Dose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies

Overview[ - collapse ][ - ]

Purpose The subject is invited to take part in this research study because s/he has been diagnosed with Burkitt lymphoma and/or leukemia, Diffuse Large B-Cell Lymphoma (DLBCL), Primary Mediastinal B-cell Lymphoma (PMBCL), or Post-transplant Lymphoproliferative Disorder (PTLD). In an attempt to improve cure rates while reducing harmful effects from drugs, oncologists are developing new treatment protocols. One such protocol, entitled dose-adjusted EPOCH-R, utilizes two major new strategies. First, the treatment approach utilizes continuous infusion of chemotherapy over four days, instead of being administered over minutes or hours. Secondly, the doses of some medications involved are increased or decreased based on how the drugs affect the subject's ability to produce blood cells, which is used as a measure of how rapidly the body is processing drugs. Using this approach in adults, researchers have shown improved cure rates in these cancers. Additionally, the harmful effects experienced by patients has been mild, with mucositis, severe infections, and tumor lysis syndrome occurring rarely. However, this new dosing method has never been used in children, and the effectiveness and side effects of this new method are unknown in children. The purpose of this study is to look at the safety of dose-adjusted EPOCH-R in the treatment of children with mature B-cell cancers, and to see if we can maintain cure rates (as has been shown in adults). This study represents the first trial of dose-adjusted EPOCH-R in children.
ConditionBurkitt Lymphoma
Burkitt Leukemia
Diffuse Large B Cell Lymphoma
Post Transplant Lymphoproliferative Disorder
Primary Mediastinal (Thymic) Large B-cell Lymphoma
InterventionDrug: DA-EPOCH-R for BL and B-ALL
Drug: Methotrexate
Drug: Etoposide
Drug: Doxorubicin
Drug: Vincristine
Drug: Rituximab
Drug: Cyclophosphamide
Drug: Prednisone
Drug: G-CSF
Drug: DA-EPOCH-R for DLBCL, PTLD & PMBCL
PhaseN/A
SponsorBaylor College of Medicine
Responsible PartyBaylor College of Medicine
ClinicalTrials.gov IdentifierNCT01760226
First ReceivedDecember 17, 2012
Last UpdatedOctober 22, 2013
Last verifiedOctober 2013

Tracking Information[ + expand ][ + ]

First Received DateDecember 17, 2012
Last Updated DateOctober 22, 2013
Start DateJanuary 2013
Estimated Primary Completion DateJanuary 2026
Current Primary Outcome MeasuresMeasure and assess adverse events [Time Frame: 1 year] [Designated as safety issue: Yes]Adverse event data will be collected to evaluate the safety and feasibility of dose-adjusted EPOCH-R in the treatment of children with mature B-cell malignancies.
Current Secondary Outcome MeasuresMeasure and assess immune function [Time Frame: 1 year] [Designated as safety issue: No]Blood will be taken to identify tumor and plasma biomarkers and mutations in patients with mature B-cell malignancies that correlate with disease response and outcome using this novel therapeutic approach.

Descriptive Information[ + expand ][ + ]

Brief TitleDose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies
Official TitleUse of Dose Adjusted EPOCH-R in the Treatment of Childhood Mature B Cell Malignancies
Brief Summary
The subject is invited to take part in this research study because s/he has been diagnosed
with Burkitt lymphoma and/or leukemia, Diffuse Large B-Cell Lymphoma (DLBCL), Primary
Mediastinal B-cell Lymphoma (PMBCL), or Post-transplant Lymphoproliferative Disorder (PTLD).

In an attempt to improve cure rates while reducing harmful effects from drugs, oncologists
are developing new treatment protocols. One such protocol, entitled dose-adjusted EPOCH-R,
utilizes two major new strategies. First, the treatment approach utilizes continuous
infusion of chemotherapy over four days, instead of being administered over minutes or
hours. Secondly, the doses of some medications involved are increased or decreased based on
how the drugs affect the subject's ability to produce blood cells, which is used as a
measure of how rapidly the body is processing drugs.

Using this approach in adults, researchers have shown improved cure rates in these cancers.
Additionally, the harmful effects experienced by patients has been mild, with mucositis,
severe infections, and tumor lysis syndrome occurring rarely. However, this new dosing
method has never been used in children, and the effectiveness and side effects of this new
method are unknown in children.

The purpose of this study is to look at the safety of dose-adjusted EPOCH-R in the treatment
of children with mature B-cell cancers, and to see if we can maintain cure rates (as has
been shown in adults). This study represents the first trial of dose-adjusted EPOCH-R in
children.
Detailed Description
The subject will need to have a variety of tests, exams, or procedures to find out if s/he
can be on the study.

