Lymphoma, Large B-Cell, Diffuse Clinical Trial
Official title:
A Phase 2, Open-label, Multicenter Study to Evaluate the Safety and Clinical Activity of Durvalumab in Combination With Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (R-CHOP) or With Lenalidomide Plus R-CHOP (R2-CHOP) in Subjects With Previously Untreated, High-Risk Diffuse Large B-Cell Lymphoma
Verified date | April 2023 |
Source | Celgene |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This Phase 2, two-arm, open-label study is designed to evaluate the safety, clinical activity, and predictive biomarkers of durvalumab in combination with R-CHOP or R2-CHOP, followed by durvalumab consolidation therapy in previously untreated subjects with high-risk diffuse large B-cell lymphoma (DLBCL). Induction treatment with R-CHOP (± lenalidomide) will last for a total of up to 6 to 8 treatment cycles (21 day cycles), and the total time on study treatment, including durvalumab consolidation, will last up to 12 months. On 05-Sep-2017, the US FDA has issued a Partial Clinical Hold on this study resulting in the discontinuation of enrollment into Arm B (Durvalumab + Lenalidomide + R-CHOP). After the US FDA Partial Clinical Hold, new eligible participants have been enrolled in Arm A (Durvalumab + R-CHOP).
Status | Completed |
Enrollment | 46 |
Est. completion date | April 24, 2022 |
Est. primary completion date | April 24, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: 1. CD20+Diffuse Large B-Cell Lymphoma. 2. Ann Arbor stage 3 or 4 or stage 2 with bulky disease 3. High or high-intermediate disease risk. 4. No prior anti-lymphoma treatment. 5. Subject is willing and able to undergo biopsy. 6. Investigator considers R-CHOP immunochemotherapy appropriate. 7. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. 8. Adequate hematology laboratory results (absolute neutrophil count = 1.5 * 10^9/L, platelet count = 75 * 10^9/L, hemoglobin = 10.0 g/dL). 9. Adequate biochemistry laboratory results (aspartate aminotransferase (AST/SGOT) and alanine aminotransferase (ALT/SGPT) = 3.0 * upper limit of normal; bilirubin = 2.0 mg/dL; creatinine clearance of = 40 mL/min). 10. Bi-dimensionally measurable disease (> 2.0 cm). 11. Subject is using effective contraception. Exclusion Criteria: 1. Diagnosis of lymphoma other than Diffuse Large B-Cell Lymphoma. 2. Composite lymphoma or transformed lymphoma. 3. Primary or secondary Central Nervous System involvement by lymphoma. 4. Seropositive or active viral infection with hepatitis B virus, human immunodeficiency virus or hepatitis C virus. 5. History of other malignancies, unless disease-free for = 5 years. 6. Left ventricular ejection fraction < 50%. 7. Peripheral neuropathy = Grade 2. 8. Prior use of lenalidomide, or monoclonal antibodies against CTLA-4, PD-1, or PD-L1. 9. High risk of developing thromboembolic events, who are unwilling to take venous thromboembolism prophylaxis. 10. Active or prior documented autoimmune or inflammatory disorders within the past 3 years. 11. Current or prior use of immunosuppressive medication within 28 days before start of treatment. |
Country | Name | City | State |
---|---|---|---|
Austria | Innsbruck Medical University Department of Internal Medicine | Innsbruck | |
Austria | Landeskrankenhaus Salzburg | Salzburg | |
Austria | Local Institution - 101 | Vienna | |
Austria | Medical University of Vienna Internalmedicine 1, Hematology | Vienna | |
Austria | Hanusch Krankenhaus | Wien | |
Denmark | Aarhus Sygehus | Arhus C | |
Denmark | Rigshospitalet, Kobenhavns Universitet - Centre for Clinical Intervention Research - The Copenhagen | Copenhagen | |
Denmark | Odense Universitetshospital | Odense C | |
Estonia | (North Estonia Medical Centre) - Onkoloogia-ja Hematoloogiakliinik | Tallinn | |
Estonia | Tartu University Hospital | Tartu | |
United Kingdom | University Hospital Birmingham | Birmingham | |
United Kingdom | Royal Marsden Hospital | London | |
United Kingdom | Oxford University Hospitals NHS Trust- Churchill Hospital-Oxford Centre for Respiratory Medicine | Oxford | |
United States | Roswell Park Cancer Institute | Buffalo | New York |
United States | Mid Ohio Oncology Hematology Inc | Columbus | Ohio |
United States | Parkview Research Center | Fort Wayne | Indiana |
United States | Banner MD Anderson Cancer Center | Gilbert | Arizona |
United States | Mayo Clinic | Rochester | Minnesota |
United States | University of Rochester Medical Center | Rochester | New York |
United States | Swedish Cancer Institute | Seattle | Washington |
Lead Sponsor | Collaborator |
---|---|
Celgene |
United States, Austria, Denmark, Estonia, United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Percentage of Participants Who Achieved a Complete Response (CR) at the End of Induction Therapy | The primary efficacy analysis evaluated the complete response rate (CRR) at the end of the induction therapy in the efficacy evaluable population in a comparative manner against historical control. The response to treatment was assessed according to the 2014 International Working Group (IWG) Response Criteria for Non-Hodgkin's Lymphoma (NHL) (Cheson, 2014). CR was defined as a complete metabolic response and radiographic evidence showing target nodes/nodal masses regressed to = 1.5 cm in longest diameter, no new lesions, regression of lymph nodes to normal size, absence of splenomegaly, and absence of bone marrow involvement. Clopper-Pearson two-sided 95% confidence interval is reported. Null hypothesis for the primary endpoint was rejected if the lower limit of the confidence interval for the complete response rate at the completion of the induction therapy in the efficacy evaluable population is above 55%. | From first dose of study drug to end of Induction therapy (Day 1 up to Week 26 - maximum duration of Induction Period). | |
Secondary | Percentage of Participants Who Responded During Induction and Continued Into Consolidation Therapy (Database Cutoff Date: 02-Aug-2018) | The percentage of participants who achieved a partial response (PR) or complete response (CR) at the end of Induction and continued into consolidation period in the efficacy evaluable population in a comparative manner against historical control. The response to treatment was assessed according to the 2014 International Working Group (IWG) Response Criteria for Non-Hodgkin's Lymphoma (NHL) (Cheson, 2014). CR was defined in outcome #1. PR was defined as a partial metabolic response and radiographic evidence showing = 50% decrease in sum of perpendicular diameters (SPD) of up to 6 target measurable nodes and extranodal sites, no new lesions, spleen must have regressed > 50% in length beyond normal, and residual bone marrow involvement improved from baseline. Clopper-Pearson two-sided 95% confidence interval is reported. Null hypothesis was rejected if the lower limit of the confidence interval for the rate of subjects who continue consolidation therapy out of all subjects. | From first dose of study drug to completion of at least one cycle in the Consolidation Period (Day 1 up to Week 52) | |
Secondary | Percentage of Participants Who Achieved a Clinical Response in the Biomarker Subpopulation for Immunohistochemistry (IHC) CD8 T-Cell Density | Data in the analysis include all participants who received durvalumab, irrespective of the study arm in which they enrolled, because the selected biomarkers have been associated with response in other anti-PD1 or anti-PDL1 studies, such as durvalumab. IHC analysis was performed on the baseline tumor biopsy to quantify CD8 T-cell density. Participants with 'high' values, i.e. above the threshold defined as the median value of 774 cells/mm^2 found in commercial DLBCL samples using matched analytical methods, were predicted to be responders to treatment with durvalumab. The definition of a complete response was that used in the primary outcome. | Biomarker biopsies: Days -28 to Day -1. Clinical response: From first dose of study drug to end of Induction therapy (Day 1 up to Week 26 - maximum duration of Induction Period). | |
