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Study Summary
No. 2007-0906:.......Lymphoma......Anas Younes......Lymphoma/Myeloma
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Study Summary Title
Study Summary
Number:
2007-0906
Study Title:A Phase 1b Study to Evaluate the Safety and Tolerability of AMG 655 in Combination with Bortezomib or Vorinostat in Subjects with Relapsed or Refractory Lymphoma
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Physician New Patient Referral
Name:Anas YounesPatients Call:800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)
Dept:Lymphoma/MyelomaReferring MD
Call:
800-392-1611 (in U.S.A.) 713-792-6161 (outside U.S.A.)
Phone:713-792-2860
Contact us about clinical trials
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General Information
Disease Group:LymphomaSupported By:Amgen, Inc.
Phase of Study:Phase IReturn
Visit:
Dose Escalation and Dose Expansion: Screening,days 1,2,4,8,11,15,
22,43,64,every 3 weeks at cycle 5, end of study. follow up visit 60 days after
end of study.
Treatment
Agents:
AMG 655
Bortezomib
Vorinostat
Home Care:n/a
Treatment Loc:Both at MDACC & outside MDACC at one or more Collaborating Sites or Institutions
Estimated
Length of Stay
in Houston:
n/a
Description/
Intervention:
The goal of this clinical research study is to learn about the safety of AMG
655 when given in combination with bortezomib or vorinostat to patients with
lymphoma that has returned or has not responded to standard therapy.

AMG 655 in combination with bortezomib or vorinostat in patients with lymphoma
is in the early stages of being tested in humans.
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Study Objectives / Outcomes
Primary
Primary objectives include the following:

Part 1 (Dose escalation): To determine the safety and tolerability of escalating doses of AMG 655 in combination with bortezomib or vorinostat

Part 2 (Dose expansion): To estimate the efficacy, as measured by the objective response rate, of AMG 655 therapy, in combination with bortezomib, in subjects with mantle cell lymphoma as measured using International Working Group (IWG) criteria.

Secondary
Secondary objectives include the following:

Part 1 (Dose escalation):
To determine the maximum tolerated dose of AMG 655 up to a target dose of 15 mgkg that can be administered in combination with bortezomib or vorinostat
To evaluate the pharmacokinetics of AMG 655
To evaluate the incidence of anti-AMG 655 antibody formation
To evaluate the best tumor response (eg, complete response [CR], partial response [PR]), objective response rate (CR or PR) and duration of response as measured using IWG criteria.

Part 2 (Dose expansion):
To evaluate parameters of clinical benefit as measured by duration of response, progression-free survival, and an estimate of overall survival (Cheson et al, 2007)
To evaluate the pharmacokinetics of AMG 655
To evaluate the incidence of anti-AMG 655 antibody formation

Exploratory
Exploratory Objectives in Parts 1 and 2 include the following:

To investigate the pharmacodynamic response to AMG 655 in combination with bortezomib or vorinostat, as assessed by apoptosis biomarkers (eg, caspase 8, caspase 3/7, serum and/or plasma genomic DNA levels)

To investigate the development of other potential biomarkers (eg, biochemical levels and abundance of drug targets) by biochemical analysis of blood andlor lymph tissue, and correlate with treatment outcome

To investigate the genetic variation in drug metabolism genes, cancer genes, and drug target genes, and correlate with treatment outcomes (optional)

To investigate receptor occupancy by AMG 655

To evaluate best tumor response (eg, complete response [CR], unconfirmed complete response [CRu], and partial response [PR]), objective response rate (CR or CRu or PR), duration of response and progression free survival as measured using IWG criteria (Part 2 only)
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Study Status Information
Study Activation / Registration Date:07/10/2008
IRB Review and Approval Date:07/10/2008
Study Type:Phase I
Recruitment Status:Open
Projected Accrual:Up to a maximum of 62 patients.
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Enrollment Eligibility
If you do not meet the enrollment eligibility, there may be other treatment options for you. Please Contact the Referral Office for more information.

