E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
The study population includes patients with aggressive B cell Non-Hodgkin Lymphoma (NHL) planned to receive systemic anti-cancer therapy with at least 6 cycles of R-CHOP-21, according to local standards. |
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E.1.1.1 | Medical condition in easily understood language |
The study population includes patients with aggressive B cell Non-Hodgkin Lymphoma (NHL) planned to receive systemic anti-cancer therapy with at least 6 cycles of R-CHOP-21 |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10066481 |
E.1.2 | Term | Hematological malignancy |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this study is to demonstrate non-inferiority of lipegfilgrastim (Lonquex, Teva) vs. pegfilgrastim (Neulasta®, Amgen) for the duration of severe neutropenia (DSN) in the first cycle of chemotherapy. |
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E.2.2 | Secondary objectives of the trial |
-To compare efficacy of lipegfilgrastim and pegfilgrastim in elderly patients with B cell NHL receiving chemotherapy with R-CHOP-21 throughout the study. -To compare safety and tolerability of lipegfilgrastim and pegfilgrastim in elderly patients with B cell NHL receiving chemotherapy with R-CHOP-21 throughout the study. -To assess incidence and severity of infections throughout the study. -To compare effect of lipegfilgrastim and pegfilgrastim treatment on quality of life. -To further characterize the immunogenicity of lipegfilgrastim in comparison to pegfilgrastim.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
a. Signed and dated Independent Ethics Committee (IEC)-approved written informed consent b. Age ≥65 years and ≤85 years c. Histological documentation of aggressive B cell Non-Hodgkin Lymphoma d. Planned to receive systemic anticancer therapy with at least 6 cycles of R-CHOP-21, according to local standards e. Eastern Cooperative Oncology Group (ECOG) score ≤2 f. Life expectancy of at least 3 months g. Adequate bone marrow, renal and hepatic function as evidenced by the following within 14 days before start of chemotherapy: - absolute neutrophil count (ANC) ≥1.5 x 109/L - platelets ≥100 x 109/L - hemoglobin ≥9.0 g/dL - serum creatinine ≤1.5 x upper limit of the normal range (ULN) OR glomerular filtration rate (GFR) ≥30 mL/minute/1.73 m2 - AST and ALT ≤2.5 x ULN; bilirubin ≤1.5 x ULN; alkaline phosphatase limit ≤2.5 x ULN h. The patient is capable of understanding and complying with parameters as outlined in the protocol. i. Women of childbearing potential (not surgically sterile or 2 years postmenopausal) must use a medically accepted method of contraception and must agree to continue use of this method for the duration of the treatment and for 30 days after discontinuation of study drug. Acceptable methods of contraception include intrauterine device (IUD), steroidal contraceptive (oral, implanted, transdermal, or injected), barrier method with spermicide, abstinence, and partner vasectomy. j. The patient, if a man, is surgically sterile, or, if capable of producing offspring, is currently using an approved method of birth control and agrees to continued use of this method for the duration of the treatment (and for 90 days after taking the last dose of study drug because of the possible effects on spermatogenesis). Acceptable methods of contraception include abstinence, female partner’s use of an acceptable method of contraception (described above), or if female partner is surgically sterile or 2 years post-menopausal. In addition, male patients may not donate sperm for the duration of the study and for 90 days after taking study drug. |
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E.4 | Principal exclusion criteria |
a. Participation in a clinical study within 30 days before randomization b. Any chemotherapy within the last 3 months before start of chemotherapy. A prephase to reduce tumor burden prior to start of R-CHOP is allowed. c. The patient is a pregnant or lactating woman. (Any woman becoming pregnant during the study will be withdrawn from the study.) d. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days before start of chemotherapy. e. Active cardiac disease including any of the following: - Congestive heart failure ≥ New York Heart Association (NYHA) class 2. - Unstable angina, new-onset angina, myocardial infarction less than 6 months before start of chemotherapy. - Cardiac arrhythmias requiring anti-arrhythmic therapy (beta blockers or digoxin are permitted). - Uncontrolled hypertension. f. Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 6 months before start of chemotherapy. g. Ongoing infection, known history of human immunodeficiency virus (HIV) infection, tuberculosis, or chronic hepatitis B or C. h. Patients with evidence or history of bleeding diathesis. i. Non-healing wound, ulcer or bone fracture. j. Renal failure requiring hemo- or peritoneal dialysis. k. Any conditions that may interfere with the patient’s participation in the study or evaluation of the study results. l. Known hypersensitivity to any of the study drugs, study drug classes, or excipients in the formulation. m. Any illness or medical conditions that are unstable or could jeopardize the safety of the patient and his/her compliance in the study. n. Treatment with lithium at screening or planned during the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint for this study is the duration of severe neutropenia in days in the first cycle of chemotherapy. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
days 1, 3, 5, 8, 10, 12, 15 |
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E.5.2 | Secondary end point(s) |
- Incidence of febrile neutropenia (FN) by cycle and across all cycles - Incidence of severe/very severe neutropenia in Cycle 1 - Depth of ANC nadir in Cycle 1 - Proportion of patients with severe neutropenia lasting <1 day, <2 days, <3 days, or ≥3 days in Cycle 1 - Time to ANC recovery in first treatment cycle - Incidence and severity of infections. - Time in hospital and time in intensive care unit due to all causes and due to FN or connected infections. - Incidence of hospitalizations by cycle due to FN. - Incidence of treatment with IV and oral antibiotics due to FN or connected infections. - Percentage of actually delivered vs. scheduled cumulative chemotherapy dose. - Proportion of patients with chemotherapy doses reduced, omitted, or delayed. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Daily temperature measurement; ANC assessment days 1, 3, 5, 8, 10, 12, 15 in cycle one and days 1, 8, 15 in all other cycles |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 50 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 60 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 1 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 1 |
E.8.9.2 | In all countries concerned by the trial days | 0 |