Description:
The main aims of this clinical study are to find out the maximum dose that can be given
safely to patients, the potential side effects of the drug and how they can be managed. The
study will also look at what happens to Anti-CD19 (DI-B4) inside the body.
DI-B4 is a type of drug called an Anti-CD19 monoclonal antibody which is being used to stop
the growth and kill cancerous immune cells by targeting the B-cell marker (CD-19) expressed
on their surface. This drug has not been given to patients before.
DI-B4 will be given weekly by intravenous infusion for four weeks. The study is in two parts.
In Part 1, small groups of patients will be treated at increasing doses to find the highest
safest dose and best dose for part 2 of the study. Approximately 16-20 patients will be
treated in this part. In Part 2, the dose identified in Part 1 will be given to approximately
20 patients.
Patients recruited to the study will receive four weeks (cycles) of treatment. They will
attend an end of therapy visit eight weeks after their last dose of DI-B4, and attend
follow-up visits up to eighteen months after their first dose of DI-B4. Information on the
overall and progression free survival will be collected for a period up to eighteen months
after the final patient is treated on the study.
Patients will have blood and urine samples taken each week during treatment amongst other
clinical tests. CT scans will be performed at the start of the study, at eight weeks post
treatment and six months after the study start. Bone marrow biopsies and FDG-PET scans will
only be taken if needed. Research blood samples will also be taken to look at what happens to
the drug inside the body.
It is important to explain that patients will have advanced cancer so it is unlikely that
patients will benefit directly from taking part but the study may help improve future
treatment of cancer.
Title
- Brief Title: A Phase I Trial of DI-B4 in Patients With Advanced CD19 Positive Indolent B-cell Malignancies
- Official Title: A Cancer Research UK Phase I Trial of the Anti-CD19 DI-B4 Monoclonal Antibody Given Intravenously, Weekly for Four Weeks, in Patients With Advanced CD19 Positive Indolent B-cell Malignancies
Clinical Trial IDs
- ORG STUDY ID:
CRUKD/12/003
- NCT ID:
NCT01805375
Conditions
- Indolent B-cell Lymphoma
- Chronic Lymphocytic Leukaemia
- Waldenström Macroglobulinaemia
Interventions
Purpose
The main aims of this clinical study are to find out the maximum dose that can be given
safely to patients, the potential side effects of the drug and how they can be managed. The
study will also look at what happens to Anti-CD19 (DI-B4) inside the body.
DI-B4 is a type of drug called an Anti-CD19 monoclonal antibody which is being used to stop
the growth and kill cancerous immune cells by targeting the B-cell marker (CD-19) expressed
on their surface. This drug has not been given to patients before.
DI-B4 will be given weekly by intravenous infusion for four weeks. The study is in two parts.
In Part 1, small groups of patients will be treated at increasing doses to find the highest
safest dose and best dose for part 2 of the study. Approximately 16-20 patients will be
treated in this part. In Part 2, the dose identified in Part 1 will be given to approximately
20 patients.
Patients recruited to the study will receive four weeks (cycles) of treatment. They will
attend an end of therapy visit eight weeks after their last dose of DI-B4, and attend
follow-up visits up to eighteen months after their first dose of DI-B4. Information on the
overall and progression free survival will be collected for a period up to eighteen months
after the final patient is treated on the study.
Patients will have blood and urine samples taken each week during treatment amongst other
clinical tests. CT scans will be performed at the start of the study, at eight weeks post
treatment and six months after the study start. Bone marrow biopsies and FDG-PET scans will
only be taken if needed. Research blood samples will also be taken to look at what happens to
the drug inside the body.
It is important to explain that patients will have advanced cancer so it is unlikely that
patients will benefit directly from taking part but the study may help improve future
treatment of cancer.
Detailed Description
Patients with relapsed or refractory CD19 positive indolent B-cell lymphoma, Waldenström
Macroglobulinaemia or chronic lymphocytic leukaemia will be entered into this study.
For the vast majority of patients, B-cell non Hodgkin lymphoma and chronic lymphocytic
leukaemia are incurable using existing therapeutic approaches.
Although anti-CD20 directed therapy has improved outcomes, more than fifty percent of
patients still relapse following treatment or are refractory to it and therefore additional
novel non-cross resistant therapies are urgently required.
DI-B4 is a humanised, low-fucosylated anti-CD19 Immunoglobulin (Ig) G1 monoclonal antibody
with potent antibody-dependent cell-mediated cytotoxicity (ADCC) but minimal complement
dependent cytotoxicity (CDC). The target antigen, CD19, is the canonical B-cell marker that
is expressed on all B-cells including the malignant B-cells in NHL, CLL and acute
lymphoblastic leukaemia (ALL). The CD19 antigen is therefore an attractive B-cell lineage
specific target for monoclonal antibody therapy. DI-B4 is expected to act through the
depletion of normal and malignant CD19 positive cells, primarily via ADCC.
This is a multi-centre, Phase I, dose escalation/dose expansion study. For the first three
cohorts, an intra-patient dose escalation scheme will be followed unless a DLT is observed.
From Cohort 4 onwards, a standard 3 + 3 dose escalation schedule of DI-B4 will be continued
until the maximum tolerated dose (MTD) is defined, up to a maximum dose of 1000mg.
Trial Arms
Name | Type | Description | Interventions |
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Eligibility Criteria
Inclusion Criteria:
1. Histologically proven relapsed or refractory indolent B-cell lymphoma or chronic
lymphocytic leukaemia. Patients must have received at least one line of previous therapy.
2. CD19 positive malignancy as demonstrated by immunohistochemistry or flow cytometry
3. Life expectancy of at least 12 weeks
4. World Health Organisation (WHO) performance status of 0-1
5. Haematological and biochemical indices within the ranges shown below. These measurements
must be performed within one week (Day -7 to Day 1) before the patient commences treatment
with DI-B4.
Laboratory Test Value required Haemoglobin (Hb) ≥ 9.0 g/dL (red cell support is
permissible), Absolute neutrophil count (ANC) ≥1.0 x 10^9/L (or ≥0.5 x 10^9/L if bone
marrow involvement), Platelet count ≥75 x 10^9/L (or ≥30 x 10^9/L if bone marrow
involvement), Serum bilirubin ≤1.5 x upper limit of normal (ULN), unless raised due to
Gilbert's syndrome in which case up to 3 x ULN is permissible Alanine amino-transferase
(ALT) and/or aspartate amino-transferase (AST) ≤ 2.5 x (ULN) unless raised due to hepatic
involvement in which case up to 5 x ULN is permissible
6. 18 years or over
7. Written (signed and dated) informed consent and be capable of co-operating with
treatment and follow-up
8. Indolent B-cell lymphoma patients only: Patient has either at least one measurable
lesion by CT scan (defined as >1.5 cm in one axis) or in the case of Waldenström's
macroglobulinemia, disease must be assessable by the protocol criteria.
Exclusion Criteria:
1. Radiotherapy (except for palliative reasons), endocrine therapy, immunotherapy,
chemotherapy or investigational medicinal products during the previous 4 weeks before
treatment.
2. Ongoing toxic manifestations of previous treatments. Exceptions to this are alopecia or
certain Grade 1 toxicities, which in the opinion of the Investigator and the Drug
Development Office (DDO) should not exclude the patient.
3. Known to be serologically positive for hepatitis B (unless due to vaccination),
hepatitis C or human immunodeficiency virus (HIV).
4. Patients with clinically active leptomeningeal or central nervous system
lymphoma/leukaemia.
5. Patients with transformed lymphoma from a pre-existing indolent lymphoma. Patients with
a previous history of transformation, but on this disease episode have a biopsy proven
indolent recurrence may be included.
6. Patients receiving corticosteroids, except where the patient has been on a stable dose
for the preceding seven days. Doses of prednisolone or equivalent >10 mg daily are not
permitted whilst on the study, doses up to 20mg can be taken any time prior to Cycle 1, Day
1
7. Concurrent congestive heart failure, prior history of class III/ IV cardiac disease (New
York Heart Association [NYHA]), history of unstable angina pectoris or myocardial
infarction up to 1 year prior to patient enrolment into the trial, presence of severe
valvular heart disease or presence of a ventricular arrhythmia requiring treatment
8. Ability to become pregnant (or already pregnant or lactating). However, those female
patients who have a negative serum or urine pregnancy test before enrolment and agree to
use two highly effective forms of contraception (oral, injected or implanted hormonal
contraception and condom, have an intra-uterine device and condom, diaphragm with
spermicidal gel and condom) during the trial and for six months afterwards are considered
eligible.
9. Male patients with partners of child-bearing potential (unless they agree to take
measures not to father children by using one form of highly effective contraception [condom
plus spermicide] during the trial and for six months afterwards). Men with pregnant or
lactating partners should be advised to use barrier method contraception (e.g. condom plus
spermicidal gel) to prevent exposure to the foetus or neonate.
10. Major thoracic or abdominal surgery from which the patient has not yet recovered.
11. At high medical risk because of non-malignant systemic disease including active
uncontrolled infection.
12. Is a participant or plans to participate in another interventional clinical trial,
whilst taking part in this Phase I study of DI-B4. Participation in an observational trial
would be acceptable.
13. Any other condition which in the Investigator"s opinion would not make the patient a
good candidate for the clinical trial.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | To recommend a dose for future trials with a new drug called DI-B4 by finding the highest safe dose which can be given to patients |
Time Frame: | 38 Months |
Safety Issue: | |
Description: | |
Secondary Outcome Measures
Measure: | Measuring of PK parameter values for DI-B4 including AUC, Cmax, Tmax, and half life T1/2. |
Time Frame: | Samples taken during the four weeks of treatment and analysed in batches per cohort within 6 months of sampling |
Safety Issue: | |
Description: | |
Measure: | To evaluate the effect of DI-B4 on the depletion of peripheral blood and bone marrow B-cells. |
Time Frame: | Samples taken during the four weeks of treatment, and for 18 month follow-up and analysed in batches per cohort within 6 months of sampling |
Safety Issue: | |
Description: | |
Measure: | To look for signs of anti-tumour activity of DI-B4 in patients with relapsed or refractory indolent B-cell malignancies. |
Time Frame: | 38 months |
Safety Issue: | |
Description: | |
Measure: | To assess immunogenicity of DI-B4 in patients with relapsed or refractory indolent B-cell malignancies |
Time Frame: | 54 months |
Safety Issue: | |
Description: | |
Measure: | To measure the time to disease progression and eighteen month survival |
Time Frame: | 54 months |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Cancer Research UK |
Trial Keywords
- Phase I, Cancer, CD19 positive, B-Cell lymphoma, chronic lymphocytic leukaemia
- Waldenström Macroglobulinaemia
Last Updated
February 5, 2018