This study is to improve the first-line induction chemotherapy, by combining either Ibrutinib, or Lenalidomide, to a conventional immuno- chemotherapy of R-MPV type (Rituximab-Methotrexate-Procarbazine-Vincristine). This is a randomized Phase II trial, preceded by a dose escalation phase Ib. The objective of the phase Ib is to rule out any limiting toxicity of the new treatment associations, and to determine the recommended dose of Lenalidomide and Ibrutinib to be used in the phase II. In the phase II study, patients will receive 4 cycles of R-MPV + Lenalidomide or 4 cycles of R-MPV + Ibrutinib. The therapeutic response will be evaluated after the 2nd and the 4th cycle. Patients in good therapeutic response will proceed to the consolidation phase with Autologous Stem Cell Transplantation (ASCT).
The objective of this proposal is to test the feasibility and efficacy of two targeted induction chemotherapies obtained by adding either Lenalidomide or Ibrutinib to a standard Rituximab-High Dose (HD) Methotrexate (MTX) based induction chemotherapy regimen. The R-MPV regimen is chosen as the backbone chemotherapy because of its wide use with robust reproducible results and a good and manageable toxicity profile
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
118
Patients will receive 4 cycles of induction chemotherapy with R-MPV + Lenalidomide using the Maximum Tolerated Dose (MTD) of Lenalidomide and Ibrutinib as determined in the phase-Ib part of the study.
Patients will receive 4 cycles of induction chemotherapy with R-MPV + Ibrutinib, using the Maximum Tolerated Dose (MTD) of Lenalidomide and Ibrutinib as determined in the phase-Ib part of the study.
CHU Amiens
Amiens, France
CHU Angers
Angers, France
CH côte Basque
Bayonne, France
CHU Besançon
Besançon, France
Institut Bergonié
Bordeaux, France
CHU Caen
Caen, France
CHU Clermont-Ferrand
Clermont-Ferrand, France
CH Colmar
Colmar, France
CHU Créteil
Créteil, France
CHU Dijon
Dijon, France
...and 18 more locations
Dose Limiting Toxicity (DLT) during the first cycle of treatment for each treatment arm.
Occurrence of a Dose Limiting Toxicity (DLT) during the first cycle of treatment for each treatment arm. The phase Ib is a 3+3 dose escalation design
Time frame: 1 month
Complete Response (CR) rate including unconfirmed Complete Response (uCR) at the end of the 4 cycles of induction therapy
The primary endpoint for the phase II part of the study is the Complete Response (CR) rate including unconfirmed CR (CR+uCR) at the end of the 4 cycles of induction therapy. Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
Time frame: 4 months
Response rates (CR + uCR) after 2 cycles of induction treatment
Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
Time frame: 2 months
Overall response (CR + uCR + Partial Response(PR)), stable disease (SD), and primary refractory patients (PD) after 2 cycles of induction treatment
Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
Time frame: 2 months
Overall response (CR + uCR + Partial Response(PR)), stable disease (SD), and primary refractory patients (PD) after 4 cycles of induction treatment
Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
Time frame: 4 months
Overall Survival (OS)
Overall Survival (OS) will be calculated from the date of randomization to the date of death, whatever the cause. Patients alive at the date of last contact will be censored at this date.
Time frame: 142 months
Progression-Free Survival (PFS)
Progression-Free Survival (PFS) will be calculated from the date of randomization to the date of progression or death (if the patient does not progress). Patients alive without progression at the date of last contact will be censored at this date
Time frame: 142 months
The severity of the toxicity of treatment induction or ASCT
Toxicity of treatment induction or ASCT will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE 5.0) whenever possible and described by system organ class, preferred term
Time frame: 7 months
Patients who will receive ASCT
The percentage of patients who will receive ASCT will be presented
Time frame: 7 months
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