Romidepsin and Lenalidomide in Treating Patients With Previously Untreated Peripheral T-Cell Lymphoma

Phase 2

Active, not recruiting

Conditions: Adult Nasal Type Extranodal NK/T-cell Lymphoma
Hepatosplenic T-cell Lymphoma
Peripheral T-cell Lymphoma
Stage II Cutaneous T-cell Non-Hodgkin Lymphoma
Stage IIIB Mycosis Fungoides/Sezary Syndrome
Stage IVB Mycosis Fungoides/Sezary Syndrome
Anaplastic Large Cell Lymphoma
Stage I Cutaneous T-cell Non-Hodgkin Lymphoma
Stage IA Mycosis Fungoides/Sezary Syndrome
Stage IVA Mycosis Fungoides/Sezary Syndrome

Interventions: Drug: romidepsin
Drug: lenalidomide
Other: laboratory biomarker analysis

Registration Number: NCT02232516

Lead Sponsor: Northwestern University

Brief Summary: The purpose of this study is to evaluate how safe and effective the combination of the study drugs romidepsin and lenalidomide is for treating patients with peripheral t-cell lymphoma (PTCL) who have not been previously treated for this cancer. Currently, there is no standard treatment for patients with PTCL; the most common treatment used is a combination of drugs called CHOP, but this can be a difficult treatment to tolerate because of side effects, and is not particularly effective for most patients with PTCL. Romidepsin (Istodax®) is a type of drug called an HDAC inhibitor. It interacts with DNA (genetic material in cells) in ways that can stop tumors from growing. It is given as an infusion through the veins. Lenalidomide (Revlimid®) is a type of drug known as an immunomodulatory drug, or IMID for short. This drug affects how tumor cells grow and survive, including affecting blood vessel growth in tumors. It is given as an oral tablet (by mouth).

Detailed Description: PRIMARY OBJECTIVES:

I. To evaluate the efficacy of the combination of romidepsin plus lenalidomide in patients with previously untreated peripheral T-cell lymphoma (PTCL).

SECONDARY OBJECTIVES:

I. Evaluate the safety of the combination of romidepsin and lenalidomide. II. Further evaluate efficacy of the combination of romidepsin and lenalidomide.

III. Evaluate the delay to cytotoxic chemotherapy.

TERTIARY OBJECTIVES:

I. Evaluate the use of Northwestern Medicine (NM) positron emission tomography (PET)/computed tomography (CT) vs CT imaging in PTCL.

II. Validate a new prognostic model for newly diagnosed PTCL. III. Investigate the tumor immunohistochemical profile to identify potential biomarkers associated with prognosis and treatment response.

OUTLINE:

Patients receive romidepsin intravenously (IV) over 4 hours on days 1, 8, and 15 and lenalidomide orally (PO) once daily (QD) on days 1-21. Treatment repeats every 28 days for up to 1 year in the absence of disease progression, inter-current illness that prevents further administration of treatment, unacceptable toxicity, patient decides to withdraw from study treatment (or study as a whole), or general or specific changes in the patient's condition render the patient unacceptable for further treatment in the judgment of the treating investigator.

After completion of study treatment, patients are followed up every 3 months for 1 year and then every 6 months for 3 years.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 30

Inclusion Criteria

Histologically confirmed diagnosis of PTCL (using the most recent edition of the World Health Organization [WHO] Classification of Tumors of Hematopoietic and Lymphoid Tissues as guidance) including:
- Anaplastic large cell lymphoma, anaplastic large cell kinase (ALK)-negative
- Angioimmunoblastic T-cell lymphoma
- Enteropathy-type T-cell lymphoma
- Extranodal natural killer (NK)/T-cell lymphoma, nasal type
- Hepatosplenic gamma-delta T-cell lymphoma
- Peripheral T-cell lymphoma, unspecified (not otherwise specified [NOS])
- Transformed mycosis fungoides
- Subcutaneous panniculitis-like T-cell lymphoma.
- NOTE: Patients with adequate archived (well-preserved, formalin-fixed) biopsy tissue remaining will be required to submit a portion for exploratory studies; this is not optional if tissue is available; however, lack of adequate tissue for exploratory studies will not preclude patients from participating
Patients must have bi-dimensionally measurable disease (>= 1 cm) by CT imaging
- NOTE: Patients with marrow-only disease are eligible; response for these patients will be assessed by repeat bone marrow biopsy
Patients must fit into one of the following categories:
- Age >= 18 years to < 60 years with a cumulative illness rating scale (CIRS) score >= 6 OR deemed ineligible for cytotoxic chemotherapy by the treating investigator
- >= 60 years
Patients must have adequate organ and marrow function (documented within 14 days prior to registration) as outlined below:
- Absolute neutrophil count (ANC) >= 750/mcl
- Hemoglobin >= 8 g/dl
- Platelets >= 50,000/mcl
- Total bilirubin =< 2 x upper limit normal (ULN)
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum pyruvate glutamate transaminase [SPGT]) =< 3 x ULN
- Creatinine =< 2 x ULN
Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status =< 2
All patients must agree to use effective contraception while on study, and all patients must agree to undergo counseling sessions every 28 days about pregnancy precautions and risks of fetal exposure
- Females of childbearing potential (FCBP) must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control: one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before starting lenalidomide, during lenalidomide therapy, during dose interruptions, and for at least 28 days following discontinuation of lenalidomide therapy
- Males receiving lenalidomide must agree to use a latex condom during any sexual contact with FCBPs even if they have undergone a successful vasectomy
- NOTE: A FCBP is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:
  - Has not undergone a hysterectomy or bilateral oophorectomy
  - Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months)
- FCBP should be referred to a qualified provider of contraceptive methods, if needed
FCPB must have a negative urine or serum pregnancy test within 7 days prior to registration, and be willing to adhere to the scheduled pregnancy testing as required in the Revlimid Risk Evaluation and Mitigation Strategies (REMS®) program
- NOTE: Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
Patients must be free of any prior malignancies for >= 1 year
- NOTE: The exception to this would be currently treated squamous cell and basal cell carcinoma of the skin, carcinoma in situ of the cervix, breast, or bladder, or surgically removed melanoma in situ of the skin (stage 0) with histologically confirmed free margins of excision
All study participants must be registered into the mandatory Revlimid REMS® program, and be willing and able to comply with the requirements of the REMS® program
Patients must have the ability to understand and the willingness to sign a written informed consent prior to registration

