PET and EBV DNA-directed Therapy for Localized Nasal Extranodal NK/T Cell Lymphoma

Trial Title: PET and EBV DNA-directed Therapy for Localized Nasal Extranodal NK/T Cell Lymphoma

NCT ID: NCT06069830

Condition: NK-T-Cell Lymphoma, Extranodal

Conditions: Official terms:
Lymphoma
Lymphoma, T-Cell
Lymphoma, T-Cell, Peripheral
Lymphoma, Extranodal NK-T-Cell
Antineoplastic Agents, Immunological
Pegaspargase
Asparaginase
Antibodies
Immunoglobulins
Antibodies, Monoclonal

Study type: Interventional

Study phase: N/A

Overall status: Recruiting

Study design:

Allocation: N/A

Intervention model: Single Group Assignment

Primary purpose: Treatment

Masking: None (Open Label)

Intervention:

Intervention type: Drug
Intervention name: 4 cycles of ESA regimen with sandwiched radiotherapy
Description: Pegaspargase, 2500U/m2, i.m. d1; etoposide, 200mg, p.o., d2-d4; Dexamethasone, 40mg, p.o. d2-d4；
Arm group label: Interim PET and EBV DNA-directed therapy

Intervention type: Drug
Intervention name: 2 cycles of ESA regimen sequential radiotherapy and 2 cycles of PD-1 monoclonal antibody combined with pegaspargase
Description: Pegaspargase, 2500U/m2, IM, d1; PD-1 monoclonal antibody, 200mg, i.v. d2;
Arm group label: Interim PET and EBV DNA-directed therapy

Intervention type: Drug
Intervention name: 2 cycles of ESA regimen, 2 cycles of PD-1 monoclonal antibody and concurrent radiotherapy, 2 cycles of PD-1 monoclonal antibody combined with pegaspargase
Description: PD-1 monoclonal antibody, 200mg, i.v. d1
Arm group label: Interim PET and EBV DNA-directed therapy

Summary: A prospective, open-abel, phase 2 clinical study to investigate whether interim Positron Emission Tomography (PET) and Epstein-Barr virus (EBV) DNA-directed therapy can improve the prognosis of localized nasal extranodal NK/T cell lymphoma (ENKTL) patients.

Detailed description: This study aims to evaluate the significance of mid-term PET and EBV DNA-directed therapy for localized nasal ENKTL. Patients receive 2 cycles of ESA (Pegaspargase, Etoposide, Dexamethasone) regimen, then according to the mid-term PET and EBV DNA results, patients are divided into three cohorts: 1) cohort A: patients with Deauville score 1-3 and EBV DNA negative receive sequential radiotherapy and 2 cycles of ESA regimen; 2) cohort B: patients with Deauville score 1-3 and EBV DNA positive receive sequential radiotherapy and 2 cycles of PD-1 monoclonal antibody combined with pegaspargase; 3) cohort C: patients with Deauville score 4-5 receive 2 cycles of PD-1 monoclonal antibody and concurrent radiotherapy, then 2 cycles of PD-1 monoclonal antibody combined with pegaspargase.

Criteria for eligibility:
Criteria:
Inclusion Criteria: - Pathologically newly diagnosed extranodal NK/T cell lymphoma, nasal type (according to the WHO classification 2016); - No previous anti-lymphoma treatment; - Age ≥ 18 years old; - Ann Arbor stage I/II; - ECOG 0-2 score; - Patients with a life expectancy of at least 3 months; - At least one measurable / evaluable lesion from diagnostic biopsy to the beginning of treatment; - Sufficient bone marrow and liver and kidney function, namely: 1. Absolute neutrophil count (ANC)> 1000 / μL, platelet count> 50, 000 / μl, hemoglobin> 9g/ dl; 2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <3 times the upper limit of normal (ULN); Serum total bilirubin <1. 5 times ULN (patients with Gilbert syndrome can be included); 3. Serum creatinine <2 times ULN or creatinine clearance rate> 50 ml/min. - Able to comply with the research procedures and cooperate in the implementation of the entire research process; - Written informed consent; - Women with fertility agree to take appropriate measures to avoid pregnancy during the treatment period until at least one year after the end of treatment; Men agree to maintain abstinence or use barrier contraception. Exclusion Criteria: - Diagnosed invasive NK cell leukemia and extranasal ENKTL; - Ann Arbor stage III/IV; - Pregnant or lactation; - Autoimmune diseases that require systemic treatment in the past 2 years (namely, antirheumatic drugs, hormones or immunosuppressants), including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid syndrome related vascular thrombosis, Wegener's granuloma, Sjogren's syndrome, Guillain Barre syndrome, multiple sclerosis, vasculitis or glomerulonephritis. The following cases are allowed to be included: autoimmune hypothyroidism or type I diabetes receiving stable treatment, hormone replacement treatment (such as thyroxine, insulin, or supplement of physiological hormone due to insufficient adrenal or pituitary gland) are not considered as systematic treatment and are allowed to be included. - Other invasive cancers that have not received curative treatment or are still receiving anti-cancer treatment (including hormone therapy for breast cancer or prostate cancer) in the past 3 years; - Pneumonia requiring steroid medication treatment (non-infectious); Or had clinical evidence of interstitial lung disease or active and non-infectious pneumonia; - Active infections that require systemic treatment; - Severe cardiovascular disease, or myocardial infarction, unstable arrhythmia, or unstable angina pectoris occurring 3 months ago; - Previous treatment with anti PD-1, anti PD-L1, or anti PD-L2 drugs; - HBsAg, HCV, or HIV positivity; HBV and HCV serological positivity is allowed, but DNA/RNA must be negative; - Live attenuated vaccine vaccination within 4 weeks before the treatment; patients are prohibited from receiving live attenuated vaccines during the study period, including influenza vaccines; - Central nervous system diseases; - Previous allogeneic tissue/solid organ transplantation; - Active tuberculosis; - Other concurrent uncontrollable medical conditions that may interfere the participation of the study.

Gender: All

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: Ruijin Hospital

Address:
City: Shanghai
Zip: 200020
Country: China

Status: Recruiting

Contact:
Last name: Weili Zhao

Phone: +862164370045

Phone ext: 610707
Email: zwl_trial@163.com

Start date: December 6, 2023

Completion date: October 2026

Lead sponsor:
Agency: Ruijin Hospital
Agency class: Other

Source: Ruijin Hospital

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT06069830