Adult T-cell Leukemia/Lymphoma, Angioimmunoblastic T-cell Lymphoma, Enteropathy Associated T-cell Lymphoma, Hepato-splenic T-cell Lymphoma, NK T-cell Lymphoma, T-cell Lymphoma
Conditions
Keywords
Lymphoma, Leukemia, Brentuximab Vedotin
Brief summary
This study will include patients with mature T-cell lymphoma (MTCL) that has been treated with at least one type of chemotherapy, but is not responding or coming back after the previous treatment. This clinical trial uses a drug called Brentuximab Vedotin. The Food and Drug Administration (FDA) has approved Brentuximab Vedotin for sale in the United States for certain diseases. Brentuximab is still being studied in clinical trials like this one to learn more about what its side effects are and whether or not it is effective in the disease or condition being studied. Brentuximab Vedotin is a type of drug called an antibody drug conjugate (ADC). ADCs usually have 2 parts; a part that targets cancer cells (the antibody) and a cell killing part (the chemotherapy). Antibodies are proteins that are part of your immune system. They can stick to and attack specific targets on cells. The antibody part of Brentuximab Vedotin sticks to a target called CD30. CD30 is an important molecule on some cancer cells (including non Hodgkin lymphoma) and some normal cells of the immune system. The cell killing part of Brentuximab Vedotin is a chemotherapy called monomethyl auristatin E (MMAE). It can kill cells that the antibody part of Brentuximab Vedotin sticks to. Brentuximab Vedotin has also been shown to kill cancer cells with levels of CD30 that cannot be seen by traditional methods. This study is being done to test if the study drug has an effect on Mature T cell Lymphoma with such low levels of a target called CD30 and how your disease respond to the study drug.
Detailed description
Primary Objective • To determine overall response rate (CR+PR) of brentuximab vedotin in CD30 low (\<10%) relapsed or refractory T cell lymphoma (TCL) Secondary Objective(s) * Complete remission (CR) rate * Duration of response (DOR) * Progression free survival (PFS) * Overall survival (OS) * Time to treatment failure (TTF)
Interventions
study drug given intravenously to determine efficacy in study diseases
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients must have histologically or cytologically confirmed relapsed/refractory CD30 low (\<10%) TCL: including peripheral TCL not otherwise specified (PTCL NOS), angioimmunoblastic T cell lymphoma (AITL), hepato-splenic T cell lymphoma (HTCL), adult T cell leukemia/lymphoma (ATLL), enteropathy associated T cell lymphoma (EATL), adult T cell leukemia/lymphoma (ATLL), enteropathy associated T cell lymphoma (EATL), NK T cell lymphoma (NK/TCL) * At least 1 prior chemotherapy regimen * Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. ECOG Performance Status (PS) 3 will be permitted if the decreased PS is attributed to the lymphoma * Adequate organ function * Bilirubin ≤1.5X upper limit of normal (ULN), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3X ULN even in patients with documented hepatic involvement with lymphoma * Serum creatinine clearance ≥30 ml/min * Absolute neutrophil count (ANC) ≥1000/μL (unless documented bone marrow involvement with lymphoma) * Platelet count ≥50,000/μL (unless documented bone marrow involvement with lymphoma) * At least 6 weeks from autologous stem cell transplantation * At least 3 months from allogeneic stem cell transplantation and off immunosuppression and no evidence of graft versus host disease (GVHD) * Previous treatment with brentuximab vedotin will be allowed if it was done 6 months prior to enrollment and patient was not refractory * Measurable disease ≥1.5 cm seen on computed tomography (CT) scan and Fluorodeoxyglucose (FDG) avid disease on positron emission Tomography (PET) scan. Splenomegaly measuring \>12 cm, if attributed to TCL and/or positive bone marrow involvement with lymphoma are also eligible. * Females of childbearing potential must have a negative serum or urine pregnancy test result within 7 days prior to the first dose of study treatment. Women of child-bearing age must agree to use an effective contraception method during the study and for at least 6 months following the last dose of study drug. * Males who have partners of childbearing potential must agree to use an effective contraceptive method during the study and for 6 months following the last dose of study drug. * Subjects must have the ability to understand and the willingness to sign a written informed consent document
Exclusion criteria
* Anaplastic large cell lymphoma (ALCL) both alk positive and negative * Cutaneous T cell lymphomas except transformed Mycosis fungoides (MF) * Prior treatment with Brentuximab in the last 6 months or previously refractory to Brentuximab Vedotin (BV) or had progressive disease (PD) while on BV * Pregnancy or breast feeding women * Prior malignancy within the past 3 years except non melanoma skin cancer or other localized cancer treated with curative intent * Presence of grade \>2 peripheral neuropathy or patients with the demyelinating form of Charcot-Marie-Tooth syndrome. * Presence of central nervous system (CNS) involvement requiring active treatment * History of progressive multifocal leukoencephalopathy (PML) * Myocardial infarction within the past 6 months * Patients with the following medical conditions that could affect their participation in the study: * any active acute or chronic or uncontrolled infection * liver disease including history of viral hepatitis B or C, evidence of cirrhosis, chronic active or persistent hepatitis * a known history of HIV * symptomatic cardiac disease, including congestive heart failure, coronary artery disease, and arrhythmias * Prior hypersensitivity to any component in the ADC formulation * Treatment with chemotherapy or investigational agents within 2 weeks of start of study treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate | Three years after end of treatment, up to 49 months | The primary objective is to evaluate overall response rate (ORR). Overall response rate will be estimated by the total number of patients who achieve a CR and PR divided by the total number of patients who received treatment. Response was assessed using CT scans according to the revised Cheson criteria. * CR is defined as complete resolution of all clinically detectable disease and disease related symptoms that were present prior to therapy * PR is defined as at least 50% decrease in sum of the product of the diameters (SPD) of up to six of the largest dominant nodes or nodal masses Patients should have completed at least 1 cycle of treatment to be evaluable for ORR. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival | Three years after end of treatment, up to 49 months | Progression-free survival (PFS) is defined as the time from treatment initiation into the study to disease progression or death due to any cause. The distribution of PFS will be estimated using the Kaplan-Meier method. Disease progression may be defined as the date of documentation of a new lesion or enlargement of a previous lesion, or the date of the scheduled clinic visit immediately after radiologic assessment has been completed. For a patient who is alive without progression at the end of study follow-up, observation of PFS is censored on the date of last contact. |
| Overall Survival | Three years after end of treatment, up to 49 months | The overall survival (OS) is defined as the time from treatment initiation to the time of death due to any cause. For a patient who is alive at the end of study follow-up, observation of OS is censored on the date of last contact. The distribution of OS will be estimated using the Kaplan-Meier method. |
| Complete Response | Three years after end of treatment, up to 49 months | Complete Response is defined as complete resolution of all clinically detectable disease and disease related symptoms that were present prior to therapy. A post-treatment residual mass of any size is permitted as long as it is PET negative. CR rate was calculated by dividing the total number of patients who have achieved a complete response by the total number of patients who received treatment. |
| Time to Treatment Failure (TTF) | Up to 13 months after start of treatment | Time to treatment failure (TTF) is defined as the time from treatment initiation to discontinuation of treatment for any reason, including disease progression, treatment toxicity, and death. Date of last follow-up was collected for patients who did not have disease progression, but it is unknown for which reasons treatment was stopped for these patients. In this case, time to treatment failure (TTF) is the same as time to progression. |
| Time to Response (TTR) | Three years after end of treatment, up to 49 months | Time to treatment failure (TTR) is defined as time from treatment initiation to first documentation of objective tumor response (CR or PR). |
| Duration of Response | Three years after end of treatment, up to 49 months | Duration of response (DOR) among responders is defined as the time from first documentation of objective tumor response (CR or PR) to the time of first progression or death due to any cause. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Brentuximab Vedotin Brentuximab vedotin 1.8 mg/kg intravenously (IV) once every 3 weeks
Brentuximab vedotin: study drug given intravenously to determine efficacy in study diseases | 23 |
| Total | 23 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Death | 1 |
| Overall Study | Disease progression | 2 |
| Overall Study | Lack of Efficacy | 13 |
| Overall Study | Lost to Follow-up | 1 |
| Overall Study | Physician Decision | 1 |
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | Brentuximab Vedotin |
|---|---|
| Age, Customized 20-29 | 3 years |
| Age, Customized 40-49 | 2 years |
| Age, Customized 50-59 | 3 years |
| Age, Customized 60-69 | 9 years |
| Age, Customized 70-79 | 4 years |
| Age, Customized Unknown | 2 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 23 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 6 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 | 0 Participants |
| Race (NIH/OMB) White | 16 Participants |
| Sex: Female, Male Female | 8 Participants |
| Sex: Female, Male Male | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 17 / 23 |
| other Total, other adverse events | 23 / 23 |
| serious Total, serious adverse events | 10 / 23 |
Outcome results
Overall Response Rate
The primary objective is to evaluate overall response rate (ORR). Overall response rate will be estimated by the total number of patients who achieve a CR and PR divided by the total number of patients who received treatment. Response was assessed using CT scans according to the revised Cheson criteria. * CR is defined as complete resolution of all clinically detectable disease and disease related symptoms that were present prior to therapy * PR is defined as at least 50% decrease in sum of the product of the diameters (SPD) of up to six of the largest dominant nodes or nodal masses Patients should have completed at least 1 cycle of treatment to be evaluable for ORR.
