Inclusion Criteria:
1. Men and women ≥ 18 years of age.
2. Patients must have histologic confirmation of relapsed or refractory lymphoma.
3. Baseline FDG-PET scans must demonstrate positive lesions compatible with CT defined
anatomical tumor sites.
a) CT scan showing at least:
- i. 2 or more clearly demarcated lesions/nodes with a long axis >1.5cm and short
axis ≥ 1.0cm, or
- ii. 1 clearly demarcated lesion/node with a long axis >2.0cm and short axis
≥1.0cm.
4. Patient must have been previously treated for B cell non-Hodgkin lymphoma with any of
the allowable below:
1. First-line treatment with rituximab and an anthracycline-based chemotherapy.
2. Monotherapy rituximab, dosed prior to first-line rituximab combined with
anthracycline containing chemotherapy, or as maintenance therapy.
3. Radiotherapy as part of the first-line treatment plan including anthracycline and
rituximab.
5. Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2.
6. Life expectancy of greater than 6 weeks.
7. Patients must have normal organ and marrow function as defined below,
1. absolute neutrophil count ≥ 1000/microliters (mcL) (unless due to lymphoma
involvement of the bone marrow),
2. platelets ≥75,000/mcL (unless due to lymphoma involvement of the bone marrow),
3. total bilirubin <1.5 x within normal institutional limits (unless due to lymphoma
involvement of liver or a known history of Gilbert's disease),
4. Aspartate transaminase (AST) (SGOT)/Alanine transaminase (ALT) (SGPT) ≤ 2.5 ×
institutional upper limit of normal (unless due to lymphoma involvement of
liver),
5. creatinine within normal institutional limits, or
6. creatinine clearance ≥40 mL/min/1.73 m2 for patients with creatinine levels above
institutional normal. (unless due to lymphoma).
8. Major surgical procedure within 28 days of first dose of study drug. If a subject had
major surgery, they must have recovered adequately from any toxicity and/or
complications from the intervention before the first dose of study drug.
9. Women who are sexually active and can bear children must agree to use highly effective
forms of contraception during the study and for 90 days after the last dose of
acalabrutinib + R-ICE.
10. Men who are sexually active and can beget children must agree to use highly effective
forms of contraception during the study and for 90 days after the last dose of
acalabrutinib + R-ICE.
11. Men must agree to refrain from sperm donation during the study and for 90 days after
the last dose of study drug.
12. Willing and able to participate in all required evaluations and procedures in this
study protocol including swallowing capsules without difficulty.
13. Ability to understand the purpose and risks of the study and provide signed and dated
informed consent and authorization to use protected health information (in accordance
with national and local subject privacy regulations).
Exclusion Criteria:
1. Germinal-center cell-of-origin DLBCL.
2. Patients who have had chemotherapy or radiotherapy < 21 days prior to first
administration of study treatment or those who have not recovered from adverse events
due to agents administered more than 4 weeks earlier.
3. Patients who are receiving any other investigational agents.
4. Patients with known central nervous system involvement of lymphoma.
5. History of allergic reactions attributed to compounds of similar chemical or biologic
composition to acalabrutinib or R-ICE with the exception of first-infusion reaction to
rituximab.
6. Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements. Recent infections requiring systemic treatment need to have
completed therapy > 7 days before the first dose of study drug.
7. Pregnant women are excluded from this study because an acalabrutinib R-ICE is a
chemotherapy program with the potential for teratogenic or abortifacient effects.
Because there is an unknown but potential risk for adverse events in nursing infants
secondary to treatment of the mother with acalabrutinib R-ICE, breastfeeding should be
discontinued if the mother is treated with acalabrutinib R-ICE.
8. HIV-positive patients on combination antiretroviral therapy are eligible, unless the
patient's CD4 count is below the institutional lower limit of normal, or the patient
is taking prohibited CYP3A4/5 strong inhibitors or inducers.
9. Patients may not have received any anti-cancer therapy for their primary rel/ref DLBCL
with the exception of palliative radiation therapy (RT).
10. Uncontrolled Autoimmune Hemolytic Anemia or immune thrombocytopenia purpura (ITP)
resulting in (or as evidenced by) declining platelet or Hgb levels within the 4 weeks
prior to first dose of study drug.
11. Presence of transfusion-dependent thrombocytopenia.
12. Prior exposure to a Bruton's tyrosine kinase (BTK) inhibitor.
13. History of prior malignancy, with the exception of the following:
1. Malignancy treated with curative intent felt to be at low risk for recurrence by
treating physician,
2. Adequately treated non-melanomatous skin cancer or lentigo maligna melanoma
without current evidence of disease,
3. Adequately treated cervical carcinoma in situ without current evidence of
disease.
14. Currently active clinically significant cardiovascular disease such as uncontrolled
arrhythmia, congestive heart failure, or Class 3 or 4 congestive heart failure as
defined by the New York Heart Association Functional Classification, or history of
myocardial infarction, unstable angina, or acute coronary syndrome within 6 months
prior to first dose with study drug.
15. Unable to swallow capsules, or disease significantly affecting gastrointestinal
function or, resection of the stomach or small bowel, or symptomatic inflammatory
bowel disease or ulcerative colitis, or partial or complete bowel obstruction.
16. Serologic status reflecting active hepatitis B or C infection. Patients that are
positive for hepatitis B core antibody, hepatitis B surface antigen (HBsAg), or
hepatitis C antibody will need a negative polymerase chain reaction (PCR) prior to
enrollment. (PCR positive patients will be excluded.) Hepatitis C antibody positive
patients are eligible if PCR is negative. Hepatitis B core antibody (+) patients
without evidence of HBsAg or Hep B PCR (+) are eligible with appropriate Hepatitis B
reactivation prophylaxis.
17. History of stroke or intracranial hemorrhage within 6 months prior to enrollment.
18. Current life-threatening illness, medical condition, or organ system dysfunction
which, in the Investigator's opinion, could compromise the patient's safety, or put
the study at risk.
19. Received anticoagulation therapy with Coumadin or equivalent vitamin K antagonists
within the last 28 days.
20. Vaccinated with live, attenuated vaccines with 4 weeks of first does of study drug.
21. Unresolved toxicities from prior anti-cancer therapy, defined as having not resolved
to Common Terminology Criteria for Adverse Event (CTCAE, version 5), grade ≤1, or to
the levels dictated in the inclusion/exclusion criteria with the exception of
alopecia.
22. Known bleeding disorders (e.g., von Willebrand's disease) or hemophilia.
23. Unwilling or unable to participate in all required study evaluations and procedures.
24. Currently active, clinically significant hepatic impairment (≥ moderate hepatic
impairment according to the NCI/Child Pugh classification.
25. Breastfeeding or pregnant.
26. Concurrent participation in another therapeutic clinical trial.
27. Patients who require proton pump inhibitors at baseline (prior to fist dose of study
drug) or strong CYP3A4 inhibitor or inducer and are not able to switch to another
medication
