A Randomized Phase 3 Interim Response Adapted Trial Comparing Standard Therapy with Immuno-Oncology Therapy for Children and Adults with Newly Diagnosed Stage I and II Classic Hodgkin Lymphoma
1. To compare the PFS of a standard chemotherapy approach versus an IO therapy approach (brentuximab vedotin and nivolumab) in patients with newly diagnosed early stage cHL who have a rapid early response (RER) as determined by PET2 after 2 cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy.
2. To compare the PFS of a standard chemotherapy approach versus an IO therapy approach (brentuximab vedotin and nivolumab) plus involved site radiation therapy (ISRT) in patients with newly diagnosed early stage cHL who have a slow early response (SER) as determined by PET2 after 2 cycles of ABVD chemotherapy
BLEOMYCIN
VINBLASTINE
ADRIAMYCIN
DACARBAZINE
Opdivo (Nivolumab)
- Rutgers Cancer Institute of New Jersey
- RWJBarnabas Health
- Community Medical Center
- Cooperman Barnabas, Livingston
- Jersey City Medical Center, Jersey City
- Monmouth Medical Center
- Monmouth Medical Center Vantage Point Center
- Newark Beth Israel Medical Center
Inclusion Criteria
- Patients must be 5 to 60 years of age at the time of enrollment
- Patients with newly diagnosed untreated histologically confirmed classic Hodgkin
lymphoma (cHL) (nodular sclerosis, mixed cellularity, lymphocyte-rich, or
lymphocyte-depleted, or not otherwise specified [NOS]) with stage I or II disease
- Patients must have bidimensionally measurable disease (at least one lesion with
longest diameter >= 1.5 cm)
- Patients must have a whole body or limited whole body PET scan performed within 42
days prior to enrollment. PET-CT is strongly preferred. PET-MRI allowed if
intravenous contrast enhanced CT is also obtained
- Pediatric patients (age 5-17 years) must have an upright posteroanterior (PA) chest
X-ray (CXR) for assessment of bulky mediastinal disease. Adult patients must have
either a CXR or CT chest
- Patients >= 18 years must have a performance status corresponding to Zubrod scores
of 0, 1 or 2
- Patients =< 17 years of age must have a Lansky performance score of >= 50
- Pediatric patients (age 5-17 years): A serum creatinine based on age/gender as
follows (within 7 days prior to enrollment):
- 2 to < 6 years (age): 0.8 mg/dL (male), 0.8 mg/dL (female)
- 6 to < 10 years (age): 1 mg/dL (male), 1 mg/dL (female)
- 10 to < 13 years (age): 1.2 mg/dL (male), 1.2 mg/dL (female)
- 13 to < 16 years (age): 1.5 mg/dL (male), 1.4 mg/dL (female)
- >= 16 years (age): 1.7 mg/dL (male), 1.4 mg/dL (female) OR a 24 hour urine
creatinine clearance >= 50 mL/min/1.73 m^2 (within 7 days prior to enrollment)
OR a glomerular filtration rate (GFR) >= 50 mL/min/1.73 m^2 (within 7 days
prior to enrollment). GFR must be performed using direct measurement with a
nuclear blood sampling method OR direct small molecule clearance method
(iothalamate or other molecule per institutional standard)
- Note: Estimated GFR (eGFR) from serum or plasma creatinine, cystatin C or other
estimates are not acceptable for determining eligibility
- For adult patients (age 18 years or older) (within 7 days prior to enrollment):
Creatinine clearance >= 30 mL/min, as estimated by the Cockcroft and Gault formula
or a 24-hour urine collection. The creatinine value used in the calculation must
have been obtained within 28 days prior to registration. Estimated creatinine
clearance is based on actual body weight
- Total bilirubin =< 2 x upper limit of normal (ULN) (within 7 days prior to
enrollment)
- Unless due to Gilbert's disease, lymphomatous involvement of liver or vanishing
bile duct syndrome
- Aspartate aminotransferase (AST) =< 3 x ULN (within 7 days prior to enrollment)
- Unless due to Gilbert's disease, lymphomatous involvement of liver or vanishing
bile duct syndrome
- Alanine aminotransferase (ALT) =< 3 x ULN (within 7 days prior to enrollment)
- Unless due to Gilbert's disease, lymphomatous involvement of liver or vanishing
bile duct syndrome
- Shortening fraction of >= 27% by echocardiogram (ECHO), multigated acquisition scan
(MUGA), or functional cardiac imaging scan (within 7 days prior to enrollment) or
ejection fraction of >= 50% by radionuclide angiogram, ECHO, MUGA, or cardiac
imaging scan (within 7 days prior to enrollment)
- Diffusion capacity of the lung for carbon monoxide (DLCO) >= 50% of predicted value
as corrected for hemoglobin by pulmonary function test (PFT) (within 7 days prior to
