Sequential Regimen of Bendamustin-Debulking Followed by Ofatumumab and Ibrutinib in CLL Patients (CLL2-BIO)

Chronic Lymphocytic Leukemia Clinical Trial

Official title:

Prospective, Open-label, Multicentre Phase-II Trial to Evaluate Efficacy and Safety of a Sequential Regimen of Bendamustine Followed by Ofatumumab and Ibrutinib Followed by Ibrutinib and Ofatumumab Maintenance in CLL Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02689141
• Other study ID #: CLL2-BIO
• Secondary ID: 2014-000590-39
• Status: Completed
• Phase: Phase 2
• Start date: February 4, 2016
• Est. completion date: February 6, 2020

Study information

• Verified date: June 2020
• Source: German CLL Study Group
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A prospective, open-label, multicentre phase-II trial to evaluate the efficacy and safety of a sequential regimen of bendamustine followed by ofatumumab and ibrutinib followed by ibrutinib and ofatumumab maintenance in CLL patients.

Description:

In the CLL2-BIO trial an allcomer CLL population with indication for treatment will be included.

Patient will receive 2 cycles of debulking treatment with bendamustin unless contraindications are existing or debulking is not indicated. Afterwards 6 cycles of induction therapy with ofatumumab and ibrutinib will be applied, each with a duration of 28 days. Primary endpoint overall Response rate will be assessed at final restaging.

Patients benefitting from BIO treatment will enter the maintenance phase of the trial. Maintenance treatment will be continued if no unacceptable toxicity occurs until three months after negativity of minimal residual disease (MRD) is achieved in peripheral blood in patients with (clinical) complete response (CR) or (clinical) incomplete complete response (CRi) confirmed by 2 consecutive testings of MRD within 3 months, progression of CLL, start of a subsequent therapy or up to 8 cycles of maintenance (each cycle with a duration of 84 calendar days = 3 months), whichever occurs first.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 66
• Est. completion date: February 6, 2020
• Est. primary completion date: July 13, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Documented CLL requiring treatment (irrespective if first- or relapse treatment) according to International Working Group on CLL (iwCLL) criteria

In case of previously treated patients, these must have recovered from acute toxicities and treatment regimen must be stopped within the following time periods before start of the study treatment in the CLL2-BIO trial:

• chemotherapy within = 28 days

• antibody treatment within = 14 days

• kinase inhibitors, Bcl-2-antagonists or immunomodulatory agents within = 3 days

• corticosteroids may be applied until the start of the BIO-regimen, these have to be reduced to an equivalent of = 20 mg prednisolone during treatment

2. Adequate hematologic function as indicated by a platelet count = 25 x 109/L, a neutrophil count = 1,0 x 109/L and a hemoglobin value = 8.0 g/dL, unless directly attributable to the patient´s CLL (e.g. bone marrow infiltration)

3. Adequate renal function as indicated by a creatinine clearance = 30ml/min calculated according to the modified formula of Cockcroft and Gault or directly measured with 24 hrs urine collection

4. Adequate liver function as indicated by a total bilirubin = 2x, aspartate aminotransferase (AST)/ alanin aminotransferase (ALT) = 2.5x the institutional upper limit of normal (ULN) value, unless directly attributable to the patient's CLL or to Gilbert's Syndrome

5. Negative serological testing for hepatitis B, negative testing for hepatitis-C RNA and negative HIV antibody test within 6 weeks prior to registration

6. Age = 18 years

7. Eastern Cooperative Oncology Group (ECOG) Performance Status 0 to 2, ECOG 3 is only permitted if related to CLL (e.g. due to anemia or severe constitutional symptoms)

8. Life expectancy = 6 months

9. Ability and willingness to provide written informed consent and to adhere to the study visit schedule and other protocol requirements

Exclusion Criteria:

1. Transformation of CLL (i.e. Richter's transformation, pro-lymphocytic leukemia)

2. Known central nervous system (CNS) involvement

3. Patients with confirmed progressive multifocal leukoencephalopathy (PML)

4. Malignancies other than CLL currently requiring systemic therapy

5. Uncontrolled infection requiring systemic treatment

6. Any comorbidity or organ system impairment rated with a cumulative illness rating scale (CIRS) score of 4, excluding the eyes/ears/nose/throat/larynx organ system or any other life- threatening illness, medical condition or organ system dysfunction that - in the investigator´s opinion - could compromise the patients safety or interfere with the absorption or metabolism of the study drugs (e.g, inability to swallow tablets or impaired resorption in the gastrointestinal tract)

7. Use of investigational agents which might interfere with the study drug within 3 days prior to Registration

8. Known hypersensitivity to ofatumumab, ibrutinib or any of the excipients Please note:

Patients with a known hypersensitivity to bendamustine are allowed to participate but will not receive a debulking with bendamustine

9. Requirement of treatment with strong CYP3A4-inhibitors/-inducers or anticoagulant with phenprocoumon (marcumar), warfarin, or other vitamin k antagonists

10. History of stroke or intracranial hemorrhage within 6 months prior to registration

11. Pregnant women and nursing mothers (a negative pregnancy test is required for all women of childbearing potential within 7 days before start of treatment and monthly during debulking, induction and maintenance therapy)

12. Fertile men or women of childbearing potential unless:

• surgically sterile or = 2 years after the onset of menopause, or

• willing to use two methods of reliable contraception including one highly effective (Pearl Index < 1) and one additional effective (barrier) method during study treatment and for 12 months after end of study treatment.

13. Vaccination with a live vaccine = 28 days prior to registration

14. Legal incapacity

15. Prisoners or subjects who are institutionalized by regulatory or court order

16. Persons who are in dependence to the sponsor or an investigator

Related Conditions & MeSH terms

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

Intervention

Drug:
• Bendamustine
Debulking: Cycles 1 - 2, d1 & 2: 70 mg/m2 i.v.
• Ofatumumab
Induction: Cycle 1: Day 1 300 mg i.v.; Day 8 1000 mg i.v.; Day 15 1000 mg i.v. Cycle 2-6: Day 1 1000 mg i.v. Maintenance: After the induction ofatumumab iv 1000 mg every three months will be continued. Cycle 1-8: Day 1 1000 mg i.v.
• Ibrutinib
Induction: Cycle 2-6: d1-28: 420 mg p.o. Maintenance: After the induction ibrutinib p.o. 420 mg daily will be continued. Cycle 1-8: d1-84: 420 mg p.o.

Locations

Country	Name	City	State
Germany	German CLL Study Group	Cologne

Sponsors (3)

Lead Sponsor	Collaborator
German CLL Study Group	Gilead Sciences, Novartis Pharmaceuticals

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Overall response rate (ORR)	Proportion of patients responding according to international working Group on chronic lymphocytic leukemia criteria	84 days after first dose of last induction cycle
Secondary	Safety: Adverse events (AEs) and adverse events of special interest (AESI)	Type, frequency, and severity of adverse events (AEs) and adverse events of special interest (AESI) and their relationship to study treatment.	up to 48 months after first dose of study drug
Secondary	minimal residual disease (MRD)	Rate of MRD responses in peripheral blood measured by immunophenotyping	up to 48 months after first dose of study drug

External Links

•   Click here for more information about this study: CLL2-BIO (German CLL Study Group)