Description:
The purpose of this study is to see if acalabrutinib is effective in treating a type of
cancer call central nervous system (CNS) lymphoma. Acalabrutinib has not been approved by the
Food and Drug Administration (FDA) for the treatment of CNS lymphoma. However, FDA has
approved its use for treatment of another type of lymphoma called mantle cell lymphoma.
Currently, there are no standard FDA approved treatments for treatment of CNS lymphoma.
Acalabrutinib acts similar to another cancer drug called ibrutinib. Ibrutinib was tested in
several research trials for management of CNS lymphomas, and the results were promising.
Acalabrutinib and ibrutinib attack a similar target found in CNC lymphoma. Research studies
show that acalabrutinib does a better job in attacking this target than ibrutinib, and this
might be beneficial for using this drug in treating CNS lymphoma. The purpose of this study
is test whether giving acalabrutinib is safe and could help controlling with CNS lymphoma.
The study doctors will be looking to see if acalabrutinib can shrink the cancer.
In this research study, participants will be given acalabrutinib and isavuconazol, because it
helps in preventing fungal infections. Fungal infection is a common side effect of
acalabrutinib. Treatment with acalabrutinib and isavuconazole will continue unless the cancer
progresses or participants experience bad side effects.
Title
- Brief Title: LCCC1841: A Phase 2 Trial of Acalabrutinib in Relapsed/Refractory Primary and Secondary CNS Lymphomas
- Official Title: LCCC1841: A Phase 2 Trial of Acalabrutinib in Relapsed/Refractory Primary and Secondary CNS Lymphomas
Clinical Trial IDs
- ORG STUDY ID:
LCCC1841
- NCT ID:
NCT04548648
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Acalabrutinib | ACP-196, CALQUENCE | Open-label, single-arm |
Isavuconazole | Cresemba | Open-label, single-arm |
Purpose
The purpose of this study is to see if acalabrutinib is effective in treating a type of
cancer call central nervous system (CNS) lymphoma. Acalabrutinib has not been approved by the
Food and Drug Administration (FDA) for the treatment of CNS lymphoma. However, FDA has
approved its use for treatment of another type of lymphoma called mantle cell lymphoma.
Currently, there are no standard FDA approved treatments for treatment of CNS lymphoma.
Acalabrutinib acts similar to another cancer drug called ibrutinib. Ibrutinib was tested in
several research trials for management of CNS lymphomas, and the results were promising.
Acalabrutinib and ibrutinib attack a similar target found in CNC lymphoma. Research studies
show that acalabrutinib does a better job in attacking this target than ibrutinib, and this
might be beneficial for using this drug in treating CNS lymphoma. The purpose of this study
is test whether giving acalabrutinib is safe and could help controlling with CNS lymphoma.
The study doctors will be looking to see if acalabrutinib can shrink the cancer.
In this research study, participants will be given acalabrutinib and isavuconazol, because it
helps in preventing fungal infections. Fungal infection is a common side effect of
acalabrutinib. Treatment with acalabrutinib and isavuconazole will continue unless the cancer
progresses or participants experience bad side effects.
Detailed Description
LCCC 1841 is a multicenter open-label, single-arm, phase 2 study designed to investigate the
antitumor effects of acalabrutinib in subjects with relapsed primary central nervous system
lymphoma (PCNSL), and relapsed secondary CNS lymphoma (SCNSL) with no evidence of current
systemic disease. Subjects with the following histological subtypes of lymphoma will be
included in the study: diffuse large B-cell lymphoma (DLBCL, all subtypes); mantle cell
lymphoma (MCL, all subtypes); plasmablastic lymphoma, and lymphoplasmacytic lymphoma. Up to
32 subjects will receive acalabrutinib at the dose of 100 mg approximately every 12 hours. A
Simon two-stage design will be used to minimize the expected sample size if the regimen has
low activity. In the first stage, 15 evaluable subjects will be enrolled and treated. If =8
subjects have an overall response of stable disease or better as determined by the
International Primary CNS Lymphoma Collaborative Group Response Assessment Criteria , an
additional 13 subjects will be enrolled and treated in the second stage of the study for a
total of 28 evaluable subjects treated on the trial. The study will accrue up to 32 subjects
to ensure data from 28 evaluable subjects. If <8 subjects have an overall response of stable
disease or better as determined by the International Primary CNS Lymphoma Collaborative Group
Response Assessment Criteria, the study will be closed to accrual and no additional subjects
will be enrolled. If the study shows a positive effect of acalabrutinib in treating CNS
lymphomas, acalabrutinib could become the standard relapsed CNS lymphoma regimen, not only
for PCNSL, but also in certain subtypes of SCNSL. Any complete responses to acalabrutinib
treatment will be clinically notable as spontaneous remissions do not occur.
