Ibrutinib, Nivolumab and Blinatumomab in Richter Transformation

Hematopoietic/Lymphoid Cancer Clinical Trial

Official title: A Phase II Study of Ibrutinib, Nivolumab and Blinatumomab in Richter Transformation

Status Terminated

Clinical Trial Summary

The goal of this clinical research study is to learn if blinatumomab can help to control Richter Transformation (RT, a type of blood cancer). The safety of this drug will also be studied.

This is an investigational study. Blinatumomab is FDA approved and commercially available for the treatment of acute lymphoblastic leukemia (ALL). It is investigational to use blinatumomab to treat patients with RT. The study doctor can explain how the study drug is designed to work.

Up to 21 participants will be enrolled in this study. All will take part at MD Anderson.

Clinical Trial Description

Study Drug Administration:

The study has 2 study cycles. Cycle 1 is 8 weeks, followed by a 4-8 week break, and then Cycle 2 is 4 weeks.

If you are found to be eligible to take part in this study, you will receive blinatumomab by a central venous catheter (CVC) continuously (non-stop) for 1-2 cycles, depending on how you are responding to the study drug. A CVC is a sterile flexible tube that will be placed into a large vein while you are under local anesthesia. Your doctor will explain this to you in more detail, and you will be required to sign a separate consent form for this procedure.

During Cycle 1, the blinatumomab infusion will be started in the hospital. You will be in the hospital for up to at least 16 nights/17 days so that you can be checked for side effects. During Cycle 2, the blinatumomab infusion will also be started in the hospital. You will be in the hospital for at least 2 nights/3 days. Your doctor will decide when you can leave the hospital. Also, if treatment is interrupted for more than 4 hours, for any reason, you will need to be admitted to the hospital to restart the treatment.

Blinatumomab will be delivered by a small pump, which you will carry with you for the whole time you receive the drug. You will be given a shoulder or belt bag to hold the pump and infusion bag. You will be able to wear regular clothes, walk around, and perform daily living activities. You will be given instructions for taking a shower and other activities. There will be some things that you should not do, such as go swimming. The study staff will give you more information on activities you should not do while receiving the drug.

You will need to come to MD Anderson to have the infusion bags changed every 48 hours. The study staff will let you know when you need to return to the clinic.

You will be given standard drugs, such as dexamethasone, to help decrease the risk of side effects. You may ask the study staff for information about how the drugs are given and their risks.

If you have severe side effects, your study doctor may decide to stop treatment permanently or temporarily. If you recover or if the symptoms have improved, the treatment may be continued. If the doctor thinks it is needed, you will have an MRI and possibly also a spinal tap (lumbar puncture) to test the fluid around the brain, before you restart treatment.

Length of Study:

You may receive blinatumomab for up to 2 cycles. You will no longer be able to take the study drug if the disease gets worse, if serious side effects occur, or if you are unable to follow study directions. Additionally, if your doctor feels it is in your best interests to receive an alternative treatment for your Richter Transformation, such as allogeneic stem cell transplantation, you will no longer be able to receive blinatumomab.

Your participation on this study will be over after you have completed follow-up.

Study Visits:

At any time the doctor thinks it is needed, you may have a neurological exam.

Based on the results of the below tests after Cycle 1, the study doctor will decide if you will continue to receive the study drug during Cycle 2. If you do not receive the drug during Cycle 2, you will have an end-of-study visit (described below).

On Days 1-17 of Cycle 1 (the time you are in the hospital), every week during Cycle 1, Days 1-3 of Cycle 2, and every week of Cycle 2:

• You will have a physical exam.

• Blood (about 2-3 teaspoons) will be drawn for routine tests.

About 2-4 weeks after Cycles 1 and 2:

• You will have a physical exam.

• Blood (about 2-3 teaspoons) will be drawn for routine tests.

• You will have a bone marrow biopsy/aspiration to check the status of the disease.

• You will have a PET/CT or CT scan.

About 24 weeks after the first dose of study drug and then every 12 weeks after that for up to 96 weeks:

• You will have a physical exam.

• Blood (about 2-3 teaspoons) will be drawn for routine tests.

• You will have a PET/CT or CT scan to check the status of the disease.

End-of-Study Visit:

After the last dose of study drug, you will continue to receive routine medical care as part of your standard care. However, if the disease comes back or worsens while you are receiving the study drug:

• You will have a physical exam.

• Blood (about 2-3 teaspoons) will be drawn for routine tests.

• You will have a bone marrow biopsy/aspiration

• You will have a PET/CT scan to check the status of the disease.

• If the doctor thinks it is needed, you may have a lymph node biopsy to confirm that the disease has come back.

• If you can become pregnant, blood (about 1 teaspoon) or urine will be collected for a pregnancy test.

Long-Term Follow-up:

After you have completed your participation in this study, you will be asked to participate in a separate leukemia department protocol (DR09-0223). The purpose of this protocol is to determine how long patients live after receiving leukemia treatment. On this study, if you are not having follow-up at MD Anderson, study staff will contact you via phone, email, or MyMDAnderson every 6-12 months, to see how you are doing. Phone calls will take approximately 5-10 minutes. If you agree, you will sign a separate consent form for this study. ;

Related Conditions & MeSH terms

• Hematopoietic/Lymphoid Cancer
• Richter's Transformation

• NCT number: NCT03121534
• Study type: Interventional
• Source: M.D. Anderson Cancer Center
• Status: Terminated
• Phase: Phase 2
• Start date: June 22, 2017
• Completion date: February 11, 2022