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Trial record 1 of 1 for:    ACCRU-LY-1806
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Polatuzumab Vedotin, Venetoclax, and Rituximab and Hyaluronidase Human for the Treatment of Relapsed or Refractory Mantle Cell Lymphoma

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ClinicalTrials.gov Identifier: NCT04659044
Recruitment Status : Recruiting
First Posted : December 9, 2020
Last Update Posted : August 26, 2022
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Academic and Community Cancer Research United

Brief Summary:
This phase II trial studies the effect of polatuzumab vedotin, venetoclax, and rituximab and hyaluronidase human in treating patients with mantle cell lymphoma that has come back (relapsed) or does not respond to treatment (refractory). Polatuzumab vedotin is a monoclonal antibody, polatuzumab, linked to a toxic agent called vedotin. Polatuzumab attaches to CD79B positive cancer cells in a targeted way and delivers vedotin to kill them. Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cell growth. Rituximab hyaluronidase is a combination of rituximab and hyaluronidase. Rituximab binds to a molecule called CD20, which is found on B cells (a type of white blood cell) and some types of cancer cells. This may help the immune system kill cancer cells. Hyaluronidase allows rituximab to be given by injection under the skin. Giving rituximab and hyaluronidase by injection under the skin is faster than giving rituximab alone by infusion into the blood. Giving polatuzumab vedotin, venetoclax, and rituximab and hyaluronidase human may work better than standard therapy in treating patients with mantle cell lymphoma.

Condition or disease Intervention/treatment Phase
Recurrent B-Cell Non-Hodgkin Lymphoma Recurrent Grade 1 Follicular Lymphoma Recurrent Grade 2 Follicular Lymphoma Recurrent Grade 3a Follicular Lymphoma Recurrent Mantle Cell Lymphoma Recurrent Marginal Zone Lymphoma Recurrent Small Lymphocytic Lymphoma Refractory B-Cell Non-Hodgkin Lymphoma Refractory Grade 1 Follicular Lymphoma Refractory Grade 2 Follicular Lymphoma Refractory Grade 3a Follicular Lymphoma Refractory Mantle Cell Lymphoma Refractory Marginal Zone Lymphoma Refractory Small Lymphocytic Lymphoma Drug: Polatuzumab Vedotin Biological: Rituximab Biological: Rituximab and Hyaluronidase Human Drug: Venetoclax Phase 2

Detailed Description:

PRIMARY OBJECTIVE:

I. To evaluate the end of induction (EOI) complete response rate (CR) for treatment with the regimen of rituximab and hyaluronidase human + polatuzumab vedotin + venetoclax (RSC + Pola + Ven) in relapsed/refractory mantle cell lymphoma (MCL).

SECONDARY OBJECTIVES:

I. To evaluate the EOI overall response rate (ORR) for the combination of RSC + Pola + Ven in relapsed/refractory MCL.

II. To evaluate the best response (CR, partial response [PR]) in patients who continue on to maintenance therapy and evaluate the improvement in the depth of response.

III. To evaluate the progression free survival (PFS) and overall survival (OS) for the combination of RSC + Pola + Ven) in relapsed/ refractory MCL.

IV. To compare the ORR, CR, PFS, and OS in ibrutinib refractory compared to ibrutinib naive patients.

V. To evaluate regimen-related toxicity for patients treated with RSC + Pola + Ven.

CORRELATIVE RESEARCH OBJECTIVES:

I. To evaluate changes in minimal residual disease (MRD) status in both responding and non-responding patients at EOI and end of maintenance and compared to baseline as well as correlate MRD status with PFS and OS.

II. To evaluate changes in systemic immune profiles and T cell activation induced by treatment with RituxSC (RSC) + Pola + Ven.

III. To evaluate the prognostic importance of high risk cytogenetic alterations, and other risk stratification scores in patients with relapsed/refractory MCL receiving RituxSC + Pola + Ven.

OUTLINE:

INDUCTION: Patients receive rituximab intravenously (IV) on day 1 of cycle 1 and rituximab and hyaluronidase human subcutaneously (SC) over 5 minutes on day 1 of cycles 2-6. Patients also receive polatuzumab vedotin IV over 30-90 minutes on day 1 and venetoclax orally (PO) daily on days 1-21. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.

MAINTENANCE: Patients receive venetoclax PO daily and rituximab and hyaluronidase human SC over 5 minutes every 60 days for up to 1 year in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 90 days for up to 5 years.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 63 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 2 Trial of the Combination of Polatuzumab Vedotin, Venetoclax and Rituximab and Hyaluronidase Human for Relapsed and Refractory Mantle Cell Lymphoma
Actual Study Start Date : April 1, 2021
Estimated Primary Completion Date : December 31, 2023
Estimated Study Completion Date : December 31, 2025


Arm Intervention/treatment
Experimental: Treatment (rituximab, polatuzumab vedotin, venetoclax)

INDUCTION: Patients receive rituximab IV on day 1 of cycle 1 and rituximab and hyaluronidase human SC over 5 minutes on day 1 of cycles 2-6. Patients also receive polatuzumab vedotin IV over 30-90 minutes on day 1 and venetoclax PO daily on days 1-21. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.

MAINTENANCE: Patients receive venetoclax PO daily and rituximab and hyaluronidase human SC over 5 minutes every 60 days for up to 1 year in the absence of disease progression or unacceptable toxicity.

Drug: Polatuzumab Vedotin
Given IV
Other Names:
  • ADC DCDS4501A
  • Antibody-Drug Conjugate DCDS4501A
  • DCDS4501A
  • FCU 2711
  • polatuzumab vedotin-piiq
  • Polivy
  • RG7596
  • Ro 5541077-000

Biological: Rituximab
Given IV
Other Names:
  • ABP 798
  • BI 695500
  • C2B8 Monoclonal Antibody
  • Chimeric Anti-CD20 Antibody
  • CT-P10
  • IDEC-102
  • IDEC-C2B8
  • IDEC-C2B8 Monoclonal Antibody
  • MabThera
  • Monoclonal Antibody IDEC-C2B8
  • PF-05280586
  • Rituxan
  • Rituximab ABBS
  • Rituximab Biosimilar ABP 798
  • Rituximab Biosimilar BI 695500
  • Rituximab Biosimilar CT-P10
  • Rituximab Biosimilar GB241
  • Rituximab Biosimilar IBI301
  • Rituximab Biosimilar JHL1101
  • Rituximab Biosimilar PF-05280586
  • Rituximab Biosimilar RTXM83
  • Rituximab Biosimilar SAIT101
  • rituximab biosimilar TQB2303
  • rituximab-abbs
  • RTXM83
  • Truxima

Biological: Rituximab and Hyaluronidase Human
Given SC
Other Names:
  • Rituxan Hycela
  • Rituximab Plus Hyaluronidase
  • Rituximab/Hyaluronidase
  • Rituximab/Hyaluronidase Human

Drug: Venetoclax
Given PO
Other Names:
  • ABT-0199
  • ABT-199
  • ABT199
  • GDC-0199
  • RG7601
  • Venclexta
  • Venclyxto




Primary Outcome Measures :
  1. Complete response (CR) rate [ Time Frame: At Study Completion, up to 5 years from registration ]
    Objective status of CR measured by positron emission tomography (PET)-computed tomography (CT) scans according to Lugano 2014.


Secondary Outcome Measures :
  1. Overall response rate (ORR) [ Time Frame: At Study Completion, up to 5 years from registration ]
    The ORR at the end of induction will be estimated by the total number of patients who achieve a complete response (CR) or partial response (PR) by PET-CT scans according to Lugano 2014 divided by the total number of evaluable patients. The ORR between ibrutinib-naive and ibrutinib-pretreated patients will be compared using Fisher's exact test.

  2. Best response rate to maintenance therapy [ Time Frame: At Study Completion, up to 5 years from registration ]
    CR, PR, and stable disease (SD) rates for patients who continue to maintenance will be estimated by number of patients who continue on maintenance therapy and achieve CR, PR or SD, respectively, at the end of maintenance divided by the total number of evaluable patients who continue to maintenance.

  3. Progression free survival (PFS) [ Time Frame: From registration to the earliest date of documentation of disease progression by CT or PET/CT or death due to any cause, assessed up to 5 years ]
    The distribution of PFS will be estimated using the method of Kaplan-Meier. The PFS between ibrutinib-naive and ibrutinib-pretreated patients will be compared using log-rank test.

