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A Study of TAK-659 in Combination With Venetoclax for Adult Participants With Previously Treated Non-Hodgkin Lymphoma

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ClinicalTrials.gov Identifier: NCT03357627
Recruitment Status : Recruiting
First Posted : November 30, 2017
Last Update Posted : October 30, 2018
Sponsor:
Information provided by (Responsible Party):
Takeda ( Millennium Pharmaceuticals, Inc. )

Brief Summary:
The purpose of this study is to determine the maximum tolerated dose (MTD) and/or recommended phase 2 dose (RP2D) of TAK-659 and venetoclax when administered in combination in participants with non-Hodgkin lymphoma (NHL) relapsed and/or refractory after at least 1 prior line of therapy and to evaluate safety and tolerability of TAK-659 and venetoclax when administered in combination.

Condition or disease Intervention/treatment Phase
Lymphoma, Non-Hodgkin Lymphoma, Large B-cell, Diffuse Lymphoma, Follicular Drug: TAK-659 Drug: Venetoclax Phase 1

Detailed Description:

The drugs being tested in this study are called TAK-659 and venetoclax. TAK-659 in combination with venetoclax is being tested to treat people who have advanced NHL after at least 1 prior line of therapy. This study will look at the safety data, pharmacokinetic (PK) data and any early anti-tumor activity observed.

The study will enroll approximately 53 participants.

• TAK-659 and venetoclax doses will be escalated according to a Bayesian logistic regression model (BLRM) with overdose control escalation schema. TAK-659 60 mg + Venetoclax 400 mg is the starting dose.

Participants could also receive 40 mg, 60 mg, 80 mg or 100 mg TAK-659 during dose escalation and 200 mg, 400 mg, 800 mg, or 1200 mg of venetoclax.

Following dose escalation the safety and tolerability of the MTD/RP2D of the TAK-659+venetoclax combination will be further explored in two dose-safety expansion cohorts, Cohort A in participants with DLBCL and Cohort B in participants with FL.

All participants will be asked to take one tablet of TAK-659 on an empty stomach at least 1 hour before and no sooner than 2 hours after eating food and/or drinking fluids other than water. Venetoclax will be taken with a meal and water 2 hours after TAK-659 has been taken. No food or drink (except water) are allowed between TAK-659 and venetoclax. TAK-659 and venetoclax should be taken at the same time each day throughout the study.

This multi-center trial will be conducted in the United States, Canada and Europe. The overall time to participate in this study is 20 months or until disease progression, unacceptable toxicities, or withdrawal from study by participant. Participants will make multiple visits to the clinic, and will be followed for 28 days (+10) days after the last dose of TAK-659 or venetoclax or the start of subsequent alternative anticancer therapy to permit the detection of any delayed treatment-related AEs. For participants enrolled in either the dose escalation or safety expansion phases, the maximum duration of treatment will be 12 months unless, in the opinion of the investigator and with the agreement of the sponsor, the participant would derive benefit from continued therapy beyond 12 months. Participants enrolled in the safety expansion part who stop treatment for any reason other than disease progression will continue PFS follow-up every 2 months after the last dose of study drug for up to 6 months or until disease progression or the start of alternative therapy, whichever occurs first.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 53 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: A Phase 1b Study of TAK-659 in Combination With Venetoclax for Adult Patients With Previously Treated Non-Hodgkin Lymphoma
Actual Study Start Date : February 16, 2018
Estimated Primary Completion Date : January 12, 2020
Estimated Study Completion Date : July 9, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lymphoma
Drug Information available for: Venetoclax

Arm Intervention/treatment
Experimental: Dose Escalation: TAK-659 + Venetoclax
TAK-659 40, 60, 80, or 100 milligram (mg) (tablet, orally, once daily, up to 35 days in Cycle 1 or in different intermittent schedules [7 days dosing followed by 7 days off or 14 days dosing followed by 7 days off or other intermittent dosing schedules]) along with venetoclax 200, 400, 800 or 1200 mg (tablet, orally, once daily, up to 35 days in Cycle 1). After Cycle 1, TAK-659 and venetoclax will be administered once daily in a 28-day treatment cycle until disease progression, unacceptable toxicities, or discontinuation by participant.
Drug: TAK-659
TAK-659 tablets.

Drug: Venetoclax
Venetoclax tablets.

Experimental: Safety Expansion: Diffuse Large B-cell Lymphoma (DLBCL) Cohort
TAK-659 tablet, orally, once daily along with venetoclax tablet, orally, once daily in a 28-day treatment cycle until disease progression, unacceptable toxicities, or discontinuation by participant. TAK-659 and venetoclax MTD/RP2D will be determined from the dose escalation phase.
Drug: TAK-659
TAK-659 tablets.

Drug: Venetoclax
Venetoclax tablets.

Experimental: Safety Expansion: Follicular Lymphoma (FL) Cohort
TAK-659 tablet, orally, once daily along with venetoclax tablet, orally, once daily in a 28-day treatment cycle until disease progression, unacceptable toxicities, or discontinuation by participant. TAK-659 and venetoclax MTD/RP2D will be determined from the dose escalation phase.
Drug: TAK-659
TAK-659 tablets.

