A Phase I/II Study of Betalutin for Treatment of Relapsed Non-Hodgkin Lymphoma (LYMRIT-37-01)

September 9, 2022 updated by: Nordic Nanovector

A Phase I/II Study of Lutetium (177Lu)-Lilotomab Satetraxetan (Betalutin®) Antibody-radionuclide-conjugate for Treatment of Relapsed Non-Hodgkin Lymphoma.

This study is a phase I/II open-label study in patients with relapsed indolent NHL (Part A) or relapsed/refractory FL (Part B). Part A of the study assessed the safety and preliminary efficacy. This seamless design study now has four parts: 1) Part A, Ph I - dose escalation, 2) Part A, Ph II - dose expansion, 3) Part B, Ph II randomized - refinement of dose, and 4) Part B and C, Phase II, single-arm. As of August 7, 2020, patients are enrolling in the fourth part of the study.

Study Overview

Study Type

Interventional

Enrollment (Actual)

191

Phase

  • Phase 2
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Hobart, Australia, 7000
        • Royal Hobart Hospital
      • Innsbruck, Austria, 6020
        • Medizinische Universitaet Innsbruck
      • Wien, Austria, 1090
        • Medizinische Universität Wien - AKH Wien, Universitaetsklinik fuer Innere Medizin I
      • Gent, Belgium, 9000
        • Universitair Ziekenhuis Gent (UZ Gent)
      • La Louvière, Belgium
        • CH Jolimont
      • Leuven, Belgium, 3000
        • UZ Leuven
      • London, Canada, N6A 5W9
        • London Health Sciences Centre
      • Sault Ste Marie, Canada, P6B 0A8
        • Sault Area Hospital
      • Toronto, Canada, M5G 2M
        • Princes Margaret Cancer Centre
      • Zagreb, Croatia, 10 000
        • Clinical Hospital Centre Zagreb
      • Olomouc, Czechia, 779 00
        • University Hospital Olomouc
      • Ostrava-Poruba, Czechia, 708 52
        • FNsP Ostrava
      • Aarhus, Denmark, DK-8000
        • Aarhus Universitetshospital
      • Odense, Denmark, DK-5000
        • Odense Univerisity Hospital
      • Helsinki, Finland
        • Helsinki University Hospital Comprehensive Cancer Center
      • Jyväskylä, Finland
        • Central Hospital of Central Finland
      • Bordeaux, France
        • Institut Bergonié
      • Grenoble, France
        • CHU Grenoble - Hopital Michallon
      • Paris, France, 75010
        • Hopital Saint Louis
      • Paris, France, 75013
        • AP-HP La Pitié Salpêtrière
      • Pierre-Bénite, France
        • Centre Hospitalier Lyon Sud
      • Tours, France
        • Centre Hospitalier Regional Universitaire de Tours (CHRU de Tours) - Hopital Bretonneau
      • Budapest, Hungary
        • Orszagos Onkologiai Intezet, A-Belgyogyaszati Onkologiai Osztaly
      • Budapest, Hungary
        • Semmelweis Egyetem, I Belgyogyaszati Klinika, Hematologiai Osztaly
      • Dublin, Ireland
        • Mater Misericordiae University Hospital
      • Dublin, Ireland
        • St James's Hospital
      • Galway, Ireland
        • University Hospital Galway
      • Afula, Israel
        • Haemek Medical Center
      • Be'er Ya'aqov, Israel
        • Asaf Harofeh Medical Center
      • Haifa, Israel
        • Bnai Zion Medical Center (BZMC)
      • Haifa, Israel
        • Rambam Health Care Campus (RHCC)
      • Jerusalem, Israel
        • יHadassah Ein Karem Medical Center
      • Tel Aviv, Israel
        • Sourasky Medical Center
      • Alessandria, Italy
        • SS Antonio & Biagio and C. Arrigo Hospital
      • Bologna, Italy, 40138
        • "Istituto di Ematologia ed Oncologia Medica "" L. & A. Seragnoli""-Policlinico S. Orsola Malpighi"
      • Firenze, Italy, 50134
        • Universita Degli Studi Di Firenze-Azienda Ospedaliero-Universitaria Careggi (AOUC)
      • Meldola, Italy
        • Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS
      • Milano, Italy
        • Istituto Europeo di Oncologia (IEO)
      • Napoli, Italy
        • "Istituto Nazionale Tumori Fondazione G. Pascale"
      • Reggio Emilia, Italy
        • Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS
      • Torino, Italy
        • AO Ordine Mauriziano di Torino
      • Jeonju, Korea, Republic of
        • Chonbuk National University Hospital
      • Seoul, Korea, Republic of
        • Samsung Medical Center
      • Ulsan, Korea, Republic of
        • Ulsan University Hospital
      • Groningen, Netherlands
