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Acalabrutinib With or Without Obinutuzumab in Treating Patients With Early-Stage Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

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ClinicalTrials.gov Identifier: NCT03516617
Recruitment Status : Recruiting
First Posted : May 4, 2018
Last Update Posted : August 25, 2021
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Mayo Clinic

Brief Summary:
This phase II trials studies how well acalabrutinib with or without obinutuzumab works in treating patients with early-stage chronic lymphocytic leukemia or small lymphocytic lymphoma. Acalabrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as obinutuzumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. It is not yet known whether giving acalabrutinib with or without obinutuzumab will work better in treating patients with early-stage chronic lymphocytic leukemia or small lymphocytic lymphoma.

Condition or disease Intervention/treatment Phase
Chronic Lymphocytic Leukemia Small Lymphocytic Lymphoma Drug: Acalabrutinib Other: Laboratory Biomarker Analysis Biological: Obinutuzumab Other: Patient Observation Other: Quality-of-Life Assessment Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized Phase 2 Study Comparing Acalabrutinib to Acalabrutinib and Obinutuzumab in the Treatment of Patients With Early-Stage Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) Who Are at High Risk of Disease Progression
Actual Study Start Date : September 10, 2018
Estimated Primary Completion Date : March 15, 2025
Estimated Study Completion Date : March 15, 2026


Arm Intervention/treatment
Experimental: Arm A (acalabrutinib)
Patients receive acalabrutinib PO BID on days 1-28. Treatment repeats every 28 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients then receive acalabrutinib PO BID on days 1-84. Treatment repeats every 84 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients may continue treatment with acalabrutinib If MRD negative CR/CRi is not achieved after 12 cycles.
Drug: Acalabrutinib
Given PO
Other Names:
  • ACP-196
  • Bruton Tyrosine Kinase Inhibitor ACP-196
  • Calquence

Other: Laboratory Biomarker Analysis
Correlative studies

Other: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment

Experimental: Arm B (acalabrutinib, obinutuzumab)
Patients receive acalabrutinib PO BID on days 1-28 and obinutuzumab IV on days 1, 2, 8, and 15 of cycle 1 and days 1 of subsequent cycles. Treatment repeats every 28 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients then receive acalabrutinib PO BID on days 1-84. Treatment repeats every 84 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients may continue treatment with acalabrutinib If MRD negative CR/CRi is not achieved after 12 cycles.
Drug: Acalabrutinib
Given PO
Other Names:
  • ACP-196
  • Bruton Tyrosine Kinase Inhibitor ACP-196
  • Calquence

Other: Laboratory Biomarker Analysis
Correlative studies

Biological: Obinutuzumab
Given IV
Other Names:
  • Anti-CD20 Monoclonal Antibody R7159
  • GA-101
  • GA101
  • Gazyva
  • huMAB(CD20)
  • R7159
  • RO 5072759
  • RO-5072759
  • RO5072759

Other: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment

Active Comparator: Arm C (observation)
Patients will be observed every 6 months for up to 2 years.
Other: Laboratory Biomarker Analysis
Correlative studies

Other: Patient Observation
Undergo observation
Other Names:
  • Active Surveillance
  • deferred therapy
  • expectant management
  • Observation
  • Watchful Waiting

Other: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment




Primary Outcome Measures :
  1. Rate of minimal residual disease (MRD)-negative complete response (Arm A and Arm B) [ Time Frame: After 12 courses ]
    Defined as an objective status of complete response (CR) or CR with incomplete marrow recovery (CRi) along with MRD negativity in the bone marrow by flow cytometry. Will be compared between the two arms. The proportion of successes will be estimated in each arm by the number of successes divided by the total number of evaluable patients. Ninety-five percent confidence intervals for the true success proportion will be calculated in each arm based on the normal approximation. Comparison of MRD-negative complete response rates between the two treatment groups will be performed using a one-sided z-test (based on normal approximation with pooled variance of standardized test statistics) at significance level 0.10.

  2. Time to first therapy in patients (Arm C) [ Time Frame: From the date of registration, assessed after 12 courses ]
    Will be estimated using the method of Kaplan-Meier.


Secondary Outcome Measures :
  1. Overall response rate (Arms A and B) [ Time Frame: Up to 5 years ]
    Will be estimated in each arm by the number of patients who achieve a CR, CRi, clinical complete response (CCR), nodular partial response (nPR), or partial response (PR) at any time during treatment divided by the total number of evaluable patients. Exact binomial 95% confidence intervals for the true success rate will be calculated.

  2. Progression-free survival (Arms A and B) [ Time Frame: From randomization up to 5 years ]
    Will be estimated in each arm using the method of Kaplan-Meier. Progression-free survival will be compared between the two arms using log-rank statistics.

  3. Time to next therapy (Arms A and B) [ Time Frame: From the date of randomization up to 5 years ]
    Will be estimated in each arm using the method of Kaplan-Meier. Time to next therapy will be compared between the two arms using log-rank statistics.

  4. Overall survival (Arms A and B) [ Time Frame: From randomization up to 5 years ]
    Will be estimated in each arm using the method of Kaplan-Meier. Overall survival will be compared between the two arms using log-rank statistics.

  5. Progression-free survival (Arm C) [ Time Frame: From randomization up to 5 years ]
    Will be estimated in using the method of Kaplan-Meier.

  6. Overall survival (Arm C) [ Time Frame: From randomization up to 5 years ]
    Will be estimated in using the method of Kaplan-Meier.

  7. Incidence of adverse events rates (Arms A and B) [ Time Frame: Up to 5 years ]
    Will be assessed according to Common Terminology Criteria for Adverse Events version 4.0. The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed for each arm to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration.


Other Outcome Measures:
  1. Quality of life measures [ Time Frame: Up to 5 years ]
    Will be assessed used Functional Assessment of Cancer Therapy-General (FACT-G). Descriptive statistics by arm at each time point will include means, standard deviations, medians, and ranges for each scale. Descriptive graphical techniques will include mean plots by arm over time for each scale. For evaluating changes over time in each score, a minimally important difference will be defined as a change of 7 points, based on previously established cutoffs for the transformed FACT-G scores. Changes from baseline will be assessed using a paired sample t-test.

  2. T-cells, natural killer (NK)-cells, and NK-T cells [ Time Frame: Baseline ]
    Will be assessed in peripheral blood immune profile using 8-color flow cytometry. Values over time will be summarized graphically and descriptively. Paired sample approaches (Wilcoxon signed rank test) for these types of quantitative measures will be used to assess differences over time. Differences between treatments (Arms A and B only) will be assessed.

  3. Bone marrow hematopoiesis (Arms A and B) [ Time Frame: Up to 5 years ]
    will be evaluated by estimation of colony forming capacity by purified hematopoietic stem cells (HSCs) and their differentiated progeny (i.e. multipotent progenitor, common myeloid progenitor, common lymphoid progenitor) as continuous measures. Degree of cytopenia in the peripheral blood will be evaluated on a continuous scale for each blood cell component (hemoglobin, platelets, etc.). In each arm, correlation between each blood cell component and its corresponding pre-cursor will be evaluated using Spearman's rank correlation coefficients.

  4. Percent killing of chronic lymphocytic leukemia (CLL) B-cells (Arms A and B) [ Time Frame: After 12 courses ]
    Will be measured as a continuous measure. In each arm, the relationship between percent killing and response (responder versus [vs.] non-responder) after 12 cycles of treatment will be evaluating using Wilcoxon's rank sum test.

  5. Somatic genetic mutations (Arms A and B) [ Time Frame: After 12 courses ]
    Will be evaluated as present vs. absent for each gene. In each arm, the relationship between each mutation and response (responder vs. non-responder) after 12 cycles of treatment will be evaluated using Fisher's exact test.



