| Eligibility |
Inclusion Criteria:
- Ability to understand the purpose and risks of the study and to provide signed
informed consent
- Pathologically confirmed MCL, with documentation of chromosome translocation
t(11;14)(q13;q32) and/or overexpression of cyclin D1 in association with other
relevant markers (e.g., CD5, CD19, CD20, PAX5)
- Age 18-64 with one or more of the following poor risk features defined as:
- High risk mutational variants including p53 mutation and/or17p deletion;
- Blastoid or pleomorphic phenotype;
- Complex karyotype with = 3 abnormalities (in addition to t(11,14)) on routine
karyotyping;
- Ki67 > 30%;
- sMIPI > 6.2; and/or
- p53 expression on immunohistochemistry (IHC), defined as > 20%
- Age = 65. For this population, no poor risk features are required to be eligible
- No prior systemic anticancer therapies for MCL
- Presence of radiologically measurable lymphadenopathy and/or extranodal lymphoid
malignancy
- Able to provide biosamples for MRD testing and pathology. If fresh tissue is not
available, archival samples can be used at the discretion of the investigator
- Eastern Cooperative Oncology Group (ECOG) performance status of = 2
- Absolute neutrophil count (ANC) = 1.0 × 10^9/L independent of growth factor support
- Platelets = 1.0 × 10^9/L (= 0.5 × 10^9/L if bone marrow [BM] involvement), independent
of transfusion support in either situation
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) = 3 × upper limit
of normal (ULN)
- Total bilirubin = 1.5 × ULN (unless due to Gilbert's syndrome or of non hepatic
origin)
- Serum creatinine = ULN; or estimated creatinine clearance = 50 mL/min by Cockroft
Gault method or other approved methods, at the discretion of the investigator
- Undetectable hepatitis B virus (HBV) surface antigen (sAg) serology. Confirmed by
polymerase chain reaction (PCR) for HBV deoxyribonucleic acid (DNA) if results are
disputable
- Undetectable hepatitis C virus (HCV) antigen serology. Confirmed by PCR for HCV
ribonucleic acid (RNA) if results are disputable
- Undetectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) based on PCR
testing within 7 days of enrollment
- Undetectable HIV based on serology. Enrollment will be considered if HIV is controlled
with treatment (i.e., undetectable viral load for 6 months prior and the CD4 counts is
= 200/µL). Such patients must be willing to modify HIV therapy while on-treatment and
during applicable wash-out periods, as needed, to address drug-drug interactions
- Willing and able to participate in all required evaluations and procedures in this
protocol including swallowing capsules without difficulty
- Persons of childbearing potential (PCBP): Persons of childbearing potential must have
a negative serum (beta-human chorionic gonadotropin [b-hCG]) or urine pregnancy test
at Screening and be willing to use approved contraception while on treatment and for
the longest following, applicable time period: 18 months after the last dose of
obinutuzumab, 2 months after the last dose of glofitamab, 3 months for tocilizumab, or
1 month after the last dose of ibrutinib. Women who are pregnant or breastfeeding are
ineligible for this study
- Persons that produce viable sperm: Willingness to use approved contraception while
on-treatment and for the longest applicable time period following: 6 months after the
last dose of obinutuzumab or 2 months after the last dose of glofitamab, tocilizumab,
or ibrutinib
- Willingness to not breastfeed or donate ova or sperm: If obinutuzumab was the last
study drug received, the participant must wait for 6 months. Otherwise, patients must
agree to wait 3 months for sperm and 1 month for ova donations (and to breastfeed)
after the last dose other study drugs
- The effects of GLIB on the developing human fetus are unknown. Should a participant or
participant's sexual partner become pregnant or suspect a pregnancy while
participating in this study, the individual should inform their treating physician
immediately
Exclusion Criteria:
- Previous MCL-directed treatment. Treatment with corticosteroids (up to 20 mg
dexamethasone or equivalent daily) is allowed prior to and during the screening period
for patients with aggressive clinical behavior. All steroids used for disease control
