Tag: rituximab

Chemotherapy Free Novel Combination of Lenalidomide and Rituximab Displays Promising Results as Initial Therapy for Patients with Mantle Cell Lymphoma

Ruan FaceBy Jia Ruan, MD, PhD

Yesterdays results presented at ASH 2014 provides the first demonstrated feasibility and efficacy of a chemotherapy-free, biologic approach using lenalidomide and rituximab as an initial therapy for mantle cell lymphoma (MCL).  These findings present an important chemotherapy-free alternative initial treatment for MCL, as current conventional upfront chemoimmunotherapies are generally not curative.

During this multi-center phase II study patients were administered lenalidomide at 20 mg in days 1-21 of a 28-day cycle for a total of 12 cycles, with doses escalated to 25 mg when tolerated. Rituximab was administered weekly x 4 during first cycle and then once every other cycle for a total of 9 doses.  The induction phase was followed by a maintenance phase, which at the 13th cycle, lenalidomide was administered at 15 mg on days 1-21 of a 28 day cycle, while rituximab maintenance was employed once every other cycle until disease progression.

Of the 38 patients with previously untreated MCL the median age was 65 years (range 42-86), with a male to female ratio of 2.5:1. Treatment was generally well tolerated with mild to moderate side effects. The overall response rate in patients was 84.2%, complete response rate was over 50%, with median time to objective response being 2.8 months. The median progression-free survival has not been reached, and the 2 year progression free survival rate is estimated to be 83.9%.

This study demonstrated that a high proportion of MCL patients can achieve durable remissions while maintaining a high quality of life. The data gathered from this trial justifies further evaluations of the lenalidomide and rituximab regimen both alone and in combination with other treatment approaches to MCL.

Second Interim Analysis of Idelalisib and Rituximab for Patients with Relapsed CLL Confirms Previous Findings

Picture3By Dr. Richard Furman, MD

There is high unmet need for treatment of unfit patients with relapsed CLL, particularly in those characterized by adverse prognostic factors including del (17p) and/or TP53 mutations. Idelalisib is a first-in-class, targeted, highly selective, oral inhibitor of PI3 Kinase-delta enzyme recently approved for the treatment of relapsed CLL in combination with rituximab. During the 56th annual meeting of the American Society of Hematology (ASH) updated results were presented from a phase III study evaluating idelalisib in combination with rituximab in patients with relapsed CLL.

This study tested the efficacy of idelalisib in combination with rituximab compared to placebo with rituximab in patients with relapsed and refractory CLL who were considered unfit to receive cytotoxic therapy due to comorbidities, poor kidney function, or myelosuppression. 220 randomized patients (110 per group) received idelalisib + rituximab or a placebo + rituximab.  At progression, patients were given the option of enrolling in an extension study where they would receive idelalisib.  The primary endpoint was progression free survival.

At the first interim analysis, the results supported a marked improvement for patients who received idelalisib + rituximab compared with placebo + rituximab, with the median PFS not reached for patients taking idelalisib + rituximab compared with  5.5 months for patients taking the placebo. At 12 months, PFS rates for patients on idelalisib + rituximab was 66% compared to 13% for placebo + rituximab. The benefit favoring idelalisib + rituximab was seen in all risk‑groups. At the time of this analysis, 19 total deaths had occurred on the primary study: 6 on idelalisib + rituximab and 13 on placebo + rituximab.

For patients unfit to receive chemotherapy with relapsed CLL, idelalisib + rituximab demonstrated significant improvement over placebo + rituximab in terms of PFS, ORR, and OS with an acceptable safety profile. These results confirm the 1st interim analysis of the study.

New Clinical Trial: Ibrutinib in Combination with Bendamustine & Rituximab or R-CHOP in Subjects with Previously Treated Indolent Non-Hodgkin Lymphoma

The Weill Cornell Lymphoma Program has recently opened a new clinical trial for men and women with previously treated follicular or marginal zone lymphoma. The study sponsor is Janssen Research & Development LLC., and the principal investigator at Weill Cornell is Dr. Peter Martin. For more information about the study, please call Amelyn Rodgriguez, RN at (212) 746-1362 or e-mail Amelyn at amr2017@med.cornell.edu.

Key eligibility:

  • Open to men and women age 18 and older
  • Follicular or Marginal Zone Non-Hodgkin lymphoma
  • Relapsed or Refractory after receiving at least one prior chemotherapy regimen
  • At least one site of measurable disease
  • Detailed eligibility reviewed when you contact the study team

Study Details

The purpose of this study is to compare whether adding ibrutinib to the standard chemotherapy options for this population bendamustine & rituximab (BR) or R-CHOP results in a longer progression-free survival than BR or R-CHOP alone. The type of chemotherapy that the patient will receive will be dependent on refractory versus relapsed disease, type of indolent non-Hodgkin Lymphoma, and number of prior lines of therapy.

Treatment Plans

All participants will be randomized (randomly) in a one to one ratio to receive the study drug, ibrutinib, or placebo.

Randomization arms: This study is comparing BR or R-CHOP in combination with ibrutinib or placebo. This is a double blind study so neither the patient or the physician will know if they are receiving the study medication, ibrutinib or placebo. The placebo is a blank pill that will look similar to ibrutinib but contains no medicine. The physicians will decide whether patients will receive BR or R-CHOP chemotherapy depending on prior treatments.

Patients will receive the standard 6 cycles of BR or R-CHOP and will continue taking ibrutinib or placebo as long as they are responding to therapy and not experiencing unacceptable side effects.