Geriatric Assessment Guided Interventions to Accelerate Functional Recovery After CAR-T Therapy for Patients 60 Years and Older With B-cell Non-Hodgkin Lymphoma or Multiple Myeloma, GOCART Study
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ClinicalTrials.gov Identifier: NCT06052826 |
Recruitment Status :
Recruiting
First Posted : September 25, 2023
Last Update Posted : September 25, 2023
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Condition or disease | Intervention/treatment | Phase |
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B-Cell Non-Hodgkin Lymphoma Multiple Myeloma | Other: Best Practice Other: Cognitive Intervention Other: Comprehensive Geriatric Assessment Other: Nutritional Intervention Procedure: Physical Therapy Other: Questionnaire Administration | Phase 2 |
PRIMARY OBJECTIVE:
I. Evaluate the effects of a GA-informed multi-disciplinary intervention in attenuating physical function decline among older patients receiving CAR-T therapy at day +30 post-CAR-T infusion.
SECONDARY OBJECTIVES:
I. Determine success in coordinating trimodality optimization before lymphodepletion.
II. Compare rates of geriatric syndromes of frailty, cognitive impairment and malnourishment in SOC and GA-intervention cohorts at 30 days post-CAR-T infusion.
III. Evaluate rates and duration of CAR-T related neurotoxicity in SOC and GA-intervention groups.
EXPLORATORY OBJECTIVES:
I. Quantify trimodality optimization intensity throughout treatment course. II. Compare longitudinal trajectory of Short Physical Performance Battery (SPPB), frailty, cognitive impairment and malnourishment between the two arms, at day +100 post-CAR-T infusion.
III. Evaluate quality of life trajectories using the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale at baseline and days +30 and +100 in both cohorts.
IV. Incidence of intensive care unit (ICU) admissions by day 100. V. Overall survival, response rate and progression-free survival through one year.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients undergo GA before lymphodepleting chemotherapy and recommendations based on assessment results communicated to treating physicians. Patients receive physical therapy (PT) and delirium prevention education prior to lymphodepletion, at least once before CAR-T therapy, at least 2 times a week while inpatient, and at least once every other week outpatient up to day 30. Additionally, patients receive personalized nutritional guidance from a registered dietician prior to lymphodepletion, prior to CAR-T therapy and at least once a week up to day 30.
ARM II: Patients undergo GA and receive standard of care throughout study.
After completion of study treatment, patients are followed up at day 100 and then up to 1 year.
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 164 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Supportive Care |
Official Title: | Geriatric (G) Assessment Guided Optimization (O) to Accelerate Functional Recovery After Chimeric Antigen Receptor T-Cell (CAR-T) Therapy for Patients 60 Years and Older With B-Cell Non-Hodgkin Lymphoma or Multiple Myeloma (GOCART) |
Actual Study Start Date : | June 23, 2023 |
Estimated Primary Completion Date : | October 5, 2026 |
Estimated Study Completion Date : | October 5, 2026 |
Arm | Intervention/treatment |
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Experimental: Arm I (PT, cognitive education, nutrition education)
Patients undergo GA before lymphodepleting chemotherapy and recommendations based on assessment results communicated to treating physicians. Patients receive PT and delirium prevention education prior to lymphodepletion, at least once before CAR-T therapy, at least 2 times a week while inpatient, and at least once every other week outpatient up to day 30. Additionally, patients receive personalized nutritional guidance from a registered dietician prior to lymphodepletion, prior to CAR-T therapy and at least once a week up to day 30.
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Other: Cognitive Intervention
Receive delirium prevention education Other: Comprehensive Geriatric Assessment Undergo geriatric assessment Other: Nutritional Intervention Undergo nutritional optimization Procedure: Physical Therapy Undergo physical function optimization
Other Names:
Other: Questionnaire Administration Ancillary studies |
Active Comparator: Arm II (standard of care)
Patients undergo GA and receive standard of care throughout study.
