Clinical Trials /

Pevonedistat and Ibrutinib in Treating Participants With Relapsed or Refractory Chronic Lymphocytic Leukemia or Non-Hodgkin Lymphoma

NCT03479268

Description:

This phase I trial studies the side effects and best dose of pevonedistat when given together with ibrutinib in participants with chronic lymphocytic leukemia or non-Hodgkin lymphoma that has come back or has stopped responding to other treatments. Pevonedistat and ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

Related Conditions:
  • Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
  • Diffuse Large B-Cell Lymphoma
  • Follicular Lymphoma
  • Lymphoplasmacytic Lymphoma
  • Mantle Cell Lymphoma
  • Marginal Zone Lymphoma
  • Non-Hodgkin Lymphoma
  • Prolymphocytic Leukemia
  • Richter Syndrome
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Pevonedistat and Ibrutinib in Treating Participants With Relapsed or Refractory Chronic Lymphocytic Leukemia or Non-Hodgkin Lymphoma
  • Official Title: A Phase I Study of Pevonedistat (MLN4924, TAK924) in Combination With Ibrutinib in Patients With Relapsed/Refractory Chronic Lymphocytic Leukemia and Non-Hodgkin Lymphoma

Clinical Trial IDs

  • ORG STUDY ID: STUDY00017005
  • SECONDARY ID: NCI-2018-00315
  • SECONDARY ID: STUDY00017005
  • SECONDARY ID: P30CA069533
  • NCT ID: NCT03479268

Conditions

  • B-Cell Prolymphocytic Leukemia
  • Recurrent Chronic Lymphocytic Leukemia
  • Recurrent Diffuse Large B-Cell Lymphoma
  • Recurrent Follicular Lymphoma
  • Recurrent Lymphoplasmacytic Lymphoma
  • Recurrent Mantle Cell Lymphoma
  • Recurrent Marginal Zone Lymphoma
  • Recurrent Non-Hodgkin Lymphoma
  • Recurrent Small Lymphocytic Lymphoma
  • Refractory Chronic Lymphocytic Leukemia
  • Refractory Diffuse Large B-Cell Lymphoma
  • Refractory Follicular Lymphoma
  • Refractory Lymphoplasmacytic Lymphoma
  • Refractory Mantle Cell Lymphoma
  • Refractory Marginal Zone Lymphoma
  • Refractory Non-Hodgkin Lymphoma
  • Refractory Small Lymphocytic Lymphoma
  • Richter Syndrome

Interventions

DrugSynonymsArms
IbrutinibBTK Inhibitor PCI-32765, CRA-032765, Imbruvica, PCI-32765Treatment (pevonedistat, ibrutinib)
PevonedistatMLN4924, Nedd8-Activating Enzyme Inhibitor MLN4924Treatment (pevonedistat, ibrutinib)

Purpose

This phase I trial studies the side effects and best dose of pevonedistat when given together with ibrutinib in participants with chronic lymphocytic leukemia or non-Hodgkin lymphoma that has come back or has stopped responding to other treatments. Pevonedistat and 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 safety and tolerability of pevonedistat administered in combination with
      ibrutinib in patients with relapsed or refractory chronic lymphocytic leukemia (CLL) and
      non-Hodgkin lymphoma (NHL).

      SECONDARY OBJECTIVES:

      I. Overall response rate (ORR) will be determined based on the proportion of study
      participants who achieve complete response (CR), complete response with incomplete marrow
      recovery (CRi), partial response (PR) or nodular partial response (nPR) assessed after
      completion of therapy.

      II. Event-free survival (EFS), defined as the interval between the date of first study
      treatment and the date of objective signs of disease recurrence, subsequent anti-leukemic
      therapy, or death, whichever is first reported.

      OUTLINE: This is a dose-escalation study of pevonedistat.

      Participants receive pevonedistat intravenously (IV) over 1 hour on days 1, 3, and 5, and
      ibrutinib orally (PO) daily on days 2-21 of course 1 and days 1-21 of subsequent courses.
      Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or
      unacceptable toxicity. Participants then receive only ibrutinib PO daily on days 1-21.
      Treatment repeats every 21 days for up to 10 courses in the absence of disease progression or
      unacceptable toxicity.

