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Phase I Study of Carfilzomib for the Treatment of T-Cell Lymphoma


Phase 1
19 Years
N/A
Open (Enrolling)
Both
Adult Nasal Type Extranodal NK/T-cell Lymphoma, Anaplastic Large Cell Lymphoma, Angioimmunoblastic T-cell Lymphoma, Peripheral T-cell Lymphoma, Recurrent Adult T-cell Leukemia/Lymphoma

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Trial Information

Phase I Study of Carfilzomib for the Treatment of T-Cell Lymphoma


PRIMARY OBJECTIVES:

I. To establish the maximum tolerated dose (MTD) of single agent carfilzomib in patients
with relapsed and refractory peripheral T-cell lymphoma (PTCL) including angioimmunoblastic
T-cell lymphoma (AITL), anaplastic large cell lymphoma (ALCL) anaplastic lymphoma receptor
tyrosine kinase (ALK)+/ALK-, adult T-cell leukemia/lymphoma (ATLL), natural killer (NK)-cell
lymphoma (NKL), and PTCL-unspecified (PTCL-U).

II. To assess the safety and preliminary efficacy of single agent carfilzomib in patients
with relapsed and refractory peripheral T-cell lymphoma (PTCL) including angioimmunoblastic
T-cell lymphoma (AITL), anaplastic large cell lymphoma (ALCL) ALK+/ALK-, adult T-cell
leukemia/lymphoma (ATLL), natural killer (NK)-cell lymphoma (NKL), and PTCL-unspecified
(PTCL-U).

III. To evaluate nuclear transcription factor kappa-B (NF-kappa B) activation in PTCL tumor
tissue and correlate that with response to carfilzomib, a novel proteosome inhibitor, which
targets NF-kappa B.

OUTLINE: This is a dose escalation study.

Patients receive carfilzomib intravenously (IV) over 30 minutes on days 1, 2, 8, 9, 15, and
16. Treatment repeats every 28 days for up to 6 courses in the absence of disease
progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for year 1,
then every 4 months for year 2, then every 6 months for years 3 and 4, and then yearly
thereafter.


Inclusion Criteria:



- Relapsed and refractory peripheral T-cell lymphoma (PTCL), including
angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma (ALCL)
ALK+/ALK-, adult T-cell leukemia/lymphoma (ATLL), NK-cell lymphoma (NKL), and
PTCL-unspecified (PTCL-U) patients who have failed standard therapy/transplant for
their histological confirmed disease or who are not transplant eligible are eligible
to participate in this trial

- Expected survival duration of >= three months

- Karnofsky Performance Status >= 70

- Absolute neutrophil count (ANC) >= 700 cells/mm^3, unless due to lymphoma involvement
of the bone marrow or spleen

- Platelet Count >= 50 mm^3, unless due to lymphoma involvement of the bone marrow or
spleen

- Hemoglobin >= 8 g/dL, unless due to lymphoma involvement of the bone marrow

- Aspartate aminotransferase (AST), alanine aminotransferase (ALT) =< 3 x upper limits
of normal (ULN) unless due to lymphoma or due to Gilberts disease

- Bilirubin =< 3 x ULN unless due to lymphoma or due to Gilberts disease

- Left ventricle ejection fraction (LVEF) >= 40% 2-D transthoracic echocardiogram
(ECHO) is the preferred method of evaluation; multigated acquisition scan (MUGA) is
acceptable if ECHO is not available

- Serum creatinine < 2.0 mg/dL or calculated creatinine clearance (CrCl) > 40 mL/min

- Able to adhere to the study visit schedule and other protocol requirements

- Patients must be willing to give written informed consent, and sign an
institutionally approved consent form before performance of any study-related
procedure not part of normal medical care, with the understanding that consent may be
withdrawn by the subject at any time without prejudice to future medical care

- Non-pregnant and non-nursing, study drug may be harmful to the developing fetus and
newborn; men and women of reproductive potential may not participate unless they have
agreed to use an effective contraceptive method while on the study

- No serious disease or condition that, in the opinion of the investigator, would
compromise the patient's ability to participate in the study

- Patients aged >= 60 years, or patients with a history of coronary artery disease,
congestive heart failure, hypertension, diabetes, or hyperlipidemia must have an
estimated ejection fraction >= 0.45 (45%) by Multi Gated Acquisition Scan (MUGA) or
echocardiography, performed within two months of study entry

Exclusion Criteria:

- Pregnant or breast feeding females

- Active serious infection requiring treatment (IV antibiotic, antivirals, or
antifungals) within 14 days prior to the start of carfilzomib

- Active hepatitis or uncontrolled human immunodeficiency virus (HIV)

- Unstable angina or myocardial infarction within 6 months prior to enrollment, New
York Heart Association (NYHA) Class III or IV heart failure, uncontrolled angina,
history of severe coronary artery disease, severe uncontrolled ventricular
arrhythmias, sick sinus syndrome, or electrocardiographic evidence of acute ischemia
or Grade 3 conduction system abnormalities unless subject has a pacemaker

- Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to the start
of carfilzomib

- Patients in whom the schedule of oral and IV fluid hydration is contraindicated,
e.g., due to pre-existing pulmonary, cardiac, or renal impairment, will not be
eligible to participate in the clinical trial

- Prior malignancies within the past 2 years with exception of adequately treated basal
cell, squamous cell skin cancer, or thyroid cancer; carcinoma in situ of the cervix
or breast; prostate cancer of Gleason Grade 6 or less with stable prostate specific
antigen (PSA) levels

- Significant peripheral neuropathy (Grades 3-4, or Grade 2 with pain) within 14 days
prior to the start of carfilzomib

- Known history of allergy to Captisol (a cyclodextrin derivative used to solubilize
carfilzomib)

- Concurrent use of other anti-cancer agents, investigative agents, or treatments

- Contraindication to any of the required concomitant drugs or supportive treatments,
including hypersensitivity to all anticoagulation and antiplatelet options, antiviral
drugs, or intolerance to hydration due to preexisting pulmonary or cardiac impairment

- Any other clinically significant medical disease or condition laboratory abnormality
or psychiatric illness that, in the Investigator's opinion, may interfere with
protocol adherence or a subject's ability to give informed consent

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

MTD of carfilzomib, determined by incidence of dose-limiting toxicity (DLT) as assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0

Outcome Time Frame:

28 days

Safety Issue:

Yes

Principal Investigator

Julie Vose

Investigator Role:

Principal Investigator

Investigator Affiliation:

University of Nebraska

Authority:

United States: Food and Drug Administration

Study ID:

518-10

NCT ID:

NCT01336920

Start Date:

June 2011

Completion Date:

Related Keywords:

  • Adult Nasal Type Extranodal NK/T-cell Lymphoma
  • Anaplastic Large Cell Lymphoma
  • Angioimmunoblastic T-cell Lymphoma
  • Peripheral T-cell Lymphoma
  • Recurrent Adult T-cell Leukemia/Lymphoma
  • Immunoblastic Lymphadenopathy
  • Leukemia
  • Leukemia, T-Cell
  • Leukemia-Lymphoma, Adult T-Cell
  • Lymphoma
  • Lymphoma, Large B-Cell, Diffuse
  • Lymphoma, Non-Hodgkin
  • Lymphoma, T-Cell
  • Lymphoma, T-Cell, Peripheral
  • Lymphoma, Large-Cell, Anaplastic
  • Lymphoma, Extranodal NK-T-Cell

Name

Location

University of Nebraska Medical Center Omaha, Nebraska  68198-3330
M D Anderson Cancer Center Houston, Texas  77030