Ignite Creation Date:
2024-05-05 @ 11:59 AM
Last Modification Date:
2024-10-26 @ 9:18 AM
Study NCT ID:
NCT00209209
Status:
UNKNOWN
Last Update Posted:
2017-03-07
First Post:
2005-09-13
Brief Title:
Induction Chemotherapy R-CHOP Vs R-FC Followed by Interferon Maintenance Versus Rituximab Maintenance in MCL
Sponsor:
European Mantle Cell Lymphoma Network
Organization:
European Mantle Cell Lymphoma Network
Study Overview
Official Title:
Efficacy of Maintenance Therapy With Rituximab After Induction Chemotherapy R-CHOP vs R-FC for Elderly Patients With Mantle Cell Lymphoma Not Suitable for Autologous Stem Cell Transplantation
Status:
UNKNOWN
Status Verified Date:
2017-03
Last Known Status:
ACTIVE_NOT_RECRUITING
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
MCLelderly
Brief Summary:
The aim of this study is to answer the following independent questions in the treatment of mantle cell lymphomas
Can rituximab-fludarabine cyclophosphamide R-FC improve the reduction of lymphoma mass compared to rituximab-cyclophosphamide doxorubicin vincristine prednisone R-CHOP and so become a new standard for initial cytoreductive therapy
Can maintenance with rituximab substitute the interferon maintenance and even improve the progression free survival in patients after successful initial cytoreductive therapy
Can rituximab-fludarabine cyclophosphamide R-FC improve the reduction of lymphoma mass compared to rituximab-cyclophosphamide doxorubicin vincristine prednisone R-CHOP and so become a new standard for initial cytoreductive therapy
Can maintenance with rituximab substitute the interferon maintenance and even improve the progression free survival in patients after successful initial cytoreductive therapy
Detailed Description:
This study investigates two independent questions in the treatment of elderly patients with mantle cell lymphomas
1 To test in elderly patients with advanced mantle cell lymphoma whether rituximab plus a combination of fludarabine with cyclophosphamide 6 FC cycles results in a higher reduction of lymphoma mass measured by the percentage of CR than rituximab combined with the standard chemotherapy scheme 8 CHOP cycles
2 To compare maintenance therapy with rituximab with maintenance with interferon-alpha or pegylated interferon for progression free survival after 2 different regimens of induction chemo-immunotherapy in elderly patients with mantle cell lymphoma
This study will be performed as a prospective randomized open-label multicenter phase III trial All patients will be randomized for an initial cytoreductive therapy with R-FC or R-CHOP
The parameter for the comparison of R-FC and R-CHOP will be the percentage of complete remissions after initial cytoreductive therapy According to the known results of R-FC and R-CHOP in lymphoma therapy a relevant difference between R-CHOP and R-FC in the overall response rates is not expected For both therapies an overall response rate of about 90 is expected Since it is well known that the prognosis of patients who do not reach at least a PR in the initial therapy is very poor it will be also necessary to control this parameter during the study If an unexpected relevant difference in the overall response rates is observed during the study the initial randomisation should be stopped and all patients should be assigned to the superior therapy In this case the CR rates will not be important for the choice of the initial therapy If no relevant differences in the overall response rates are observed a one sided Fisher test will be performed at the end of the recruitment to test whether the rate of CRs after R-FC is significantly improved compared to R-CHOP
The statistical parameters for controlling the overall response rates and for testing the CR rates are chosen in the following way The working significance level for all statistical evaluations in this part of the study will be set to alpha005 The expected CR rate after R-CHOP is according to the observations about 50 a clinical relevant improvement by R-FC would be a CR rate of 65 Such an improvement should be detected by the one sided Fisher test with a power of about 95 According to these parameters about 246 observations for each treatment would be necessary To control the overall response rates a difference of 85 to 95 will be clinically so relevant that initial randomisation should be terminated with a probability of about 95 Overall response rates will be controlled by a restricted sequential procedure
Patients achieving at least a partial remission after R-FC or R-CHOP will be randomised for interferon maintenance versus rituximab maintenance in order to evaluate the impact of maintenance therapy in progression free survival
The improvement expected by the new maintenance with rituximab for progression free survival can be expressed by reduction of relative risk rr Since a risk reduction to 60 was observed for indolent lymphomas by interferon maintenance this seems to be a clinical relevant improvement for the new maintenance therapy For a working significance level alpha005 and a power of 95 the number of events relapse or death necessary for a two sided fixed sample trial is about 200 During this study the progression free survival in patients after successful initial therapy will be monitored by an equivalent restricted sequential procedure with a maximum number of 240 observation
In order to evaluate the impact of initial therapy and maintenance therapy on overall survival in this patients a total follow up of about 15 years for this study is expected
1 To test in elderly patients with advanced mantle cell lymphoma whether rituximab plus a combination of fludarabine with cyclophosphamide 6 FC cycles results in a higher reduction of lymphoma mass measured by the percentage of CR than rituximab combined with the standard chemotherapy scheme 8 CHOP cycles
2 To compare maintenance therapy with rituximab with maintenance with interferon-alpha or pegylated interferon for progression free survival after 2 different regimens of induction chemo-immunotherapy in elderly patients with mantle cell lymphoma
This study will be performed as a prospective randomized open-label multicenter phase III trial All patients will be randomized for an initial cytoreductive therapy with R-FC or R-CHOP
The parameter for the comparison of R-FC and R-CHOP will be the percentage of complete remissions after initial cytoreductive therapy According to the known results of R-FC and R-CHOP in lymphoma therapy a relevant difference between R-CHOP and R-FC in the overall response rates is not expected For both therapies an overall response rate of about 90 is expected Since it is well known that the prognosis of patients who do not reach at least a PR in the initial therapy is very poor it will be also necessary to control this parameter during the study If an unexpected relevant difference in the overall response rates is observed during the study the initial randomisation should be stopped and all patients should be assigned to the superior therapy In this case the CR rates will not be important for the choice of the initial therapy If no relevant differences in the overall response rates are observed a one sided Fisher test will be performed at the end of the recruitment to test whether the rate of CRs after R-FC is significantly improved compared to R-CHOP
The statistical parameters for controlling the overall response rates and for testing the CR rates are chosen in the following way The working significance level for all statistical evaluations in this part of the study will be set to alpha005 The expected CR rate after R-CHOP is according to the observations about 50 a clinical relevant improvement by R-FC would be a CR rate of 65 Such an improvement should be detected by the one sided Fisher test with a power of about 95 According to these parameters about 246 observations for each treatment would be necessary To control the overall response rates a difference of 85 to 95 will be clinically so relevant that initial randomisation should be terminated with a probability of about 95 Overall response rates will be controlled by a restricted sequential procedure
Patients achieving at least a partial remission after R-FC or R-CHOP will be randomised for interferon maintenance versus rituximab maintenance in order to evaluate the impact of maintenance therapy in progression free survival
The improvement expected by the new maintenance with rituximab for progression free survival can be expressed by reduction of relative risk rr Since a risk reduction to 60 was observed for indolent lymphomas by interferon maintenance this seems to be a clinical relevant improvement for the new maintenance therapy For a working significance level alpha005 and a power of 95 the number of events relapse or death necessary for a two sided fixed sample trial is about 200 During this study the progression free survival in patients after successful initial therapy will be monitored by an equivalent restricted sequential procedure with a maximum number of 240 observation
In order to evaluate the impact of initial therapy and maintenance therapy on overall survival in this patients a total follow up of about 15 years for this study is expected
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None