Time frame: Three years after end of treatment, up to 49 months
Population: 1 participant did not complete one cycle; 3 additional participants did not have response data
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Brentuximab Vedotin | Overall Response Rate | 89.5 percentage of participants |
Complete Response
Complete Response is defined as complete resolution of all clinically detectable disease and disease related symptoms that were present prior to therapy. A post-treatment residual mass of any size is permitted as long as it is PET negative. CR rate was calculated by dividing the total number of patients who have achieved a complete response by the total number of patients who received treatment.
Time frame: Three years after end of treatment, up to 49 months
Population: 1 participant did not complete one cycle; 3 additional participants did not have response data
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Brentuximab Vedotin | Complete Response | 10.5 percentage of participants |
Duration of Response
Duration of response (DOR) among responders is defined as the time from first documentation of objective tumor response (CR or PR) to the time of first progression or death due to any cause.
Time frame: Three years after end of treatment, up to 49 months
Population: 6 participants did not have ORR
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Brentuximab Vedotin | Duration of Response | 5.4 Month |
Overall Survival
The overall survival (OS) is defined as the time from treatment initiation to the time of death due to any cause. For a patient who is alive at the end of study follow-up, observation of OS is censored on the date of last contact. The distribution of OS will be estimated using the Kaplan-Meier method.
Time frame: Three years after end of treatment, up to 49 months
Population: 1 participant did not have at least one dose
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Brentuximab Vedotin | Overall Survival | 10.8 Month |
Progression Free Survival
Progression-free survival (PFS) is defined as the time from treatment initiation into the study to disease progression or death due to any cause. The distribution of PFS will be estimated using the Kaplan-Meier method. Disease progression may be defined as the date of documentation of a new lesion or enlargement of a previous lesion, or the date of the scheduled clinic visit immediately after radiologic assessment has been completed. For a patient who is alive without progression at the end of study follow-up, observation of PFS is censored on the date of last contact.
Time frame: Three years after end of treatment, up to 49 months
Population: 1 participant did not have at least one dose
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Brentuximab Vedotin | Progression Free Survival | 8.0 Month |
Time to Response (TTR)
Time to treatment failure (TTR) is defined as time from treatment initiation to first documentation of objective tumor response (CR or PR).
Time frame: Three years after end of treatment, up to 49 months
Population: 6 participants did not have ORR
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Brentuximab Vedotin | Time to Response (TTR) | 2.7 Month |
Time to Treatment Failure (TTF)
Time to treatment failure (TTF) is defined as the time from treatment initiation to discontinuation of treatment for any reason, including disease progression, treatment toxicity, and death. Date of last follow-up was collected for patients who did not have disease progression, but it is unknown for which reasons treatment was stopped for these patients. In this case, time to treatment failure (TTF) is the same as time to progression.
Time frame: Up to 13 months after start of treatment
Population: 6 participants did not have progression at last follow-up
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Brentuximab Vedotin | Time to Treatment Failure (TTF) | 7.4 Month |