PET Scans in Patients With Diffuse Large B-Cell Lymphoma Receiving Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone

Lymphoma Clinical Trial

Official title:

Prospective Evaluation of the Predictive Value of PET in Patients With Diffuse Large B-cell-lymphoma Under R-CHOP-14. A Multicenter Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00544219
• Other study ID #: SAKK 38/07
• Secondary ID: SWS-SAKK-38-07EU
• Status: Completed
• Phase: N/A
• Start date: September 2007
• Est. completion date: January 2016

Study information

• Verified date: May 2019
• Source: Swiss Group for Clinical Cancer Research
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

RATIONALE: Studying PET scans given to patients with cancer who are undergoing treatment may help doctors predict how patients will respond to treatment.

PURPOSE: This clinical trial is studying PET scans in patients with diffuse large B-cell lymphoma who are receiving rituximab together with cyclophosphamide, doxorubicin, vincristine, and prednisone.

Description:

OBJECTIVES:

Primary

• To evaluate if an early positive positron emission tomography (PET) scan after 2 courses of rituximab with cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone can be used to identify a group of patients having a poor prognosis.

Secondary

• To compare modified PET/CT scan response criteria with revised standard response criteria.

• To evaluate, in a prospective manner, whether a proliferation-inducing ligand (APRIL) expression is a prognostic factor in patients treated with this regimen.

OUTLINE: This is a multicenter study.

Patients receive rituximab IV, cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine IV on day 1 and oral prednisone on days 1-5. Treatment repeats every 14 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Rituximab IV alone is continued for an additional 2 courses after completion of the initial 6 courses.

Patients undergo positron emission tomography (PET) scan prior to and after completion of study therapy. Patients also undergo PET scan after course 2, and those with a positive PET result undergo an additional PET scan after course 4.

Previously collected tumor samples are analyzed for a proliferation-inducing ligand (APRIL) expression.

After completion of study treatment, patients are followed periodically for up to 5 years.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 156
• Est. completion date: January 2016
• Est. primary completion date: September 2012
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

DISEASE CHARACTERISTICS:

Inclusion criteria:

• Histologically confirmed diagnosis of CD20+ diffuse large B-cell lymphoma (DLBCL)

• Stage I-IV disease

• All IPI risk groups

• Must be positron emission tomography (PET)-positive

• At least one measurable lesion = 15 mm in its shortest axis (greatest transverse diameter) for jugulodigastric and infra-carinal lymph nodes with CT scan (MRI is allowed only if CT scan cannot be performed)

• Otherwise the shortest axis (greatest transverse diameter) must be = 10 mm

• Lesions should be selected according to the following features:

• Clearly measurable in two perpendicular dimensions

• From as disparate regions of the body as possible

• Include mediastinal and retroperitoneal areas of disease whenever these sites are involved

Exclusion criteria:

• Secondary DLBCL (in transformation)

• Evidence of symptomatic CNS disease

PATIENT CHARACTERISTICS:

Inclusion criteria:

• ECOG or WHO performance status 0-2

• Cardiac ejection fraction = 50% as assessed by echocardiography

• Sufficient hematological values, hepatic and renal function

• Patient condition, compliance, and geographic proximity must allow proper staging and completion of treatment and follow-up

• Not pregnant or nursing

• Negative pregnancy test

• Fertile patients must use effective contraception during and for 12 months after completion of study therapy

Exclusion criteria:

• Prior or concurrent hematological malignancies

• Patients who have had prior solid organ tumors that required no treatment over the past 5 years and are currently disease-free are allowed

• Unstable cardiac disease within the past 6 months

• Any serious underlying medical condition (at the judgment of the investigator) that could impair the ability of the patient to participate in the study (e.g., active autoimmune disease, uncontrolled diabetes, HIV- and hepatitis-infection)

• Known hypersensitivity to any component of the study drugs

PRIOR CONCURRENT THERAPY:

Exclusion criteria:

• Prior chemotherapy, radiotherapy, or immunotherapy (e.g., rituximab) for lymphoma

• Prior anthracycline treatment

• Concurrent radiotherapy

• Concurrent regular corticosteroids in the past 4 weeks

• Doses = 20 mg/day of prednisone for indications other than lymphoma or lymphoma-related symptoms allowed

• Concurrent drugs contraindicated for use with the study drugs according to the Swissmedic-approved product information

• Other concurrent experimental drugs or other anticancer therapy

Related Conditions & MeSH terms

• Lymphoma
• Lymphoma, B-Cell
• Lymphoma, Large B-Cell, Diffuse

Intervention

Biological:
• rituximab
375 mg/m2 i.v. per cycle

Drug:
• cyclophosphamide
750 mg/m2 i.v. per cycle
• doxorubicin hydrochloride
50 mg/m2 i.v. per cycle
• prednisone
100 mg/day p.o. per cycle
• vincristine sulfate
1.4 mg/m2 (max. 2.0 mg) i.v. per cycle

Procedure:
• positron emission tomography
PET Scan during treatment

Locations

Country	Name	City	State
Italy	European Institute of Oncology	Milan
Switzerland	Hirslanden Klinik Aarau	Aarau
Switzerland	Kantonspital Aarau	Aarau
Switzerland	Kantonsspital Baden	Baden
Switzerland	Praxis Dr. Streit	Baden
Switzerland	Saint Claraspital AG	Basel
Switzerland	Universitaetsspital-Basel	Basel
Switzerland	Oncology Institute of Southern Switzerland	Bellinzona
Switzerland	Inselspital Bern	Bern
Switzerland	Kantonsspital Bruderholz	Bruderholz
Switzerland	Kantonsspital Graubuenden	Chur
Switzerland	Hopital Cantonal Universitaire de Geneve	Geneva
Switzerland	Kantonsspital Liestal	Liestal
Switzerland	Kantonsspital Olten	Olten
Switzerland	Praxis Dr. Beretta	Rheinfelden
Switzerland	Kantonsspital - St. Gallen	St. Gallen
Switzerland	Regionalspital	Thun
Switzerland	Kantonsspital Winterthur	Winterthur
Switzerland	UniversitaetsSpital Zuerich	Zurich

Sponsors (1)

Lead Sponsor	Collaborator
Swiss Group for Clinical Cancer Research

Countries where clinical trial is conducted

Italy,  Switzerland, 

References & Publications (3)

Juskevicius D, Jucker D, Klingbiel D, Mamot C, Dirnhofer S, Tzankov A. Mutations of CREBBP and SOCS1 are independent prognostic factors in diffuse large B cell lymphoma: mutational analysis of the SAKK 38/07 prospective clinical trial cohort. J Hematol On — View Citation

Mamot C, Klingbiel D, Hitz F, Renner C, Pabst T, Driessen C, Mey U, Pless M, Bargetzi M, Krasniqi F, Gigli F, Hany T, Samarin A, Biaggi C, Rusterholz C, Dirnhofer S, Zucca E, Martinelli G. Final Results of a Prospective Evaluation of the Predictive Value — View Citation

Tzankov A, Leu N, Muenst S, Juskevicius D, Klingbiel D, Mamot C, Dirnhofer S. Multiparameter analysis of homogeneously R-CHOP-treated diffuse large B cell lymphomas identifies CD5 and FOXP1 as relevant prognostic biomarkers: report of the prospective SAKK — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Event-free survival		at 2 years
Secondary	Event-free survival		at 5 years
Secondary	Overall survival during follow-up		at 2 and 5 years
Secondary	Objective response		at 2 years
Secondary	Positron emission tomography (PET) results		at 2 years
Secondary	Histological results of remaining PET-positive lesion(s) after treatment		at 2 years