Clinical Trials /

BI-1206 and an Anti-CD20 Antibody in Patients With CD32b Positive B-cell Lymphoma or Leukaemia

NCT02933320

Description:

The purpose of this trial is to identify the tolerable dose of BI-1206 (both alone and in combination) for patients with B-cell lymphoma and leukaemia and further evaluate BI-1206 alone and in combination with an anti-CD20 antibody.

Related Conditions:
  • Chronic Lymphocytic Leukemia
  • Mantle Cell Lymphoma
Recruiting Status:

Completed

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: BI-1206 and an Anti-CD20 Antibody in Patients With CD32b Positive B-cell Lymphoma or Leukaemia
  • Official Title: A Cancer Research UK Phase I/IIa Clinical Trial of BI-1206; an Antibody to FcƔRIIB (CD32b), as a Single Agent and in Combination With an Anti-CD20 Antibody in Patients With CD32b Positive B-cell Malignancy

Clinical Trial IDs

  • ORG STUDY ID: CRUKD16001
  • SECONDARY ID: 2015-004999-29
  • NCT ID: NCT02933320

Conditions

  • B-cell Lymphoma
  • Chronic Lymphocytic Leukaemia
  • Waldenström Macroglobulinemia

Interventions

DrugSynonymsArms
BI-1206 single agent dose escalation phasePart A: Arm 1: BI-1206 single agent dose escalation phase
Combination of BI-1206 with rituximab escalation phasePart A: Arm 2: Combination of BI-1206 with rituximab escalation phase
BI-1206 single agent expansion phasePart B: Arm1: BI-1206 single agent expansion phase
Combination of BI-1206 with rituximab expansion phasePart B: Arm 2: Combination of BI-1206 with rituximab expansion phase

Purpose

The purpose of this trial is to identify the tolerable dose of BI-1206 (both alone and in combination) for patients with B-cell lymphoma and leukaemia and further evaluate BI-1206 alone and in combination with an anti-CD20 antibody.

Detailed Description

      The molecule CD32b is thought to be present on many B-cells including the malignant B-cells
      in some types of lymphoma and leukaemia. The study drug, BI-1206, is an anti-CD32b monoclonal
      antibody which attaches to CD32b on the surface of B-cells and is thought to act by
      recruiting host immune cells toward the tumour leading to cancer cell death as well as
      enhancing the anti-cancer effect of other anti-CD20 antibodies such as rituximab by stopping
      them being absorbed by cells.

      The study is a first in man clinical trial of the drug called BI-1206 on its own and then
      also in combination with an anti-CD20 antibody (such as rituximab) which is commonly used to
      treat lymphoma and some types of leukaemia.

      The four main aims of this trial are to find out:

        -  The maximum dose of BI-1206 that can be given safely to patients (to a maximum dose of
           800mg) on it's own and in combination with an anti-CD20 antibody, rituximab.

        -  More about the potential side effects of BI-1206 and how they can be managed.

        -  What happens to BI-1206 inside the body.

        -  The effect of BI-1206 treatment (with or without rituximab) on tumour size and survival.

      Approximately 81 patients with relapsed or refractory CD32b positive B-cell lymphoma or
      leukaemia were planned for the trial. Approximately 34 patients to establish the maximum
      tolerated doses (MTDs) in Part A and a further 40 to 50 patients recruited to two expansion
      cohorts; one of BI-1206 alone and one of BI-1206 plus rituximab (Part B). The final number
      depending on the number of dose escalations required to reach the MTD.
    

Trial Arms

NameTypeDescriptionInterventions
Part A: Arm 1: BI-1206 single agent dose escalation phaseExperimentalBI-1206 given by IV infusion to all patients once weekly for a period of four weeks, patients will then have a follow-up period of four weeks (8 week period classified as induction therapy).
  • BI-1206 single agent dose escalation phase
Part A: Arm 2: Combination of BI-1206 with rituximab escalation phaseExperimentalArm 2, an investigation of combination treatment of BI-1206 with rituximab, involving an initial assessment of the appropriate dose of BI-1206 that can be given in combination with rituximab (combination dose escalation cohorts).
  • Combination of BI-1206 with rituximab escalation phase
Part B: Arm1: BI-1206 single agent expansion phaseExperimentalPart B Arm 1, an expansion cohort of up to 25 patients treated with single agent BI-1206 at the RP2D as determined in Part A Arm 1. Expansion to include a minimum of 12 chronic lymphocytic leukaemia (CLL) patients and six mantle cell lymphoma (MCL) patients.
  • BI-1206 single agent expansion phase
Part B: Arm 2: Combination of BI-1206 with rituximab expansion phaseExperimentalPart B Arm 2, an expansion cohort of up to 25 patients treated with a combination of BI-1206 and rituximab at the RP2D as determined in Part A Arm 2. Expansion to include a minimum of 12 CLL patients and six MCL patients.
  • Combination of BI-1206 with rituximab expansion phase

Eligibility Criteria

        Inclusion Criteria:

          1. Written (signed and dated) informed consent and be capable of co-operating with
             treatment and follow-up.

          2. B-cell lymphoma or CLL proven by histology or flow cytometry, relapsed or refractory
             to conventional treatment, or for which no conventional therapy exists or is declined
             by the patient. Patients should have received at least one line of conventional
             previous therapy which must have included a rituximab based regimen.

