Description:
This Phase 3 multinational, randomized, double-blind study is designed to compare the efficacy and safety of the combination of ibrutinib and venetoclax vs. ibrutinib and placebo in subjects with MCL.
This Phase 3 multinational, randomized, double-blind study is designed to compare the efficacy and safety of the combination of ibrutinib and venetoclax vs. ibrutinib and placebo in subjects with MCL.
Recruiting
Phase 3
Drug | Synonyms | Arms |
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Ibrutinib | Phase 3: Ibrutinb + Venetoclax | |
Venetoclax | Phase 3: Ibrutinb + Venetoclax | |
Placebo Oral tablet to match Venetoclax | Phase 3: Ibrutinib + Placebo |
Name | Type | Description | Interventions |
---|---|---|---|
Safety Run-in Period | Experimental | Subjects are enrolled into the open-label Safety Run-in Period to evaluate the occurrence of tumor lysis syndrome (TLS) and DLTs with the concurrent administration of ibrutinib and venetoclax. Safety run-in phase for the study is closed to further enrollment as of 07-Nov-2018. |
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Phase 3: Ibrutinb + Venetoclax | Experimental | Subjects will be randomized to receive ibrutinib and venetoclax/placebo until clinical disease progression or unacceptable toxicity |
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Phase 3: Ibrutinib + Placebo | Placebo Comparator | Subjects will be randomized to receive ibrutinib and venetoclax/placebo until clinical disease progression or unacceptable toxicity |
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Treatment-naive | Experimental | This open-label arm is designed to explore the efficacy and safety of the combination of ibrutinib and venetoclax in subjects with treatment-naive MCL. Approximately 75 subjects (of which ~25 subjects with TP53 mutation) will be enrolled and treated with ibrutinib and venetoclax. |
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Relapsed/Refractory Arm Inclusion Criteria: - Pathologically confirmed MCL (in tumor tissue), with documentation of either overexpression of cyclin D1 in association with other relevant markers (eg, CD19, CD20, PAX5, CD5) or evidence of t(11;14) as assessed by cytogenetics, fluorescent in situ hybridization (FISH), or polymerase chain reaction (PCR). - At least 1 measurable site of disease on cross-sectional imaging (CT/PET). - At least 1, but no more than 5, prior treatment regimens for MCL. - Failure to achieve at least partial response (PR) with, or documented disease progression after, the most recent treatment regimen. - Subjects must have adequate fresh or paraffin embedded tissue. - Adequate hematologic, hepatic and renal function. - Eastern Cooperative Oncology Group (ECOG) performance status (PS) of <= 2. Exclusion Criteria: - History or current evidence of central nervous system lymphoma. - Concurrent enrollment in another therapeutic investigational study or prior therapy with ibrutinib or other BTK inhibitors. - Prior treatment with venetoclax or other BCL2 inhibitors. - Anticancer therapy including chemotherapy, radiotherapy, small molecule and investigational agents 21 days prior to receiving the first dose of study drug. - Treatment with any of the following within 7 days prior to the first dose of study drug: moderate or strong cytochrome P450 3A (CYP3A) inhibitors or strong CYP3A inducers. Treatment Naïve Arm Inclusion Criteria: - Pathologically confirmed treatment-naive MCL (tumor tissue), with documentation of either overexpression of cyclin D1 in association with other relevant markers (eg, CD19, CD20, PAX5, CD5) or evidence of t(11;14), as assessed by cytogenetics, fluorescent in situ hybridization (FISH), or polymerase chain reaction (PCR). - Men and women ≥18 years of age with a TP53 mutation. - At least 1 measurable site of disease. - Must have adequate fresh or paraffin-embedded tissue. - Eastern Cooperative Oncology Group (ECOG) performance status score 0-2. - Adequate hematologic, hepatic, and renal function. Exclusion Criteria: - Blastoid variant of MCL - History or current evidence of CNS lymphoma. - Concurrent enrollment in another therapeutic investigational study or prior therapy including ibrutinib or other BTK inhibitors. - Prior treatment with venetoclax or other BCL2 inhibitors. - Vaccinated with live, attenuated vaccines within 4 weeks of the first dose of study drug. - Clinically significant infection requiring IV systemic treatment that was completed <=14 days before the first dose of study drug. - Any uncontrolled active systemic infection. - Known bleeding disorders (eg, von Willebrand's disease or hemophilia). - History of stroke or intracranial hemorrhage within 6 months prior to enrollment. - History of HIV or active HCV or HBV. - Major surgery within 4 weeks of the first dose of study drug. - Any life-threatening illness, medical condition, or organ system dysfunction that, in the investigator's opinion, could compromise the participant's safety or put the study outcomes at undue risk. - Currently active, clinically significant cardiovascular disease; or a history of myocardial infarction, unstable angina, or acute coronary syndrome within 6 months prior to randomization. - Unable to swallow capsules or tablets, or malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, symptomatic inflammatory bowel disease or ulcerative colitis, or partial or complete bowel obstruction. - Treatment with any of the following within 7 days prior to the first dose of study drug: Moderate or strong cytochrome P450 3A (CYP3A) inhibitors or moderate or strong CYP3A inducers. - Known allergy to xanthine oxidase inhibitors and/or rasburicase for subjects with known risk factors (as defined by high tumor burden and/or diminished renal function, as detailed in "Study Design" section above) for TLS. - Chronic liver disease with hepatic impairment Child-Pugh class B or C. - Unwilling or unable to participate in all required study evaluations and procedures. - Known hypersensitivity to the active ingredient or other components of one or more study drugs.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Measure: | Occurrence of Tumor Lysis Syndrome (TLS) (Safety Run-in Period) |
