Trial Outcomes & Findings for A Pilot Study to Determine the Safety and Tolerability of Sirolimus Given With Hyper-CVAD Chemotherapy (NCT NCT01184885)

NCT ID: NCT01184885

Last Updated: 2025-05-04

Results Overview

This will be assessed by evaluating the tolerability of this regimen compared to historical controls who received Hyper-CVAD or Hyper-CVAD/ Rituximab regimens. The treatment will be designated feasible for an individual subject if in 80% of chemotherapy cycles the subject has count recovery that allows for starting the subsequent cycle by Day 28. Count recovery is defined as ANC (absolute neutrophil count) of \> 0.5 x 10\^9/L and platelet count \> 50 x 10\^9/L. Hyper-CVAD/Rapamycin will be deemed acceptable if it is feasible to administer in 80% or more of subjects.

Recruitment status

COMPLETED

Study phase

EARLY_PHASE1

Target enrollment

7 participants

Primary outcome timeframe

18 months

Results posted on

2025-05-04

Participant Flow

Participant milestones

Participant milestones
Measure
Hyper-CVAD and Sirolimus
Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are \< 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Overall Study
STARTED
7
Overall Study
COMPLETED
7
Overall Study
NOT COMPLETED
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

A Pilot Study to Determine the Safety and Tolerability of Sirolimus Given With Hyper-CVAD Chemotherapy

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Hyper-CVAD and Sirolimus
n=7 Participants
Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are \< 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Age, Categorical
<=18 years
0 Participants
n=5 Participants
Age, Categorical
Between 18 and 65 years
6 Participants
n=5 Participants
Age, Categorical
>=65 years
1 Participants
n=5 Participants
Age, Continuous
41.68 years
STANDARD_DEVIATION 18.94 • n=5 Participants
Sex: Female, Male
Female
2 Participants
n=5 Participants
Sex: Female, Male
Male
5 Participants
n=5 Participants
Region of Enrollment
United States
7 participants
n=5 Participants

PRIMARY outcome

Timeframe: 18 months

This will be assessed by evaluating the tolerability of this regimen compared to historical controls who received Hyper-CVAD or Hyper-CVAD/ Rituximab regimens. The treatment will be designated feasible for an individual subject if in 80% of chemotherapy cycles the subject has count recovery that allows for starting the subsequent cycle by Day 28. Count recovery is defined as ANC (absolute neutrophil count) of \> 0.5 x 10\^9/L and platelet count \> 50 x 10\^9/L. Hyper-CVAD/Rapamycin will be deemed acceptable if it is feasible to administer in 80% or more of subjects.

Outcome measures

Outcome measures
Measure
Hyper-CVAD and Sirolimus
n=7 Participants
Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m\^2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m\^2 on day 6; Decadron 40mg/day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Cycle B: Methotrexate 1000mg/m\^2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are \< 0.1 umol/L; Ara-C 3000mg/m\^2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Rituximab (if given) will be 375 mg/m\^2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Number of Participants With Count Recovery That Allows for Starting a Phase II Study to Evaluate Response Rates and Survival
7 participants

SECONDARY outcome

Timeframe: 18 months

Induction mortality. Hyper-CVAD/ Rapamycin will be considered acceptable if induction mortality does not exceed 31% in patients older than 60, or 15% in those younger than 60

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: Every 21 days or as count recovery allows (at least 14 days apart) up to 24 weeks

To describe response rates to hyper-CVAD and sirolimus in adults with ALL and other aggressive lymphoid malignancies. Bone marrow (\<5% blasts) with adequate bone marrow cellularity, no evidence of circulating blasts or extramedullary disease and normalization of peripheral blood counts except for platelets (neutrophil count =1,000/µL).

