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Phase I Trial of Nelfinavir and Bortezomib in Advanced Hematologic Malignancies


Phase 1
18 Years
N/A
Open (Enrolling)
Both
Leukemia, Lymphoma, Mature T-cell and Nk-cell Neoplasms, Multiple Myeloma and Plasma Cell Neoplasm

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Trial Information

Phase I Trial of Nelfinavir and Bortezomib in Advanced Hematologic Malignancies


OBJECTIVES:

- To assess the safety of nelfinavir mesylate in combination with bortezomib in patients
with relapsed or progressive, advanced hematologic malignancies.

- To establish the phase II recommended dose of nelfinavir mesylate in these patients.

OUTLINE: This is a multicenter, dose-escalation study of nelfinavir mesylate.

Patients receive oral nelfinavir mesylate twice daily on days 1-21 and bortezomib IV on days
8, 11, 15, and 18 in course 1. Course 1 has a duration of 28 days. Beginning in course 2,
patients receive oral nelfinavir mesylate twice daily on days 1-14 and bortezomib IV on days
1, 4, 8, and 11. Treatment repeats every 21 days for 2 courses. Patients with responding
disease may continue to receive nelfinavir mesylate and bortezomib for up to 4 additional
courses.

After completion of study treatment, patients are followed for 30 days.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Diagnosed with advanced hematologic malignancies meeting the following criteria:

- Multiple myeloma

- Received ≥ 2 lines of prior chemotherapy (induction chemotherapy followed
by high-dose chemotherapy and autologous stem cell transplant with or
without maintenance therapy is considered one line of therapy)

- Acute myeloid leukemia

- Acute lymphoblastic leukemia

- Diffuse large B-cell lymphoma

- Hodgkin lymphoma

- Mantle cell lymphoma

- Mature T- and NK-cell neoplasms restricted to the following WHO-defined
entities:

- T-cell prolymphocytic leukemia

- T-cell large granular lymphocytic leukemia

- Aggressive NK-cell leukemia

- Adult T-cell leukemia/lymphoma

- Extranodal NK/T-cell lymphoma (nasal type)

- Mycosis fungoides

- Sézary syndrome

- Primary CD30-positive T-cell lymphoproliferative disorders

- Primary cutaneous anaplastic large cell lymphoma

- Primary cutaneous gamma-delta T-cell lymphoma

- Peripheral T-cell lymphoma (not otherwise specified)

- Angioimmunoblastic T-cell lymphoma

- Anaplastic large cell lymphoma (ALK-positive/ALK-negative)

- Grade 3B follicular lymphoma

- Relapsed following or progressed during standard therapy

- Meeting the following criteria:

- Standard intensive therapy is not feasible

- Current disease state for which there is no standard effective therapy

- Refused standard therapy where no curative option exists

- Measurable disease, defined as the following:

- Myeloma: measurable serum monoclonal protein > 1 g/dL for IgG, or > 0.5 g/dL for
IgA, IgM or IgD, or difference between involved and uninvolved free light chain
levels in serum > 100 mg/L

- Lymphoma: must have ≥ 1 lesion measurable by CT (longest diameter ≥ 15 mm)

- Acute leukemia: ≥ 20% blasts in bone marrow or in peripheral blood (≥ 200/mL
blasts in peripheral blood)

- No HIV-associated lymphoma

PATIENT CHARACTERISTICS:

- WHO performance status 0-2

- Absolute neutrophil count ≥ 1,500/mm³

- Platelet count ≥ 75,000/mm³ (if bone marrow impairment, ≥ 20,000/mm^3)

- Hemoglobin > 80 g/L (if considered to be caused by the underlying hematologic
malignancy or bone marrow impairment, > 80 g/L after transfusion)

- Bilirubin ≤ 1.5 times upper limit of normal (ULN) (if suspected hemolysis, direct
bilirubin ≤ 1.5 times ULN)

- ALT ≤ 2.5 times ULN

- Calculated creatinine clearance > 30 mL/min

- Not pregnant or nursing

- Negative pregnancy test

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

- Willing and capable to comply with an oral regimen

- Capable of understanding information given by the investigator on the trial

- Able to adhere and remain in geographic proximity to allow proper staging, treatment,
and followup

