Safety and Efficacy Study of Loncastuximab Tesirine + Ibrutinib in Diffuse Large B-Cell or Mantle Cell Lymphoma

Mantle Cell Lymphoma Clinical Trial

Official title:

A Phase 1/2 Open-Label Study to Evaluate the Safety and Efficacy of Loncastuximab Tesirine and Ibrutinib in Patients With Advanced Diffuse Large B-Cell Lymphoma or Mantle Cell Lymphoma (LOTIS-3)

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT03684694
• Other study ID #: ADCT-402-103
• Secondary ID: 2018-002625-38
• Status: Terminated
• Phase: Phase 1/Phase 2
• Start date: December 1, 2018
• Est. completion date: November 8, 2022

Study information

• Verified date: January 2024
• Source: ADC Therapeutics S.A.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this Phase 1/2 study is to evaluate the safety and efficacy of Loncastuximab Tesirine (ADCT-402) in combination with Ibrutinib in participants with Advanced Diffuse Large B-Cell Lymphoma or Mantle Cell Lymphoma.

Description:

The Phase 1 portion of the study will cover the dose escalation portion of the study. This will then be followed by the Phase 2 portion of the study, which will treat participants with the dose of loncastuximab tesirine determined in the Phase 1 portion of the study. The ibrutinib dose of 560 mg daily, will remain the same throughout both phases of the study.

A standard 3+3 dose escalation design will be used for the Phase 1 portion of the study. The dose-limiting toxicity (DLT) period will be the 21 days following the first dose of ibrutinib. The dose escalation cohort will receive loncastuximab tesirine for 2 cycles with concurrent ibrutinib (concomitant therapy) and may then continue ibrutinib therapy up to one year.

The Phase 2 portion of the study will involve 3 cohorts:

• Non-germinal center B-cell diffuse large B-cell lymphoma (Non-GCB DLBCL) cohort

• Germinal center B-cell diffuse large B-cell lymphoma (GCB DLBCL) cohort

• Mantle cell lymphoma (MCL) cohort

Each of the cohorts will be treated with the recommended dose of loncastuximab tesirine determined in the Phase 1 portion of the study.

The study will include a Screening Period (of up to 28 days), a Treatment Period (cycles of 3 to 4 weeks), and a Follow-up Period (approximately every 12 week visits for up to 2 years after treatment discontinuation).

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 136
• Est. completion date: November 8, 2022
• Est. primary completion date: November 8, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Male or female participant aged 18 years or older

2. Pathologic diagnosis of DLBCL or MCL (For Italy Sites Only: MCL patients are excluded.)

3. Participants with DLBCL must have relapsed or refractory disease and have failed or been intolerant to available standard therapy

4. Participants with MCL must have relapsed or refractory disease and have received at least one prior line of therapy (For Italy Sites Only: This exclusion criterion is not applicable)

5. Participants who have received previous CD19-directed therapy must have a biopsy which shows CD19 expression after completion of the CD19-directed therapy

6. Measurable disease as defined by the 2014 Lugano Classification

7. Availability of formalin-fixed paraffin-embedded (FFPE) tumor tissue block (or minimum 10 freshly cut unstained slides if block is not available)

8. ECOG performance status 0 to 2

9. Screening laboratory values within the following parameters:

1. Absolute neutrophil count (ANC) =1.0 × 103/µL (off growth factors at least 72 hours)

2. Platelet count =75 × 103/µL without transfusion in the past 7 days

3. Hemoglobin =8 g/dL (4.96 mmol/L), transfusion allowed

4. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transferase (GGT) =2.5 × the ULN

5. Total bilirubin =1.5 × ULN (participants with known Gilbert's syndrome may have a total bilirubin up to =3 × ULN)

6. Blood creatinine =1.5 × ULN or calculated creatinine clearance =60 mL/min by the Cockcroft and Gault equation

10. Negative beta-human chorionic gonadotropin (ß-HCG) pregnancy test within 7 days prior to start of study drugs on C1D1 for women of childbearing potential

11. Women of childbearing potential must agree to use a highly effective method of contraception from the time of giving informed consent until at least 9 months after the last dose of loncastuximab tesirine or 1 month after last dose of ibrutinib, whichever comes last. Men with female partners who are of childbearing potential must agree that they will use a highly effective method of contraception from the time of giving informed consent until at least 6 months after the participant receives his last dose of loncastuximab tesirine or 3 months after last dose of ibrutinib, whichever comes last

Exclusion Criteria:

1. Known history of hypersensitivity to or positive serum human anti-drug antibody (ADA) to a CD19 antibody

2. Known history of hypersensitivity to ibrutinib

3. Previous therapy with ibrutinib or other BTK inhibitors

4. Previous therapy with loncastuximab tesirine

5. Requires treatment or prophylaxis with a moderate or strong cytochrome P450 (CYP) 3A inhibitor

6. Allogenic or autologous transplant within 60 days prior to start of study drugs (C1D1)

7. Active graft-versus-host disease

8. Post-transplantation lymphoproliferative disorder

9. Active autoimmune disease, including motor neuropathy considered of autoimmune origin and other central nervous system (CNS) autoimmune disease

10. Known seropositive and requiring anti-viral therapy for human immunodeficiency (HIV) virus, hepatitis B virus (HBV), or hepatitis C virus (HCV).

11. History of Stevens-Johnson syndrome or toxic epidermal necrolysis

12. Lymphoma with active CNS involvement at the time of screening, including leptomeningeal disease

13. Clinically significant third space fluid accumulation (i.e., ascites requiring drainage or pleural effusion that is either requiring drainage or associated with shortness of breath)

14. Breastfeeding or pregnant

15. Significant medical comorbidities, including but not limited to, uncontrolled hypertension (blood pressure [BP] =160/100 millimeters of mercury (mmHg) repeatedly), unstable angina, congestive heart failure (greater than New York Heart Association class II), electrocardiographic evidence of acute ischemia, coronary angioplasty or myocardial infarction within 6 months prior to screening, uncontrolled atrial or ventricular cardiac arrhythmia, poorly controlled diabetes mellitus, or severe chronic pulmonary disease, or tuberculosis infection (tuberculosis screening based on local standards).

16. Major surgery, radiotherapy, chemotherapy, or other anti-neoplastic therapy within 14 days prior to start of study drugs (C1D1), except shorter if approved by the Sponsor

17. Use of any other experimental medication within 14 days prior to start of study drugs (C1D1)

18. Planned live vaccine administration after starting study drugs (C1D1)

19. Any condition that could interfere with the absorption or metabolism of ibrutinib including malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel

20. Inherited or acquired bleeding disorders

21. Ongoing anticoagulation treatment, except for low-dose heparinisation or equivalent

22. Failure to recover to Grade =1 (Common Terminology Criteria for Adverse Events [CTCAE] version 4.0) from acute non-hematologic toxicity (Grade =2 neuropathy or alopecia) due to previous therapy prior to screening

23. Congenital long QT syndrome or a corrected QTcF interval of >480 ms at screening (unless secondary to pacemaker or bundle branch block)

24. Active second primary malignancy other than non-melanoma skin cancers, non metastatic prostate cancer, in situ cervical cancer, ductal or lobular carcinoma in situ of the breast, or other malignancy that the Sponsor's medical monitor and Investigator agree, and document should not be exclusionary

25. Any other significant medical illness, abnormality, or condition that would, in the Investigator's judgement, make the participant inappropriate for study participation or put the participant at risk

Related Conditions & MeSH terms

• Diffuse Large B-Cell Lymphoma
• Lymphoma
• Lymphoma, B-Cell
• Lymphoma, Large B-Cell, Diffuse
• Lymphoma, Mantle-Cell
• Mantle Cell Lymphoma

Intervention

Drug:
• Loncastuximab Tesirine
Intravenous (IV) infusion.
• Ibrutinib
Oral capsule.

Locations

Country	Name	City	State
Belgium	GasthuisZusters Antwerpen Sint-Augustinus	Wilrijk
Belgium	CHU UCL Namur (Site Godinne)	Yvoir
France	Centre Hospitalier Universitaire de Rennes Hôpital Pontchailou	Bretagne
France	Hôpital Hôtel-Dieu	Loiré
France	Hôpital Saint-Eloi	Montpellier
France	Hôpital Saint-Louis	Paris
France	Centre Hospitalier Lyon Sud	Pierre-Bénite
France	Centre Hospitalier Universitaire De Poitier - Hopital De La Miletrie - Hopital Jean Bernard	Poitiers
Italy	Azienda Ospedaliera Pap Giovanni XXIII	Bergamo
Italy	Policlinico Sant'Orsola Malpighi	Bologna
Italy	Azienda Socio Sanitaria Territoriale Degli Spedali Civili Di Brescia	Brescia
Italy	Istituto Scientifico Rmagnolo per lo Studio e la Cura dei Tumori	Meldola FC
Italy	Istituto Europeo di Oncologia	Milano
Italy	Azienda Unita Sanitaria Locale de Ravenna	Ravenna
Italy	IRCCS istituto Clinico Humanitas U.O. di Oncologia ed Ematologia	Via Manzoni	Rozzano
Spain	Hospital Duran I Reynals	Barcelona
Spain	Hospital Universitario Vall d'Hebrón	Barcelona
Spain	Hospital General Universitario Gregorio Marañón	Madrid
Spain	Hospital Universitario Fundación Jiménez Díaz	Madrid
Spain	Hospital Universitario Marqués de Valdecilla	Santander
Spain	Hospital Universitario Virgen del Rocio	Sevilla
United Kingdom	The Christie NHS Foundation Trust	Manchester
United Kingdom	Abertawe Bro Morgannwg University Health Board	Swansea
United States	University of Michigan Comprehensive Cancer Center	Ann Arbor	Michigan
United States	The Blood and Marrow Transplant Group of Georgia	Atlanta	Georgia
United States	Georgia Cancer Center at Augusta University	Augusta	Georgia
United States	The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins	Baltimore	Maryland
United States	Saint Vincent Healthcare	Billings	Montana
United States	Case Western Reserve University	Cleveland	Ohio
United States	Norton Cancer Institute, St. Matthews Campus	Louisville	Kentucky
United States	Miami Cancer Institute	Miami	Florida
United States	University of Miami	Miami	Florida
United States	University of Minnesota	Minneapolis	Minnesota
United States	University of California Irvine Health Chao Family Comprehensive Cancer Center	Orange	California
United States	Redlands Community Hospital	Redlands	California

Sponsors (1)

Lead Sponsor	Collaborator
ADC Therapeutics S.A.

Countries where clinical trial is conducted

United States,  Belgium,  France,  Italy,  Spain,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Phase 1: Number of Participants With Treatment-emergent Adverse Events (TEAEs)	A TEAE was defined as an adverse event (AE) that occurred or worsened in the period extending from the first dose of study drug to 30 days after the last dose of study drug in this study or start of a new anticancer therapy, whichever is earlier. Any clinically significant changes form baseline in safety laboratory values, vital signs, Eastern Cooperative Oncology Group (ECOG) performance status, and 12-lead electrocardiograms (ECGs) which occurred after first dose of study drug were recorded as TEAEs.	Day 1 until 30 days after last dose; max duration of treatment was 686 days for Phase 1 (up to approximately 716 days total)
Primary	Phase 1: Number of Participants With Serious TEAEs	A serious TEAE was defined as any AE which occurred after the first dose of study drug that resulted in death, was life threatening, required inpatient hospitalization or prolongation of existing hospitalization (hospitalization for elective procedures or for protocol compliance was not considered a serious adverse event), resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, or important medical events that did not meet the preceding criteria but based on appropriate medical judgement may have jeopardized the participant or may have required medical or surgical intervention to prevent any of the outcomes listed above.	Day 1 until 30 days after last dose; max duration of treatment was 686 days for Phase 1 (up to approximately 716 days total)
Primary	Phase 1: Number of Participants With Dose-Limiting Toxicities (DLTs)	A DLT was defined as any of the following events which occur during the DLT Period (first 21 days of ibrutinib treatment), except those that are clearly due to underlying disease or extraneous causes: a hematologic DLT (grade =3 anaemia, grade 4/febrile neutropenia, grade =3 thrombocytopenia), a non-hematologic DLT (including aspartate aminotransferase [AST] and/or alanine aminotransferase [ALT] >3× upper limit of normal (ULN) and bilirubin >2× ULN), any other non-hematologic toxicities = Grade 3, with exceptions.	21 days
Primary	Phase 1: Number of Participants With Dose Interruptions		Up to a maximum of 686 days
Primary	Phase 1: Number of Participants With Dose Reductions		Up to a maximum of 686 days
Primary	Phase 2: Complete Response Rate (CRR)	CRR according to the 2014 Lugano classifications determined by Independent Review Committee (IRC). CRR was defined as the percentage of participants with a best overall response (BOR) of complete response (CR).	Up to approximately 38 months
Secondary	Phase 1: Overall Response Rate (ORR)	ORR according to the 2014 Lugano classification, defined as the percentage of participants with a BOR of CR or partial response (PR).	Up to approximately 38 months
Secondary	Phase 1 and Phase 2: Duration of Response (DOR)	DOR was defined as the time from the first documentation of tumor response to disease progression or death.	Up to approximately 36 months
Secondary	Phase 1 and Phase 2: Relapse-Free Survival (RFS)	RFS was defined as the time from the documentation of CR to disease progression or death.	Up to approximately 36 months
Secondary	Phase 1 and Phase 2: Progression-Free Survival (PFS)	PFS was defined as the time between start of treatment and the first documentation of progression, or death.	Up to approximately 37 months
Secondary	Phase 1 and Phase 2: Overall Survival (OS)	OS was defined as the time between the start of treatment and death from any cause.	Up to approximately 38 months
Secondary	Phase 1 and Phase 2: Time to Reach Maximum Concentration (Tmax) of Loncastuximab Tesirine (Total Antibody, PBD-Conjugated Antibody and Unconjugated Cytotoxin SG3199)	Blood samples were collected for analysis of PK data of loncastuximab tesirine (total antibody, PBD-conjugated antibody and unconjugated cytotoxin SG3199)	C1D1 pre-dose, EOI, 4h PD, C1D8 168h PD, C1D15 336h PD, C2D1 pre-dose, EOI, 4h PD, C2D8 168h PD, C2D15 336h PD (3 week cycles)
Secondary	Phase 1 and Phase 2: Maximum Observed Concentration (Cmax) of Loncastuximab Tesirine (Total Antibody, PBD-Conjugated Antibody and Unconjugated Cytotoxin SG3199)	Blood samples were collected for analysis of PK data of loncastuximab tesirine (total antibody, PBD-conjugated antibody and unconjugated cytotoxin SG3199)	C1D1 pre-dose, EOI, 4h PD, C1D8 168h PD, C1D15 336h PD, C2D1 pre-dose, EOI, 4h PD, C2D8 168h PD, C2D15 336h PD (3 week cycles)
Secondary	Phase 1 and Phase 2: Area Under the Concentration-Time Curve From Time Zero to the Last Quantifiable Concentration (AUClast) of Loncastuximab Tesirine (Total Antibody, PBD-Conjugated Antibody and Unconjugated Cytotoxin SG3199)	Blood samples were collected for analysis of PK data of loncastuximab tesirine (total antibody, PBD-conjugated antibody and unconjugated cytotoxin SG3199)	C1D1 pre-dose, EOI, 4h PD, C1D8 168h PD, C1D15 336h PD, C2D1 pre-dose, EOI, 4h PD, C2D8 168h PD, C2D15 336h PD (3 week cycles)
Secondary	Phase 1 and Phase 2: Area Under the Concentration-Time Curve From Time Zero to the End of the Dosing Interval (AUCtau) of Loncastuximab Tesirine (Total Antibody, PBD-Conjugated Antibody and Unconjugated Cytotoxin SG3199)	Blood samples were collected for analysis of PK data of loncastuximab tesirine (total antibody, PBD-conjugated antibody and unconjugated cytotoxin SG3199).	C1D1 pre-dose, EOI, 4h PD, C1D8 168h PD, C1D15 336h PD, C2D1 pre-dose, EOI, 4h PD, C2D8 168h PD, C2D15 336h PD (3 week cycles)
Secondary	Phase 1 and Phase 2: Area Under the Concentration-Time Curve From Time Zero to Infinity (AUCinf) of Loncastuximab Tesirine (Total Antibody, PBD-Conjugated Antibody and Unconjugated Cytotoxin SG3199)	Blood samples were collected for analysis of PK data of loncastuximab tesirine (total antibody, PBD-conjugated antibody and unconjugated cytotoxin SG3199).	C1D1 pre-dose, EOI, 4h PD, C1D8 168h PD, C1D15 336h PD, C2D1 pre-dose, EOI, 4h PD, C2D8 168h PD, C2D15 336h PD (3 week cycles)
Secondary	Phase 1 and Phase 2: Clearance (CL) of Loncastuximab Tesirine (Total Antibody, PBD-Conjugated Antibody and Unconjugated Cytotoxin SG3199)	Blood samples were collected for analysis of PK data of loncastuximab tesirine (total antibody, PBD-conjugated antibody and unconjugated cytotoxin SG3199).	C1D1 pre-dose, EOI, 4h PD, C1D8 168h PD, C1D15 336h PD, C2D1 pre-dose, EOI, 4h PD, C2D8 168h PD, C2D15 336h PD (3 week cycles)
Secondary	Phase 1 and Phase 2: Accumulation Index (AI) Loncastuximab Tesirine (Total Antibody, PBD-Conjugated Antibody and Unconjugated Cytotoxin SG3199)	Blood samples were collected for analysis of PK data of loncastuximab tesirine (total antibody, PBD-conjugated antibody and unconjugated cytotoxin SG3199).	C1D1 pre-dose, EOI, 4h PD, C1D8 168h PD, C1D15 336h PD, C2D1 pre-dose, EOI, 4h PD, C2D8 168h PD, C2D15 336h PD (3 week cycles)
Secondary	Phase 1 and Phase 2: Number of Participants With Positive Anti-Drug Antibody (ADA) Titers to Loncastuximab Tesirine at Any Time	Detection of ADAs was performed by using a screening assay for identification of antibody positive samples/participants, a confirmation assay, and titer assessment.	Up to a maximum of 711 days
Secondary	Phase 2: ORR	ORR according to the 2014 Lugano classification, defined as the percentage of participants with a BOR of CR or PR.	Up to approximately 38 months
Secondary	Phase 2: CRR in Non-GCB DLBCL, GCB DLBCL, All DLBCL and MCL Participants	CRR according to the 2014 Lugano classifications determined by the IRC. CRR was defined as the percentage of participants with a BOR of CR in non-GCB DLBCL, GCB DLBCL, all DLBCL, and MCL participants.	Up to approximately 38 months
Secondary	Phase 2: Number of Participants With TEAEs	A TEAE was defined as an adverse event (AE) that occurred or worsened in the period extending from the first dose of study drug to 30 days after the last dose of study drug in this study or start of a new anticancer therapy, whichever is earlier. Any clinically significant changes form baseline in safety laboratory values, vital signs, ECOG performance status, and 12-lead ECGs which occurred after first dose of study drug were recorded as TEAEs.	Day 1 until 30 days after last dose; max duration of treatment was 711 days for Phase 2 (up to approximately 741 days total)
Secondary	Phase 2: Number of Participants With Serious TEAEs	A serious TEAE was defined as any AE which occurred after the first dose of study drug that resulted in death, was life threatening, required inpatient hospitalization or prolongation of existing hospitalization (hospitalization for elective procedures or for protocol compliance was not considered a serious adverse event), resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, or important medical events that did not meet the preceding criteria but based on appropriate medical judgement may have jeopardized the participant or may have required medical or surgical intervention to prevent any of the outcomes listed above.	Day 1 until 30 days after last dose; max duration of treatment was 711 days for Phase 2 (up to approximately 741 days total)