Outcome measures

Outcome measures
Measure
Hyper-CVAD and Sirolimus
n=7 Participants
Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m\^2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m\^2 on day 6; Decadron 40mg/day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Cycle B: Methotrexate 1000mg/m\^2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are \< 0.1 umol/L; Ara-C 3000mg/m\^2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Rituximab (if given) will be 375 mg/m\^2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Complete Response
4 participants

Adverse Events

Hyper-CVAD and Sirolimus

Serious events: 6 serious events
Other events: 7 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Hyper-CVAD and Sirolimus
n=7 participants at risk
Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are \< 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Blood and lymphatic system disorders
Febrile neutropenia
71.4%
5/7 • Number of events 8
Infections and infestations
Infection
28.6%
2/7 • Number of events 2
Skin and subcutaneous tissue disorders
Edema
14.3%
1/7 • Number of events 1
General disorders
Fever
14.3%
1/7 • Number of events 1
Nervous system disorders
Ataxia
14.3%
1/7 • Number of events 1
General disorders
Speech impairment
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Hypotension
28.6%
2/7 • Number of events 2
Immune system disorders
Gram negative sepsis
14.3%
1/7 • Number of events 1
General disorders
Face pain
14.3%
1/7 • Number of events 1
Respiratory, thoracic and mediastinal disorders
Shortness of breath
14.3%
1/7 • Number of events 1
Respiratory, thoracic and mediastinal disorders
Adult respiratory distress syndrome
14.3%
1/7 • Number of events 1
Immune system disorders
Septic shock
14.3%
1/7 • Number of events 1

