80 Participants Needed

Ascorbic Acid + Chemotherapy for Lymphoma

Recruiting at 6 trial locations
CT
Overseen ByClinical Trials Referral Office
Age: 18+
Sex: Any
Trial Phase: Phase 2
Sponsor: Mayo Clinic
Must be taking: Platinum-based regimens
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial

Trial Summary

Will I have to stop taking my current medications?

The trial protocol does not specify if you need to stop taking your current medications. However, it mentions that patients on ibrutinib or corticosteroids may continue therapy until the new regimen starts, at the investigator's discretion. It's best to discuss your specific medications with the trial team.

What evidence supports the effectiveness of the drug combination including Ascorbic Acid and Rituximab for treating lymphoma?

Research shows that adding rituximab to chemotherapy regimens for lymphoma, such as R-CHOP, improves treatment outcomes and survival rates. Rituximab has been effective in enhancing the response to chemotherapy in various types of lymphoma, suggesting potential benefits when combined with other drugs like Ascorbic Acid.12345

Is the combination of ascorbic acid and chemotherapy drugs like carboplatin and cisplatin safe for humans?

Research shows that carboplatin and cisplatin, when used together, can have manageable side effects like low blood cell counts, nausea, and vomiting, but they are generally considered safe with careful monitoring. Carboplatin is noted for having fewer kidney-related side effects compared to cisplatin, making it a safer option in some cases.678910

What makes the Ascorbic Acid + Chemotherapy treatment for lymphoma unique?

This treatment combines ascorbic acid (vitamin C) with a mix of chemotherapy drugs, including rituximab, which has shown improved response rates and survival in lymphoma patients. The unique aspect is the addition of ascorbic acid, which may enhance the effectiveness of chemotherapy, although its precise role in lymphoma treatment is still being studied.12111213

What is the purpose of this trial?

This trial tests if adding high doses of vitamin C to standard chemotherapy can better treat certain cancers that have returned or are resistant to treatment. The goal is to see if vitamin C makes the chemotherapy more effective at killing cancer cells. The study focuses on patients with specific types of lymphoma, CCUS, and CMML. High-dose intravenous vitamin C (IVC) has been explored for its potential to enhance the effectiveness of cancer chemotherapy, with some clinical evidence suggesting benefits, though rigorous data are lacking.

Research Team

TE

Thomas E. Witzig, M.D.

Principal Investigator

Mayo Clinic

Eligibility Criteria

Adults with recurrent or refractory lymphoma, including various subtypes like Diffuse Large B-Cell Lymphoma, who haven't responded to therapy within 6 months or have relapsed after a response lasting more than 6 months. Participants must be in good physical condition (ECOG PS 0-2), able to return for follow-up, and have measurable disease. They should not be pregnant/nursing and must agree to use contraception.

Inclusion Criteria

Willingness to return to enrolling institution for follow-up (during the active monitoring phase of the study)
My white blood cell count is healthy.
Patients must meet specific laboratory criteria to be enrolled
See 16 more

Exclusion Criteria

Receiving any other investigational agent which would be considered as a treatment for the lymphoma
I have been diagnosed with a blood cancer.
I have active brain lymphoma or cancer cells in my spinal fluid needing specific treatment.
See 12 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive ascorbic acid and combination chemotherapy. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

12 weeks
Multiple visits for IV administration on days 1, 3, 5, 8, 10, 12, 15, 17, and 19 of each cycle

Follow-up

Participants are monitored for safety and effectiveness after treatment completion. Follow-up occurs every 3 months, then every 6 months after progressive disease for up to 2 years.

Up to 2 years
Regular follow-up visits every 3 to 6 months

Extension

Participants with stable disease after 12 cycles may continue decitabine with or without ascorbic acid as long as clinically appropriate.

