Clinical Trials /

Ibrutinib in Treating Patients With Relapsed or Refractory B-cell Acute Lymphoblastic Leukemia

NCT02129062

Description:

This phase II trial studies how well ibrutinib works in treating patients with B-cell acute lymphoblastic leukemia that has come back after treatment or has not responded to other treatment. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

Related Conditions:
  • Acute Lymphoblastic Leukemia
Recruiting Status:

Terminated

Phase:

Phase 2

Trial Eligibility

Document

<span class="go-doc-concept go-doc-intervention">Ibrutinib</span> in Treating Patients With Relapsed or Refractory B-cell <span class="go-doc-concept go-doc-disease">Acute Lymphoblastic Leukemia</span>

Title

  • Brief Title: Ibrutinib in Treating Patients With Relapsed or Refractory B-cell Acute Lymphoblastic Leukemia
  • Official Title: A Phase 2 Study to Determine the Efficacy of the BTK Inhibitor Ibrutinib (PCI-32765) in Patients With Relapsed or Refractory Precursor-B Lymphoblastic Leukemia (B-ALL)
  • Clinical Trial IDs

    NCT ID: NCT02129062

    ORG ID: NCI-2014-00886

    NCI ID: NCI-2014-00886

    Trial Conditions

    Adult B Acute Lymphoblastic Leukemia

    Adult B Acute Lymphoblastic Leukemia With t(9;22)(q34;q11.2); BCR-ABL1

    Recurrent Adult Acute Lymphoblastic Leukemia

    Trial Interventions

    Drug Synonyms Arms
    Ibrutinib BTK Inhibitor PCI-32765, CRA-032765, IBRUTINIB, PCI-32765 Treatment (ibrutinib)

    Trial Purpose

    This phase II trial studies how well ibrutinib works in treating patients with B-cell acute
    lymphoblastic leukemia that has come back after treatment or has not responded to other
    treatment. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes
    needed for cell growth.

    Detailed Description

    PRIMARY OBJECTIVES:

    I. To evaluate the efficacy of ibrutinib in patients with relapsed or refractory B-cell
    acute lymphoblastic leukemia (B-ALL) as measured by objective response rate (ORR).

    SECONDARY OBJECTIVES:

    I. To evaluate the global safety profile of ibrutinib in patients with relapsed or
    refractory B-ALL.

    II. To assess response duration. III. To assess Bruton's tyrosine kinase (BTK) target
    inhibition, biomarkers, and gene expression profiles in B-ALL patient samples before and
    during treatment with ibrutinib.

    OUTLINE:

    Patients receive ibrutinib orally (PO) once daily (QD) on days 1-28. Courses repeat every 4
    weeks in the absence of disease progression or unacceptable toxicity.

    After completion of study treatment, patients are followed up at 30 days.

    Trial Arms

    Name Type Description Interventions
    Treatment (ibrutinib) Experimental Patients receive ibrutinib PO QD on days 1-28. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity. Ibrutinib

    Eligibility Criteria

    Inclusion Criteria:

    - Relapsed or refractory B-ALL due to receive salvage 1, 2, 3, 4, 5, or 6; half of the
    patients, i.e. 5 out of the first 10 patients, and 5 out of 10 patients thereafter,
    need to be in earlier line of salvage therapy, defined as 1st, 2nd, or 3rd line of
    salvage therapy; Philadelphia chromosome-positive (Ph+) B-ALL patients must have
    failed treatment with at least 1 second generation tyrosine kinase inhibitor;
    patients in salvage 1 with late relapse should be deemed poor candidates for
    reinduction with initial therapy; patients with ALL of T cell origin (T-ALL) can not
    be treated

    - Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)

    - Total bilirubin =< 1.5 upper limit of normal (ULN) (unless Gilbert's syndrome or
    disease infiltration of the liver is present)

    - Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
    [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
    =< 2.0 institutional ULN

    - Creatinine clearance (Cockcroft-Gault) greater than or equal to 30 mL/min or
    estimated (est) glomerular filtration rate (GFR) greater than or equal to 30
    mL/min/1.73 m^2

    - For any surgery or invasive procedure requiring sutures or staples for closure,
    ibrutinib should be held at least 7 days prior to the intervention and should be held
    at least 7 days after the procedure, and restarted at the discretion of the
    investigator when the surgical site is reasonably healed without serosanguineous
    drainage or the need for drainage tubes

    - Bone marrow involvement with >= 5% lymphoblasts, peripheral blast count less than
    5,000 per uL

    - Women of child-bearing potential and men must agree to use adequate contraception
    (hormonal or barrier method of birth control; abstinence) prior to study entry and
    for the duration of study participation; should a woman become pregnant or suspect
    she is pregnant while she or her partner is participating in this study, she should
    inform her treating physician immediately; female patients need a negative serum or
    urine pregnancy test within 14 days of study start (applies only if patient is of
    childbearing potential); non-childbearing is defined as >= 1 year postmenopausal or
    surgically sterilized; men treated or enrolled on this protocol must also agree to
    use adequate contraception prior to the study, for the duration of study
    participation, and 4 months after completion of ibrutinib administration

    - Ability to understand and the willingness to sign a written informed consent document

    Exclusion Criteria:

    - Patients who receive other chemotherapy; patients must have been off previous therapy
    for >= 2 weeks and must have recovered from clinically significant toxicity (to grade
    1 or less) of all previous therapy prior to enrollment (consent signing) with the
    following exceptions: steroids, hydroxyurea, oral mercaptopurine, methotrexate,
    vincristine (including prophylactic intrathecal medication), thioguanine, and
    tyrosine kinase inhibitors are permitted within 2 weeks of randomization as
    maintenance or to reduce the peripheral blood blast counts; during ibrutinib therapy,
    only steroids and hydroxyurea are permitted to reduce peripheral blood blast counts;
    patients who have had chemotherapy or radiotherapy within 2 weeks (6 weeks for
    nitrosoureas or mitomycin C) prior to entering the study or those who have not
    recovered from adverse events due to agents administered more than 2 weeks earlier

    - Patients who are receiving any other investigational agents

    - Active central nervous system (CNS) leukemia, as defined by unequivocal morphologic
    evidence of lymphoblasts in the cerebrospinal fluid (CSF), use of CNS-directed local
    treatment for active disease within the prior 28 days, symptomatic CNS leukemia
    (i.e., cranial nerve palsies or other significant neurologic dysfunction) within 28
    days; prophylactic intrathecal medication is not a reason for exclusion; patients
    with known brain metastases should be excluded from this clinical trial

    - History of allergic reactions attributed to compounds of similar chemical or biologic
    composition to ibrutinib

    - Concomitant use of drugs that strongly inhibit cytochrome P450, family 3, subfamily
    A, polypeptide 4/5 (CYP3A4/5)

    - Uncontrolled intercurrent illness including, but not limited to, ongoing or active
    infection or an infection requiring systemic antibiotics, symptomatic congestive
    heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric
    illness/social situations that would limit compliance with study requirements

    - Pregnant and breastfeeding women are excluded from this study; breastfeeding should
    be discontinued if the mother is treated with ibrutinib

    - Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral
    therapy are eligible, unless the patient's cluster of differentiation (CD)4 count is
    below the institutional lower limit of normal, or the patient is taking prohibited
    CYP3A4/5 strong inhibitors or inducers

    - Uncontrolled autoimmune hemolytic anemia or idiopathic thrombocytopenic purpura (ITP)
    resulting in (or as evidenced by) declining platelet or hemoglobin (Hgb) levels
    within the 4 weeks prior to first dose of study drug

    - Presence of transfusion-dependent thrombocytopenia

    - Prior exposure to ibrutinib

    - History of prior malignancy, with the exception of the following:

    - Malignancy treated with curative intent and with no evidence of active disease
    present for more than 3 years prior to screening and felt to be at low risk for
    recurrence by treating physician

    - Adequately treated non-melanomatous skin cancer or lentigo maligna melanoma
    without current evidence of disease

    - Adequately treated cervical carcinoma in situ without current evidence of
    disease

    - Burkitt's or mixed lineage leukemia, T cell ALL

    - Isolated extramedullary relapse (i.e., testicular or CNS)

    - Patients with a cardiac ejection fraction (as measured by either multi gated
    acquisition scan [MUGA] or echocardiogram) < 45% are excluded; currently active
    clinically significant cardiovascular disease such as uncontrolled arrhythmia,
    congestive heart failure, any class 3 or 4 cardiac disease as defined by the New York
    Heart Association Functional Classification, or history of myocardial infarction
    within 6 months prior to first dose with study drug

    - Unable to swallow capsules, or disease significantly affecting gastrointestinal
    function and/or inhibiting small intestine absorption, such as malabsorption
    syndrome, resection of the small bowel, or poorly controlled inflammatory bowel
    disease affecting the small intestine

    - Serologic status reflecting active hepatitis B or C infection; patients that are
    hepatitis B core antibody positive but antigen negative will need a negative
    polymerase chain reaction (PCR) prior to enrollment; (hepatitis B antigen or PCR
    positive patients will be excluded;) (this may not be a necessary exclusion for an
    ibrutinib monotherapy protocol)

    - History of stroke or intracranial hemorrhage within 6 months prior to enrollment

    - Current life-threatening illness, medical condition, or organ system dysfunction
    which, in the Investigator's opinion, could compromise the patient's safety, or put
    the study at risk; any other severe concurrent disease, or have a history of serious
    organ dysfunction or disease involving the heart, kidney, liver or other organ system
    that may place the subject at undue risk to undergo therapy with ibrutinib

    - Any serious medical condition, laboratory abnormality, or psychiatric illness that
    places the subject at unacceptable risk if he/she were to participate in the study

    - Received anticoagulation therapy with warfarin or equivalent vitamin K antagonists
    within the last 28 days

    - Evidence of clinically significant bleeding diathesis or coagulopathy

    - Major surgical procedure, open biopsy, or significant traumatic injury, within 28
    days prior to day 1, anticipation of need for major surgical procedure during the
    course of the study; (minor surgical procedures, fine needle aspirations or core
    biopsies within 7 days prior to day 1; bone marrow aspiration +/- biopsy is allowed)

    - Prior allogeneic stem cell transplant in previous 3 months

    Minimum Eligible Age: 18 Years

    Maximum Eligible Age: N/A

    Eligible Gender: Both

    Primary Outcome Measures

    Objective response rate

    Overall survival time

    Secondary Outcome Measures

    Trial Keywords