In a previous study, ibrutinib showed a CR rate of 45% and an ORR of 68% ; in another study
], ibrutinib showed a CR rate of 17% and an ORR of 55%. Thus, in order to recommend further
investigation of acalabrutinib as a regimen for primary CNS lymphoma, acalabrutinib treatment
must show an overall response rate (ORR) of at least 70%, which would demonstrate that it is
not inferior to previously approved regimens.
Trial Arms
Name | Type | Description | Interventions |
---|
Open-label, single-arm | Other | A multicenter open-label, single-arm, phase 2 study designed to investigate the antitumor effects of acalabrutinib in subjects with relapsed primary central nervous system lymphoma (PCNSL), and relapsed secondary CNS lymphoma (SCNSL) with no evidence of current systemic disease. Subjects will receive acalabrutinib at the dose of 100 mg every 12 hours. Prophylactic administration of broad spectrum triazole antifungal agent isavuconazole will be performed while subjects receive acalabrutinib. | - Acalabrutinib
- Isavuconazole
|
Eligibility Criteria
Inclusion Criteria:
1. Written informed consent obtained to participate in the study and HIPAA authorization
for release of personal health information.
2. Age ≥18 years at the time of consent.
3. Subject has adequate performance status as defined by ECOG of ≤ 2. (Note: Performance
status can be assessed after administration of corticosteroids.)
4. Subject has histological confirmation of biopsy-proven CNS lymphoma OR MRI findings
consistent with CNS lymphoma if biopsy is not possible (due to inaccessible location).
Subjects with intra-ocular lymphoma will not be excluded as long as there is also
parenchymal disease.
5. Subject has B-cell Non-Hodgkin Lymphoma.
6. Subject has no evidence of systemic involvement of lymphoma confirmed by CT or PET-CT
imaging within 28 days prior to first dosing in the study.
7. Subject must have received at least one prior line of chemotherapy for primary or
secondary CNS lymphoma. There is no limit on the number of prior treatment regimens.
8. Subject has adequate organ function as demonstrated by: System Laboratory Value
Hematological* Absolute Neutrophil Count (ANC) ≥ 1 x 109/L Platelets ≥ 75 x 109/L
Renal* Calculated creatinine clearance ≥ 30 mL/min using the Cockcroft-Gault formula
(Appendix B) Hepatic* Bilirubin ≤ 1.5 × upper limit of normal (ULN). Subjects with
Gilbert's syndrome may be enrolled despite a total bilirubin level >1.5 mg/dL if their
conjugated bilirubin is <1.5× ULN) Aspartate aminotransferase (AST) ≤ 2.5 × ULN
Alanine aminotransferase (ALT) ≤ 2.5 × ULN Coagulation International Normalized Ratio
(INR) or Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) ≤ 2 ×
ULN (in the absence of lupus anticoagulant)
9. Subject is able to receive isavuconazole for prophylaxis of invasive aspergillosis
while subject receives acalabrutinib therapy.
10. Female subjects of childbearing potential must have a negative serum pregnancy test
within three days (72 hours) prior to initiating study treatment. Note: Females are
considered of childbearing potential unless they are surgically sterile (have
undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they
are naturally postmenopausal for at least 12 consecutive months. Documentation of
postmenopausal status must be provided.
10. Females of childbearing potential must be willing to abstain from heterosexual activity
or to use 2 forms of effective methods of contraception from the time of informed consent
until 2 days after the last dose of acalabrutinib. The two contraception methods can be
comprised of two barrier methods, or a barrier method plus a hormonal method.
Exclusion Criteria:
1. Subjects meeting any of the following exclusion criteria will not be able to participate
in this study 2.Prior cancer treatment that was completed less than 14 days prior to Day 1
of study dosing or if subject has not recovered from all reversible acute toxic effects of
the regimen to grade ≤1 or baseline.
3. Prior brain radiotherapy under the following conditions:
- Whole-brain radiotherapy (WBRT) that was completed less than 28 days prior to Day 1 of
study dosing
- Stereotactic radiosurgery (SRS) that was competed less than 14 days prior to Day 1 of
study dosing.
3. Currently participating in or has participated in a study of an investigational
agent within 28 days of first dosing with study treatment.
4.Subject is pregnant or breastfeeding (Note: breast milk cannot be stored for future
use while the mother is being treated on study).
5 Subject has a known additional malignancy that is active and/or progressive
requiring treatment; exceptions include basal cell or squamous cell skin cancer, in
situ cervical or bladder cancer, or other cancer for which the subject has been
disease-free for at least five years.
6. Subject has active CSF involvement that requires ongoing intrathecal chemotherapy.
7. Previous exposure to a BTK inhibitor. 8. Subjects with severe hepatic
insufficiency, as defined by Child-Pugh Score > 6 (Appendix C).