- No other non-hematologic malignancy within the past 5 years, except adequately
treated cervical carcinoma in situ or localized nonmelanoma skin cancer

- No known chronic hepatitis B or C infection or known HIV infection

- No serious underlying medical condition (at the judgment of the investigator) which
would impair the ability of the patient to participate in the trial, including any of
the following:

- Active autoimmune disease

- Uncontrolled diabetes

- Ongoing or active infection

- Symptomatic congestive heart failure

- Unstable angina pectoris

- Cardiac arrhythmia

- Psychiatric disorder

- No myocardial infarction within the past 6 months

- No polyneuropathy > grade 1 significantly interfering with activities of daily living
or painful polyneuropathy

- No known hypersensitivity to trial drugs or hypersensitivity to any other component
of the trial drugs

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No more than 4 prior lines of chemotherapeutic regimens (induction chemotherapy
followed by high-dose chemotherapy and autologous stem cell transplant with or
without maintenance therapy is considered one line of therapy)

- More than 30 days since prior treatment in a clinical trial

- More than 30 days since prior and no concurrent chemotherapy or biologic agents

- For patients with acute leukemia, hydroxyurea may be given up to 48 hours before
first administration of the trial treatment, and low dose cytarabine (up to 20
mg/m^2) and mitoxantrone up to 20 mg up to 14 days before first dosing

- At least 1 week since prior and no concurrent CYP3A4 modulators

- No concurrent other experimental drugs

- No concurrent radiotherapy

- No concurrent antineoplastic therapy with chemotherapeutic or biologic agents

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Dose limiting toxicity

Outcome Time Frame:

during first cycle

Safety Issue:

Yes

Principal Investigator

Christoph Driessen, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Kantonsspital St. Gallen

Authority:

Switzerland: Swissmedic

Study ID:

SAKK 65/08

NCT ID:

NCT01164709

Start Date:

July 2010

Completion Date:

March 2013

Related Keywords:

  • Leukemia
  • Lymphoma
  • Mature T-cell and Nk-cell Neoplasms
  • Multiple Myeloma and Plasma Cell Neoplasm
  • refractory multiple myeloma
  • recurrent adult acute myeloid leukemia
  • recurrent adult acute lymphoblastic leukemia
  • recurrent adult diffuse large cell lymphoma
  • recurrent adult Hodgkin lymphoma
  • recurrent mantle cell lymphoma
  • recurrent adult T-cell leukemia/lymphoma
  • adult nasal type extranodal NK/T-cell lymphoma
  • angioimmunoblastic T-cell lymphoma
  • peripheral T-cell lymphoma
  • T-cell large granular lymphocyte leukemia
  • anaplastic large cell lymphoma
  • recurrent grade 3 follicular lymphoma
  • recurrent cutaneous T-cell non-Hodgkin lymphoma
  • recurrent mycosis fungoides/Sezary syndrome
  • aggressive NK-cell leukemia
  • adult acute myeloid leukemia with 11q23 (MLL) abnormalities
  • adult acute myeloid leukemia with inv(16)(p13;q22)
  • adult acute myeloid leukemia with t(15;17)(q22;q12)
  • adult acute myeloid leukemia with t(16;16)(p13;q22)
  • adult acute myeloid leukemia with t(8;21)(q22;q22)
  • secondary acute myeloid leukemia
  • stage III adult diffuse large cell lymphoma
  • stage IV adult diffuse large cell lymphoma
  • stage III adult Hodgkin lymphoma
  • stage IV adult Hodgkin lymphoma
  • stage III mantle cell lymphoma
  • stage IV mantle cell lymphoma
  • stage III adult T-cell leukemia/lymphoma
  • stage IV adult T-cell leukemia/lymphoma
  • stage III grade 3 follicular lymphoma
  • stage IV grade 3 follicular lymphoma
  • stage III mycosis fungoides/Sezary syndrome
  • stage IV mycosis fungoides/Sezary syndrome
  • stage III cutaneous T-cell non-Hodgkin lymphoma
  • stage IV cutaneous T-cell non-Hodgkin lymphoma
  • prolymphocytic leukemia
  • Neoplasms
  • Leukemia
  • Lymphoma
  • Multiple Myeloma
  • Neoplasms, Plasma Cell
  • Plasmacytoma

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