Response-Based Therapy Assessed by PET Scan in Treating Patients with Stage I or Stage II Hodgkin Lymphoma

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Basic Trial Information

PhaseTypeAgeTrial IDs
Phase IIBiomarker/Laboratory analysis, Diagnostic, Treatment18 to 60CALGB 50801
NCI-2011-02034, CDR0000669076, NCT01118026

Trial Description

Summary

This phase II clinical trial studies how well response-based therapy assessed by positron emission tomography (PET) scan works in treating patients with stage I or stage II Hodgkin lymphoma. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells. Radiation therapy uses high energy x-rays to kill cancer cells. Giving chemotherapy together with radiation therapy may kill more cancer cells. Diagnostic procedures, such as PET scan, done before, during, and after chemotherapy may help doctors plan the best treatment.

Further Study Information

PRIMARY OBJECTIVES:

I. To determine the progression-free survival (PFS) at 36 months from enrollment for patients with bulky stage I or II Hodgkin lymphoma.

SECONDARY OBJECTIVES:

I. To evaluate the complete response (CR) rate in patients diagnosed with bulky stage I and II Hodgkin lymphoma following positron emission tomography (PET)-response-adapted chemotherapy with or without radiation therapy.

II. To determine the predictive value of fludeoxyglucose (FDG) uptake using various semiquantitative approaches at baseline, after 2 courses of doxorubicin hydrochloride, bleomycin sulfate, vinblastine sulfate, and dacarbazine (ABVD), and at completion of therapy.

III. To determine the predictive value of volumetric vs. 2-dimensional (2-D) measurement changes on computed tomography (CT) between baseline and after 2 cycles, at the end of chemotherapy (PET negative patients only), and after radiotherapy (RT) (PET positive patients only) and compare with PET parameters.

IV. To determine if changes in both qualitative and semiquantitative FDG-PET findings between baseline and after cycle 2, at end of chemotherapy (PET negative patients only) and after RT (PET positive patients only) with combination analyses with incorporating changes obtained from dedicated CT scans, correlate with response and PFS.

V. To compare the predictive value of both qualitative and semiquantitative FDG-PET changes, 2-D and volumetric CT changes, and combinatorial analyses (PET + dedicated CT data) with molecular parameters and conventional parameters, including International Prognostic Score (IPS).

VI. To assess whether elevated baseline serum soluble cluster of differentiation 30 (CD30) (sCD30), interleukin (IL)10, chemokine (C-C motif) ligand 17 (CCL17), and CCL22 correlate with clinical response and PFS.

VII. To assess whether persistent or recurrent elevation of serial serum sCD30, IL10, CCL17, or CCL22 correlate with relapse/progression or PET scan results.

VIII. To confirm independently useful tissue biomarkers (B-cell lymphoma 2 [bcl-2], MAL, forkhead box P3 [FOXP3], CD68, granzyme B [GzB]) for risk stratification in patients with bulky stage I or II Hodgkin lymphoma treated with this regimen.

IX. To compare mediastinal bulk on standing PA and lateral chest x-ray (> 0.33 maximum chest diameter) with chest CT (mass > 10 cm).

OUTLINE:

ABVD CHEMOTHERAPY: All patients receive doxorubicin hydrochloride intravenously (IV) over 3-5 minutes, bleomycin sulfate IV, vinblastine IV over 3-5 minutes, and dacarbazine IV over 30 minutes on days 1 and 15. Treatment repeats every 28 days for 2 courses in the absence of disease progression or unacceptable toxicity. Patients then undergo a PET/CT scan and CT scan of the neck (if it was positive at baseline), chest, abdomen, and pelvis. Patients who are PET-positive proceed to escalated bleomycin sulfate, etoposide, doxorubicin hydrochloride, cyclophosphamide, vincristine sulfate, procarbazine hydrochloride and prednisone (BEACOPP) chemotherapy. Patients who are PET-negative receive 4 additional courses of ABVD chemotherapy in the absence of disease progression or unacceptable toxicity.

ESCALATED BEACOPP CHEMOTHERAPY: Patients receive doxorubicin hydrochloride IV over 3-5 minutes and cyclophosphamide IV over 60 minutes on day 1; etoposide IV over 60 minutes on days 1, 2, and 3; procarbazine hydrochloride orally (PO) once daily (QD) on days 1-7; prednisone PO on days 1-14; and bleomycin sulfate IV and vincristine sulfate IV on day 8. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients undergo another PET/CT scan and CT scan of the neck (if it was positive at baseline), chest, abdomen, and pelvis. Patients then undergo involved-field radiation therapy 5 days per week for 3½ weeks (for a total of 30.6 Gy).

