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)
Non-Hodgkin Lymphom
- NHL 15B
- NIVEAU
- ORACLE
NHL 15B
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