      After completion of study treatment, participants will be followed up for every 3 months for
      1 year and then every 6 months thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (pevonedistat, ibrutinib)ExperimentalParticipants receive pevonedistat IV over 1 hour on days 1, 3, and 5, and ibrutinib PO daily on days 2-21 of course 1 and days 1-21 of subsequent courses. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity. Participants then receive only ibrutinib PO daily on days 1-21. Treatment repeats every 21 days for up to 10 courses in the absence of disease progression or unacceptable toxicity.
  • Ibrutinib
  • Pevonedistat

Eligibility Criteria

        Inclusion Criteria:

          -  Dose escalation cohort:

               -  Histologically or flow cytometry confirmed diagnosis of B-CLL/small lymphocytic
                  lymphoma (SLL) according to National Cancer Institute sponsored Working Group
                  (NCI-WG) 1996 guidelines

               -  The following types of NHL as documented by medical records and with histology
                  based on criteria established by the World Health Organization (WHO):

                    -  Mantle cell lymphoma (MCL)

                    -  Follicular lymphoma (FL) - grades 1-3a

                    -  Lymphoplasmacytic lymphoma (LPL)

                    -  Marginal zone lymphoma (MZL)

                    -  CLL in Richter's transformation

                    -  B-cell prolymphocytic leukemia (B-PLL)

                    -  Diffuse large B-cell lymphoma (DLBCL)

          -  Expansion cohort - histologically or flow cytometry confirmed diagnosis of B-CLL/SLL
             according to NCI-WG 1996 guidelines; patients who lack CD23 expression on their
             leukemia cells should be examined for (and found NOT to have) either t(11;14) or
             cyclin D1 overexpression, to rule out mantle cell lymphoma

          -  Patients with MCL underwent >= 1 chemoimmunotherapy-based regimen; patients with FL
             and MZL underwent >= 1 prior chemotherapy-based and/or immunotherapy-based regimen;
             patients with DLBCL and CLL in Richter's transformation underwent >= 1
             chemoimmunotherapy-based regimen and are not transplant-eligible; patients with CLL,
             B-PLL and LPL underwent >= 1 chemotherapy-based, or immunotherapy-based or targeted
             therapy regimen (e.g., PI3K inhibitors [idelalisib], venetoclax, ibrutinib or an
             investigational agent, including an investigational BTK inhibitor); all regimens must
             have been administered for >= 2 cycles, and patients must have had either documented
             disease progression or no response (stable disease) to the most recent treatment
             regimen

          -  Patients with CLL/SLL demonstrate active disease meeting at least 1 of the
             International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 criteria for
             requiring treatment:

               -  A minimum of any one of the following constitutional symptoms:

                    -  Unintentional weight loss > 10% within the previous 6 months prior to
                       screening

                    -  Extreme fatigue (unable to work or perform usual activities)

                    -  Fevers of greater than 100.5 F for >= 2 weeks without evidence of infection

                    -  Night sweats without evidence of infection

               -  Evidence of progressive marrow failure as manifested by the development of, or
                  worsening of anemia or thrombocytopenia

               -  Massive (i.e., > 6 cm below the left costal margin), progressive or symptomatic
                  splenomegaly

               -  Massive nodes or clusters (i.e., > 10 cm in longest diameter) or progressive
                  lymphadenopathy

               -  Progressive lymphocytosis with an increase of > 50% over a 2-month period, or an
                  anticipated doubling time of less than 6 months

               -  Autoimmune anemia or thrombocytopenia that is poorly responsive to
                  corticosteroids

               -  Patients with NHL and with B-cell prolymphocytic leukemia must have an indication
                  for treatment in the opinion of the investigator

          -  For diseases other than LPL and CLL, presence of radiographically measurable
             lymphadenopathy or extra-nodal lymphoid malignancy (defined as the presence of >= 1
             lesion that measures >= 2.0 cm in the longest dimension [LD] and >= 1.0 cm in the
             longest perpendicular dimension [LPD] as assessed by computed tomography [CT] or
             magnetic resonance imaging [MRI]); for LPL, measurable disease will be defined as
             serum monoclonal IgM > 0.5 g/dL or meeting at least 1 of the recommendations from the
             Second International Workshop on LPL for requiring treatment

          -  Patients must have Eastern Cooperative Oncology Group (ECOG) performance status 0-2
             and expected survival > 3 months from study enrollment

          -  Total bilirubin =< institutional upper limit of normal (ULN) (unless due to known
             Gilbert's syndrome or compensated hemolysis directly attributable to CLL); patients
             with Gilbert's syndrome may enroll if direct bilirubin =< 1.5 x ULN of the direct
             bilirubin; elevated indirect bilirubin due to post-transfusion hemolysis is allowed

          -  Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) less than 2.5 X
             institutional ULN