Inclusion Criteria:1) Part 1: Subjects must have a pathologically confirmed diagnosis of lymphoma that is relapsed or refractory to standard treatment or for which no curative therapy is available. lymphoma subtypes that are eligible for enrollment include low grade lymphoma, mantle cell lymphoma, diffuse large cell lymphoma, and Hodgkin's disease.

2) Part 2: Subjects must have relapsed or refractory mantle cell lymphoma with at least one objective measurable disease site (ie, measurable in at least 2 perpendicular parameters. The diagnosis of mantle cell lymphoma must be pathologically confirmed including overexpression of cyclin D l or evidence of t(11;14) translocation. (Continued in inclusion # 3).

3) (Continued from inclusion # 2). Subjects must have had at least one prior antineoplastic therapy, up to a maximum of 3. At least one therapy must have included an anthracycline. Subjects must have had documented relapse or progression following the last therapy (ie, most recent therapy given prior to enrollment). An abnormal PET scan will not constitute evaluable disease, unless verified by CT or MRI scan).

4) Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

5) Life expectancy of > 3 months in the opinion of the investigator

6) Men or women >/= I8 years old

7) Hematological function, as follows: Hemoglobin >/= 9 g/dL. For enrollment in Part 1, a hemoglobin >/=9 g/dL must be achieved without the administration of erythropoietin within 14 days of enrollment. For enrollment in Part 2, concomitant administration of erythropoietin is permitted. Absolute neutrophil count (ANC) >/=1.5 x 10^9/L. For enrollment in Part 1 an ANC of >/= 1.5 x 10^9/L must be achieved without the administration of granulocyte-colony stimulating factor (GCSF) or granulocyte-macrophage colony-stimulating factor (GMCSF) within 28 days of enrollment. (Continued in inclusion # 8.)

8) (Continued from Inclusion # 7) Platelet count >/= 75 x 10^9/L (without a transfusion within 14 days before enrollment)

9) Renal function, as follows: Serum creatinine </= 2.0 mg/dL

10) Hepatic function, as follows: Aspartate aminotransferase (AST) < 2.5 x upper limit of normal (IULN) (if attributable to liver involvement by lymphoma, </= 5 x IULN); Alanine aminotransferase (ALT) < 2.5 x IULN (if attributable to liver involvement by lymphoma, </= 5 x IULN); Alkaline phosphatase < 2.0 x IULN (if attributable to liver involvement by lymphoma, </= 5 x IULN); Total bilirubin < 2.0 x IULN; Amylase </= 2.0 x IULN; Lipase </= 2.0 x IULN; Partial thromboblastin time PTT <1.2 x IULN.

11) Serum chemistry, as follows: Serum potassium, calcium and magnesium should be within the normal range. Hypokalemia or hypomagnesemia should be corrected prior to administration of study medication.

12) Vorinostat cohorts only: Able to tolerate and swallow oral medications

13) Willing to provide existing and/or future paraffin-embedded tumor samples

14) Female subject is post-menopausal (no menstrual period for a minimum of 12 months) or surgically sterilized and have a negative serum pregnancy test upon entry into this study. Female subject of child bearing potential must use an oral or implanted contraceptive, a double-barrier method of birth control or an intrauterine device during the period of therapy and be willing to use contraception 3 months following the last study drug administration

15) Male subject is surgically sterile or is willing to use contraception upon enrollment, during the course of the study, and for 6 months following the last study drug administration

16) Competent to comprehend, sign, and date an institutional review board (IRB) - approved informed consent form

Exclusion Criteria:1) A history of other malignancies, except: adequately treated non-melanoma skin cancer, curatively treated in-situ cancer of the cervix, or other solid tumors curatively treated with no evidence of disease for >/= 5 years.

