RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer cell growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cell-killing substances to them. Drugs used in chemotherapy, such as bendamustine hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Lenalidomide may stop the growth of cancer by blocking blood flow to the tumor. Giving rituximab together with bendamustine hydrochloride and lenalidomide may kill more cancer cells. PURPOSE: This phase I/II trial is studying the side effects and best dose of giving rituximab together with bendamustine hydrochloride and lenalidomide in treating patients with aggressive B-cell lymphoma.
OBJECTIVES: Primary * To determine the maximum-tolerated dose of the combination of rituximab, bendamustine hydrochloride, and lenalidomide in patients with aggressive B-cell lymphoma not eligible for anthracycline-based first-line treatment or intensive regimens including high-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) in refractory or relapsing disease, or as treatment for patients relapsing after HDT with ASCT. (phase I). * To identify the recommended dose of this regimen for a phase II study (phase I). * To determine the efficacy and safety of this regimen in these patients (phase II). Secondary * To assess the quality of life (QOL) of patients treated with this regimen (phase II). * To evaluate the usefulness and feasibility of the SAKK Cancer-Specific Geriatric Assessment (C-SGA) in patients treated with this regimen (phase II). * To assess the association between WHO performance status, QOL indicators, and SAKK C-SGA scores (phase II). * To describe changes in SAKK C-SGA scores from pre- to post-treatment and in QOL (phase II). OUTLINE: This is a multicenter, phase I dose-escalation study of bendamustine hydrochloride and lenalidomide followed by a phase II study. Patients receive rituximab IV on day 1, bendamustine hydrochloride IV over 30-60 minutes on days 1-2, and oral lenalidomide on days 1-21. Courses repeat every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients on phase II study complete the SAKK Cancer-Specific Geriatric Assessment at baseline and after completion of course 1. Patients also complete quality-of-life questionnaires at baseline and periodically during study. After completion of study therapy, patients are followed for up to 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
49
day 1 at a fixed dose of 375mg/m2
Bendamustine at day 1 and 2 according to the dose escalation in phase I, and at the recommended dose in phase II: 70mg/m2.
Lenalidomide at days 1-21 according to the dose escalation in phase I, and at the recommended dose in phase II: 10mg
Kantonsspital Baden
Baden, Switzerland
Universitaetsspital Basel
Basel, Switzerland
St. Claraspital AG
Basel, Switzerland
Istituto Oncologico della Svizzera Italiana - Ospedale Regionale Bellinzona e Valli
Bellinzona, Switzerland
Inselspital Bern
Bern, Switzerland
Kantonsspital Bruderholz
Bruderholz, Switzerland
Kantonsspital Graubünden
Chur, Switzerland
Hopital Fribourgeois
Fribourg, Switzerland
Hôpitaux Universitaires de Genève HUG
Geneva, Switzerland
Centre Hospitalier Universitaire Vaudois
Lausanne, Switzerland
...and 6 more locations
Dose-limiting toxicity (phase I)
Time frame: at 4 weeks.
Maximum-tolerated dose (phase I)
Time frame: at the end of phase I (31 August 2011)
Objective response (complete and partial response) (phase II)
Time frame: phase II (3 years)
Adverse events according to NCI CTCAE v. 3.0
Time frame: All AEs will be assessed according to NCI CTCAE v3.0 until 30 days after trial therapy end.
Event-free survival (phase II)
Time frame: up to 30 months for each patient.
Response duration (phase II)
From the time when criteria for response (CR/CRu or PR) are met, until documentation of relapse or progression thereafter. Only patients with a response (CR/ CRu or PR) shall be included in this analysis. Patients with no disease progression or relapse shall be censored at the last time they were known to be in remission
Time frame: up to 30 months for each patient.
Time to progression (phase II)
Defined as the time from registration until documented lymphoma progression or death as a result of lymphoma. Patients not experiencing an event will be censored at the last time they were known to be in remission
Time frame: up to 30 months for each patient.
Overall survival (phase II)
Time frame: up to 30 months for each patient.
Quality of life
Time frame: approx. 5 months for each patient.
Usefulness and feasibility of the SAKK C-SGA
Time frame: End of phase II (excluding follow-up) at 3 years.
Association between WHO performance status, QOL indicators, and SAKK C-SGA scores
Time frame: End of phase II (excluding follow-up) at 3 years.
Progression Free Survival (PFS)
Time from registration until one of the following events (whichever occurs first): * Relapse or progression assessed according to the International Workshop NHL criteria (1999) * Death of any cause
Time frame: up to 30 months for each patient.
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