9. Subject is receiving prohibited medications or treatments as listed in Section 5.3
of the protocol that cannot be discontinued/replaced by an alternative therapy.
Subject requires treatment with a strong cytochrome P450 3A4 (CYP3A4)
inhibitor/inducer other than isavuconazole (please consult Section 5.3). Subjects may
be eligible if they are medically able to discontinue CYP3A4 inhibitors/inducers at
least 14 days before the first dose of study treatment.
10. Subject requires or receiving anticoagulation with warfarin or equivalent vitamin
K antagonists (e.g., phenprocoumon) within 14 days of first dose of study drug.
Subjects requires or is taking direct oral anticoagulants (e.g. apixaban, rivaroxaban,
edoxaban, lovenox) within 7 days of first dose of study drug.
11. Subject requires treatment with proton pump inhibitors (e.g., omeprazole,
esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole). Subjects
receiving proton pump inhibitors who switch to H2-receptor antagonists or antacids are
eligible for enrollment to this study.
12. Subject is currently receiving any chemotherapy, anticancer immunotherapy. Note:
Subjects receiving corticosteroids will be eligible, but corticosteroids are expected
to be tapered off as soon as possible from a clinical standpoint.
13. Subject has clinically significant cardiovascular disease such as ventricular
dysfunction, symptomatic coronary artery disease, uncontrolled or symptomatic
arrhythmias, congestive heart failure, or myocardial infarction within 6 months of
screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart
Association (NYHA) Functional Classification (Appendix D) at screening. Subjects with
controlled, asymptomatic atrial fibrillation during screening can enroll on study.
14. Subject has familial short QT syndrome. 15. Subject has a history of malabsorption
syndrome, disease significantly affecting gastrointestinal function, or resection of
the stomach or small bowel, symptomatic inflammatory bowel disease, partial or
complete bowel obstruction, or gastric restrictions and bariatric surgery, such as
gastric bypass that is likely to affect absorption.
16. Subject has a known history of infection with HIV or any uncontrolled active
significant infection (e.g., bacterial, viral or fungal).
17. Subject has a known history of drug-specific hypersensitivity or anaphylaxis to
acalabrutinib or isavuconazole (including active ingredient or excipient components).
18. Subject has active bleeding or history of bleeding diathesis (e.g., hemophilia or
von Willebrand disease).
19. Subject has a history of uncontrolled AIHA (autoimmune hemolytic anemia) or ITP
(idiopathic thrombocytopenic purpura).
20. Subject has a history of significant cerebrovascular disease/event, including
stroke or intracranial hemorrhage, within 6 months before the first dose of
acalabrutinib.
21. Subject had major surgical procedure within 28 days of first dose of
acalabrutinib. Note: 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 acalabrutinib.
22. Subject must either have hepatitis B core antibody negative OR if a subject is
hepatitis B core antibody positive they must have their hepatitis B viral load
checked. These subjects will be excluded if their viral load is positive. Subject who
are core antibody positive and viral load negative will be considered eligible, but
must receive entecavir prophylaxis.
23. Subjects who are hepatitis C antibody positive must have a negative polymerase
chain reaction (PCR) result. Those who are hepatitis C PCR positive will be excluded.
24. Subjects who are unable to swallow oral medications
Maximum Eligible Age: | 99 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall response rate |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Overall response rate (ORR; ORR= Partial Response + Complete Response) will be assessed at 2 months as measured by the International Primary CNS Lymphoma Collaborative Group Response assessment criteria in subjects with relapsed/refractory primary and secondary CNS lymphoma receiving acalabrutinib. |
Secondary Outcome Measures
Measure: | Number of different types of toxicities |
Time Frame: | 3 years |
Safety Issue: | |
Description: | Toxicity will be classified and graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE, version 5.0). |
Measure: | Progression-free survival (PFS) |
Time Frame: | 5 years |
Safety Issue: | |
Description: | Progression-free survival (PFS) is defined from the date of initiating study treatment to the date of disease progression per the International Primary CNS Lymphoma Collaborative Group response assessment criteria or death as a result of any cause. |
Measure: | Complete response (CR) rate |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Complete Response (CR) is defined using the International Primary CNS Lymphoma Collaborative Group response assessment criteria for primary CNS lymphoma. |
Measure: | Duration of response (DoR) |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Duration of response (DoR) is defined as time from documentation of tumor response to disease progression according to the International Primary CNS Lymphoma Collaborative Group response assessment criteria. |
Measure: | Overall Survival (OS) |
Time Frame: | 5 years |
Safety Issue: | |
Description: | OS will be measured from the date of initiating study treatment to the date of death or 5 years (whichever is first). Subjects who have not died by the analysis data cut-off date will be censored at their last date of contact. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | UNC Lineberger Comprehensive Cancer Center |
Trial Keywords
Last Updated
July 15, 2021