This is a dose-escalation to determine the MTD and/or RPII for combinations of ibrutinib (PCI-32765) plus lenalidomide/rituximab in patients with relapsed/refractory mantle cell lymphoma.
Mantle cell lymphoma (MCL) is a relatively rare subtype (3% to 6% (Zhou, 2008) of mature B cell non-Hodgkin lymphomas (NHL), with a median age at diagnosis in mid to late 60's, a male predominance (3/1) and typically advanced stage presentation though only about 1/3 of patients are truly symptomatic at baseline (Armitage, 1998). Although significant controversies remain in the management of MCL, all would agree that the challenges associated with MCL, particularly the poor results with standard chemotherapy and frequent chemoresistance have pushed the community to be more innovative and active in clinical research. Hence the median OS has clearly improved over the last 3 decades (from 2-3y to \>5y) (Goy, 2011a), thanks to deeper responses obtained with intensive regimens in younger patients (an early CR translates into clearly better outcome) and also better salvage therapies with now MCL being the only lymphoma with 4 new biologicals approved (3 in the US and 1 in EU).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
27
Dose escalation of lenalidomide. Patients will receive 10, 15, 20, or 25 mg PO days 1-21
560 mg PO daily
375 mg/m2 IV Day 1
The Cancer Center at Hackensack University Medical Center
Hackensack, New Jersey, United States
Determine the MTD (Measured in mg) Based on the Number of Patients With Adverse Events
Define maximum tolerated dose (MTD) and /or recommended phase II dose for the combinations of Bruton's Tyrosine Kinase (BTK) Inhibitor, Ibrutinib (PCI-32765) plus lenalidomide / rituximab in relapsed or refractory MCL by assessing the incidence of dose limiting toxicities (DLTs) in cycle 1 through an assessment of adverse events
Time frame: 28 Days
Assess Safety Profile Through Review of Adverse Events
Assess safety and tolerability of the combinations through the review of adverse events. Patients will remain on treatment until disease progression or unacceptable toxicity. There is no predetermined length of treatment.
Time frame: Through 28 Days After Discontinuation of Study Drug
Assess Radiologic Progression-Free Survival
Assess preliminary anti-tumor activity of the combinations by radiological progression-free survival. Patients will remain on treatment until disease progression or unacceptable toxicity. There is no predetermined length of treatment.
Time frame: Response is evaluated after 2, 4 and 6 cycles, after initiation of treatment and later every 3 cycles until disease progression or patient taken off study
Assess Radiologic Response Rate
Assess preliminary anti-tumor activity of the combinations by radiological response rate. Patients will remain on treatment until disease progression or unacceptable toxicity. There is no predetermined length of treatment.
Time frame: Response is evaluated after 2, 4 and 6 cycles, after initiation of treatment and later every 3 cycles until disease progression or patient taken off study
Assess Drug-drug Interaction of Combination Therapy
Investigate potential drug-drug interaction between Ibrutinib (PCI-32765) plus lenalidomide / rituximab. Patients will remain on treatment until disease progression or unacceptable toxicity. There is no predetermined length of treatment.
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Time frame: Through 28 Days After Discontinuation of Study Drug