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A Multi-center, Phase IB/II, Open Label, Single Arm Study of Inotuzumab Ozogamicin Plus Rituximab (R-CMC544)Alternating With Gemcitabine-oxaliplatin Plus Rituximab(R-GEMOX)in Patients Aged From 18 to 80 Years With CD20 and CD22 Positive Diffuse Large B-cell Lymphoma (DLBCL) in Relapse After/Refractory to 1ST or 2ND Line Treatment, Who Are no Candidates for Autologous Transplant.


Phase 1/Phase 2
18 Years
80 Years
Open (Enrolling)
Both
Diffuse Large B-Cell Lymphoma

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Trial Information

A Multi-center, Phase IB/II, Open Label, Single Arm Study of Inotuzumab Ozogamicin Plus Rituximab (R-CMC544)Alternating With Gemcitabine-oxaliplatin Plus Rituximab(R-GEMOX)in Patients Aged From 18 to 80 Years With CD20 and CD22 Positive Diffuse Large B-cell Lymphoma (DLBCL) in Relapse After/Refractory to 1ST or 2ND Line Treatment, Who Are no Candidates for Autologous Transplant.


This study is a multicenter, phase Ib/II, open-label, single arm trial evaluating the
efficacy and safety of R-CMC544 alternated with R-GEMOX in patients with CD20 and CD22
positive DLBCL in relapse after/refractory to 1st or 2nd line treatment, who are no
candidates for autologous transplant.

The study consists of 2 phases. In part 1 (potential dose de-escalation phase) subjects will
be enrolled at a fixed dose of CMC544. In case of occurrence of dose limiting toxicity
(DLT), cohorts of 3 to 6 subjects will evaluate a de-escalating dose of CMC544 in
combination with set doses of rituximab, gemcitabine and oxaliplatin in order to obtain the
MTD or recommended dose of CMC544 in this regimen. In part 2 (dose expansion phase) further
safety and preliminary efficacy data of the proposed combination will be analyzed.

All patients will receive two 56 day induction cycles of alternating R-CMC544 (given on day
1) and R-GEMOX (given on day 29 and 43). Patients who obtain CR or PR, will then go on a
consolidation of another two 56 day cycles of alternating R-CMC544 (given on day 1) and
R-GEMOX (given on day 29 and 43).


Inclusion Criteria:



- Histologically documented CD20 and CD22 positive diffuse large B-cell lymphoma,
according to WHO classification. CD20 and CD22 immunophenotyping at initial diagnosis
is acceptable. If such prior documentation is not available, then the
immunophenotyping at relapse must be established by fine-needle aspirate or biopsy
or by circulating CD20 and CD22 positive NHL cells from peripheral blood during
screening. Upon registration the pathological report confirming the diagnosis, must
be available

- In first or second relapse or refractory to first and/or second line treatment.
Refractory is defined as having exhibited less than or PR to a prior rituximab
containing regimen or having relapsed within 6 months of the last dose of a prior
rituximab containing regimen.

- Measurable disease by bidimensional transverse CT scan assessment

- Not eligible for autologous transplantation.

- Previously treated with a chemotherapy regimen containing anthracyclines and
rituximab.

- Aged 18 - 80 years.

- ECOG performance status 0 to 2.

- Minimum life expectancy of 3 months.

- Signed written informed consent.

Exclusion Criteria:

- Burkitt, mantle cell and T-cell lymphomas.

- Central nervous system or meningeal involvement by the lymphoma.

- Contraindication to any drug contained in the R-GEMOX combination chemotherapy.

- Treatment with any investigational drug within 30 days before the first planned cycle
of chemotherapy and during the study.

- Nitrosurea or mitomycin C administration within 6 weeks prior to study start.

- Major debulking surgery within 3 weeks of treatment.

- Any of the following lab abnormalities (unless related to the lymphoma or bone marrow
infiltration):

Absolute neutrophil count (ANC) < 1.500/µL (1,5.109/L).

Platelet count < 100.000/µL (100.109/L).

Creatinin level > 150 µmol/L (1,7 mg/dL) or 1,5 - 2,0x ULN.

Total bilirubin level > 30 µmol/L (1,8 mg/dL) or 1,5x ULN.

Serum AST/SGOT or ALT/SGPT >2,5x ULN.

- Documented infection with HIV, active hepatitis B or C infection.

- Any serious active disease or co-morbid medical condition that, according to the
investigator's decision, will substantially increase the risk associated with the
subject's participation in the study. Prior history of malignancies other than
lymphoma with the exception of non-melanoma skin tumors (basal cell or squamous cell
carcinoma of the skin) or stage 0 (in situ) cervical carcinoma unless the subject has
been disease-free for 5 or more years..

- LVEF less than 50% (measured by echocardiography or scintigraphy).

- Previous myocardial infarction or pulmonary hypertension within 6 months before the
first dose of investigational product.

- Congestive heart failure NYHA stage III or IV

- Known chronic liver disease (eg. Cirrhosis) or suspected alcohol abuse.

- Pregnant or lactating females

- Men and women who are biologically capable of having children not willing to use an
adequate method of birth control during the study and up to 18 months after the last
dose of investigational product.

- Adult patient unable to provide informed consent because of intellectual impairment,
any serious medical condition, laboratory abnormality or psychiatric illness.

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Determination of the Recommended Dose of R-CMC544

Outcome Description:

Determination of recommended dose will be based on safety parameters and particularly on incidence of DLTs

Outcome Time Frame:

Up to 16 weeks

Safety Issue:

Yes

Principal Investigator

Fritz OFFNER, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Lymphoma Study Association

Authority:

Belgium: Federal Agency for Medicinal Products and Health Products

Study ID:

CMC-R-GEMOX

NCT ID:

NCT01562990

Start Date:

December 2012

Completion Date:

October 2016

Related Keywords:

  • Diffuse Large B-Cell Lymphoma
  • Lymphoma
  • Lymphoma, B-Cell
  • Lymphoma, Large B-Cell, Diffuse

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