Phase II Study of Dose-Adjusted EPOCH-Rituximab in Adults With Untreated Burkitt Lymphoma and c-MYC+ Diffuse Large B-Cell Lymphoma
Phase: Phase 2
Diagnosis: Non-Hodgkin's Lymphoma
NCT ID: NCT01092182
(View complete trial on ClinicalTrials.gov)
DFCI Protocol ID: 10-116
Background: - Burkitt lymphoma/leukemia (BL) is highly treatable, but most of the standard therapies require multiple doses of intensive chemotherapy that may require long hospital stays and frequently have severe side effects. In addition, BL is a fairly common type of cancer in patients who also have human immunodeficiency virus (HIV), but treatment outcomes are poor because standard treatments do not work very well in HIV-positive patients and the more intense treatment regimens are highly toxic. New approaches are needed that expand the ways to treat BL with the same efficiency but with reduced side effects. - DA-EPOCH-R is a standard chemotherapy treatment that consists of the drugs etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab. It may be able to treat BL with similar effectiveness but with fewer side effects. Researchers are interested in confirming the results of previous studies that investigated the effectiveness of DA-EPOCH-R in treating BL. Objectives: - To determine the safety and effectiveness of DA-EPOCH-R in treating Burkitt lymphoma. Eligibility: - Individuals at least 18 years of age who have been diagnosed with Burkitt lymphoma and have not had any prior chemotherapy treatments. Design: - Individuals will have a series of blood and other tests to determine their suitability for participating in the study. Eligible participants will be divided into high-risk and low-risk groups based on their disease prognosis and the possibility that the BL may or already has spread into the central nervous system. - Participants will receive intravenous infusion of the six chemotherapy drugs in DA-EPOCH-R in 21-day treatment cycles. The exact doses will be adjusted depending on participants' white blood cell counts and other tests. - High-risk participants will receive six cycles of DA-EPOCH-R. To treat BL that may have entered the central nervous system, high-risk participants will also receive infusions of other chemotherapy drugs into their spinal fluid. - Low-risk participants will receive up to six cycles of DA-EPOCH-R, with an additional dose of rituximab during each cycle. - Frequent blood and urine tests will be performed during treatment, as well as body imaging scans and other tests of cancer progression as directed by the study doctors. Participants will receive additional medicines to help prevent possible adverse side effects of DA-EPOCH-R. - Participants who respond successfully to the treatment will be asked to return for follow-up exams every 3 months for the first 18 months, then every year for the next 3 years. Participants who do not respond successfully to the treatment will be given the opportunity to participate in additional research and treatment protocols, if any are available.
Dana-Farber Cancer Institute, Massachusetts General Hospital, Beth-Israel Deaconess Medical Center
Ann LaCasce, MD,
Dana-Farber Cancer Institute
Robin Joyce, MD,
Beth Israel Deaconess Medical Center
Jeremy Abramson, MD,
Massachusetts General Hospital
Dana-Farber Cancer Institute:
Beth-Israel Deaconess Medical Center:
Cancer Trials Call Center, 617-667-3060
Massachusetts General Hospital:
Cancer Trials Call Center, 877-789-6100
- INCLUSION CRITERIA:
- Burkitt lymphoma or B-cell lymphoma, unclassifiable, with features intermediate
between Diffuse Large B-cell lymphoma and Burkitt Lymphoma, c-MYC + DLBCL or c-MYC+
plasmablastic lymphoma by histology. Cytogenetic results are not required prior to
- Age greater than or equal to 18.
- Pathology confirmed by treating institution's Pathology Department.
- No prior treatment except local radiation or short course steroids for acute
- All disease stages.
- HIV negative or positive.
- ECOG 0-4
- Ability of patient or durable power of attorney (DPA) for healthcare to give informed
- Inadequate renal function or creatinine clearance less than 50 ml/min/1.73m(2) unless
- Inadequate hepatic or hematological function: bilirubin greater than 2 mg/dl (total)
except greater than 5 mg/dl in patients with Gilbert's syndrome as defined by greater
than 80% unconjugated; ANC less than 1000 and platelets less than 75,000 unless
- Female subject of child-bearing potential not willing to use an acceptable method of
birth control (i.e., a hormonal contraceptive, intra-uterine device, diaphragm with
spermicide, condom with spermicide, or abstinence) for the duration of the study and
one year beyond treatment completion.
- Female subject pregnant or breast-feeding. Confirmation that the subject is not
pregnant must be established by a negative serum beta-human chorionic gonadotropin
(beta-hCG) pregnancy test result obtained during screening. Pregnancy testing is not
required for women without child-bearing potential.
- Male subject unwilling to use an acceptable method for contraception for the duration
of the study and one year beyond treatment completion.
- History of a prior invasive malignancy in past 5 years.
- Active symptomatic ischemic heart disease, myocardial infarction or congestive heart
failure within the past year. If echo is obtained the LVEF should exceed 40%.
- Serious concomitant medical illnesses that would jeopardize the patient's ability to
receive the regimen with reasonable safety.
- HIV positive patients not willing to suspend HAART therapy during the treatment
period of the protocol.