NIH Clinical Research Studies

Protocol Number: 97-C-0110

Active Accrual, Protocols Recruiting New Patients

Title:
Phase I/II Study of Tac-Expressing Malignancies Other than Adult T-Cell Leukemia (ATL) with Yttrium-90 Radiolabeled Humanized Anti-Tac and Calcium-DTPA
Number:
97-C-0110
Summary:
The purpose of the study is to determine (1) the maximum tolerated dose of humanized-anti-Tac monoclonal antibody conjugated with Yttrium-90 (90Y) and (2) the clinical response in patients with Tac-expressing malignancies other than adult T-cell leukemia (ATL). This study represents an extension of Metabolism Branch, NCI protocols utilizing modifications of the anti-Tac monoclonal antibody in the treatment of ATL. The scientific basis for these therapeutic studies is that the malignant cells of patients with various hematologic malignancies express abnormally high levels of the Tac antigen (the IL-2R alpha) on their surfaces whereas resting normal cells, including T cells, do not. The administration of 90Yttrium-humanized anti-Tac (90Y-HAT) and intravenous calcium DTPA for patients with ATL is permitted under protocol #96-C-0147. The maximum tolerated dose in the Phase I trial of 90Y-murine anti-Tac (90Y-MAT) (without the intravenous chelate) was 10 mCi. In 1993 a phase II study of Yttrium-90 (90Y)-labeled humanized anti-Tac, also without the chelate, Protocol #93-C-0066 was initiated. In that trial all patients received an initial dose of 10 mCi of 90Y-HAT followed by up to 8 successive doses of 5 mCi. A review of the results of the first 15 patients treated has shown evidence of both less efficacy and less toxicity than seen in the 90Y-murine anti-Tac study. Also, recent data from another group has indicated that the maximum tolerated dose of the 90Yttrium can be significantly increased through use of an intravenous chelate, calcium DTPA (Ca-DTPA) to facilitate urinary excretion of 90Y. As a result we proposed and obtained approval for a Phase I/II, dose escalation trial of 90Yttrium labeled humanized anti-Tac with a fixed dose of calcium-DTPA for the treatment of patients with Tac-expressing ATL. We seek to redesign the ongoing trial of 90Y-HAT for the treatment of Tac-expressing post-thymic T-cell malignancies [other than ATL] (CC Protocol # 94-C-0068) to include the same modifications and to expand the patient population to include other Tac-positive malignancies. There will be two phases to the study, a phase I dose escalation element to define the maximum tolerated dose and a phase II element at the maximum tolerated dose of 90Y-anti-Tac defined in the first element.
Sponsoring Institute:
National Cancer Institute (NCI)
Recruitment Detail
Type: Active Accrual Of New Subjects
Gender: Male & Female
Referral Letter Required: No
Population Exclusion(s): None

Eligibility Criteria:
INCLUSION CRITERIA:

All patients must have a histologically confirmed diagnosis of Hodgkin's disease, non-Hodgkin's lymphoma or lymphoid leukemia.

At least 10% of each patient's malignant cells from peripheral blood, lymph node, skin, or other extranodal sites must react with anti-Tac , as determined by immunofluorescent or immunoperoxidase staining.

Diagnoses and Stage of Disease:

1) Non-Hodgkin's Lymphoma (NHL): Patients with all histopathologic subtypes of Tac-expressing NHL are eligible. Patients with indolent NHL Stages II through IV are eligible if they have failed at least one standard therapy and have disease requiring treatment. Patients with aggressive NHL are eligible if they have relapse after standard chemotherapy and either are not eligible for or have refused salvage chemotherapy or bone marrow transplantation.

2) Hodgkin's disease: Patients who are considered to have a low potential for cure with conventional chemotherapy or radiation therapy are eligible. Specifically, patients with stages II-IV Hodgkin's disease are eligible if they have relapsed or failed to attain a complete remission after first-line chemotherapy and either are not eligible for or have refused salvage chemotherapy or bone marrow transplantation.

3) Cutaneous T-cell Lymphoma (CTCL): Patients with all stages of Tac-expressing CTCL are eligible with the exception of Stage Ia. Patients with Stages Ib through III are eligible if they have failed at least one standard therapy. Patients with stage IV are eligible regardless of whether they have had previous therapy.

4) Peripheral T-cell Lymphoma (PTCL): Patients with stages I-IV PTCL are eligible if they have relapsed after first-line chemotherapy and either are not eligible for or have refused salvage chemotherapy or bone marrow transplantation.

Other: Patients with lymphoid leukemias or lymphomas not easily classified in the above categories will be eligible providing they have failed standard therapy and are not eligible for or have refused bone marrow transplantation.

Patients must have a Karnofsky performance status of at least 50.

Patients must have a creatinine of less than 2.0 mg/dl. If they patient has an abnormally elevated creatinine a creatinine clearance must be greater than 50 ml/min.

Patients must have SGOT and SGPT less than 2.5 times the upper limit of normal, bilirubin less than 2.0 unless this is felt to be due to the malignancy.

Patients must not have clinical cardiac failure. Patients with symptomatic pulmonary dysfunction are eligible only if it is due to the underlying malignancy.

The patients must have a granulocyte count of at least 1,500/mm(3) and a platelet count of greater than 100,000/mm(3).

Patients must be able to understand and sign informed consent.

Breast-feeding females are not eligible for the study.

Omission of cytotoxic chemotherapy or other systemic therapy of the malignancy for 3 weeks prior to entry into trial. However, patients receiving corticosteroids will not be excluded. Patients receiving corticosteroids must be on a stable dose for at least three weeks before receiving 90Y-HAT on this study.

Patients must have a life expectancy of greater than 1 month.

Patients must be at least 18 years old.

EXCLUSION CRITERIA:

Female patients of child bearing potential will be tested for pregnancy; pregnant patients will be excluded from the study.

Patients who are HIV antibody positive.

Patients with a history of prior bone marrow transplant.

Patients with symptomatic disease that is due to malignant involvement of the central nervous system.

Patients with active second primary cancer.

Patients receiving chronic anticoagulant therapy will be excluded from the study.

Patients requiring urgent chemotherapy or radiation therapy for management of their malignancy will be excluded.

Special Instructions:
Many protocols are potentially hazardous, are intended only for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this protocol should be consulted before using this protocol. Dose and schedule modifications are required for patients who develop gastrointestinal, hematologic, neurologic, and biochemical (renal, hepatic, etc.) and/or other abnormalities after the administration of therapy. Additionally, Federal regulations for the protection of human subjects require approval of clinical trials by your local Institutional Review Board.
Keywords:
Non-Hodgkin's Lymphoma
Hodgkin's Disease
Cutaneous T-Cell Lymphoma (CTCL)
Peripheral T-Cell Lymphoma
Radiolabeled Antibody
Recruitment Keywords:
None
Conditions:
Cutaneous T Cell Lymphoma
Hodgkin's Disease
Neoplasm
Non Hodgkin's Lymphoma
Peripheral T Cell Lymphoma
Investigational Drug(s):
Y-90 Humanized Anti-Tac
Calcium-DTPA
Investigational Device(s):
None

Contacts:
CSSC
Clinical Studies Support Center/NCI
164 Rollins Avenue
2nd FLoor
Rockville, MD 20852
Phone: (888) 624-1937
Fax: (301) 881-8239
Electronic Address: ncicssc@mail.nih.gov

Citations:
Radioimmunotherapy of interleukin-2R-expressing adult T-cell leukemia with yttrium-90-labeled anti-tac

Reduced immunogenicity and improved pharmacokinetics of humanized anti-tac in cynomolgus monkeys

Peripheral/post-thymic t-cell lymphomas: a spectrum of disease: clinical, pathologic, and immunologic features of 78 cases

Active Accrual, Protocols Recruiting New Patients

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