Within 3-8 weeks after completion of chemotherapy, patients undergo an additional PET/CT scan (utilizing fludeoxyglucose F 18) and CT scan of the neck (if it was positive at baseline), chest, abdomen, and pelvis. Patients who are PET-negative proceed to follow up. Patients who are PET-positive undergo a biopsy*, patients with a negative biopsy proceed to follow up, and patients with a positive biopsy are treated at the discretion of the investigator.

NOTE: *Patients for whom a biopsy is neither clinically appropriate nor medically feasible proceed to follow up. Patients who defer the biopsy undergo scanning 3 months later and then undergo biopsy as above.

After completion of study treatment, patients are followed up every 3 months for 1 year, every 6 months for 2 years, and then annually for 7 years.

Eligibility Criteria

Inclusion Criteria:

Bilirubin* =< 2 x upper limit of normal

In the absence of Gilbert’s disease

Absolute neutrophil count (ANC) >= 1000/uL

Non-pregnant and non-nursing; women and men of reproductive potential should agree to use an effective means of birth control

Patients with known human immunodeficiency virus (HIV) must have a CD4 count > 350 and be on concurrent antiretrovirals; patients with a history of intravenous drug abuse or any behavior associated with an increased risk of HIV infection should be tested for exposure to the HIV virus; an HIV test is not required for entry on this protocol, but is required if the patient is perceived to be at risk

LVEF by ECHO or MUGA within institutional normal limits unless thought to be disease related; DLCO >= 60% with no symptomatic pulmonary disease unless thought to be disease related

Patients may have had one cycle only of ABVD prior to enrolling on study; no other prior treatment (chemotherapy or radiation therapy) for Hodgkin lymphoma is allowed; if patient has had one cycle of ABVD, in order to be eligible to enroll on Cancer and Leukemia Group B (CALGB) 50801, the patient must have had all of the following tests prior to starting the first cycle of ABVD:

Left ventricular ejection fraction (LVEF) by echocardiogram (ECHO) or multi gated acquisition (MUGA)

Pulmonary function tests (PFTs) (including diffusing capacity of the lung for carbon monoxide [DLCO]/forced vital capacity [FVC])

CT scan (neck**, chest, abdomen, pelvis)

FDG-PET/CT scan

Chest X-ray, posterioranterior (PA) & lateral

Complete blood count (CBC), differential, platelets

Erythrocyte sedimentation rate (ESR0

Serum creatinine

Glucose

Aspartate aminotransferase (AST)

Alkaline phosphatase

Bilirubin

Lactate dehydrogenase (LDH)

  • Patients with a negative FDG-PET/CT scan do not need to have had a dedicated neck CT scan prior to starting the previous cycle of ABVD

No “currently active” second malignancy other than non-melanoma skin cancers; patients are not considered to have a “currently active” malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse

Histologically documented Hodgkin lymphoma subclassified according to the World Health Organization (WHO) modification of the Rye Classification and staged according to the modified Ann Arbor Staging Classification system; patients must have clinical stage IA, IB, IIA or IIB; patients with “E” extensions will be eligible if all other criteria have been met; nodular lymphocyte predominant Hodgkin lymphoma is excluded

AST =< 2 x upper limit of normal

Platelet count >= 100,000/uL

Eastern Cooperative Oncology Group (ECOG) performance status 0-2

Serum creatinine =< 2 mg/dL

Has a mediastinal mass > 0.33 maximum intrathoracic diameter on standing postero-anterior chest x-ray or mass measuring > 10 cm in its largest diameter

Trial Contact Information

Trial Lead Organizations / Sponsors / Collaborators

Alliance for Clinical Trials in Oncology

  • National Cancer Institute
Ann Steward LaCasce, Principal Investigator

Trial Sites

U.S.A.

