Non-Hodgkin Lymphom

NHL 15B
NIVEAU
ORACLE
Pola-R-ICE

NHL 15B

Phase II single-arm „window-of-opportunity“ study of a combination of obinutuzumab (GA-101) and venetoclax (ABT-199) in relapsed or refractory diffuse large B-cell lymphoma (DLBCL)

Synopsis

Short title: AGMT_NHL-15B

Title: Phase II single-arm „window-of-opportunity“ study of a combination of obinutuzumab (GA-101) and venetoclax (ABT-199) in relapsed or refractory diffuse large B-cell lymphoma (DLBCL)

Status: active, not recruiting

Start: January 2017

Coordinating Investigator: Univ. Prof. Dr. Ulrich Jäger

EudraCT Number: 2016-001760-10

ClinicalTrialsID: NCT02987400

Number of patients: 21

Sponsor: AGMT gemeinnützige GmbH

Design

Obinutuzumab is given i.v. at a dose of 1000 mg on days 1, 8, 15 in cycle 1 and on day 1 of each following cycle. Venetoclax is given at 800mg daily p.o. One cycle is 21 days. This combination treatment is repeated for up to 3 cycles. Eligible patients will then proceed to stem cell transplantation (in some patients stem cells were already harvested successfully).

A 9 cycles (27 weeks) maintenance phase with obinutuzumab and venetoclax will be given in patients ineligible for transplant.

The study had a 6 patient run-in phase to determine safety and to adjust treatment. A futility analysis is conducted when the first 10 patients have been evaluated for response: If at least two patients had an objective response (CR or PR) the study will be continued.

Primary objective:
  • To evaluate clinical activity and tolerability of obinutuzumab in combination with venetoclax in patients with relapsed/refractory DLBCL
Secondary objectives:
  • Safety: Incidence of dose-limiting toxicities of the combination treatment.
  • Response duration (from first documented response)
  • Progression-free survival
  • Overall survival
  • Ability to proceed to further stem cell transplantation (assessed by number of eligible
  • patients reaching transplant)
  • Identification of genetically/biomarker defined subgroups regarding response and survival

Inclusion/Exclusion criteria

Inclusion criteria (selected):
  • Patients ≥ 18 years of age
  • Diffuse large B-cell lymphoma (DLBCL)
    • with histologically confirmed relapse within 12 months after having achieved a PR or CR with initial R-anthracycline containing therapy, or
    • with refractoriness to initial R-anthracycline containing therapy (not achieving at least a partial response)
  • At least one bi-dimensionally measurable lesion on CT scan defined as > 1.5 cm in its longest dimension
  • ECOG Performance Status of 0, 1, or 2
  • Adequate organ function
Exclusion criteria (selected):
  • DLBCL transformed from other malignancies or CD20 negative DLBCL
  • Radiation, chemotherapy, or immunotherapy or any other anti-cancer therapy ≤ 4 weeks prior to Cycle 1 Day 1
  • Ongoing corticosteroid use > 30 mg/day of prednisone or equivalent
  • Acute or uncontrolled chronic infections
  • Presence of positive test results for Hepatitis B, Hepatitis C and CMV
  • Any sensory or motor peripheral neuropathy greater than or equal to Grade 2

DSHNHL_NIVEAU

Improvement of Outcome in Elderly Patients or Patients Not Eligible for High-dose Chemotherapy With Aggressive NHL in First Relapse/Progression by Adding Nivolumab to Gemcitabine, Oxaliplatin Plus Rituximab in Case of B-cell Lymphoma

Synopsis

Short title: DSHNHL 2015-1_NIVEAU

Title: Improvement of Outcome in Elderly Patients or Patients Not Eligible for High-dose Chemotherapy With Aggressive NHL in First Relapse/Progression by Adding Nivolumab to Gemcitabine, Oxaliplatin Plus Rituximab in Case of B-cell Lymphoma

Status: open

Start: September 2019 (in Austria)

Coordinating Investigator: Univ. Prof. Dr. Ulrich Jäger

EudraCT Number: 2016-002272-27

ClinicalTrialsID: NCT03366272

Number of patients: 388 (international)

Sponsor: University Hospital, Saarland; AGMT Sponsor representative in Austria

Design

This trial is designed as an international, multicentre, randomised, open-label, treatment optimisation study, preceded by safety run-in phases conducted for B-cell and T-cell lymphoma separately.

