The purpose of this study is to assess the initial activity, tolerability, safety and to identify a recommended dose and regimen of vedolizumab intravenous (IV) administered for treatment of steroid-refractory acute intestinal GvHD in participants who have undergone allo-HSCT.
The drug being tested in this study is called vedolizumab. This study will look at the tolerability and effectiveness of vedolizumab IV in participants with acute intestinal GvHD who have received no systemic therapy for the treatment of acute GvHD (prophylaxis acceptable) other than corticosteroids. The study enrolled 17 participants. Participants will be randomly assigned (by chance, like flipping a coin) to one of the two treatment groups: * Vedolizumab 300 mg * Vedolizumab 600 mg All participants will be infused intravenously at the same time each day throughout the study. Vedolizumab IV will be administered on Days 1, 15, 43, 71, and 99. After approximately 10 participants are enrolled at each dose level and have data available from the Day 28 evaluation, safety, tolerability, efficacy, and pharmacokinetic (PK), results will be assessed for each dose level, and the appropriate dose for subsequent participants in the study will be determined. This multi-center trial will be conducted in multiple countries. The overall time to participate in this study is 32 weeks. Participants will make multiple visits to the clinic after last dose of study drug for a follow-up assessment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
17
Vedolizumab IV infusion
Massachusetts General Hospital
Boston, Massachusetts, United States
Washington University
St Louis, Missouri, United States
Mount Sinai - PRIME
Lake Success, New York, United States
Percentage of Participants With Overall Response (Partial Response [PR]+Very Good Partial Response [VGPR]+Complete Response [CR]) at Day 28
CR is defined as the resolution of all signs and symptoms of acute graft-versus-host-disease (GvHD). VGPR is defined as resolution of the signs and symptoms of the GvHD: 1) Skin: no rash, or residual erythematous rash involving \<25% of the body surface, without bullae (excluding residual faint erythema and hyperpigmentation). 2) Liver: total serum bilirubin concentration \<2 mg/dL or \<25% of baseline at enrollment. 3) Gut: a) participant tolerates food or enteral feeding; b) predominantly formed stools; c) no overt gastrointestinal bleeding or abdominal cramping; d) no more than occasional nausea or vomiting. PR is defined as improvement of 1 GvHD stage in 1 or more organs without progression in any organ.
Time frame: Day 28
Number of Participants Who Experienced Serious Adverse Events (SAEs) Through Day 28
An Adverse Event (AE) is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An SAE is defined as an untoward medical occurrence, significant hazard, contraindication, side effect or precaution that at any dose: results in death, is life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is medically significant.
Time frame: From first dose up to Day 28
Percentage of Participants Who Died in the Absence of Primary Malignancy Relapse After Allo-HSCT at Month 6
Time frame: Month 6
Percentage of Participants With Acute GvHD Complete Response (CR) at Day 28
CR is defined as the resolution of all signs and symptoms of acute GvHD.
Time frame: Day 28
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
OSU - James Comprehensive Cancer Center
Columbus, Ohio, United States
Baylor University Medical Center
Dallas, Texas, United States
Seattle Cancer Care Alliance
Seattle, Washington, United States
ZNA Stuivenberg
Antwerp, Belgium
AZ Sint-Jan Brugge
Bruges, Belgium
UZ Leuven
Leuven, Belgium
CHU Nantes - Hotel Dieu
Nantes, Loire Atlantique, France
...and 5 more locations
Percentage of Participants With Intestinal Overall Response at Day 28
Symptoms of acute intestinal GvHD were measured using the BMT CTN-modified International Bone Marrow Transplant Registry Database (IBMTR) index. Intestinal overall response is either CR, VGPR or PR for intestine only. CR is defined as the resolution of all signs and symptoms of GvHD. VGPR is defined as resolution of the majority of signs and symptoms of intestinal GvHD: a) participant tolerates food or enteral feeding; b) predominantly formed stools; c) no overt gastrointestinal bleeding or abdominal cramping; d) no more than occasional nausea or vomiting. PR is defined as improvement of intestinal GvHD by at least 1 stage.
