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Recurrent Anaplastic Large Cell LymphomaPhase 1NCT07691450

Belinostat in Combination With Azacitidine or Pralatrexate for the Treatment of Relapse or Refractory T-cell Lymphoma

A Phase 1 study testing Azacitidine, Belinostat and Biospecimen Collection in people with Recurrent Anaplastic Large Cell Lymphoma and Recurrent Enteropathy-Associated T-Cell Lymphoma, run by City of Hope Medical Center at 1 site in United States.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record

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Trial summary

This phase I trial tests the safety, side effects and best dose of azacitidine in combination with belinostat and how well the combination works in treating patients with follicular helper T cell lymphoma (TFH) that has come back after a period of improvement (relapsed) or that has not responded to previous treatment… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Azacitidine, Belinostat and Biospecimen Collection
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteUnited States
Study dates
3 Jan 2027to 24 Nov 2029
Phase
Phase 1

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Ability to understand and willingness to sign a written informed consent document
  • Documented informed consent of the participant and/or legally authorized representative. Assent, when appropriate, will be obtained per institutional guidelines
  • Age: ≥ 18 years
  • Have a performance status of 0-1 on the Eastern Cooperative Oncology Group (ECOG) Scale (performance status [PS]) at time of enrollment. Patients with a performance status of 2 on the ECOG Scale due to lymphoma may be eligible with principal investigator (PI) approval
  • Histologically confirmed PTCL in the following subtypes below (by local review). Eligible histologies include:
  • Arm A
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  • Histologically confirmed TFH cell lymphomas. Nodal TFH cell lymphomas encompasses three subtypes:
  • Angioimmunoblastic T-cell lymphoma (AITL)(World Health Organization [WHO]4R)/follicular helper T-cell lymphoma (TFH lymphoma), angioimmunoblastic type (ICC)/nodal TFH cell lymphoma, angioimmunoblastic-type (WHO5)
  • Nodal PTCL with TFH phenotype (nodal PTCL, TFH)(WHO4R)/TFH lymphoma, NOS (ICC)/nodal TFH cell lymphoma, not otherwise specified (NOS) (WHO5)
  • Follicular T-cell lymphoma (FTCL)(WHO4R)/TFH lymphoma, follicular type (ICC)/ nodal TFH cell lymphoma, follicular-type (WHO5)
  • Arm B
  • Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS)
  • Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL)
  • Enteropathy-associated T-cell lymphoma (EATL)
  • Anaplastic large cell lymphoma (ALCL)
  • Hepatosplenic T-cell lymphoma
  • Cutaneous T-cell lymphoma (CTCL) with large cell transformation
  • Subcutaneous panniculitis-like T-cell lymphoma
  • Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma (CD8+ PCAETL)
  • Primary cutaneous gamma-delta T-cell lymphoma (PCGDTL)
  • Must have received at least one prior systemic therapy and have an indication for treatment
  • NOTE: For systemic ALCL, prior systemic therapy must have included brentuximab vedotin
  • Measurable disease, including at least 1 nodal site measuring ≥ 1.5cm or 1 extranodal site measuring 1.0 cm in longest dimension on CT or FDG-PET or marrow-only disease (disease only found on bone marrow biopsy)
  • Life expectancy > 12 weeks
  • Without bone marrow involvement: Absolute neutrophil count (ANC) ≥ 1,000/mm^3
  • NOTE: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement
  • With bone marrow involvement: ANC ≥ 750/mm^3
  • NOTE: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement
  • Without bone marrow involvement: Platelets ≥ 75,000/mm^3
  • NOTE: Platelet transfusions are not permitted within 7 days of platelet assessment unless cytopenia is secondary to disease involvement
  • With bone marrow involvement: Platelets ≥ 50,000/mm^3
  • NOTE: Platelet transfusions are not permitted within 7 days of platelet assessment unless cytopenia is secondary to disease involvement
  • Hemoglobin ≥ 8g/dL
  • NOTE: Red blood cell transfusions are not permitted within 7 days of hemoglobin assessment unless cytopenia is secondary to disease involvement
  • Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
  • NOTE: Patients with documented Gilbert's disease, documented liver or pancreatic involvement in lymphoma may be enrolled if total bilirubin ≤ 3.0 x ULN OR direct bilirubin ≤ ULN for patients with total bilirubin levels > 1.5 ULN
  • Aspartate aminotransferase (AST) ≤ 3.0 x ULN OR ≤ 5 x ULN for patients with liver involvement by lymphoma
  • Alanine aminotransferase (ALT) ≤ 3.0 x ULN OR ≤ 5 x ULN for patients with liver involvement by lymphoma
  • Measured or calculated creatinine clearance ≥ 60 mL/min (glomerular filtration rate [GFR] can also be used in place of creatinine clearance [CrCl])
  • If not receiving anticoagulants: International normalized ratio (INR) OR prothrombin (PT) ≤ 1.5 x ULN
  • If on anticoagulant therapy: PT must be within therapeutic range of intended use of anticoagulants
  • If not receiving anticoagulants: Activated partial thromboplastin time (aPTT) ≤ 1.5 x ULN
  • If on anticoagulant therapy: aPTT must be within therapeutic range of intended use of anticoagulants
  • Women of childbearing potential (WOCBP): Negative urine or serum pregnancy test
  • If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
  • Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual intercourse for the course of the study and after completion of study treatment as described below separately for males and females
  • WOCBP must remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods that result in a failure rate of ≤ 1% per year during the treatment period and for at least 1 month after the last dose of study treatment. Women must refrain from donating eggs during this same period
  • Examples of contraceptive methods with a failure rate of ≤ 1% per year include bilateral tubal ligation, male sterilization, hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices
  • The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient
  • Periodic abstinence (e.g., calendar, ovulation, symptothermal, or post-ovulation methods) and withdrawal are not acceptable methods of contraception
  • For male participants: agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agreement to refrain from donating sperm, as defined below:
  • With female partners of childbearing potential or pregnant female partners, men must remain abstinent or use a condom during the treatment period and for at least 1 month after the last treatment. Men must refrain from donating sperm during this same period
  • The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of preventing drug exposure
  • Childbearing potential defined as being post-menarcheal (women only), not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only)
  • Diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) within 7 days prior to cycle 1 day 1, for indications other than lymphoma symptom control. Patients who require lymphoma symptom control during screening may receive steroids in the following manner:
  • Up to 30 mg/day of prednisone or equivalent may be used for lymphoma symptom control during screening, including prior to finalization of staging (not included as part of pre-phase treatment). If glucocorticoid treatment is urgently required at higher doses for lymphoma symptom control prior to the start of study treatment, tumor assessments must be completed prior to initiation of > 30-100 mg/day of prednisone or equivalent. Prednisone > 30-100 mg/day or equivalent may be given for a maximum of 7 days as a pre-phase treatment. If patients exceed the allowed dosing of corticosteroids, patients may still be eligible for the study provided that baseline imaging is performed (or repeated) after completion of the course of higher dose of steroids. Allowed corticosteroid dosing resets from the point of imaging forward and patients who do not exceed the allowed corticosteroid dosing from the point of imaging until initiation of study treatment may enroll. Steroids at a dose less than the equivalent of 10 mg/day of prednisone and inhaled, nasal, and topical steroids are permitted. Adrenal replacement steroid doses > 10 mg daily prednisone equivalent in the absence of active autoimmune disease are permitted. Treatment with a short course of steroids (< 7 days) up to 7 days prior to cycle 1 day 1 is permitted

