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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT01771107
Other study ID # NCI-2013-00046
Secondary ID NCI-2013-0004620
Status Active, not recruiting
Phase Phase 1/Phase 2
First received
Last updated
Start date March 7, 2013
Est. completion date February 28, 2025

Study information

Verified date April 2024
Source National Cancer Institute (NCI)
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This pilot phase I/II trial studies the side effects and the best dose of brentuximab vedotin when given together with combination chemotherapy and to see how well they work in treating patients with stage II-IV human immunodeficiency virus (HIV)-associated Hodgkin lymphoma. Brentuximab vedotin is a monoclonal antibody, called brentuximab, linked to a chemotherapy drug called vedotin. Brentuximab attaches to CD30-positive cancer cells in a targeted way and delivers vedotin to kill them. Drugs used in chemotherapy, such as doxorubicin hydrochloride, vinblastine sulfate, and dacarbazine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving brentuximab vedotin together with combination chemotherapy may kill more cancer cells.


Description:

PRIMARY OBJECTIVES I. To identify the maximum tolerated dose (MTD) of brentuximab vedotin when combined with the doxorubicin hydrochloride, vinblastine sulfate, and dacarbazine (AVD) chemotherapy regimen in the treatment of HIV-associated stage II-IV Hodgkin lymphoma. (Phase I) II. Establish an estimate of the two-year progression-free survival (PFS) for participants with HIV-associated stage II-IV Hodgkin lymphoma when treated using brentuximab vedotin plus the AVD chemotherapy regimen. (Phase II) SECONDARY OBJECTIVES: I. To evaluate the toxicity of AVD and brentuximab vedotin with highly active antiretroviral therapy (HAART). II. To estimate the partial response (PR) rate, complete response (CR) rate, overall survival (OS), and event free survival (EFS) at 2 and 5 years. III. To evaluate the effect of AVD and brentuximab vedotin on cluster of differentiation (CD)4 and CD8 counts after cycle 1, 4, at the end of therapy, and every 3 months after treatment completion for one year. IV. To investigate the prognostic value of fludeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans at baseline, after cycle 2, and at treatment completion, with respect to 2-year progression free survival. V. To evaluate HAART status at baseline and to correlate this with tumor response to therapy and OS and PFS. VI. To characterize the histologic subtypes in HIV-Hodgkin lymphoma (HL) in the highly active antiretroviral therapy (HAART) era. VII. To assess the neurotoxicity of HAART in combination with AVD and brentuximab vedotin. VIII. To evaluate effect of AVD and brentuximab vedotin on viral load after cycles 1, 4, at the completion of therapy, and every 3 months after treatment completion for one year. IX. To perform pharmacokinetic and immunogenicity studies to determine drug levels during therapy. X. To perform micro ribonucleic acid (miRNA) profile analysis on the HIV-HL tumor specimens and to correlate miRNA expression with OS, PFS, tumor response to therapy, histologic subtype of HIV-HL, and HIV disease characteristics. XI. To perform tissue microarray analysis on HIV-HL tumor specimens and to correlate the markers studied with OS, PFS, and tumor response to therapy. XII. To identify Epstein-Barr virus (EBV)-associated tumor derived deoxyribonucleic acid (DNA) in the plasma of study participants and to correlate these levels during therapy with disease response and OS. (Phase II) XIII. To identify cytokines in the plasma of participants during therapy that can be used as tumor and prognostic markers. (Phase II) XIV. To assess latent and expressed HIV reservoirs before, during, and post chemotherapy. To understand how cytotoxic chemotherapeutic agents affect HIV expression. OUTLINE: This is a phase I, dose-escalation study of brentuximab vedotin followed by a phase II study. Patients receive doxorubicin hydrochloride intravenously (IV), vinblastine sulfate IV, and dacarbazine IV on days 1 and 15. Patients also receive brentuximab vedotin IV over 30 minutes on days 1 and 15. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.


Other known NCT identifiers
  • NCT02298257

Recruitment information / eligibility

Status Active, not recruiting
Enrollment 41
Est. completion date February 28, 2025
Est. primary completion date October 15, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - HIV positive; documentation of HIV-1 infection by means of any one of the following: - Documentation of HIV diagnosis in the medical record by a licensed health care provider; - Documentation of receipt of antiretroviral therapy (ART) by a licensed health care provider; - HIV-1 RNA detection by a licensed HIV-1 RNA assay demonstrating > 1000 RNA copies/mL; - Any licensed HIV screening antibody and/or HIV antibody/antigen combination assay confirmed by a second licensed HIV assay such as a HIV-1 western blot confirmation or HIV rapid multispot antibody differentiation assay - NOTE: A "licensed" assay refers to a United States (US) Food and Drug Administration (FDA)-approved assay, which is required for all investigational new drug (IND) studies - Histologic diagnosis of CD30-positive classical HL as defined by the 2008 World Health Organization (WHO) Classification of Hematological diseases; nodular lymphocyte predominant Hodgkin lymphoma is not eligible - Stage II, III or IV disease as defined by the Ann Arbor Staging System - Participants must have previously untreated HIV-classical HL (cHL), with the exception of up to 14 consecutive days of steroids, emergency radiation, or 1 prior cycle of cyclophosphamide to reduce tumor burden and improve hyperbilirubinemia in the setting of lymphoma related liver involvement - Normal baseline cardiac ejection fraction >= 50% - Serum creatinine of =< 1.5 mg/dL; if creatinine > 1.5 mg/dL, creatinine clearance must be >= 60 mL/minute - Absolute neutrophil count (ANC) >= 1000/uL - Platelets >= 75,000/uL unless related to bone marrow involvement by HIV-cHL - Total bilirubin must be < 1.5 x the upper limit of normal, unless the elevation of bilirubin is thought to be secondary to Gilbert's syndrome or combined antiretroviral therapy (cART); if, however, the elevated bilirubin is felt to be secondary to antiretroviral therapy, the total bilirubin must be =< 3.5 mg/dL, provided that the direct bilirubin is normal and the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x the upper limit of normal; also, if the elevated bilirubin is thought to be secondary to cHL the same criteria for hyperbilirubinemia should be applied; however 1 prior cycle of cyclophosphamide is permitted in attempt to make the participant eligible; patients should not be excluded from study participation unless dosing cannot be safely established - Female participants must have a negative pregnancy test within 1 week of enrollment and all participants must agree to use two reliable methods of contraception simultaneously if conception is possible during the study and for 6 months after stopping treatment; should a woman subject become pregnant or suspect she is pregnant while the subject is participating in this study, she should inform her treating physician immediately; the participant will then be removed from protocol therapy; participants who father a child while participating in the study will be permitted to continue with the protocol; the participant, however, is required to notify the investigator if he fathers a child - Ability to understand and the willingness to sign a written informed consent document - Karnofsky performance status > 30% (given the aggressiveness of this disease and the often severely debilitated nature of the patients at initial presentation) - Measurable or non-measurable (evaluable) tumor parameter(s); non-measurable tumor parameters will be defined as not having bi-dimensional measurements (i.e., gastric or marrow involvement) but can be followed for response by other diagnostic tests such as gallium, PET imaging and/or bone marrow biopsy - Patients already receiving erythropoietin or granulocyte colony stimulating factor (GCSF) for treatment of HIV-related cytopenia are eligible - CD4 count >= 50 cells/ul - Participants are required to be on antiretroviral regimens that are in accordance with the current International Acquired Immune Deficiency Syndrome (AIDS) Society guidelines concurrently with chemotherapy; the specific agents are at the discretion of the investigator and the use of investigational agents currently available on an expanded access basis is allowed; use of experimental antiretroviral agents or those containing zidovudine (including Combivir and Trizivir) or ritonavir (includes Norvir or Kaletra), cobicistat, didanosine (Videx or Videx EC), or similar potent cytochrome P450 (CYP)3 inhibitors are prohibited; in order to be eligible, participants taking zidovudine or ritonavir, or cobicistat, didanosine, or other CYP3 inhibitors must change to a different regimen 7 days prior to therapy initiation; changes to HAART therapy during the study may be made if medically necessary (toxicity, failure of regimen, etc.); participants must be on HAART at least 7 days prior to therapy - Negative for hepatitis B, or if infected with hepatitis B, receiving anti-hepatitis B therapy; all participants will be required to be screened for hepatitis B; per Infectious Disease Society of America (IDSA) and Assistance for AIDS Specific Drugs (AASD) guidelines, those participants that show no immunity, defined by the lack of hepatitis B surface antigen antibody, and show evidence of chronic infection (i.e. hepatitis B surface antigen [HBsAg]+, hepatitis B core [HBcore]+, hepatitis B surface antibody [HBsAB]-) will be required to be on anti-hepatitis B therapy during the study in order to be eligible; patients will be permitted to enroll in the study provided normal liver function tests and no evidence of cirrhosis; the exact hepatitis B therapy will be at the discretion of the infection disease specialist or investigator; however all patients who present with acute hepatitis B or show normal transaminases and are hepatitis B virus HBsAg surface protein antigen (HBsAg) positive (+) and immunoglobulin M (IgM)+ for hepatitis core antigen will not be eligible for trial enrollment - Patients diagnosed with hepatitis C who are hepatitis C antibody positive, whether hepatitis C RNA level is measurable or not, must have no evidence of cirrhosis and have liver function tests - Brentuximab vedotin is partially metabolized via the CYP3A4 pathway and is cleared from the cells via the P-glycoprotein pump; therefore, participants must discontinue use of the following agents within 7 days prior to therapy - Strong CYP3A4 inhibitors that treat HIV - Other strong CYP3A inhibitors - Moderate CYP3A4 inhibitors should be used with caution but are not excluded; if 2 moderate CYP3A4 inhibitors are used concurrently, one must be discontinued at least 7 days (1 week) prior to the initiation of chemotherapy - P-glycoprotein inhibitors - If patients are taking any of these excluded medications, they must be discontinued at least 7 days (1 week) prior to the initiation of chemotherapy All concomitant medications must be reviewed by the study chair or co-chair prior to enrollment by email; because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference for a list of drugs to avoid or minimize use of Exclusion Criteria: - Patients with prior anthracycline therapy will be excluded - Female participants who are pregnant or breast-feeding; confirmation that the subject is not pregnant must be established by a negative serum beta (b)-human chorionic gonadotropin (b-hCG) or urine pregnancy test result obtained during screening; pregnancy testing is not required for post-menopausal or surgically sterilized women - Medical illness unrelated to HL, which in the opinion of the study physician will preclude administration of chemotherapy safely; this includes patients with uncontrolled infection (including opportunistic), chronic renal failure, myocardial infarction (MI) within the past 6 months, unstable angina, or cardiac arrhythmias other than chronic atrial fibrillation, or second malignancy requiring active treatment - Prior malignancy within 2 years before enrollment other than curatively treated cutaneous basal cell or squamous cell carcinoma, carcinoma in situ of the cervix, anal intraepithelial neoplasia, or cutaneous Kaposi's sarcoma (KS); participants with prior malignancies must have completed all therapy at least 2 years before enrollment with no evidence of disease since therapy completion - Grade 2 or greater peripheral neuropathy - Evidence of progressive multifocal leukoencephalopathy (PML) identified on the pretreatment magnetic resonance imaging (MRI) - Central nervous system disease - Patients with history of John Cunningham (JC) virus identified in the cerebrospinal fluid (CSF) or previous history of PML will be excluded from the study - Cirrhosis secondary to any cause will be excluded

