A trial of atezolizumab with standard treatment for diffuse B cell lymphoma (ARGO)

Cancer type:

Blood cancers
High grade lymphoma
Lymphoma
Non-Hodgkin lymphoma

Status:

Open

Phase:

Phase 2
This trial is looking at whether atezolizumab can improve treatment for a people with a type of non-Hodgkin lymphoma called diffuse B cell lymphoma (DBCL). 
 
The trial is for people:
  • whose lymphoma has come back or continued to grow following at least 1 or 2 different types of treatment
  • who are not suitable for high dose chemotherapy Open a glossary item
Cancer Research UK supports this trial.

More about this trial

You might have rituximab, gemcitabine and oxaliplatin (called R-GemOx) to treat diffuse B cell lymphoma that has come back or if treatment has stopped working. R-GemOx is one of the standard treatments Open a glossary item if you aren’t suitable to have high dose chemotherapy. Or if you have already had it.
 
But sometimes R-GemOx stops working. So, doctors want to look at how they can improve treatment. In this trial, they are looking at adding a drug called atezolizumab. 
 
Atezolizumab is a type of immunotherapy Open a glossary item. It blocks a protein called PD-1. This triggers the immune system Open a glossary item to attack and kill lymphoma cells.
 
Doctors hope that adding atezolizumab to R-GemOx can improve the way it works. 
 
The aims of the trial are to:
  • find out how well treatment works
  • find out what happens to atezolizumab in the body
  • learn more about the side effects

Who can enter

The following bullet points list the entry conditions for this trial. Talk to your doctor or the trial 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 trial if all of the following apply. 
You:
  • have diffuse B cell lymphoma
  • have lymphoma that has come back or continued to grow after at least 1 or 2 different types of treatment - one of these must have included treatment with rituximab and an anthracycline Open a glossary item or anthracenedione such as mitoxantrone
  • can’t have a stem cell transplant Open a glossary item because of your age, other medical conditions or you have had high dose chemotherapy in the past
  • have lymphoma that shows up on a PET scan Open a glossary item 
  • have a scan that shows 2 or more lymphoma tumours or nodes that measure at least 1.5 cm long and 1 cm across or 1 lesion that measures at least 2 cm long or 1 cm across
  • have a tissue sample (biopsy Open a glossary item) available for the trial team to do some tests
  • are well enough to be up and about for at least some of each day, even if you need help looking after yourself (performance status 0, 1, 2 or 3)
  • have satisfactory blood test results
  • are willing to use 2 forms of reliable contraception during treatment and for up to 1 year after the last dose of the trial drug
  • are at least 16 years old
 
Who can’t take part
 
You cannot join this trial if any of these apply. 
 
Cancer/lymphoma related
You:
  • have lymphoma that has spread to the brain or spinal cord
  • have had a stem cell transplant Open a glossary item with somebody else’s cells
  • have had chemotherapy or radiotherapy in the 2 weeks before starting trial treatment, unless you had radiotherapy for symptoms such as pain
  • have side effects from past treatments unless the trial doctor thinks it won’t affect you taking part
  • have lymphoma that got worse or came back within 3 months of having gemcitabine
  • have had treatment with an experimental treatment within 4 weeks of joining the trial or it has cleared your body completely
  • have had any other cancer in the last 2 years apart from basal cell skin cancer Open a glossary item or squamous cell skin cancer  Open a glossary item
 
Medical conditions
You:
  • have an autoimmune condition  Open a glossary itemunless it is vitiligo, type 1 diabetes, hair loss (alopecia), thyroid problems that are controlled by medications or a skin condition called psoriasis that doesn’t need treatment
  • have had major surgery within 4 weeks of joining the trial
  • have had a stroke or a bleed into the brain within 6 months of joining the trial
  • have moderate to severe tingling or numbness in your hands and feet
  • have problems with your heart, such as a heart attack in the last 6 months, angina that is not well controlled, congestive heart failure or the left side of the heart doesn’t pump blood around the body properly
  • have a lung condition called pulmonary fibrosis or pneumonitis
  • have a known infection or any other major infection and you needed antibiotics as a drip into a vein within 2 weeks of starting trial treatment
  • have HIV
  • have hepatitis B or hepatitis C
  • have any other serious medical condition or mental health problem that the trial team think could affect you taking part 
 
Other
You:
  • are allergic to certain antibodies
  • are sensitive or allergic to any of the drugs in the trial
  • have had a vaccination with 28 days of starting trial treatment
  • are pregnant or breast feeding 

Trial design

This phase 2 trial is taking place in the UK. The trial team need 112 people to take part. 
 
It is a randomised trial. A computer puts you into treatment groups. Neither you nor your doctor will be able to decide which group you are in. 
 