Time Frame: | Approximately 3 months after last subject enrolled into safety run-in portion |
Safety Issue: | |
Description: | To evaluate the occurrence of tumor lysis syndrome (TLS) with the concurrent administration of ibrutinib and venetoclax. |
Measure: | Complete Response (CR) (Randomization Period) |
Time Frame: | approximately 1 year after last subject has stopped treatment with study drug(s) |
Safety Issue: | |
Description: | Complete response rate (CR) based on the best overall response per investigator assessment according to the Revised Response Criteria for Malignant Lymphoma. |
Measure: | Overall response rate (ORR) (Randomization Period and Treatment-Naive Arm) |
Time Frame: | approximately 1 year after last subject has stopped treatment with study drug(s) |
Safety Issue: | |
Description: | ORR is defined as CR or PR per investigator assessment according to the Revised Response Criteria for Malignant Lymphoma. |
Measure: | MRD-negative remission rate in participants who achieve CR per investigator assessment (Randomization Period and Treatment-Naive Arm) |
Time Frame: | approximately 1 year after last subject has stopped treatment with study drug(s) |
Safety Issue: | |
Description: | MRD-negative remission is defined as undetectable MRD at documented CR in subjects who were MRD positive at screening as assessed by flow cytometry in bone marrow and/or peripheral blood, with requirement of confirmation of MRD negativity in the subsequent peripheral blood 12 weeks later. |
Measure: | Overall Survival (OS) (Randomization Period and Treatment-Naive Arm) |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | OS is defined as the time from the date of the first dose of study treatment to death from any cause. |
Measure: | Duration of Response (DOR) (Randomization Period and Treatment-Naive Arm) |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | DOR is defined as participants who achieve an overall response as the time from the first occurrence of response (CR or PR) to disease progression or death, whichever occurs first. |
Measure: | Time to Next Treatment (TTNT) (Randomization Period and Treatment-Naive Arm) |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | TTNT is defined as the duration from the date of randomization to the start date of any anti-lymphoma treatment subsequent to study treatment. |
Measure: | Percentage of participants experiencing Adverse Events (Randomization Period) |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | An AE is any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. |
Measure: | Occurrence of Tumor Lysis Syndrome (TLS) (Randomization Period) |
Time Frame: | Approximately 3 months after last subject enrolled into safety run-in portion |
Safety Issue: | |
Description: | To evaluate the occurrence of tumor lysis syndrome (TLS) with the concurrent administration of ibrutinib and venetoclax. |
Measure: | Cmax if Ibrutinib (Randomization Period) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | Cmax if Ibrutinib. |
Measure: | Tmax if Ibrutinib (Randomization Period) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | Tmax if Ibrutinib. |
Measure: | AUClast if Ibrutinib (Randomization Period) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | AUClast if Ibrutinib. |
Measure: | Half-Life (T1/2) if Ibrutinib (Randomization Period) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | Half-Life (T1/2) if Ibrutinib. |
Measure: | Cmax of Venetoclax (Randomization Period) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | Cmax of Venetoclax. |
Measure: | Tmax of Venetoclax (Randomization Period) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | Tmax of Venetoclax. |
Measure: | AUC of Venetoclax (Randomization Period) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | AUC of Venetoclax. |
Measure: | Time to worsening in FACT-Lym subscale of the health-related quality of life (Randomization Period) questionnaire (FACT-Lym) |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | Time to worsening in FACT-Lym subscale of the health-related quality of life questionnaire (FACT-Lym) will be compared between treatment arms. |
Measure: | Duration of CR (Treatment-Naive Arm Period) |
Time Frame: | Up to approximately 5 years |
Safety Issue: | |
Description: | Duration of CR, defined for subjects who achieve CR as the time from the first occurrence of CR to disease progression or death, whichever occurs first. |
Measure: | Progression-free Survival (PFS) (Treatment-Naive Arm Period) |
Time Frame: | approximately 1 year after last subject has stopped treatment with study drug(s) |
Safety Issue: | |
Description: | To evaluate PFS of ibrutinib and venetoclax compared to ibrutinib and placebo. |
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Pharmacyclics LLC. |
July 27, 2021