As long as clinically appropriate

Treatment Details

Interventions

  • Ascorbic Acid
  • Carboplatin
  • Cisplatin
  • Cytarabine
  • Dexamethasone
  • Etoposide
  • Gemcitabine Hydrochloride
  • Ifosfamide
  • Rituximab
Trial Overview The trial is testing the effectiveness of ascorbic acid (vitamin C) combined with chemotherapy drugs such as Ifosfamide, Carboplatin, Etoposide, Rituximab and others against lymphomas that are difficult to treat. The goal is to see if vitamin C can make cancer cells more vulnerable to chemo.
Participant Groups
5Treatment groups
Experimental Treatment
Active Control
Group I: Arm D (ascorbic acid)Experimental Treatment8 Interventions
Patients receive ascorbic acid IV TIW. Treatments repeat every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PICC or portacath placement prior to starting treatment, blood sample collection, bone marrow aspiration and biopsy throughout study.
Group II: Arm C (ascorbic acid and combination chemotherapy)Experimental Treatment19 Interventions
Patients receive ascorbic acid IV on days 1, 3, 5, 8, 10, 12, 15, 17, and 19. Patients also receive ifosfamide, carboplatin, and etoposide IV or PO, or cisplatin, cytarabine, and dexamethasone IV or PO, or gemcitabine hydrochloride, dexamethasone, and cisplatin IV or PO, or gemcitabine hydrochloride and oxaliplatin IV or PO, or oxaliplatin, cytarabine, and dexamethasone IV or PO according to standard regimen schedule. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients who achieve MR or SD after 2 cycles may switch to an alternative chemotherapy regimen. Patients additionally, undergo blood sample collection, core needle biopsy, bone marrow aspiration and biopsy, ECHO, PET/CT or MRI throughout study.
Group III: Arm A (ascorbic acid, combination chemotherapy)Experimental Treatment18 Interventions
Patients receive ascorbic acid IV on days 1, 3, 5, 8, 10, 12, 15, 17, and 19, and rituximab intravenously IV, ifosfamide IV, carboplatin IV and etoposide IV on days 1-3. Patients who achieve MR or SD after 2 cycles may receive rituximab IV or PO, cisplatin IV or PO, cytarabine IV or PO, and dexamethasone IV or PO. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients additionally, undergo blood sample collection, core needle biopsy, bone marrow aspiration and biopsy, ECHO, PET/CT or MRI throughout study.
Group IV: ARM E (ascorbic acid, decitabine)Experimental Treatment7 Interventions
Patients receive ascorbic acid IV on days 1, 3 and 5 and decitabine IV over 1 hour on days 1-5. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients with stable disease after 12 cycles may continue decitabine with or without ascorbic acid as long as clinically appropriate. Patients may also take vitamin C PO on days 6-28. Patients undergo PICC or portacath placement prior to starting treatment, blood sample collection, bone marrow aspiration and biopsy throughout study.
Group V: Arm B (placebo, combination chemotherapy)Active Control18 Interventions
Patients receive placebo (normal saline) IV on days 1, 3, 5, 8, 10, 12, 15, 17, and 19, and rituximab intravenously IV, ifosfamide IV, carboplatin IV and etoposide IV on days 1-3. Patients who achieve MR or SD after 2 cycles may receive rituximab IV or PO, cisplatin IV or PO, cytarabine IV or PO, and dexamethasone IV or PO. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients additionally, undergo blood sample collection, core needle biopsy, bone marrow aspiration and biopsy, ECHO, PET/CT or MRI throughout study.

Carboplatin is already approved in United States, European Union, Canada for the following indications:

🇺🇸
Approved in United States as Paraplatin for:
  • Ovarian cancer
  • Testicular cancer
  • Lung cancer
  • Head and neck cancer
  • Brain cancer
🇪🇺
Approved in European Union as Carboplatin for:
  • Ovarian cancer
  • Small cell lung cancer
🇨🇦
Approved in Canada as Carboplatin for:
  • Ovarian cancer
  • Small cell lung cancer
  • Testicular cancer

Find a Clinic Near You

Who Is Running the Clinical Trial?