The subject will also require placement of a catheter that stays in the vein for safe
administration of chemotherapy drugs.

During the study...

If all of the tests that have been done show that s/he can participate and s/he chooses to
participate, treatment cycles will begin.

For patients with Burkitt Lymphoma and B-ALL:

A cycle equals three weeks. The subject will have a minimum of 6 cycles of treatment. The
cancer drugs s/he will receive are etoposide, vincristine, doxorubicin, cyclophosphamide,
prednisone, and rituximab with each cycle. The amount of the drugs will be determined by the
subject's weight at first, and some of the drugs will be adjusted up or down for later
cycles.

After two cycles of treatment, the subject will have imaging scans to see how the cancer
responded to treatment. If the cancer responded partially or completely to treatment, s/he
will receive an additional four cycles of treatment that are dose-adjusted like before.

For subjects with DLBCL, PTLD, and PMBCL:

A cycle equals three weeks. The subject will have a minimum of 6 cycles of treatment,
possibly 8. The cancer drugs s/he will receive are etoposide, vincristine, doxorubicin,
cyclophosphamide, prednisone, and rituximab with each cycle. The amount of the drugs will be
determined by the subject's weight at first, and some of the drugs will be adjusted up or
down for later cycles.

Rituximab will be given on Day 1 prior to continuous infusion drugs.

After 4 cycles, the subject will have imaging scans again to see how the cancer responded
to treatment. If the cancer responds completely after 4 cycles, s/he will get 2 more cycles
(6 cycles total). If the cancer partially responds, s/he will get 4 more cycles (8 total
cycles).

For all subjects:

If the subject has cancer in the Central Nervous System, s/he will receive a drug called
methotrexate. If s/he does not have cancer in the CNS, s/he will get methotrexate to try to
prevent CNS cancer.
Study TypeInterventional
Study PhaseN/A
Study DesignAllocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Condition
  • Burkitt Lymphoma
  • Burkitt Leukemia
  • Diffuse Large B Cell Lymphoma
  • Post Transplant Lymphoproliferative Disorder
  • Primary Mediastinal (Thymic) Large B-cell Lymphoma
InterventionDrug: DA-EPOCH-R for BL and B-ALL
Day 1: Rituximab IV
Days 1-4: After rituximab, etoposide, vincristine, and doxorubicin will be given in a vein over 96 hours as a continuous infusion.
Day 5: cyclophosphamide will be given in a vein
Days 1-5: prednisone given by mouth twice a day
G-CSF 5mcg/kg/day will be given under the skin from day 6 until ANC has improved.
Drug: Methotrexate
CNS negative patients with Burkitt's lymphoma and high CNS risk DLBCL will receive age based, intrathecal dosing of MTX on days 1 and 5 of cycles 3 - 6 only.
CNS positive patients will receive age based, intrathecal (within the spinal fluid) MTX twice weekly for 2 weeks past the first negative cytology with a minimum of 4 weeks treatment. Then, weekly for 6 weeks and then every 4 weeks for 6 months.
DLBCL/PTLD/PMBCL CNS prophylaxis for cycles 3-6 ONLY if:
2+ extranodal sites
elevated LDH,
MYC rearrangement OR
bone or marrow disease.
ALL OTHERS receive IT MTX cycles 3-6.
Other Names:
MTXDrug: Etoposide
Etoposide will be given at 50mg/m2/day on days 1-4 of the first cycle of therapy (dose based on patient height and weight). The doses in later cycles will be adjusted up or down based on the patient's blood test results.
Other Names:
VP-16Drug: Doxorubicin
Doxorubicin will be given at 10mg/m2/day on days 1-4 of the first cycle (dose based on patient height and weight). The doses in later cycles will be adjusted up or down based on the patient's blood test results.
Other Names:
  • Adriamycin
  • hydroxydaunorubicin
Drug: Vincristine
Vincristine will be given on days 1-4 of each cycle at 0.4mg/m2/day (dose based on patient height and weight).
Other Names:
  • Oncovin
  • LCR
  • VCR
  • Vincasar Pfs
Drug: Rituximab
Rituximab (375mg/m2/dose) will only be given on Day 1 of each cycle prior to all the other chemotherapy agents. Dose is based on patient height and weight.
Other Names:
RituxanDrug: Cyclophosphamide
Cyclophosphamide will be given on Day 5 of each cycle. In cycle 1, the dose will be 750 mg/m2 (based on patient height and weight), and the dose will be adjusted up or down for future cycles based on blood test results.
Other Names:
  • Cytoxan
  • Neosar
  • CTX
Drug: Prednisone
Prednisone will be given by mouth at 60mg/m2/dose (based on height and weight) twice a day on days 1-5 of each cycle.
Other Names:
DeltasoneDrug: G-CSF
G-CSF will be given at 5 mcg/kg/day during each cycle, starting on day 6, until the patient's ANC (absolute neutrophil count) is greater than 5000/mcL past nadir.
Other Names:
  • Neupogen
  • Granulocyte - Colony Stimulating Factor
Drug: DA-EPOCH-R for DLBCL, PTLD & PMBCL
Day 1: Rituximab IV
Days 1-4: After rituximab, etoposide, vincristine, and doxorubicin will be given in a vein over 96 hours as a continuous infusion.
Day 5: cyclophosphamide will be given in a vein
Days 1-5: prednisone given by mouth twice a day
G-CSF 5mcg/kg/day will be given under the skin from day 6 until ANC has improved.
Other Names:
DA-EPOCH-R
Study Arm (s)
  • Experimental: DA-EPOCH-R for DLBCL, PTLD & PMBCL
    Minimum of 6 cycles (cycle=3 weeks), possibly 8. Dosages of the drugs will be determined by the subject's weight and height for cycle 1. Thereafter, the dosages of some drugs will be adjusted up or down for the next cycle, dependent on the blood tests results.
    DA-EPOCH-R for 2 cycles then two more cycles of DA-EPOCH-R. If complete response (CR), then DA-EPOCH-R for more 2 cycles. If no CR, DA-EPOCH-R for 4 more cycles.
  • Experimental: DA-EPOCH-R for BL and B-ALL
    Minimum of 6 cycles (cycle=3 weeks). Dosages of the drugs will be determined by the subject's weight and height for cycle 1. Thereafter, some of the dosages will be adjusted up or down for the next cycle, dependent on the blood tests results.
    DA-EPOCH-R for 2 cycles then DA-EPOCH-R for 4 cycles plus CNS prophylaxis.

