Description:
Phase II study with a two-stage design to evaluate efficacy and safety of ibrutinib in
combination with rituximab (I+R) in untreated patients with indolent clinical forms of MCL.
An extensive biological study will be conducted in order to further characterize this
population of MCL patients and evaluate the response obtained with the mutational profile of
the tumor.
Title
- Brief Title: Ibrutinib in Combination With Rituximab in Patients With Indolent Clinical Forms of MCL
- Official Title: Multicentric Phase II Trial to Evaluate the Efficacy and Safety of Ibrutinib in Combination With Rituximab in Patients With Indolent Clinical Forms of Mantle Cell Lymphoma
Clinical Trial IDs
- ORG STUDY ID:
GELTAMO-IMCL-2015
- SECONDARY ID:
2015-004158-17
- NCT ID:
NCT02682641
Conditions
Interventions
Drug | Synonyms | Arms |
---|
IBRUTINIB | Imbruvica | IBRUTINIB + RITUXIMAB |
Rituximab | | IBRUTINIB + RITUXIMAB |
Purpose
Phase II study with a two-stage design to evaluate efficacy and safety of ibrutinib in
combination with rituximab (I+R) in untreated patients with indolent clinical forms of MCL.
An extensive biological study will be conducted in order to further characterize this
population of MCL patients and evaluate the response obtained with the mutational profile of
the tumor.
Detailed Description
Patients with mantle cell lymphoma (MCL) have a median survival of 3-5 years despite
treatment. Indeed, the best therapeutic approach for different patients with MCL remains to
be established, coexisting different options of immunochemotherapy regimes which may include
autologous transplantation in first-line treatment or rituximab maintenance.
Moreover, last years MCL starts to be recognized as a heterogeneous disease both from
biological and clinical stand points. For instance, MCL cases with a non-nodal clinical
presentation, usually have distinctive biological features such as SOX-11 negativity,
hypermutated IGHV genes and a low number of genetic lesions associated. The outcome of these
cases is much more favourable compared to conventional MCL, reaching median survivals over 7
to 10 years even receiving less intensive treatments. In addition to that, up to 30% of the
patients with newly diagnosed MCL can be safely deferred from initial therapy until
progression . Therapeutic abstention may be prolonged for more than one year in 50% of cases.
These patients usually show longer survivals from the start of treatment compared to patients
immediately treated after diagnosis. Therefore, all these observations indicate that there
are indolent clinical forms in MCL, so its clinico-biological identification is crucial to
tailor treatment appropriately. However, at present there is no consensus on the diagnostic
criteria or treatment recommendations in cases of indolent MCL. This results in difficulties
for the identification of these forms in the clinical practice as well as with a certain
therapeutic in definition, as indolent forms of MCL can be treated either with therapeutic
abstention until progression or receive immediate treatment with conventional or more
intensive immuno-chemotherapy regimes, which may even include an autologous hematopoietic
stem cell transplantation. With the emergence of new biological agents in the therapeutic
arsenal of MCL arises the question whether a completely different approach with new drugs and
chemotherapy-free could be more appropriate in selected subsets of patients such as indolent
MCL forms.
Trial Arms
Name | Type | Description | Interventions |
---|
IBRUTINIB + RITUXIMAB | Experimental | Subjects will receive the ibrutinib in combination with rituximab according to the following schedule:
Ibrutinib 560 mg daily po until disease progression or unacceptable toxicity. In case of sustained negative MRD (at least for 6 months) after 2 years of continuous therapy, ibrutinib will be discontinued.
Rituximab 375 mg/m2 iv day 1,8, 15 and 22 (cycle 1). Rituximab 375 mg/m2 iv, day one of every cycle 3, 5, 7 and 9. | |
Eligibility Criteria
Inclusion Criteria:
1. Subjects with confirmed diagnosis of Mantle Cell Lymphoma (World Health Organization
Classification, WHO 2008). Classical, small-cell variants and marginal-zone variants
can be included.
2. Age 18 years or older.
3. Subjects must not have received any prior therapies (excluding diagnostic
splenectomy).
4. Asymptomatic patients.
5. Ann Arbor clinical stages I-IV.
6. Eastern Cooperative Oncology Group (ECOG) performance status <2 (0-1).
7. Subjects with a non-nodal MCL presentation with mainly bone marrow or peripheral blood
involvement.
8. Other asymptomatic clinical presentations are acceptable in case of low tumor burden,
including nodal MCL with lymph node enlargement ≤3 cm in the maximum diameter and with
low proliferation index (Ki-67 ≤ 30%).
9. The following laboratory values at screening: a) Neutrophil count ≥ 1×10e9/L,
Hemoglobin level ≥ 100 g/L or platelet count ≥100×10e9/L; b) Transaminases (AST and
ALT) ≤ 3 x ULN. c)Total bilirubin ≤1.5 x ULN unless bilirubin rise is due to Gilbert's
syndrome or of non-hepatic origin; d) Creatinine ≤ 2 x ULN or calculated creatinine
clearance ≥ 40 mL/min/1.73 m2.
10. Stable disease without evidence of clinical progression criteria for at least 3
months. Patients in prolonged therapeutic abstention may be included.
11. Women of childbearing potential and men who are sexually active must be practising a
highly effective method of birth control during and after the study consistent with
local regulations regarding the use of birth control methods for subjects
participating in clinical trials. Men must agree to not donate sperm during and after
the study. For females, these restrictions apply for 1 month after the last dose of
study drug. For males, these restrictions apply for 3 months after the last dose of
study drug.
12. Women of childbearing potential must have a negative serum (beta-human chorionic
gonadotropin [-hCG]) or urine pregnancy test at Screening. Women who are pregnant or
breastfeeding are ineligible for this study.
13. Sign (or their legally-acceptable representatives must sign) an informed consent
document indicating that they understand the purpose of and procedures required for
the study, including biomarkers, and are willing to participate in the study.
Exclusion Criteria:
1. Aggressive histological variants: blastic and pleomorphic variants (blastoid).
2. Proliferation index measured by Ki-67 > 30%.
3. B-cell monoclonal lymphocytosis with MCL phenotype
4. Eastern Cooperative Oncology Group (ECOG) performance status ≥2. Presence of B
symptoms or any relevant symptoms related to the MCL.
6. Nodal clinical forms with lymph node enlargement >3 cm (maximum diameter). 7. Cytopenias
attributable to MCL: Neutrophil count < 1×10e9/L, Hemoglobin level < 100 g/L or platelet
count < 100×10e9/L.
8. Organ dysfunction related to MCL including creatinine level > 2 x ULN or altered liver
biochemistry (> 3x ULN).
9. Gradual increase in different determinations of serum LDH attributable to MCL that
exceeds 20% of the ULN.
10. Known CNS infiltration. 11. Subjects with expected therapy requirement for MCL in a
short time (< 3 months) 12. Patients with active hepatitis B or C infection or HIV
infection. Positive test results for chronic HBV infection (defined as positive HBsAg
serology) or positive test results for hepatitis C (hepatitis C virus [HCV] antibody
serology testing) will be excluded with the following exceptions. Patients with occult or
prior HBV infection (defined as negative HBsAg and positive total HBcAb) may be included if
HBV DNA is undetectable, provided that they are willing to undergo monthly DNA testing or
antiviral prophylaxis. Patients who have protective titers of hepatitis B surface antibody
(HBsAb) after vaccination or prior but cured hepatitis B are eligible. Patients positive
for HCV antibody are eligible only if PCR is negative for HCV RNA.
13. Anticoagulation requirement with vitamin K antagonists. 14. Past medical history of
stroke or intracranial haemorrhage within 6 months prior to inclusion.
15. Required medication with strong CYP3A4/5 inhibitors 16. Any serious comorbidity that
makes the patient unacceptable for receiving the treatment.
17. Concomitant or previous malignancies the last 2 years other than basal skin cancer or
in situ uterine cervix cancer.
18. Pregnancy or lactation. 19. Major surgery within 4 weeks of inclusion. 20. Clinically
significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias,
congestive heart failure, or myocardial infarction within 6 months of Screening, or any
Class 3 (moderate) or Class 4 (severe) cardiac disease as defined by the New York Heart
Association Functional Classification.
21. Vaccinated with live, attenuated vaccines within 4 weeks of randomization. 22.
Uncontrolled systemic infection requiring intravenous (IV) antibiotics. 23. Any
life-threatening illness, medical condition, or organ system dysfunction which, in the
investigator's opinion, could compromise the subject's safety, interfere with the
absorption or metabolism of ibrutinib capsules, or put the study outcomes at undue risk.
Maximum Eligible Age: | 99 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Rate of complete remission |
Time Frame: | 12 months |
Safety Issue: | |
Description: | Percentage of patients who are alive and in complete response at 12 months from the date of treatment initiation. All patients will be evaluated with PET- CT and bone marrow biopsy at that time. |
Secondary Outcome Measures
Measure: | Overall Response Rate (OR) |
Time Frame: | 12 months |
Safety Issue: | |
Description: | Including complete response and partial response according to the International Response Criteria for Non- Hodgkin Lymphoma |
Measure: | Progression Free Survival |
Time Frame: | 7 years |
Safety Issue: | |
Description: | Percentage of patients without progression of disease |
Measure: | Response Duration |
Time Frame: | 7 years |
Safety Issue: | |
Description: | Length of time between |
Measure: | Minimal residual disease (MRD) |
Time Frame: | within 12 months after initiation of study treatment |
Safety Issue: | |
Description: | Proportion of subjects who are MRD negative (ie, less than the lower limit of detection for the MRD assay). |
Measure: | Overall survival |
Time Frame: | 7 years |
Safety Issue: | |
Description: | Percentage of patients alive from first dose of treatment to end of follow-up. |
Measure: | Adverse Events (AEs), Serious Adverse Events (SAES) and Suspected Unexpected Serious Adverse Reactions (SUSARs) |
Time Frame: | 7 years |
Safety Issue: | |
Description: | Number of events classified according to the Common Toxicity Criteria of the National Cancer Institute (CTC AE V 4.03). |
Measure: | Score of the EORTC quality of life questionnaire QLQ-30 |
Time Frame: | 12 months |
Safety Issue: | |
Description: | Health related quality of life questionnaire |
Measure: | Secore of the FACT-LYM |
Time Frame: | 12 months |
Safety Issue: | |
Description: | Health related quality of life questionnaire |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea |
Last Updated
May 7, 2020