computed tomography (CT) Spleen, Liver: Not palpable, nodules disappeared Bone Marrow: Infiltrate cleared on repeat biopsy; if indeterminate by morphology, immunohistochemistry should be negative

Time frame: up to 30 weeks

ArmMeasureValue (NUMBER)
SyB L-0501The Complete Response (CR) Rate Determined on the Basis of Revised Response Criteria for Malignant Lymphoma37.3 Percentage of participants
Secondary

The Half-life Period (t1/2) of Unchanged SyB L-0501 in Japan

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEDIAN)Dispersion
SyB L-0501The Half-life Period (t1/2) of Unchanged SyB L-0501 in Japan0.39 hourStandard Deviation 0.1
Secondary

The Half-life Period (t1/2) of Unchanged SyB L-0501 in Korea

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEDIAN)Dispersion
SyB L-0501The Half-life Period (t1/2) of Unchanged SyB L-0501 in Korea0.48 hourStandard Deviation 0.18
Secondary

The Maximum Concentration (Cmax) of Unchanged SyB L-0501 in Japan

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEAN)Dispersion
SyB L-0501The Maximum Concentration (Cmax) of Unchanged SyB L-0501 in Japan8365.82 ng/mLStandard Deviation 3522.73
Secondary

The Maximum Concentration (Cmax) of Unchanged SyB L-0501 in Korea

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEAN)Dispersion
SyB L-0501The Maximum Concentration (Cmax) of Unchanged SyB L-0501 in Korea8095.99 ng/mLStandard Deviation 4339.74
Secondary

The Maximum Drug Concentration Time (Tmax) of Unchanged SyB L-0501 in Japan

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEDIAN)Dispersion
SyB L-0501The Maximum Drug Concentration Time (Tmax) of Unchanged SyB L-0501 in Japan1.0 hourStandard Deviation 0
Secondary

The Maximum Drug Concentration Time (Tmax) of Unchanged SyB L-0501 in Korea

Time frame: Prior to and 30 min after start of administration, and 0, 30, 60, 120 min after completion of administration on Day 2 of the 1st cycle

ArmMeasureValue (MEDIAN)Dispersion
SyB L-0501The Maximum Drug Concentration Time (Tmax) of Unchanged SyB L-0501 in Korea0.9 hourStandard Deviation 0.3

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026