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Study to Evaluate Loncastuximab Tesirine With Rituximab Versus Immunochemotherapy in Participants With Relapsed or Refractory Diffuse Large B-Cell Lymphoma (LOTIS 5)

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ClinicalTrials.gov Identifier: NCT04384484
Recruitment Status : Recruiting
First Posted : May 12, 2020
Last Update Posted : December 2, 2021
Sponsor:
Information provided by (Responsible Party):
ADC Therapeutics S.A.

Brief Summary:
The purpose of this study is to evaluate the efficacy of loncastuximab tesirine (ADCT-402) combined with rituximab compared to standard immunochemotherapy.

Condition or disease Intervention/treatment Phase
Relapsed Diffuse Large B-Cell Lymphoma Refractory Diffuse Large B-Cell Lymphoma Drug: Loncastuximab Tesirine Drug: Rituximab Drug: Gemcitabine Drug: Oxaliplatin Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 350 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 3 Randomized Study of Loncastuximab Tesirine Combined With Rituximab Versus Immunochemotherapy in Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma (DLBCL) (LOTIS-5)
Actual Study Start Date : September 16, 2020
Estimated Primary Completion Date : June 30, 2025
Estimated Study Completion Date : June 30, 2028


Arm Intervention/treatment
Experimental: Part 1: Loncastuximab Tesirine + Rituximab (Lonca-R)

Part 1 consists of a non-randomized safety run-in period evaluating the study drug for the first 20 participants.

Participants will receive Lonca-R on Day 1 of each cycle for up to 8 cycles, where 1 cycle is 3 weeks. Lonca-R will be administered via an intravenous infusion of loncastuximab tesirine 150 µg/kg + rituximab 375 mg/m^2 Q3W for 2 cycles, then loncastuximab tesirine 75 µg/kg + rituximab 375 mg/m^2 Q3W for up to 6 additional cycles.

Drug: Loncastuximab Tesirine
Intravenous Infusion
Other Names:
  • Zynlonta
  • ADCT-402

Drug: Rituximab
Intravenous Infusion

Experimental: Part 2: Loncastuximab Tesirine + Rituximab (Lonca-R)
Randomized participants will receive Lonca-R on Day 1 of each cycle for up to 8 cycles, where 1 cycle is 3 weeks. Lonca-R will be administered via an intravenous infusion of loncastuximab tesirine 150 µg/kg + rituximab 375 mg/m^2 every Q3W for 2 cycles, then loncastuximab tesirine 75 µg/kg + rituximab 375 mg/m^2 Q3W for up to 6 additional cycles.
Drug: Loncastuximab Tesirine
Intravenous Infusion
Other Names:
  • Zynlonta
  • ADCT-402

Drug: Rituximab
Intravenous Infusion

Active Comparator: Part 2: Standard Immunochemotherapy (R-GemOx)
Randomized participants will receive R-GemOx consisting of rituximab, gemcitabine and oxaliplatin as a standard immunochemotherapy treatment on Day 1 of each cycle for up to 8 cycles, where 1 Cycle is 2 weeks. R-GemOx will be administered via an intravenous infusion of rituximab 375 mg/m^2 + gemcitabine 1000 mg/m^2 + oxaliplatin 100 mg/m^2 every 2 weeks (Q2W) for up to 8 cycles.
Drug: Rituximab
Intravenous Infusion

Drug: Gemcitabine
Intravenous Infusion

Drug: Oxaliplatin
Intravenous Infusion




Primary Outcome Measures :
  1. Progression-free Survival (PFS) [ Time Frame: Up to 4 years ]

Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: Up to 4 years ]
  2. Overall Response Rate (ORR) [ Time Frame: Up to 4 years ]
  3. Complete Response Rate (CRR) [ Time Frame: Up to 4 years ]
  4. Duration of Response (DOR) [ Time Frame: Up to 4 years ]
  5. Number of Participants Who Experience At Least One Treatment-Emergent Adverse Event (TEAE) [ Time Frame: Day 1 up to a maximum of Week 25 ]
  6. Number of Participants Who Experience At Least One Serious Adverse Event (SAE) [ Time Frame: Up to 4 years ]
  7. Number of Participants Who Experience a Clinically Significant Change From Baseline in Clinical Laboratory Results [ Time Frame: Day 1 up to a maximum of Week 25 ]
  8. Number of Participants Who Experience a Clinically Significant Change From Baseline in Vital Sign Measurements [ Time Frame: Day 1 up to a maximum of Week 25 ]
  9. Number of Participants Who Experience a Clinically Significant Change From Baseline in Physical Examinations [ Time Frame: Day 1 up to a maximum of Week 25 ]
  10. Number of Participants Who Experience a Clinically Significant Change From Baseline in Eastern Cooperative Oncology Group (ECOG) Performance Status [ Time Frame: Day 1 up to a maximum of Week 25 ]
  11. Number of Participants Who Experience a Clinically Significant Change From Baseline in Electrocardiogram (ECG) Results [ Time Frame: Day 1 up to a maximum of Week 25 ]
  12. Average Concentration of Loncastuximab Tesirine at the End of Infusion [ Time Frame: Day 1 of Cycles 1 through 6 (each cycle is 3 weeks) ]
  13. Average Concentration of Loncastuximab Tesirine Before Infusion [ Time Frame: Day 1 of Cycles 2 through 6 (each cycle is 3 weeks) ]
  14. Number of Participants With Anti-Drug Antibody (ADA) Titers to Loncastuximab Tesirine [ Time Frame: Day 1 up to a maximum of Week 25 ]
  15. Part 2: Change from Baseline in Health-Related Quality of Life (HRQoL) as Measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire -Core 30 (EORTC QLQ-C30) [ Time Frame: Baseline up to a maximum of Week 25 ]
  16. Part 2: Change from Baseline in Health-Related Quality of Life (HRQoL) as Measured by the Lymphoma Subscale of Functional Assessment of Cancer Therapy- Lymphoma (LymS of FACT-Lym) [ Time Frame: Baseline up to a maximum of Week 25 ]
  17. Part 2: Change from Baseline in Health-Related Quality of Life (HRQoL) as Measured by GP5 Item of the Functional Assessment of Cancer Therapy- Lymphoma (FACT-Lym) [ Time Frame: Baseline up to a maximum of Week 25 ]
  18. Part 2: Change from Baseline in Health-Related Quality of Life (HRQoL) as Measured by EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) [ Time Frame: Baseline to up to 4 years ]


Information from the National Library of Medicine

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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:

  • Male or female participant aged 18 years or older
  • Pathologic diagnosis of DLBCL, as defined by the 2016 World Health Organization classification (including participants with DLBCL transformed from indolent lymphoma), or high-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
  • Relapsed (disease that has recurred following a response) or refractory (disease that failed to respond to prior therapy) disease following at least one multi-agent systemic treatment regimen
  • Not considered by the investigator to be a candidate for stem cell transplantation based on performance status, advanced age, and/or significant medical comorbidities such as organ dysfunction
  • Participants who have received previous CD19-directed therapy must have a biopsy which shows CD19 expression after completion of the CD19-directed therapy
  • Measurable disease as defined by the 2014 Lugano Classification as assessed by positron-emission tomography (PET)- computed tomography (CT) or by CT or magnetic resonance imaging (MRI) if tumor is not fluorodeoxyglucose (FDG)-avid on screening PET-CT
  • Availability of formalin-fixed paraffin-embedded (FFPE) tumor tissue block (or minimum 10 freshly cut unstained slides if block is not available) Note: Any biopsy since initial diagnosis is acceptable, but if several samples are available, the most recent sample is preferred
  • ECOG performance status 0-2
  • Adequate organ function as defined by screening laboratory values within the following parameters:

    1. Absolute neutrophil count ≥1000/μL (off growth factors for at least 72 hours)
    2. Platelet count ≥100000/μL without transfusion within the past 2 weeks
    3. ALT, AST, and GGT ≤2.5 × the upper limit of normal (ULN)
    4. Total bilirubin ≤1.5 × ULN (participants with known Gilbert's syndrome may have a total bilirubin up to ≤3 × ULN)
    5. Calculated creatinine clearance ≥30 mL/min by the Cockcroft and Gault equation

Note: A laboratory assessment may be repeated a maximum of two times during the Screening period to confirm eligibility.

  • Negative beta-human chorionic gonadotropin (β-hCG) pregnancy test within 7 days prior to start of study drug (Cycle 1 Day 1) for women of childbearing potential
  • Women of childbearing potential must agree to use a highly effective method of contraception from the time of giving informed consent until at least 12 months after the last dose of study treatment. Men with female partners who are of childbearing potential must agree to use a condom when sexually active or practice total abstinence from the time of giving informed consent until at least 6 months after the participant receives his last dose of study treatment.

