Bendamustine + Obinutuzumab Induction With Obinutuzumab Maintenance in Untreated Mantle Cell Lymphoma
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|ClinicalTrials.gov Identifier: NCT03311126|
Recruitment Status : Recruiting
First Posted : October 16, 2017
Last Update Posted : April 6, 2021
|Condition or disease||Intervention/treatment||Phase|
|Mantle Cell Lymphoma Non-hodgkin Lymphoma Non Hodgkin Lymphoma||Drug: Bendamustine Drug: Obinutuzumab||Phase 2|
This is a phase II single-arm, open-label, multicenter study evaluating the efficacy and safety of the combination of induction chemoimmunotherapy with bendamustine and obinutuzumab (BO) followed by consolidation therapy and maintenance therapy with obinutuzumab in subjects who have not received prior cytotoxic chemotherapy for their MCL (i.e., prior single-agent rituximab is permitted, prior involved-field radiotherapy is permitted). Therapy for individual subjects will be risk-adapted based on results of minimal residual disease (MRD) testing performed after the consolidation phase. The study will be carried out at the University of Wisconsin Carbone Cancer Center (UWCCC) and participating community and academic practice sites within the Wisconsin Oncology Network (WON). There will be 6-10 sites participating in this study.
The subject participation will include a screening period, treatment period, and a follow-up period. The induction chemoimmunotherapy regimen consists of bendamustine and obinutuzumab for 4-6 cycles, followed by consolidation and maintenance therapy with obinutuzumab in subjects achieving an objective response to induction therapy (i.e., complete or partial response; stable disease with objective evidence of tumor shrinkage. Subjects who are MRD-negative (determined by MRD testing on bone marrow and PB) after consolidation therapy will omit maintenance therapy.
Subjects will undergo disease reassessment after C4 of induction BO chemoimmunotherapy, after obinutuzumab consolidation therapy, and after C4 and C8 of maintenance obinutuzumab. MRD testing will be done after C2 of induction (PB only), after consolidation (BMA and PB), and post-maintenance or EOT (PB only).
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||32 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Bendamustine + Obinutuzumab Induction Chemoimmunotherapy With Risk-adapted Obinutuzumab Maintenance Therapy in Previously Untreated Mantle Cell Lymphoma|
|Actual Study Start Date :||October 19, 2017|
|Estimated Primary Completion Date :||May 15, 2024|
|Estimated Study Completion Date :||May 15, 2026|
Experimental: Bendamustine + Obinutuzumab (BO)
Induction chemoimmunotherapy (28 day cycles):
Bendamustine 90 mg/m2 IV days 1 & 2 every 28 days X 4-6 cycles
Obinutuzumab 1000 mg IV weekly X 4 doses
Maintenance phase (8 week cycles):
Obinutuzumab 1000 mg IV on day 1 of cycles 1-8
Bendamustine is a chemotherapeutic agent that has dual functional properties of both an alkylating agent and a nitrogen mustard. Through these unique cytostatic properties, bendamustine is able to inhibit DNA transcription, replication, and repair. Bendamustine is approved in the U.S. for treatment of CLL and for indolent B cell NHLs progressing during or within 6 months of rituximab or a rituximab - containing regimen.
Obinutuzumab is a glycoengineered, humanized, type II anti-CD20 mAb.
- Progression Free Survival (PFS) at 2 years [ Time Frame: Up to 2 years ]For each patient, progression-free survival (PFS) will be defined as the number of days from C1D1 of induction chemoimmunotherapy to the day patient experiences an event of disease progression or death, whichever occurs first. If a patient has not experienced an event at the time of analysis, patient's data will be censored at the date of the last available evaluation. The 2-year PFS probability will be estimated using the Kaplan-Meier method. From the date of C1D1 of induction therapy to the date of progression or death; in the absence of progression or death, subjects will be followed for a minimum of 24 months after completion of study-related treatment.
- Minimal Residual Disease (MRD) status [ Time Frame: At the end of Cycle 2 of induction therapy (each cycle is 28 days), following consolidation phase of therapy (after 6 cycles of induction, consolidation is 4 weekly doses of obinutuzumab), and within 30 days of completing protocol therapy ]
MRD defined as reduction to >=10^-6 fold reduction in the IgVH unique clone of MCL (mantle cell lymphoma) by NGS (next generation sequencing).
MRD status will be evaluated after 2 cycles of induction chemoimmunotherapy with bendamustine and obinutuzumab, after 4 cycles of consolidation with obinutuzumab, and after an additional 8 cycles of maintenance with obinutuzumab. MRD status will be summarized using frequency and proportion with 95% confidence intervals.
MRD status will be collected on peripheral blood after cycle 2 of induction therapy, on peripheral blood and bone marrow aspirate after consolidation obinutuzumab, and peripheral blood after maintenance therapy completion.
- Estimate the concordance rate between peripheral blood (PB) and bone marrow aspirates (BMA) in predicting MRD status. [ Time Frame: At the end of Cycle 2 of induction therapy (each cycle is 28 days), following consolidation phase of therapy (after 6 cycles of induction, consolidation is 4 weekly doses of obinutuzumab), and within 30 days of completing protocol therapy ]Concordance between PB and BMA in predicting MRD negative status will be summarized by percent of subjects in which MRD status is concordant (i.e., both positive in the PB and BMA or both negative in the PB and BMA).
- Determine objective response rates (CR + PR) with induction BO in previously untreated MCL using the Lugano classification for response in lymphoma [ Time Frame: At the end of induction cycle 4 (each cycle is 28 days), after consolidation therapy (post-induction, consolidation is 4 weekly doses Obinutuzumab), and after Cycles 4 and 8 of Maintenance Obinutuzumab (each cycle is 8 weeks) ]
Lugano criteria will be used to assess radiographic response by CT and/or PET imaging.
Imaging for response assessment will be performed after 4 cycles of induction therapy, after consolidation obinutuzumab, and after cycles 4 and 8 of maintenance obinutuzumab. Bone marrow biopsy will be performed verify complete responses.
- Overall Survival (OS) [ Time Frame: Up to 2 years ]For a given subject, OS will be defined as the number of days from C1D1 of the induction chemoimmunotherapy to the day the subject dies. Survival times of subjects who are still alive at the end of the follow-up period will be censored. OS will be summarized using point estimate of the median OS, along with the 95% confidence interval.
- Number of participants with treatment-related adverse events as assessed by CTCAE v5.0 during therapy induction BO chemoimmunotherapy and obinutuzumab consolidation and maintenance [ Time Frame: Up to 25 months (until 30 days after completion of final dose of study-related treatment) ]Count of toxicities from the initiation of study treatment until 30 days following the last administration of study treatment or study discontinuation/termination; after this period, only SAES that are possibly, probably, or definitely attributed will be reported. For a given subject, toxicities will be assessed from the time of C1D1 of study therapy until 30 days after completion of final dose of study-related treatment.
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): NCT03311126
|Contact: Cancer Connectfirstname.lastname@example.org|
|United States, Wisconsin|
|University of Wisconsin Carbone Cancer Center||Recruiting|
|Madison, Wisconsin, United States, 53792|
|Contact: Cancer Connect 800-622-8922 email@example.com|
|Principal Investigator: Julie Chang, MD|
|Principal Investigator:||Julie Chang, MD||University of Wisconsin, Madison|