  4. Overall survival (OS) [ Time Frame: From registration to death due to any cause, assessed up to 5 years ]
    The distribution of OS will be estimated using the method of Kaplan-Meier. The OS between ibrutinib-naive and ibrutinib-pretreated patients will be compared using log-rank test.

  5. Incidence of adverse events (AEs) [ Time Frame: Up to 5 years ]
    All AEs occurring on or after first study treatment will be summarized by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 grade.


Other Outcome Measures:
  1. Minimal residual disease (MRD) analysis [ Time Frame: At Study Completion, up to 5 years from registration ]
    MRD status for both responders and non-responders at each time point will be reported descriptively, and explored for correlation with clinical factors and patient outcomes such as PFS and OS.

  2. T cell subset analysis [ Time Frame: At Study Completion, up to 5 years from registration ]
    T cell activation will be investigated using multi-parameter flow cytometry.

  3. Cytokine subset analysis [ Time Frame: At Study Completion, up to 5 years from registration ]
    Systemic immune profiles will be investigated using cytokine analysis in the peripheral blood of patients.

  4. High risk cytogenetic alterations [ Time Frame: At Study Completion, up to 5 years from registration ]
    Will be summarized using frequency and percentages.

  5. Risk stratification scores [ Time Frame: At Study Completion, up to 5 years from registration ]
    Will be summarized using frequency and percentages.



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:

  • Pathologically confirmed relapsed or primary refractory mantle cell lymphoma with concurrent or prior tissue sample immunohistochemistry (IHC) positive for cyclin D1 or that is positive for fluorescence in situ hybridization (FISH) or cytogenetics for t(11;14)

    • NOTE: Safety Portion only: MCL or indolent B cell non-Hodgkin lymphoma (NHL) (follicular lymphoma [FL] [grades I-IIIa] marginal zone lymphoma [MZL]), or, small lymphocytic lymphoma (SLL) stratified as low risk for tumor lysis syndrome (TLS), relapsed or progressed after at least two lines of therapy (or one BTK inhibitor containing line of therapy). No limit to prior lines of therapy
    • NOTE: Expansion Portion only: MCL relapsed or progressed after at least two lines of therapy or one BTK inhibitor line of therapy. Prior autologous stem cell transplant (AutoSCT) is allowed. No limit to number of prior therapies. May have received prior BTK inhibitor therapy
  • Measurable disease as defined with at least one lesion measuring >= 1 x 1.5 cm
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
  • Absolute neutrophil count (ANC) >= 1000/mm^3 (obtained =< 14 days prior to registration)
  • Platelet count >= 75,000/mm^3 (obtained =< 14 days prior to registration)
  • Hemoglobin >= 9.0 g/dL (obtained =< 14 days prior to registration)
  • International normalized ratio =< 1.5 x upper limit of normal (ULN) for patients not receiving therapeutic anticoagulation (obtained =< 14 days prior to registration)
  • Partial thromboplastin time (PTT) or activated PTT (aPTT) =< 1.5 x ULN (obtained =< 14 days prior to registration)
  • Calculated creatinine (Cr) clearance >= 45 ml/min using the modified Cockcroft-Gault formula (obtained =< 14 days prior to registration)
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2.5 x ULN (obtained =< 14 days prior to registration)
  • Total bilirubin < 1.5 x ULN (or =< 3 x ULN for patients with documented Gilbert syndrome) (obtained =< 14 days prior to registration)
  • Negative serum pregnancy test done =< 7 days prior to registration, for women of childbearing potential only
  • Able to provide informed written consent, and ability to comply with study related procedures
  • Willing to return to enrolling institution for follow-up (during the Active Monitoring Phase of the study)
  • Willing to provide tissue samples for mandatory correlative research
  • For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use a contraceptive method with a failure rate of < 1% per year during the treatment period and for at least 30 days after the last dose of venetoclax or 18 months after the last dose of rituximab and hyaluronidase human, whichever is longer. For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating sperm, as defined below:

    • With female partners of childbearing potential, men must remain abstinent or use a condom plus an additional contraceptive method that together result in a failure rate of < 1% per year during the treatment period and for at least 6 months after the last dose. Men must refrain from donating sperm during this same period.
    • With pregnant female partners, men must remain abstinent or use a condom during the treatment period and for at least 6 months after the last dose to avoid exposing the embryo

Exclusion Criteria:

  • Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:

    • Pregnant women
    • Nursing women
    • Men or women of childbearing potential who are unwilling to employ adequate contraception
  • 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
  • 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 or chemotherapeutic agent which would be considered as a treatment for the primary neoplasm
  • Known CD20-negative status at relapse or progression
  • Prior allogeneic SCT
  • Completion of autologous SCT =< 100 days prior to registration
  • Radioimmunoconjugate =< 12 weeks prior to registration
  • Monoclonal antibody or antibody-drug conjugate (ADC) therapy within 5 half-lives or 4 weeks prior to registration, whichever is longer
  • Radiotherapy, chemotherapy, hormonal therapy, or targeted small-molecule therapy within 2 weeks prior to registration (with the exception of ibrutinib to prevent tumor flare, patients taking ibrutinib who are progressing must discontinue ibrutinib 2 half-lives or 2 days prior to initiating protocol therapy)
  • Clinically significant toxicity (other than alopecia) from prior therapy that has not resolved to grade =< 2 (per National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE] version [v]5.0) prior to registration
  • Current grade > 1 peripheral neuropathy
  • Any history of central nervous system (CNS) lymphoma or leptomeningeal infiltration
  • Treatment with systemic corticosteroids > 20 mg/day prednisone or equivalent Patients who are receiving corticosteroids =< 20 mg/day, prednisone or equivalent, for non-lymphoma treatment reasons must be documented to be on a stable dose for at >= 4 weeks prior to registration. If corticosteroid treatment is urgently required for lymphoma symptom control prior to the start of study treatment, up to 100 mg/day of prednisone or equivalent can be given for a maximum of 5 days, but all tumor assessments must be completed prior to start of corticosteroid treatment
  • History of severe allergic or anaphylactic reaction or known sensitivity to humanized or murine monoclonal antibodies rituximab, polatuzumab vedotin, and venetoclax
  • Active bacterial, viral, fungal, or other infection
  • Requirement for warfarin treatment (because of potential drug-drug interactions [DDIs] that may increase the exposure of warfarin)
  • Treatment with the following agents =< 7 days prior to registration

    • Strong and moderate CYP3A inhibitors such as fluconazole, ketoconazole, and clarithromycin
    • Strong and moderate CYP3A inducers such as rifampin and carbamazepine. If taking proton pump inhibitors willing to avoid co-administration and stagger venetoclax dosing
  • Consumption of grapefruit, grapefruit products, Seville oranges (including marmalade that contains Seville oranges), or star fruit =< 3 days prior to registration
  • Clinically significant history of liver disease, including viral or other hepatitis, current alcohol abuse, or cirrhosis
  • Active hepatitis B or hepatitis C infection. Patients who have been successfully treated and cleared their virus as evidenced a negative hepatitis (Hep) B or Hep C polymerase chain reaction (PCR) are eligible
  • Known history of human immunodeficiency virus (HIV) positive status or known infection with human T-cell leukemia virus 1. For patients with unknown HIV status, HIV testing will be performed at screening if required by local regulations
  • History of PML (progressive multifocal leukoencephalopathy)
  • Vaccination with a live virus vaccine =< 28 days prior to registration
  • History of other malignancy that could affect compliance with the protocol or interpretation of results, with the exception of the following: curatively treated carcinoma in situ of the cervix, good-prognosis ductal carcinoma in situ of the breast, basal- or squamous-cell skin cancer, stage I melanoma, or low-grade, early-stage localized prostate cancer
  • Any previously treated malignancy that has been in remission without treatment for =< 3 years prior to registration
  • Evidence of any significant, uncontrolled concomitant disease that could affect compliance with the protocol or interpretation of results, including significant cardiovascular disease (such as New York Heart Association class III or IV cardiac disease, myocardial infarction within the previous 6 months, unstable arrhythmia, or unstable angina) or significant pulmonary disease (such as obstructive pulmonary disease or history of bronchospasm)
  • Major surgical procedure other than for diagnosis =< 28 days prior to day 1 of cycle 1, or anticipation of a major surgical procedure during the course of the study
  • Inability or unwillingness to swallow pills
  • History of malabsorption syndrome or other condition that would interfere with enteral absorption
  • History of inflammatory bowel disease (e.g., Crohn's disease or ulcerative colitis) or active bowel inflammation (e.g., diverticulitis)

