Using ultra low dose radiation with targeted therapy for relapsed mantle cell lymphoma

Phase II Trial to Assess the Efficacy of Ultra Low Radiation Dose Delivered Prior or After Chemotherapy Free Targeted Therapy for the Treatment of Relapsed/Refractory Mantle Cell Lymphoma

This study is testing if using very low doses of radiation along with targeted therapy can help people with relapsed mantle cell lymphoma feel better and live longer while causing fewer side effects.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 80 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: M.D. Anderson Cancer Center (other)
• Drugs / interventions: radiation, chemotherapy
• Locations: 1 site (Houston, Texas)
• Trial ID: NCT04054167 on ClinicalTrials.gov

What this trial studies

This phase II trial investigates the effectiveness of ultra low dose radiation therapy administered before or after chemotherapy-free targeted therapy in patients with relapsed or refractory mantle cell lymphoma. The study aims to evaluate the overall response rate, progression-free survival, and overall survival of patients receiving this treatment. By utilizing ultra low dose radiation, the trial seeks to minimize side effects while potentially enhancing the efficacy of the targeted therapy. Patients will be monitored for their response and overall health for up to five years following treatment.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with confirmed mantle cell lymphoma, whether newly diagnosed or relapsed/refractory, who have measurable disease.

Not a fit: Patients with non-measurable disease or those presenting with gastrointestinal or bone marrow-only involvement may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could improve treatment outcomes and quality of life for patients with difficult-to-treat mantle cell lymphoma.

How similar studies have performed: While the use of ultra low dose radiation in this context is innovative, similar studies have shown promise in enhancing treatment responses in other types of cancers.

Eligibility criteria

Inclusion Criteria:

* Patients must have a confirmed diagnosis of mantle cell lymphoma with positivity in tissue biopsy. Biopsy does not need to be done of the lesions to be treated.
* Patients can be newly diagnosed or previously treated relapsed and/or refractory MCL.
* Understand and voluntarily sign an IRB-approved informed consent form.
* Age ≥ 18 years at the time of signing the informed consent.
* Patients must have bi-dimensional measurable disease (Measurable disease by CT scan defined as at least 1 lesion that measures =/\>1.5 cm in single dimension.) Patient presenting with lesions in the presence of leukemia phase (peripheral blood involvement), non-measurable disease, gastrointestinal (GI) MCL, or bone marrow (BM) MCL are also eligible.
* Gastrointestinal or bone marrow or spleen only patients are allowable and will be analyzed separately.
* Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less (see Appendix 1).
* Willing and able to participate in all study related procedures and therapy including swallowing capsules without difficulty.
* Females of childbearing potential (FCBP)1 must have a negative serum or urine pregnancy test and must be willing to use acceptable methods of birth control during the study and for 30 days after the last dose of study treatment.
* Male patients must use an effective barrier method of contraception during the study and for 30 days following the last dose of study treatment if sexually active with a female of childbearing potential.
* Serum bilirubin \<1.5 mg/dl and Cr Clearance ≥ 30 mL/min, platelet count \>25,000/mm3 and absolute neutrophil count (ANC) \> 1,000/mm3, AST (SGOT) and ALT (SGPT) \< 3 x upper limit of normal or \< 5 x upper limit of normal if hepatic metastases are present.
* Patients who have bone marrow infiltration by MCL are eligible if their ANC is ≥ 1000/mm3 \[growth factor not allowed\] or their platelet level is ≥ 25,000/mm3

Exclusion Criteria:

* Has had prior radiation therapy to the potential radiation target such that additional radiation therapy is considered unsafe by the treating radiation oncologist
* Has a diagnosis of active scleroderma or lupus or any other autoimmune disease that by the opinion of the treating radiation oncologist would put the patient at unacceptable risk of toxicity.
* Any serious medical condition including but not limited to, uncontrolled hypertension, uncontrolled diabetes mellitus, uncontrolled infection, active/symptomatic coronary artery disease, COPD, renal failure, active hemorrhage, or psychiatric illness that, in the investigators opinion places the patient at unacceptable risk and would prevent the subject from signing the informed consent form.
* Pregnant or breast-feeding females.
* All patients with central nervous system lymphoma that needs attention prior to treatment of the lesions.
* If the total fields of radiation will include a marrow volume of more than 40%. Physician can include as many fields to respect the 40 % of marrow volume and come back in 4-6 weeks later to address the rest of the disease after insuring that the Blood counts are adequate. Blood counts should be back to back to the numbers prior to starting the first phase of radiation +- 10% variance.
* If given radiation prevent them from going through an alternative phase I trial

Where this trial is running

Houston, Texas

• M D Anderson Cancer Center — Houston, Texas, United States (RECRUITING)

Study contacts

• Principal investigator: Bouthaina S Dabaja — M.D. Anderson Cancer Center
• Study coordinator: Bouthaina S Dabaja

Conditions: Recurrent Mantle Cell Lymphoma, Refractory Mantle Cell Lymphoma