California
Saint Helena

Saint Helena Hospital

Gregory B. Smith
Ph: 707-967-3698

Gregory B. Smith
Principal Investigator

San Diego

Naval Medical Center -San Diego

Craig D. Norris
Ph: 619-532-8712

Craig D. Norris
Principal Investigator

Delaware
Newark

Christiana Care Health System-Christiana Hospital

Stephen Scott Grubbs
Ph: 302-733-6227

Stephen Scott Grubbs
Principal Investigator

Illinois
Chicago

University of Chicago Comprehensive Cancer Center

Chadi Nabhan
Ph: 773-834-7424

Chadi Nabhan
Principal Investigator

Evanston

NorthShore University HealthSystem-Evanston Hospital

David L. Grinblatt
Ph: 847-570-2109

David L. Grinblatt
Principal Investigator

Indiana
Mishawaka

Memorial Regional Cancer Center Day Road

Thomas Joseph Reid
Ph: 800-284-7370

Thomas Joseph Reid
Principal Investigator

South Bend

Memorial Hospital of South Bend

Thomas Joseph Reid
Ph: 800-284-7370

Thomas Joseph Reid
Principal Investigator

Kansas
Wichita

Cancer Center of Kansas - Main Office

Shaker R. Dakhil
Ph: 316-262-4467

Shaker R. Dakhil
Principal Investigator

Via Christi Regional Medical Center

Shaker R. Dakhil
Ph: 316-262-4467

Shaker R. Dakhil
Principal Investigator

Massachusetts
Boston

Dana-Farber Cancer Institute

Ann Steward LaCasce
Ph: 877-442-3324

Ann Steward LaCasce
Principal Investigator

Massachusetts General Hospital Cancer Center

Ann Steward LaCasce
Ph: 877-442-3324

Ann Steward LaCasce
Principal Investigator

Missouri
Saint Louis

Washington University School of Medicine

Nancy L. Bartlett
Ph: 800-600-3606
Email: info@siteman.wustl.edu

Nancy L. Bartlett
Principal Investigator

Springfield

CoxHealth South Hospital

Jay W. Carlson
Ph: 800-821-7532

Jay W. Carlson
Principal Investigator

Mercy Hospital Springfield

Jay W. Carlson
Ph: 800-821-7532

Jay W. Carlson
Principal Investigator

Nebraska
Omaha

University of Nebraska Medical Center

Philip Jay Bierman
Ph: 402-559-6941
Email: unmcrsa@unmc.edu

Philip Jay Bierman
Principal Investigator

New York
Syracuse

State University of New York Upstate Medical University

Dorothy C. Pan
Ph: 315-464-5476

Dorothy C. Pan
Principal Investigator

North Carolina
Charlotte

Carolinas Medical Center/Levine Cancer Institute

David Weldon Miller
Ph: 704-355-2884

David Weldon Miller
Principal Investigator

Novant Health Presbyterian Medical Center

Justin Peter Favaro
Ph: 704-384-5369

Justin Peter Favaro
Principal Investigator

Concord

Carolinas HealthCare System NorthEast

David Weldon Miller
Ph: 704-355-2884

David Weldon Miller
Principal Investigator

Durham

Duke University Medical Center

Jeffrey Crawford
Ph: 888-275-3853

Jeffrey Crawford
Principal Investigator

Goldsboro

Wayne Memorial Hospital

James N. Atkins
Ph: 919-580-0000

James N. Atkins
Principal Investigator

Statesville

Iredell Memorial Hospital

Ruby Ann Grimm
Ph: 704-873-5661

Ruby Ann Grimm
Principal Investigator

Winston-Salem

Wake Forest University Health Sciences

David Duane Hurd
Ph: 336-713-6771

David Duane Hurd
Principal Investigator

Ohio
Columbus

Ohio State University Comprehensive Cancer Center

Ann Steward LaCasce

Ann Steward LaCasce
Principal Investigator

Oregon

Saint Charles Hospital

Rex B. Mowat
Ph: 800-444-3561

Rex B. Mowat
Principal Investigator

Toledo

Mercy Saint Anne Hospital

Rex B. Mowat
Ph: 800-444-3561

Rex B. Mowat
Principal Investigator

Toledo Clinic Cancer Centers-Toledo

Rex B. Mowat
Ph: 800-444-3561

Rex B. Mowat
Principal Investigator

South Carolina
Greenville

Saint Francis Hospital

Charles E. Bowers
Ph: 800-486-5941

Charles E. Bowers
Principal Investigator

Spartanburg

Spartanburg Medical Center

Charles E. Bowers
Ph: 800-486-5941

Charles E. Bowers
Principal Investigator

Vermont
Berlin

Central Vermont Medical Center/National Life Cancer Treatment

Gurpreet Lamba
Ph: 802-656-8990

Gurpreet Lamba
Principal Investigator

Burlington

University of Vermont College of Medicine

Gurpreet Lamba
Ph: 802-656-8990

Gurpreet Lamba
Principal Investigator

Wisconsin
La Crosse

Gundersen Lutheran Medical Center

Kurt Oettel
Ph: 608-775-2385
Email: cancerctr@gundluth.org

Kurt Oettel
Principal Investigator

Link to the current ClinicalTrials.gov record.
NLM Identifer NCT01118026

Note: Information about participating sites on pharmaceutical industry trials may be incomplete. Please visit the ClinicalTrials.gov record via the link above for more information about participating sites.