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): NCT04659044


Locations
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United States, Arizona
Mayo Clinic in Arizona Withdrawn
Scottsdale, Arizona, United States, 85259
United States, Illinois
Carle Cancer Center NCI Community Oncology Research Program Recruiting
Urbana, Illinois, United States, 61801
Contact: Tyler Mbuvi    217-383-4085    Pauline.mbuvi@carle.com   
Principal Investigator: Suparna Mantha         
United States, Iowa
Iowa-Wide Oncology Research Coalition NCORP Withdrawn
Des Moines, Iowa, United States, 50309
Siouxland Regional Cancer Center Recruiting
Sioux City, Iowa, United States, 51101
Contact: Tom Hoopingarner    712-252-9326    hoopingarnert@JENCC.com   
Principal Investigator: Donald B. Wender         
United States, Michigan
St. Joseph Mercy Hospital Recruiting
Ann Arbor, Michigan, United States, 48106
Contact: Joan Strohm    734-715-7251    joan.strohm@stjoeshealth.org   
Principal Investigator: Tareq Albaghdadi, MD         
United States, Minnesota
Mayo Clinic in Rochester Not yet recruiting
Rochester, Minnesota, United States, 55905
Contact: ACCRU Operations    507-538-7448    ACCRU@mayo.edu   
Principal Investigator: Jonas Paludo         
United States, Missouri
Washington University School of Medicine Recruiting
Saint Louis, Missouri, United States, 63110
Contact: Anne Fischer    314-362-3021    afischer@wustl.edu   
Principal Investigator: Brad S. Kahl         
United States, Nebraska
University of Nebraska Medical Center Withdrawn
Omaha, Nebraska, United States, 68198
United States, New York
Laura and Isaac Perlmutter Cancer Center at NYU Langone Recruiting
New York, New York, United States, 10016
Contact: Leonelle Beto    929-455-2451    Leonelle.betobedou@nyulangone.org   
Principal Investigator: Catherine S. Diefenbach         
United States, Pennsylvania
University of Pennsylvania Abramson Cancer Center Not yet recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Jennifer Castillo    216-614-1846    Jeniffer.Castillo@uphs.upenn.edu   
Principal Investigator: Jakob Svoboda         
United States, Washington
University of Washington Medical Center - Montlake Withdrawn
Seattle, Washington, United States, 98195
United States, Wisconsin
Aurora Cancer Care-Milwaukee Withdrawn
Milwaukee, Wisconsin, United States, 53209
Sponsors and Collaborators
Academic and Community Cancer Research United
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Catherine S Diefenbach Academic and Community Cancer Research United
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Responsible Party: Academic and Community Cancer Research United
ClinicalTrials.gov Identifier: NCT04659044    
Other Study ID Numbers: ACCRU-LY-1806
NCI-2020-08188 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
ACCRU-LY-1806 ( Other Identifier: Academic and Community Cancer Research United )
P30CA015083 ( U.S. NIH Grant/Contract )
First Posted: December 9, 2020    Key Record Dates
Last Update Posted: August 26, 2022
Last Verified: August 2022

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Lymphoma
Lymphoma, Follicular
Lymphoma, Non-Hodgkin
Lymphoma, Mantle-Cell
Lymphoma, B-Cell, Marginal Zone
Leukemia, Lymphocytic, Chronic, B-Cell
Lymphoma, B-Cell
Recurrence
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Disease Attributes
Pathologic Processes
Leukemia, B-Cell
Leukemia, Lymphoid
Leukemia
Rituximab
Antineoplastic Agents, Immunological
Venetoclax
Antibodies
Immunoglobulins
Antibodies, Monoclonal
Immunoconjugates
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents
Antirheumatic Agents