Study Design


Intervention

Drug:
Brentuximab Vedotin
Given IV
Dacarbazine
Given IV
Doxorubicin Hydrochloride
Given IV
Other:
Pharmacological Study
Correlative studies
Drug:
Vinblastine
Given IV

Locations

Country Name City State
France Centre Hospitalier Universitaire (CHU) de Toulouse Cedex
France Hopital Antoine Beclere Clamart
France Henri Mondor University-Hospital Center Creteil
France Hopital l'Archet-CHU de Nice Nice
France Hopital Saint Louis Paris
France Hospital Saint-Antoine Paris
France Centre Hospitalier Lyon-Sud Pierre Benite
France Chu Purpan Toulouse
United States Johns Hopkins University/Sidney Kimmel Cancer Center Baltimore Maryland
United States Beth Israel Deaconess Medical Center Boston Massachusetts
United States Boston Medical Center Boston Massachusetts
United States Montefiore Medical Center-Einstein Campus Bronx New York
United States John H Stroger Jr Hospital of Cook County Chicago Illinois
United States UC San Diego Moores Cancer Center La Jolla California
United States UCLA / Jonsson Comprehensive Cancer Center Los Angeles California
United States UCLA Center for Clinical AIDS Research and Education Los Angeles California
United States University of Miami Miller School of Medicine-Sylvester Cancer Center Miami Florida
United States Louisiana State University Health Science Center New Orleans Louisiana
United States Memorial Sloan Kettering Cancer Center New York New York
United States Fox Chase Cancer Center Philadelphia Pennsylvania
United States Pennsylvania Hospital Philadelphia Pennsylvania
United States University of California Davis Comprehensive Cancer Center Sacramento California
United States Siteman Cancer Center at Washington University Saint Louis Missouri
United States Washington University - Jewish Saint Louis Missouri
United States Washington University School of Medicine Saint Louis Missouri
United States Fred Hutchinson Cancer Center Seattle Washington
United States Harborview Medical Center Seattle Washington
United States Virginia Mason Medical Center Seattle Washington

