A Single Agent Phase II Study of Romidepsin (Depsipeptide, FK228) in the Treatment of Cutaneous T-cell Lymphoma (CTCL)

Cutaneous T-cell Lymphoma Clinical Trial

Official title:

A Single Agent Phase II Study of Depsipeptide (FK228) in the Treatment of Cutaneous T-cell Lymphoma

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00106431
• Other study ID #: GPI-04-0001
• Status: Completed
• Phase: Phase 2
• Start date: January 1, 2005
• Est. completion date: December 1, 2008

Study information

• Verified date: October 2019
• Source: Celgene
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

GPI-04-0001 was a Phase II, non-randomized, open label, single arm study that was conducted at approximately 30 sites, primarily in the United States, Europe and Russia. It assessed the efficacy, safety, and tolerability of romidepsin as a treatment for cutaneous T-cell lymphoma (CTCL). Study patients (pts) received romidepsin in a dose of 14 mg/m^2 intravenously over 4 hours on Days 1, 8 and 15 of each 28-day cycle. The duration of study treatment was 6 cycles although pts who showed an objective response or stable disease could continue to receive therapy, at the discretion of the investigator, until disease progression or another withdrawal criterion was met.

Description:

Responses were evaluated according to a composite assessment (Objective Primary Disease Response Evaluation Criteria [OPDREC]) that included cutaneous manifestations of disease, lymph node involvement, and circulating malignant T-cells (Sézary cells). Skin involvement was measured using a weighted body surface area skin assessment tool (WBSA/SWAT) or an erythroderma score, depending upon the pt's disease. Disease response was assessed by the Investigators and an Independent Response Review Committee (IRRC) with the IRRC assessment considered supportive of the Investigator's evaluations using the following criteria:

Complete Response (CR):

• Complete resolution of skin patches, skin plaques, and skin tumors, or erythroderma

• No evidence of abnormal lymph nodes

• Absence of circulating Sézary cells.

• No evidence of new tumors (cutaneous or non-cutaneous)

• Findings confirmed by skin biopsy

Clinical complete response (CCR):

• Same as CR but without skin biopsy

Partial Response (PR):

• ≥50% improvement in the summation of (change in Skin + change in Lymph Node + change in Peripheral Blood) with

• At least >30% improvement in Skin and

• No worsening in Lymph Node or Sézary cells.

• No evidence of new tumors (cutaneous/non-cutaneous)

Stable Disease (SD):

• Not enough improvement or worsening in the summation of (change in Skin + change in Lymph Node + change in Peripheral Blood to qualify as PR or PD

• No evidence of new tumors (cutaneous/non-cutaneous)

SD90:

• SD90 was defined as documented evidence of SD for at least 90 Days Duration

Progressive Disease (PD):

• Evidence of new tumor (cutaneous or non-cutaneous), OR

• >25% worsening in the summation of (change in Skin + change in Lymph Node + change in Peripheral Blood) with >15% worsening in change in Skin.

Other known NCT identifiers

• NCT00337025

Recruitment information / eligibility

• Status: Completed
• Enrollment: 102
• Est. completion date: December 1, 2008
• Est. primary completion date: June 1, 2008
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria: Patients had to fulfill all of the following criteria to be eligible for study participation:

• Males or non-pregnant females aged 18 or over.

• Histologically confirmed diagnosis of CTCL, including mycosis fungoides and Sézary syndrome.

• Patients with CTCL stages II-A, II-B, III, and IV-A only.

• Patients with CTCL stage IB who had relapsed following previous therapy and where, in the investigator's opinion, the potential benefit of treatment with romidepsin outweighed the possible risks.

• Patients who had failed standardized skin-directed therapy and had had at least one course of systemic therapy, such as interferon, Ontak®, chemotherapy or Targretin®, etc., which they were deemed to have failed.

• Anticipated life expectancy greater than six months.

• Written informed consent to participate in the study.

Exclusion Criteria: Patients were ineligible for entry if any of the following criteria were met:

• ECOG Performance Status >1.

• Patients who had not received at least 1 course of prior systemic therapy for CTCL.

• Visceral involvement i.e. Stage 4B disease (lymphadenopathy was allowed).

• Patients with known cardiac abnormalities such as:

• Congenital long QT syndrome

• QTc (Corrected QT interval on ECG) interval >480 milliseconds

• Any cardiac arrhythmia requiring anti-arrhythmic medication.

• Patients who had had a myocardial infarction within 12 months of study entry.

• Patients who had a history of coronary artery disease (CAD) e.g. angina Canadian class II to IV. In any patient in whom there was doubt, the patient should have had a stress imaging study and exercise electrocardiogram (ECG) and, if abnormal, angiography to define whether or not CAD was present.