Drug: Venetoclax
Venetoclax tablets.




Primary Outcome Measures :
  1. Number of Participants with a Dose Limiting Toxicity (DLT) [ Time Frame: Baseline up to 5 weeks ]
    Toxicity will be evaluated according to National Cancer Institute Common Terminology Criteria for Adverse Event (NCI CTCAE), Version 5.0 DLT will be defined as any of the events specified in the protocol that are considered by the investigator to be at least possibly related to therapy with study medications and that occur within the first cycle.

  2. Percentage of Participants Reporting one or More Treatment-emergent Adverse Events (TEAEs), Grade 3 or Higher Adverse Events (AEs), Serious Adverse Events (SAEs) and AEs Leading to Discontinuation [ Time Frame: Baseline up to 13 months ]
    AE Grades will be evaluated as per NCI CTCAE, version 5.0.


Secondary Outcome Measures :
  1. Cmax: Maximum Observed Plasma Concentration for TAK-659 and Venetoclax [ Time Frame: Cycle 1 Days 1 and 21 or 28: Pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length is equal to [=] 35 days) ]
  2. Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for TAK-659 and Venetoclax [ Time Frame: Cycle 1 Days 1 and 21 or 28: Pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length =35 days) ]
  3. AUCτ: Area Under the Plasma Concentration-time Curve from Time 0 to Time Over the Dosing Interval for TAK-659 and Venetoclax [ Time Frame: Cycle 1 Days 1 and 21 or 28: Pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length =35 days) ]
  4. Oral Clearance (CL/F) for TAK-659 and Venetoclax [ Time Frame: Cycle 1 Days 1 and 21 or 28: Pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length =35 days) ]
  5. Peak-trough Ratio (PTR) for TAK-659 and Venetoclax [ Time Frame: Cycle 1 Days 1 and 21 or 28: Pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length =35 days) ]
  6. Accumulation Ratio (Rac) for TAK-659 and Venetoclax [ Time Frame: Cycle 1 Days 1 and 21 or 28: Pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length =35 days) ]
  7. Trough Concentration (C trough) for TAK-659 and Venetoclax [ Time Frame: Cycle 1 Days 1 and 21 or 28: Pre-dose and at multiple time points (up to 24 hours) post-dose (Cycle length =35 days) ]
  8. Overall Response Rate (ORR) [ Time Frame: Up to 12 months ]
    ORR is calculated as percentage of participants with complete response (CR) + percentage of participants with partial response (PR) as assessed by International Working Group (IWG) criteria for malignant lymphoma.

  9. Duration of Overall Response [ Time Frame: Up to 12 months ]
  10. CR Rate [ Time Frame: Up to 12 months ]
    CR rate is calculated as percentage of participants with CR as assessed by IWG criteria for malignant lymphoma.

  11. Duration of CR [ Time Frame: Up to 12 months ]
  12. Time to Progression (TTP) [ Time Frame: Up to 13 months ]
    TTP will be measured as the time in months from the first dose of study treatment to the date of the first documented disease progression as assessed using IWG criteria.

  13. Progression-free Survival (PFS) [ Time Frame: Up to 18 months ]
    PFS is defined as the time from date of first study drug administration to the day of first documented disease progression or death due to any cause, whichever occurs first.



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
Criteria

Inclusion Criteria:

  1. For the Dose Escalation phase, participants must have histologically confirmed diagnosis of advanced NHL of any histology (with the exception of participants with mantle cell lymphoma [MCL] or chronic lymphoma leukemia [CLL]).
  2. For the Safety Expansion phase, participants must have histologically confirmed diagnosis of advanced DLBCL or FL.
  3. Radiographically or clinically measurable disease with greater than or equal to (>=) 1 target lesion per IWG criteria for malignant lymphoma.
  4. Refractory or relapsed after at least 1 prior line of therapy for whom no effective standard therapy is available per investigator's assessment.

    o Participants who are either treatment-naive to, relapsed after, or refractory to ibrutinib, idelalisib, or any other investigational B cell receptor (BCR) pathway inhibitors not directly targeting spleen tyrosine kinase (SYK) are allowed.

  5. Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1.
  6. Life expectancy of greater than 3 months.
  7. Suitable venous access for the study-required blood sampling that is, including PK and pharmacodynamic sampling.
  8. Recovered (that is, less than or equal to [<=] Grade 1 toxicity) from the reversible effects of prior anticancer therapy.

