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Comparing Two Schedules of Rituximab Maintenance in Rituximab-Responding Patients With Untreated, Chemotherapy Resistant or Relapsed Follicular Lymphoma: A Randomized Phase III Trial


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Lymphoma

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Trial Information

Comparing Two Schedules of Rituximab Maintenance in Rituximab-Responding Patients With Untreated, Chemotherapy Resistant or Relapsed Follicular Lymphoma: A Randomized Phase III Trial


OBJECTIVES:

Primary

- Compare the efficacy of induction therapy with rituximab followed by short- vs
long-term maintenance therapy with rituximab, in terms of event-free survival, in
patients with follicular non-Hodgkin's lymphoma.

Secondary

- Compare the safety of these regimens in these patients.

- Compare the pharmaeconomical aspects of these regimens in these patients.

- Compare the evolution of immunologic competence in patients treated with these
regimens.

OUTLINE: This is a randomized, multicenter study.

- Induction therapy: Patients receive rituximab IV weekly in weeks 1-4 and undergo
restaging between weeks 11-13. Patients with stable disease or progressive disease are
taken off study. Patients achieving partial or complete response are stratified
according to prior treatment status (untreated* vs treated with or without anti-CD20
therapy), presence of bulky disease** at study entry (yes vs no), and participating
center. Patients are then randomized to 1 of 2 maintenance treatment arms.

NOTE: *Patients treated with radiotherapy only are considered as therapy-naïve.

NOTE: **Defined as a mass or lymph node conglomerate ≥ 5 cm diameter.

- Maintenance therapy: Patients start maintenance therapy within 7 days of randomization.

- Arm I: Patients receive rituximab IV every 2 months for 4 treatments.

- Arm II: Patients receive rituximab IV every 2 months for up to 5 years in the
absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months until disease
progression or relapse and then annually for up to 10 years after randomization.

PROJECTED ACCRUAL: A total of 270 patients will be accrued for this study within 3 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed follicular lymphoma

- Grade 1, 2, 3a, or 3b disease by WHO staging system

- CD20-positive by immunohistochemistry

- Previously untreated disease OR meets 1 of the following criteria for response to
prior treatment:

- Chemotherapy-resistant disease

- Relapsed or progressive disease

- Stable disease

- At least 12 weeks since prior systemic treatment

- At least 1 bidimensionally measurable lesion ≥ 11 mm by CT scan or MRI

- No transformation to high-grade lymphoma secondary to low-grade follicular lymphoma

- No prior or current CNS disease (i.e., CNS lymphoma or lymphomatous meningosis) NOTE:
A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ.
The terminology of "indolent" or "aggressive" lymphoma will replace the former
terminology of "low", "intermediate", or "high" grade lymphoma. However, this
protocol uses the former terminology.

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- WHO 0-2

Life expectancy

- Not specified

Hematopoietic

- Not specified

Hepatic

- Not specified

Renal

- Not specified

Cardiovascular

- Ejection fraction ≥ 50% by echocardiography or MUGA

Immunologic

- No acute or ongoing infection

- No HIV infection

- No active autoimmune disease

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for 12 months after
completion of the study treatment

- No uncontrolled diabetes mellitus

- No other medical condition that would preclude study participation

- No other malignancy except nonmelanoma skin cancer or adequately treated carcinoma in
situ of the cervix

- No other condition (e.g., geographic proximity) that would preclude study compliance
and follow-up

PRIOR CONCURRENT THERAPY:

Biologic therapy

- See Radiotherapy

- Prior rituximab allowed

Chemotherapy

- See Disease Characteristics

Endocrine therapy

- More than 4 weeks since prior regular administration of corticosteroids

- Dose equivalent to ≤ 20 mg/day prednisone allowed for conditions other than
lymphoma or lymphoma-related symptoms

- No concurrent corticosteroids for prevention or treatment of side effects except
acute life-threatening side effects

Radiotherapy

- Prior radiolabeled anti-CD20 therapy (administered alone or in combination with
cytostatic drugs) allowed provided patient has achieved partial or complete response
after the therapy

- At least 12 months since prior anti-CD20 therapy

Surgery

- Not specified

Other

- More than 30 days since prior systemic tumor therapy

- More than 30 days since prior participation in another clinical trial

- No other concurrent anticancer therapy

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Event-free survival

Outcome Time Frame:

at 10 years

Safety Issue:

No

Principal Investigator

Christian Taverna, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Kantonsspital Münsterlingen

Authority:

Switzerland: Swissmedic

Study ID:

SAKK 35/03

NCT ID:

NCT00227695

Start Date:

June 2004

Completion Date:

September 2017

Related Keywords:

  • Lymphoma
  • stage I grade 1 follicular lymphoma
  • stage I grade 2 follicular lymphoma
  • stage I grade 3 follicular lymphoma
  • stage III grade 1 follicular lymphoma
  • stage III grade 2 follicular lymphoma
  • stage III grade 3 follicular lymphoma
  • stage IV grade 1 follicular lymphoma
  • stage IV grade 2 follicular lymphoma
  • stage IV grade 3 follicular lymphoma
  • contiguous stage II grade 1 follicular lymphoma
  • contiguous stage II grade 2 follicular lymphoma
  • contiguous stage II grade 3 follicular lymphoma
  • noncontiguous stage II grade 1 follicular lymphoma
  • noncontiguous stage II grade 2 follicular lymphoma
  • noncontiguous stage II grade 3 follicular lymphoma
  • recurrent grade 1 follicular lymphoma
  • recurrent grade 2 follicular lymphoma
  • recurrent grade 3 follicular lymphoma
  • Lymphoma
  • Lymphoma, Follicular
  • Lymphoma, Non-Hodgkin

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