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APR-246 in Combination With Ibrutinib or Venetoclax-R in Subjects With TP53-Mutant R/R Non Hodgkin Lymphomas (NHL) (R/R)

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ClinicalTrials.gov Identifier: NCT04419389
Recruitment Status : Recruiting
First Posted : June 5, 2020
Last Update Posted : January 19, 2021
Sponsor:
Information provided by (Responsible Party):
Aprea Therapeutics

Brief Summary:
Study to determine the preliminary safety, tolerability, and pharmacokinetic (PK) profile of APR-246 in combination with either ibrutinib or venetoclax + rituximab therapy in subjects with TP53-mutant NHL, including relapsed and/or refractory (R/R) CLL and R/R MCL.

Condition or disease Intervention/treatment Phase
Non Hodgkin Lymphoma Chronic Lymphocytic Leukemia Mantle Cell Lymphoma Drug: APR-246 (eprenetapopt) Drug: Ibrutinib Drug: venetoclax-R Phase 1 Phase 2

Detailed Description:

Phase 1, open-label, dose-finding and cohort expansion study to determine the preliminary safety, tolerability, and pharmacokinetic (PK) profile of APR-246 (eprenetapopt) in combination with either ibrutinib or venetoclax + rituximab therapy in subjects with TP53-mutant NHL, including relapsed and/or refractory (R/R) CLL and R/R MCL.

The study includes a safety lead-in portion followed by an expansion portion in subjects with R/R CLL and R/R MCL.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 116 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: Phase 1 and Dose Expansion Study of APR-246 in Combination With Ibrutinib or Venetoclax-based Therapy in Subjects With TP53-Mutant R/R NHL Including Chronic Lymphocytic Leukemia (CLL) and Mantle Cell Lymphoma (MCL)
Estimated Study Start Date : January 2021
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : June 2023


Arm Intervention/treatment
Experimental: Safety Lead-In Cohort 1
Subjects with R/R TP53-mutant CLL.
Drug: APR-246 (eprenetapopt)
APR-246 D1-4 of each cycle

Drug: Ibrutinib
Ibrutinib will be given at a standard dose and schedule.

Experimental: Safety Lead-In Cohort 2
Subjects with R/R TP53-mutant CLL.
Drug: APR-246 (eprenetapopt)
APR-246 D1-4 of each cycle

Drug: venetoclax-R
Venetoclax and Rituximab will be given at a standard dose and schedule.

Experimental: Expansion Cohorts
Subjects with R/R TP53-mutant CLL and/or MCL
Drug: APR-246 (eprenetapopt)
APR-246 D1-4 of each cycle

Drug: Ibrutinib
Ibrutinib will be given at a standard dose and schedule.

Drug: venetoclax-R
Venetoclax and Rituximab will be given at a standard dose and schedule.




Primary Outcome Measures :
  1. To determine the DLT of APR-246 in combination with ibrutinib or in combination with venetoclax + rituximab therapy in subjects with TP53 mutant NHL, including subjects with R/R CLL and R/R MCL. [ Time Frame: Through study completion, approximately 1 year ]
    The occurrence of DLTs, classified and graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events .

  2. To assess the frequency of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) related to APR-246 in combination with ibrutinib and with venetoclax + rituximab therapy. [ Time Frame: Through study completion, approximately 1 year ]
    The frequency of TEAEs and SAEs related to APR-246 in combination with ibrutinib and with venetoclax + rituximab therapy

  3. To determine the maximum tolerated dose (MTD) and the recommended Phase 2 dose (RP2D) in subjects with TP53 mutant NHL, including subjects with R/R CLL and R/R MCL. [ Time Frame: Through study completion, approximately 1 year ]
    The highest dose of APR-246 with acceptable toxicity (RP2D of APR-246) (the dose producing ≤ 20% of DLT).



