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Study to Assess Enzastaurin + R-CHOP in Subjects With DLBCL With the Genomic Biomarker DGM1™

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT03263026
Recruitment Status : Active, not recruiting
First Posted : August 28, 2017
Last Update Posted : February 7, 2022
Information provided by (Responsible Party):
Denovo Biopharma LLC

Brief Summary:
This randomized, placebo-controlled phase 3 study is planned to enroll approximately 235 treatment-naïve subjects with high-risk Diffuse Large B-Cell Lymphoma (DLBCL). Subjects will be randomized 1:1 to R-CHOP plus enzastaurin or R CHOP (plus placebo during induction). All subjects will receive up to 6 cycles (3 weeks per cycle) of treatment. PET/ CT will be used to assess radiographic response at the end of treatment. Each subject's treatment assignment will be unblinded after initial phase of treatment. Subjects randomized to the enzastaurin arm who have a response will be offered maintenance treatment of the study drug for up to 2 additional years.

Condition or disease Intervention/treatment Phase
Diffuse Large B-Cell Lymphoma Drug: Enzastaurin Hydrochloride Other: R-CHOP + placebo Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 235 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:

Subjects will be randomly assigned to receive one of the following: R-CHOP plus enzastaurin or R-CHOP plus placebo, during two treatment periods: induction and maintenance. Induction phase: all subjects will receive R-CHOP for up to six, 21-day cycles. Subjects in the enzastaurin arm will receive a 1125 mg loading dose on Day 2 followed by 500 mg daily. Subjects in the placebo arm will take an identical number of tablets.

After 4-<6 cycles of induction therapy treatment assignment will be unblinded. Subjects in the enzastaurin arm who have achieved a response will have the opportunity to continue in the single-agent, maintenance phase of the study, and will receive single-agent enzastaurin at 500 mg/day for up to 2 years. Eligible subjects must begin the maintenance phase of the study within 6 weeks of completing induction therapy.

Masking: Triple (Participant, Care Provider, Investigator)
Masking Description: Denovo Biopharma, the study Sponsor, will also be blinded.
Primary Purpose: Treatment
Official Title: A Randomized Phase 3 Study to Evaluate the Efficacy and Safety of Enzastaurin Plus R-CHOP Versus R-CHOP in Treatment-Naive Subjects With High-Risk Diffuse Large B-Cell Lymphoma Who Possess the Novel Genomic Biomarker DGM1™
Actual Study Start Date : March 20, 2018
Estimated Primary Completion Date : May 2022
Estimated Study Completion Date : September 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lymphoma

Arm Intervention/treatment
Active Comparator: R-CHOP + enzastaurin hydrochloride
Subjects in the R-CHOP + enzastaurin Arm will receive R-CHOP (Rituximab-375 mg/m2 i.v., Cyclophosphamide-750 mg/m2 i.v., Doxorubicin-50 mg/m2 i.v., Vincristine-1.4 mg/m2 i.v. (2 mg max), and Prednisone-100 mg p.o.), as directed, plus a 1125 mg loading dose of enzastaurin on Day 2 followed by 500 mg daily.
Drug: Enzastaurin Hydrochloride
R-CHOP + Enzastaurin (Kinenza®) 125 mg
Other Name: Kinenza®

Placebo Comparator: R-CHOP + placebo
Subjects in the R-CHOP + placebo Arm will receive R-CHOP (Rituximab-375 mg/m2 i.v., Cyclophosphamide-750 mg/m2 i.v., Doxorubicin-50 mg/m2 i.v., Vincristine-1.4 mg/m2 i.v. (2 mg max), and Prednisone-100 mg p.o.), as directed, plus an identical number of tablets as the subjects in the enzastaurin Arm.
Other: R-CHOP + placebo
R-CHOP + placebo
Other Name: Placebo

Primary Outcome Measures :
  1. Overall survival in subjects who possess the DGM1™ biomarker [ Time Frame: 3.5 years ]
    The primary objective of this study is to compare the effect of R-CHOP/enzastaurin versus R-CHOP alone on overall survival in treatment naive, high-risk subjects with DLBCL who possess the DGM1™ biomarker.

Secondary Outcome Measures :
  1. Overall survival in subjects who do not possess the DGM1™ biomarker [ Time Frame: 3.5 years ]
    A secondary objective of this study is to compare the effect of R-CHOP/enzastaurin versus R-CHOP alone on overall survival in treatment naive, high-risk subjects with DLBCL who do not possess the DGM1™ biomarker.

  2. Safety of enzastaurin by assessing incidence of adverse events/serious adverse events, change of vital signs, ECG results, lab results, and physical exam findings from baseline [ Time Frame: 3.5 years ]

    The safety analysis will include the following:

    • Summary of extent of exposure
    • Summary of the number of blood transfusions required
    • Summary of adverse events, serious adverse events, and subjects discontinuing for adverse events rates
    • Summary of laboratory findings and change from baseline
    • Summary of QTc data and change from baseline according to ICH E14
    • Summary of other relevant safety observations
    • Listings of laboratory and non-laboratory adverse events by maximum CTCAE grade and relationship to study drug using CTCAE v4.03

Other Outcome Measures:
  1. Presence of chromaturia as a predictor of efficacy [ Time Frame: 3.5 years ]
    Urine color will be analyzed by the central lab and overall survival will be determined for subjects with reddish discoloration of the urine. Testing may be performed to define the chemical profile of the urine.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria

  1. Male or female at least 18 years of age and able to provide informed consent.
  2. Histologically-confirmed diagnosis of CD20-positive DLBCL based on the WHO classification (2016); the diagnosis must be confirmed at the enrolling site. Subjects with high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements and high-grade B-cell lymphoma, NOS are eligible.
  3. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.
  4. International Prognostic Index (IPI) score of at least 3.
  5. Estimated life expectancy of at least 12 weeks.
  6. Adequate organ function as follows (within 14 days prior to randomization):

    1. Hepatic: total bilirubin ≤1.5 times upper limit of normal (ULN); alanine transaminase (ALT) and aspartate transaminase (AST) ≤1.5 times ULN (<5 times ULN if liver involvement)
    2. Renal: creatinine clearance of >50 mL/min by Cockcroft- Gault equation
    3. Bone marrow: platelets ≥75 x 109/L, absolute neutrophil count (ANC) ≥1.5 x 109/L, hemoglobin ≥10 g/dL. (Platelets ≥50 x 109/L, ANC ≥1.0 x 109/L, hemoglobin ≥8 g/dL permitted if documented bone marrow involvement)
  7. Male or female with reproductive potential, must be willing to use an approved contraceptive method (for example, intrauterine device (IUD), birth control pills, or barrier device) during and for 3 months after discontinuation of study treatment. Women of childbearing potential must have a negative serum pregnancy test within 7 days prior to randomization.

    1. Men are considered of reproductive potential unless they have undergone a vasectomy and confirmed sterile by a post-vasectomy semen analysis.
    2. Women are considered of reproductive potential unless they have undergone hysterectomy and/or surgical sterilization (at least 6 weeks following a bilateral oophorectomy, bilateral tubal ligation, or bilateral tubal occlusive procedure that has been confirmed in accordance with the device's label) or achieved postmenopausal status (defined as cessation of regular menses for greater than 12 consecutive months in women at least 45 years of age).
  8. Left ventricular ejection fraction ≥50% by echocardiography or nuclear medicine multi-gated scan.
  9. Must be able to swallow tablets.
  10. Must be able to comply with study protocol procedures.
  11. Willing to consent to have blood stored for possible future biomarker and disease analysis.
  12. Must have available and willing to submit pre-systemic treatment DLBCL tumor biopsy tissue/slides for central pathology review.

Exclusion Criteria

  1. Received treatment with an investigational drug within the last 30 days.
  2. Receiving or has received radiation or any other systemic anticancer treatment for lymphoma (Up to 7 days of corticosteroids are permitted but must be administered after eligibility IPI determination and imaging scans).
  3. History of indolent lymphoma or follicular Grade 3b lymphoma.
  4. Primary mediastinal (thymic) large B-cell lymphoma.
  5. B-cell lymphoma, unclassifiable, with features. intermediate between DLBCL and classical Hodgkin lymphoma.
  6. Burkitt lymphoma.
  7. Pregnancy or breastfeeding.
  8. Known central nervous system (CNS) involvement.
  9. Any significant concomitant disorder based on the discretion of the investigator, including but not limited to active bacterial, fungal, or viral infection, incompatible with participation in the study.
  10. A second primary malignancy (except adequately treated non-melanoma skin cancer); subjects who have had another malignancy in the past, but have been disease-free for more than 5 years, and subjects who have had a localized malignancy treated with curative intent and disease free for more than 2 years are eligible.
  11. Use of a strong inducer or moderate or strong inhibitor of CYP3A4 within 7 days prior to start of study therapy or expected requirement for use on study therapy.
  12. Personal or immediate family history of long QT syndrome, QTc interval >450 msec (males) or >470 msec (females) at screening (recommended that QTc be calculated using Fridericia correction formula, QTcF: see Section 6.2.1), or a history of unexplained syncope.
  13. Use of any medication that can prolong the QT/QTc interval within 7 days prior to start of study therapy or expected requirement for use on study therapy.
  14. History of severe allergic or anaphylactic reaction to monoclonal antibody therapy.
  15. Confirmed diagnosis of progressive multifocal leukoencephalopathy.
  16. Ongoing grade 2 or higher peripheral neuropathy.
  17. Have any of the following cardiac disorders: uncontrolled hypertension, unstable angina, myocardial infarction within 8 weeks of Day1, NYHA Grade 2 or higher congestive heart failure, ventricular arrhythmia requiring medication within 1 year of Day 1, NYHA Grade 2 or higher peripheral vascular disease.
  18. Received a live vaccine within 28 days of study Day 1.
  19. HIV positive.
  20. Evidence of chronic hepatitis C infection as indicated by antibody to HCV with positive HCV-RNA.
  21. Evidence of chronic hepatitis B infection as indicated by either:

    1. HBsAg+ or
    2. HBcAb+ with HBV-DNA+ (any detectable amount is considered positive)

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 identifier (NCT number): NCT03263026

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Sponsors and Collaborators
Denovo Biopharma LLC
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Denovo Biopharma LLC Identifier: NCT03263026    
Other Study ID Numbers: DB102-02
First Posted: August 28, 2017    Key Record Dates
Last Update Posted: February 7, 2022
Last Verified: February 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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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 Denovo Biopharma LLC:
Non-Hodgkin's Lymphoma
Additional relevant MeSH terms:
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Lymphoma, B-Cell
Lymphoma, Large B-Cell, Diffuse
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin