ClinicalTrials.gg
CompletedNCT01092182Updated Apr 27, 2023Results posted

Phase II Study of Dose-Adjusted EPOCH-Rituximab in Adults With Untreated Burkitt Lymphoma and c-MYC+ Diffuse Large B-Cell Lymphoma

A Phase 2 interventional study of EPOCH-R and EPOCH-RR in Burkitt Lymphoma, Diffuse Large B-cell Lymphoma, c-MYC Positive and Plasmablastic Lymphoma, sponsored by National Cancer Institute (NCI). Completed at 30 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-04-27.

Sponsored by National Cancer Institute (NCI) · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
194
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study summary

Background:

  • Burkitt lymphoma/leukemia (BL) is highly treatable, but most of the standard therapies require multiple doses of intensive chemotherapy that may require long hospital stays and frequently have severe side effects. In addition, BL is a fairly common type of cancer in patients who also have human immunodeficiency virus (HIV), but treatment outcomes are poor because standard treatments do not work very well in HIV-positive patients and the more intense treatment regimens are highly toxic. New approaches are needed that expand the ways to treat BL with the same efficiency but with reduced side effects.
  • Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) is a standard chemotherapy treatment that consists of the drugs etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab. It may be able to treat BL with similar effectiveness but with fewer side effects. Researchers are interested in confirming the results of previous studies that investigated the effectiveness of DA-EPOCH-R in treating BL.

Objectives:

  • To determine the safety and effectiveness of DA-EPOCH-R in treating Burkitt lymphoma.

Eligibility:

  • Individuals at least 18 years of age who have been diagnosed with Burkitt lymphoma and have not had any prior chemotherapy treatments.

Design:

  • Individuals will have a series of blood and other tests to determine their suitability for participating in the study. Eligible participants will be divided into high-risk and low-risk groups based on their disease prognosis and the possibility that the BL may or already has spread into the central nervous system.
  • Participants will receive intravenous infusion of the six chemotherapy drugs in DA-EPOCH-R in 21-day treatment cycles. The exact doses will be adjusted depending on participants white blood cell counts and other tests.
  • High-risk participants will receive six cycles of DA-EPOCH-R. To treat BL that may have entered the central nervous system, high-risk participants will also receive infusions of other chemotherapy drugs into their spinal fluid.
  • Low-risk participants will receive up to six cycles of DA-EPOCH-R, with an additional dose of rituximab during each cycle.
  • Frequent blood and urine tests will be performed during treatment, as well as body imaging scans and other tests of cancer progression as directed by the study doctors. Participants will receive additional medicines to help prevent possible adverse side effects of DA-EPOCH-R.
  • Participants who respond successfully to the treatment will be asked to return for follow-up exams every 3 months for the first 18 months, then every year for the next 3 years. Participants who do not respond successfully to the treatment will be given the opportunity to participate in additional research and treatment protocols, if any are available.
Read the detailed description

Background:

  • Burkitt lymphoma/leukemia (BL) is highly curable. Standard treatment employs dose intense multi-agent chemotherapy and though effective is associated with high morbidity. Therefore, novel approaches are needed that improve the therapeutic index of BL while maintaining or improving efficacy. In human immunodeficiency virus (HIV)+ BL, outcome has been poor, mainly due to the use of cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone (CHOP) based regimens in this disease.
  • Two National Cancer Institute (NCI) phase II trials have used etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH) chemotherapy with 1 or 2 doses of rituximab (R) per cycle in untreated BL. (Dose-adjusted) etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH)-Rituximab has been used in16 HIV negative BL, and 8 HIV positive patients have received 3 to 4 cycles of EPOCHRR to minimize toxicity and risk of opportunistic infections. All patients remain in continuous remission. Treatment was very well tolerated and represents a novel therapeutic strategy in BL.
  • This trial seeks to assess the effectiveness of a risk adaptive approach with DA-EPOCHR in untreated BL (HIV+/-). Because this treatment represents a major conceptual departure from standard treatment, it is important to obtain additional Phase II results in limited/advanced stage BL
  • c-MYC positive Diffuse large B cell (DLBCL) is a rare variant of Diffuse Large B-Cell Lymphoma (DLBCL). There is very little data on the biology of this disease and what the optimal therapeutic approach should be has not been defined. Therefore, based on our impression that this behaves aggressively and is likely characterized by a high tumor proliferation rate, we plan to accrue patients with this disease in addition to BL patients.
  • Plasmablastic lymphoma, another variant of DLBCL is frequently characterized by the activation of MYC and has had a poor outcome historically with standard treatment. We plan to include these patients in the study also. As they are cluster of differentiation 20 (CD20) negative, they will receive DA-EPOCH without Rituximab.

Objectives:

  • Determine progression free survival (PFS), event free survival (EFS) and overall survival (OS) of risk adaptive DA-EPOCH-R in untreated BL and c-MYC + DLBCL and DA-EPOCH in c-MYC+ plasmablastic lymphoma.
  • Assess predictive value of early fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans on PFS.
  • Obtain pilot comparative molecular profiling in HIV negative and positive BL and c- MYC + DLBCL, including c-MYC+ plasmablastic lymphoma.

Eligibility:

  • Burkitt lymphoma, c-MYC + DLBCL and c-MYC + plasmablastic lymphoma age greater than or equal to 18 years.
  • No prior treatment except limited-field radiotherapy, short course of glucocorticoids and/or cyclophosphamide for an urgent problem at diagnosis.
  • Adequate major organ function unless impairment due to lymphoma.

Study Design:

  • Phase II Study of risk adapted DA-EPOCH-R in BL, c-MYC + DLBCL and DA-EPOCH in c-MYC+ plasmablastic lymphoma
  • Low risk: DA-EPOCH-RR x 3 cycles.
  • High risk , c-MYC + DLBCL and c-MYC+ plasmablastic lymphoma : DA-EPOCH (+/-) R x 6 cycles or 8 cycles in select patients.
  • Cerebrospinal fluid (CSF) cytology and flow cytometry for analysis of BL.
  • High Risk CSF negative - Prophylactic intrathecal treatment
  • CSF positive - Active intrathecal treatment
  • FDG-PET/CT pre- and post-cycle 2 in all patients.
  • A total of 194 patients will be enrolled in the protocol.
02

Conditions studied

  • Burkitt Lymphoma
  • Diffuse Large B-cell Lymphoma, c-MYC Positive
  • Plasmablastic Lymphoma

Keywords

  • Microarray
  • Toxicity
  • Therapeutic Index
  • HIV Positive
  • HIV Negative
  • HIV Infections
03

In context

Burkitt Lymphoma

976 studies on the registry are indexed under Burkitt Lymphoma; 159 are open to participants now.

This study's enrollment of 194 is above the median of 36 across 765 interventional studies indexed under Burkitt Lymphoma.

Browse Burkitt Lymphoma studies →

Lead sponsor

National Cancer Institute (NCI) is the lead sponsor of 3,556 studies on the registry; 336 are open to participants now.

Of its 411 completed or terminated interventional studies of FDA-regulated products, 373 (91%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

Patients must have one of the following histologic diagnoses:

-Patients must have Burkitt Lymphoma. Effective with Amendment J (version date: 06/24/2014), the following histologies were removed as the maximum number allowed for these sub-groups has been reached: B-cell lymphoma: unclassifiable with features intermediate between Diffuse Large B cell lymphoma and Burkitt Lymphoma ; c-MYC + Diffuse large B-cell lymphoma (DLBCL) and c-MYC+ plasmablastic lymphoma.

If questions arise related to diagnosis, please contact the National Cancer Institute (NCI) Principal Investigator, Dr. Mark Roschewski or the NCI study coordinator, A. Nicole Lucas.