2) A history of allogeneic stem-cell transplantation

3) Primary central nervous system (CNS) tumors including primary CNS lymphoma

4) Central nervous system involvement by lymphoma

5) Myocardial infarction within 6 months before enrollment, symptomatic congestive heart failure (New York Heart Association >class II), unstable angina, or unstable cardiac arrhythmia requiring medication

6) Clinically significant ECG changes which obscure the ability to assess the PR, QT, and QRS intervals

7) Congenital long QT syndrome

8) Patients with a QTc interval > 470 msec

9) Vorinostat cohorts only: History of significant GI surgery or disease, which would impair intestinal absorption

10) Vorinostat cohorts only: Active peptic ulcer disease

11) Unresolved toxicities from prior anti-cancer therapy, defined as having not resolved to Common Terminology Criteria for Adverse Events (CTCAE) grade 0 or 1, or to levels dictated in the inclusion/exclusion criteria with the exception of alopecia

12) Recent infection requiring systemic anti-infective treatment that was completed </= 14 days before enrollment/randomization (with the exception of uncomplicated urinary tract infection or upper respiratory tract infection)

13) Subject known to have tested positive for human immunodeficiency virus (HIV)

14) Subject known to have tested positive for hepatitis C virus or acute or chronic hepatitis B infection

15) Any co-morbid medical condition that would increase the risk of toxicity in the opinion of Investigator or Sponsor

16) Treatment with anti-cancer therapy (chemotherapy, molecular targeted therapy, retinoid therapy, or hormonal therapy) within 28 days prior to study day 1 (6 weeks for nitrosoureas and mitomycin C).

17) Antibody therapy for the treatment of underlying malignancy within 28 days prior to study Day 1, with the exception of bevacizumab and other monoclonal antibodies with a half-life of greater than 10 days, which must be discontinued at least 8 weeks prior to study Day 1. Radioimmunoconjugates must be discontinued at least 10 weeks prior to study Day 1.

18) Prior exposure to AMG 655 or other investigational TRAIL receptor agonists is not permitted

19) Prior treatment with bortezomib or vorinostat is not permitted for subjects enrolling in the bortezomib and vorinostat cohorts, respectively

20) Part 1 only: Concomitant anticoagulant use other than for prophylaxis against central venous catheter thrombosis is not permitted

21) Part 1 only: Concomitant therapy with erythropoietin within 14 days of enrollment

22) Part 1 only: Concomitant therapy with granulocyte-colony stimulating factor (GCSF) or granulocyte-macrophage colony-stimulating factor (GMCSF) within 28 days of enrollment

23) Vorinostat cohort only: Concomitant therapy with anti-arrhythmic medicines or other medicinal products that lead to QT prolongation is not permitted

24) Vorinostat cohort only: Concomitant therapy with a histone deacetylase (HDAC) inhibitor (eg, valproic acid)

25) Therapeutic or palliative radiation therapy within 2 weeks before enrollment

26) Concurrent immunosuppressant therapy (eg, cyclosporine A, tacrolimus, etc. or chronic administration of > 5 mg/day of prednisone) within 28 days of day 1

27) Bortezomib cohorts only: Use of the following medications (prescription or nonprescription) or herbal supplements: CYP enzyme inhibitors (eg, ketoconazole, itraconazole, fluconazole, erythromycin, and clarithromycin) within 14 days or 5 half-lives (whichever is longer) before the first dose of investigational agent; CYP enzyme inducers (eg, rifampin, rifabutin, phenobarbital, phenytoin, and carbamazepine) and St. John's Wort) within 28 days or 5 half-lives (whichever is longer) before the first dose of investigational agent.

28) Vorinostat cohorts only: Consumption of grapefruit or grapefruit-containing products within 7 days before the first dose of investigational agent

29) Subject is not able to tolerate intravenous drug infusions

30) Known allergy to the excipients or investigational product

31) Bortezomib cohorts only: Known allergy to mannitol or boron

32) Prior participation in clinical trials (with investigational device or agent) within 28 days before the first dose of AMG 655

33) Major surgery within 28 days before the first dose of AMG 655

34) Subject of child-bearing potential is pregnant or nursing

35) Subject has previously enrolled in this study

36) Subject has any kind of disorder that compromises the ability of the subject to give written informed consent and/or comply with the study procedures

37) Subject will not be available for follow up assessments

38) Subject is unwilling to comply with the study requirements

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Links
Registration Number: NCT00791011
Study Information on Clinical Trials Registry (clinicaltrials.gov)

Other Links:
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Results


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