A Multi-Center Study of Ibrutinib in Combination With Obinutuzumab Versus Chlorambucil in Combination With Obinutuzumab in Patients With Treatment naïve Chronic Lymphocytic Leukemia (CLL) or Small Lymphocytic Lymphoma (SLL)

Chronic Lymphocytic Leukemia Clinical Trial

Official title:

A Randomized, Multi-center, Open-label, Phase 3 Study of the Bruton's Tyrosine Kinase Inhibitor Ibrutinib in Combination With Obinutuzumab Versus Chlorambucil in Combination With Obinutuzumab in Subjects With Treatment-naïve Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02264574
• Other study ID #: PCYC-1130-CA
• Status: Completed
• Phase: Phase 3
• Start date: October 6, 2014
• Est. completion date: September 3, 2019

Study information

• Verified date: August 2020
• Source: Pharmacyclics LLC.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The primary objective of this study is to evaluate the efficacy of ibrutinib in combination with obinutuzumab compared to chlorambucil in combination with obinutuzumab based on the Independent Review Committee (IRC) assessment of progression free survival (PFS). Efficacy will be evaluated according to 2008 International Workshop for Chronic Lymphocytic Leukemia (IWCLL) criteria with the modification for treatment-related lymphocytosis, in subjects with treatment-naive CLL or SLL.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 229
• Est. completion date: September 3, 2019
• Est. primary completion date: March 26, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Disease Related:

1. Diagnosis of CLL/SLL that meets IWCLL diagnostic criteria.

2. Age 65 yrs and older OR if less than 65 years, must have at least one of the following criteria:

• Cumulative Illness Rating Score (CIRS) >6

• Creatinine clearance estimated <70 mL/min using Cockcroft-Gault equation.

• Del 17p by fluorescence in situ hybridization (FISH) or TP53 mutation by polymerase chain reaction (PCR) or Next Generation Sequencing

3. Active disease meeting at least 1 of the following IWCLL criteria for requiring treatment:

• Evidence of progressive marrow failure as manifested by the development of, or worsening of, anemia and thrombocytopenia

• Massive, progressive, or symptomatic splenomegaly

• Massive nodes (at least 10 cm longest diameter), or progressive or symptomatic lymphadenopathy.

• Progressive lymphocytosis with an increase of more than 50 percent over a 2-month period or a lymphocyte doubling time (LDT) of <6 months. LDT may be obtained by linear regression extrapolation of absolute lymphocyte counts obtained at intervals of 2 weeks over an observation period of 2 to 3 months. In patients with initial blood lymphocyte counts of <30,000/µL, LDT should not be used as a single parameter to define indication for treatment. In addition, factors contributing to lymphocytosis or lymphadenopathy other than CLL (eg, infections) should be excluded.

• Autoimmune hemolytic anemia and/or immune thrombocytopenia that is poorly responsive to corticosteroids or other standard therapy.

• Autoimmune hemolytic anemia is defined by at least one marker of hemolysis (indirect bilirubin above the upper limit of normal (ULN) not due to liver disease, increased lactate dehydrogenase (above ULN) without alternative etiology, or increased absolute reticulocytosis (above ULN) or bone marrow erythropoiesis in the absence of bleeding AND at least one marker direct or indirect autoimmune mechanism (positive direct antiglobulin for immunoglobulin G [IgG] or C3d, cold agglutinins).

• Immune thrombocytopenia is defined by platelets =100,000/µL and increased megakaryocytes on the bone marrow exam.

• Constitutional symptoms, defined as one or more of the following disease-related symptoms or signs, documented in the patient's record prior to randomization:

• unintentional weight loss >10 percent within 6 months prior to screening.

• significant fatigue (inability to work or perform usual activities).

• fevers >100.5°F or 38.0°C for 2 or more weeks prior to screening without evidence of infection.

• night sweats for more than 1 month prior to screening without evidence of infection.

4. Measurable nodal disease by computed tomography (CT), defined as at least 1 lymph node >1.5 cm in the longest diameter in a site that has not been previously irradiated. An irradiated lesion may be assessed for measurable disease only if there has been documented progression in that lesion since radiotherapy has ended.