  • Age greater than or equal to 18 years. Because no dosing or adverse event data are currently available on the use of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) in patients \<18 years of age, children are excluded from this study, but may be eligible for future pediatric trials
  • Pathology confirmed by treating institutions Pathology Department.
  • No prior treatment except patients may be entered if they have had prior limited-field radiotherapy, a short course of , cyclophosphamide for an urgent problem at diagnosis (e.g. epidural cord compression, superior vena cava syndrome) and/or a single dose of intrathecal methotrexate (MTX) at the time of the pre-treatment diagnostic lumbar puncture.
  • All disease stages.
  • (HIV) negative or positive.
  • HIV positive patients on antiretroviral therapy regimen must be willing to suspend all Highly Active Antiretroviral Therapy (HAART) except in circumstances described in section 6.5.
  • (ECOG) 0-4
  • Ability of patient or durable power of attorney (DPA) for healthcare to give .
  • + patients may be enrolled at the discretion of the investigator.

Exclusion criteria

EXCLUSION CRITERIA:

  • Patients with Primary central nervous system (CNS) Lymphoma.
  • Inadequate renal function, defined as serum creatinine (Cr) > 1.5 or \< 50ml/min/1.73m\^2 unless lymphoma related.
  • Inadequate hepatic or hematological function: as follows, unless lymphoma-/disease-related: greater than 2 mg/dl (total) except greater than 5 mg/dl in patients with Gilbert's syndrome as defined by greater than 80% unconjugated, (ANC) less than 1000 and less than 75,000.
  • The effects of EPOCH-R on the developing human fetus are unknown. For this reason and because chemotherapy agents are known to be teratogenic, female subject of not willing to use an acceptable method of (i.e., a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study and one year beyond treatment completion will not be eligible to participate in the study.
  • Female subject pregnant or breast-feeding. Confirmation that the subject is not pregnant must be established by a negative serum beta-human chorionic gonadotropin (beta-human chorionic gonadotropin (hCG) pregnancy test result obtained during screening. Pregnancy testing is not required for women without child-bearing potential.
  • The effects of EPOCH-R on the developing human fetus are unknown. For this reason and because chemotherapy agents are known to be teratogenic, male subject unwilling to use an acceptable method for contraception for the duration of the study and one year beyond treatment completion, will not be eligible to participate in the study.
  • History of a prior invasive in past 5 years.
  • Active symptomatic ischemic heart disease, myocardial infarction or congestive heart failure within the past year. If echo is obtained the (LVEF) should exceed 40%.
  • Serious concomitant medical illnesses that would jeopardize the patient's ability to receive the regimen with reasonable safety.
  • positive patients with advanced immune suppression and evidence of HIV resistant to all combinations of antiretroviral therapy considered at high risk of non lymphoma related death within 12-months due to other acquired immunodeficiency syndrome (AIDS) complications should not be enrolled on the study.
Terms in these criteria, in plain language(13)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
194 participants (actual)

Study arms

  • Experimental
    Group A - Burkitt lymphoma Low Risk Arm

    Burkitt lymphoma Low Risk Arm Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) every 21 days for 6 cycles

    Drug: EPOCH-RR

  • Experimental
    Group B - Burkitt lymphoma High Risk Arm

    Burkitt lymphoma High Risk Arm Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) every 21 days for 6 cycles

    Drug: EPOCH-R

  • Experimental
    Group C - DLBCL high risk arm

    Diffuse large B-cell lymphoma (DLBCL) high risk arm Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) every 21 days for 6 cycles

    Drug: EPOCH-R

Interventions

  • DrugEPOCH-R

    Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) every 21 days for 6 cycles

    Also known as: Etoposide, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin, Rituximab

  • Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) every 21 days for 3 cycles

    Also known as: Etoposide, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin, Rituximab

06

What researchers measure

Primary outcomes

  1. Percentage of Participants With Kaplan-Meier Curve Progression Free Survival (PFS) Constructed With an 95% Confidence Interval

    PFS is the time interval from start of treatment to documented evidence of disease progression. Disease progression was measured by the International Workshop Criteria (IWC). Progression is a positive positron emission tomography (PET) finding corresponding to the computed tomography (CT) abnormality (new lesion, increasing size of previous lesion), or a negative PET and a CT abnormality (new lesion, increasing size of previous lesion) of \< 1.5 cm (\< 1.0 cm in the lungs). Kaplan-Meier curves were constructed with an 95% confidence interval.

