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Report for Clinical Trial NCT02670707

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

Randomization of Cytarabine Monotherapy Versus Standard-of-Care Vinblastine/Prednisone for Frontline Treatment of Langerhans Cell Histiocytosis (TXCH LCH0115)

Langerhans Cell Histiocytosis (LCH) is a type of cancer that can damage tissue or cause lesions to form in one or more places in the body. Langerhans cell histiocytosis (LCH) is a cancer that begins in LCH cells (a type of dendritic cell which fights infection). Sometimes there are mutations (changes) in LCH cells as they form. These include mutations of the BRAF gene. These changes may make the LCH cells grow and multiply quickly. This causes LCH cells to build up in certain parts of the body, where they can damage tissue or form lesions. For most patients with LCH, standard-of-care vinblastine/prednisone are used as front-line therapy while cytarabine therapy has been used as therapy for patients who develop recurrence. No alternate treatment strategy has been developed for frontline therapy in LCH. The purpose of this research study is to compare previously used vinblastine/prednisone to single therapy with cytarabine for LCH. We will evaluate the utility of an imaging study called a positron emission tomography (PET) scan to more accurately assess areas of LCH involvement not otherwise seen in other imaging studies as well as response to therapy. We also want to identify if genetic and other biomarkers (special proteins in patient's blood and in patient's cancer) relate to the response of patients LCH to study treatment.

NCT02670707 Langerhans Cell Histiocytosis
MeSH:Histiocytosis, Langerhans-Cell Histiocytosis
HPO:Histiocytosis

2 Interventions

Name: Cytarabine

Description: Cytarabine 100 mg/m^2/day IV for five consecutive days. This five-day cycle will be repeated every 21 days for a total of four cycles for all patients regardless of response. Each new cycle may not begin until absolute neutrophil count (ANC) is ≥ 750/mcL and platelet count is ≥ 75,000/mcL.
Type: Drug
Group Labels: 5

Cytarabine ( Cytarabine (" Cytarabine ("experimental Cytarabine ("experimental" Cytarabine ("experimental") arm

Name: Vinblastine/prednisone

Description: Vinblastine 6 mg/m^2/dose IV push weekly Prednisone (or prednisolone) 20 mg/m2/dose by mouth twice a day
Type: Drug
Group Labels: 5

Vinblastine/prednisone ( Vinblastine/prednisone (" Vinblastine/prednisone ("standard Vinblastine/prednisone ("standard" Vinblastine/prednisone ("standard") arm


Primary Outcomes

Description: A Kaplan-Meier curve will be used to compare event-free survival between treatment groups. Curves will be compared using the log-rank statistic. Patients will be followed for up to 5 years after one year of therapy. Patients who have not had the event by the 5-year mark will be censored observations. Patients who are lost to follow-up without having an event will be censored at the time of last contact. Statistical significance will be assessed at the 0.05 level. A Cox proportional hazards model will also be used to estimate the Hazards Rate for combined events in the Cytarabine group versus standard therapy. A multiple regression model will also be used to estimate the adjusted HRs for genotype and baseline risk of death (high vs. low).

Measure: Time to determine 1-year event-free survival (EFS) of patients treated with cytarabine monotherapy for LCH, compared directly with that of standard-of-care vinblastine/prednisone (Events include progression of LCH, relapse, or death).

Time: up to 60 months

Secondary Outcomes

Description: Overall disease response at each timepoint will be assigned based on the lesion or organ system with worst response. For disease response not defined by the criteria included in the protocol, guidelines established in the RECIST criteria will be used.

Measure: Durable responses with 2-year and 5-year EFS and OS of the patients treated with cytarabine versus vinblastine/prednisone for LCH.

Time: 2-years and 5-years post treatment

Description: Toxicity will be graded by the NCI Common Toxicity Criteria Version 5.0.

Measure: Number of toxicities (including psychosis, hypertension, neuropathy, fever, headache) in the patients treated with cytarabine versus vinblastine/prednisone for LCH.

Time: up to 60 months after completion of therapy

Description: RECIST criteria will be used for assessing disease response

Measure: Rate at which patients achieve non-active disease on cytarabine versus vinblastine/prednisone therapy.

Time: up to 60 months after completion of therapy

Description: This will be quantified by quantitative real-time PCR.

Measure: Time to eradication of BRAF-V600E cells or other LCH-defining mutation

Time: within 6-24 weeks of therapy initiation

Description: For disease response not defined by the criteria included in the protocol, guidelines established in the RECIST criteria will be used.

Measure: Number of patients who have 18-FDG PET/CT positivity in identifying high-risk organ (liver, spleen, or bone marrow) involvement and correlation of PET/CT response with presence of disease activity as well as presence of circulating cells with BRAF-V600E.

Time: up to 60 months after completion of therapy

Description: This trial will utilize RECIST criteria for assessing disease response, which uses standard oncology response criteria terminology. Using RECIST terminology, we define response criteria for organs that may not have measurable lesions (i.e. bone marrow) but are clearly critical sites of disease. In addition, definitions of response in terms of metabolic activity from PET scans will also be prospectively analyzed based on prior retrospective radiologic reviews.

Measure: RECIST criteria and terminology in conjunction with metabolic PET imaging (where applicable) to assess disease response to therapy.

Time: up to 60 months after completion of therapy

Description: Evaluation of CNS+ site involvement at start of therapy, somatic BRAFV600E mutation status and measurable peripheral/marrow levels, ethnicity, age at onset, and extent of disease in predicting risk of neurodegenerative disease and/or pituitary involvement.

Measure: Number of risk factors for and time to development of diabetes insipidus and neurodegenerative disease.

Time: up to 60 months after completion of therapy

Purpose: Treatment

Allocation: Randomized

Parallel Assignment


There is one SNP

SNPs


1 V600E

Time to eradication of BRAF-V600E cells or other LCH-defining mutation. --- V600E ---

This will be quantified by quantitative real-time PCR.. Number of patients who have 18-FDG PET/CT positivity in identifying high-risk organ (liver, spleen, or bone marrow) involvement and correlation of PET/CT response with presence of disease activity as well as presence of circulating cells with BRAF-V600E.. --- V600E ---



HPO Nodes


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