You have 1 of the following treatments:
  • R-GemOx
  • R-GemOx and atezolizumab
You are 3 times more likely to have atezolizumab.
 
You have treatment in cycles. Each treatment period is 2 weeks. You have up to 6 cycles of treatment. This takes about 3 months in total. 
 
The first day of each cycle is called day 1. On day 1 you have:
  • rituximab
  • gemcitabine
  • oxaliplatin
For those having atezolizumab, you start it with the second cycle of treatment. You have it from cycle 2 to cycle 6. You have it with the other drugs on day 1 of the second cycle. 
 
For cycle 1 all of these drugs are given as a drip into a vein. For the rest of the cycles you have:
  • gemcitabine and oxaliplatin as a drip into a vein
  • rituximab as an injection under the skin
  • atezolizumab as a drip into a vein
 
R-GemOx group
After 6 cycles you stop treatment. The trial team will follow you up regularly, every 3 weeks either by telephone or at the hospital for check ups for 6 months.
 
R-GemOx and atezolizumab group
After 6 cycles you have further atezolizumab if your lymphoma hasn’t got worse. We call this maintenance treatment. Some people might have radiotherapy before starting atezolizumab. Your doctor can tell you more about this. The aim is to keep the lymphoma under control for longer. You have this once every 3 weeks for 6 months.
 
Everyone has a CT scan after the 3rd cycle of treatment. And a PET-CT scan after the 6th cycle.
 
You stop treatment if your lymphoma gets worse. Your doctor will talk to you about other treatment options. A month after treatment finishes you see the trial team for a check up.
 
Research samples
You give some extra blood samples during treatment. You give the samples at specific times and the trial team will provide you with information about this. They plan to use the samples to:
  • see how well the treatment is working
  • find what happens to the drugs in the body
  • look at genes Open a glossary item to help understand more about DBCL
  • look for biomarkers Open a glossary item to predict who will benefit from treatment 
The doctors will ask permission to collect and store some of your blood and a sample of your lymphoma (tissue sample). This is for future research. 

Hospital visits

You see a doctor and have some tests before you can take part in the trial. These include:
You might need to give a tissue sample if there isn’t a sample available for the trial team to do some tests on.
 
You have a CT scan at:
  • 6 weeks
  • 15 weeks
  • the end of maintenance treatment
  • 1 year
  • 2 years
You have a PET scan at:
  • 15 weeks
  • the end of maintenance treatment or check ups
Follow up
In the R-GemOx group you go to hospital every 6 weeks for a check up for 6 months. In between these visits they will phone you to see how you are getting on.
 
They then follow up both groups every 4 to 6 months for about 3 years.  
 
You see the trial doctor and have a CT scan every 3 months if you stopped treatment but your lymphoma hasn’t got worse. You then continue to have check ups until either your lymphoma gets worse or you start another anti lymphoma treatment.

Side effects

As R-GemOx and atezolizumab is a new combination of treatment, there might be some side effects we don’t know about yet. The trial team will monitor you during the time you have treatment and you’ll have a phone number to call if you are worried about anything. 
 
The most common side effects of atezolizumab include:
  • tiredness (fatigue)
  • loss of appetite
  • feeling sick
  • high temperatures (fever)
  • constipation or diarrhoea
  • increased risk of infection
  • skin rash, itchy skin or dryness
  • thyroid changes
  • immune problems such as immune related swelling in the lung tissue  (pneumonitis), hepatitis or diabetes 
The most common side effects of Gem-Ox chemotherapy include:
  • a drop in blood cells causing an increased risk of infection, bleeding problems, tiredness and breathlessness
  • hair loss
  • feeling or being sick
  • sore mouth, sore throat and mouth ulcers (mucositis)
  • loss of appetite and taste changes
  • constipation or diarrhoea
  • tiredness
  • numbness or tingling in hands or feet
  • risk of blood clots
Some common side effects of rituximab include:
  • a reaction to the drug such as fever, chills, or flu like symptoms
  • skin rash or itching
  • a drop in blood pressure
  • hot flushes or night sweats
  • headache
  • throat irritation
  • runny nose
  • cough, wheeze or shortness of breath
  • pain in your enlarged lymph nodes
The trial team will explain all the possible side effects of treatment before you join the trial.
 
We have more information about:

Location

Colchester
Glasgow
Harrogate
Leicester
Liverpool
Manchester
Newcastle upon Tyne
Oldham
Southampton
Stafford
Stoke-on-Trent
Sunderland
Truro

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 Davies

Supported by

Cancer Research UK
Roche
Southampton Clinical Trials Unit
University Hospital Southampton NHS Foundation Trust

Other information

This is Cancer Research UK trial number CRUKE/16/028.

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

15323

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

Over 60,000 cancer patients enrolled on clinical trials in the UK last year.

Last reviewed:

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