Aim of the phase-III trial is to test whether prognosis of patients with relapsed or refractory aggressive Non-Hodgkin Lymphoma not eligible for neither autologous nor allogeneic stem cell transplantation can be improved by combining nivolumab with (R)-GemOx.

All patients with  first relapse or progression of an aggressive Non-Hodgkin’s lymphoma aged older than 65 years or older than 18 years with HCT-CI score > 2 are eligible for this study irrespective of their gender or stage of disease. There is no upper limit of age. Also patients not eligible neither autologous nor allogeneic stem cell transplantation are eligible for this study.

The duration of therapy according to study protocol ranges between 16 and 52 weeks. Patients randomised to receive eight 2-week cycles of (R)-GemOx are 16 weeks on therapy. Patients randomised to receive eight 2-week cycles nivolumab plus (R)-GemOx followed by 18 2-week applications of nivolumab are 52 weeks on treatment.

Follow-up observation within the study will end for all patients presumably in Q4/2024, which is 2 years after inclusion of the last patient. Thus duration within the clinical study will last at least 2 years for the individual patient.

Primary objective:
  • 1-year Progression free survival (PFS)
Secondary objectives (selected):
  • Complete response rate after eight cycles of (R)-GemOx
  • Partial response rate after eight cycles of (R)-GemOx
  • Overall response rate after eight cycles of (R)-GemOx
  • Duration of response
  • Progression rate, relapse rate
  • EFS, OS, Toxicity

Inclusion/Exclusion criteria

Inclusion criteria (selected):
  • Histologically proven aggressive Non-Hodgkin’s lymphoma
  • Ineligibility for neither autologous nor allogeneic stem cell transplantation
  • Patients must have only one prior chemotherapy regimen including an anthracycline
  • All patient >65 years of age or older than 18 years if HCT-CI score > 2
  • All risk groups (IPI 0 to 5)
  • Performance status ECOG 0 – 2
Exclusion criteria (selected):
  • Already initiated lymphoma therapy after  rst relapse or progression
  • Serious accompanying disorder or impaired organ function
  • Previous therapy with Gemcitabine or Oxaliplatin
  • Patients with an active, known or suspected autoimmune disease
  • Prior chemo- or radiotherapy, long-term use of corticosteroids or anti-neoplastic drugs for previous disorder (except for  rst-line therapy of lymphoma)
  • CNS involvement of lymphoma or primary CNS lymphoma

ORACLE

Randomized Phase 3 Study evaluating the Efficacy and the Safety of Oral Azacitidine (CC-486) compared to Investigator’s Choice Therapy in Patient with Relapsed or Refractory Angioimmunoblastic T cell Lymphoma

Synopsis

Short title: ORACLE (OA-CL-LYM-LYSARC-13134)

Title: Randomized Phase 3 Study evaluating the Efficacy and the Safety of Oral Azacitidine (CC-486) compared to Investigator’s Choice Therapy in Patient with Relapsed or Refractory Angioimmunoblastic T cell Lymphoma

Status: active, not recruiting

Start: September 2019 (in Austria)

Coordinating Investigator: Assoc.-Prof. Priv.-Doz. DDr. Philipp Staber

EudraCT Number: 2017-003909-17

ClinicalTrialsID: NCT03593018

Number of patients: 86 (international)

Sponsor: LYSARC; AGMT Sponsor representative in Austria

Design

This study evaluates the efficacy of Oral azacitidine versus single-agent Investigator’s Choice Therapy in patients with Relapsed or Refractory Angioimmunoblastic T-cell Lymphoma.

Compared to B-cell Non-Hodgin Lymphoma (NHL), Angioimmunoblastic T-cell Lymphoma (AITL) is more resistant to conventional chemotherapy and is generally associated with an inferior outcome. In case of relapsed of refractory disease, survival durations are in the range of only a few months.

Several agents have been evaluated in this setting in recent years: romidepsin, bendamustine or belinostat. The response rate with these agents rarely exceeds 30% and responses are usually of limited duration.

Azacitidine is a nucleoside metabolic inhibitor indicated for the treatment of patients with various myelodysplastic syndrome (MDS) subtypes. In this case, azacitidine significantly increase the survival time compared to standard of care option. This response to azacitidine could be correlated to the existence of recurrent mutations and those mutations have also been described in AITL.

The present protocol will use Azacitidine according to the same schedule than in MDS that is continuous treatment until progression or unacceptable toxicity.

Experimental: Oral Azacitidine
Oral azacitidine 300mg during 14 first days of 28-days cycle for European (EU) patients, Oral azacitidine 200mg during 14 first days of 28-days cycle for Asian patients (Treatment until progression, patient decision or toxicity)

Active Comparator: Investigator’s choice therapy
Bendamustine 120mg/m² on days 1 and 2 of a 21-days cycle (during 6 cycles) or Gemcitabine 1200mg/m² on days 1, 8 and 15 of a 28-days cycle (during 6 cycles)

Primary objective:
  • Progression free survival (PFS) using local assessment of progressive disease according to Lugano Response Criteria (2014)
Secondary objectives (selected):
  • Overall Survival (OS) as key secondary endpoint
  • PFS by the Independent Review Committee (IRC)
  • Overall response rate (ORR)
  • Complete response rate (CRR)
  • Duration of response
  • Time to response
  • Safety

Inclusion/Exclusion criteria

Inclusion criteria (selected):
  • Patient is ≥ 18 years of age at the time of signing the informed consent form (ICF)
  • Patient had local diagnosed peripheral T cell lymphoma (PTCL) with T-follicular helper (TFH) phenotype according to the criteria of the latest WHO classification based on a surgical lymph node biopsy or needle core biopsy including any one of:
    • Angioimmunoblastic T cell lymphoma (AITL)
    • Follicular T cell lymphoma
    • Nodal peripheral T-cell lymphoma with TFH phenotype
    • There should be a documented expression of minimum two TFH markers by the tumoral cells among this panel of markers: CD10, CXCL13, PD1, ICOS, and BCL6 by the tumoral cells by immunohistochemistry
  • ECOG performance status 0 to 3
  • Relapsed (after partial or complete response) or refractory AITL after at least one line of systemic therapy
  • At least one measurable lesion on CT that is greater than 1.5 cm in the longest diameter for nodal lesions and greater than 1.0 cm in the longest diameter for extranodal lesions. The lesion must be measurable in two perpendicular dimensions. Patients with only cutaneous disease will be excluded.
Exclusion criteria (selected):
  • Clinical evidence of central nervous system involvement by lymphoma
  • Uncontrolled systemic fungal, bacterial, or viral infection
  • Prior exposure to azacitidine and/ or any other demethylating agent
  • Prior exposure to planned investigator’s choice therapy (eg. prior exposure to gemcitabine is an exclusion if gemcitabine is the planned investigator’s choice therapy prior to randomization)
  • Candidate for hematopoietic stem cell transplantation

Pola-R-ICE

An open-label, prospective Phase III clinical study to compare polatuzumab vedotin plus rituximab, ifosfamide, carboplatin and etoposide (Pola-R-ICE) with rituximab, ifosfamide, carboplatin and etoposide (R-ICE) alone as salvage therapy in patients with primary refractory or relapsed diffuse large B-cell lymphoma (DLBCL)

Synopsis

Short title: Pola-R-ICE

Title: An open-label, prospective Phase III clinical study to compare polatuzumab vedotin plus rituximab, ifosfamide, carboplatin and etoposide (Pola-R-ICE) with rituximab, ifosfamide, carboplatin and etoposide (R-ICE) alone as salvage therapy in patients with primary refractory or relapsed diffuse large B-cell lymphoma (DLBCL)

Status: approved

Start: November 2021 (in Austria)

Coordinating Investigator: Univ.-Prof. Dr. Richard Greil (in Austria)

EudraCT Number: 2019-002962-10

ClinicalTrialsID: NCT04833114

Number of patients: 334 (international)

Sponsor: GWT-TUD GmbH; AGMT Sponsor representative in Austria

Design

The study is designed as an international, multicenter, open-label, two-arm, prospective phase III study to compare the treatment of polatuzumab vedotin plus rituximab, ifosfamide, carboplatin and etoposide (Pola-R-ICE) with the combination of rituximab, ifosfamide, carboplatin and etoposide (R-ICE) alone as salvage therapy in patients with primary refractory or relapsed DLBCL.

