Clinical Trials /

A Study of Ruxolitinib and Duvelisib in People With Lymphoma

NCT05010005

Description:

This study will test the safety of ruxolitinib, given at one dose that does not change, and duvelisib, given at different doses, to find out what effects, if any, the study treatment has on people with relapsed or refractory NK-cell or T-cell lymphoma.

Related Conditions:
  • Adult T-Cell Acute Lymphoblastic Leukemia
  • Aggressive NK-Cell Leukemia
  • Angioimmunoblastic T-Cell Lymphoma
  • Cutaneous Lymphoma
  • Enteropathy-Associated T-Cell Lymphoma
  • Follicular T-Cell Lymphoma
  • Hepatosplenic T-Cell Lymphoma
  • Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma
  • Nasal Type Extranodal NK/T-Cell Lymphoma
  • Nodal Peripheral T-Cell Lymphoma with TFH Phenotype
  • Peripheral T-Cell Lymphoma
  • Primary Cutaneous Anaplastic Large Cell Lymphoma
  • Primary Cutaneous Gamma-Delta T-Cell Lymphoma
  • Primary Cutaneous T-Cell Non-Hodgkin Lymphoma
  • Subcutaneous Panniculitis-Like T-Cell Lymphoma
  • Systemic Anaplastic Large Cell Lymphoma
  • T-Cell Large Granular Lymphocyte Leukemia
  • T-Cell Prolymphocytic Leukemia
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: A Study of Ruxolitinib and Duvelisib in People With Lymphoma
  • Official Title: Phase I Multicenter Study of Ruxolitinib and Duvelisib in Relapsed or Refractory T- or NK-Cell Lymphomas

Clinical Trial IDs

  • ORG STUDY ID: 21-176
  • NCT ID: NCT05010005

Conditions

  • T-cell Lymphomas
  • NK-Cell Lymphomas

Interventions

DrugSynonymsArms
RuxolitinibRuxolitinib and Duvelisib
DuvelisibRuxolitinib and Duvelisib

Purpose

This study will test the safety of ruxolitinib, given at one dose that does not change, and duvelisib, given at different doses, to find out what effects, if any, the study treatment has on people with relapsed or refractory NK-cell or T-cell lymphoma.

Trial Arms

NameTypeDescriptionInterventions
Ruxolitinib and DuvelisibExperimentalRuxolitinib 20mg BID plus Duvelisib 25mg, 50mg, or 75mg BID. Patients will be instructed to take duvelisib and ruxolitinib by mouth every 12 hours, the same time each day, +/- 2 hours. Duvelisib and ruxolitinib will be provided via the institutional investigational pharmacy. Dose escalation. The researchers will utilize a dose-escalation standard 3+3 design in which we evaluate 3 doses of duvelisib (25mg BID, 50mg BID, and 75mg BID) in combination with ruxolitinib 20mg BID. A minus-1 dose level of duvelisib (15mg BID) can be used if de-escalation is needed. The cohort expansion phase will have two treatment groups JAK/STAT activation or mutation present or JAK/STAT activation or mutation absent or unknown.
  • Ruxolitinib
  • Duvelisib

Eligibility Criteria

        Inclusion Criteria:

          1. Pathologically-confirmed mature T-cell lymphomas at the enrolling institution.

        Permitted histologies include:

        i) Stage ≥Ib CTCL, which has relapsed or progressed after at least two systemic therapies.
        In order to ensure balanced enrollment for patients with systemic T-cell lymphoma and CTCL,
        a maximum of 15 CTCL patients will be enrolled in expansion cohort.

        ii) Systemic anaplastic large cell lymphoma that has relapsed after therapy containing
        brentuximab vedotin

        For the following histologies, patients are required have received at least 1 prior
        therapy:

        iii) T-cell prolymphocytic leukemia

        iv) T-cell large granular lymphocytic leukemia

        v) Aggressive NK-cell leukemia

        vi) Adult T-cell leukemia/lymphoma

        vii) Extranodal NK/T- cell lymphoma, nasal type

        viii) Enteropathy-associated T-cell lymphoma

        ix) Monomorphic epitheliotropic intestinal t-cell lymphoma

        x) Hepatosplenic T cell lymphoma

        xi) Subcutaneous panniculitis-like T-cell lymphoma

        xii) Primary cutaneous anaplastic large cell lymphoma

        xiii) Primary cutaneous gamma/delta T-cell lymphoma

        xiv) Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma

        xv) Peripheral T-cell lymphoma, not otherwise specified

        xvi) Angioimmunoblastic T cell lymphoma

        xvii) Follicular T-cell lymphoma

        xviii) Nodal peripheral T-cell lymphoma wih T follicular helper phenotype

        b) Age ≥18 years at time of enrollment

        c) Performance status, as assessed in the ECOG grading system, ≤2

        d) Laboratory criteria.

        Laboratory criteria

        i) For dose escalation phase:

          1. Absolute neutrophil count ≥1.0 K/mcL (Note: growth factor is allowed)

          2. Platelet count ≥80 K/μl or ≥50 K/μl if due to lymphoma

          3. Calculated creatinine clearance ≥60mL/min by Cockcroft-Gault

          4. Total bilirubin ≤1.5x upper limit of normal (ULN) or ≤3x ULN if documented hepatic
             involvement with lymphoma, or ≤5x ULN if history of Gilbert's syndrome; AST and ALT ≤
             3x ULN; or ≤ 5x ULN if due to lymphoma involvement

        ii) For dose expansion phase:

          1. Absolute neutrophil count ≥1.0 K/mcL or ≥0.5 K/mcL if due to lymphoma or ≥0.0 K/mcL if
             due to T-PLL or large granular lymphocytic leukemia (LGL) (Note: growth factor is
             allowed).

