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Acalabrutinib Maintenance for the Treatment of Patients With Large B-cell Lymphoma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT05256641
Recruitment Status : Not yet recruiting
First Posted : February 25, 2022
Last Update Posted : June 9, 2022
Sponsor:
Collaborator:
AstraZeneca
Information provided by (Responsible Party):
Jonsson Comprehensive Cancer Center

Brief Summary:
This phase Ib/II trial studies the side effects and efficacy of maintenance acalabrutinib following cellular therapy in treating patients with large B-cell lymphoma at very high risk of the cancer coming back. Acalabrutinib is a small molecular inhibitor that may interfere with the ability of cancer cells to grow and spread.

Condition or disease Intervention/treatment Phase
Diffuse Large B-Cell Lymphoma High-grade B-cell Lymphoma Transformed Lymphoma Secondary Central Nervous System Lymphoma Drug: Acalabrutinib Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Acalabrutinib Maintenance Following Cellular Therapy for Large B-Cell Lymphoma Patients at Very High Risk for Relapse
Estimated Study Start Date : September 1, 2022
Estimated Primary Completion Date : September 1, 2023
Estimated Study Completion Date : September 1, 2025


Arm Intervention/treatment
Experimental: Group I (acalabrutinib)
Beginning day 90, patients receive acalabrutinib PO QD and then PO BID once no longer on prophylactic antifungal (CYP34A inhibitors) until day 365 in the absence of disease progression or unacceptable toxicity.
Drug: Acalabrutinib
Given PO
Other Names:
  • ACP-196
  • Bruton Tyrosine Kinase Inhibitor ACP-196
  • Calquence

Experimental: Group II (acalabrutinib)
Beginning day 60, patients receive acalabrutinib PO QD and then PO BID from day 74 if there are no dose reductions until day 365 in the absence of disease progression or unacceptable toxicity.
Drug: Acalabrutinib
Given PO
Other Names:
  • ACP-196
  • Bruton Tyrosine Kinase Inhibitor ACP-196
  • Calquence

Experimental: Group III (acalabrutinib)
Beginning anytime between days 28-104, patients receive acalabrutinib PO BID until day 365 in the absence of disease progression or unacceptable toxicity.
Drug: Acalabrutinib
Given PO
Other Names:
  • ACP-196
  • Bruton Tyrosine Kinase Inhibitor ACP-196
  • Calquence




Primary Outcome Measures :
  1. Permanent discontinuation of acalabrutinib [ Time Frame: Up to 12 months from cellular therapy ]
    Tolerability will be determined by the number of patients who permanently discontinue acalabrutinib within 12 months from cellular therapy due to intolerance. The proportion of patients with acalabrutinib discontinuation will be reported along with 95% and 90% confidence intervals.


Secondary Outcome Measures :
  1. Progression-free survival (PFS) [ Time Frame: At 12 months from cellular therapy ]
    The 1-year PFS will be evaluated based on progression of disease per Lugano criteria or death, and will be reported based on Kaplan-Meier estimates along with 95% confidence interval.

  2. PFS [ Time Frame: Up to 5 years ]
    Will be reported based on 95% confidence intervals at annual time points.

  3. Overall survival [ Time Frame: Up to 5 years ]
    Time from cellular therapy to death due to any cause, assessed at 1 and 5 years based on Kaplan-Meier estimates along with 95% confidence interval

  4. Rate of conversion from partial response following chimeric antigen receptor (CAR) T-cell therapy to complete response after the addition of acalabrutinib maintenance [ Time Frame: Up to day 365 ]
    Will be reported based on 95% confidence intervals.

  5. Incidence of dose reductions, interruptions, or discontinuations of acalabrutinib based on the protocol criteria [ Time Frame: Up to day 365 ]
    Will be reported based on 95% confidence intervals.

  6. Incidence of graft versus host disease (GvHD) >= stage 2 [ Time Frame: Up to day 365 ]
    Based on the Mount Sinai Acute GVHD International Consortium criteria for acute GvHD and the National Institutes of Health consensus criteria for chronic GvHD. Will be reported based on 95% confidence intervals.

  7. Incidence of hematologic adverse events [ Time Frame: Up to day 365 ]
    Based on Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0. Will be reported based on 95% confidence intervals.

  8. Incidence of non-hematologic adverse events [ Time Frame: Up to day 365 ]
    Based on CTCAE v5.0. Will be reported based on 95% confidence intervals.


Other Outcome Measures:
  1. CAR T-cell persistence [ Time Frame: Up to 5 years ]
    CAR T-cell persistence measured by mass cytometry upon enrollment, 90 days after initiation of acalabrutinib, and at time of relapse.

  2. Immunophenotyping of peripheral blood mononuclear cells [ Time Frame: Up to 5 years ]
    Types and numbers of proteins present on the leukemia cell surface via mass cytometry upon enrollment, 90 days after initiation of acalabrutinib, and at time of relapse

  3. Intracellular cytokine and phospho-protein profiling of peripheral blood mononuclear cells [ Time Frame: Up to 5 years ]
    Types of proteins involved in cell signaling in leukemia cells via mass cytometry upon enrollment, 90 days after initiation of acalabrutinib, and at time of relapse.

  4. Acalabrutinib metabolite [ Time Frame: At 1-3 weeks after initiation of acalabrutinib ]
    Acalabrutinib metabolite detected in the cerebral spinal fluid at 1-3 weeks after initiation of acalabrutinib in participants with history of secondary central nervous system lymphoma.