Laboratory

5. Adequate hematologic function independent of transfusion and growth factor support for at least 7 days prior to screening and randomization.

6. Adequate hepatic and renal function

7. Men and women = 18 years of age.

8. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.

Exclusion Criteria:

1. Any prior treatment of CLL or SLL

2. Evidence of central nervous system (CNS) involvement with primary disease of CLL/SLL

3. History of other malignancies, except:

• Malignancy treated with curative intent and with no known active disease present for =3 years before the first dose of study drug and felt to be at low risk for recurrence by treating physician.

4. Uncontrolled autoimmune hemolytic anemia or idiopathic thrombocytopenic purpura

5. Known or suspected history of Richter's transformation.

6. Concurrent administration of >20mg/day of prednisone within 7 days of randomization unless indicated for prophylaxis or management of allergic reactions (eg, contrast)

7. Known hypersensitivity to one or more study drugs

8. Vaccinated with live, attenuated vaccines within 4 weeks of first dose of study drug.

9. Any uncontrolled active systemic infection or an infection requiring systemic treatment that was completed = 7 days before randomization.

10. Known bleeding disorders or hemophilia.

11. History of stroke or intracranial hemorrhage within 6 months prior to enrollment.

12. Known history of human immunodeficiency virus (HIV) or active with hepatitis B virus (HBV) or hepatitis C virus (HCV).

13. Major surgery within 4 weeks of randomization.

14. Any life-threatening illness, medical condition, or organ system dysfunction that, in the investigator's opinion, could compromise the subject's safety or put the study outcomes at undue risk.

15. Currently active, clinically significant cardiovascular disease, such as uncontrolled arrhythmia or Class 3 or 4 congestive heart failure or a history of myocardial infarction, unstable angina, or acute coronary syndrome within 6 months prior to randomization.

16. Unable to swallow capsules or malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, symptomatic inflammatory bowel disease or ulcerative colitis, or partial or complete bowel obstruction.

17. Concomitant use of warfarin or other vitamin K antagonists.

18. Requires treatment with a strong cytochrome P450 (CYP) 3A inhibitor.

19. Lactating or pregnant

20. Unwilling or unable to participate in all required study evaluations and procedures.

21. Unable to understand the purpose and risks of the study and to provide a signed and dated informed consent form (ICF) and authorization to use protected health information (in accordance with national and local subject privacy regulations).

Related Conditions & MeSH terms

• Chronic Lymphocytic Leukemia
• Leukemia
• Leukemia, Lymphocytic, Chronic, B-Cell
• Leukemia, Lymphoid
• Lymphoma
• Small-Cell Lymphoma

Intervention

Drug:
• Ibrutinib
Ibrutinib will be supplied as 140 mg hard gelatin capsules for oral (PO) administration.
• Obinutuzumab
Obinutuzumab will be supplied as 1000 mg/40 mL solution in a single-use vial for intravenous (IV) administration
• Chlorambucil
Chlorambucil will be supplied as 2 mg film-coated tablets for oral (PO) administration

Locations

Country	Name	City	State
Australia	Site Reference ID/Investigator# 0650	Adelaide	South Australia
Australia	Site Reference ID/Investigator# 0888	Ballarat	Victoria
Australia	Site Reference ID/Investigator# 0193	Box Hill	Victoria
Australia	Site Reference ID/Investigator# 0633	Fitzroy	Victoria
Australia	Site Reference ID/Investigator# 0170	Heidelberg	Victoria
Australia	Site Reference ID/Investigator #0503	Woolloongabba	Queensland
Austria	Site Reference ID/Investigator# 0352	Linz
Austria	Site Reference ID/Investigator# 0869	Salzburg
Belgium	Site Reference ID/Investigator# 0559	Leuven
Belgium	Site Reference ID/Investigator# 0850	Turnhout
Canada	Site Reference ID/Investigator# 018	Edmonton	Alberta
Czechia	Site Reference ID/Investigator# 0564	Hradec Kralove
Czechia	Site Reference ID/Investigator# 0854	Praha 10
France	Site Reference ID/Investigator# 0855	Bayonne	Pyrenees Atlantiques
France	Site Reference ID/Investigator# 0520	Nantes cedex 1	Loire Atlantique
France	Site Reference ID/Investigator# 0769	Pessac cedex	Gironde
France	Site Reference ID/Investigator# 0775	Vandoeuvre les Nancy	Meurthe Et Moselle
Israel	Site Reference ID/Investigator# 0573	Haifa
Israel	Site Reference ID/Investigator# 0577	Jerusalem
Israel	Site Reference ID/Investigator# 0579	Jerusalem
Israel	Site Reference ID/Investigator# 0575	Petach Tikva
Israel	Site Reference ID/Investigator# 0856	Tel Aviv
Israel	Site Reference ID/Investigator# 0875	Zerifin
Italy	Site Reference ID/Investigator# 0860	Firenze
Italy	Site Reference ID/Investigator# 0523	Milano
Italy	Site Reference ID/Investigator# 0581	Milano
Italy	Site Reference ID/Investigator# 0584	Milano
Italy	Site Reference ID/Investigator# 0524	Modena
Italy	Site Reference ID/Investigator# 0582	Novara
Italy	Site Reference ID/Investigator# 0732	Roma
Italy	Site Reference ID/Investigator# 0859	Siena
New Zealand	Site Reference ID/Investigator# 0663	Auckland
New Zealand	Site Reference ID/Investigator# 662	Auckland
New Zealand	Site Reference ID/Investigator# 0586	Hamilton
Poland	Site Reference ID/Investigator# 0592	Brzozow
Poland	Site Reference ID/Investigator# 0531	Lodz
Russian Federation	Site Reference ID/Investigator# 0708	Nizhniy Novgorod
Russian Federation	Site Reference ID/Investigator# 0707	Ryazan
Russian Federation	Site Reference ID/Investigator# 0881	Saint-Petersburg
Russian Federation	Site Reference ID/Investigator# 710	St. Petersburg
Russian Federation	Site Reference ID/Investigator# 304	Yaroslavl
Spain	Site Reference ID/Investigator# 0533	Barcelona
Spain	Site Reference ID/Investigator# 0534	Barcelona
Spain	Site Reference ID/Investigator# 0535	Barcelona
Spain	Site Reference ID/Investigator# 0604	L'Hospitalet de Llobregat	Madrid
Spain	Site Reference ID/Investigator# 0537	Madrid
Spain	Site Reference ID/Investigator# 0864	Madrid
Spain	Site Reference ID/Investigator# 0874	Madrid
Spain	Site Reference ID/Investigator# 0536	Majadahonda	Madrid
Spain	Site Reference ID/Investigator# 0790	Salamanca
Sweden	Site Reference ID/Investigator# 0870	Borås
Sweden	Site Reference ID/Investigator# 0865	Luleå
Sweden	Site Reference ID/Investigator# 0631	Lund
Sweden	Site Reference ID/Investigator# 0632	Stockholm
Turkey	Site Reference ID/Investigator# 0608	Ankara
Turkey	Site Reference ID/Investigator# 606	Ankara
Turkey	Site Reference ID/Investigator# 0889	Denizli
Turkey	Site Reference ID/Investigator# 0678	Istanbul	Nisantasi
Turkey	Site Reference ID/Investigator# 0601	Izmir
Turkey	Site Reference ID/Investigator# 0866	Samsun
United Kingdom	Site Reference ID/Investigator# 0867	Harlow	Essex
United Kingdom	Site Reference ID/Investigator# 0365	London
United Kingdom	Site Reference ID/Investigator# 0543	London
United States	Site Reference ID/Investigator# 0868	Chattanooga	Tennessee
United States	Site Reference ID/Investigator# 0845	Cincinnati	Ohio
United States	Site Reference ID/Investigator# 0844	Fort Myers	Florida
United States	Site Reference ID/Investigator# 0241	La Jolla	California
United States	Site Reference ID/Investigator# 0712	Las Vegas	Nevada
United States	Site Reference ID/Investigator# 071	Louisville	Kentucky
United States	Site Reference ID/Investigator# 0123	Nashville	Tennessee
United States	Site Reference ID/Investigator# 0763	West Palm Beach	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Pharmacyclics LLC.

Countries where clinical trial is conducted

United States,  Australia,  Austria,  Belgium,  Canada,  Czechia,  France,  Israel,  Italy,  New Zealand,  Poland,  Russian Federation,  Spain,  Sweden,  Turkey,  United Kingdom, 

References & Publications (1)

Moreno C, Greil R, Demirkan F, Tedeschi A, Anz B, Larratt L, Simkovic M, Samoilova O, Novak J, Ben-Yehuda D, Strugov V, Gill D, Gribben JG, Hsu E, Lih CJ, Zhou C, Clow F, James DF, Styles L, Flinn IW. Ibrutinib plus obinutuzumab versus chlorambucil plus o — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Primary Analysis: Progression Free Survival (PFS) Based on Independent Review Committee (IRC) Assessment - Kaplan Meier Landmark Estimates at Month 30	PFS was defined as time from the date randomization to the date of first IRC-confirmed disease progression (PD) or date of death due to any cause, whichever occurred first, regardless of the use of subsequent antineoplastic therapy prior to documented PD or death. Assessment of PD was conducted in accordance with the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 criteria (Halleck et al) with the modification that treatment-related lymphocytosis in the absence of other signs or symptoms of disease progression was not considered progressive disease.; The primary analysis was performed after observing 94 PFS events as pre-specified in the study protocol. As the median PFS was not reached in the experimental (IBR+OB) arm at the time of the analysis, Kaplan Meier landmark estimates of the PFS rate at 30 months (that is, the estimated percentage of participants with progression-free survival at Month 30) are presented.	Month 30 (Median follow-up time was 31.3 months at the time of the primary analysis [data cutoff date: 26 March 2018]).
Primary	Final Analysis: PFS Based on Investigator Assessment - Kaplan Meier Landmark Estimates at Month 48	PFS was defined as time from the date randomization to the date of first investigator-confirmed PD or date of death due to any cause, whichever occurred first, regardless of the use of subsequent antineoplastic therapy prior to documented PD or death. Assessment of PD was conducted in accordance with the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 criteria (Halleck et al) with the modification that treatment-related lymphocytosis in the absence of other signs or symptoms of disease progression was not considered progressive disease.; As the median PFS was not reached in the experimental (IBR+OB) arm at the time of the analysis, Kaplan Meier landmark estimates of the PFS rate at 48 months (that is, the estimated percentage of participants with progression-free survival at Month 48) are presented.	Month 48 (Median follow-up time was 44.6 months at the time of the final analysis [data cutoff date: 17 October 2019]).
Secondary	Primary Analysis: PFS in High-Risk Sub-Population (del17p/TP53 Mutation/Del 11q) Based on IRC Assessment - Kaplan Meier Landmark Estimates at Month 30	PFS was analyzed within the high-risk sub-population of participants with del17p or TP53 mutation or del 11q at baseline per central lab results. PFS was defined as time from the date randomization to the date of first IRC-confirmed PD or date of death due to any cause, whichever occurred first, regardless of the use of subsequent antineoplastic therapy prior to documented PD or death. Assessment of PD was conducted in accordance with the IWCLL 2008 criteria (Halleck et al) with the modification that treatment-related lymphocytosis in the absence of other signs or symptoms of PD was not considered progressive disease.; As the median PFS was not reached in the experimental (IBR+OB) arm at the time of the analysis, Kaplan Meier landmark estimates of the PFS rate at 30 months (that is, the estimated percentage of participants with progression-free survival at Month 30) are presented.	Month 30 (Median follow-up time was 31.3 months at the time of the primary analysis [data cutoff date: 26 March 2018]).
Secondary	Primary Analysis: Rate of Sustained Hemoglobin Improvement	Percentage of participants with sustained hemoglobin improvement, defined as hemoglobin increase = 2 g/dL over baseline continuously for = 56 days without blood transfusions or growth factors.	Median follow-up time was 31.3 months at the time of the primary analysis (data cutoff date: 26 March 2018).
Secondary	Primary Analysis: Rate of Minimal Residual Disease (MRD)-Negative Response	Percentage of participants who achieved MRD-negative response, defined as < 1 CLL cell per 10,000 leukocytes as assessed by flow cytometry of a bone marrow aspirate per central laboratory. MRD samples were collected before initiation of subsequent antineoplastic treatment and MRD status was reported by central lab within 5 days after collection date. Participants with missing MRD data were considered non-responders.	Median follow-up time was 31.3 months at the time of the primary analysis (data cutoff date: 26 March 2018).
Secondary	Primary Analysis: Overall Response Rate (ORR) Based on IRC Assessment	ORR, defined as the percentage of participants achieving a best overall response of protocol-specified complete response (CR), CR with incomplete blood count recovery (CRi), nodular partial response (nPR), or partial response (PR) per IRC assessment at or prior to initiation of subsequent antineoplastic therapy. Assessment of response included physical examination, radiographic imaging, and evaluation of blood and marrow (if applicable), evaluated in accordance with the IWCLL 2008 criteria (Halleck et al). CR, CRi, nPR, and PR required confirmation with 2 consecutive assessments that were at least 56 days apart and no use of blood supportive product and/or growth factor during this period. Kaplan-Meier estimate.	Median follow-up time was 31.3 months at the time of the primary analysis (data cutoff date: 26 March 2018).
Secondary	Primary Analysis: Overall Survival (OS) - Kaplan Meier Landmark Estimates at Month 30	OS, defined as the time from the date of randomization to the date of death from any cause. All deaths observed as the time of the analysis were considered as events. For participants who were not known to have died at the time of the analysis, OS data were censored at the date last known alive.; As the median OS was not reached in either treatment arm at the time of the analysis, Kaplan Meier landmark estimates of the OS rate (that is, the estimated percentage of participants still surviving at Month 30 [primary analysis]) are presented.	Month 30 (Median follow-up time was 31.3 months at the time of the primary analysis [data cutoff date: 26 March 2018]).
Secondary	Primary Analysis: Rate of Grade = 3 or Serious Infusion-Related Reaction (IRR) Adverse Events	Percentage of participants experiencing grade = 3 (severe or life threatening) or serious IRR adverse events that started on the day of an obinutuzumab infusion and were assessed as related or possibly related to obinutuzumab. Categories included those events with the Medical Dictionary for Regulatory Activities (MedDRA) dictionary preferred term of IRR and those events which are among the customized standardized MedDRA query (SMQ) for IRR.	Median follow-up time was 31.3 months at the time of the primary analysis (data cutoff date: 26 March 2018).
Secondary	Primary Analysis: Rate of Sustained Platelet Improvement	Percentage of participants with platelet counts increase = 50% over baseline continuously for = 56 days without blood transfusion or growth factors.	Median follow-up time was 31.3 months at the time of the primary analysis (data cutoff date: 26 March 2018).
Secondary	Primary Analysis: Rate of Clinically Meaningful Improvement in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EuroQol Five-Dimension (EQ-5D-5L)	Percentage of participants with EQ-5D-5L utility score increase = 0.08 points over baseline at or prior to initiation of subsequent antineoplastic therapy. The EQ-5D-5L is a standardized non-disease specific instrument for describing and valuing health-related quality of life, comprising 5 dimensions of health (mobility, self -care, usual activities, pain/discomfort, and anxiety/depression) to describe the participant's current health state. Each dimension comprises 5 levels with corresponding numeric scores, where 1 indicates no problems, and 5 indicates extreme problems. A unique EQ-5D-5L health state is defined by combining the numeric level scores for each of the 5 dimensions and the total score is normalized from -0.594 to 1.000, with higher scores representing a better health state. An increase in the EQ-5D-5L total score indicates improvement. Participants with missing EQ-5D-5L data were considered not achieving clinically meaningful improvement.	Median follow-up time was 31.3 months at the time of the primary analysis (data cutoff date: 26 March 2018).