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:

  • Diagnosis of:

    • Biopsy-proven small lymphocytic lymphoma (SLL) , or
    • Diagnosis of chronic lymphocytic leukemia (CLL) with a clonal B-cell population in the peripheral blood with immunophenotyping consistent with CLL as follows:

      • The population of lymphocytes share both B-cell antigens (CD19, CD20 [typically dim expression], or CD23) as well as CD5 in the absence of other pan-T-cell markers (CD3, CD2, etc.)
      • Clonality as evidenced by kappa or lambda light chain expression (typically dim immunoglobulin expression) or other genetic method (e.g. IGHV analysis)
      • Before diagnosing CLL or SLL, mantle cell lymphoma must be excluded by demonstrating a negative fluorescence in situ hybridization (FISH) analysis for t(11;14)(IgH/CCND1)
  • Patients must be previously untreated

    • Note: Prior chemotherapy or monoclonal antibody based therapy for treatment of CLL or SLL will be considered prior therapy; nutraceutical treatments with no established benefit in CLL (such as epigallocatechin gallate or EGCG, found in green tea or other herbal treatments or supplemental vitamins) will not be considered "prior treatment"; prior corticosteroid therapy for an indication other than CLL/SLL will not be considered "prior treatment"
  • All patients will undergo testing for prognostic factors according to the CLL-IPI (testing obtained =< 730 days prior to registration)

    • Note: If the results for any of the prognostic factors included in the CLL-IPI are unknown including IGVH mutation status results not being available due to a failed laboratory assay, the patient is not eligible
    • Note: When determining CLL-IPI, use most recent test results, if more than one result is available
    • Note: Patients with CLL-IPI risk category of high risk or very high risk (total score of 4-10) will be randomized to Arms A or B
    • Note: Patients with CLL-IPI risk category of low risk or intermediate risk (total score of 0-3) will be registered to Arm C
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2
  • Provide written informed consent
  • Willing to provide blood and saliva samples for correlative research purposes
  • Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
  • For high risk and very high risk CLL-IPI (Arms A and B) only: Absolute neutrophil count (ANC) >= 1500/mm^3 (obtained =< 30 days prior to randomization)
  • For high risk and very high risk CLL-IPI (Arms A and B) only: Platelet count >= 100,000/mm^3 (obtained =< 30 days prior to randomization)
  • For high risk and very high risk CLL-IPI (Arms A and B) only: Hemoglobin >= 11.0 g/dL (obtained =< 30 days prior to randomization)
  • For high risk and very high risk CLL-IPI (Arms A and B) only: Aspartate aminotransferase (aspartate transaminase [AST]) =< 3 x upper limit of normal (ULN) (obtained =< 30 days prior to randomization)
  • For high risk and very high risk CLL-IPI (Arms A and B) only: Creatinine =< 1.5 X ULN (obtained =< 30 days prior to randomization)
  • For high risk and very high risk CLL-IPI (Arms A and B) only: Total bilirubin =< 1.5 x upper limit of normal (ULN) (or total bilirubin =< 3.0 x ULN with direct bilirubin =< 1.5 x ULN in patients with well-documented Gilbert's syndrome (obtained =< 30 days prior to randomization)
  • For high risk and very high risk CLL-IPI (Arms A and B) only: Prothrombin time (PT), international normalized ratio (INR), and partial thromboplastin time (PTT) =< 1.5 X ULN OR if patient is receiving anticoagulant therapy and PT or PTT is within therapeutic range of intended use of coagulants (obtained =< 30 days prior to randomization)
  • Negative serum pregnancy test done =< 7 days prior to registration, for persons of childbearing potential only
  • Will provide bone marrow aspirate sample for correlative research purposes

Exclusion Criteria:

  • Date of CLL/SLL diagnosis >= 24 months prior to registration
  • Prior exposure to ibrutinib or to a BCR inhibitor (e.g. Btk or PI3 kinase or Syk inhibitors) or a BCL-2 inhibitor (e.g. venetoclax)
  • Known central nervous system (CNS) lymphoma or leukemia
  • Patients with any of the following indications for chemotherapy:

    • Evidence of progressive marrow failure as manifested by the development of or worsening anemia (=< 11 g/dL) and/or thrombocytopenia (=< 100 x 10^9/L) not due to autoimmune disease
    • Symptomatic or progressive lymphadenopathy, splenomegaly or hepatomegaly
    • One or more of the following disease-related symptoms:

      • Weight loss >= 10% within the previous 6 months
      • Extreme fatigue attributed to CLL
      • Fevers >= 100.4 degrees Fahrenheit (F) for 2 weeks without evidence of infection
      • Drenching night sweats without evidence of infection
  • Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • Patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy; NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
  • Other active malignancy =< 2 years prior to registration; EXCEPTIONS: Non-melanotic skin cancer, carcinoma-in-situ of the cervix, or early stage prostate cancer
  • History of myocardial infarction =< 6 months prior to registration, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
  • For high risk and very high risk CLL-IPI (Arms A and B) only:

    • Any of the following:

      • Pregnant persons
      • Nursing persons
      • Persons of childbearing potential who are unwilling to employ highly effective contraception
    • Serologic status reflecting active hepatitis B or C infection

      • NOTE: Subjects with hepatitis B core antibody positive who are surface antigen negative or who are hepatitis C antibody positive will need to have a negative polymerase chain reaction (PCR) result before randomization; those who are hepatitis B surface antigen positive or hepatitis B PCR positive and those who are hepatitis C PCR positive will be excluded
    • History of stroke or intracranial hemorrhage within 6 months before randomization
    • History of bleeding diathesis (e.g. hemophilia, von Willebrand disease)
    • Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists (e.g. phenprocoumon) within 7 days of first dose of study drug and while on study
    • Requires treatment with a strong CYP3A inducer
    • Requires treatment with proton-pump inhibitors (e.g. omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole)
    • Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months before screening
    • History of confirmed progressive multifocal leukoencephalopathy (PML)
    • Received a vaccination with a live vaccine =< 28 days prior to randomization

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): NCT03516617


Locations
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United States, Arizona
Mayo Clinic in Arizona Recruiting
Scottsdale, Arizona, United States, 85259
Contact: Clinical Trials Referral Office    855-776-0015    mayocliniccancerstudies@mayo.edu   
Principal Investigator: Jose F. Leis, M.D.         
United States, Florida
Mayo Clinic in Florida Recruiting
Jacksonville, Florida, United States, 32224-9980
Contact: Clinical Trials Referral Office    855-776-0015    mayocliniccancerstudies@mayo.edu   
Principal Investigator: Asher A. Chanan-Khan, M.D.         
United States, Minnesota
Mayo Clinic in Rochester Recruiting
Rochester, Minnesota, United States, 55905
Contact: Clincial Trials Referral Office    855-776-0015    mayocliniccancerstudies@mayo.edu   
Principal Investigator: Sameer A. Parikh, M.D.         
Sponsors and Collaborators
Mayo Clinic
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Sameer A Parikh Mayo Clinic in Rochester
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Responsible Party: Mayo Clinic
ClinicalTrials.gov Identifier: NCT03516617    
Other Study ID Numbers: MC168E
NCI-2018-00591 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
MC168E ( Other Identifier: Mayo Clinic in Rochester )
P30CA015083 ( U.S. NIH Grant/Contract )
First Posted: May 4, 2018    Key Record Dates
Last Update Posted: August 25, 2021
Last Verified: August 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Lymphoma
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
Obinutuzumab
Acalabrutinib
Antineoplastic Agents, Immunological
Antineoplastic Agents