Combination Chemotherapy Plus Low-Dose Radiation Therapy in Treating Patients With Stage I or Stage IIA Hodgkin's Lymphoma

NCT ID: NCT00026208

Last Updated: 2018-07-24

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

76 participants

Study Classification

INTERVENTIONAL

Study Start Date

2001-06-30

Study Completion Date

2017-02-13

Brief Summary

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RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy may kill more tumor cells.

PURPOSE: This phase 2 trial is studying how well giving combination chemotherapy together with low-dose radiation therapy works in treating patients with stage I or stage IIA Hodgkin's lymphoma.

Detailed Description

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OBJECTIVES:

* Evaluate the freedom from progression in patients with stage I or IIA Hodgkin's lymphoma with a favorable prognosis treated with "Stanford V-C" chemotherapy comprising cyclophosphamide, doxorubicin, vinblastine, prednisone, vincristine, bleomycin, and etoposide with low-dose radiotherapy (RT).
* Minimize the early and late effects of treatment in these patients by avoiding staging laparotomy and its consequences, limiting cumulative doses of chemotherapy, and reducing the dose of RT to moderately bulky sites of disease.
* Assess early and late treatment-related toxicity, freedom from second disease progression, and overall survival at 5 and 10 years in patients treated with this regimen.

Participants receive Stanford V-C chemotherapy comprising cyclophosphamide IV over 30 to 60 minutes weekly on weeks 1 and 5; doxorubicin IV and vinblastine IV over 5 minutes once weekly on weeks 1, 3, 5, and 7; oral prednisone every other day on weeks 1 to 8; vincristine IV, and bleomycin IV over 5 minutes once weekly on weeks 2, 4, 6, and 8; and etoposide IV over 60 minutes on days 1 and 2 of weeks 3 and 7. Prior to protocol amendment, participants were assigned to treatment on the basis of tumor size (\< 5 cm vs 5 to 10 cm), with only the participants with larger tumors receiving RT. Beginning 2 to 3 weeks after completion of chemotherapy, participants in the +RT group will receive low-dose radiotherapy 5 days a week for approximately 3 weeks. Subsequent to amendment, all participants received RT.

Participants are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

Conditions

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Lymphoma, Hodgkin Disease Lymphoma Hodgkin Disease Lymphoma: Hodgkin

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Patients with tumors 5 to 10 cm were to be assigned to concurrent radiotherapy, and participants with tumors less than 5 cm were initially planned to not receive radiotherapy.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Stanford V-C + Low-dose Radiotherapy

"Sanford V-C" = Vinblastine, cyclophosphamide, doxorubicin, prednisone, bleomycin, + etoposide.

Radiotherapy = 20 Gy modified involved field radiotherapy

Group Type EXPERIMENTAL

Vincristine

Intervention Type DRUG

1.4 mg/m² intravenously (IV) on week 2, 4, 6, 8

Cyclophosphamide

Intervention Type DRUG

650 mg/m², on week 1 and 5

Doxorubicin

Intervention Type DRUG

25 mg/m², on week 1, 3, 5, 7

Prednisone

Intervention Type DRUG

40 mg/m², oral, every other day. Taper-reduction 10 mg/m² every other day during last 2 weeks of chemotherapy

Bleomycin

Intervention Type DRUG

5 u/m² intravenously (IV) on week 2, 4, 6, 8

Etoposide

Intervention Type DRUG

60 mg/m² x 2 intravenously (IV) on week 3, 7 (d 15, 16, 43, 44)

Low-dose radiotherapy (RT)

Intervention Type RADIATION

20 Grey (Gy) modified involved field radiotherapy administered as consolidative irradiation will beginning between 2 and 12 weeks after the completion of Stanford V-C chemotherapy regimen.

Stanford V-C only

"Sanford V-C" = Vinblastine, cyclophosphamide, doxorubicin, prednisone, bleomycin, + etoposide.

Group Type EXPERIMENTAL

Vincristine

Intervention Type DRUG

1.4 mg/m² intravenously (IV) on week 2, 4, 6, 8

Cyclophosphamide

Intervention Type DRUG

650 mg/m², on week 1 and 5

Doxorubicin

Intervention Type DRUG

25 mg/m², on week 1, 3, 5, 7

Prednisone

Intervention Type DRUG

40 mg/m², oral, every other day. Taper-reduction 10 mg/m² every other day during last 2 weeks of chemotherapy

Bleomycin

Intervention Type DRUG

5 u/m² intravenously (IV) on week 2, 4, 6, 8

Etoposide

Intervention Type DRUG

60 mg/m² x 2 intravenously (IV) on week 3, 7 (d 15, 16, 43, 44)

Interventions

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Vincristine

1.4 mg/m² intravenously (IV) on week 2, 4, 6, 8

Intervention Type DRUG

Cyclophosphamide

650 mg/m², on week 1 and 5

Intervention Type DRUG

Doxorubicin

25 mg/m², on week 1, 3, 5, 7

Intervention Type DRUG

Prednisone

40 mg/m², oral, every other day. Taper-reduction 10 mg/m² every other day during last 2 weeks of chemotherapy

Intervention Type DRUG

Bleomycin

5 u/m² intravenously (IV) on week 2, 4, 6, 8

Intervention Type DRUG

Etoposide

60 mg/m² x 2 intravenously (IV) on week 3, 7 (d 15, 16, 43, 44)

Intervention Type DRUG

Low-dose radiotherapy (RT)

20 Grey (Gy) modified involved field radiotherapy administered as consolidative irradiation will beginning between 2 and 12 weeks after the completion of Stanford V-C chemotherapy regimen.

