Combination treatment for nodal T-cell lymphoma with T-follicular helper phenotype

Multicenter, Open Label, Phase I/II of Azacitidine-CHOP for Patients With Nodal T-cell Lymphoma With T-follicular Helper Phenotype

This study is testing a new combination of a drug called azacitidine with standard chemotherapy to see if it helps people with a specific type of nodal T-cell lymphoma feel better and have better results.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 41 (estimated)
• Ages: 20 Years to 85 Years
• Sex: All
• Sponsor: Samsung Medical Center (Academic / other)
• Drugs / interventions: chemotherapy, immunotherapy, doxorubicin, Cyclophosphamide
• Locations: 1 site (Seoul)
• Trial ID: NCT05230680 on ClinicalTrials.gov

What this trial studies

This clinical trial evaluates the safety and efficacy of azacitidine combined with the CHOP chemotherapy regimen in patients with newly diagnosed nodal T-cell lymphoma characterized by the T-follicular helper phenotype. The study is conducted in two phases, starting with a dose escalation in Phase I to determine the maximum tolerated dose of azacitidine, followed by a Phase II evaluation of the determined dose in combination with CHOP. Patients will receive treatment every three weeks for a total of six cycles, with specific monitoring for toxicities and hematologic recovery. The trial aims to improve treatment outcomes for this specific type of lymphoma.

Who should consider this trial

Good fit: Ideal candidates are treatment-naïve patients aged 20 to 85 with newly diagnosed nodal T-cell lymphoma of the T-follicular helper phenotype.

Not a fit: Patients with prior treatment for T-cell lymphoma or those with significant comorbidities affecting their ability to tolerate chemotherapy may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new effective option for patients with nodal T-cell lymphoma with T-follicular helper phenotype.

How similar studies have performed: While there is limited data on this specific combination, similar approaches using azacitidine in hematologic malignancies have shown promise in other studies.

Eligibility criteria

Inclusion Criteria:

1. Treatment-naïve patients with newly diagnosed nodal T-cell lymphoma with T-follicular helper (TFH) phenotype as determined by the following 2016 WHO diagnostic criteria:

   * Angioimmunoblastic T-cell lymphoma
   * Follicular helper T-cell lymphoma
   * Peripheral T-cell lymphoma with follicular helper T-cell type
2. 20 to 85 years of age at diagnosis
3. ECOG performance status 0-2
4. Cardiac function suitable for chemotherapy: LVEF ≥45% on echocardiography or MUGA
5. Appropriate renal function: Serum Cr ≤2.0mg/dL or eGFR ≥ 30mL/min according to the Cockroft-Gault formula
6. Appropriate hepatic function: ALT ≤2.5x upper limit of normal (ULN) (or ≤5x ULN in the presence of liver involvement), total bilirubin ≤2x ULN (or ≤3x ULN in the presence of liver involvement)
7. Appropriate hematologic findings: absolute neutrophil count (ANC) ≥1,500/μL, platelets ≥100,000/μL (or ANC ≥500/μL and platelets ≥50,000/ μL in the presence of bone marrow involvement)
8. Written informed consent to participate in the study
9. Capable of following the study visit schedule and other requirements in the protocol
10. For women of childbearing potential, a negative pregnancy test
11. Women of childbearing potential must use an effective method of contraception (i.e., hormonal contraception, intrauterine device, diaphragm with spermicide, condom with spermicide, or abstinence) during the study period and for 3 months afterward. Men are to use an effective method of contraception during the study period and for 3 months afterward.
12. Life expectancy ≥90 days (3 months)
13. Hepatitis B or C infection: Hepatitis B carriers and subjects with inactive hepatitis C infection (normal levels of aminotransferases) are eligible if they take prophylactic antiviral drugs

Exclusion Criteria:

1. Other subtypes of non-Hodgkin's lymphoma
2. History of chemotherapy for Hodgkin's or other non-Hodgkin's lymphoma in the last 5 years
3. History of active cancer diagnosed within the last 3 years (with the exception of completely resected non-melanoma skin cancer, papillary thyroid cancer, carcinoma in situ of cervical cancer or breast cancer, and localized prostate cancer)
4. Uncontrolled hepatitis B (with the exception of asymptomatic HBsAg-positive or anti-HBcAb-positive cases receiving antiviral prophylaxis such as entecavir or tenofovir)
5. History of chronic hepatitis C (with the exception of HCV IgG positive with a negative HCV-RNA quantification)
6. History of human immunodeficiency virus (HIV) infection
7. Congestive heart failure (NYHA class ≥3)
8. Acute coronary syndrome (new-onset unstable angina or myocardial infarction) or ventricular tachycardia within 6 months prior to study entry
9. History of major neurological or psychiatric illness, including dementia or epilepsy
10. Severe chronic obstructive pulmonary disease with hypoxemia
11. Cerebrovascular disease within 3 months prior to study entry (including transient cerebral ischemia)
12. Unresolved wounds, ulcers, or bone fractures
13. Uncontrolled active infections (viral, bacterial, or fungal infections)
14. Concurrent use of other experimental drugs under investigation
15. Known hypersensitivity to the investigational drugs
16. History of major surgery or serious trauma within 21 days prior to study treatment. Open biopsy within 7 days prior to study treatment
17. Male subjects who had not undergone a vasectomy and have a partner who plans to become pregnant or are unable to use a medically acceptable method of contraception (partner's sterilization or intrauterine device placement, or barrier method combined with diaphragm or condom) during the subject's participation in the study
18. Pregnant or breastfeeding women or women of childbearing potential and men who are not willing to use appropriate methods of contraception during the study
19. Previously treated for T-cell lymphoma with immunotherapy or chemotherapy, except for short-term corticosteroids (for less than 8 days) prior to selection
20. Prior radiotherapy, except for those localized to a single lymph node
21. Central nervous system involvement
22. Contraindication to any of the drugs included in the chemotherapy
23. History of administration of doxorubicin at \>200 mg/m²

Where this trial is running

Seoul

• 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea — Seoul, South Korea (Recruiting)

Study contacts

• Study coordinator: kim wonseog, phD

Conditions T Cell Lymphoma