Description:
Eligible untreated patients will receive single arm venetoclax, bendamustine and rituximab as
induction therapy. After 6 cycles, maintenance rituximab may be administered per physician
discretion.
Venetoclax is an oral Bcl-2 family protein inhibitor. It targets the B-cell lymphoma 2
(BCL-2) protein, which supports cancer cell growth and is overexpressed in many patients with
mantle cell lymphoma. Venetoclax may make the cancer cells sensitive to chemotherapy. This
may help to slow down the growth of cancer or may cause cancer cells to die.
The purpose of this study is to see if venetoclax in combination with bendamustine and
rituximab chemotherapy is effective in treating people who have mantle cell lymphoma and to
examine the side effects, good and bad, associated with this combination.
Title
- Brief Title: Phase II Study of Bendamustine and Rituximab Plus Venetoclax in Untreated Mantle Cell Lymphoma Over 60 Years of Age
- Official Title: Phase II Study of Bendamustine and Rituximab Plus Venetoclax in Untreated Mantle Cell Lymphoma Over 60 Years of Age
Clinical Trial IDs
- ORG STUDY ID:
PrE0405
- SECONDARY ID:
ML40551
- NCT ID:
NCT03834688
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Venetoclax | GDC-0199, ABT-199, RO5537382 | Induction |
Bendamustine | Bendamustine hydrochloride | Induction |
Rituximab | Chimeric anti-CD20 monoclonal antibody, Rituxan | Induction |
Purpose
Eligible untreated patients will receive single arm venetoclax, bendamustine and rituximab as
induction therapy. After 6 cycles, maintenance rituximab may be administered per physician
discretion.
Venetoclax is an oral Bcl-2 family protein inhibitor. It targets the B-cell lymphoma 2
(BCL-2) protein, which supports cancer cell growth and is overexpressed in many patients with
mantle cell lymphoma. Venetoclax may make the cancer cells sensitive to chemotherapy. This
may help to slow down the growth of cancer or may cause cancer cells to die.
The purpose of this study is to see if venetoclax in combination with bendamustine and
rituximab chemotherapy is effective in treating people who have mantle cell lymphoma and to
examine the side effects, good and bad, associated with this combination.
Detailed Description
Mantle cell lymphoma (MCL) is a subtype of Non-Hodgkin Lymphoma (NHL) which is considered
incurable with conventional therapy. With an incidence of approximately 70,000 cases
diagnosed in the United States (US) per year, the disease is rare.
This is an open-label phase II study of venetoclax in combination with bendamustine and
rituximab. Patients will receive induction therapy with venetoclax, bendamustine and
rituximab for six cycles (1 cycle = 28 days). There will be an interim analysis after 19
patients are enrolled to evaluate for tumor lysis syndrome (TLS). TLS is caused by the fast
breakdown of cancer cells which can lead to electrolyte and kidney problems.
Tumor assessments will be performed after Cycle 3-4 and at end of induction therapy.
Mandatory pre-treatment tumor tissue sample (i.e., obtained in the course of standard biopsy
or surgery) will be required for research (if sufficient tissue is available).
Mandatory bone marrow aspirate (obtained in the course of standard biopsy) and peripheral
blood sample will be collected at the end of treatment for Minimal Residual Disease (MRD).
MRD measures the disease remaining after treatment. Optional peripheral blood samples will
also be collected for future research.
Trial Arms
Name | Type | Description | Interventions |
---|
Induction | Experimental | Venetoclax, bendamustine and rituximab as induction therapy for 6 cycles of 28 days. | - Venetoclax
- Bendamustine
- Rituximab
|
Eligibility Criteria
Inclusion Criteria:
- Patients must have histologically confirmed (biopsy-proven) diagnosis of mantle cell
lymphoma (MCL), with documented cyclin D1 (BCL1) expression by immunohistochemical
stains and/or t(11;14) by cytogenetics or FISH.
- Patients must have measurable or evaluable disease as defined as a lymph node
measuring >1.5 cm in any dimension or splenomegaly with spleen >15 cm in craniocaudal
dimension.
- Age ≥ 60 years.
- No intention to undergo consolidation with high dose chemotherapy and autologous stem
cell rescue (Autologous Stem Cell Transplant) in first remission.
- ECOG performance status of 0-2.
- Ability to understand and willingness to sign Institutional Review Board
(IRB)-approved informed consent.
- Willing to provide mandatory tissue samples (if sufficient tissue available), bone
marrow and blood samples for research purposes.
