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A Study of Acalabrutinib vs Investigator's Choice of Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in R/R CLL

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ClinicalTrials.gov Identifier: NCT02970318
Recruitment Status : Active, not recruiting
First Posted : November 22, 2016
Last Update Posted : May 4, 2021
Sponsor:
Information provided by (Responsible Party):
Acerta Pharma BV

Brief Summary:
This study is designed to evaluate the efficacy of acalabrutinib compared with rituximab in combination with idelalisib or bendamustine in previously treated subjects with chronic lymphocytic leukemia (CLL).

Condition or disease Intervention/treatment Phase
Chronic Lymphocytic Leukemia Drug: Acalabrutinib (ACP-196) Drug: Rituximab Drug: Idelalisib Drug: Bendamustine Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 311 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Multicenter, Open-Label, Phase 3 Study of Acalabrutinib (ACP-196) Versus Investigator's Choice of Either Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Subjects With R/R Chronic Lymphocytic Leukemia
Actual Study Start Date : February 2, 2017
Estimated Primary Completion Date : June 25, 2021
Estimated Study Completion Date : March 19, 2026


Arm Intervention/treatment
Experimental: Acalabrutinib (ACP-196)
Acalabrutinib (ACP-196) Monotherapy
Drug: Acalabrutinib (ACP-196)
Acalabrutinib monotherapy

Active Comparator: Rituximab Plus Idelalisib or Bendamustine
Investigator's Choice of Rituximab Plus Idelalisib or Bendamustine
Drug: Rituximab
Rituximab in combination with idelalisib or bendamustine

Drug: Idelalisib
Idelalisib in combination with rituximab

Drug: Bendamustine
Bendamustine in combination with rituximab




Primary Outcome Measures :
  1. IRC-assessed progression-free survival (PFS) in Arm A compared to Arm B [ Time Frame: 48 months ]
    PFS, defined as the time from date of randomization to date of IRC-assessed disease progression or death due to any cause, whichever comes first. Response is per International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 20008 criteria (Hallek, et al), with clarification for treatment-related lymphocytosis (Cheson et al) 2012.


Secondary Outcome Measures :
  1. 1. Investigator-assessed progression-free survival (PFS) in Arm A compared to Arm B [ Time Frame: 48 months ]
    PFS, defined as the time from date of randomization to date of IRC-assessed disease progression or death due to any cause, whichever comes first. Response is per International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 20008 criteria (Hallek, et al), with clarification for treatment-related lymphocytosis (Cheson et al) 2012.

  2. 2. Investigator and IRC-assessed overall response rate (ORR) in Arm A compared to Arm B [ Time Frame: 48 months ]
    ORR is defined as best response of complete response (CR), complete response with incomplete bone marrow recovery (CRi), nodular partial response (nPR), or partial response as assessed by the IRC and Investigator, on or before initiation of subsequent anticancer therapy.

  3. 3. Overall survival (OS) in Arm A compared to Arm B [ Time Frame: 48 months ]
    OS is defined as the time from date of randomization to death due to any cause.

  4. 4. Patient reported outcomes (PROs) in Arm A compared to Arm B [ Time Frame: 48 months ]
    PROs are based on Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-Fatigue). PROs are not collected with Protocol Amendment Version 6.

  5. 5. Investigator and IRC-assessed duration of response (DOR) in Arm A compared to Arm B [ Time Frame: 48 months ]
    DOR is defined as the interval from first documentation of Investigator and IRC-assessed CR, CRi, nPR or PR, to first documentation of disease progression or death from any cause, whichever is earlier.

  6. 6. Time to next treatment (TTNT) in Arm A compared to Arm B [ Time Frame: 48 months ]
    TTNT is defined as the time from date of randomization to the date of institution of non-protocol specified treatment for CLL (or first dose of acalabrutinib for Arm B subjects who crossed over to receive acalabrutinib) or death due to any cause, whichever comes first.



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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Men and women ≥ 18 years of age.
  2. ECOG performance status of 0 to 2.
  3. Diagnosis of CLL that meets published diagnostic criteria (Hallek 2008):

    1. Monoclonal B-cells (either kappa or lambda light chain restricted) that are clonally co-expressing ≥ 1 B-cell marker (CD19, CD20, or CD23) and CD5.
    2. Prolymphocytes may comprise ≤ 55% of blood lymphocytes.
    3. Presence of ≥ 5 x 10^9 B lymphocytes/L (5000/μL) in the peripheral blood (at any point since initial diagnosis).
  4. Must have documented CD20-positive CLL.
  5. Active disease meeting ≥ 1 of the following IWCLL 2008 criteria for requiring treatment:

