Study Evaluating the Non-inferiority of a Treatment Adapted to the Early Response Evaluated With 18F-FDG PET Compared to a Standard Treatment, for Patients Aged From 18 to 80 Years With Low Risk (aa IPI = 0) Diffuse Large B-cells Non Hodgkin’s Lymphoma CD 20+

This study is currently recruiting participants.
Verified March 2012 by The Lymphoma Academic Research Organisation

First Received on January 14, 2011.  
Last Updated on March 12, 2012  
History of Changes
This Clinical Trial Sponsored By: The Lymphoma Academic Research Organisation
Information provided by (Responsible Party): The Lymphoma Academic Research Organisation
ClinicalTrials.gov Identifier: NCT01285765
 

Purpose for Clinical Trial

Localized stages DLBCL with low IPI (aaIPI = 0) have a very good prognostic after a standard immuno-chemotherapy with 6 cycles of R-CHOP 21. Five years PFS is estimated over 75%, whatever the age of the patient.

PET scan is actually considered as "the gold standard" for the initial staging and the evaluation of response after treatment. With this new technique, the response criteria have been redefined by Cheson and al. in 2007. Moreover, several recent studies showed that early evaluation of response with PET scan after only 2 cycles of chemotherapy was accurate to define two groups of patients:

"Early-good-responders", when PET scan is negative "Early-poor-responders", when PET scan remains positive Prognostic for the first group is very good, and for the second poorer. At the present time, the interest of the modification and/or the intensification of the treatment for the early-poor-responder patients is not demonstrated by any publication. New studies are ongoing for patients with advanced stages of DLBC NHL (GELA trial LNH 07-3B) or Hodgkin’s lymphoma (GELA and EORTC trial H10); the aim is to evaluate a new strategy of treatment adapted to early response criteria.

No trial has already been made for low IPI DLBCL. In this study, the investigators purpose is to evaluate the adaptation of treatment with early response based on PET scan results after 2 cycles of chemotherapy, for patient aged from 18 to 80 years, with low IPI DLBCL.

This is an open randomized study.

The primary endpoint is to evaluate the 3 years PFS with the aim to demonstrate the non inferiority of the experimental arm in comparison to standard arm:

In standard arm, the patients will receive 6 cycles of R-CHOP 21 without taking into account of PET scan results after 2 cycles.

In experimental arm, early good responder patients (defined as having a negative PET scan after 2 cycles, confirmed after 4 cycles) will receive only 4 cycles of R-CHOP 21.

In both arms, if the PET scan remains positive after 4 cycles of chemotherapy, a biopsy exam is needed to confirm the failure and an intensive chemotherapy is then recommended.

All of the patients, in both arms, will have an early evaluation with PET scan. All PET scan will be reviewed by a group of expert according to Deauville criteria defined by Meignan et al to adapt the decision after the 2nd cycle in experimental arm and after the 4th cycle for all patients. The final evaluation of response will be made according to 2007 Cheson’s criteria.

Condition Study Intervention Clinical Trial Phase
DLBCL Drug: RCHOP21 Phase 3

Study Type: Study Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Study Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Randomized Phase III Study Evaluating the Non-inferiority of a Treatment Adapted to the Early Response Evaluated With 18F-FDG PET Compared to a Standard Treatment, for Patients Aged From 18 to 80 Years With Low Risk (aa IPI = 0) Diffuse Large B-cells Non Hodgkin’s Lymphoma CD 20+

Resource links provided by NLM:

MedlinePlus related topics:
Lymphoma
Nuclear Scans

U.S. FDA Resources

Further study details as provided by The Lymphoma Academic Research Organisation:

Primary Outcome Measures For Clinical Trial:

  • Progression Free Survival [ Time Frame: 3 years ] [ Designated as safety issue: No ]
    Evaluate by PFS at 3 years the non-inferiority of a chemotherapy treatment with 4 or 6 cycles of R-CHOP 21, determined according to early response assessed by PET at the end of 2 cycles versus standard chemotherapy of 6 cycles of R-CHOP 21 in patients with DLBCL lymphoma CD20+ with no factors of the IPI age adjusted.