must be discontinued within 7 days after starting study treatment
- Clinically significant cardiovascular disease such as uncontrolled or symptomatic
arrhythmias, congestive heart failure, or myocardial infarction within 6 months of
screening, or any class 3 (moderate) or class 4 (severe) cardiac disease as defined by
the New York Heart Association Functional Classification
- History of prior malignancy except for the following:
- Malignancy treated with curative intent and with no evidence of active disease
present for more than 2 years before screening and felt to be at low risk for
recurrence by treating physician
- Persons with low grade prostate cancer on a watch and wait strategy are eligible
- Adequately treated lentigo maligna melanoma without current evidence of disease
or adequately controlled nonmelanomatous skin cancer
- Adequately treated carcinoma in situ without current evidence of disease
- Ongoing hormonal therapy alone for prior malignancy is allowed
- Concurrent use of cytotoxic chemotherapy; radiotherapy; immunotherapy; hormone therapy
(other than contraceptives, hormone-replacement therapy, or megestrol acetate); and
biologic agents (other than hematopoietic growth factors, if clinically indicated and
used in accordance with manufacture and Investigator recommendations), unless approved
by the investigator
- Received systemic immunosuppressive medications (e.g., cyclophosphamide, azathioprine,
methotrexate, thalidomide, and anti-tumor necrosis factor agents) within 2 weeks prior
to Gpt infusion with the exceptions of corticosteroid = 25 mg/day prednisone or
equivalent and inhaled and topical steroids
- Known history of hypersensitivity to
- Humanized or murine monoclonal antibodies or products
- A CD3 and / or CD20 antibody
- Glofitamab
- Ibrutinib
- Tocilizumab
- Current or past history of epilepsy, central nervous system (CNS) vasculitis, and
neurodegenerative disease
- History of autoimmune disease (e.g., myocarditis, pneumonitis, myasthenia gravis,
myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis,
inflammatory bowel disease, vascular thrombosis associated with antiphospholipid
syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barre syndrome,
multiple sclerosis, vasculitis, or glomerulonephritis. Patients with a remote history
of, or well controlled, autoimmune disease may be eligible to enroll after
consultation with the primary investigator
- History of bleeding risks:
- Stroke, transient ischaemic attack (TIA),or intracranial hemorrhage within 2
years of first dose of study drug given no remaining neurological deficits
- Known bleeding diathesis (e.g., hemophilia or von Willebrand disease)
- Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months prior
to cycle 1 day 1 (C1D1)
- Requires or receiving anticoagulation with warfarin or equivalent vitamin K
antagonists (e.g., phenprocoumon) within 7 days of first dose of C1D1
- Requires treatment with a strong CYP3A inhibitor/inducer, except for the following:
- A plan to modify concurrent CYP3A inhibitor/inducer and/or wash-out periods prior
to C1D1
- Topical ketoconazole: Based on its low overall bioavailability, there are no
restrictions
- Concurrent participation in another therapeutic clinical trial
- History of confirmed progressive multifocal leukoencephalopathy (PML) or lymphomatous
involvement of the CNS
- Known or suspected history of hemophagocytic lymphohistiocystosis (HLH)
- Evidence of ongoing acute or systemic infections (bacterial, fungal, or viral), or any
major episode of infection requiring hospitalization or treatment with IV antibiotics
(for IV antibiotics this pertains to completion of last course of antibiotic
treatment) within 4 weeks of dosing, except localized fungal infections of skin or
nails. Subjects may be receiving prophylactic antiviral or antibacterial therapies at
the discretion of the investigator
- Receipt of live vaccine within 4 weeks of enrollment or during study treatment period
- Any life-threatening illness, medical condition, or organ system dysfunction which, in
the investigator's opinion, could compromise the subject's safety, interfere with the
absorption or metabolism of ibrutinib capsules, or put the study outcomes at undue
risk
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