          -  Estimated creatinine clearance (CrCL) using the Cockcroft-Gault equation >= 50 mL/min

          -  Platelets >= 50,000/mm^3 independent of transfusion support, with no active bleeding,
             and absolute neutrophil count >= 1000/mm^3, unless due to disease involvement in the
             bone marrow

          -  Albumin > 2.7 g/dL

          -  Hemoglobin > 8 g/dL; patients may be transfused to achieve this value

          -  Voluntary written consent must be given before performance of any study related
             procedure not part of standard medical care, with the understanding that consent may
             be withdrawn by the patient at any time without prejudice to future medical care

          -  Female patients who:

               -  Are postmenopausal for at least 1 year before the screening visit, OR

               -  Are surgically sterile, OR

               -  If they are of childbearing potential:

               -  Agree to practice 1 highly effective method and 1 additional effective (barrier)
                  method of contraception at the same time, from the time of signing the informed
                  consent through 4 months after the last dose of study drug, OR

               -  Agree to practice true abstinence, when this is in line with the preferred and
                  usual lifestyle of the subject; (periodic abstinence [eg, calendar, ovulation,
                  symptothermal, post-ovulation methods] withdrawal, spermicides only, and
                  lactational amenorrhea are not acceptable methods of contraception; female and
                  male condoms should not be used together)

          -  Male patients, even if surgically sterilized (i.e., status post-vasectomy), who:

               -  Agree to practice effective barrier contraception during the entire study
                  treatment period and through 4 months after the last dose of study drug, OR

               -  Agree to practice true abstinence, when this is in line with the preferred and
                  usual lifestyle of the subject; (periodic abstinence [e.g., calendar, ovulation,
                  symptothermal, post-ovulation methods for the female partner] withdrawal,
                  spermicides only, and lactational amenorrhea are not acceptable methods of
                  contraception; female and male condoms should not be used together)

        Exclusion Criteria:

          -  Prior therapeutic intervention with any of the following:

               -  Therapeutic anticancer antibodies (rituximab, obinutuzumab) within 4 weeks

               -  Radio- or toxin-immunoconjugates within 10 weeks

               -  Inhibitors of PI3K (idelalisib), ibrutinib, BH3-mimetic venetoclax, lenalidomide,
                  and other targeted therapy (including investigational BTK inhibitors and other
                  investigational therapy) within 6 half-lives

               -  All other chemotherapy, radiation therapy within 3 weeks prior to initiation of
                  therapy

          -  Intolerance of ibrutinib

          -  Inadequate recovery from adverse events related to prior therapy to grade =< 1
             (excluding grade 2 alopecia and neuropathy)

          -  Chronic use of corticosteroids in excess of prednisone 20 mg/day or its equivalent

          -  Stem cell transplant recipients must have no evidence of active graft-versus-host
             disease and should not be receiving treatment for it

          -  Known involvement of central nervous system

          -  Use of full dose, therapeutic anti-coagulation or patients with uncontrolled
             coagulopathy or bleeding disorder

          -  Treatment with strong CYP3A inhibitors or inducers within 14 days before the first
             dose of study drug; strong CYP3A inhibitors/inducers are not permitted during the
             study, including nutraceutical preparations, e.g., grapefruit juice and St John's
             wort; patients must have no prior history of amiodarone in the 6 months prior to the
             first dose of pevonedistat

          -  Patient requiring chronic treatment with BCRP inhibitors (cyclosporine, eltrombopag)

          -  History prior malignancy except:

               -  Malignancy treated with curative intent and no known active disease present for
                  >= 2 years prior to initiation of therapy on current study

               -  Adequately treated non-melanoma skin cancer or lentigo maligna (melanoma in situ)
                  without evidence of disease

               -  Adequately treated in situ carcinomas (e.g., cervical, esophageal, etc.) without
                  evidence of disease

               -  Asymptomatic prostate cancer managed with watch and wait strategy

               -  Myelodysplastic syndrome which is clinically well controlled and no evidence of
                  the cytogenetic abnormalities characteristic of myelodysplasia on the bone marrow
                  at screening

          -  Uncontrolled immune hemolysis or thrombocytopenia (positive direct antiglobulin test
             in absence of hemolysis or history of immune-mediated cytopenias are not exclusions)

          -  History of human immunodeficiency virus (HIV) infection

          -  Known hepatitis B surface antigen seropositive or known or suspected active hepatitis
             C Infection; Note: Patients who have isolated positive hepatitis B core antibody
             (i.e., in the setting of negative hepatitis B surface antigen and negative hepatitis B
             surface antibody) must have an undetectable hepatitis B viral load