    Time frame: Time of progression or death at 4 years

  2. Percentage of Participants With Kaplan-Meier Curve Event Free Survival (EFS) Constructed With an 95% Confidence Interval

    EFS was determined from the date of enrolment in the study until the date of progression, last documentation of disease at or after the last treatment cycle, death, or last follow-up (whichever occurred first). Disease progression was measured by the International Workshop Criteria (IWC). Progression is a positive positron emission tomography (PET) finding corresponding to the computed tomography (CT) abnormality (new lesion, increasing size of previous lesion), or a negative PET and a CT abnormality (new lesion, increasing size of previous lesion) of \< 1.5 cm (\< 1.0 cm in the lungs). Kaplan-Meier curves were constructed with an 95% confidence interval.

    Time frame: At 4 years

  3. Percentage of Participants Kaplan-Meier Curve Overall Survival (OS) Constructed With an 95% Confidence Interval

    OS was calculated from the enrolment date until date of death or last follow-up using the Kaplan Meier. Kaplan-Meier curves were constructed with an 95% confidence interval.

    Time frame: At 4 years

Secondary outcomes

  1. Kaplan-Meier Progression Free Survival (PFS) Constructed With an 95% Confidence Interval in Participants Who Underwent Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) and/or Computed Tomography (CT) Scans After Cycle 2

    The predictive value of early FDG-PET/CT scans on PFS was assessed after cycle 2. PFS is the time interval from start of treatment to documented evidence of disease progression, assessed by the International Workshop Criteria (IWC). Progression is a positive positron emission tomography (PET) finding corresponding to the computed tomography (CT) abnormality (new lesion, increasing size of previous lesion), or a negative PET and a CT abnormality (new lesion, increasing size of previous lesion) of \< 1.5 cm (\< 1.0 cm in the lungs). Kaplan-Meier curves were constructed with an 95% confidence interval.

    Time frame: After 2 cycles of therapy and prior to cycle 3

Other outcomes

  1. Number of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0)

    Here is the number of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.

    Time frame: Date treatment consent signed to date off study, approximately 102 months and 25 days for Group A, 125 months and 28 days for Group B and 117 months and 29 days for group C.

07

Results

Posted Oct 19, 2021

Participant flow

Participant flow — Overall Study
MilestoneLow-risk Burkitt Lymphoma (BL)High-Risk Burkitt Lymphoma (BL)High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
Started159881
Completed148053
Not completed11828
Withdrew: Death053
Withdrew: Participant safety120
Withdrew: Physician decision060
Withdrew: Did not meet criteria0025
Withdrew: Non-compliance030
Withdrew: Participant refused follow-up020

Outcome measures

PrimaryPercentage of Participants With Kaplan-Meier Curve Progression Free Survival (PFS) Constructed With an 95% Confidence Interval

PFS is the time interval from start of treatment to documented evidence of disease progression. Disease progression was measured by the International Workshop Criteria (IWC). Progression is a positive positron emission tomography (PET) finding corresponding to the computed tomography (CT) abnormality (new lesion, increasing size of previous lesion), or a negative PET and a CT abnormality (new lesion, increasing size of previous lesion) of \< 1.5 cm (\< 1.0 cm in the lungs). Kaplan-Meier curves were constructed with an 95% confidence interval.

