A Phase 1 Trial of the Combination of Everolimus (RAD001) and Bortezomib (VELCADE) for Relapsed or Refractory Lymphoma
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed relapsed or refractory Non-Hodgkin lymphoma (NHL), according
to the World Health Organization (WHO)/Revised European-American Lymphoma
Classification, including any of the following subtypes:
- Mantle cell lymphoma
- Hairy cell leukemia
- Grade I, II, or III follicular lymphoma
- Marginal zone B-cell lymphoma
- Small lymphocytic lymphoma/B-cell chronic lymphocytic leukemia (SLL/CLL)
- Lymphoplasmacytic lymphoma (with or without Waldenstrom macroglobulinemia)
- History of transformed lymphoma and relapsed or refractory diffuse large B cell
lymphoma are included if patients are ineligible for or refuse hematopoietic stem
cell transplant
- Cutaneous B and T cell lymphoma are permitted. Cutaneous T cell lymphoma must be
refractory to 1 prior systemic therapy (topical therapy, photopheresis, and radiation
are not considered systemic therapy. Transformed B and T cell cutaneous lymphoma are
permitted.
- Relapsed or refractory nodal, leukemic, and extranodal T cell lymphomas are eligible.
Subtypes that are eligible include:
- Anaplastic large cell lymphoma
- Angioimmunoblastic T cell lymphoma
- PTCL-NOS
- Nasal or disseminated extranodal T/NK lymphoma
- Enteropathy-associated T cell lymphoma
- Hepatosplenic gamma/delta T cell lymphoma
- Subcutaneous panniculitis-like T cell lymphoma
- T-prolymphocytic leukemia
- Adult T-cell leukemia/lymphoma
- Large granular lymphocytic leukemia
- Aggressive NK leukemia
- Refractory to or relapsed after receiving ≥ 1 prior treatment regimen for lymphoma
(which may have included prior autologous stem cell transplantation) AND demonstrated
evidence of progressive disease by clinical and/or radiographic characteristics
- Measurable disease by radiographic criteria (≥ 2 cm by CT scan)
- Patients with leukemic forms of SLL/CLL must have an absolute lymphocytosis > 5
times 10^9/L with a B-cell phenotype and > 30% bone marrow lymphocytes
- No plasma cell myeloma or Hodgkin lymphoma
- No uncontrolled brain or leptomeningeal metastases, including ongoing requirement for
glucocorticoids for brain or leptomeningeal metastases
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2
- Bilirubin ≤ 1.5 times upper limit of normal (ULN) (unless attributed to active
hemolysis or ineffective erythropoiesis)
- AST or ALT ≤ 2.5 times ULN (≤ 5 times ULN for patients with liver involvement by
lymphoma)
- ANC ≥ 1,500/μL
- WBC ≥ 3,000/μL
- Platelet count ≥ 100,000/μL
- Hemoglobin ≥ 9.0 g/dL
- Creatinine ≤ 1.5 times ULN
- Fasting cholesterol > 300 mg/dL (or > 7.75 mmol/L)
- Fasting triglycerides > 2.5 times ULN
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Histologic confirmation of diagnosis, either are initial diagnosis or at any
subsequent relapse. Biopsy is not required at relapse, but is suggested
- No other malignancies within the past 3 years, except for adequately treated
carcinoma of the cervix, basal cell or squamous cell carcinoma of the skin, or
curatively treated low-risk prostate cancer
- No severe and/or uncontrolled medical condition that would preclude study
participation, including the following:
- Unstable angina pectoris
- New York Heart Association class III or IV symptomatic congestive heart failure
- Myocardial infarction within the past 6 months
- Serious uncontrolled cardiac arrhythmia
- Severely impaired lung function
- Any active (acute or chronic) or uncontrolled infection and/or disorder
- Liver disease (e.g., viral hepatitis B or C, cirrhosis, chronic active
hepatitis, or chronic persistent hepatitis)
- Known history of HIV seropositivity
- Impairment of gastrointestinal function or gastrointestinal disease that may
significantly alter the absorption of everolimus (e.g., ulcerative disease,
uncontrolled nausea, vomiting, or diarrhea, or malabsorption syndrome)
- Non-malignant medical illness that is uncontrolled or whose control may be
jeopardized by study therapy
- None of the following diabetic conditions:
- Diabetes mellitus currently requiring insulin therapy
- Preexisting poorly controlled diabetes mellitus (e.g., hemoglobin A1c value > 9%
within the past 4 weeks)
- Uncontrolled diabetes, defined by fasting serum glucose > 1.5 times ULN (off
medications)
- No preexisting peripheral neuropathy ≥ grade 2
- No active bleeding diathesis
- No known hypersensitivity to everolimus or other rapamycins (e.g., sirolimus,
temsirolimus) or to its excipients, or to bortezomib, boron, or mannitol
- No history of noncompliance to medical regimens
- No personal, medical, or psychiatric reason that would preclude compliance with study
requirements
PRIOR CONCURRENT THERAPY:
- More than 4 weeks since prior chemotherapy or investigational drug
- More than 3 months since prior monoclonal antibody
- More than 1 week since prior and no concurrent strong P450/CY3PA4 inhibitors
- No prior allogeneic stem cell transplantation
- No prior small bowel resection that may significantly alter the absorption of
everolimus
- No concurrent immunization with attenuated live vaccine
- No concurrent chronic treatment with systemic steroids or other immunosuppressive
agents
- No other concurrent investigational or anticancer agents