A Phase I/Randomized Phase II Trial of Idelalisib, Lenalidomide and Rituximab in Patients With Relapsed/Refractory Mantle Cell Lymphoma
Outline: This is a phase I, dose-escalation study followed by a phase II study.
The phase I treatment plan includes the following:
1. Lenalidomide will be tested at sequential dose levels in a standard 3+3 design.
1. Dose Level 0 = 15mg/day for days 1-21 every 28 days
2. Dose Level 1 = 20mg/day for days 1-21 every 28 days and
3. Dose Level 2 = 25mg/day for days 1-21 every 28 days.
Patients can continue lenalidomide for up to 48 weeks (12 cycles) of treatment.
2. Idelalisib will be orally administered starting at Dose Level 1 (150 mg twice daily)
for continuous 28-day cycles until progression, intolerence, or patient/physician
discretion.
3. Rituximab will be administered intravenously at 375 mg/m2 for cycle 1 (ie, cycle 1, day
1, day 8, day 15, day 22) and then on day 1 of cycles 4,6,8,10. There will be no dose
reductions or escalations of rituximab.
Patients are randomized to 1 of 2 treatment arms in the Phase II treatment plan described in
the "Arms" section. The primary and secondary objectives for this study are:
1. Phase I Primary Objective: To determine the safety and tolerability of the combination
of lenalidomide and rituximab with idelalisib in sequential dose cohorts.
2. Phase II Primary Objective: To determine the progression-free survival (PFS) of the
combination of lenalidomide and rituximab, with or without idelalisib in a randomized
phase II design.
3. Phase II Secondary Objectives:
1. To determine the overall response rate (ORR), complete response rate (CR), and
overall survival (OS) of the combination of lenalidomide and rituximab, with or
without idelalisib in a randomized phase II design.
2. To determine the prognostic and/or predictive significance of proliferation
markers and cell cycle components in patients with relapsed/refractory mantle cell
lymphoma (MCL) treated with idelalisib and lenalidomide.
3. To determine whether phosphorylated protein kinase B (pAKT) expression levels are
correlated with response to idelalisib plus lenalidomide.
4. To determine whether notch homolog 1, translocation-association (NOTCH1)
intracellular domain (ICD) immunohistochemistry (IHC) correlates with mutation and
outcome in MCL patients treated with idelalisib and lenalidomide.
5. To determine whether sex determining region Y-box 11 (SOX11) expression correlates
with response in patients with relapsed/refractory MCL treated with idelalisib and
lenalidomide.
6. To correlate cereblon (CRBN) expression with response in patients with
relapsed/refractory MCL treated with idelalisib and lenalidomide.
7. To evaluate several plasma cytokines and correlate observed changes to objective
response rates.
Interventional
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Maximum tolerated dose (MTD) of idelalisib and lenalidomide, determined according to incidence of dose-limiting toxicity (DLT) graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase I)
28 days
Yes
Sonali Smith, M.D.
Study Chair
University of Chicago
United States: Food and Drug Administration
A051201
NCT01838434
July 2013
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