Primary Central Nervous System Lymphoma
Conditions
Brief summary
This is a multicenter, single-arm, prospective phase II study to evaluate the efficacy and safety of a novel combination regimen for relapsed/refractory PCNSL. Specifically, ibrutinib will be administered in combination with ifosfamide, etoposide and rituximab (IBER) as a salvage chemotherapy, which is followed by maintenance ibrutinib monotherapy of fixed duration.
Detailed description
Given the limited activity of salvage therapy with high-dose methotrexate re-treatment and/or alkylator-based treatment in patients with relapse or refractory PCNSL, the development of novel salvage chemotherapy regimen remains an area of clinical unmet need. Ibrutinib, an oral inhibitor of bruton tyrosine kinase (BTK), is known to induce death of diffuse large B-cell lymphoma (DLBCL) cells with dysregulated B-cell receptor (BCR) signaling and has shown promising activity in patients with a variety of B-cell malignancies. Recently, several studies reported that ibrutinib may have an excellent single-agent clinical activity against relapsed or refractory PCNSL. Furthermore, proven pharmacokinetic data suggested that ibrutinib successfully penetrated the BBB and reached the achievable concentration in cerebrospinal fluid. When ibrutinib is administered in combination with BBB-destructing chemotherapeutic agents (such as, temozolomide or etoposide) for salvage treatment of PCNSL, therefore, anti-lymphoma activity of ibrutinib could be maximized. In this context, this phase II study is designed to evaluate the efficacy and safety of IBER salvage chemotherapy followed by ibrutinib maintenance for transplant ineligible patients with relapsed or refractory PCNSL.
Interventions
DRUGIBER salvage chemotherapy followed by ibrutinib maintenance therapy
Induction therapy with IBER (up to 6 cycles) \[ Ibrutinib 560 mg/d on D1-21 + Rituximab 375 mg/m2 on D1 (on D1/8/15 in C1) + Ifosfamide 3.75 g/m2 on D2 + Etoposide 100 mg/m2 on D2-4 \], followed by ibrutinib 560 mg/d maintenance therapy for up to 6 months
Sponsors
Deok-Hwan Yang
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed PCNSL of CD20+ diffuse large B cell lymphoma (DLBCL) * PCNSL relapsed or refractory after frontline methotrexate-based chemotherapy (with or without radiation therapy) * At least one measurable lesion, which is defined as longest diameter of lesion \> 0.5 cm, by contrast-enhanced MRI * ECOG performance status 0-2 * Normal function of major organs
Exclusion criteria
* PCNSL other than DLBCL * Primary ocular lymphoma * PCNSL accompanied by systemic involvement * Active infection with hepatitis B or C virus * Known history of human immunodeficiency virus (HIV) infection * Therapy with myelosuppressive chemotherapy or biologic therapy \< 21 days prior to registration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall response rate | From date of starting the study treatment until the date of finishing the study treatment for any reason, assessed up to 10 months | The percentage of patients with a complete response (CR) or a partial response (PR) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Safety and tolerability of the study treatment | From the first day of the first cycle of IBER induction chemotherapy to 30 days after the last dose of study drug, assessed up to 12 months | Treatment-emergent adverse events graded according to the NCI-CTCAC version 4.0 |
Countries
South Korea
Contacts
Primary ContactDeok-Hwan Yang, M.D., Ph.D.
Backup ContactYoon Seok Choi, M.D., Ph.D.
Outcome results
None listed