• Patients with an ECG recorded at screening showing evidence of cardiac ischaemia (ST depression of >=2 mm). If in any doubt, the patient should have had a stress imaging study and exercise ECG and, if abnormal, angiography to define whether or not CAD is present.

• Patients with congestive heart failure that met New York Heart Association class II to IV definitions and/or ejection fraction <40% by multiple gated acquisition (MUGA) scan or <50% by echocardiogram and/or magnetic resonance imaging (MRI)

• Patients with a history of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), Torsade de Pointes, or cardiac arrest, unless currently addressed with an automatic implantable cardioverter defibrillator (AICD).

• Patients with hypertrophic cardiomegaly or restrictive cardiomyopathy from prior treatment or other causes (if in doubt, see ejection fraction criteria above).

• Patients with uncontrolled hypertension, i.e. >=160/95 mmHg.

• Concomitant use of any anti-cancer therapy.

• Concomitant use of warfarin (due to a drug interaction).

• Concomitant use of any investigational agent.

• Use of any investigational agent within 4 weeks of study entry.

• Concomitant use of drugs which may cause a prolongation of the QTc interval.

• Patients with a potassium level of <3.5 mmol/L and a magnesium level of <0.8 mmol/L.

• Clinically significant active infection.

• Known infection with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C.

• Inadequate bone marrow or other organ function, as evidenced by:

• unsupported haemoglobin <9.0 g/dL (transfusions and/or erythropoietin were permitted);

• absolute neutrophil count (ANC) <=1.5 x 10^9/L;

• platelet count <100 x 10^9/L;

• total bilirubin >1.25 x upper limit of normal (ULN) for institution,

• aspartate transaminase/glutamic oxaloacetic transaminase (AST/SGOT) and alanine transaminase/ glutamic pyruvic transaminase (ALT/SGPT) >2.0 x ULN, serum creatinine >2.0 x ULN for age and sex;

• Coexistent second malignancy or history of prior malignancy within previous 5 years (excluding basal or squamous cell carcinoma of the skin or cervical epithelial neoplasm [CIN1, carcinoma in situ] that had been treated curatively).

• Any significant medical or psychiatric condition that might have prevented the patient from complying with all study procedures.

• Patients who were pregnant or breast-feeding. All women of child bearing potential were to use an effective method of contraception (either an intrauterine device or a double barrier method using condoms or a diaphragm plus spermicide) during the study and for at least one month after receiving the last dose of romidepsin. Male patients were to use a barrier method of contraception (condoms) during the treatment period and for at least 1 month thereafter. Hormonal methods of contraception such as the contraceptive pill or patch (particularly those containing ethinyl estradiol) were to be avoided due to a potential drug interaction.

• Use of topical steroids in the previous 2 weeks or systemic steroids in the previous 4 weeks.

• Having previously given consent to participate in this study.

• Concomitant use of CYP3A4 inhibitors.

Related Conditions & MeSH terms

• Cutaneous T-cell Lymphoma
• Lymphoma
• Lymphoma, T-Cell
• Lymphoma, T-Cell, Cutaneous

Intervention

Drug:
• romidepsin (depsipeptide, FK228)
Study patients received romidepsin at a dose of 14 mg/m^2 intravenously over 4 hours on Days 1, 8 and 15 of each 28-day cycle. The duration of study treatment was 6 cycles although patients who showed an objective response or stable disease could continue to receive therapy, at the discretion of the investigator, until disease progression or another withdrawal criterion was met.

Locations

Country	Name	City	State
France	Research Site	Multiple Locations
Germany	Research Site	Multiple Locations
Poland	Research Site	Multiple Locations
Russian Federation	Research Site	Multiple Locations
United Kingdom	Research Site	Multiple Locations
United States	Boston Medical Center	Boston	Massachusetts
United States	MD Anderson Cancer Center	Houston	Texas
United States	UCLA Jonsson Cancer Center	Los Angeles	California
United States	Vanderbilt-Ingram Cancer Center	Nashville	Tennessee
United States	University of Pennsylvania Abrahamson Cancer Center	Philadelphia	Pennsylvania
United States	Stanford Comprehensive Cancer Center	Stanford	California

Sponsors (2)

Lead Sponsor	Collaborator
Celgene	Celgene Corporation

Countries where clinical trial is conducted

United States,  France,  Germany,  Poland,  Russian Federation,  United Kingdom, 

References & Publications (7)

Cabell C, et al. Systematic Assessment of Potential Cardiac Effects of the Novel Histone Deacetylase (HDAC) Inhibitor Romidepsin. Presented at 2009 ASCO Annual Meeting, May 29-June 2, 2009, Orlando, FL. Abstract No: e19533. C J Clin Oncol 2009;27(suppl)