          2. Platelet count ≥80 K/μl or ≥50 K/μl if due to lymphoma

          3. Calculated creatinine clearance ≥60mL/min by Cockcroft-Gault

          4. Total bilirubin ≤1.5x upper limit of normal (ULN) or ≤3x ULN if documented hepatic
             involvement with lymphoma, or ≤5x ULN if history of Gilbert's syndrome; AST and ALT ≤
             3x ULN; or ≤ 5x ULN if due to lymphoma involvement

        e) Measurable disease, defined by at least one of the following:

        °Revised International Working Group Classification for systemic lymphoma19

        °Atypical T lymphocytes quantifiable by flow cytometry or morphology in the peripheral
        blood or bone marrow

          -  mSWAT (Modified Severity Weighted Assessment Tool) >0

             f) Ability to swallow pills

             g) Women of reproductive potential* must have a negative serum or urine β human
             chorionic gonadotropin (βhCG) pregnancy test within 14 days of initiating therapy. All
             women of reproductive potential and all sexually active male patients must agree to
             use adequate methods of birth control (e.g. latex condoms) throughout the study and
             for 3 months after the last dose of study drug.

             °*A woman of reproductive potential is a sexually-mature woman who: has not undergone
             a hysterectomy or bilateral oophorectomy; or has not been naturally postmenopausal for
             at least 24 consecutive months (i.e. has had menses at any time in the preceding 24
             consecutive months).

          -  The effects of duvelisib on conception, pregnancy, and lactation are unknown. Since
             duvelisib has not been evaluated in pregnant or nursing women, the treatment of
             pregnant women or women of childbearing potential who are not using a highly effective
             contraception is contraindicated.

        Exclusion Criteria:

          1. Any serious medical condition, laboratory abnormality, or psychiatric illness that
             would prevent the subject from signing the informed consent form.

          2. Pregnant women. (Lactating women must agree not to breast feed while taking study
             medications).

          3. Prior allogeneic stem cell transplant.

          4. Prior use of duvelisib or ruxolitinib if either agent was discontinued due to
             toxicity.

          5. Previous systemic anti-cancer therapy for TCL within 14 days of initiating study drug
             a. Patients who have received localized RT as part of their immediate prior therapy
             may be allowed to enroll with shorter washout period after discussion with the MSK
             Principal Investigator.

        b. Systemic corticosteroids must be tapered to 20mg/day or less prednisone (or equivalent)
        upon start of investigational treatment.

        c. Topical steroids for CTCL is permitted on study.

        f) Ongoing use of immunosuppressant medications, including corticosteroids greater than
        20mg of prednisone or equivalent at the time of enrollment

        g) History of chronic liver disease, veno-occlusive disease, or current alcohol abuse

        h) Administration of a live vaccine within 6 weeks of first dose of study drug.

        i) Prior surgery or gastrointestinal condition that may adversely affect drug absorption
        (e.g., gastric bypass surgery, gastrectomy)

        j) Patients with HIV infection if they meet either of the below criteria:

        i. detectable viral load ii. undetectable viral load with CD4 count <200 or not taking
        anti-retroviral medications.

        k) Patients with chronic hepatitis B or C as defined by positive hepatitis B or C serology:

          -  Subjects with a negative HBsAg and a positive HBcAb require an undetectable/negative
             hepatitis B DNA test (e.g., polymerase chain reaction [PCR] test) to be enrolled, and
             must receive hepatitis B prophylaxis until at least 6 months after completion of study
             drug(s).

             l) Subjects with active CMV (defined as positive CMV PCR with clinical manifestations
             consistent with active CMV infection) and requiring therapy. Carriers will be
             monitored per institutional guidelines.

             m) Unable or unwilling to receive prophylaxis against pneumocystis, herpes simplex
             virus, or herpes zoster

             g) Use of medications or consumption of foods that are strong inducers or inhibitors
             of CYP3A

          -  Such agents must be discontinued at least 2 weeks prior to study intervention

          -  Patients who (after enrollment) require use of a strong CYP3A4 inhibitor to treat a
             fungal/mold infection will require dose reductions n) Receipt of treatment for
             tuberculosis within 2 years prior to enrollment

             o) Receiving therapy for another primary malignancy (other than T-cell lymphoma).

          -  Patients with more than one type of lymphoma may be enrolled after discussion with the
             MSK Principal Investigator.

          -  Early-stage cutaneous basal cell and squamous cell carcinomas are permissible

          -  Adjuvant or maintenance therapy to reduce the risk of recurrence of other malignancy
             is potentially permissible after discussion with the MSK Principal Investigator.

             p) Known central nervous system or meningeal involvement by TCL (in the absence of
             symptoms, investigation into central nervous system involvement is not required).

             q) Unstable or severe uncontrolled medical condition (e.g., unstable cardiac function,
             unstable pulmonary condition) or any important medical illness that would, in the
             Investigator's judgment, increase the risk to the patient associated with his or her
             participation in the study.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Assessment for MTD/optimal dose
Time Frame:1 year
Safety Issue:
Description:3 subjects will be enrolled and followed for eight weeks of safety assessments. If no DLT is observed after all three subjects have been observed for eight weeks, a second cohort of 3 subjects will be enrolled at the next highest dose level. Cohorts will continue to be enrolled and observed until one subject experiences a DLT or the maximum dose level is reached with 0 or 1/6 DLTs.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Memorial Sloan Kettering Cancer Center

Trial Keywords

  • mature T-cell lymphomas
  • Ruxolitinib
  • Duvelisib
  • Relapsed or Refractory
  • 21-176

Last Updated

August 23, 2021