          3. CD32b positive malignancy as demonstrated centrally by immunohistochemistry or flow
             cytometry prior to study entry. Available tissue or blood must have been taken within
             six months of study entry.

          4. Life expectancy of at least 12 weeks.

          5. World Health Organisation (WHO) performance status of 0-2 (Appendix 1).

          6. Haematological and biochemical indices within the ranges shown below. These
             measurements must be performed within one week before their first dose of mAb (BI-1206
             and/or rituximab) as part of this study.

             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 due to lymphoma),
             granulocyte - colony stimulating factor (G-CSF) support is not permissible at
             screening

             Platelet count ≥50 x 10^9/L (or ≥30 x 10^9/L if due to malignant involvement of bone
             marrow)

             Either:

             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.

             Or:

             Alanine amino-transferase (ALT) and /or aspartate amino-transferase (AST) ≤ 2.5 x ULN
             unless raised due to malignant hepatic involvement in which case up to 5 x ULN is
             permissible

             Either:

             Calculated creatinine clearance (Cockcroft Gault) ≥30 mL/min (uncorrected value)

             Or:

             Isotope clearance measurement ≥30 mL/min (corrected)

          7. 18 years or over.

          8. B-cell lymphoma patients only: patients has at least one measurable lesion by CT scan
             (defined as greater than 1.5 cm in one axis) or in the case of Waldenström's
             macroglobulinemia, disease must be assessable by the criteria stated in Appendix 6 of
             the protocol.

          9. Patients recruited to Arm 2 in Parts A and B (combination arms) only: CD20 positive
             malignancy as demonstrated by immunohistochemistry or flow cytometry prior to trial
             entry.

        Exclusion Criteria:

          1. Allogenic bone marrow transplant within 12 months prior to the first dose of BI-1206
             or presence of chronic graft versus host disease.

          2. Patients with clinically active leptomeningeal or central nervous system
             lymphoma/leukaemia.

          3. Doses of prednisolone >10 mg daily (or equipotent doses of other corticosteroids) are
             not permitted whilst on the study other than as pre-medication. During the screening
             period, doses of up to 20 mg per day may be given but the dose must be reduced to 10
             mg/day by Cycle 1 Day 1 (or Day -7 in the CLL combination expansion).

          4. Known or suspected hypersensitivity to study drugs.

          5. Cardiac or renal amyloid light-chain (AL) amyloidosis.

          6. Radiotherapy, endocrine therapy, immunotherapy, chemotherapy or investigational
             medicinal products during the previous 4 weeks before treatment.

          7. 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
             Sponsor should not exclude the patient.

          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 forms of contraception (one highly effective form plus a barrier method)
             [oral, injected or implanted hormonal contraception and condom; intra-uterine device
             and condom; diaphragm with spermicidal gel and condom] or agree to sexual abstinence^4
             for four weeks before entering the trial, during the trial and for twelve months after
             completing treatment are considered eligible.

          9. Male patients with partners of child-bearing potential (unless they agree to take
             measures not to father children by using a barrier method of contraception [condom
             plus spermicide] or to sexual abstinence effective from the first administration of
             BI-1206 or rituximab on the study, throughout the trial and for twelve months
             afterwards. Men with partners of child-bearing potential must also be willing to
             ensure that their partner uses an effective method of contraception for the same
             duration for example, hormonal contraception, intrauterine device, diaphragm with
             spermicidal gel or sexual abstinence4). 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 infection.

         12. Known to be serologically positive for Hepatitis B, Hepatitis C or Human
             Immunodeficiency Virus (HIV).

         13. Patients with an active, known or suspected autoimmune disease (not including CLL
             auto-immune disease). Patients with Type I diabetes mellitus, hypothyroidism only
             requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or
             alopecia) not requiring systemic treatment, or conditions not expected to recur in the
             absence of an external trigger will be permitted to participate.

         14. Concurrent congestive heart failure, prior history of class III/ IV cardiac disease
             (New York Heart Association [NYHA]), prior history of cardiac ischaemia or prior
             history of cardiac arrhythmia.

         15. Patients for whom rituximab is contraindicated due to severe previous hypersensitivity
             or any other reason (Arm 2 in Parts A and B [combination arms] only).