Who cannot join

  • Patients who received prior therapy with belinostat or azacitidine (Arm A) or belinostat or pralatrexate (Arm B) without having had evidence of objective response (i.e. patients whose best response was stable disease or progressive disease)
  • Note: Patients who previously responded to any of these agents are eligible. Their last dose of either belinostat, azacitidine or pralatrexate must be > 14 days prior to day 1 of protocol therapy
  • Chemotherapy, radiation therapy, biological therapy, immunotherapy within 14 days or five half-lives (whichever is shorter for non-radiation therapy) prior to day 1 of protocol therapy
  • Prior autologous stem cell transplantation within 60 days of day 1 of protocol therapy
  • Major surgery within 4 weeks prior to the start of cycle 1, other than for diagnosis confirmation
  • UGT1A1 inhibitors within 14 days prior to day 1 of protocol therapy
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  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agents
  • Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) which requires systemic treatment. Patients may proceed with screening during treatment for infection, but systemic treatment must be completed by cycle 1 day 1
  • If a patient has signs/symptoms suggestive of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the patient must have a negative molecular (e.g., polymerase chain reaction [PCR]) test or 2 negative antigen test results at least 24 hours apart. Patients who do not meet SARS-CoV-2 infection eligibility criteria must be screen-failed and may only be re-screened if the following have been met:
  • At least 10 days since first positive test result have passed in asymptomatic patients or at least 10 days since recovery, defined as resolution of fever without use of antipyretics and improvement in symptoms
  • Subjects with concurrent active hepatitis B (defined as hepatitis B virus surface antigen [HBsAg] positive and/or detectable hepatitis B virus [HBV] DNA) and/or hepatitis C virus (defined as anti-hepatitis C virus [HCV] antibody [Ab] positive and detectable HCV ribonucleic acid [RNA]) infection.
  • Hepatitis B and C screening tests are not required unless: (1) Known history of HBV and HCV infection or (2) As mandated by local health authority
  • Subjects with HIV infection
  • Other active malignancy. Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
  • Note: If such malignancies were treated with either belinostat, azacitidine, or pralatrexate the 14 day washout applies
  • Females only: Pregnant or breastfeeding
  • Known active central nervous system lymphoma
  • Participants who are receiving other investigational agents
  • Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
  • Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

United States1 site

  • City of Hope Medical Center

    Duarte, California, 91010

    Christina Poh, 626-256-4673 ext. 82405, cpoh@coh.org

    Christina Poh

Other trials in United States

About this study

Official title: Phase 1 Investigation of Belinostat-Based Combinations in Relapsed/Refractory T-Cell Lymphoma

This phase I trial tests the safety, side effects and best dose of azacitidine in combination with belinostat and how well the combination works in treating patients with follicular helper T cell lymphoma (TFH) that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory). This phase I trial also tests the safety, side effects and best dose of pralatrexate in combination with belinostat and how well the combination works in treating patients with relapsed or refractory peripheral T cell lymphoma (PTCL) and cutaneous T cell lymphoma (CTCL) with large cell transformation and cytotoxic phenotype. Azacitidine stops cells from making deoxyribonucleic acid (DNA) and may kill cancer cells. It is a type of antimetabolite. Pralatrexate stops cells from using folic acid to make DNA. This may help keep cancer cells from growing and may kill them. Pralatrexate is a type of antimetabolite and a type of dihydrofolate reductase inhibitor. Belinostat blocks certain enzymes needed for cell division and may kill cancer cells. It may also prevent the growth of new blood vessels that tumors need to grow and may help make cancer cells easier to kill with other anticancer drugs. It is a type of histone deacetylase inhibitor, a type of antiangiogenesis agent, and a type of chemosensitizer. Giving azacitidine in combination with belinostat may be safe, tolerable, and/or effective in treating patients with relapsed/refractory (R/R) TFH. In additional, giving pralatrexate in combination with belinostat may be safe, tolerable, and/or effective in treating patients with R/R PTCL and CTCL with large cell transformation and cytotoxic phenotype.

Read the detailed description

PRIMARY OBJECTIVES:

  1. To evaluate the safety and feasibility of combining azacitidine with belinostat in R/R nodal TFH cell lymphoma. (Arm A) II. To evaluate the safety and feasibility of combining pralatrexate with belinostat in R/R PTCL and CTCL with large cell transformation. (Arm B)

SECONDARY OBJECTIVES:

  1. To measure the clinical efficacy as measured by overall response rate (ORR), complete response (CR) rate, and time to next treatment (TTNT) of belinostat and azacitidine. (Arm A) II. Patient-reported outcomes as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health37 and Functional Assessment of Cancer Therapy (FACT)-Item GP5 scale. (Arm A) III. To measure the clinical efficacy as measured by ORR, CR rate, and TTNT of belinostat and pralatrexate. (Arm B) IV. Patient-reported outcomes as measured by the PROMIS Global Health37 and FACT-Item GP5 scale. (Arm B)

