A Phase 2 interventional study of Panobinostat in Classical Hodgkin's Lymphoma, sponsored by Novartis Pharmaceuticals. Completed at 46 sites in 13 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-07-28.
Sponsored by Novartis Pharmaceuticals · Phase 2, Interventional, and Treatment
This study evaluated the efficacy of oral panobinostat in participants with refractory/relapsed classical Hodgkins lymphoma (HL) who have received prior treatment with high dose chemotherapy and autologous stem cell transplant. Safety of panobinostat also was assessed. Other markers that may correlate with efficacy or safety were explored.
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This study's enrollment of 129 is above the median of 40 across 4,508 interventional studies indexed under Lymphoma.
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Participant has progressive disease after receiving high dose chemotherapy with autologous hematopoietic stem cell transplant (AHSCT).
Note: If last therapy was ≥ 18 months ago, then biopsy should be performed to confirm diagnosis.
Note: Participant should have received ≤ 5 prior systemic treatment regimens (See Post-text supplement 2 for definitions and examples).
Note: Participant will be allowed on study who have also received an allogeneic hematopoietic stem cell transplant, however this therapy alone is not sufficient for inclusion into this study.
Participant has at least one site of measurable nodal disease at baseline ≥ 2.0 centimeter (cm) in the longest transverse diameter and clearly measurable in at least two perpendicular dimensions, as determined by computed tomography (CT) scan (magnetic resonance imaging [MRI] is allowed only if CT scan can not be performed).
Note: Participant with bone marrow involvement are eligible, but this criteria alone should not be used for disease measurement.
Participant has the following laboratory values (labs may be repeated, if needed, to obtain acceptable values before screen fail):
Note: Potassium, calcium, magnesium, sodium, and/or phosphorus supplements may be given to correct values that are \< lower limits of normal (LLN). Post-correction values must not be deemed to be a clinically significant abnormality prior to participant being dosed.
Exclusion Criteria:
Participant has impaired cardiac function including any of the following:
Male participant whose sexual partner(s) are WOCBP who are not willing to use a double method of contraception, one of which includes a condom, during the study and for 3 months after the end of treatment.
Participants with any of the following contraindications to positron emission tomography (PET) are excluded from the [18F]- fludeoxyglucose (FDG) PET study (only applicable for centers participating in the PET study):
Participants received panobinostat 40 mg, capsules, orally, thrice every week (i.e. days 1, 3 and 5), in each cycle of 21 days until unacceptable toxicity, disease progression, start of new anti-cancer therapy or withdrawal of consent (up to approximately 48 months).
Drug: Panobinostat
Panobinostat hard gelatin capsules.
Also known as: LBH589, LBH
Objective Response Rate (ORR) as Assessed by the Investigator Based on Cheson Response Criteria
ORR was number of participants with best overall disease response of complete response(CR)/partial response(PR).Best overall disease response was best disease response recorded from start of treatment until disease progression/recurrence.CR=complete normalization of all index nodal,extranodal lesions,complete disappearance of all extranodal lesions.PR=50% decrease in SPD for up to 6 identified dominant lesions (splenic,hepatic nodules) from baseline.Stable=neither sufficient shrinkage to qualify for PR nor sufficient increase for progressive disease (PD), reference smallest sum diameters while on study.Progression=50% increase in sum of longest diameter of all target lesions,from smallest sum of longest diameter of all target lesions recorded at or after baseline/a new lesion/progression of non-target lesions.Unknown is progression not documented,one/more of index lesions not assessed or have been assessed using a different method than baseline at the time of radiologic evaluation.
Time frame: From the start of the treatment of last participant up to 32 weeks
Response Rate Based on Central Review of Computed Tomography (CT) Scan/Magnetic Resonance Imaging (MRI)
Best overall radiological response (CT/MRI) was recorded from start of treatment until progression/ recurrence. CR=complete normalization of all index nodal,extranodal lesions,complete disappearance of all extranodal lesions.PR=50% decrease in SPD for up to 6 identified dominant lesions (splenic,hepatic nodules) from baseline.Stable=neither sufficient shrinkage to qualify for PR nor sufficient increase for progressive disease (PD), reference smallest sum diameters while on study.Progression=50% increase in sum of longest diameter of all target lesions,from smallest sum of longest diameter of all target lesions recorded at or after baseline/a new lesion/progression of non-target lesions.Unknown is progression not documented,one/more of index lesions not assessed or have been assessed using a different method than baseline at the time of radiologic evaluation.
Time frame: From start of treatment until progression/recurrence or start of a new cancer therapy (up to approximately 5 years)
Time To Overall Disease Response in Responders
Time to overall disease response (CR or PR) was defined as the time from the date of randomization/start of treatment to the date of first documented disease response (PR or CR). Per Cheson response criteria, CR= is a complete normalization of all index nodal and extranodal lesions and complete disappearance of all extranodal lesions. PR= is a 50% decrease in the SPD for up to 6 identified dominant lesions, including splenic and hepatic nodules from baseline. Participants were considered responders if they had a partial or complete response to a treatment while in the study as per Investigator's assessment.
Time frame: From the start of treatment up to approximately 5 years
Duration of Overall Disease Response
Duration of overall response (CR or PR) was defined as the time from the date of first documented disease response (CR or PR) to the date of first documented progression or death due to lymphoma. Per Cheson response criteria, CR= is a complete normalization of all index nodal and extranodal lesions and complete disappearance of all extranodal lesions. PR= is a 50% decrease in the SPD for up to 6 identified dominant lesions, including splenic and hepatic nodules from baseline. Participants were considered responders if they had a partial or complete response to a treatment while in the study.
Time frame: From the start of treatment up to approximately 5 years
Progression Free Survival (PFS)
Progression-free survival (PFS) was defined as the time from the date of randomization/start of treatment to the date of event defined as the first documented progression or death due to any cause. If a participant has not had an event, progression-free survival was censored at the date of the last adequate assessment.
Time frame: From the start of treatment up to approximately 5 years
The Overall Survival (OS)
OS was the duration from date of randomization to date of death from any cause. If a participant has not had an event, overall survival was censored at the date of the last adequate assessment.
Time frame: Baseline to date of death from any cause (up to approximately 5 years)
Percentage of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs), And Deaths as a Measure of Safety and Tolerability of Panobinostat
An AE is the appearance of (or worsening of any pre-existing) undesirable sign(s), symptom(s), or medical condition(s) occurring after signing the informed consent even if the event is not considered to be related to the study drug(s). SAEs are AEs leading to death, are life-threatening, require hospitalizations or prolongation of hospitalizations, represent an innate malformation or a congenital abnormality.
Time frame: Up to approximately 5 years
Maximum Observed Concentration (Cmax) of Panobinostat
Time frame: Cycle 1, Day 1: Pre-dose, 0.25, 1, 3, 5, 7, 24, and 28 hours post-dose
The Time to Reach Maximum Plasma Concentration (Tmax) of Panobinostat
Time frame: Cycle 1, Day 1: Pre-dose, 0.25, 1, 3, 5, 7, 24, and 28 hours post-dose
Area Under the Plasma Concentration-Time Curve From Time Zero to 28 Hours (AUC0-28) for Panobinostat
Time frame: Cycle 1, Day 1: Pre-dose, 0.25, 1, 3, 5, 7, 24, and 28 hours post-dose
Area Under the Plasma Concentration-Time Curve From Time Zero to Infinity (AUC0-∞) for Panobinostat
Time frame: Cycle 1, Day 1: Pre-dose, 0.25, 1, 3, 5, 7, 24, and 28 hours post-dose
Participants were enrolled at 45 sites in 13 countries from 16 September 2008 to 12 August 2013.
| Milestone | Panobinostat |
|---|---|
| Started | 129 |
| Completed | 0 |
| Not completed | 129 |
| Withdrew: Disease progression | 76 |
| Withdrew: New cancer therapy | 19 |
| Withdrew: Withdrawal by subject | 18 |
| Withdrew: Death | 7 |
| Withdrew: Lost to follow-up | 4 |
| Withdrew: Follow up phase completed as per protocol | 2 |
| Withdrew: Missing | 2 |
| Withdrew: Administrative problems | 1 |
ORR was number of participants with best overall disease response of complete response(CR)/partial response(PR).Best overall disease response was best disease response recorded from start of treatment until disease progression/recurrence.CR=complete normalization of all index nodal,extranodal lesions,complete disappearance of all extranodal lesions.PR=50% decrease in SPD for up to 6 identified dominant lesions (splenic,hepatic nodules) from baseline.Stable=neither sufficient shrinkage to qualify for PR nor sufficient increase for progressive disease (PD), reference smallest sum diameters while on study.Progression=50% increase in sum of longest diameter of all target lesions,from smallest sum of longest diameter of all target lesions recorded at or after baseline/a new lesion/progression of non-target lesions.Unknown is progression not documented,one/more of index lesions not assessed or have been assessed using a different method than baseline at the time of radiologic evaluation.
| Participants | Panobinostat |
|---|---|
| Complete Response | 5 |
| Partial Response | 30 |
| Stable Disease | 71 |
| Progressive Disease | 14 |
| Unknown | 9 |
Best overall radiological response (CT/MRI) was recorded from start of treatment until progression/ recurrence. CR=complete normalization of all index nodal,extranodal lesions,complete disappearance of all extranodal lesions.PR=50% decrease in SPD for up to 6 identified dominant lesions (splenic,hepatic nodules) from baseline.Stable=neither sufficient shrinkage to qualify for PR nor sufficient increase for progressive disease (PD), reference smallest sum diameters while on study.Progression=50% increase in sum of longest diameter of all target lesions,from smallest sum of longest diameter of all target lesions recorded at or after baseline/a new lesion/progression of non-target lesions.Unknown is progression not documented,one/more of index lesions not assessed or have been assessed using a different method than baseline at the time of radiologic evaluation.
| percentage of participants | Panobinostat |
|---|---|
| Complete Response | 0.8 |
| Partial Response | 20.9 |
| Stable Disease | 56.6 |
| Progressive Disease | 15.5 |
| Unknown | 6.2 |
Time to overall disease response (CR or PR) was defined as the time from the date of randomization/start of treatment to the date of first documented disease response (PR or CR). Per Cheson response criteria, CR= is a complete normalization of all index nodal and extranodal lesions and complete disappearance of all extranodal lesions. PR= is a 50% decrease in the SPD for up to 6 identified dominant lesions, including splenic and hepatic nodules from baseline. Participants were considered responders if they had a partial or complete response to a treatment while in the study as per Investigator's assessment.
| weeks | Panobinostat |
|---|---|
| Time To Overall Disease Response in Responders | 9.9 (6.0 to 12.1) |
Duration of overall response (CR or PR) was defined as the time from the date of first documented disease response (CR or PR) to the date of first documented progression or death due to lymphoma. Per Cheson response criteria, CR= is a complete normalization of all index nodal and extranodal lesions and complete disappearance of all extranodal lesions. PR= is a 50% decrease in the SPD for up to 6 identified dominant lesions, including splenic and hepatic nodules from baseline. Participants were considered responders if they had a partial or complete response to a treatment while in the study.
| weeks | Panobinostat |
|---|---|
| Duration of Overall Disease Response | 30.1 (17.4 to 35.9) |
Progression-free survival (PFS) was defined as the time from the date of randomization/start of treatment to the date of event defined as the first documented progression or death due to any cause. If a participant has not had an event, progression-free survival was censored at the date of the last adequate assessment.
| months | Panobinostat |
|---|---|
| Progression Free Survival (PFS) | 6.1 (5.4 to 8.3) |
OS was the duration from date of randomization to date of death from any cause. If a participant has not had an event, overall survival was censored at the date of the last adequate assessment.
| months | Panobinostat |
|---|---|
| The Overall Survival (OS) | 34.9 (0.7 to 53) |
An AE is the appearance of (or worsening of any pre-existing) undesirable sign(s), symptom(s), or medical condition(s) occurring after signing the informed consent even if the event is not considered to be related to the study drug(s). SAEs are AEs leading to death, are life-threatening, require hospitalizations or prolongation of hospitalizations, represent an innate malformation or a congenital abnormality.
| percentage of participants | Panobinostat |
|---|---|
| AEs | 100 |
| SAEs | 39.5 |
| Deaths | 45.0 |
| nanograms per milliliter (ng/mL) | Panobinostat |
|---|---|
| Maximum Observed Concentration (Cmax) of Panobinostat | 41.88 ± 22.165 |
| hours | Panobinostat |
|---|---|
| The Time to Reach Maximum Plasma Concentration (Tmax) of Panobinostat | 1.1 (0.30 to 6.10) |
| hour*nanograms per milliliter (h.ng/mL) | Panobinostat |
|---|---|
| Area Under the Plasma Concentration-Time Curve From Time Zero to 28 Hours (AUC0-28) for Panobinostat | 233.38 ± 112.138 |
| h.ng/mL | Panobinostat |
|---|---|
| Area Under the Plasma Concentration-Time Curve From Time Zero to Infinity (AUC0-∞) for Panobinostat | 239.36 ± 104.263 |
Collected over Up to approximately 5 years. Non-serious events are listed at a 2% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Panobinostat | — | 51/129 (39.5%) | 129/129 (100%) |
| Event | Panobinostat |
|---|---|
| ThrombocytopeniaBlood and lymphatic system disorders | 12/129 |
| AnaemiaBlood and lymphatic system disorders | 5/129 |
| PneumoniaInfections and infestations | 5/129 |
| SepsisInfections and infestations | 4/129 |
| DyspnoeaRespiratory, thoracic and mediastinal disorders | 4/129 |
| Atrial fibrillationCardiac disorders | 3/129 |
| HypotensionVascular disorders | 3/129 |
| NeutropeniaBlood and lymphatic system disorders | 2/129 |
| DiarrhoeaGastrointestinal disorders | 2/129 |
| VomitingGastrointestinal disorders | 2/129 |
| Event | Panobinostat |
|---|---|
| ThrombocytopeniaBlood and lymphatic system disorders | 109/129 |
| DiarrhoeaGastrointestinal disorders | 96/129 |
| NauseaGastrointestinal disorders | 87/129 |
| FatigueGeneral disorders | 60/129 |
| PyrexiaGeneral disorders | 56/129 |
| VomitingGastrointestinal disorders | 55/129 |
| AnaemiaBlood and lymphatic system disorders | 52/129 |
| Decreased appetiteMetabolism and nutrition disorders | 48/129 |
| NeutropeniaBlood and lymphatic system disorders | 36/129 |
| CoughRespiratory, thoracic and mediastinal disorders | 36/129 |
Full analysis set (FAS) included all participants who received at least one dose of study drug.
| Age, Continuous(years) | Panobinostat |
|---|---|
| Mean | 34.7 ± 12.24 |
| Sex: Female, Male(Participants) | Panobinostat |
|---|---|
| Female | 63 |
| Male | 66 |
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