Secondary	Final Analysis: PFS in High-Risk Population (del17p/TP53 Mutation/Del 11q/Unmutated Immunoglobulin Heavy Chain Variable Region [IGHV]) Based on Investigator Assessment - Kaplan Meier Landmark Estimates at Month 48	PFS was analyzed within the high-risk population of participants with del17p or TP53 mutation or del 11q or IGHV unmutated at baseline per central lab results. PFS was defined as time from the date randomization to the date of first investigator-confirmed PD or date of death due to any cause, whichever occurred first, regardless of the use of subsequent antineoplastic therapy prior to documented PD or death. Assessment of PD was conducted in accordance with the IWCLL 2008 criteria (Halleck et al) with the modification that treatment-related lymphocytosis in the absence of other signs or symptoms of PD was not considered progressive disease.; As the median PFS was not reached in the experimental (IBR+OB) arm at the time of the analysis, Kaplan Meier landmark estimates of the PFS rate at 48 months (that is, the estimated percentage of participants with progression-free survival at Month 48) are presented.	Month 48 (Median follow-up time was 44.6 months at the time of the final analysis [data cutoff date: 17 October 2019]).
Secondary	Final Analysis: Rate of Sustained Hemoglobin Improvement	Percentage of participants with sustained hemoglobin improvement, defined as hemoglobin increase = 2 g/dL over baseline continuously for = 56 days without blood transfusions or growth factors.	Median follow-up time was 44.6 months at the time of the final analysis (data cutoff date: 17 October 2019).
Secondary	Final Analysis: Rate of Minimal Residual Disease (MRD)-Negative Response	Percentage of participants who achieved MRD-negative response, defined as < 1 CLL cell per 10,000 leukocytes as assessed by flow cytometry of a bone marrow aspirate per central laboratory. MRD samples were collected before initiation of subsequent antineoplastic treatment and MRD status was reported by central lab within 5 days after collection date. Participants with missing MRD data were considered non-responders.	Median follow-up time was 44.6 months at the time of the final analysis (data cutoff date: 17 October 2019).
Secondary	Final Analysis: ORR Based on Investigator Assessment	ORR, defined as the percentage of participants achieving a best overall response of protocol-specified CR, CRi, nPR or PR per investigator assessment at or prior to initiation of subsequent antineoplastic therapy. Assessment of response included physical examination, radiographic imaging, and evaluation of blood and marrow (if applicable), evaluated in accordance with the IWCLL 2008 criteria (Halleck et al). CR, CRi, nPR, and PR required confirmation with 2 consecutive assessments that were at least 56 days apart and no use of blood supportive product and/or growth factor during this period. Kaplan-Meier estimate.	Median follow-up time was 44.6 months at the time of the final analysis (data cutoff date: 17 October 2019).
Secondary	Final Analysis: Overall Survival (OS) - Kaplan Meier Landmark Estimates at Month 48	OS, defined as the time from the date of randomization to the date of death from any cause. All deaths observed as the time of the analysis were considered as events. For participants who were not known to have died at the time of the analysis, OS data were censored at the date last known alive.; As the median OS was not reached in either treatment arm at the time of the analysis, Kaplan Meier point estimates of the OS rate (that is, the estimated percentage of participants still surviving at Month 48 [final analysis]) are presented.	Month 48 (Median follow-up time was 44.6 months at the time of the final analysis [data cutoff date: 17 October 2019]).
Secondary	Final Analysis: Rate of Sustained Platelet Improvement	Percentage of participants with platelet counts increase = 50% over baseline continuously for = 56 days without blood transfusion or growth factors.	Median follow-up time was 44.6 months at the time of the final analysis (data cutoff date: 17 October 2019).