Non-Hodgkin's Lymphoma Clinical Trial
Official title:
Phase I/II Study of the Combination of Bendamustine, Rituximab and Pixantrone in Patients With Relapsed/Refractory B Cell Non-Hodgkin's Lymphoma
This is a phase I trial of the combination of bendamustine, rituximab and pixantrone in
patients with relapsed/refractory B cell non-Hodgkin lymphoma. A standard 3+3 design will be
used to determine the maximum tolerated dose (MTD) of the combination. A static dose of
bendamustine and rituximab will be used and the dose of pixantrone will be escalated in each
cohort. Pixantrone will be dosed on a 21 day cycle at 55mg/m2, 85mg/m2, and 115mg/m2 in
sequential cohorts dependent on acceptable toxicity profile at each dose level. MTD will be
determined based on DLTs that occur during the first 2 cycles of the drug combination.
Phase II did not proceed as planned due to withdrawal of pixantrone from the US.
This is a phase I trial utilizing a traditional 3+3 design to evaluate maximum tolerated dose
(MTD) and optimal dose schedule of pixantrone in combination with bendamustine (120mg/m2 on
day 1 of each 21 day cycle) and rituximab (375mg/m2 on day 1 of each 21 day cycle). No
patients will be entered on an escalated dosage level until at least 3 patients have been
treated at the previous level and assessed for a dose limiting toxicity. Dose levels will be
escalated in cohorts of 3 patients as long as no drug-related DLT occurs in the first 2
cycles. If one patient is observed to suffer a DLT, this cohort will be expanded to include
at least 6 patients total. If less than 2 patients in the expanded cohort of 6 patients
experience a DLT, dose escalation will resume. If 2 of 6 patients enrolled at the same dose
level experience a DLT, the MTD has been exceeded, and the dose escalation will cease. The
next lower dose will be considered the MTD. If any patient withdraws from the study prior to
completing 2 cycles for reasons other than a DLT then that patient will be replaced in order
to determine the MTD.
If dose limiting toxicity is observed at the initial dose level in 2 patients, the MTD has
been exceeded and the starting dose level will be reduced to 25mg/m2. If 1 patient
experiences a DLT in the -1 dose range, the cohort will be expanded to at least 6 patients.
If a second patient experiences a DLT at the -1 dose level, the trial will be closed.
For part 1, those who have a confirmed diagnosis of relapsed/refractory B cell non-Hodgkin's
lymphoma of any subtype will be considered eligible for enrollment. Each cycle will be 21
days. Subjects will be assessed for DLTs during the first 2 cycles of study drug. They will
be assessed for response after cycle 2. Patients not experiencing a DLT during the first 2
cycles and who have stable disease or better may continue to receive up to 6 cycles of
treatment with the triplet combination. If any patient withdraws from the study prior to
completing 2 cycles for reasons other than a DLT then that patient will be replaced in order
to determine the MTD.
Phase II did not proceed as planned due to withdrawal of pixantrone from the US.
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