Time frame: Day 28
Kaplan-Meier Estimate of Percentage of Participants Achieving Survival at Months 6 and 12
The Kaplan-Meier estimate reports the percentage of participants surviving at Months 6 and 12.
Time frame: Months 6 and 12
Percentage of Participants Alive Without GvHD or Primary Malignancy Relapse at Months 6 and 12
Time frame: Months 6 and 12
Total Dose of Steroids Administered
Total Steroids administered in mg/kg/day of methylprednisolone or equivalent
Time frame: From first dose of study drug up to Months 6 and 12
Number of Participants Who Experienced Treatment Emergent Adverse Events (TEAEs)
An AE is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (example, a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug, whether or not it is considered related to the drug. A TEAE is defined as an adverse event with an onset that occurs after receiving study drug.
Time frame: From first dose of study drug to 18 weeks after last dose (Up to Week 32)
Number of Participants Who Experienced Serious Adverse Events (SAEs) Through Week 32
An AE is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An SAE is defined as an untoward medical occurrence, significant hazard, contraindication, side effect or precaution that at any dose: results in death, is life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is medically significant.
Time frame: From first dose of study drug to 18 weeks after last dose (Up to Week 32)
Number of Participants With Markedly Abnormal Laboratory Parameters Values
Clinical Laboratory parameters included tests for chemistry, hematology and urinalysis. Markedly abnormal values during treatment period were categorized as:alanine aminotransferase (ALT)\>3.0 U/L\*upper limit of normal(ULN),albumin\<25 g/L\*lower limit of normal(LLN),alkaline phosphatase \>3.0 U/L\*ULN,aspartate aminotransferase \>3.0 U/L\*ULN,bilirubin \>2 umol/L\*ULN,blood urea nitrogen(BUN) \>10.7 mmol/L,calcium \<1.75 mmol/L, \>2.88 mmol/L,chloride \<75 mmol/L, \>126 mmol/L,creatinine \>177umol/L,gamma glutamyl transferase (GGT) \>3 U/L\*ULN,glucose \<2.8 mmol/L, \>19.4 mmol/L,phosphate \<0.52 mmol/L, \>2.10 mmol/L,potassium\<3 mmol/L, \>6 mmol/L,sodium \<130 mmol/L, \>150 mmol/L,basophils \>3(10\^9/L)\*ULN,eosinophils \>2(10\^9/L)\*ULN,hematocrit (%) \<0.8\*LLN, \>1.2\*ULN,hemoglobin \<0.8 g/L\*LLN, \>1.2 g/L\*ULN,leukocytes \<0.5 (10\^9/L)\*LLN, \>1.5 (10\^9/L)\*ULN,lymphocytes \<0.5 (10\^9/L)\*LLN, \>1.5(10\^9/L)\*ULN,monocytes \>2 (10\^9/L)\*ULN,neutrophils \<0.5(10\^9/L)\*LLN, \>1.5 (10\^9/L)\*ULN,platelets \<75(10\^9/L), \>600(10\^9/L).
Time frame: From Baseline up to last dose of study drug (Day 99)
Number of Participants With Markedly Abnormal Vital Signs
Vital signs included heart rate, respiratory rate, systolic and diastolic blood pressure, temperature and weight. The vital sign values outside the range: systolic blood pressure (SBP) \<85 mmHg and change from Baseline (BL) \<=-20 mmHg, \>180 mmHg and change from Baseline \>=20 mmHg,diastolic blood pressure (DBP) \<50 mmHg and change from Baseline \<=-15 mmHg, \>110 mmHg and change from Baseline \>=15 mmHg, heart rate \<50 beats per minute (bpm),\>120 beats per minute, temperature \<35.6 Degree C, \>37.7 Degree C and weight change from Baseline \<=-7 % and weight change from Baseline \>=7 % assessed during treatment period were considered markedly abnormal.
Time frame: From Baseline up to last dose of study drug (Day 99)
Ctrough: Trough Serum Concentrations of Vedolizumab
Time frame: Day 99 (pre-dose)