Sponsors (2)

Lead Sponsor Collaborator
National Cancer Institute (NCI) The Lymphoma Academic Research Organisation

Countries where clinical trial is conducted

United States,  France, 

Outcome

Type Measure Description Time frame Safety issue
Primary Maximal Tolerated Dose of Brentuximab Vedotin (Phase I) Defined as the dose level at which =< 1 of 6 subjects experience dose limiting toxicity. 28 days
Primary 2-year Progression-free Survival (PFS) 2-year PFS is determined based on the Kaplan-Meier estimates and corresponding 95% confidence intervals based on standard errors using Greenwood's formula. 2 years
Secondary Frequency of Adverse Events Number of Participants who had one or more adverse events Up to 5 years
Secondary Partial Response Rate Number of participants who achieved a partial response per RECIST v1.0 criteria 2 years
Secondary Partial Response Rate Number of participants who achieved a partial response per RECIST v1.0 criteria 5 years
Secondary Complete Response Rate Number of participants who experienced a complete response per RECIST v1.0 criteria 2 years
Secondary Complete Response Rate Number of participants who achieved a complete response per RECIST v1.0 criteria 5 years
Secondary 2-year Overall Survival Proportion of study participants who are alive at 2 years estimated using the Kaplan-Meier survival function 2 years
Secondary Overall Survival Proportion of participants who are alive at 5 years using a Kaplan-Meier estimate 5 years
Secondary Event-free Survival Proportion of participants who are alive and progression-free at 2 years 2 years
Secondary Event-free Survival Binomial probabilities and their 95% confidence intervals will be used to estimate the response rates (i.e., partial response rate, complete response rate, overall response rate) and event free survival at 2 and 5 years of AVD and brentuximab vedotin for a treatment of patients with stage III/IV HIV-associated Hodgkin lymphoma. 5 years
Secondary CD4 Counts CD4 counts (absolute) at visit 4 (cycle 5) 5 months
Secondary CD8 Counts Absolute CD8 counts at cycle 5 5 months
Secondary Viral Load HIV viral load (detectable) 5 months
Secondary Prognostic Value of Fludeoxyglucose F-18 (FDG)-Positron Emission Tomography (PET) in Patient With HIV and Hodgkin Lymphoma (HL) With Respect to 2 Year Progression Free Survival Log-rank analysis will be used to investigate the prognostic value of FDG-PET scans at baseline, after 2 courses and post-therapy in patients with HIV and HL with respect to progression free survival. Baseline
Secondary Prognostic Value of FDG-PET in Patient With HIV and HL With Respect to 2 Year Progression Free Survival Log-rank analysis will be used to investigate the prognostic value of FDG-PET scans at baseline, after 2 courses and post-therapy in patients with HIV and HL with respect to progression free survival. 8 weeks (after 2 courses)
Secondary Prognostic Value of FDG-PET in Patient With HIV and HL With Respect to 2 Year Progression Free Survival Log-rank analysis will be used to investigate the prognostic value of FDG-PET scans at baseline, after 2 courses and post-therapy in patients with HIV and HL with respect to progression free survival. 24 weeks (end of treatment)
Secondary HAART Status Log-rank analysis will be used to evaluate HAART status at baseline for difference in outcome in terms of overall survival and progression free survival. Baseline
Secondary Characterization of Histologic Subtypes in HIV-HL in the HAART Era Participants with mixed cellularity histologic subtype Baseline
Secondary Incidence of Neurotoxicity Number of participants who experience neurotoxicity at cycle 5 (visit 4) 5 months
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