Recruitment Information[ + expand ][ + ]

Recruitment StatusRecruiting
Estimated Enrollment12
Estimated Completion DateJanuary 2026
Estimated Primary Completion DateJanuary 2017
Eligibility Criteria
Inclusion Criteria:

- Patient with newly diagnosed, histologically confirmed, Group B or C Burkitt lymphoma
or leukemia (acute lymphoblastic leukemia, L3 subtype); diffuse large B-cell
lymphoma; or primary mediastinal B-cell lymphoma. Patients with Group B/C post
transplant lymphoproliferative disorder are eligible for the study regardless of
whether disease is newly diagnosed. (Murphy staging will be used for group
classification.)

Exclusion Criteria:

- Patient who has received previous chemotherapy or radiation therapy in the previous 3
months, except for empiric initial intrathecal administration at diagnosis. Rituximab
or steroid administration is not an exclusion criterion.

- Patient who has received any prior anthracyclines.

- Patient with symptomatic cardiac failure unrelieved by medical therapy or evidence of
significant cardiac dysfunction by echocardiogram (shortening fraction <28%) NOT due
to mediastinal mass.

- Patient with severe renal disease (i.e. creatinine greater than 3 times normal for
age; creatinine clearance less than 50 ml/min/1.73m2).

- Patient with severe hepatic disease (direct bilirubin greater than 3 mg/dl or AST
greater than 500 IU/L).

- Patient with a Karnofsky performance score <50% or Lansky score <50%.

- HIV-positive patients will be excluded unless antiretroviral therapy can be safely
withheld during chemotherapy administration, based on clinical determination of
infectious disease team evaluation.

- Female patient who is pregnant or breastfeeding.

- Patient with reproductive potential not willing to use an acceptable method of birth
control (i.e. hormonal contraception, intrauterine device, condom or diaphragm with
spermicide, or abstinence) for the duration of the study and one year post completion
of therapy.

- Patient with group classification A disease, or group classification B stage I or II
disease with normal LDH level AND tumor mass less than 7 cm.
GenderBoth
AgesN/A
Accepts Healthy VolunteersNo
ContactsContact: Stephen Simko, MD
832-824-4848
sjsimko@txch.org
Location CountriesUnited States

Administrative Information[ + expand ][ + ]

NCT Number NCT01760226
Other Study ID NumbersH-30759, DA-EPOCH-R
Has Data Monitoring CommitteeYes
Information Provided ByBaylor College of Medicine
Study SponsorBaylor College of Medicine
CollaboratorsNational Cancer Institute (NCI)
Texas Children's Hospital
Investigators Principal Investigator: Stephen Simko, MD Baylor College of Medicine
Verification DateOctober 2013

Locations[ + expand ][ + ]

Texas Children's Hospital
Houston, Texas, United States, 77030
Contact: Stephen Simko, MD | 832-824-4848 | sjsimko@txch.org
Recruiting