Other adverse events

Other adverse events
Measure
Hyper-CVAD and Sirolimus
n=7 participants at risk
Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are \< 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. * Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
General disorders
Shoulder pain
14.3%
1/7 • Number of events 1
General disorders
Abdominal pain
57.1%
4/7 • Number of events 5
General disorders
Weight gain
28.6%
2/7 • Number of events 2
Skin and subcutaneous tissue disorders
Edema
71.4%
5/7 • Number of events 10
General disorders
Fatigue
100.0%
7/7 • Number of events 15
General disorders
Constipation
28.6%
2/7 • Number of events 4
General disorders
Extremity swelling
14.3%
1/7 • Number of events 1
General disorders
Itching
57.1%
4/7 • Number of events 4
General disorders
Weakness
100.0%
7/7 • Number of events 10
General disorders
Bad taste in mouth
14.3%
1/7 • Number of events 1
General disorders
Nightmares
14.3%
1/7 • Number of events 1
Cardiac disorders
Tachycardia
71.4%
5/7 • Number of events 11
General disorders
Blood in stool
14.3%
1/7 • Number of events 1
Psychiatric disorders
Anxiety
57.1%
4/7 • Number of events 4
General disorders
Weight loss
28.6%
2/7 • Number of events 3
General disorders
Sweats
57.1%
4/7 • Number of events 7
General disorders
Chest pain
57.1%
4/7 • Number of events 6
General disorders
Opacified left maxillary sinus
14.3%
1/7 • Number of events 1
General disorders
Back pain
57.1%
4/7 • Number of events 4
General disorders
Sinusitis
14.3%
1/7 • Number of events 1
Nervous system disorders
Numbness/tingling
42.9%
3/7 • Number of events 4
Musculoskeletal and connective tissue disorders
Muscle pain/tightness
28.6%
2/7 • Number of events 2
General disorders
Neutropenic fever
42.9%
3/7 • Number of events 5
Blood and lymphatic system disorders
Hyponatremia
14.3%
1/7 • Number of events 1
General disorders
Chills
71.4%
5/7 • Number of events 9
General disorders
Nausea
85.7%
6/7 • Number of events 11
General disorders
Abdominal ascites
14.3%
1/7 • Number of events 1
General disorders
Gingivitis
14.3%
1/7 • Number of events 1
Gastrointestinal disorders
Dyspepsia
14.3%
1/7 • Number of events 1
General disorders
Insomnia
57.1%
4/7 • Number of events 4
General disorders
Cough
57.1%
4/7 • Number of events 7
Renal and urinary disorders
Nocturia
42.9%
3/7 • Number of events 3
General disorders
Stiff neck
28.6%
2/7 • Number of events 2
General disorders
Congestion
14.3%
1/7 • Number of events 1
Respiratory, thoracic and mediastinal disorders
Shortness of breath
71.4%
5/7 • Number of events 8
General disorders
Fever
71.4%
5/7 • Number of events 9
Gastrointestinal disorders
Gastric reflux
28.6%
2/7 • Number of events 2
Skin and subcutaneous tissue disorders
Rash
85.7%
6/7 • Number of events 12
General disorders
Vomiting
57.1%
4/7 • Number of events 5
Eye disorders
Blurred vision
14.3%
1/7 • Number of events 1
General disorders
Post nasal drip
14.3%
1/7 • Number of events 1
Eye disorders
Eye pain
14.3%
1/7 • Number of events 2
General disorders
Nosebleed
57.1%
4/7 • Number of events 6
General disorders
Hypoxia
28.6%
2/7 • Number of events 4
Respiratory, thoracic and mediastinal disorders
Pleural effusion
28.6%
2/7 • Number of events 2
General disorders
Lightheadedness
28.6%
2/7 • Number of events 2
Renal and urinary disorders
Urinary incontinence
14.3%
1/7 • Number of events 1
Gastrointestinal disorders
Stomach upset
28.6%
2/7 • Number of events 2
Skin and subcutaneous tissue disorders
Abscess
28.6%
2/7 • Number of events 2
Infections and infestations
Infection
42.9%
3/7 • Number of events 4
Nervous system disorders
Neuropathy
57.1%
4/7 • Number of events 6
General disorders
Alopecia
57.1%
4/7 • Number of events 4
Skin and subcutaneous tissue disorders
Dry skin
14.3%
1/7 • Number of events 1
General disorders
Poor appetite
71.4%
5/7 • Number of events 5
Blood and lymphatic system disorders
Positive blood culture
28.6%
2/7 • Number of events 3
Blood and lymphatic system disorders
Low platelets
14.3%
1/7 • Number of events 1
General disorders
Tooth problem
28.6%
2/7 • Number of events 2
Blood and lymphatic system disorders
Low hemoglobin
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Pulse oxygen dropped
14.3%
1/7 • Number of events 1
General disorders
Mouth sores
14.3%
1/7 • Number of events 1
Metabolism and nutrition disorders
Anorexia
42.9%
3/7 • Number of events 4
Blood and lymphatic system disorders
Hypertension
28.6%
2/7 • Number of events 3
Skin and subcutaneous tissue disorders
Facial flushing
28.6%
2/7 • Number of events 2
Psychiatric disorders
Confusion
42.9%
3/7 • Number of events 4
General disorders
Headache
57.1%
4/7 • Number of events 9
General disorders
Speech impairment
14.3%
1/7 • Number of events 1
General disorders
Throat pain
14.3%
1/7 • Number of events 1
Skin and subcutaneous tissue disorders
Erythema
14.3%
1/7 • Number of events 1
Renal and urinary disorders
Urinary frequency
14.3%
1/7 • Number of events 1
Eye disorders
Double vision
14.3%
1/7 • Number of events 1
Eye disorders
Unable to move right eye
14.3%
1/7 • Number of events 1
General disorders