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Other: Best Practice
Undergo standard of care
Other Names:
Other: Questionnaire Administration Ancillary studies |
- Changes in Short Physical Performance Battery (SPPB) [ Time Frame: From baseline to day 30 after chimeric antigen receptor T-cell (CAR-T) infusion ]T-test will be used to compare SPPB changes score between two arms at 30 days after CAR-T infusion.
- Successful in coordinating initial optimization [ Time Frame: From enrollment to start of lymphodepletion ]A physical or virtual visit will be tabulated separately for functional optimization, delirium prevention and nutrition. Adherence will be deemed to have been met if >=70% or more comlete tri-modality optimization before lymphodepletion in the modified intent to treat population.
- Frailty progression [ Time Frame: At 30 days post CAR-T infusion ]Frailty progression will be defined as a score of 3 or more at T2 if T1 not frail (<3); if frail at T1 (score 3-5), any worsening of the score; a score of 5 at day 30 if baseline score already at the maximum frailty of 5.
- Cognitive impairment [ Time Frame: At 30 days post CAR-T infusion ]Assessed using the Montreal Cognitive Assessment (MoCA). Cognitive impairment defined as MoCA score of < 23 or unable to complete the MoCA due to cognitive impairment. The proportion of patients with cognitive impairment at day 30, irrespective of baseline cognition, will be compared between the two arms using Chi-square test.
- Weight loss [ Time Frame: Up to 30 days post CAR-T infusion ]Malnourishment will be measured using weight loss and dichotomized as > 5% weight loss from baseline to day +30. The proportion of patients with over 5% weight loss from T1 to T2 will be compared between the two arms using Chi-square test.
- CAR-T associated neurotoxicity [ Time Frame: Up to day 100 ]Assessed using American Society for Transplantation and Cellular Therapy consensus grading for cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS). The time to neurotoxicity (days), the maximum grade (1-4) and the duration of neurotoxicity (days) will be recorded. The cumulative incidence of ICANS (percentages) will be compared between arms as well as the maximum grade (1-4), and duration of neurotoxicity (days).
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Ages Eligible for Study: | 60 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Ability to provide informed consent
- Patient's physician must agree for patient participation. A physician may elect to provide blanket agreement for participation of any eligible CAR-T patient under their care
- Ability to read English, or Spanish. Other languages will be acceptable with site principal investigator (PI) agreement if surveys are available and language does not preclude completing study procedures
- Age: >= 60 years at the time of enrollment
- Scheduled to receive an Food and Drug Administration (FDA)-approved CAR-T for treatment of multiple myeloma or B-cell non- Hodgkin lymphoma
- Willing and able to complete study requirements
- Patients expect to be able to participate at least once before lymphodepletion with trimodality optimization visits
Exclusion Criteria:
- Prior CAR-T therapy
- Any 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)
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT06052826
United States, California | |
City of Hope Medical Center | Recruiting |
Duarte, California, United States, 91010 | |
Contact: Andrew S. Artz 626-218-2405 aartz@coh.org | |
Principal Investigator: Andrew S. Artz |
Principal Investigator: | Andrew S Artz | City of Hope Medical Center |
Responsible Party: | City of Hope Medical Center |
ClinicalTrials.gov Identifier: | NCT06052826 |
Other Study ID Numbers: |
22422 NCI-2023-04359 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) 22422 ( Other Identifier: City of Hope Medical Center ) P30CA033572 ( U.S. NIH Grant/Contract ) |
First Posted: | September 25, 2023 Key Record Dates |
Last Update Posted: | September 25, 2023 |
Last Verified: | September 2023 |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Lymphoma Multiple Myeloma Neoplasms, Plasma Cell Lymphoma, Non-Hodgkin Lymphoma, B-Cell Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases |
Hemostatic Disorders Vascular Diseases Cardiovascular Diseases Paraproteinemias Blood Protein Disorders Hematologic Diseases Hemorrhagic Disorders Coal Tar Keratolytic Agents Dermatologic Agents |