Time frame:
Time of progression or death at 4 years
Reported as:
Number · percentage of participants
Percentage of Participants With Kaplan-Meier Curve Progression Free Survival (PFS) Constructed With an 95% Confidence Interval
percentage of participantsGroup A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
Percentage of Participants With Kaplan-Meier Curve Progression Free Survival (PFS) Constructed With an 95% Confidence Interval100 (1 to 100)82.1 (72.7 to 88.5)71.0 (56.5 to 81.4)
PrimaryPercentage of Participants With Kaplan-Meier Curve Event Free Survival (EFS) Constructed With an 95% Confidence Interval

EFS was determined from the date of enrolment in the study until the date of progression, last documentation of disease at or after the last treatment cycle, death, or last follow-up (whichever occurred first). Disease progression was measured by the International Workshop Criteria (IWC). Progression is a positive positron emission tomography (PET) finding corresponding to the computed tomography (CT) abnormality (new lesion, increasing size of previous lesion), or a negative PET and a CT abnormality (new lesion, increasing size of previous lesion) of \< 1.5 cm (\< 1.0 cm in the lungs). Kaplan-Meier curves were constructed with an 95% confidence interval.

Time frame:
At 4 years
Reported as:
Number · percentage of participants
Percentage of Participants With Kaplan-Meier Curve Event Free Survival (EFS) Constructed With an 95% Confidence Interval
percentage of participantsGroup A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
Percentage of Participants With Kaplan-Meier Curve Event Free Survival (EFS) Constructed With an 95% Confidence Interval100 (1 to 100)82.1 (72.7 to 88.5)71.0 (58.5 to 81.4)
PrimaryPercentage of Participants Kaplan-Meier Curve Overall Survival (OS) Constructed With an 95% Confidence Interval

OS was calculated from the enrolment date until date of death or last follow-up using the Kaplan Meier. Kaplan-Meier curves were constructed with an 95% confidence interval.

Time frame:
At 4 years
Reported as:
Number · percentage of participants
Percentage of Participants Kaplan-Meier Curve Overall Survival (OS) Constructed With an 95% Confidence Interval
percentage of participantsGroup A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
Percentage of Participants Kaplan-Meier Curve Overall Survival (OS) Constructed With an 95% Confidence Interval100 (1 to 100)84.9 (75.8 to 90.8)76.7 (62.6 to 86.1)
SecondaryKaplan-Meier Progression Free Survival (PFS) Constructed With an 95% Confidence Interval in Participants Who Underwent Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) and/or Computed Tomography (CT) Scans After Cycle 2

The predictive value of early FDG-PET/CT scans on PFS was assessed after cycle 2. PFS is the time interval from start of treatment to documented evidence of disease progression, assessed by the International Workshop Criteria (IWC). Progression is a positive positron emission tomography (PET) finding corresponding to the computed tomography (CT) abnormality (new lesion, increasing size of previous lesion), or a negative PET and a CT abnormality (new lesion, increasing size of previous lesion) of \< 1.5 cm (\< 1.0 cm in the lungs). Kaplan-Meier curves were constructed with an 95% confidence interval.

Time frame:
After 2 cycles of therapy and prior to cycle 3
Reported as:
Number · percentage of participants
Kaplan-Meier Progression Free Survival (PFS) Constructed With an 95% Confidence Interval in Participants Who Underwent Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) and/or Computed Tomography (CT) Scans After Cycle 2
percentage of participantsGroup A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
Kaplan-Meier Progression Free Survival (PFS) Constructed With an 95% Confidence Interval in Participants Who Underwent Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) and/or Computed Tomography (CT) Scans After Cycle 2100 (1 to 100)90.0 (77.7 to 95.7)78.7 (60.5 to 89.2)
Other pre-specifiedNumber of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0)

Here is the number of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.

Time frame:
Date treatment consent signed to date off study, approximately 102 months and 25 days for Group A, 125 months and 28 days for Group B and 117 months and 29 days for group C.
Reported as:
Count of participants · Participants
Number of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0)
ParticipantsGroup A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
Number of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0)138772