          -  Known cardiopulmonary disease defined as one of the following:

               -  Unstable angina

               -  Uncontrolled high blood pressure (ie, systolic blood pressure > 180 mmHg,
                  diastolic blood pressure > 95 mm Hg )

               -  Congestive heart failure (New York Heart Association [NYHA] class III or IV)

               -  Myocardial infarction (MI) within 6 months prior to first dose (patients who had
                  ischemic heart disease such as a (acute chest syndrome [ACS]), MI, and/or
                  revascularization greater than 6 months before screening and who are without
                  cardiac symptoms may enroll)

               -  Cardiomyopathy

               -  Clinically significant arrhythmia: 1) History of polymorphic ventricular
                  fibrillation or torsade de pointes, 2) Permanent atrial fibrillation [a fib],
                  defined as continuous a fib for >= 6 months, 3) Persistent a fib, defined as
                  sustained a fib lasting > 7 days and/or requiring cardioversion in the 4 weeks
                  before screening, 4) grade 3 a fib defined as symptomatic and incompletely
                  controlled medically, or controlled with device (e.g. pacemaker), or ablation and
                  5) Patients with paroxysmal a fib or < grade (Gr) 3 a fib for period of at least
                  6 months are permitted to enroll provided that their rate is controlled on a
                  stable regimen

               -  Implantable cardioverter defibrillator

               -  Moderate to severe aortic and/or mitral stenosis or other valvulopathy (ongoing)

               -  Pulmonary hypertension

               -  Prolong rate corrected QT (QTc) interval >= 500 msec. calculated according to
                  institutional guidelines

               -  Left ventricular ejection fraction (LVEF) < 50% as assessed by echocardiogram or
                  radionuclide angiography

          -  Known moderate to severe chronic obstructive pulmonary disease (COPD), interstitial
             lung disease, and pulmonary fibrosis

          -  Known hepatic cirrhosis or severe pre-existing hepatic impairment

          -  Major surgery (requiring general anesthesia) within 14 days before the first dose of
             study drug or a scheduled surgery during study period

          -  Female patients who are both lactating and breastfeeding or have a positive serum
             pregnancy test during the screening period or a positive urine pregnancy test on day 1
             before first dose of study drug

          -  Inability to swallow and retain an oral medication; patients with clinically
             significant medical condition of malabsorption, inflammatory bowel disease, chronic
             conditions which manifest with diarrhea, refractory nausea, vomiting or any other
             condition that will interfere significantly with the absorption of ibrutinib

          -  Active uncontrolled infection or severe infection disease (e.g., severe pneumonia,
             meningitis, septicemia, or methicillin resistant Staphylococcus aureus infection)

          -  Any condition for which participation in the study is judged by the investigator to be
             detrimental to the patient with inter-current illness or psychiatric/social situations
             that would jeopardize compliance with study requirements

          -  Female patients who intend to donate eggs (ova) during the course of this study or 4
             months after receiving their last dose of study drug(s)

          -  Male patients who intend to donate sperm during the course of this study or 4 months
             after receiving their last dose of study drug(s)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of dose limiting toxicities (DLTs)
Time Frame:Up to 42 days
Safety Issue:
Description:All adverse events will be tabulated and summarized by major organ category, grade, anticipation, and drug attribution. SAE specific incidence and exact 95% confidence interval will be provided where appropriate.

Secondary Outcome Measures

Measure:Overall response rate (ORR) determined based on proportion of participants who achieve complete response (CR), with incomplete marrow recovery (CRi), partial response (PR), or nodular partial response (nPR)
Time Frame:Up to 1 year
Safety Issue:
Description:According to International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 criteria in patients with chronic lymphocytic leukemia (CLL) and Lugano criteria in patients with non-Hodgkin lymphoma (NHL). The ORR, along with exact two-sided 95% confidence intervals, will be reported for the study.
Measure:Event-free survival (EFS)
Time Frame:From date of first study treatment until progression, start of anti-leukemic therapy, or death, assessed up to 4 years
Safety Issue:
Description:Defined as the interval between the date of first study treatment and the date of objective signs of disease recurrence, subsequent anti-leukemic therapy, or death, whichever is first reported. The Kaplan-Meier product limit method will be used to estimate progression-free survival (PFS) of the median PFS and PFS rates at clinically relevant time points will be provided with the 95% confidence interval (CI).

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:OHSU Knight Cancer Institute

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