        • University Medical Center Groningen
      • Bergen, Norway
        • Haukeland Universitetssjukehus
      • Oslo, Norway, 0310
        • The Norwegian Radium Hospital
      • Trondheim, Norway, 7006
        • St Olav hospital
      • Gdynia, Poland
        • Szpital Morski Im.Pck W Gdynia
      • Krakow, Poland, 50-510
        • Pratia MCM Krakow
      • Warszawa, Poland, 02-097
        • Centrum Onkologii
      • Singapore, Singapore
        • National University Hospital
      • Barcelona, Spain
        • Corporació Sanitària Parc Taulí
      • Cadiz, Spain
        • Hospital Universitario Puerta Del Mar
      • Majadahonda, Spain
        • Hospital Universitario Puerta de Hierro de Majadahonda
      • Ourense, Spain
        • Complexo Hospitalario Universitario de Ourense
      • Pamplona, Spain
        • Clinica Universidad de Navarra
      • Salamanca, Spain
        • Hospital Clinico Universitario de Salamanca
      • Seville, Spain
        • Hospital Universitario Virgen Macarena
      • Valencia, Spain, 46020
        • Health Research Institute La Fe - Hospital La Fe
      • Valencia, Spain, 46026
        • Hospital Universitario Doctor Peset
      • Umeå, Sweden
        • Cancercentrum -Center of Oncology
      • Chur, Switzerland
        • Kantonsspital Graubünden
      • Adana, Turkey
        • Cukurova Universitesi Tip Fakültesi, Ic Hastaliklari Anabilim Dali
      • Ankara, Turkey
        • Ankara Onkoloji Egitim Ve Arastirma Hastanesi
      • Ankara, Turkey
        • Ankara Universitesi Tip Fakultesi Cebeci Hastanesi Ic
      • Ankara, Turkey
        • Hacettepe University Oncology Hospital
      • Eskişehir, Turkey
        • Eskisehir Osmangazi Universitesi Tip Fakultesi Ic Hastaliklar
      • Fatih, Turkey
        • Istanbul Universitesi Istanbul Tip Fakultesi
      • Manisa, Turkey
        • Celal Bayar Universitesi Tip Fakultesi
      • Samsun, Turkey
        • Ondokuz Mayis Universitesi
      • İzmir, Turkey
        • Ege Universitesi Tip Fakultesi
      • Şehitkamil, Turkey
        • Gaziantep Universitesi Sahinbey Arastirma ve Uygulama
      • Bristol, United Kingdom, BS2 8ED
        • Bristol Haematology and Oncology Centre
      • Edinburgh, United Kingdom
        • Western General Hospital
      • Glasgow, United Kingdom, G12 0YN
        • Beatson West of Scotland Cancer Centre
      • London, United Kingdom, W12 0HS
        • Imperial College Healthcare NHS Trust, Hammersmith Hospital
      • London, United Kingdom
        • University College London Hospitals NHS Foundation Trust
      • Manchester, United Kingdom, M20 4BX
        • The Christie Nhs Foundation Trust
      • Plymouth, United Kingdom
        • Derriford Hospital
      • Sutton, United Kingdom
        • The Royal Marsden NHS Foundation Trust
    • Dorset
      • Poole, Dorset, United Kingdom, BH15 2JB
        • Dorset Cancer Centre Poole Hospital
    • Arkansas
      • Little Rock, Arkansas, United States, 72205
        • University of Arkansas for Medical Sciences
    • California
      • Long Beach, California, United States, 90813
        • Pacific Shores Medical Group
      • San Francisco, California, United States, 94143
        • University of California, San Francisco (UCSF)
    • Florida
      • Boca Raton, Florida, United States, 33486
        • Boca Raton Regional Hospital
    • Illinois
      • Maywood, Illinois, United States, 60153
        • Loyola University Medical Center
    • Kentucky
      • Louisville, Kentucky, United States, 40207
        • Norton Cancer Institute
    • Louisiana
      • New Orleans, Louisiana, United States, 70121
        • Ochsner Clinic Foundation
    • New York
      • Stony Brook, New York, United States, 11794
        • Stony Brook University Medical Center
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • Duke University Medical Center
    • Oregon
      • Portland, Oregon, United States, 97239
        • Oregon Health & Science University
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • University of Pennsylvania
      • Pittsburgh, Pennsylvania, United States, 15224
        • West Penn Hospital
      • Pittsburgh, Pennsylvania, United States, 15232
        • University of Pittsburgh Medical Center
    • Texas
      • Dallas, Texas, United States, 75246
        • Baylor College of Medicine