Intervention Type RADIATION

Other Intervention Names

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Vinblastine Leurocristine sulfate Oncovin Vincasar LCR VCR Vincristin Vincristina Vincristinum 22-Oxovincaleukoblastin 22-Oxovincaleukoblastine Cytoxan Neosar Cyclophosphamidum Cyclophosphamid Ciclofosfamida Cytophosphane Ledoxina Bis(2-chloroethyl)phosphoramide cyclic propanolamide ester 2-[Bis(2-chloroethylamino)]-tetrahydro-2H-1,3,2-oxazaphosphorine-2-oxide N,N-Bis(2-chloroethyl)tetrahydro-2H-1,3,2-oxazaphosphorin-2-amine 2-oxide Adriamycin Doxorubicinum Doxorubicine Rubex Hydroxydaunomycin HCl Hydroxydoxorubicin HCl Hydroxydaunorubicin 14-hydroxydaunomycin 14-hydroxydaunorubicine (1S,3S)-3-Glycoloyl-3,5,12-trihydroxy-10-methoxy-6,11-dioxo-1,2,3,4,6,11-hexahydrotetracen-1-yl 3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranoside (8S-cis)-10-((3-amino-2,3,6-Trideoxy-alpha-L-lyxo-hexopyranosyl)oxy)-7,8,9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-5,12-naphthacenedione Dehydrocortisone Deltasone Liquid Pred Meticorten Orasone Prednicot predniSONE Intensol Rayos Sterapred Prednisona Prednisonum 1,2-Dehydrocortisone 1,4-Pregnadiene-17alpha,21-diol-3,11,20-trione 17,21-Dihydroxypregna-1,4-diene-3,11,20-trione Bleomycin A2 Bleomycine Bleocin Bleomicin Bleomicina Bleomycinum BLM Toposar Etopophos Vepesid VP-16 Etoposido Etoposidum trans-Etoposide 4-demethylepipodophyllotoxin β-D-ethylideneglucoside 4'-Demethylepipodophyllotoxin 9-(4,6-O-(R)-ethylidene-beta-D-glucopyranoside) 9-((4,6-O-Ethylidine-beta-D-glucopyranosyl)oxy)-5,8,8a,9-tetrahydro-5-(4-hydroxy-3,4-dimethyloxyphenyl)furo(3',4'':6,7)naptho-(2,3-d)-1,3-dioxol-6(5aH)-one

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of previously untreated stage I or IIA Hodgkin's lymphoma, eligible subtypes

* Nodular sclerosis
* Mixed cellularity
* Classical, not otherwise specified
* Age ≥ 18 years and ≤ 70 years
* Granulocytes ≥ 2 x 10e6/µL
* Platelets ≥ 150 x 10e6/µL
* Bilirubin ≤ 2.5 mg/dL
* Serum creatinine ≤ 2 mg/dL
* Patients \> 50 years or those with a history of cardiac disease should have an ejection fraction ≥ 50%
* All scans, X-rays, laboratory tests must be performed within 6 weeks of enrollment
* Pathologic material reviewed at Stanford University
* Evaluation by Stanford Medical Oncology and Radiation Oncology with review at the Hodgkin's Disease Staging Conference
* Written informed consent

Exclusion Criteria

* Lymphocytic predominance Hodgkin's disease
* Prior treatment for Hodgkin's disease
* Mediastinal mass equal to or greater than one-third the maximum intrathoracic diameter on a standing posteroanterior chest x-ray
* Any lymph node mass \> 10 cm in greatest trans-axial diameter
* Two or more extranodal sites of disease
* Constitutional (B) symptoms present at diagnosis
* Prior or concurrent malignancies within 5 years (EXCEPTION: basal cell carcinoma of the skin)
* Any medical contraindication to the planned treatment, including:

* Pregnant
* Positive antibody test for the human immunodeficiency virus (HIV)
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Stanford University

OTHER

Sponsor Role lead

Responsible Party

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Ranjana Advani

Saul A. Rosenberg, MD, Professor of Lymphoma

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ranjana H Advani, MD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

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Stanford University School of Medicine

Stanford, California, United States

Site Status

Kaiser Permanente Medical Center

Vallejo, California, United States

Site Status

Countries

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United States

Other Identifiers

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LYMHD0002

Identifier Type: OTHER

Identifier Source: secondary_id

IRB-13081

Identifier Type: -

Identifier Source: org_study_id

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