Obatoclax and Bortezomib in Treating Patients With Aggressive Relapsed or Recurrent Non-Hodgkin Lymphoma

National Cancer Institute (NCI)

Status and phase

Terminated

Phase 1

Conditions

Recurrent Grade 1 Follicular Lymphoma

Adult Non-Hodgkin Lymphoma

Recurrent Small Lymphocytic Lymphoma

Recurrent Mantle Cell Lymphoma

Recurrent Grade 2 Follicular Lymphoma

Recurrent Adult Diffuse Large Cell Lymphoma

Recurrent Grade 3 Follicular Lymphoma

Recurrent Marginal Zone Lymphoma

Treatments

Drug: bortezomib

Drug: obatoclax mesylate

Other: laboratory biomarker analysis

Other: pharmacological study

Study type

Interventional

Funder types

NIH

Identifiers

NCT00538187

U01CA062505 (U.S. NIH Grant/Contract)

CDR0000566357

PHI-58

NCI-2009-00253

Details and patient eligibility

About

Obatoclax may stop the growth of non-Hodgkin lymphoma by blocking blood flow to the cancer. Bortezomib and obatoclax may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving obatoclax together with bortezomib may kill more cancer cells. This phase I/II trial is studying the side effects and best dose of obatoclax when given together with bortezomib and to see how well they work in treating patients with aggressive relapsed or recurrent non-Hodgkin lymphoma.

Full description

PRIMARY OBJECTIVES:

I. To establish the maximum tolerated dose of obatoclax mesylate when administered with bortezomib in patients with aggressive relapsed or recurrent non-Hodgkin lymphoma.

II. To describe the toxicities of this regimen at each dose studied in these patients.

III. To characterize the pharmacokinetic behavior of this regimen in these patients.

IV. To obtain preliminary information regarding the effect of obatoclax mesylate on several apoptotic regulatory pathways.

V. To document all clinical responses in these patients to this regimen.

OUTLINE: This is a multicenter study.

PHASE I: Patients receive obatoclax mesylate IV over 3 hours followed by bortezomib IV on days 1, 8, 15, and 22.

Treatment repeats every 35 days in the absence of disease progression or unacceptable toxicity. Pharmacokinetic evaluations of obatoclax mesylate are conducted in all patients during the first course.

PHASE II: Patients receive obatoclax mesylate IV over 3 hours followed by bortezomib IV on days 1, 8, 15, and 22 at the maximum tolerated dose determined in phase I.

Treatment repeats every 35 days for up to 1 year in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed for 26 weeks.

Enrollment

18 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Histologically or cytologically confirmed relapsed or refractory non-Hodgkin lymphoma for which standard curative or palliative measures do not exist or are no longer effective, including any of the following subtypes:
- Follicular grade I, II, or III lymphoma
- Marginal zone lymphoma
- Mantle cell lymphoma
- Diffuse large B cell lymphoma
- Small lymphocytic lymphoma
Must have had at least one prior chemotherapeutic regimen:
- Steroids or rituximab alone or local radiotherapy do not count as regimens
- Tositumomab or ibritumomab tiuxetan allowed as regimens
Clear evidence of disease progression or lack of response after the most recent therapy, including rituximab or local radiotherapy, is required
At least 3 months since prior autologous stem cell transplantation and relapsed (>= 1 year since prior allogeneic transplantation and relapsed) and no active related infections (i.e., fungal or viral)
In the case of allogeneic transplantation relapse, there should be no active acute graft-versus-host disease (GVHD) of any grade and no chronic GVHD other than mild skin, oral, or ocular GVHD not requiring systemic immunosuppression
No known active brain metastases, other neurological disorders/dysfunction or history of seizure disorder, or other neurological dysfunction
Karnofsky performance status 60-100%
Life expectancy > 3 months
Total bilirubin normal
AST and ALT =< 2.5 times upper limit of normal
Creatinine normal or creatinine clearance >= 60 mL/min
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective double-barrier contraception during and for 3 months after the last dose of obatoclax mesylate
At least 4 weeks since prior radiotherapy
More than 2 days since prior steroids
More than 2 weeks since prior low-dose chlorambucil
WBC >= 3,000/mm^3
ANC >= 1,500/mm^3
Platelet count >= 100,000/mm^3
At least 2 weeks since prior valproic acid

Exclusion criteria

Uncontrolled concurrent medical condition or illness including, but not limited to, any of the following:
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia including QTc > 450 msec
Patients who are intolerant or refractory to prior treatment with bortezomib (refractory is defined as no response to prior treatment with bortezomib)
Chemotherapy within the past 4 weeks (6 weeks for nitrosoureas or mitomycin C)
Rituximab within the past 3 months (unless there is evidence of progression)
Patients who have not recovered from adverse events due to agents administered more than 4 weeks earlier
Other concurrent investigational agents
Combination antiretroviral therapy for HIV-positive patients
No history of allergic reactions attributed to bortezomib, polyethylene glycol (PEG 300), or polysorbate 20
No psychiatric illness or social situation that would limit compliance with study requirements