Secondary Outcome Measures For Clinical Trial:

  • DELTA SUV [ Time Frame: 3 weeks post C4 last patient ] [ Designated as safety issue: No ]
    Determine the decrease of SUV max between PET at baseline, PET after cycle 2 and PET after cycle 4 and evaluate the changes predictive interest.

  • Overall Survival, EFS, response duration, DFS [ Time Frame: 3 years ] [ Designated as safety issue: No ]
    Assess the overall survival, the EFS (Event Free Survival – events defined as death from any cause, relapse for complete responders and undocumented complete responders, progression during or after treatment, initiation of a new anti-lymphoma therapy), the response duration, and the DFS for complete responders (disease free survival).

  • prognostic impact of the existence of a high tumor burden at diagnosis (> 10 cm) on PFS [ Time Frame: 3 years ] [ Designated as safety issue: No ]
    Evaluate the prognostic impact of the existence of a high tumor burden at diagnosis (> 10 cm).

  • biological factors [ Time Frame: 3 weeks post last cycle and 3years survival ] [ Designated as safety issue: No ]
    Identify the biological factors on blood samples and on tumor biopsy influencing the patient treatment response and prognosis.

  • Overall Response Rate [ Time Frame: 3 weeks post last cycle last patient ] [ Designated as safety issue: No ]
    Evaluate the overall response rate according to IWC (International Harmonization Project – Cheson 2007) (CR, PR) after 4 or 6 cycles of R-CHOP21 according to the treatment arm.

  • Rate of good responders according to results at PET after C2 [ Time Frame: 3 weeks post C2 last patient ] [ Designated as safety issue: No ]
    Evaluate the rate of negative PET2

Estimated Enrollment: 420
Study Start Date: December 2010
Estimated Study Completion Date: January 2017
Estimated Primary Completion Date: January 2017 (Final data collection date for primary outcome measure)

Arms

Assigned Study Interventions

Experimental: Early-PET-result-adapted treatment

4 to 6 RCHOP21
Drug: RCHOP21

Prednisone-60 mg/m2: D1 D2 D3 D4 D5;Rituximab-375 mg/m2 : D1; Doxorubicin-50 mg/m2 D1;Cyclophosphamide-750 mg/m2:D1 Vincristine-1.4 mg/m2 :D1; G-CSF SC -5 microg/kg/day: D6 to D13
Active Comparator: standard treatment

6 RCHOP21
Drug: RCHOP21

Prednisone-60 mg/m2: D1 D2 D3 D4 D5;Rituximab-375 mg/m2 : D1; Doxorubicin-50 mg/m2 D1;Cyclophosphamide-750 mg/m2:D1 Vincristine-1.4 mg/m2 :D1; G-CSF SC -5 microg/kg/day: D6 to D13

  Eligibility

Ages Eligible for Study:   18 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient with histologically proven CD20+ diffuse large B-cell lymphoma (DLBCL) (WHO classification 2008) including clinical subtypes (primitive mediastinal, intravascular, etc.). Patients with De Novo Transformed DLBCL from low grade lymphoma (Follicular, other…) may also be included; or CD20+ B-cell lymphoma with intermediate features between DLBCL and Burkitt; or with intermediate features between DLBCL and classical Hodgkin lymphoma; or CD20+ Follicular lymphoma grade 3B; or CD20+ Aggressive B-cell lymphoma unclassifiable.
  • Age from18 to 80 years.
  • Patient not previously treated.
  • Ann Arbor Stage : I or II.
  • Normal level of LDH.
  • ECOG performance status (PS) < 2.
  • Age-adjusted international prognostic index (aaIPI) = 0.
  • Baseline PET (PET0) performed before any treatment, even

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