         16. Ongoing infection requiring treatment with antibiotics, antifungals or antivirals.
             Prophylactic use of antibiotics, antifungals or antivirals would not have excluded
             patients.

         17. Any other condition which in the Investigator's opinion would not make the patient a
             good candidate for the clinical trial.

         18. Is a participant or plans to participate in another interventional clinical study,
             whilst taking part in this Phase I/IIa study of BI-1206. Participation in an
             observational study would be acceptable.

         19. Current malignancies of other types, with the exception of adequately treated
             cone-biopsied in situ carcinoma of the cervix uteri and basal or squamous cell
             carcinoma of the skin. Cancer survivors, who have undergone potentially curative
             therapy for a prior malignancy, have no evidence of that disease for three years or
             more and are deemed at negligible risk for recurrence, are eligible for the trial.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Documenting Adverse Events (AEs), Serious Adverse Events (SAEs), Dose Limiting Toxicities (DLTs) (Graded According to NCI-CTCAE Version 4.02) and Laboratory Parameters and Determining Their Causality in Relation to BI-1206.
Time Frame:Safety data were collected from the date of written informed consent and continued for 125 days after the final administration of BI-1206 or rituximab.
Safety Issue:
Description:To recommend a dose for future trials with BI-1206 by finding the highest safe dose which can be given to patients.

Secondary Outcome Measures

Measure:Measurement of PK Parameter Maximum Observed Serum Concentration (Cmax) for BI-1206
Time Frame:Doses 1 and 4 (pre-infusion, end of infusion, +4, +24, +48 and +72 hours)
Safety Issue:
Description:Maximum observed serum concentration after intravenous BI-1206 administration
Measure:Measurement of PK Parameter Area Under the Serum Concentration-time Curve From Time 0 to the Last Time Point (AUClast) for BI-1206
Time Frame:Doses 1 and 4 (pre-infusion, end of infusion, +4, +24, +48 and +72 hours)
Safety Issue:
Description:Area under the serum concentration-time curve from time 0 to the last time point after intravenous BI-1206 administration.
Measure:Measurement of PK Parameter Half-life (T1/2) for BI-1206
Time Frame:Doses 1 and 4 (pre-infusion, end of infusion, +4, +24, +48 and +72 hours)
Safety Issue:
Description:BI-1206 half-life after intravenous administration
Measure:Measurement of PK Parameter Total Body Clearance (CL) for BI-1206
Time Frame:Doses 1 and 4 (pre-infusion, end of infusion, +4, +24, +48 and +72 hours)
Safety Issue:
Description:Total body clearance after intravenous BI-1206 administration
Measure:Measurement of PK Parameter Volume of Distribution (Vss) for BI-1206
Time Frame:Doses 1 and 4 (pre-infusion, end of infusion, +4, +24, +48 and +72 hours)
Safety Issue:
Description:Volume of distribution after administration of BI-1206
Measure:Measurement of Anti-drug Antibody (ADA) Response to BI-1206 During the BI-1206 Treatment Period Using ELISA
Time Frame:Pre dose at weeks 1, 5 and 8, maintenance phase and off-study visit.
Safety Issue:
Description:Patients with true ADA response
Measure:Measurement of Peripheral Blood B-lymphocyte Depletion During the BI-1206 Treatment Period Using Flow Cytometry.
Time Frame:During induction phase (up to 8 weeks).
Safety Issue:
Description:Number of patients with B-lymphocyte depletion during BI-1206 treatment period.
Measure:Assessment of Best Disease Response According to Criteria for Malignant Lymphoma (Cheson, 2014) Waldenström Macroglobulinaemia Assessment Criteria (Owen 2013, Kimby 2006) or NCI Chronic Lymphocytic Leukaemia (CLL) Criteria (Hallek, 2008).
Time Frame:Response evaluated 4 weeks after last dose in induction phase, every 16 weeks during maintenance phase and at off-study.
Safety Issue:
Description:To look for signs of anti-tumour activity of BI-1206 alone and in combination in patients with relapsed or refractory B-cell malignancies
Measure:Measure Progression Free Survival at 1 Year After the First BI-1206 Administration on the Study for All Patients
Time Frame:From first BI-1206 administration up to 12 months
Safety Issue:
Description:To measure the time to disease progression and twelve month survival
Measure:Measure Overall Survival at 1 Year After the First BI-1206 Administration on the Study for All Patients
Time Frame:From first BI-1206 administration up to 12 months. Participants whose last reported status was not death were censored.
Safety Issue:
Description:To measure the time to disease progression and twelve month survival

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:Cancer Research UK

Trial Keywords

  • Indolent B-cell Lymphoma
  • Chronic Lymphocytic Leukaemia
  • Waldenström Macroglobulinemia
  • BI-1206
  • CD32b

Last Updated

July 8, 2021