Adverse events

Collected over Date treatment consent signed to date off study, approximately 102 months and 25 days for Group A, 125 months and 28 days for Group B and 117 months and 29 days for group C.. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Group A - Low-risk Burkitt Lymphoma (BL)0/15 (0%)3/15 (20%)13/15 (86.7%)
Group B - High-Risk Burkitt Lymphoma (BL)16/98 (16.3%)58/98 (59.2%)88/98 (89.8%)
Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)3/81 (3.7%)33/81 (40.7%)71/81 (87.7%)
Most frequent serious events
Showing 10 of 89
Most frequent serious events
EventGroup A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
Febrile neutropeniaBlood and lymphatic system disorders0/1527/9811/81
White blood cell decreasedInvestigations0/1515/985/81
AnemiaBlood and lymphatic system disorders1/1512/984/81
Neutrophil count decreasedInvestigations1/1511/985/81
Death NOSGeneral disorders0/1510/989/81
Mucositis oralGastrointestinal disorders0/158/980/81
Lymphocyte count decreasedInvestigations1/157/983/81
Catheter related infectionInfections and infestations1/150/980/81
HyponatremiaMetabolism and nutrition disorders1/153/982/81
Infections and infestations - Other, clostridium difficileInfections and infestations1/150/980/81
Most frequent other events
Showing 10 of 269
Most frequent other events
EventGroup A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)
AnemiaBlood and lymphatic system disorders6/1562/9853/81
White blood cell decreasedInvestigations7/1547/9852/81
Lymphocyte count decreasedInvestigations5/1554/9849/81
Neutrophil count decreasedInvestigations5/1555/9849/81
Platelet count decreasedInvestigations3/1552/9843/81
ConstipationGastrointestinal disorders6/1520/9822/81
Peripheral sensory neuropathyNervous system disorders5/1526/9822/81
Febrile neutropeniaBlood and lymphatic system disorders1/1529/9822/81
FatigueGeneral disorders4/1522/9822/81
AlopeciaSkin and subcutaneous tissue disorders4/159/986/81

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
<=18 years0000
Between 18 and 65 years138455152
>=65 years2142642
Age, Continuous
Age, Continuous(years)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
Mean51.47 ± 14.8546.35 ± 17.5357.47 ± 1451.39 ± 16.74
Sex: Female, Male
Sex: Female, Male(Participants)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
Female4202044
Male117861150
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
Black or African American216624
White116566142
Indian or Alaska Native1001
Indian or Alaska Native + White0101
Asian1528
Race Unknown/Not Reported011718
Hispanic or Latino110415
Not Hispanic or Latino148072166
Ethnicity Unknown/Not Reported08513
Region of Enrollment
Region of Enrollment(participants)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
United States159881194
Eastern Cooperative Oncology Group (ECOG)
Eastern Cooperative Oncology Group (ECOG)(Participants)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
011392676
14383779
2014923
304711
40325
Baseline Risk Stratification
Baseline Risk Stratification(Participants)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
Low Risk150015
High Risk09881179
International Prognostic Index Score 0-5
International Prognostic Index Score 0-5(Participants)Group A - Low-risk Burkitt Lymphoma (BL)Group B - High-Risk Burkitt Lymphoma (BL)Group C - High-Risk Diffuse Large B Cell Lymphoma (DLBCL)Total
0128727
1319729
20202848
30243054
4024529
50347

1 further baseline measures are reported on the registry.

