Temsirolimus and rituximab in patients with relapsed or refractory mantle cell lymphoma: a phase 2 study

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• 作者：Prof Stephen M Ansell MD^a ; ^{ansell.stephen@mayo.edu} ; Hui Tang PhD^b ; Prof Paul J Kurtin MD^c ; Patricia A Koenig RN^e ; David J Inwards MD^a ; Keith Shah MD^e ; Steven C Ziesmer BS^a ; Andrew L Feldman MD^c ; Radha Rao MD^e ; Mamta Gupta PhD^a ; Prof Charles Erlichman MD^d ; Prof Thomas E Witzig MD^a
• 刊名：Lancet Oncology
• 出版年：2011
• 出版时间：April 2011
• 年：2011
• 卷：12
• 期：4
• 页码：361-368
• 全文大小：161 K

文摘

Summary

Background

Temsirolimus is a mammalian target of rapamycin (mTOR) inhibitor with single-agent antitumour activity in patients with mantle cell lymphoma. We therefore tested its efficacy and toxicity in combination with rituximab (an antiCD20 antibody) in patients with relapsed or refractory mantle cell lymphoma.

Methods

In a phase 2 study, patients (aged ≥18 years) at 35 centres in the USA were given temsirolimus 25 mg/week, and rituximab 375mg/m² per week for 4 weeks during the first cycle and thereafter a single dose of rituximab every other 28-day cycle. Both drugs were administered intravenously. Responding patients after six cycles could continue treatment for a total of 12 cycles, and were then observed without additional maintenance treatment. The primary endpoint was the proportion of patients with either rituximab-sensitive or rituximab-refractory disease who had at least a partial response. The analyses were done on all patients who were treated. The study was registered with ClinicalTrials.gov, number NCT00109967.

Findings

71 patients with mantle cell lymphoma were enrolled and 69 were assessable and were included in the final analysis. The overall response rate (ORR) was 59 % (41 of 69 patients)—13 (19 % ) patients had complete responses and 28 (41 % ) had partial responses. The ORR was 63 % (30 of 48; 95 % CI 47–76) for rituximab-sensitive patients, and 52 % (11 of 21; 30–74) for rituximab-refractory patients. The most common treatment-related grade 3 or 4 adverse events in rituximab-sensitive and rituximab-refractory patients were thrombocytopenia (eight [17 % ] and eight [38 % ], respectively), neutropenia (ten [21 % ] and five [24 % ], respectively), fatigue (eight [17 % ] and two [10 % ], respectively), leucopenia (six [13 % ] and three [14 % ], respectively), pneumonia (five [10 % ] and two [10 % ], respectively), lymphopenia (five [10 % ] and two [10 % ], respectively), pneumonitis (four [8 % ] and none, respectively), oedema (four [8 % ] and none, respectively), dyspnoea (three [6 % ] and two [10 % ], respectively), and hypertriglyceridaemia (three [6 % ] and two [10 % ], respectively).

Interpretation

mTOR inhibitors in combination with rituximab could have a role in the treatment of patients with relapsed and refractory mantle cell lymphoma.

Funding

National Institutes of Health and the Predolin Foundation.