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| ID | Type | Description | Link |
|---|---|---|---|
| 12975A | |||
| N01CM62201 | U.S. NIH Grant/Contract | View source | |
| CDR0000371904 | Registry Identifier | PDQ (Physician data Query) |
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This phase I/II trial is studying the side effects and best dose of oblimersen when given together with rituximab and combination chemotherapy and to see how well they work in treating patients with relapsed or refractory aggressive non-Hodgkin's lymphoma. Monoclonal antibodies such as rituximab can locate cancer cells and either kill them or deliver cancer-killing substances to them without harming normal cells. Drugs used in chemotherapy, such as ifosfamide, carboplatin, and etoposide, work in different ways to stop cancer cells from dividing so they stop growing or die. Oblimersen may increase the effectiveness of chemotherapy by making cancer cells more sensitive to the drugs
PRIMARY OBJECTIVES:
I. Determine the maximum tolerated dose of oblimersen when given in combination with rituximab, ifosfamide, carboplatin, and etoposide in patients with relapsed or refractory aggressive B-cell non-Hodgkin's lymphoma.
II. Determine the safety and toxicity of this regimen in these patients. III. Determine the complete and partial response rate in patients treated with this regimen.
SECONDARY OBJECTIVES:
I. Determine the duration of response, overall survival, and time to progression in patients treated with this regimen.
II. Determine the effect of this regimen on hematopoietic stem cell kinetics and yield from these patients.
OUTLINE: This is a multicenter, phase I, dose-escalation study of oblimersen followed by a phase II study.
Phase I: Patients receive GRICE comprising oblimersen IV continuously on days 1-5, rituximab IV, ifosfamide IV continuously over 24 hours, and carboplatin IV over 1 hour on day 4, and etoposide IV over 30 minutes once daily on days 4-6. Treatment repeats every 14 days for 3 courses. Patients also receive filgrastim (G-CSF) subcutaneously (SC) once daily beginning on day 7 and continuing until blood counts recover OR one dose of pegfilgrastim SC on day 7 of courses 1 and 2. For course 3, all patients receive G-CSF SC twice daily beginning on day 7 and continuing until stem cell collection is complete. Patients with responding disease who are not eligible for autologous SCT may receive up to 8 total courses of GRICE or 2 additional courses beyond maximal response. Patients with responding disease to GRICE who are eligible for autologous SCT are removed from the study and undergo autologous SCT off study. Cohorts of 3-6 patients receive escalating doses of oblimersen until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
Phase II: Patients receive oblimersen at the MTD determined in phase I and rituximab, ifosfamide, carboplatin, and etoposide followed by G-CSF or pegfilgrastim as in phase I. In both phases, treatment continues in the absence of disease progression, unacceptable toxicity, or the patient becomes a candidate for autologous SCT. Patients are followed for survival.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment (genase, combination chemotherapy) | Experimental | See detailed description. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| oblimersen sodium | Biological | Given IV |
|
| Measure | Description | Time Frame |
|---|---|---|
| Toxicity graded using the NCI CTCAE version 3.0 | Up to 3 years | |
| Complete and partial response rate according to the International Workshop Criteria | Up to 3 years |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of response | From the time measurement criteria are met for CR/CRu/PR until the first date that PD is objectively documented, assessed up to 3 years | |
| Overall survival | From the first day of therapy to the date of death, assessed up to 3 years |
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Inclusion Criteria:
Histologically confirmed aggressive B-cell non-Hodgkin's lymphoma
Any 1 one of the following histological subtypes for phase I:
Any 1 of the following histological subtypes for phase II:
Measurable disease
Relapsed disease after 1, and only 1, prior anthracycline-based chemotherapy regimen
No known brain metastases
Performance status - ECOG 0-2
Performance status - Karnofsky 60-100%
More than 3 months
Absolute neutrophil count ≥ 1,000/mm^3*
Platelet count ≥ 100,000/mm^3*
Bilirubin normal**
AST and ALT ≤ 2.5 times upper limit of normal
PT and PTT normal
Creatinine normal
Creatinine clearance ≥ 60 mL/min
No symptomatic congestive heart failure
No unstable angina pectoris
No cardiac arrhythmia
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No history of allergic reactions attributed to compounds of similar chemical or biological composition to oblimersen or other study drugs
No currently active second malignancy except nonmelanoma skin cancer or carcinoma in situ of the cervix
No ongoing or active infection
No psychiatric illness or social situation that would preclude study compliance
No other concurrent uncontrolled illness
Prior rituximab allowed
No other concurrent immunotherapy
See Disease Characteristics
At least 4 weeks since prior cytotoxic chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered
No other concurrent chemotherapy
No concurrent hormonal therapy
At least 4 weeks since prior radiotherapy and recovered
No concurrent therapeutic radiotherapy
At least 4 weeks since prior surgery
No prior oblimersen or other antisense oligonucleotide therapy
No other concurrent anticancer agents or therapies
No concurrent combination antiretroviral therapy for HIV-positive patients
No other concurrent investigational agents
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| Name | Affiliation | Role |
|---|---|---|
| Sonali Smith | University of Chicago Comprehensive Cancer Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Chicago Comprehensive Cancer Center | Chicago | Illinois | 60637-1470 | United States |
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| rituximab | Biological | Given IV |
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| ifosfamide | Drug | Given IV |
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| carboplatin | Drug | Given IV |
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| etoposide | Drug | Given IV |
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| filgrastim | Biological | Given SC |
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| pegfilgrastim | Biological | Given SC |
|
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| laboratory biomarker analysis | Other | Correlative studies |
|
| Time to progression | From the first day of treatment until the date PD or death is first reported, assessed up to 3 years |
| ID | Term |
|---|---|
| D016403 | Lymphoma, Large B-Cell, Diffuse |
| D008224 | Lymphoma, Follicular |
| D020522 | Lymphoma, Mantle-Cell |
| ID | Term |
|---|---|
| D016393 | Lymphoma, B-Cell |
| D008228 | Lymphoma, Non-Hodgkin |
| D008223 | Lymphoma |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| C408162 | oblimersen |
| D000069283 | Rituximab |
| D007069 | Ifosfamide |
| C041272 | indolepropanol phosphate |
| D016190 | Carboplatin |
| D005047 | Etoposide |
| D000069585 | Filgrastim |
| D016179 | Granulocyte Colony-Stimulating Factor |
| C455861 | pegfilgrastim |
| ID | Term |
|---|---|
| D058846 | Antibodies, Monoclonal, Murine-Derived |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D003520 | Cyclophosphamide |
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
| D010078 | Oxazines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D056831 | Coordination Complexes |
| D011034 | Podophyllotoxin |
| D013764 | Tetrahydronaphthalenes |
| D009281 | Naphthalenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D011083 | Polycyclic Compounds |
| D005960 | Glucosides |
| D006027 | Glycosides |
| D002241 | Carbohydrates |
| D003115 | Colony-Stimulating Factors |
| D006023 | Glycoproteins |
| D006001 | Glycoconjugates |
| D016298 | Hematopoietic Cell Growth Factors |
| D016207 | Cytokines |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D001685 | Biological Factors |
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