    1. Evidence of progressive marrow failure as manifested by the development of, or worsening of, anemia (hemoglobin < 10 g/dL) and/or thrombocytopenia (platelets < 100,000/μL).
    2. Massive (i.e., ≥ 6 cm below the left costal margin), progressive, or symptomatic splenomegaly.
    3. Massive nodes (i.e., ≥ 10 cm in the longest diameter), progressive, or symptomatic lymphadenopathy.
    4. Progressive lymphocytosis with an increase of > 50% over a 2-month period or a LDT of < 6 months. LDT may be obtained by linear regression extrapolation of ALC obtained at intervals of 2 weeks over an observation period of 2 to 3 months. In subjects with initial blood lymphocyte counts of < 30 x 10^9/L (30,000/μL), LDT should not be used as a single parameter to define indication for treatment. In addition, factors contributing to lymphocytosis or lymphadenopathy other than CLL (e.g., infections) should be excluded.
    5. Autoimmune anemia and/or thrombocytopenia that is poorly responsive to standard therapy.
    6. Constitutional symptoms documented in the subject's chart with supportive objective measures, as appropriate, defined as ≥ 1 of the following disease-related symptoms or signs:

    i. Unintentional weight loss ≥ 10% within the previous 6 months before screening.

    ii. Significant fatigue (ECOG performance score 2; inability to work or perform usual activities).

    iii. Fevers higher than 100.5°F or 38.0°C for ≥ 2 weeks before screening without evidence of infection.

    iv. Night sweats for > 1 month before screening without evidence of infection.

  6. Meet the following laboratory parameters:

    1. ANC ≥ 750 cells/μL (0.75 x 10^9/L), or ≥ 500 cells/μL (0.50 x 10^9/L) in subjects with documented bone marrow involvement, and independent of growth factor support 7 days before assessment.
    2. Platelet count ≥ 50,000 cells/μL (50 x 10^9/L), or ≥ 30,000 cells/μL (30 x 10^9/L) in subjects with documented bone marrow involvement, and without transfusion support 7 days before assessment. Subjects with transfusion-dependent thrombocytopenia are excluded. If an Investigator has chosen bendamustine/rituximab as the Arm B treatment, platelets must be ≥ 75,000 cells/μL (75 x 10^9/L).
    3. Serum AST and ALT ≤ 2.0 x ULN.
    4. Total bilirubin ≤ 1.5 x ULN.
    5. Estimated creatinine clearance of ≥ 30 mL/min, calculated using the formula of Cockcroft and Gault [(140-Age) • Mass (kg)/(72 • creatinine mg/dL); multiply by 0.85 if female].
  7. Must have received ≥ 1 prior systemic therapies for CLL. Note: Single-agent steroids or localized radiation are not considered a prior line of therapy. If a single-agent anti-CD20 antibody was previously administered, subjects must have received ≥ 2 doses.
  8. Women who are sexually active and can bear children must agree to use highly effective forms of contraception while on the study and for 2 days after the last dose of acalabrutinib, 90 days after the last dose of idelalisib, 6 months after the last dose of bendamustine, or 12 months after the last dose of rituximab, whichever is longer. Highly effective forms of contraception are defined in Section 9.2.5.
  9. 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 idelalisib, 6 months after the last dose of bendamustine, or 12 months after the last dose of rituximab, whichever is longer. Highly effective forms of contraception are defined in Section 9.2.5.
  10. Men must agree to refrain from sperm donation during the study and for 90 days after the last dose of idelalisib, 6 months after the last dose of bendamustine, or 12 months after the last dose of rituximab, whichever is longer.
  11. Willing and able to participate in all required evaluations and procedures in this study protocol, including swallowing capsules without difficulty.
  12. 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 patient privacy regulations).

Exclusion Criteria:

  1. Known CNS lymphoma or leukemia.
  2. Known prolymphocytic leukemia or history of, or currently suspected, Richter's syndrome.
  3. Uncontrolled AIHA or ITP defined as declining hemoglobin or platelet count secondary to autoimmune destruction within the screening period or requirement for high doses of steroids (> 20 mg daily of prednisone or equivalent).
  4. Prior exposure to a BCL-2 inhibitor (e.g., venetoclax/ABT-199) or a BCR inhibitor (e.g., BTK inhibitors or PI3K inhibitors). Prior bendamustine is allowed if Investigator's choice for treatment in Arm B is idelalisib with rituximab. Bendamustine retreatment is allowed if the prior response to bendamustine lasted > 24 months.
  5. Received any chemotherapy, external beam radiation therapy, anticancer antibodies, or investigational drug within 30 days before first dose of study drug.
  6. Corticosteroid use > 20 mg daily prednisone equivalent within 1 week before first dose of study drug, except as indicated for other medical conditions such as inhaled steroid for asthma, topical steroid use, or as premedication for administration of study drug or contrast. For example, subjects requiring steroids at daily doses > 20 mg prednisone equivalent systemic exposure daily, or those who are administered steroids for leukemia control or white blood cell count lowering are excluded.
  7. Prior radio- or toxin-conjugated antibody therapy.
  8. Prior allogeneic stem cell transplant or prior autologous transplant within 6 months of first dose of study drug(s) or presence of graft-vs-host disease or receiving treatment for graft-vs-host disease.
  9. Major surgical procedure within 30 days of first dose of study drug. 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 study drug.
  10. History of prior malignancy except for the following:

    1. Malignancy treated with curative intent and with no evidence of active disease present for more than 2 years before screening and felt to be at low risk for recurrence by treating physician.
    2. Adequately treated lentigo maligna melanoma without current evidence of disease or adequately controlled nonmelanomatous skin cancer.
    3. Adequately treated carcinoma in situ without current evidence of disease.
  11. Significant cardiovascular disease such as uncontrolled or untreated 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 Functional Classification, or QTc > 480 msec (calculated using Fridericia's formula: QT/RR^0.33) at screening. Exception: Subjects with controlled, asymptomatic atrial fibrillation during screening are allowed to enroll on study.
  12. Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach, or extensive small bowel resection that is likely to affect absorption, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction, or gastric restrictions and bariatric surgery, such as gastric bypass.
  13. Received a live virus vaccination within 28 days of first dose of study drug.
  14. Known history of infection with HIV or any uncontrolled active systemic infection (e.g., bacterial, viral, or fungal). For study sites in Germany: active infection with human immunodeficiency virus (seropositivity for HIV-1 or HIV-2 antibodies, and if positive, reactivity against the HIV-specific p24 antigen).
  15. Active CMV infection (active viremia as evidenced by positive polymerase chain reaction [PCR] result for CMV DNA).
  16. Serologic status reflecting active hepatitis B or C infection.

    1. Subjects who are anti-HBc positive and who are surface antigen negative will need to have a negative PCR result before randomization. Those who are HbsAg-positive or hepatitis B PCR positive will be excluded.
    2. Subjects who are hepatitis C antibody positive will need to have a negative PCR result before randomization. Those who are hepatitis C PCR positive will be excluded.
  17. Ongoing, drug-induced liver injury, alcoholic liver disease, non-alcoholic steatohepatitis, primary biliary cirrhosis, ongoing extrahepatic obstruction caused by cholelithiasis, cirrhosis of the liver, or portal hypertension.
  18. History of or ongoing drug-induced pneumonitis.
  19. History of serious allergic reactions including anaphylaxis and toxic epidermal necrolysis.
  20. History of stroke or intracranial hemorrhage within 6 months before first dose of study drug.
  21. History of bleeding diathesis (e.g., hemophilia, von Willebrand disease).
  22. Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists (e.g., phenprocoumon) within 7 days of first dose of study drug.
  23. Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months before screening.
  24. Requires treatment with a strong CYP3A inhibitor/inducer.
  25. 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.
  26. Breast feeding or pregnant.
  27. Concurrent participation in another therapeutic clinical trial.
  28. Prothrombin time/INR or aPTT (in the absence of a Lupus anticoagulant) > 2.0 x ULN. Exception: Subjects receiving warfarin are excluded, however, those receiving other anticoagulant therapy who have a higher INR/aPTT may be permitted to enroll to this study after discussion with the medical monitor.
  29. History of confirmed progressive multifocal leukoencephalopathy (PML)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02970318


Locations
Show Show 159 study locations
Sponsors and Collaborators
Acerta Pharma BV
Investigators
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Study Director: Acerta Clinical Trials 1-888-292-9613; acertamc@dlss.com
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Acerta Pharma BV
ClinicalTrials.gov Identifier: NCT02970318    
Other Study ID Numbers: ACE-CL-309
First Posted: November 22, 2016    Key Record Dates
Last Update Posted: May 4, 2021
Last Verified: April 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal.

All request will be evaluated as per the AZ disclosure commitment:

https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. Yes, indicates that AZ are accepting requests for IPD, but this does not mean all requests will be shared.

Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA Pharma Data Sharing Principles. For details of our timelines, please rerefer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Access Criteria: When a request has been approved AstraZeneca will provide access to the deidentified individual patient-level data in an approved sponsored tool . Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
URL: https://astrazenecagroup-dt.pharmacm.com/DT/Home

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Acerta Pharma BV:
CLL
BTK
Bruton Tyrosine Kinase
acalabrutinib
ACP-196
Additional relevant MeSH terms:
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Leukemia
Leukemia, Lymphoid
Leukemia, Lymphocytic, Chronic, B-Cell
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Leukemia, B-Cell
Rituximab
Bendamustine Hydrochloride
Idelalisib
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Enzyme Inhibitors