Relapsed/Refractory Large B-cell Lymphoma Clinical Trial
— ZUMA-19Official title:
A Phase 1/2 Open-label, Multicenter Study of Lenzilumab and Axicabtagene Ciloleucel in Subjects With Relapsed or Refractory Large B-cell Lymphoma (ZUMA-19)
Verified date | July 2023 |
Source | Gilead Sciences |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The primary objectives of this study are: Phase 1: To evaluate the safety of sequenced therapy with lenzilumab and axicabtagene ciloleucel in participants with relapsed or refractory large B-cell lymphoma and identify the most appropriate dose of lenzilumab for Phase 2. Phase 2: To evaluate the incidence of neurologic events with sequenced therapy given at the recommended Phase 2 dose (RP2D) of lenzilumab in participants with relapsed or refractory large B-cell lymphoma.
Status | Terminated |
Enrollment | 6 |
Est. completion date | July 27, 2022 |
Est. primary completion date | March 16, 2021 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Key Inclusion Criteria: - Individuals with large B-cell lymphoma, including Diffuse large B-cell lymphoma (DLBCL) not otherwise specified, Primary mediastinal large B-cell lymphoma (PMBCL), High-grade B-cell lymphoma (HGBL), and DLBCL arising from Follicular lymphoma (FL) - Individuals must have relapsed disease after 2 or more lines of systemic therapy, or chemorefractory disease defined as the following: - No response to first-line therapy, including the following: - Progressive disease (PD) as best response to first therapy - Stable disease (SD) as best response after = 4 cycles of first-line therapy (eg, 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP)), with SD duration no longer than 6 months from the last dose of therapy - No response to = 2 lines of therapy, including the following: - PD as best response to most recent therapy - SD as best response after = 2 cycles of last line of therapy - Individuals must have received adequate prior therapy including at a minimum: - Anti-CD20 monoclonal antibody unless investigator determines that tumor is CD20 negative, and - An anthracycline-containing chemotherapy regimen - At least 1 measurable lesion according to the International Working Group Lugano Classification. Lesions that have been previously irradiated will be considered measurable only if progression has been documented following completion of radiation therapy. - Magnetic resonance imaging of the brain showing no evidence of central nervous system (CNS) lymphoma - Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 - Individuals with a known medical history of tuberculosis or a risk for tuberculosis exposure require negative tuberculosis testing by either tuberculin skin test or interferon gamma release assay. - Adequate bone marrow function as evidenced by: - Absolute neutrophil count = 1000/µL - Platelets = 75,000/µL - Absolute lymphocyte count = 100/µL - Adequate renal, hepatic, cardiac, and pulmonary function as evidenced by: - Creatinine clearance (Cockcroft-Gault) = 60 mL/min - Serum alanine aminotransferase or aspartate aminotransferase = 2.5 upper limit of normal - Total bilirubin = 1.5 mg/dL, except in individuals with Gilbert's Syndrome - Cardiac ejection fraction = 50% with no evidence of clinically significant pericardial effusion as determined by echocardiogram (ECHO), and no clinically significant electrocardiogram (ECG) findings - No clinically significant pleural effusion - Baseline oxygen saturation > 92% on room air Key Exclusion Criteria: - History of Richter's transformation of chronic lymphocytic leukemia - Autologous stem cell transplant (SCT) within 6 weeks of planned axicabtagene ciloleucel infusion - History of allogeneic stem cell transplantation - Prior CD19 targeted therapy or prior CAR T cell therapy - History of pulmonary alveolar proteinosis (PAP) - History of severe, immediate hypersensitivity reaction attributed to aminoglycosides - Known history of human immunodeficiency virus (HIV) infection, hepatitis B (HBsAg positive) or hepatitis C (HCV) (anti-HCV positive) infection. A history of hepatitis B or hepatitis C infection is permitted if the viral load is undetectable per quantitative polymerase chain reaction (PCR) and/or nucleic acid testing. - Individuals with detectable Cerebrospinal fluid (CSF) malignant cells, or brain metastases, or with a history of CNS lymphoma, CSF malignant cells or brain metastases - History or presence of CNS disorder such as seizure disorder, cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, or any autoimmune disease with CNS involvement Note: Other protocol defined Inclusion/Exclusion criteria may apply. |
Country | Name | City | State |
---|---|---|---|
United States | Roswell Park Cancer Institute | Buffalo | New York |
United States | Levine Cancer Center | Charlotte | North Carolina |
United States | Northwestern University | Evanston | Illinois |
United States | MD Anderson Cancer Center | Houston | Texas |
United States | Vanderbilt University | Nashville | Tennessee |
United States | Columbia University Medical Center, New York-Presbyterian Hospital | New York | New York |
United States | Stanford University | Palo Alto | California |
United States | Oregon Health & Science University | Portland | Oregon |
United States | Mayo Clinic | Rochester | Minnesota |
United States | Moffitt Cancer Center | Tampa | Florida |
Lead Sponsor | Collaborator |
---|---|
Kite, A Gilead Company | Humanigen, Inc. |
United States,
Kenderian, S. S., Oluwole, O. O., Mccarthy, P. L., Reshef, R., Shiraz, P., Ahmed, O., Le Gall, J., Nahas, M., Tang, L. And Neelapu, S. S. Zuma-19: A Phase 1/2 Multicenter Study of Lenzilumab Use With Axicabtagene Ciloleucel (Axi-Cel) In Patients (Pts) With Relapsed Or Refractory Large B Cell Lymphoma (R/R Lbcl). Blood 136(Supplement 1): 6-7, (2020). Conference Proceedings.
Olalekan O. Oluwole, MBBS, Saad S. Kenderian, MD, Parveen Shiraz, MD, Reem Karmali, MD, MSc, Ran Reshef, MD, MSc, Philip L. McCarthy, MD, Nilanjan Ghosh, MD, PhD, Aleksandr Lazaryan, MD, PhD, MPH, Simone Filosto, PhD, Soumya Poddar, PhD, Daqin Mao, PhD, Andrew Peng, MS, Adrian Kilcoyne, MD, MPH, Myrna Nahas, MD, Sattva S. Neelapu, MD. A Phase 1/2 Study of Axicabtagene Ciloleucel Plus Lenzilumab in Patients With Relapsed or Refractory Large B-Cell Lymphoma. American Society of Hemotology; Dec 10-13, 2022; New Orleans, LA. Abstract 4635
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Phase 1: Percentage of Participants Experiencing Adverse Events (AEs) Defined as Dose Limiting Toxicities (DLTs) Related to Sequenced Therapy With Lenzilumab and Axicabtagene | A DLT was defined as the following sequenced therapy-related events with onset within the first 28 days following lenzilumab and axicabtagene ciloleucel infusions:
Grade 4 neutropenia lasting longer than 21 days from the day of cell transfer Grade 4 thrombocytopenia lasting longer than 28 days from the day of cell transfer Any sequenced therapy-related AE requiring intubation, including Grade 4 encephalopathy requiring intubation for airway protection Any sequenced therapy-related Grade 5 event |
First infusion of lenzilumab and axicabtagene ciloleucel up to 28 days. | |
Primary | Phase 2: Percentage of Participants Experiencing Grade 2 or Higher Neurologic Events Within 28 Days of Axicabtagene Ciloleucel Administration | Up to 28 days | ||
Secondary | Phase 1 and Phase 2: Percentage of Participants Experiencing Adverse Events | Enrollment through 3 months after lenzilumab and axicabtagene ciloleucel infusion. | ||
Secondary | Phase 1 and Phase 2: Percentage of Participants Experiencing Serious Adverse Events | Enrollment through 3 months after lenzilumab and axicabtagene ciloleucel infusion. | ||
Secondary | Phase 1 and Phase 2: Percentage of Participants Experiencing Cytokine Release Syndrome | Enrollment through 12 months after lenzilumab and axicabtagene ciloleucel infusion or until disease progression, whichever occurred first. | ||
Secondary | Phase 1 and Phase 2: Percentage of Participants Experiencing Neurologic Events | Enrollment through 12 months after lenzilumab and axicabtagene ciloleucel infusion or until disease progression, whichever occurred first. | ||
Secondary | Phase 1 and Phase 2: Complete Response (CR) Rate Per Internal Working Group (IWG) Lugano Classification as Determined by the Study Investigators | CR rate: percentage of participants with CR (CMR;CRR). CMR: positron emission tomography(PET)5-point scale(5PS) scores of 1(no uptake above background), 2(uptake = mediastinum), 3(uptake > mediastinum but = liver) with/without a residual mass); no new sites; and no evidence of fluorodeoxyglucose (FDG)-avid disease in bone marrow. CRR: target nodes/nodal masses regressed to = 1.5 cm in longest transverse diameter (LDi) of a lesion; no extra lymphatic sites; absent non-measured lesion;organ enlargement regress to normal; no new sites; and bone marrow normal by morphology. | First infusion date axicabtagene ciloleucel to data cut off date of 09 May 2022 (maximum duration: 22.3 months). | |
Secondary | Phase 1 and Phase 2: Objective Response Rate (ORR) Per IWG Lugano Classification as Determined by Study Investigators | ORR: Percentage of participants with CR(CMR;CRR) or PR(partial metabolic response(PMR);partial radiologic response (PRR)).CMR:PET 5PS scores of 1,2,3 with/without a residual mass;no new sites;no evidence of FDG-avid disease in bone marrow.CRR:target nodes/nodal masses regressed to = 1.5 cm in LDi of a lesion;no extra lymphatic sites;absent non-measured lesion;organ enlargement regress to normal;no new sites;bone marrow normal by morphology.PMR:5PS scores of 4(uptake moderately higher than liver),or 5(uptake markedly higher than liver and/or new lesions),with reduced uptake compared to baseline and residual masses of any size;no new sites;residual update > update in normal bone marrow but reduced compared with baseline.PRR:= 50% decrease in sum of the product of perpendicular diameters of up to 6 target measurable nodes and extranodal sites;absent/normal, regressed, but no increase of nonmeasured lesions;spleen regressed by > 50% in length beyond normal;no new sites. | First infusion date axicabtagene ciloleucel to data cut off date of 09 May 2022 (maximum duration: 22.3 months). | |
Secondary | Phase 1 and Phase 2: Duration of Response (DOR) in Participants Who Experience an Objective Response Per IWG Lugano Classification as Determined by Study Investigators | DOR is defined only for participants who experience an objective response after axicabtagene ciloleucel infusion and is the time from the first objective response to disease progression or death from any cause. Objective response is defined in outcome measure (OM) 7. | First infusion date axicabtagene ciloleucel to data cut off date of 09 May 2022 (maximum duration: 22.3 months). | |
Secondary | Phase 1 and Phase 2: Progression-Free Survival (PFS) Per IWG Lugano Classification as Determined by Study Investigators | PFS is defined as the time from the axicabtagene ciloleucel infusion date to the date of disease progression per Lugano classification or death from any cause. | First infusion date axicabtagene ciloleucel to data cut off date of 09 May 2022 (maximum duration: 22.3 months). | |
Secondary | Phase 1 and Phase 2: Overall Survival (OS) | OS is defined as the time from axicabtagene ciloleucel infusion to the date of death. | First infusion date axicabtagene ciloleucel to data cut off date of 09 May 2022 (maximum duration: 22.3 months). | |
Secondary | Phase 1 and Phase 2: Pharmacodynamics: Peak Serum Level of CXCL10, Granzyme B, IFN-gamma, IL-1 RA, IL-2, IL-6, IL-8, TNF Alpha, GM-CSF, and MCP-1 | Peak is defined as the maximum post-baseline level of the analyte from baseline to Week 4. | Baseline up to Week 4 | |
Secondary | Phase 1 and Phase 2: Axicabtagene Ciloleucel Pharmacokinetics: Peak Level of Anti-CD19 CAR T Cells in Blood | Peak is defined as the maximum number of CAR T cells in blood measured after the axicabtagene ciloleucel infusion. | Baseline up to Month 3 |
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