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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. Is able to understand and is willing and able to comply with the study requirements and to provide written informed consent.
  2. Documented histologic diagnosis of R/R CLL or R/R MCL
  3. Safety Lead-In Cohort 1: Patients whose most recent regimen did not include BTK inhibitor therapy.
  4. Safety Lead-In Cohort 2: Patients whose most recent regimen did not include Bcl-2 inhibitor therapy.
  5. Prothrombin time (or international normalized ratio) and partial thromboplastin time not to exceed 1.2 × the institution's normal range.
  6. Adequate BM function independent of growth factor or transfusion support, per local laboratory reference range at screening as follows:

    1. platelet count ≥ 75 000/mm3;
    2. absolute neutrophil count (ANC) ≥ 1000/mm3 unless cytopenia is clearly due to marrow involvement from CLL or MCL
    3. total hemoglobin ≥ 9 g/dL (without transfusion support within 2 weeks of screening);
  7. Adequate organ function as defined by the following laboratory values:

    1. Creatinine clearance ≥ 30 mL/min.
    2. Total serum bilirubin ≤ 1.5 × upper limit of normal (ULN) unless due to Gilbert's syndrome, NHL organ involvement, controlled immune hemolysis or considered an effect of regular blood transfusions.
    3. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × ULN, unless due to NHL organ involvement.
  8. Age ≥18 years at the time of signing the informed consent form.
  9. At least one TP53 mutation which is not benign or likely benign.
  10. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.
  11. Projected life expectancy of ≥ 12 weeks.
  12. Women of childbearing potential and men with female partners of childbearing potential must be willing to use an effective form of contraception.

    Exclusion Criteria:

  13. Patient with known allergies to xanthine oxidase inhibitors and/or rasburicase.
  14. For patients to receive rituximab on this protocol, prior allergy to rituximab is prohibited.
  15. No concomitant anticancer therapies, immunotherapies, cellular, or radiotherapy. No major surgery within 3 weeks prior to first dose of study treatment.
  16. Uncontrolled autoimmune hemolytic anemia (AIHA) or immune thrombocytopenia.
  17. Consumption of grapefruit, grapefruit products, Seville oranges, or star fruit within 7 days of starting study treatment.
  18. Concomitant steroids for disease related pain control are allowed at any dose but must be discontinued prior to any study treatment initiation. Chronic use of corticosteroids is allowed up to ≤ 20 mg prednisone daily for non-cancer related conditions at the time of study start.
  19. History of allogeneic or autologous stem cell transplant (SCT) or CAR-T therapy within the last 30 days or with any of the following:
  20. Active graft versus host disease (GVHD)
  21. Cytopenias from incomplete blood cell count recovery post-transplant;
  22. Need for anti-cytokine therapy for residual symptoms of neurotoxicity > grade 1 from CAR-T therapy;
  23. Ongoing immunosuppressive therapy.
  24. Known history of human immunodeficiency virus (HIV) serum positivity.
  25. Active hepatitis B/C.
  26. Known central nervous system (CNS) involvement by lymphoma. Patients with previous treatment for CNS involvement who are neurologically stable and without evidence of disease may be eligible if a compelling clinical rationale is provided to sponsor.
  27. Known neurologic disorder or residual neurologic toxicities that may put patients at increased risk of neurologic toxicity in the opinion of the investigator.
  28. Cardiac abnormalities.
  29. Concomitant malignancies or previous malignancies with less than a 1 year disease- free interval at the time of signing consent.
  30. A female patient who is pregnant or breast-feeding.
  31. Active uncontrolled systemic infection.
  32. Received an investigational agent within 30 days or within 5 T1/2, whichever is shorter prior to the first dose of study treatment.
  33. Clinically significant active malabsorption syndrome or other condition likely to affect gastrointestinal (GI) absorption of ibrutinib or venetoclax.
  34. Current treatment with certain strong cytochrome P450 3A4 (CYP3A4) inhibitors or inducers and/or strong P-gp inhibitors..

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): NCT04419389


Contacts
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Contact: Eyal Attar, MD +1 617 804 6947 info@aprea.com

Locations
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United States, New York
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10065
United States, Texas
MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Sponsors and Collaborators
Aprea Therapeutics
Investigators
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Study Director: Joachim Gullbo, MD Theradex Oncology
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Responsible Party: Aprea Therapeutics
ClinicalTrials.gov Identifier: NCT04419389    
Other Study ID Numbers: A20-11197
First Posted: June 5, 2020    Key Record Dates
Last Update Posted: January 19, 2021
Last Verified: September 2020
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 Aprea Therapeutics:
APR-246
eprenetapopt
Additional relevant MeSH terms:
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Lymphoma
Leukemia
Lymphoma, Non-Hodgkin
Leukemia, Lymphoid
Leukemia, Lymphocytic, Chronic, B-Cell
Lymphoma, Mantle-Cell
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Leukemia, B-Cell
Venetoclax
Antineoplastic Agents