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Mosunetuzumab With Lenalidomide Augmentation as First-line Therapy for Follicular and Marginal Zone Lymphoma

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ClinicalTrials.gov Identifier: NCT04792502
Recruitment Status : Not yet recruiting
First Posted : March 11, 2021
Last Update Posted : March 11, 2021
Sponsor:
Information provided by (Responsible Party):
Adam Olszewski, Brown University

Brief Summary:
BrUOG-401 is a prospective, single-arm, phase 2 trial of first-line therapy in adult patients with previously untreated FL or MZL. All patients will be assigned the same initial treatment plan, modified by interim response assessment (IRA) after Cycle 4. All patients will start treatment with four 21-day cycles (C1-4) of mosunetuzumab alone (using step-up dosing during C1), followed by IRA. Patients who achieve CR at IRA will continue with additional 4 cycles (C5-8) of mosunetuzumab. Patients who achieve PR at IRA will receive mosunetuzumab with lenalidomide augmentation during C5-8. Primary response assessment (PRA) will occur after C8. Patients who remain in PR at PRA will continue for additional 4 cycles (extended augmentation).

Condition or disease Intervention/treatment Phase
Follicular Lymphoma Marginal Zone Lymphoma B-cell Lymphoma Drug: Mosunetuzumab Drug: Lenalidomide Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 52 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: BrUOG 401: A Phase 2 Study of Mosunetuzumab With Lenalidomide Augmentation as First-line Therapy for Follicular and Marginal Zone Lymphoma
Estimated Study Start Date : August 1, 2021
Estimated Primary Completion Date : August 1, 2024
Estimated Study Completion Date : August 1, 2026


Arm Intervention/treatment
Experimental: Planned Therapy Drug: Mosunetuzumab
Administered subcutaneously by injection beginning with 5 mg and increasing to 45 mg.

Drug: Lenalidomide
Patients in the augmentation cohort will be dosed continuously, 10 mg orally once daily, with or without food.




Primary Outcome Measures :
  1. Complete Response Rate [ Time Frame: At the end of Cycle 8 (each cycle is 21 days) ]
    The rate of complete response at the time of primary response assessment (PRA).


Secondary Outcome Measures :
  1. Progression Free Survival [ Time Frame: Time of study registration through end of follow-up, approximately 5 years. ]
    PFS will be determined according to the guidance from the International Working Group. The following events will be counted for PFS: disease progression, disease recurrence, initiation of new line of therapy, or death from any cause.



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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. Ability to understand and the willingness to sign a written informed consent document and to comply with the study protocol procedures.
  2. Age ≥18 years at the time of signing informed consent. Because no dosing or adverse event data are currently available on the use of mosunetuzumab in patients <18 years of age, they are excluded from this study.
  3. Histologically confirmed diagnosis of:

    • follicular lymphoma (grade 1, 2, 3a, or not otherwise specified) or
    • marginal zone lymphoma (nodal, extranodal, or splenic), according to 2016 WHO classification and confirmed to express the CD20 antigen by immunohistochemistry or flow cytometry. Patients in whom definitive pathologic subtype of FL/MZL is undetermined due to limited biopsy material can be enrolled if in the investigator's opinion integrated clinicopathologic data are consistent with the eligible diagnosis.
  4. Agreement to provide, if available, lymphoma tissue for correlative analyses.
  5. At least one bi-dimensionally measurable nodal lesion, defined as >1.5 cm in its longest dimension, or one bi-dimensionally measurable extranodal lesion, defined as >1.0 cm in its longest diameter; with the exception of splenic MZL, which must be evaluable using the International SMZL Group criteria.76,88,89
  6. No prior systemic therapy for B-cell lymphoma, except for palliative corticosteroids; prior radiation therapy is allowed.
  7. Indication to start systemic therapy for lymphoma, in the investigator's judgement. Patients with low burden of disease are eligible if they desire therapy; asymptomatic patients should thoroughly understand the risks and benefits of lymphoma-directed therapy versus watchful waiting.
  8. Performance status ECOG 0, 1, or 2.
  9. Adequate hematologic function (unless due to underlying lymphoma as established by bone marrow involvement or splenomegaly):

    • hemoglobin ≥9 g/dL,
    • absolute neutrophil count ≥1.0 x 109/L,
    • platelet count ≥75 x 109/L.
  10. Glomerular filtration rate (GFR) ≥40 mL/min/1.73m2 using the Mayo Quadratic Formula.
  11. The effects of mosunetuzumab on the developing human fetus are unknown. For this reason and because lenalidomide used in this trial is known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) and refrain from donating eggs or sperm throughout the treatment and for 3 months after the last dose of trial therapy. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.