Secondary | Percentage of Participants Who Achieved a Clinical Response in the Biomarker Subpopulation for Immunohistochemistry (IHC) Programmed Death Ligand - 1 (PDL1) Total Percentage | Data in the analysis include all participants who received durvalumab, irrespective of the study arm in which they enrolled, because the selected biomarkers have been associated with response in other anti-PD1 or anti-PDL1 studies, such as durvalumab. IHC analysis was performed on the baseline tumor biopsy to quantify CD8 T-cell density. Participants with 'high' values, i.e. above the threshold defined as the median value of 774 cells/mm^2 found in commercial DLBCL samples using matched analytical methods, were predicted to be responders to treatment with durvalumab. The definition of a complete response was that used in the primary outcome. | Biomarker biopsies: Days -28 to Day -1. Clinical response: From first dose of study drug to end of Induction therapy (Day 1 up to Week 26 - maximum duration of Induction Period). | |
Secondary | Percentage of Participants Who Achieved a Clinical Response in the Biomarker Subpopulation for Immunohistochemistry (IHC) Programmed Death Ligand - 1 (PDL1) Percentage of Tumor Cells | Data in the analysis include all participants who received durvalumab, irrespective of the study arm in which they enrolled, because the selected biomarkers have been associated with response in other anti-PD1 or anti-PDL1 studies, such as durvalumab. IHC analysis was performed on the baseline tumor biopsy to quantify CD8 T-cell density. Participants with 'high' values, i.e. above the threshold defined as the median value of 774 cells/mm^2 found in commercial DLBCL samples using matched analytical methods, were predicted to be responders to treatment with durvalumab. The definition of a complete response was that used in the primary outcome. | Biomarker biopsies: Days -28 to Day -1. Clinical response: From first dose of study drug to end of Induction therapy (Day 1 up to Week 26 - maximum duration of Induction Period). | |
Secondary | Percentage of Participants Who Achieved a Clinical Response in the Biomarker Subpopulation for the Interferon Gamma Score (IFNG-Score) From Ribonucleic Acid (RNA)-Sequencing Data | Data in the analysis include all participants who received durvalumab, irrespective of the study arm in which they enrolled, because the selected biomarkers have been associated with response in other anti-PD1 or anti-PDL1 studies, such as durvalumab. IHC analysis was performed on the baseline tumor biopsy to quantify CD8 T-cell density. Participants with 'high' values, i.e. above the threshold defined as the median value of 774 cells/mm^2 found in commercial DLBCL samples using matched analytical methods, were predicted to be responders to treatment with durvalumab. The definition of a complete response was that used in the primary outcome. | Biomarker biopsies: Days -28 to Day -1. Clinical response: From first dose of study drug to end of Induction therapy (Day 1 up to Week 26 - maximum duration of Induction Period). | |
Secondary | Participants With Treatment Emergent Adverse Events (TEAE) | An AE is any noxious, unintended, or untoward medical occurrence that may appear or worsen during a study. A serious AE is any AE occurring at any dose that: • Results in death; • Is life-threatening; • Requires or prolongs existing inpatient hospitalization; • Results in persistent or significant disability/incapacity; • Is a congenital anomaly/birth defect; • Constitutes an important medical event. The Investigator assessed the relationship of each AE to study drug and graded the severity according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE, Version 4.03): - Grade 1 = Mild (no limitation in activity or intervention); - Grade 2 = Moderate (some limitation in activity; no/minimal medical intervention required); - Grade 3 = Severe (marked limitation in activity; medical intervention required, hospitalization possible); - Grade 4 = Life-threatening; - Grade 5 = Death. Relation to IP is determined by the investigator. | From the date of the first dose of study drug to within 90 days after the last dose of durvalumab or 28 days after the last dose of any investigational product (IP) whichever is greater. (Up to approximately 72 weeks) |
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