Trial Search Results

Polatuzumab Vedotin, Rituximab, Ifosfamide, Carboplatin, and Etoposide (PolaR-ICE) as Initial Salvage Therapy for the Treatment of Relapsed/Refractory Diffuse Large B-Cell Lymphoma

This phase II trial studies the effect of polatuzumab vedotin, rituximab, ifosfamide, carboplatin, and etoposide as initial salvage therapy in treating patients with diffuse large B-cell lymphoma that has come back (relapsed) or does not respond to treatment (refractory). Polatuzumab vedotin is a monoclonal antibody, polatuzumab, linked to a toxic agent called vedotin. Polatuzumab attaches to CD79b positive cancer cells in a targeted way and delivers vedotin to kill them. Rituximab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Chemotherapy drugs, such as ifosfamide, carboplatin, and etoposide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy with immunotherapy may kill more cancer cells in patients with diffuse large B-cell lymphoma.

Stanford is currently not accepting patients for this trial.

Lead Sponsor:

City of Hope Medical Center

Collaborator: National Cancer Institute (NCI)

Stanford Investigator(s):

Intervention(s):

  • Drug: Carboplatin
  • Drug: Etoposide
  • Drug: Ifosfamide
  • Drug: Polatuzumab Vedotin
  • Biological: Rituximab

Phase:

Phase 2

Eligibility


Inclusion Criteria:

   - Documented informed consent of the participant and/or legally authorized
   representative

      - Assent, when appropriate, will be obtained per institutional guidelines

   - Be willing to provide archival tissue of a biopsy that was performed after the
   frontline systemic therapy

      - If unavailable, exceptions may be granted with study principal investigator (PI)
      approval

   - Eastern Cooperative Oncology Group (ECOG) =< 2

   - Histologically confirmed diagnosis of diffuse large B-cell lymphoma according to the
   World Health Organization (WHO) classification, with hematopathology review at the
   participating institution. Subtypes of DLBCL including transformed indolent lymphomas
   (TIL), primary mediastinal large B-cell lymphoma (PMBCL), and aggressive B-cell
   lymphoma unclassified (BCL-U) are eligible

   - Biopsy-proven relapsed or refractory disease after 1 line of frontline CD20-directed
   immunotherapy with anthracycline- or anthracenedione-based multi-agent chemotherapy.
   Monotherapy with rituximab or other CD20-directed immunotherapy prior to frontline
   chemotherapy or as maintenance therapy, and radiation therapy in a limited field or as
   a part of the frontline treatment plan are permitted

   - Prior lymphoma therapy should be completed at least 2 weeks before start of protocol
   therapy

   - Measurable disease by computed tomography (CT) or positron emission tomography
   (PET)/CT scan with one or more sites of disease >= 1.5 cm in longest dimension

   - Considered eligible for high-dose chemotherapy followed by ASCT

   - Fully recovered from the acute toxic effects (except alopecia) to =< grade 1 to prior
   anti-cancer therapy

   - Absolute neutrophil count (ANC) >= 1,000/mm^3 (without bone marrow involvement)

      - NOTE: Growth factor is not permitted within 7 days of ANC assessment unless
      cytopenia is secondary to disease involvement

   - ANC >= 750/mm^3 (with bone marrow involvement)

      - NOTE: Growth factor is not permitted within 7 days of ANC assessment unless
      cytopenia is secondary to disease involvement

   - Platelets >= 100,000/mm^3 (without bone marrow involvement)

      - NOTE: Platelet transfusions are not permitted within 7 days of platelet
      assessment unless cytopenia is secondary to disease involvement

   - Platelets >= 75,000/mm^3 (with bone marrow involvement)

      - NOTE: Platelet transfusions are not permitted within 7 days of platelet
      assessment unless cytopenia is secondary to disease involvement

   - Hemoglobin >= 8 g/dL (no erythropoietin and/or packed red blood cells (pRBC)
   transfusion allowed within 7 days prior to screening)

   - Total bilirubin =< 1.5 X upper limit of normal (ULN). If hepatic involvement by
   lymphoma, or Gilbert's disease: =< 3 X ULN