EXPLORATORY OBJECTIVES:

  1. To measure survival outcomes by progression-free survival (PFS) and overall survival (OS) of belinostat and azacitidine. (Arm A) II. Examine the association between biomarkers (e.g., genomic proofing, minimal residual disease [MRD]) and clinical outcomes (ORR, PFS). (Arm A) III. To measure survival outcomes by PFS and OS of belinostat and pralatrexate. (Arm B) IV. Examine the association between biomarkers (e.g., genomic profiling, MRD) and clinical outcomes (ORR, PFS). (Arm B)

OUTLINE: Patients are assigned to 1 of 2 arms.

ARM A: Patients receive azacitidine subcutaneously (SC) on days 1-5 and belinostat intravenously (IV) over 30-45 minutes on days 1-5 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Additionally, patients undergo blood sample collection and fludeoxyglucose F-18 (FDG)-positron emission tomography (PET), and computed tomography (CT) or PET/CT throughout the study.

ARM B: Patients receive pralatrexate SC on days 8 and 15 and belinostat IV over 30-45 minutes on days 1-3 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Additionally, patients undergo blood sample collection and FDG-PET, and CT or PET/CT throughout the study.

After completion of study treatment, patients in Arm A are followed up at 30 days, every 3 months for up to 2 years, then for up to 5 years. Patients in Arm B are followed up at 30 days, every 3 months for up to one year from start of treatment, every 6 months for up to 2 years then every 5 years.

Being tested
Azacitidine, Belinostat, Biospecimen Collection, Computed Tomography, FDG-Positron Emission Tomography
Medical subject headings
Lymphoma, Large-Cell, Anaplastic, Enteropathy-Associated T-Cell Lymphoma, Lymphoma, T-Cell, Subcutaneous panniculitis-like T-cell lymphoma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AzacitidineDrug

    Also called 5 AZC, 5-AC, 5-Azacitidine, 5-Azacytidine

    Given SC

  • BelinostatDrug

    Also called Beleodaq, PXD 101, PXD-101, PXD101

    Given IV

  • Biospecimen CollectionProcedure or surgery

    Also called Biological Sample Collection, Biospecimen Collected, Sample Collection, Specimen Collection

    Undergo blood sample collection

  • Computed TomographyProcedure or surgery

    Also called CAT, CAT Scan, Computed Axial Tomography, Computerized Axial Tomography

    Undergo CT or PET/CT

  • FDG-Positron Emission TomographyProcedure or surgery

    Also called FDG, FDG-PET, FDG-PET Imaging

    Undergo FDG-PET

  • Fludeoxyglucose F-18Other

    Also called 18FDG, FDG, Fludeoxyglucose (18F), fludeoxyglucose F 18

    Given FDG

  • Positron Emission TomographyProcedure or surgery

    Also called Medical Imaging, Positron Emission Tomography, PET, PET Scan, Positron emission tomography (procedure)

    Undergo PET/CT

  • PralatrexateDrug

    Also called 10-propargyl-10-deazaaminopterin, Difolta, Folotyn, PDX

    Given SC

  • Questionnaire AdministrationOther

    Ancillary studies

Study groups in NCT07691450
Study groupRoleWhat they receive
Arm A (azacitidine, belinostat)ExperimentalPatients receive azacitidine SC on days 1-5 and belinostat IV over 30-45 minutes on days 1-5 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Additionally, patients undergo blood sample collection and FDG-PET, and CT or PET/CT throughout the study.
Receives: Drug: Azacitidine; Drug: Belinostat; Procedure: Biospecimen Collection; Procedure: Computed Tomography; Procedure: FDG-Positron Emission Tomography; Other: Fludeoxyglucose F-18; Procedure: Positron Emission Tomography; Other: Questionnaire Administration
Arm B (pralatrexate, belinostat)ExperimentalPatients receive pralatrexate SC on days 8 and 15 and belinostat IV over 30-45 minutes on days 1-3 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Additionally, patients undergo blood sample collection and FDG-PET, and CT or PET/CT throughout the study.
Receives: Drug: Belinostat; Procedure: Biospecimen Collection; Procedure: Computed Tomography; Procedure: FDG-Positron Emission Tomography; Other: Fludeoxyglucose F-18; Procedure: Positron Emission Tomography; Drug: Pralatrexate; Other: Questionnaire Administration

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Occurrence of dose-limiting toxicities (DLT) (Arm A)

    Observed toxicities will be summarized by type, severity, timing of onset, and attribution, and will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 6.0.