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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Ages 18-70 years
  • One of the following:

    • Patients undergoing autologous stem cell transplantation (ASCT) or any Food and Drug Administration (FDA)-approved chimeric antigen receptor (CAR) T-cell therapy product for:

      • High grade B-cell lymphoma (double or triple hit) with rearrangements in bcl-2 and/or bcl-6, and rearrangement in myc
      • Large B-cell lymphoma with a history of secondary CNS involvement
      • Histologic transformation of indolent lymphoma to large B-cell lymphoma, including marginal zone lymphoma, follicular lymphoma, chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), lymphoplasmacytic leukemia, or Waldenstrom macroglobulinemia
      • High risk international prognostic index (IPI) score 4 or 5, at diagnosis or prior to CAR T-cell leukapheresis
    • Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) for large B-cell lymphoma
  • Eastern Cooperative Oncology Group (ECOG) 0-2
  • Requirements for post-ASCT and post-alloHCT participants:

    • Disease status of partial response (PR) or complete response (CR) prior to transplantation
    • Receive reduced-intensity conditioning regimen
    • Enrollment no later than day +90
  • Requirements for post-CAR T-cell therapy participants:

    • Disease status of PR or CR after post-CAR T-cell therapy positron emission tomography (PET)-computed tomography (CT) at 1-3 months
    • Enrollment no later than day +104
  • Ability to give full informed consent
  • Female subjects who are sexually active and can bear children must agree to use highly effective forms of contraception while on the study and for 2 days after the last dose of acalabrutinib
  • Willing and able to participate in all required evaluations and procedures in this study protocol, including swallowing capsules and tablets without difficulty
  • Absolute neutrophil count (ANC) > 500/uL (microliters)
  • Platelets > 50,000/uL independent of transfusions
  • Hemoglobin > 8 g/dL independent of transfusions
  • Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x upper limit of normal (ULN)
  • Total bilirubin =< 1.5 x ULN, unless directly attributable to Gilbert's syndrome
  • Creatinine clearance >= 60 mL/min based on Cockcroft-Gault glomerular filtration rate (GFR) and serum creatinine (Cr) =< 1.8 mg/dL

Exclusion Criteria:

  • Cord blood as donor source in alloHCT
  • New York Heart Association Class III or IV
  • Left ventricular ejection fraction < 50%
  • Estimated glomerular filtration rate < 30 mL/min
  • Concurrent long-term use of posaconazole or other strong CYP3A4 inhibitors and unable to replace with equivalent medication
  • Acute or chronic graft-versus-host disease (GvHD) >= stage 3 at time of enrollment
  • Received packed red blood cells (pRBC) transfusion within the past 2 weeks
  • Received platelet transfusion within the past 1 week
  • Active invasive fungal infection
  • Active bacterial or viral infection until resolution of the infection
  • History of or ongoing confirmed progressive multifocal leukoencephalopathy (PML)
  • Received any investigational drug within 30 days or 5 half-lives (whichever is shorter) before first dose of study drug
  • Major surgical procedure within 30 days before the first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug
  • Refractory nausea and vomiting, inability to swallow the formulated product, or malabsorption syndrome; chronic gastrointestinal disease, gastric restrictions, or bariatric surgery such as gastric bypass; partial or complete bowel obstruction, or previous significant bowel resection that would preclude adequate absorption, distribution, metabolism, or excretion of study treatment
  • Received a live virus vaccination within 28 days of first dose of study drug
  • Known history of infection with human immunodeficiency virus (HIV)
  • History of bleeding diathesis (e.g., hemophilia, von Willebrand disease)
  • Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists
  • Requires treatment with a strong cytochrome P450 3A (CYP3A) inhibitor or inducer. The use of strong CYP3A inhibitors within 1 week or strong CYP3A inducers within 3 weeks of the first dose of study drug is prohibited
  • Breastfeeding or pregnant
  • Concurrent participation in another therapeutic clinical trial

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): NCT05256641


Contacts
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Contact: Vlad Kustanovitch 310-206-5756 VKustanovich@mednet.ucla.edu

Locations
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United States, California
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, United States, 90095
Contact: Vlad Kustanovich    310-206-5756    VKustanovich@mednet.ucla.edu   
Principal Investigator: Caspian Oliai, MD         
University of California Davis Comprehensive Cancer Center
Sacramento, California, United States, 95817
Contact: Joseph M. Tuscano    916-734-3772    jtuscano@ucdavis.edu   
Principal Investigator: Joseph M. Tuscano         
United States, Oklahoma
University of Oklahoma
Oklahoma City, Oklahoma, United States, 73190
Contact: Matthew J. Wieduwilt    405-217-8001    Matthew-Wieduwilt@ouhsc.edu   
Principal Investigator: Matthew J. Wieduwilt         
Sponsors and Collaborators
Jonsson Comprehensive Cancer Center
AstraZeneca
Investigators
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Principal Investigator: Caspian Oliai, MD UCLA / Jonsson Comprehensive Cancer Center
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Responsible Party: Jonsson Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT05256641    
Other Study ID Numbers: 21-000979
NCI-2021-12421 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
First Posted: February 25, 2022    Key Record Dates
Last Update Posted: June 9, 2022
Last Verified: June 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, B-Cell
Lymphoma, Large B-Cell, Diffuse
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Acalabrutinib
Antineoplastic Agents