- Adequate organ function as measured by the following criteria, obtained ≤ 2 weeks
prior to registration:
- Absolute Neutrophil Count (ANC) ≥ 1000/mm³
- Hemoglobin ≥ 8 g/dL
- Platelets ˃75,000/mm³
- Creatinine clearance ≥ 40 mL/min, calculated with the use of 24-hour creatinine
clearance or by Cockcroft-Gault formula
- Total Bilirubin ≤ 1.5x Upper Limit of Normal (ULN) or ≤ 3x ULN for patients with
documented Gilbert's syndrome
- Aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) ≤ 2.5x ULN
- All females of childbearing potential (not surgically sterilized and between menarche
and 1 year post menopause) must have a blood test to rule out pregnancy within 2 weeks
prior to registration.
- Women must not be pregnant or breastfeeding. Females of childbearing potential who are
sexually active with a non-sterilized male partner and sexually active men must agree
to use 2 methods of adequate contraception (hormonal plus barrier or 2 barrier forms)
prior to study entry, for the duration of study participation, and for 12 months after
last dose of therapy. Method of contraception must be documented.
- Patients should not have prior chemotherapy, radiotherapy or immunotherapy for
lymphoma.
- Patients must have no recent (<1 year) history of malignancy except for the following:
- adequately treated non-melanoma skin cancer
- adequately treated Stage I melanoma of the skin
- in situ cervical cancer
- low grade prostate adenocarcinoma (Gleason grade ≤ 6) managed with observation
and stable for 6 months.
- Patients should not have known evidence of central nervous system (CNS) lymphoma.
- Patients must not have received a prior allogeneic stem cell transplant or solid organ
transplant (except for cornea) for any indication.
- Patients must have no active, uncontrolled infections.
- Patients must not have active hepatitis B or be chronic carriers of hepatitis B. This
is defined as patients with hepatitis B surface antigen (HBsAg) positive. Patients
with prior exposure to hepatitis B (hepatitis B core antibody (anti-HBc) positive AND
HBsAg negative) are allowed with a protective level hepatitis B surface antibody AND a
negative hepatitis B viral load by polymerase-chain reaction (PCR).
- Patients must not have active hepatitis C (HCV) as defined by a hepatitis C viral load
detectable by PCR. Patients with a negative HCV antibody are assumed to have a
negative HCV viral load. Patients with a positive HCV antibody must have a negative
hepatitis C viral load by PCR. Prior treatment for an active HCV infection will be
allowed as long as the hepatitis C viral load by PCR is negative.
- Patients must not have known active Human Immunodeficiency Virus (HIV). Testing not
required in absence of clinical suspicion.
- Patients must not have evidence of significant, uncontrolled concomitant diseases,
including psychiatric diseases, that could affect compliance with the protocol or
interpretation of results or that could increase risk to the patient.
- Patients must not have conditions that preclude oral administration or absorption of
medications through the GI tract, including but not limited to the inability to
swallow pills or malabsorption syndromes.
- Patients must not have known allergies to both xanthine oxidase inhibitors and
rasburicase.
- Patients must not require the use of warfarin. Blood thinners of other classes are
permitted.
- Patient may not receive the following agents within 7 days prior to the first dose of
venetoclax:
- Strong and moderate CYP3A inhibitors
- Strong and moderate CYP3A inducers
- Strong and moderate P-gp inhibitors
- Patients must not have consumed grapefruit, grapefruit products, Seville oranges
(including marmalade containing Seville oranges), or star fruit within 3 days prior to
the first dose of venetoclax.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 60 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Complete Response (CR) rate at end of induction |
Time Frame: | 30 months |
Safety Issue: | |
Description: | CR assessed in accordance with Lymphoma Response Criteria (Cheson Criteria) |
Secondary Outcome Measures
Measure: | Number of participants with treatment-related adverse events as assessed by CTCAE v5.0 |
Time Frame: | 60 months |
Safety Issue: | |
Description: | Number of participants with abnormal laboratory values and/or adverse events with particular attention to TLS related to treatment |
Measure: | Overall Response Rate (ORR) |
Time Frame: | 60 months |
Safety Issue: | |
Description: | ORR assessed in accordance with Lymphoma Response Criteria (Cheson Criteria) |
Measure: | Progression-Free Survival (PFS) |
Time Frame: | 60 months |
Safety Issue: | |
Description: | PFS assessed in accordance with Lymphoma Response Criteria (Cheson Criteria) |
Measure: | Overall Survival (OS) |
Time Frame: | 60 months |
Safety Issue: | |
Description: | OS assessed in accordance with Lymphoma Response Criteria (Cheson Criteria) |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | PrECOG, LLC. |
Trial Keywords
- Venetoclax
- Bendamustine
- Rituximab
- Bcl-2 Family Protein Inhibitor
Last Updated
June 25, 2021