Lower abductor pain
14.3%
1/7 • Number of events 1
General disorders
Trouble sleeping
42.9%
3/7 • Number of events 3
Gastrointestinal disorders
Diarrhea
71.4%
5/7 • Number of events 9
General disorders
Taste alteration
14.3%
1/7 • Number of events 1
General disorders
Hip pain
14.3%
1/7 • Number of events 1
General disorders
Cold
14.3%
1/7 • Number of events 1
Skin and subcutaneous tissue disorders
Groin nodule
14.3%
1/7 • Number of events 1
General disorders
Sinus congestion
28.6%
2/7 • Number of events 2
Skin and subcutaneous tissue disorders
Hyperpigmented circumscribed areas on scalp
14.3%
1/7 • Number of events 1
Eye disorders
Dry eyes
14.3%
1/7 • Number of events 1
Infections and infestations
Respiratory infection
14.3%
1/7 • Number of events 1
General disorders
Bone pain
42.9%
3/7 • Number of events 3
General disorders
Sore throat
28.6%
2/7 • Number of events 2
General disorders
Wrist pain
14.3%
1/7 • Number of events 1
General disorders
Ankle pain
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Anemia
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Pancytopenia
28.6%
2/7 • Number of events 3
Eye disorders
Eye conjunctival redness
14.3%
1/7 • Number of events 1
Gastrointestinal disorders
Gas/bloating
28.6%
2/7 • Number of events 2
General disorders
Agitation
28.6%
2/7 • Number of events 2
Psychiatric disorders
Mood alteration
28.6%
2/7 • Number of events 2
Psychiatric disorders
Psychosis
28.6%
2/7 • Number of events 2
General disorders
Rigidity
14.3%
1/7 • Number of events 1
Psychiatric disorders
Catatonia
14.3%
1/7 • Number of events 1
General disorders
Difficulty swallowing
14.3%
1/7 • Number of events 1
General disorders
Dizziness
28.6%
2/7 • Number of events 2
General disorders
Puffy face
14.3%
1/7 • Number of events 1
Psychiatric disorders
Depression
14.3%
1/7 • Number of events 1
General disorders
Swollen ankles
14.3%
1/7 • Number of events 1
Skin and subcutaneous tissue disorders
Blister
14.3%
1/7 • Number of events 1
General disorders
Mouth/throat discomfort
14.3%
1/7 • Number of events 1
General disorders
Rectal pain
14.3%
1/7 • Number of events 1
General disorders
Abnormal gait
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Hypophosphatemia
14.3%
1/7 • Number of events 1
General disorders
Jaw pain
28.6%
2/7 • Number of events 2
General disorders
Leg pain
14.3%
1/7 • Number of events 1
General disorders
Soft tissue swelling
14.3%
1/7 • Number of events 1
Cardiac disorders
Irregular heartbeat
14.3%
1/7 • Number of events 1
General disorders
Achiness
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Neutropenia
14.3%
1/7 • Number of events 2
General disorders
Sinus headache
14.3%
1/7 • Number of events 1
General disorders
Soreness of tongue
14.3%
1/7 • Number of events 1
Vascular disorders
Phlebitis
14.3%
1/7 • Number of events 1
General disorders
Stomach pain
14.3%
1/7 • Number of events 1
General disorders
Mucositis
14.3%
1/7 • Number of events 1
General disorders
Bleeding from PICC site
14.3%
1/7 • Number of events 1
Nervous system disorders
Choreiform movement
14.3%
1/7 • Number of events 1
General disorders
Transfusion reaction
14.3%
1/7 • Number of events 1
Renal and urinary disorders
Decreased urine output
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Lactic acidosis
14.3%
1/7 • Number of events 1
General disorders
Elevated bilirubin
14.3%
1/7 • Number of events 2
Eye disorders
Eyes appear uncoordinated
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Hyperglycemia
14.3%
1/7 • Number of events 1
General disorders
Bleeding from IV site
14.3%
1/7 • Number of events 1
Respiratory, thoracic and mediastinal disorders
Tachypnea
14.3%
1/7 • Number of events 1
Respiratory, thoracic and mediastinal disorders
Wheezing
14.3%
1/7 • Number of events 1
Psychiatric disorders
Delirium
14.3%
1/7 • Number of events 1
Blood and lymphatic system disorders
Hypokalemia
14.3%
1/7 • Number of events 1
Renal and urinary disorders
Autodiuresis/polyuria
14.3%
1/7 • Number of events 1
General disorders
Fall
14.3%
1/7 • Number of events 1
General disorders
Anal incontinence
14.3%
1/7 • Number of events 1
Musculoskeletal and connective tissue disorders
Increased troponins
14.3%
1/7 • Number of events 1
Renal and urinary disorders
Hematuria
14.3%
1/7 • Number of events 1
Skin and subcutaneous tissue disorders
Jaundice
14.3%
1/7 • Number of events 1
General disorders
Oral bleeding
14.3%
1/7 • Number of events 1
General disorders
Rib pain
14.3%
1/7 • Number of events 1
Gastrointestinal disorders
Decreased bowel sounds
14.3%
1/7 • Number of events 1
Renal and urinary disorders
Urinary retention
28.6%
2/7 • Number of events 2
Respiratory, thoracic and mediastinal disorders
Absent breath sounds
14.3%
1/7 • Number of events 1
Skin and subcutaneous tissue disorders
Petechiae
14.3%
1/7 • Number of events 1
General disorders
Volume overload
14.3%
1/7 • Number of events 1
General disorders
Abdominal tenderness
14.3%
1/7 • Number of events 1

Additional Information

Margaret Kasner, MD

Thomas Jefferson University

Phone: 215-955-8874

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place