The study will involve study sites in Germany, UK, Spain, and Austria. It is planned to include 324 patients who will be randomized 1:1 to receive either treatment in the experimental arm (Pola-R-ICE) or in the standard arm (R-ICE) to end up with 308 evaluable subjects for the randomized part of the trial. Further 10 patients will be treated with Pola-R-ICE during the safety run-in phase.

The study consists of a screening/inclusion visit, three chemotherapy cycles, an end-of – treatment visit (EoT), and follow-up visits. For each subject, the total duration of the study will be approximately 3 months of treatment plus at least 21 months follow-up. The study will end when the last included patient will have passed the last follow-up visit (LPLFU). For the study as a whole, the primary outcome will be evaluated when the last included patient will have completed the 21 months follow-up period or has left the study prematurely.

For the study as a whole, the primary outcome will be evaluated when the last included patient will have completed the 21 months follow-up period or has left the study prematurely.

Primary objective:

The primary objective of this study is to investigate the following question in patients with relapsed or primary refractory DLBCL: Does salvage therapy with Pola-R-ICE improve event-free survival (EFS) compared to R-ICE alone?

Secondary objectives (selected):

Secondary efficacy objectives of the study are to collect data in order to evaluate whether the addition of polatuzumab vedotin to standard therapy R-ICE

  • enhances the rate of metabolic complete response (CR) at the end of study treatment;
  • enhances the partial response (PR) rate and overall response rate (ORR) and decreases the progression rate and relapse rate;
  • enhances the duration of response, progression-free survival (PFS) and overall survival (OS);
  • impacts the mobilization of autologous CD34+ stem cells;
  • enhances the rate of patients proceeding to transplantation;
  • impacts the non-relapse mortality.

Inclusion/Exclusion criteria

Inclusion criteria:
  1. The informed consent form must be signed before any study specific tests or procedures are done
  2. Adult male and female patients ≥18 years at the time of inclusion in the study
  3. Ability to understand and follow study-related instructions
  4. Risk group: All patients with one of the following histologically defined entities: Histological diagnosis of primary refractory or relapsed aggressive B-cell non-Hodgkin lymphoma (B-NHL), confirmed by a biopsy of involved nodal or extranodal site. Patients with any of the following histologies can be included:
    • DLBCL not otherwise specified (NOS)
    • T-cell/histiocyte-rich large B-cell lymphoma
    • Primary cutaneous DLBCL, leg type
    • Epstein-Barr virus (EBV)-positive DLBCL, NOS
    • DLBCL associated with chronic inflammation
    • Primary mediastinal (thymic) large B-cell lymphoma
    • High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
    • High-grade B-cell lymphoma, NOS

    Refractory disease is defined as no complete remission to first line therapy; subjects who are intolerant to first line therapy are excluded. Three groups of patients are eligible:

    • Progressive disease (PD) as best response to first line therapy (biopsy not mandatory if diagnostic sample available).
    • Stable disease (SD) as best response after at least 4 cycles of first line therapy (e.g., 4 cycles of R-CHOP) (biopsy not mandatory if diagnostic sample available).
    • Partial response (PR) as best response after at least 6 cycles, and biopsy-proven residual disease or disease Progression after the partial response.

    Relapsed disease is defined as complete remission to first line therapy followed by biopsy proven disease relapse.