Exclusion Criteria:

  1. Central nervous system (CNS) lymphoma; active brain or leptomeningeal metastases, as indicated by positive cytology from lumbar puncture or computed tomography (CT) scan/magnetic resonance imaging (MRI).
  2. History of drug-induced pneumonitis requiring treatment with steroids; history of idiopathic pulmonary fibrosis, organizing pneumonia, or evidence of active pneumonitis on screening chest CT scan; history of radiation pneumonitis in the radiation field (fibrosis) is permitted.
  3. Participants requires the use of warfarin (use in prophylactic doses [example, deep vein thrombosis prophylaxis]) is allowed.
  4. Prior exposure to targeted SYK inhibitors.
  5. History of a prior intolerable toxicity, in the opinion of the investigator from another B-cell lymphoma (BCL)-2 family protein inhibitor study.
  6. Participants who are relapsed after or refractory to regimens containing venetoclax or other BCL2 inhibitors.
  7. Systemic anticancer treatment (including investigational agents) or radiotherapy less than 2 weeks before the first dose of study treatment (<=4 weeks for large molecule agents; <=8 weeks for cell-based therapy or anti-tumor vaccine), or not recovered from the reversible effects of prior anticancer therapy.
  8. Prior autologous stem cell transplant (ASCT) within 6 months preceding Cycle 1 Day 1.
  9. Prior allogeneic stem cell transplant and/or chimeric antigen receptor T-cell therapy at any time.
  10. Major surgery within 14 days before the first dose of study drug and not recovered fully from any complications from surgery.
  11. Known human immunodeficiency virus (HIV) positive or HIV-related malignancy.
  12. Received a live viral vaccine within 6 months prior to the first dose of study drug.
  13. Use or consumption of:

    • Medications or supplements that are known to be strong or moderate Cytochrome P4503A (CYP3A) inhibitors or strong or moderate CYP3A inducers and/or P-glycoprotein (P-gp) inhibitors or inducers within 7 days or within 5 times the inhibitor or inducer half-life (whichever is longer) before the first dose of study drugs. In general, the use of these agents is not permitted during the study except in cases in which an adverse event (AE) must be managed during interruption of study drug dosing.
    • Food or beverages containing grapefruit, Seville oranges, or Star fruit within 5 days before the first dose of study drugs. Note that food and beverages containing grapefruit, Seville orange, or Star fruit are not permitted during the study.
    • Preparations containing St. John's wort within 7 days before the first dose of study drugs. Note that preparations containing St. John's wort are not permitted during the study.

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): NCT03357627


Contacts
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Contact: Takeda Study Registration Call Center +1-866-835-2233 globaloncologymedinfo@takeda.com

Locations
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United States, Alabama
University of Alabama at Birmingham Recruiting
Birmingham, Alabama, United States, 35249
United States, Georgia
Emory University Recruiting
Atlanta, Georgia, United States, 30322
United States, Illinois
NorthShore Medical Group - Evanston Recruiting
Evanston, Illinois, United States, 60201
Ingalls Memorial Hospital Recruiting
Harvey, Illinois, United States, 60426
United States, Kentucky
Norton Cancer Institute - Shelbyville Recruiting
Shelbyville, Kentucky, United States, 40065
United States, Massachusetts
Dana Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02215
United States, New York
Icahn School of Medicine at Mount Sinai Recruiting
New York, New York, United States, 10029
United States, Texas
Baylor Scott & White Research Institute Recruiting
Dallas, Texas, United States, 75246
Canada, Quebec
Hopital Maisonneuve-Rosemont Recruiting
Montreal, Quebec, Canada, H1T 2M4
Jewish General Hospital Recruiting
Montreal, Quebec, Canada, H3T 1E2
Germany
Universitatsklinikum Heidelberg Recruiting
Heidelberg, Baden-wuerttemberg, Germany, 69120
Universitatsklinikum Ulm Recruiting
Ulm, Baden-wuerttemberg, Germany, 89081
Universitatklinikum der Ludwig-Maximilians-Universitat Munchen Suspended
Munchen, Bayern, Germany, 81377
Universitatsklinikum Frankfurt Recruiting
Frankfurt am Main, Hessen, Germany, 60590
Universitatsmedizin der Johannes Gutenberg Universitat Recruiting
Mainz, Rheinland-pfalz, Germany, 55131
Sponsors and Collaborators
Millennium Pharmaceuticals, Inc.
Investigators
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Study Director: Medical Director Millennium Pharmaceuticals, Inc.

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Responsible Party: Millennium Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT03357627     History of Changes
Other Study ID Numbers: C34008
2017-002872-14 ( EudraCT Number )
U1111-1203-9951 ( Registry Identifier: WHO )
First Posted: November 30, 2017    Key Record Dates
Last Update Posted: October 30, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Takeda makes patient-level, de-identified data sets and associated documents available after applicable marketing approvals and commercial availability have been received, an opportunity for the primary publication of the research has been allowed, and other criteria have been met as set forth in Takeda's Data Sharing Policy (see www.TakedaClinicalTrials.com/Approach for details). To obtain access, researchers must submit a legitimate academic research proposal for adjudication by an independent review panel, who will review the scientific merit of the research and the requestor's qualifications and conflict of interest that can result in potential bias. Once approved, qualified researchers who sign a data sharing agreement are provided access to these data in a secure research environment.

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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 Takeda ( Millennium Pharmaceuticals, Inc. ):
Drug therapy

Additional relevant MeSH terms:
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Lymphoma
Lymphoma, Non-Hodgkin
Lymphoma, Large B-Cell, Diffuse
Lymphoma, Follicular
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, B-Cell
Venetoclax
Antineoplastic Agents