The purpose of this study is to determine the correct dose and safety of adding a new cancer drug, venetoclax, to a standard combination of chemotherapy drugs as a second treatment for relapsed/refractory DLBCL. In this study, venetoclax will be added to RICE (rituximab, ifosfamide, carboplatin, etoposide), a common set to cancer drugs used as a second line treatment for relapsed/refractory DLBCL. Venetoclax, is a new targeted anti-cancer drug, which works by mimicking a particular protein produced by the tumor and interrupting its normal processes, ultimately causing the tumor cells to die. Adding venetoclax to the standard RICE regimen is believed to increase the chance of getting cancer into remission. Venetoclax is experimental because it is not approved by the Food and Drug Administration (FDA) for the treatment of relapsed/refractory DLBCL. Venetoclax has been FDA approved for use in patients with chronic lymphocytic leukemia (CLL).
Primary Objective: Establishment of safety of V+RICE in order to identify the recommended Phase II dose (RPD2) Secondary Objectives: 1. Determine the overall response rate (ORR) of V+RICE relative to historical controls of RICE alone in r/r DLBCL. 2. Determine the proportion of patients who proceed to autologous stem cell transplantation after V+RICE relative to historical controls. 3. Describe the progression-free survival (PFS) and overall survival (OS) for patients treated with V + RICE who do and do not proceed to auto-Stem Cell Transplant, relative to historical controls. 4. Measure total number of peripheral blood stem cells collected in patients treated with V + RICE who proceed to stem cell mobilization/harvesting, compared to historical controls.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
65
Beginning with 400mg daily on days 1-10 of cycle 1-3 Phase I dose escalation scheme: Dose Level -2 (DL-2): 100 mg daily, days 1-10, cycle 1-3 DL-1: 200 mg daily, days 1-10, cycle 1-3 DL1: 400 mg daily, days 1-10, cycle 1-3 DL2: 600 mg daily, days 1-10, cycle 1-3 DL3: 800 mg daily, days 1-10, cycle 1-3 Phase II: Given at a dose of 400mg daily for 5 days
Part of R-ICE treatment: Rituximab: 375 mg/m\^2 intravenously (IV) on Day 1 of R-ICE every 21 days
Part of R-ICE treatment: Ifosfamide: 5,000 mg/m\^2 mixed together with mesna at a dose of 5,000 mg/m\^2 over 24 hours beginning on Day 2 and completing on Day 3 of each 21-day cycle
Part of R-ICE treatment: Carboplatin: At a dose corresponding to an AUC = 5 based on Cockcroft-Gault calculation of GFR using adjusted body weight. Carboplatin is given IV on the Day 2 of RICE of each 21 day cycle
Part of R-ICE treatment: Etoposide: 100 mg/m2by IV daily on 3 consecutive days (Days 1-3) of each 21-day cycle
Washington University School of Medicine, Siteman Cancer Center
St Louis, Missouri, United States
University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
Recommended Phase II Dose
A maximum of 18 patients can theoretically participate in the initial dose escalation with Retinoic and Lithium, based on 4 dose levels with a maximum of 6 patients at each dose level. At a true dose limiting toxicity rate of 20%, the chance of escalating to the next dose level is 71% and of establishing the lower dose level as maximum tolerated dose is 29%.
Time frame: Up to 12 weeks
Overall Response Rate
number of patients with complete response or partial response as document in a positron emission tomography/ computerized tomography (PET/CT) scan and defined by the Revised Response Criteria for Malignant Lymphoma
Time frame: Up to 12 weeks
Proportion of participants Proceeding to ASCT
the number of patients with ASCT divided by the total number of patients
Time frame: Up to 12 weeks
Progression Free Survival
Average time disease did not progress as based on the Revised Response Criteria for Malignant Lymphoma up to 12 weeks
Time frame: Up to 12 weeks
Overall Survival
Average time participants are alive from starting treatment to death or 12 weeks, whichever comes first
Time frame: Up to 12 weeks
Number of Peripheral Blood Stem Cells Collected
Estimated through measurement of CD34+ cells/kg
Time frame: Up to 12 weeks
Median Number of cluster of differentiation 34 (CD34+) Cells/kg
Median value of CD34+ in cells/kg collected from patients
Time frame: Up to 12 weeks
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