Mayo Clinic

Lead Sponsor

Trials
3,427
Recruited
3,221,000+

National Cancer Institute (NCI)

Collaborator

Trials
14,080
Recruited
41,180,000+

Findings from Research

Salvage chemotherapy followed by high-dose therapy and autologous stem cell transplantation is the standard treatment for relapsed diffuse large B-cell lymphoma, but the addition of rituximab has improved outcomes after first-line treatment and relapses.
The CORAL trial found no significant difference in response rates between two salvage regimens (R-ICE and R-DHAP), and identified that factors like early relapse and certain genetic markers significantly affect survival, indicating that over 70% of patients may not benefit from standard salvage therapy.
Is there any role for transplantation in the rituximab era for diffuse large B-cell lymphoma?Gisselbrecht, C.[2022]
In a study of 91 people living with HIV and Burkitt lymphoma, adding rituximab to CODOX-M/IVAC chemotherapy did not increase severe treatment-related toxicities, indicating it is a safe option for this population.
The addition of rituximab significantly improved both overall survival (72% vs. 55%) and progression-free survival (81% vs. 55%) compared to chemotherapy alone, suggesting it enhances treatment efficacy without added risks.
Adding rituximab to CODOX-M/IVAC chemotherapy in the treatment of HIV-associated Burkitt lymphoma is safe when used with concurrent combination antiretroviral therapy.Alwan, F., He, A., Montoto, S., et al.[2022]
The CHOEA-7 chemotherapy regimen, which includes cyclophosphamide, doxorubicin, vincristine, etoposide, and ara-C, has shown excellent results in treating patients with CD 20-positive non-Hodgkin's lymphoma.
Adding rituximab to the CHOEA-7 regimen (RCHOEA-7) further enhances treatment efficacy, indicating a promising approach for improving outcomes in this patient population.
[Results of dose-intense, dose-impact weekly combination chemotherapy with rituximab for patients with CD 20-positive B-cell non-Hodgkin's lymphoma].Uzuka, Y., Saitou, Y., Saitou, K., et al.[2015]

References

Is there any role for transplantation in the rituximab era for diffuse large B-cell lymphoma? [2022]
Adding rituximab to CODOX-M/IVAC chemotherapy in the treatment of HIV-associated Burkitt lymphoma is safe when used with concurrent combination antiretroviral therapy. [2022]
[Results of dose-intense, dose-impact weekly combination chemotherapy with rituximab for patients with CD 20-positive B-cell non-Hodgkin's lymphoma]. [2015]
A retrospective, multi-center analysis of treatment intensification for human immunodeficiency virus-positive patients with high-risk diffuse large B-cell lymphoma. [2019]
Current approaches to the treatment of non-Hodgkin's lymphoma. [2021]
A phase II trial of carboplatin for recurrent or metastatic squamous carcinoma of the uterine cervix: a Southwest Oncology Group study. [2019]
Carboplatin: a very active new cisplatin analog in the treatment of small cell lung cancer. [2013]
Combined carboplatin and cisplatin therapy in patients with advanced non-small cell lung cancer. [2019]
Phase I study of carboplatin given on a five-day intravenous schedule. [2022]
Phase I and II agents in cancer therapy: two cisplatin analogues and high-dose cisplatin in hypertonic saline or with thiosulfate protection. [2019]
Rituximab in combination with CODOX-M/IVAC: a retrospective analysis of 23 cases of non-HIV related B-cell non-Hodgkin lymphoma with proliferation index >95%. [2015]
12.United Statespubmed.ncbi.nlm.nih.gov
Phase II evaluation of cis-dichlorodiammineplatinum(II) in lymphomas: a Southwest Oncology Group Study. [2013]
13.United Statespubmed.ncbi.nlm.nih.gov
Efficacy and safety of gemcitabine, carboplatin, dexamethasone, and rituximab in patients with relapsed/refractory lymphoma: a prospective multi-center phase II study by the Puget Sound Oncology Consortium. [2022]
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