Diffuse Large B Cell Non-Hodgkin's Lymphoma in the Vulnerable/Frail Elderly. A Multicentric Randomized Phase II Trial With Emphasis on Geriatric Assessment and Quality of Life
70 Years
N/A
Both
Lymphoma
Trial Information
Diffuse Large B Cell Non-Hodgkin's Lymphoma in the Vulnerable/Frail Elderly. A Multicentric Randomized Phase II Trial With Emphasis on Geriatric Assessment and Quality of Life
OBJECTIVES:
Primary
- To assess the therapeutic efficacy of rituximab, cyclophosphamide, vincristine sulfate,
and prednisone with vs without liposome-encapsulated doxorubicin citrate, in terms of
complete remission rate at 6 months, in vulnerable or frail elderly patients with stage
II, III, or IV diffuse large B-cell non-Hodgkin lymphoma.
- To assess the safety of these regimens in these patients.
Secondary
- To evaluate the progression-free survival, event-free survival, and overall survival
rates at 6 and 24 months in patients treated with these regimens.
- To evaluate the overall response rate at 6 and 24 months in patients treated with these
regimens.
- To evaluate the duration of complete remission in patients treated with these regimens.
- To evaluate the acute side effects (according to the International CTC scale) of these
regimens in these patients.
- To evaluate the geriatric condition and quality of life of patients treated with these
regimens.
OUTLINE: This is a multicenter study. Patients are randomized to 1 of 2 treatment arms.
- Arm I (R-COP regimen): Patients receive rituximab IV, cyclophosphamide IV, and
vincristine sulfate IV on day 1. Patients also receive oral prednisone on days 1-5 and
filgrastim subcutaneously (SC) on days 8-14 or pegfilgrastim SC on day 2. Treatment
repeats every 21 days for at least 3 courses.
- Arm II (R-COPY regimen): Patients receive rituximab, cyclophosphamide, vincristine
sulfate, prednisone, and filgrastim or pegfilgrastim as in arm I. Patients also receive
liposome-encapsulated doxorubicin citrate IV on day 1. Treatment repeats every 21 days
for at least 3 courses.
After 3 courses of R-COP or R-COPY, patients undergo evaluation. Patients with disease
progression or a response of < 25% are removed from the study. Patients with a response of ≥
25% receive 3 more courses of R-COP or R-COPY, followed by rituximab IV alone on day 1 of
courses 7 and 8 in the absence of disease progression or unacceptable toxicity.
After the completion of chemotherapy, some patients may undergo radiotherapy.
Patients complete quality of life and geriatric assessment questionnaires at baseline and
periodically during study treatment.
After completion of study treatment, patients are followed every 3 months for 1 year, every
6 months for 2 years, and then annually thereafter.
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Diagnosis of diffuse large B-cell non-Hodgkin lymphoma
- Stage II, III, or IV disease (according to the WHO classification), including
all morphological and clinical variants
- No Burkitt-like lymphoma (presence of small cells in the bone marrow biopsy
allowed)
- CD20+ disease
- Has ≥ 1 measurable target lesion ≥ 1.1 cm (according to the International Workshop
Criteria)
- Poor physiological status, as defined by ≥ 1 of the following criteria:
- WHO performance status 3
- Clinical evaluation and measurement of LVEF that would preclude doxorubicin
administration (i.e., LVEF < 50%)
- Creatinine clearance < 50 mL/min
- Serum bilirubin > 30 μmol/L
- Severe comorbidity that would preclude the use of CHOP chemotherapy
- Ineligible for standard R-CHOP therapy
- No cerebral or meningeal involvement
PATIENT CHARACTERISTICS:
- WHO performance status 0-3
- ANC > 750/mm^3
- Platelet count > 50,000/mm^3
- LVEF > 35%
- Able to receive either R-COP or R-COPY therapy
- No congestive heart failure, serious arrhythmia, or myocardial infarction within the
past 6 months
- No other malignancy within the past 5 years except for adequately treated basal cell
carcinoma of the skin or curatively treated carcinoma in situ of the cervix
- No active infection
- No active viral hepatitis B or C by serology
- No known HIV positivity
- No hypersensitivity to rituximab, any of its excipients, or to murine proteins
- No documented history of allergy to eggs or egg products
- No psychological, familial, sociological, or geographical condition that would
preclude compliance with study treatment or follow-up schedule
PRIOR CONCURRENT THERAPY:
- No prior therapy for this cancer
- No prior anthracycline administration with a cumulative dose > 240 mg/m² of
doxorubicin hydrochloride or > 400 mg/m² of epirubicin hydrochloride
- More than 30 days since prior participation in another clinical trial involving
investigational drugs
- No other concurrent antineoplastic agents
Type of Study:
Interventional
Study Design:
Allocation: Randomized, Primary Purpose: Treatment
Outcome Measure:
Complete remission rate at 6 months
Safety Issue:
No
Principal Investigator
Pierre Soubeyran, MD, PhD
Investigator Role:
Principal Investigator
Investigator Affiliation:
Institut Bergonié
Authority:
Unspecified
Study ID:
CDR0000636032
NCT ID:
NCT00911183
Start Date:
October 2008
Completion Date:
Related Keywords:
- Lymphoma
- contiguous stage II adult diffuse large cell lymphoma
- noncontiguous stage II adult diffuse large cell lymphoma
- stage III adult diffuse large cell lymphoma
- stage IV adult diffuse large cell lymphoma
- Lymphoma
- Lymphoma, Non-Hodgkin
- Lymphoma, B-Cell
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