Phase III Placebo-Controlled Trial of Denileukin Diftitox for Patients With Cutaneous T-Cell Lymphoma

Purpose This phase III, placebo-controlled, randomized trial was designed to investigate efficacy and safety of two doses of denileukin diftitox (DD; DAB(389)-interleukin-2 [IL-2]), a recombinant fusion protein targeting IL-2 receptor expressing malignant T lymphocytes, in patients with stage IA to III, CD25 assay positive cutaneous T-cell lymphoma (CTCL), including the mycosis fungoides and Sezary syndrome forms of the disease, who had received up to three prior therapies. The primary end point was overall response rate (ORR). Patients and Methods Patients IN = 144) with biopsy-confirmed, CD25 assay positive CTCL were randomly assigned to DD 9 mu g/kg/d In = 45), DD 18 mu g/kg/d In = 55), or placebo infusions In = 44), administered for 5 consecutive days every 3 weeks for up to eight cycles. Patients were monitored for drug efficacy, clinical benefit, and safety of DD. Results ORR was 44% for all participants treated with DD In = 100; 10% complete response [CR] and 34% partial response [PR]) compared with 15.9% for placebo-treated patients 12% CR and 13.6% PR). ORR was higher in the 18 mu g/kg/d group versus the 9 mu g/kg/d group (49.1% v 37.8%, respectively), and both doses were significantly superior to placebo. Progression-free survival (PFS) was significantly longer (median, > 2 years) for both DD doses compared with placebo (median, 124 days; P <. 001). Rates of moderately severe and severe adverse events (AEs) were slightly higher in the DD groups, whereas moderate and mild AEs were similar to placebo. No statistical differences were observed for drug-related serious AEs. Conclusion DD had a significant and durable effect on ORR and PFS with an acceptable safety profile n patients with early- and late-stage CTCL.