Demierre M, et al. Pooled analyses of two international, multicenter clinical studies of romidepsin in 167 patients with cutaneous T-cell lymphoma (CTCL). Presented at 2009 ASCO Annual Meeting, May 29-June 2, 2009, Orlando, FL. Abstract No: 8546. J Clin Oncol 27:15s, 2009 (suppl)

Duvic M, Bates SE, Piekarz R, Eisch R, Kim YH, Lerner A, Robak T, Samtsov A, Becker JC, McCulloch W, Waksman J, Whittaker S. Responses to romidepsin in patients with cutaneous T-cell lymphoma and prior treatment with systemic chemotherapy. Leuk Lymphoma. 2018 Apr;59(4):880-887. doi: 10.1080/10428194.2017.1361022. Epub 2017 Aug 30. — View Citation

Foss F, Coiffier B, Horwitz S, Pro B, Prince HM, Sokol L, Greenwood M, Lerner A, Caballero D, Baran E, Kim E, Nichols J, Balser B, Wolfson J, Whittaker S. Tolerability to romidepsin in patients with relapsed/refractory T-cell lymphoma. Biomark Res. 2014 Sep 8;2:16. doi: 10.1186/2050-7771-2-16. eCollection 2014. — View Citation

Foss F, Duvic M, Lerner A, Waksman J, Whittaker S. Clinical Efficacy of Romidepsin in Tumor Stage and Folliculotropic Mycosis Fungoides. Clin Lymphoma Myeloma Leuk. 2016 Nov;16(11):637-643. doi: 10.1016/j.clml.2016.08.009. Epub 2016 Aug 10. — View Citation

Kim YH, et al. Clinically Significant Responses Achieved with Romidepsin in 37 Patient with Cutaneous T-Cell Lymphoma (CTCL) with Blood Involvement. Presented at American Society of Hematology 2009, New Orleans, LA. Abstract No. 2683.

Whittaker SJ, Demierre MF, Kim EJ, Rook AH, Lerner A, Duvic M, Scarisbrick J, Reddy S, Robak T, Becker JC, Samtsov A, McCulloch W, Kim YH. Final results from a multicenter, international, pivotal study of romidepsin in refractory cutaneous T-cell lymphoma — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The Percent of Patients (Pts) With Objective Disease Response	The percent of pts with confirmed Objective Disease Response (confirmed best responses of complete response [CR], clinical complete response [CCR], or partial response [PR]). Responses were evaluated according to a composite assessment (Objective Primary Disease Response Evaluation Criteria - OPDREC).	6 months
Secondary	Duration of Objective Disease Response	Duration of Objective Response was defined as the number of months from the date of the first disease response (clinical complete response [CCR], or partial response [PR]) (later confirmed) until the date of progression and was determined using Kaplan-Meier product-limit estimates. In this analysis, pts who did not progress were censored as of their last evaluation with an OPDREC assessment.	Up to 10 months; median duration of follow up was 5.1 months
Secondary	Time to Objective Disease Response	Time to Objective Response was defined as the time in months from first dose date to the first date of objective disease response (later confirmed) and time to CCR was defined as the time in months from first dose date to the first date of CCR (later confirmed).	Up to 10 months
Secondary	Time to Disease Progression	Time To Progression was defined as the duration from the date of the first study drug dose to the date of progression (PD). In this analysis, pts who did not progress were censored at their last evaluation with an OPDREC assessment.	Up to 10 months; median duration of follow up was 6.1 months
Secondary	Decrease in Pruritus Visual Analogue Scale (VAS) Score of =30 mm or a Score of 0 for at Least 2 Consecutive Cycles.	Pruritus was reported monthly by pts using a 0 (no itching) to 100 (unbearable itching) mm visual analog scale (VAS). Pts were considered to have significant pruritus if the baseline VAS score was = 30 mm. Clinically meaningful reduction in pruritus was defined as a decrease in VAS score of = 30 mm or a score of 0 for at least 2 consecutive cycles.	Up to 10 months
Secondary	Duration of Objective Disease Control (ODC)	For pts with confirmed ODC (pts with CR, CCR, PR, SD90 [stable disease for 90 days]) based on OPDREC, duration of ODC was summarized with descriptive statistics, including number of censored observations, and 25th, 50th, 75th percentiles of distribution, based on Kaplan-Meier product limit estimates. For pts with confirmed progressive disease (PD), duration of ODC was calculated from first date of study drug to first date of diagnosis of confirmed PD. For pts without confirmed PD, duration of ODC was calculated from first date of study drug to date of the last visit with any OPDREC data.	Up to 10 months; median duration of follow up was 6.0 months
Secondary	Percent of Pts With Objective Disease Control	The percent of pts with confirmed ODC (CR, CCR, PR and SD90) based on OPDREC was summarized.	Up to 10 months