08

Study locations

30 sites
  • UC San Diego Moores Cancer Center
    La Jolla, California 92093, United States
  • UCLA Center for Clinical AIDS Research and Education
    Los Angeles, California 90025, United States
  • Emory University /Winship Cancer Institute
    Atlanta, Georgia 30322, United States
  • University of Illinois
    Chicago, Illinois 60607, United States
  • University of Iowa/Holden Comprehensive Cancer Center
    Iowa City, Iowa 52242, United States
  • University of Kentucky /Markey Cancer Center
    Lexington, Kentucky 40536, United States
  • National Institutes of Health Clinical Center, 9000 Rockville Pike
    Bethesda, Maryland 20892, United States
  • Massachusetts General Hospital Cancer Centers
    Boston, Massachusetts 02114, United States
  • Dana Farber Cancer Institute
    Boston, Massachusetts 02115, United States
  • Beth Israel Deaconess Medical Center
    Boston, Massachusetts, United States
  • West Michigan Cancer Center
    Kalamazoo, Michigan 49007, United States
  • Fairview - Southdale Hospital
    Edina, Minnesota, United States
  • Unity Hospital
    Fridley, Minnesota 55432, United States
  • Park Nicollet Clinic - Saint Louis Park
    Saint Louis Park, Minnesota 55416, United States
  • Washington University School of Medicine
    Saint Louis, Missouri, United States
  • University of Nebraska Medical Center
    Omaha, Nebraska 68198, United States
  • Montefiore Medical Center - Moses Campus
    Bronx, New York 10467, United States
  • Mount Sinai Hospital
    New York, New York 10017, United States
  • Memorial Sloan Kettering Cancer Center
    New York, New York 11570, United States
  • University of Rochester
    Rochester, New York 14627, United States
  • Vidant Oncology-Kinston
    Kinston, North Carolina 28501, United States
  • Wake Forest University Health Sciences
    Winston-Salem, North Carolina 27157, United States
  • Case Western Reserve University
    Cleveland, Ohio 44106-2602, United States
  • MetroHealth Medical Center
    Cleveland, Ohio 44109, United States
  • Cleveland Clinic
    Cleveland, Ohio, United States
  • University of Tennessee - Knoxville
    Knoxville, Tennessee 37996, United States
  • UT Southwestern /Simmons Cancer Center- Dallas
    Dallas, Texas 75390, United States
  • MD Anderson Cancer Center
    Houston, Texas 77030-4096, United States
  • University of Wisconsin Hospital and Clinics
    Madison, Wisconsin 53792, United States
  • Froedtert and the Medical College of Wisconsin
    Milwaukee, Wisconsin 53226, United States
09

References and documents

Publications

  • Roschewski M, Dunleavy K, Abramson JS, Powell BL, Link BK, Patel P, Bierman PJ, Jagadeesh D, Mitsuyasu RT, Peace D, Watson PR, Hanna WT, Melani C, Lucas AN, Steinberg SM, Pittaluga S, Jaffe ES, Friedberg JW, Kahl BS, Little RF, Bartlett NL, Fanale MA, Noy A, Wilson WH. Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma. J Clin Oncol. 2020 Aug 1;38(22):2519-2529. doi: 10.1200/JCO.20.00303. Epub 2020 May 26. PubMed 32453640 ↗
  • Dunleavy K, Fanale MA, Abramson JS, Noy A, Caimi PF, Pittaluga S, Parekh S, Lacasce A, Hayslip JW, Jagadeesh D, Nagpal S, Lechowicz MJ, Gaur R, Lucas A, Melani C, Roschewski M, Steinberg SM, Jaffe ES, Kahl B, Friedberg JW, Little RF, Bartlett NL, Wilson WH. Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) in untreated aggressive diffuse large B-cell lymphoma with MYC rearrangement: a prospective, multicentre, single-arm phase 2 study. Lancet Haematol. 2018 Dec;5(12):e609-e617. doi: 10.1016/S2352-3026(18)30177-7. PubMed 30501868 ↗

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: Yes — All individual participant data (IPD) recorded in the medical record will be shared with intramural investigators upon request. All collected IPD will be shared with collaborators under the terms of collaborative agreements.

Supporting information: Study protocol, Statistical analysis plan, Informed consent form

Time frame: Clinical data available during the study and indefinitely.

Access criteria: Clinical data will be made available upon request to the study principal investigator.

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Apr 27, 2023, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT01092182
Responsible party
Mark Roschewski, M.D. (Principal Investigator, National Cancer Institute (NCI)) — Principal investigator
First posted
Mar 24, 2010
Start date
Mar 25, 2010
Primary completion
Sep 30, 2020
Completion
Feb 16, 2023
Results posted
Oct 19, 2021
Last update
Apr 27, 2023

Study contacts

Mark J Roschewski, M.D.
principal investigator · National Cancer Institute (NCI)

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Etoposide

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