Exclusion Criteria:

  1. Grade 3b follicular lymphoma or transformed lymphoma.
  2. Prior treatment with any anti-CD20 antibody or lenalidomide.
  3. Prior stem cell transplantation (autologous or allogeneic) or prior solid organ transplantation.
  4. History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies or known sensitivity or allergy to murine products.
  5. Known NYHA class 3/4 congestive heart failure, LVEF <40%, myocardial infarction within 6 months prior to enrollment, unstable angina, or unstable arrhythmia.
  6. Chronic obstructive pulmonary disease (COPD) requiring oral corticosteroids or chronic oxygen.
  7. History of autoimmune disease, including, but not limited to myasthenia gravis, myositis, autoimmune hepatitis, idiopathic pulmonary fibrosis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid syndrome, granulomatosis with polyangiitis, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis, with the exception of: hypothyroidism (on stable dose of thyroid replacement therapy), asthma managed with inhaled medications only; type 1 diabetes mellitus on stable insulin regimen, Sjögren syndrome, immune thrombocytopenia or autoimmune hemolytic anemia that does not require systemic therapy; dermatologic condition (including eczema, psoriasis, lichen simplex chronicus, or vitiligo) with skin manifestations with rash covering <10% of body surface area and not requiring treatment other than low-potency topical corticosteroids for >12 months prior to registration.
  8. Use of any systemic immunosuppressive medications (including, but not limited to, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor agents) with the exception of corticosteroid treatment using <10 mg/day prednisone or equivalent within 2 weeks prior to first treatment; a brief course of palliative corticosteroids at higher doses (prednisone up to 100 mg daily, for up to 7 days) is allowed, but must be completed at least 7 days before the first dose of mosunetuzumab.
  9. Any of the following conditions:

    • active bacterial infection requiring antibiotics
    • known or suspected chronic active Epstein Barr virus (CAEBV) infection
    • history of hemophagocytic lymphohistiocytosis (HLH)
    • confirmed progressive multifocal leukoencephalopathy (PML)
    • EBV or CMV viremia
    • positive test for hepatitis B surface antigen (HBSAg). Patients with a positive total/IgG hepatitis B core antibody (HBcAb) may participate if hepatitis B virus (HBV) DNA is undetectable at screening, if they agree to take entecavir or tenofovir, and undergo periodic DNA testing
    • positive hepatitis C virus (HCV) antibody, unless a negative polymerase chain reaction (PCR) for HCV is documented
    • positive test for HIV.
  10. Administration of a live, attenuated vaccine within 4 weeks before first mosunetuzumab dose or anticipation that such a live, attenuated vaccine will be required during the study.
  11. Current or past history of CNS disease, including stroke, epilepsy, or CNS vasculitis, or an advanced neurodegenerative disease; with the exception of: stroke >2 years before registration without any residual neurologic deficits and no subsequent transient ischemic attacks; history of epilepsy with no seizures for >2 years and not using any antiepileptic therapy; well-controlled Parkinson's disease (with no need for medication adjustment for >6 months).
  12. History of other malignancy that could affect compliance with the protocol or interpretation of results; patients with a curatively treated skin cancer, in situ cervical cancer, or another malignancy treated curatively with a documented remission >2 years before registration are eligible.
  13. Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) at study enrollment or any major episode of infection requiring treatment with IV antibiotics or hospitalization within 4 weeks before the first dose of mosunetuzumab.
  14. Clinically significant liver disease, including viral or other hepatitis, current alcohol abuse, or cirrhosis.
  15. Any major surgery within 4 weeks before the first dose of mosunetuzumab, other than lymph node biopsy for diagnosis.
  16. Evidence of other significant or uncontrolled medical or psychiatric conditions that could affect compliance with the protocol.
  17. Any of the following abnormal laboratory values within 14 days prior to first dose of mosunetuzumab:

    • AST or ALT >3x ULN
    • total bilirubin >2 x ULN (unless due to Gilbert syndrome with indirect hyperbilirubinemia only)
    • INR>1.5 x ULN without anticoagulation
    • PTT or APTT >1.5x ULN in the absence of lupus anticoagulant.
  18. Any radiation therapy within 2 weeks prior to first dose of mosunetuzumab.
  19. Pregnancy, breast-feeding, or prisoner status. Women of childbearing potential must have a negative pregnancy test within 2 weeks before first dose of mosunetuzumab.

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): NCT04792502


Contacts
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Contact: BrUOG 401-863-3000 BrUOG@Brown.edu

Locations
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United States, Connecticut
Yale Cancer Center
New Haven, Connecticut, United States, 06511
Contact: BrUOG    401-863-3000    BrUOG@brown.edu   
Principal Investigator: Scott Huntington, MD         
United States, New Jersey
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, United States, 08901
Contact: BrUOG    401-863-3000    BrUOG@Brown.edu   
Principal Investigator: Rajat Bannerji, MD, PhD         
United States, Rhode Island
Lifespan Cancer Insitute
Providence, Rhode Island, United States, 02903
Contact: BrUOG    401-863-3000    BrUOG@Brown.edu   
Principal Investigator: Adam J Olszewski, MD         
Sub-Investigator: Patrycja Dubielecka-Szczerba, PhD         
Sponsors and Collaborators
Adam Olszewski
Investigators
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Principal Investigator: Adam J Olszewski, MD Brown University
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Responsible Party: Adam Olszewski, Principal Investigator, Brown University
ClinicalTrials.gov Identifier: NCT04792502    
Other Study ID Numbers: BrUOG 401
First Posted: March 11, 2021    Key Record Dates
Last Update Posted: March 11, 2021
Last Verified: March 2021

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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, Marginal Zone
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin
Lymphoma, B-Cell
Lenalidomide
Immunologic Factors
Physiological Effects of Drugs
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Antineoplastic Agents