Exclusion Criteria

Patients with a diagnosis of any of the following are not eligible:
- Anaplastic large cell lymphoma, ALK-positive
- Adult T-cell lymphoma/leukemia (ATLL)
- Anaplastic large-cell lymphoma, primary cutaneous type
- Precursor T-lymphoblastic lymphoma/leukemia
- Mycosis fungoides/Sezary syndrome (except transformed Mycosis fungoides [MF])
- NK-cell leukemia
- T-cell granular lymphocytic leukemia
- T-cell prolymphocytic leukemia
Patients must not have received prior systemic therapy for PTCL (except for corticosteroids for 10 or fewer days at any dose, no washout period required as long as they discontinue prior to starting study therapy); NOTE: topical treatment may have been given for prior existence of cutaneous lymphoma that has since become systemic PTCL; however, these topical therapies should be stopped at time of registration
Patients who received chemotherapy (including monoclonal antibodies) or radiotherapy, administered for any condition, within 4 weeks prior to registration are not eligible
Patients who received prior exposure to any other histone deacetylase (HDAC) inhibitors or immunomodulatory (IMID) agents for any reason are not eligible
Patients receiving ongoing treatment with any other investigational agents are not eligible
Patients who have known central nervous system (CNS) involvement of lymphoma are not eligible
Patients who have an uncontrolled intercurrent illness including, but not limited to, any of the following are not eligible:
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia
- Psychiatric illness/social situations that would limit compliance with study requirements
Patients with a known human immunodeficiency (HIV) infection are not eligible
Patients who are pregnant or actively nursing an infant are not eligible
Patients with a QT interval > 500 msec (using the Bazett's formula) within 28 days prior to registration are not eligible

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Treatment (romidepsin, lenalidomide)	laboratory biomarker analysis	Patients receive romidepsin IV over 4 hours on days 1, 8, and 15 and lenalidomide PO QD on days 1-21. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity.
Treatment (romidepsin, lenalidomide)	romidepsin	Patients receive romidepsin IV over 4 hours on days 1, 8, and 15 and lenalidomide PO QD on days 1-21. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity.
Treatment (romidepsin, lenalidomide)	lenalidomide	Patients receive romidepsin IV over 4 hours on days 1, 8, and 15 and lenalidomide PO QD on days 1-21. Treatment repeats every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Objective Response Rate (ORR), as Defined Per Cheson Criteria	Assessed after cycles 3 and 6, then every 6 months up to 3 years	The endpoint for this objective will be objective response rate (ORR), defined per Cheson criteria. Response will be assessed by imaging after cycles 3 and 6, and then every 6 months thereafter. Response at 3 months (after cycle 3) will be used for purposes of the interim efficacy analysis.

Secondary Outcome Measures

Name	Time	Method
Delay to Cytotoxic Chemotherapy	Up to 1 year	Time to first cytotoxic chemotherapy is defined as the time (in months) from start of study treatment to time of first dose of anti-neoplastic cytotoxic chemotherapy that is administered to treat lymphoma.
Incidence of Toxicity Assessed Using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0	Evaluated once per cycle (1 cycle=28 days) up to 1 year.	The frequency and severity of toxicity events will be evaluated. All adverse events will be summarized as to type, severity, frequency, timing and attribution. Grade 3 or greater AEs that occurred in at least 10% of the patients are reported here
Progression-free Survival (PFS)	Reported at 1 and 3 years after the start of treatment	l be progression-free survival (PFS) 1 and 3 years after start of treatment as well as the duration of response from start of therapy, defined per Cheson criteria.
Overall Survival (OS)	Reported at 1 and 2 years after the start of treatment	Survival is defined as the duration of time from start of treatment to time of death, up to three years from the start of study treatment. Overall Survival (OS) is reported below as the proportion of patients who are alive at 1 and 2 years after starting treatment.
Duration of Response, Defined Per Cheson Criteria	Assessed from start of therapy for up to 3 years	The duration of overall response is measured from the time measurement criteria are met for Complete Remission or Partial Response (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented.

Trial Locations

Locations (5): City of Hope
🇺🇸
Duarte, California, United States
Weill Cornell Medicine
🇺🇸
New York, New York, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
🇺🇸
Seattle, Washington, United States
Yale University
🇺🇸
New Haven, Connecticut, United States