Exclusion Criteria:

  • Previous treatment with loncastuximab tesirine
  • Previous treatment with R-GemOx
  • Known history of hypersensitivity to or positive serum human ADA to a CD19 antibody
  • Pathologic diagnosis of Burkitt lymphoma
  • Active second primary malignancy other than non-melanoma skin cancers, non-metastatic prostate cancer, in situ cervical cancer, ductal or lobular carcinoma in situ of the breast, or other malignancy that the Sponsor's medical monitor and Investigator agree and document should not be exclusionary
  • Autologous transplant within 30 days prior to start of study drug (Cycle 1 Day 1)
  • Allogeneic transplant within 60 days prior to start of study drug (Cycle 1 Day 1)
  • Active graft-versus-host disease
  • Post-transplantation lymphoproliferative disorders
  • Active autoimmune disease, including motor neuropathy considered of autoimmune origin and other central nervous system (CNS) autoimmune disease
  • Human immunodeficiency virus (HIV) seropositive with any of the following:

    1. CD4+ T-cell (CD4+) counts <350 cells/μL
    2. Acquired immunodeficiency syndrome-defining opportunistic infection within 12 months prior to screening
    3. Not on anti-retroviral therapy, or on anti-retroviral therapy for <4 weeks at the time of screening
    4. HIV viral load ≥400 copies/mL
  • Serologic evidence of chronic hepatitis B virus (HBV) infection and unable or unwilling to receive standard prophylactic antiviral therapy or with detectable HBV viral load
  • Serologic evidence of hepatitis C virus (HCV) infection without completion of curative treatment or with detectable HCV viral load
  • History of Stevens-Johnson syndrome or toxic epidermal necrolysis
  • Lymphoma with active CNS involvement, including leptomeningeal disease
  • Clinically significant third space fluid accumulation (i.e., ascites requiring drainage or pleural effusion that is either requiring drainage or associated with shortness of breath)
  • Breastfeeding or pregnant
  • Uncontrolled hypertension (blood pressure ≥160/100 mm Hg repeatedly), unstable angina, congestive heart failure (greater than New York Heart Association class II), electrocardiographic evidence of acute ischemia, coronary angioplasty or myocardial infarction within 6 months prior to screening, uncontrolled atrial or ventricular cardiac arrhythmia, poorly controlled diabetes, severe chronic pulmonary disease, or other serious medical condition which is likely to significantly impair the participant's ability to tolerate the study treatment
  • Major surgery within 4 weeks prior to start of study drug (Cycle 1 Day 1); radiotherapy, chemotherapy or other antineoplastic therapy within 14 days prior to start of study drug (Cycle 1 Day 1), except shorter if approved by the Sponsor
  • Use of any other experimental medication within 14 days or 5 half-lives prior to start of study drug (Cycle 1 Day 1)
  • Received live vaccine within 4 weeks of Cycle 1 Day 1
  • Failure to recover to ≤Grade 1 (Common Terminology Criteria for Adverse Events [CTCAE] version 5.0) from acute non-hematologic toxicity (except alopecia) due to previous therapy prior to screening
  • Congenital long QT syndrome or a corrected QTcF interval of ≥480 ms at screening (unless secondary to pacemaker or bundle branch block)
  • Any other significant medical illness, abnormality, or condition that would, in the Investigator's judgment, make the participant inappropriate for study participation or put the participant at risk
  • Known history of hypersensitivity to oxaliplatin or other platinum-based drugs, or gemcitabine, or rituximab, or any of their excipients

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): NCT04384484


Contacts
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Contact: ADC Therapeutics 954-903-7994 clinical.trials@adctherapeutics.com

Locations
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Sponsors and Collaborators
ADC Therapeutics S.A.
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Responsible Party: ADC Therapeutics S.A.
ClinicalTrials.gov Identifier: NCT04384484    
Other Study ID Numbers: ADCT-402-311
2020-000241-14 ( EudraCT Number )
First Posted: May 12, 2020    Key Record Dates
Last Update Posted: December 2, 2021
Last Verified: December 2021
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 ADC Therapeutics S.A.:
Loncastuximab Tesirine
Refractory Diffuse Large B-Cell Lymphoma
Relapsed Diffuse Large B-Cell Lymphoma
Diffuse Large B-Cell Lymphoma
Lymphoma
Additional relevant MeSH terms:
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Lymphoma
Lymphoma, B-Cell
Lymphoma, Large B-Cell, Diffuse
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Gemcitabine
Rituximab
Loncastuximab tesirine
Oxaliplatin
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents