A study to find out whether a PET-CT scan can help to tell who needs to have rituximab after the initial treatment for lymphoma (PETReA)

Cancer type:

Low grade lymphoma
Lymphoma
Non-Hodgkin lymphoma

Status:

Open

Phase:

Phase 3

This study is for people with follicular lymphoma. Everyone taking part is going to have treatment that reaches their whole body (systemic treatment) for the first time.

Cancer Research UK supports this trial.

More about this trial

Follicular lymphoma is a type of non Hodgkin lymphoma (NHL). Doctors usually put NHL into 2 groups, depending on how likely they are to grow and spread. The 2 groups are low grade and high grade NHL. Follicular lymphoma is a type of low grade NHL.

For follicular lymphoma, you usually have treatment with a combination of cancer drugs. You might have one of the following:

This is called the induction treatment. After the induction treatment, you might have rituximab (R) alone. This is the maintenance phase. But having more treatment with rituximab doesn’t help everyone with follicular lymphoma.

Doctors would like to know who needs to have rituximab after their initial treatment (induction). In this study, they are looking at whether PET-CT scans can help them to decide who needs to have maintenance rituximab.

A PET-CT scan combines a CT scan and a PET scan to give detailed information about the cancer.

Who can enter

The following bullet points list the entry conditions for this study. Talk to your doctor or the study team if you are unsure about any of these. They will be able to advise you.

Who can take part

You may be able to join this study if all of the following apply:

  • you have follicular lymphoma that is grade 1, 2 or 3a
  • your lymphoma is in at least 2 groups of lymph nodes (stage 2, 3 or 4)
  • you have a high number of lymphoma cells (a high tumour burden) – your doctor can tell you more about this
  • you are going to have treatment that reaches your whole body (systemic) for the first time
  • you have satisfactory blood tests results
  • your kidneys are working well
  • are well enough to be up and about for at least half of the day (performance status 0, 1 or 2)
  • you are willing to use reliable contraception during treatment if there is any possibility that you or your partner could become pregnant
  • are at least 18 years old

Who can’t take part

You cannot join this study if any of these apply. You:

  • have lymphoma in the brain or the spinal cord Open a glossary item 
  • have had another cancer in the past 5 years apart from successfully treated carcinoma in situ Open a glossary item of the cervix, breast and prostate, and non melanoma skin cancer Open a glossary item 
  • have HIV
  • have hepatitis B or hepatitis C
  • have any other serious medical condition that the trial team think could affect you taking part
  • have had a live vaccine in the past month
  • are pregnant or breastfeeding

Trial design

This is a phase 3 trial. Researchers hope that about 840 people with follicular lymphoma will agree to take part.

Everyone taking part has induction treatment with 1 of the following:

  • R-CHOP
  • R-CVP
  • bendamustine and rituximab (BR)

This is the same as the standard treatment. Your doctor will tell you which treatment you have and what to expect. You have between 6 and 8 cycles of induction treatment. It takes up to 6 months in total.

At the end of the induction treatment, you have a PET-CT scan. Doctors want to find out how well the treatment worked. The treatment you have next depends on the results of the PET-CT scan.

Negative PET-CT scan

You join this group if your lymphoma went away completely (a complete metabolic response).

This part of the study is randomised. The people taking part are put into 1 of 2 groups by a computer:

  • rituximab
  • no more treatment

Neither you nor your doctor can choose which group you join.

You have rituximab as a drip into a vein or as an injection under the skin. You have it once, every 2 months. This continues for about 2 years. Your doctor will monitor you regularly if you don’t have rituximab.

Positive PET-CT scan
You join this group if you still have active lymphoma cells. This means that there is a higher risk of your lymphoma coming back (relapse).

This part of the trial is also randomised. The people taking part are put into 1 of 2 groups by a computer:

  • rituximab
  • rituximab and lenalidomide

Neither you nor your doctor can choose which group you join.

You have rituximab every 2 months, for about 2 years.

Lenalidomide comes as tablets that you swallow whole once a day, for 21 days. After this, you have a break of a week. And then start another 21 days of lenalidomide. This continues for about 2 years.

Quality of life questionnaires
Everyone taking part completes a quality of life questionnaire before the start of treatment and at set times during the trial.

The questionnaire asks about how you are feeling and how treatment has affected your quality of life Open a glossary item.

Blood tests
You have extra blood tests as part of this study. You have it at the same time you have other tests that are part of your normal treatment.

You do not need to agree to have the extra blood tests if you don’t want to. You can still take part in this study.

Tissue sample

The trial team will ask to use a tissue sample of your cancer. This might be the sample they took to diagnose your cancer (archival tumour sample).

You do not need to agree to give an archival tumour sample if you don’t want to. You can still take part in this study.

Hospital visits

You see a doctor and have some tests before taking part. The tests might include:

During treatment, you see the trial team regularly. How often you see them depends on the treatment you have. You have a physical examination and blood tests each time you see them.

You have a CT scan before and after induction treatment, and every year after you finish treatment. You also have a PET-CT scan:

  • before the start of induction treatment
  • 6 weeks after you finish induction treatment
  • a year after the start of maintenance treatment if you have a positive PET-CT scan after the induction treatment

When you finish treatment, you see the trial team every 6 months. This continues for as long as you don’t have any signs of the lymphoma coming back.

You stop this study if your lymphoma comes back. Your doctor can tell you which other treatments you might have.

Side effects

The trial team monitor you during treatment and afterwards. You have a phone number to call them if you are worried about anything. The team will tell you about all the possible side effects before you start the study.

The most common side effects of rituximab are:

  • an allergic reaction causing palpitations, breathlessness, low blood pressure and sweating
  • redness, swelling and pain at the injection site
  • chest infections
  • skin rashes

The most common side effects of lenalidomide are:

We have more information about the possible side effects of rituximab and lenalidomide.

And information about the possible side effects of:

Location

Blackpool
Boston
Canterbury
Colchester
Derby
Epsom
Glasgow
Grantham
Leicester
Lincoln
Liverpool
London
Nottingham
Plymouth
Southend on Sea
Thornton
Wirral

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Andrew Pettitt

Supported by

Cancer Research UK

University of Liverpool

National Cancer Research Institute (NCRI)

Other information

This is Cancer Research UK trial number CRUK/16/017

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

15119

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Around 1 in 5 people take part in clinical trials

3 phases of trials

Around 1 in 5 people diagnosed with cancer in the UK take part in a clinical trial.

Last reviewed:

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