  5. Performance Status ECOG 0-2 at time of randomization or ECOG 3 at screening if this is DLBCL-related and has improved to ECOG 2 or less with a 7-day steroid treatment during the screening Phase (e.g. 1 mg/kg prednisone).
  6. Information on all 5 International Prognostic Index (IPI) factors
  7. Staging (PET-CT based-staging according to Lugano criteria 2014). Patients must have PET-positive lesions.
  8. Subjects must have received adequate first line therapy including at a minimum: i) anti-CD20 monoclonal antibody unless Investigator determines that tumor is CD20 negative, and ii) an anthracycline containing chemotherapy Regimen
  9. Intent to proceed to high-dose therapy (HDT) and stem cell transplantation (SCT) if response to second line therapy
  10. Adequate hematological function, as defined by: hemoglobin ≥ 8 g/dL, absolute neutrophil count (ANC) ≥ 1.0 x 109/L OR ≥ 0.5 x 109/L if neutropenia is attributable to underlying disease and before the administration of steroids, and platelet count ≥ 75 x 109/L OR ≥ 50 x 109/L if thrombocytopenia is attributable to Underlying disease
  11. Women of childbearing potential must have a negative pregnancy test result within 7 days prior to the first study drug Administration
  12. For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating eggs
  13. For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating sperm
Exclusion criteria:
  1. Serious accompanying disorder leading to impaired organ function causing significant clinical problems and reduced life expectancy of less than 3 months. In particular, patients with the following organ dysfunction caused by accompanying disorders are to be excluded:
    • Heart failure with left ventricular ejection fraction (LVEF) < 45%
    • Impaired pulmonary function with vital capacity (VC) or forced expiratory volume (FEV1) < 50% of normal (only in case of history of significant pulmonary disease)
    • Impaired renal function with glomerular filtration rate (GFR) < 50 mL/min (calculated)
    • Impaired liver function with alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT) or Bilirubin > 1.5 x upper limit of normal (ULN). If elevation is caused by the disease, threshold of 2.5 x ULN is accepted
    • Peripheral neuropathy > Grade II (2) Human immunodeficiency virus (HIV)-positivity with detectable viral load and/or a CD4+ count below 0.3/nL
  2. Hepatitis B and C as defined by seropositivity (HBsAG and anti HBe/ anti HBc; anti-Hc); in case of false positive serology (transfused antibodies) negative PCR-results will allow patient inclusion. Patients with occult or prior HBV infection (defined as negative HBsAg and positive hepatitis B core antibody [HBcAb]) may be included if HBV DNA is undetectable, provided that they are willing to undergo DNA testing on Day 1 of every cycle and monthly for at least 12 months after the last cycle of study Treatment
  3. Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) at study inclusion or any unresolved major episode of infection (as evaluated by the investigator) within 1 week prior to Cycle 1 Day 1
  4. Patients with suspected or latent tuberculosis. Latent tuberculosis needs to be confirmed by positive interferon-gamma release Assay
  5. Primary or secondary central nervous system (CNS) lymphoma at the time of recruitment
  6. Richter’s transformation or prior chronic lymphocytic leukemia (CLL)
  7. Vaccination with a live vaccine within 4 weeks prior to Treatment
  8. Recent major surgery (within 6 weeks before the start of Cycle 1 Day 1) other than for diagnosis
  9. Treatment with radiotherapy, chemotherapy, immunotherapy, immunosuppressive therapy, or any investigational agent for the purposes of treating cancer within 2 weeks prior to Cycle 1 Day1
  10. Received more than one line of therapy for DLBCL
  11. Received polatuzumab vedotin as part of the first line therapy
  12. Any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications
  13. Ongoing treatment or study procedures within any other Investigational Medicinal Product (IMP) clinical trial with the exception of follow-up. In case of a preceding clinical trial, last application of the respective IMP(s) must have been done more than five elimination half-lives before start of study medication in this trial.
  14. History of severe allergic or anaphylactic reactions to human, humanized, chimeric, or murine monoclonal antibodies
  15. History of hypersensitivity to any of the study drugs or their ingredients or to drugs with similar structure
  16. Contraindications according to the Investigator´s Brochure (IB) of polatuzumab vedotin or the local Summary of Product Characteristics (SmPCs) of the used rituximab, ifosfamide, carboplatin or etoposide products
  17. Criteria which in the opinion of the investigator preclude participation for scientific reasons, for reasons of compliance, or for reasons of the subject’s Safety
  18. Pregnancy or breastfeeding, or intending to become pregnant during the study or within 12 months after the last dose of study drug
  19. Close affiliation with the investigator (e.g. a close relative) or persons working at the study site
  20. Subject is an employee of the sponsor or involved Contract Research Organization

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