   - Aspartate aminotransferase (AST) =< 2.5 x ULN. If hepatic involvement by lymphoma: AST
   =< 5 x ULN

   - Alanine aminotransferase (ALT) =< 2.5 x ULN. If hepatic involvement by lymphoma: ALT
   =< 5 x ULN

   - Creatinine clearance of >= 50 mL/min per 24 hour urine test or the Cockcroft-Gault
   formula

   - If not receiving anticoagulants: international normalized ratio (INR) OR prothrombin
   (prothrombin time [PT]) =< 1.5 x ULN. If on anticoagulant therapy: PT must be within
   therapeutic range of intended use of anticoagulants

   - If not receiving anticoagulants: activated partial thromboplastin time (aPTT) =< 1.5 x
   ULN. If on anticoagulant therapy: aPTT must be within therapeutic range of intended
   use of anticoagulants

   - Women of childbearing potential (WOCBP): negative urine or serum pregnancy test. If
   the urine test is positive or cannot be confirmed as negative, a serum pregnancy test
   will be required

   - Agreement by females and males of childbearing potential* to use an effective method
   of birth control or abstain from heterosexual activity for the course of the study
   through at least 12 months after the last dose of polatuzumab vedotin or rituximab for
   women, at least 5 months following the last dose of polatuzumab vedotin or 3 months
   following the last dose of rituximab for men, and at least 6 months following the last
   dose of ifosfamide, carboplatin, or etoposide for both women and men

      - Childbearing potential defined as not being surgically sterilized (men and women)
      or have not been free from menses for > 1 year (women only)

Exclusion Criteria:

   - Patients who are not hematopoietic stem cell transplant candidates are excluded

   - Prior solid organ transplantation

   - Systemic steroid therapy or any other form of immunosuppressive therapy for lymphoma
   symptom control must be tapered down to =< 10 mg/day prednisone or equivalent.
   Exceptions are:

      - Inhaled or topical steroids

      - Adrenal replacement doses > 10 mg daily prednisone equivalents in the absence of
      active autoimmune disease

   - Peripheral neuropathy >= grade 2 or demyelinating form of Charcot-Marie-Tooth disease

   - Known active central nervous system (CNS) involvement by lymphoma, including
   leptomeningeal involvement

   - Active infection requiring systemic therapy

   - Other active malignancy requiring therapy. Exceptions include basal cell carcinoma of
   the skin or squamous cell carcinoma of the skin that has undergone potentially
   curative therapy or in situ cervical cancer

   - History of severe allergic reactions attributed to compounds of similar chemical or
   biologic composition to study agents

   - Recent major surgery (within 4 weeks) prior to start of protocol therapy, other than
   for diagnosis

   - Symptomatic cardiac disease (including symptomatic ventricular dysfunction,
   symptomatic coronary artery disease, and symptomatic arrhythmias), cerebrovascular
   event/stroke or myocardial infarction within the past 6 months

   - Known active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Patients
   with past HBV infection (defined as negative hepatitis B surface antigen [HBsAg] and
   positive hepatitis B core antibody [HBcAb]) are eligible if HBV DNA is undetectable.
   Patients who are positive for HCV antibody are eligible if polymerase chain reaction
   (PCR) is negative for HCV ribonucleic acid (RNA). Testing to be done only in patients
   suspected of having infections or exposures

   - Known active human immunodeficiency virus (HIV) infection. Subjects who have an
   undetectable or unquantifiable HIV viral load with CD4 >= 200 and are on highly active
   antiretroviral therapy (HAART) medication are allowed. Testing to be done only in
   patients suspected of having infections or exposures

   - History of or current progressive multifocal leukoencephalopathy (PML)

   - Females only: Pregnant or breastfeeding

   - Any other condition that would, in the investigator's judgment, contraindicate the
   patient's participation in the clinical study due to safety concerns with clinical
   study procedures

   - Prospective participants who, in the opinion of the investigator, may not be able to
   comply with all study procedures (including compliance issues related to
   feasibility/logistics)

Ages Eligible for Study

18 Years - N/A

Genders Eligible for Study

All

Not currently accepting new patients for this trial

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Mariel Rojas
650-723-0530
Not Recruiting