enrollment). If unable to obtain PFTs, the criterion is: a pulse oximetry reading of
> 92% on room air
- Known human immunodeficiency virus (HIV)-infected patients on effective
anti-retroviral therapy with undetectable viral load within 6 months are eligible
for this trial
- For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV
viral load must be undetectable on suppressive therapy, if indicated. Patients with
a history of hepatitis C virus (HCV) infection must have been treated and cured. For
patients with HCV infection who are currently on treatment, they are eligible if
they have an undetectable HCV viral load
Exclusion Criteria
- Patients with nodular lymphocyte predominant Hodgkin lymphoma
- Patients with a history of active interstitial pneumonitis or interstitial lung
disease
- Patients with a diagnosis of inherited or acquired immunodeficiency that is poorly
controlled or requiring active medications, such as primary immunodeficiency
syndromes or organ transplant recipients
- Patients with any known uncontrolled intercurrent illness that would jeopardize the
patient's safety such as infection, autoimmune conditions, cardiac arrhythmias,
angina pectoris, and gastrointestinal disorders affecting swallowing and/or
absorption of pills
- Patients with a condition requiring systemic treatment with either corticosteroids
(defined as equivalent to > 10 mg daily prednisone for patients >= 18 years or > 0.5
mg/kg [up to 10 mg/day] for patients < 18 years) or other immunosuppressive
medications within 14 days prior to enrollment
- Note: Replacement therapy such as thyroxine, insulin, or physiologic
corticosteroid for adrenal or pituitary insufficiency is not considered a form
of systemic treatment. Inhaled or topical steroids, and adrenal replacement
doses (=< 10 mg daily for patients >= 18 years or =< 0.5 mg/kg [up to 10
mg/day] prednisone equivalents) are permitted in the absence of active
autoimmune disease
- Note: Steroid use for the control of Hodgkin lymphoma symptoms is allowable,
but must be discontinued by cycle 1, day 1
- Patients with peripheral neuropathy > grade 1 at the time of enrollment or patients
with known Charcot-Marie-Tooth syndrome
- Patients with a prior or concurrent malignancy whose natural history or treatment
has the potential to interfere with the safety or efficacy assessment of the
investigational regimen
- Administration of prior chemotherapy, radiation, or antibody-based treatment for cHL
- Prior solid organ transplant
- Prior allogeneic stem cell transplantation
- Live vaccine within 30 days prior to planned day 1 of protocol therapy (e.g.,
measles, mumps, rubella, varicella, yellow fever, rabies, bacillus calmette guerin
[BCG], oral polio vaccine, and oral typhoid). Administration of messenger
ribonucleic acid (mRNA) vaccines are permitted
- Female patients who are pregnant since fetal toxicities and teratogenic effects have
been noted for several of the study drugs. A pregnancy test within 28 days prior to
enrollment is required for female patients of childbearing potential
- Lactating females who plan to breastfeed their infants starting with the first dose
of study therapy and for at least 6 months after the last treatment
- Sexually active patients of reproductive potential who have not agreed to use a
highly effective contraceptive method (failure rate of < 1% per year when used
consistently and correctly) for the duration of their study drug therapy. Following
therapy, patients will be advised to use contraception as per institutional practice
or as listed below for investigational agents, whichever is longer
- Men and women of childbearing potential must continue contraception for a
period of 6 months after last dose of brentuximab vedotin
- Women of child-bearing potential (WOCBP) must continue contraception for a
period of at least 5 months after the last dose of nivolumab
- All patients and/or their parents or legal guardians must sign a written informed
consent
- All institutional, Food and Drug Administration (FDA), and National Cancer Institute
(NCI) requirements for human studies must be met
Please note that we have obtained the inclusion and exclusion criteria information from the National Institutes of Health’s clinical trials web site ClinicalTrials.gov. The listed criteria may not necessarily reflect recent amendments to the protocol and the current criteria.
For further information about clinical trials, please contact us at 732-235-7356.