    Measured: Prior to cycle 2 day 1 (cycle length = 28 days)

  2. Occurrence of DLT (Arm B)

    Observed toxicities will be summarized by type, severity, timing of onset, and attribution, and will be graded according to the CTCAE, version 6.0.

    Measured: Prior to cycle 2 day 1 (cycle length = 21 days)

  3. Maximum tolerated dose (MTD) (Arm A)

    Will be defined as the highest dose of azacitidine tested in which at most 1 out of 6 DLT-evaluable patients treated at that dose experience a DLT. The MTD will be designated as the recommended phase 2 dose (RP2D), provided no additional safety concerns are identified.

    Measured: During the first cycle of treatment (cycle length = 28 days)

  4. MTD (Arm B)

    Will be defined as the highest dose of pralatexate tested in which at most 1 out of 6 DLT-evaluable patients treated at that dose experience a DLT. The MTD will be designated as the RP2D, provided no additional safety concerns are identified.

    Measured: During the first cycle of treatment (cycle length = 21 days)

Secondary outcomes (10)

  1. Overall response rate (ORR) (Arm A)

    Will be estimated using simple binary proportions with corresponding two-sided 95% confidence intervals.

    Measured: Up to 5 years

  2. ORR (Arm B)

    Will be estimated using simple binary proportions with corresponding two-sided 95% confidence intervals.

    Measured: Up to 5 years

  3. Complete response (CR) rate (Arm A)

    Will be defined as the proportion of patients achieving a complete response according to standard response criteria. Will be estimated using simple binary proportions with corresponding two-sided 95% confidence intervals.

    Measured: Up to 5 years

  4. CR rate (Arm B)

    Will be defined as the proportion of patients achieving a complete response according to standard response criteria. Will be estimated using simple binary proportions with corresponding two-sided 95% confidence intervals.

    Measured: Up to 5 years

  5. Time to next treatment (TTNT) (Arm A)

    Continuous variables will be summarized using measures such as mean, standard deviation, median, range, and standard error, as appropriate. Categorical variables will be summarized using counts and percentages.

    Measured: From the first dose of study treatment to initiation of subsequent anti-lymphoma therapy, assessed up to 5 years

  6. TTNT (Arm B)

    Continuous variables will be summarized using measures such as mean, standard deviation, median, range, and standard error, as appropriate. Categorical variables will be summarized using counts and percentages.

    Measured: From the first dose of study treatment to initiation of subsequent anti-lymphoma therapy, assessed up to 5 years

  7. Patient reported outcomes (Arm A) - PROMIS Global Health37

    Will be measured by the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health37. Will be summarized descriptively.

    Measured: Up to 5 years

  8. Patient reported outcomes (Arm A) - FACT Item GP5

    Will be measured by the Functional Assessment of Cancer Therapy (FACT)-Item GP5 scale. Will be summarized descriptively.

    Measured: Up to 5 years

  9. Patient reported outcomes (Arm B) - PROMIS Global Health37

    Will be measured by the PROMIS Global Health37. Will be summarized descriptively.

    Measured: Up to 5 years

  10. Patient reported outcomes (Arm B) - FACT Item GP5

    Will be measured by the FACT-Item GP5 scale. Will be summarized descriptively.

    Measured: Up to 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Jul 2026
  2. Study start3 Jan 2027 (estimated)
  3. Primary completion24 Nov 2029 (estimated)
  4. Study completion24 Nov 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07691450
Sponsor's protocol ID
25715
Other IDs
NCI-2026-04270, 25715, P30CA033572
Status last verified
Jul 2026
First submitted
25 Jun 2026
Last updated
9 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

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