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Part A and Part C:

Inclusion Criteria:

  • Histologically confirmed (by WHO classification) relapsed incurable non- Hodgkin B-cell lymphoma of following subtypes; follicular grade I-IIIA, marginal zone, small lymphocytic, lymphoplasmacytic, mantle cell.
  • Age ≥ 18 years
  • A pre-study WHO performance status of 0-1
  • Life expectancy should be ≥ 3 months
  • <25% tumour cells in bone marrow biopsy
  • Measurable disease by radiological methods

Exclusion Criteria:

  • Absolute Neutrophil Counts (ANC) ≤ 1.5 x 109 /l
  • Platelet count ≤ 150 x 109 /l
  • Total bilirubin ≥ 30 mmol/l
  • ALP and ALAT ≥ 4x normal level
  • Creatinine ≥ 115 µmol/l (men), 97 µmol/l (women))
  • Known CNS involvement of lymphoma
  • Previous total body irradiation
  • Known history of HAMA
  • Chemotherapy or immunotherapy received within the last 4 weeks prior to start of study treatment. Pretreatment with rituximab is allowed
  • Previous hematopoietic stem cell transplantation (autologous and allogenic)
  • Previous treatment with radioimmunotherapy
  • Receipt of live, attenuated vaccine within 30 days prior to enrolment
  • Test positive for hepatitis B (HBsAg and anti-HBc)
  • A known hypersensitivity to rituximab, HH1, Betalutin or murine proteins or any excipient used in rituximab, HH1 or Betalutin

Part B:

Inclusion Criteria:

Histologically confirmed (by WHO classification) relapsed non-Hodgkin B-cell FL (follicular grade I-IIIA).

2. Male or female aged ≥ 18 years. 3. Received at least 2 prior anti-neoplastic or immunotherapy-based regimens (maintenance therapy following a CR/PR is not considered to be a separate line of therapy).

4. Prior therapy must include rituximab/anti-CD20 agent and an alkylating agent. Prior exposure to other systemic anti-neoplastic agents (including idelalisib or other phosphatidylinositol 3-kinase (PI3K) inhibitors etc.) is also allowed.

5. Patients must be refractory to any previous regimen containing rituximab or an anti-CD20 agent, defined as: no response (no CR/PR) during therapy, or a response (CR/PR) lasting less than 6 months after the completion of a regimen including rituximab/anti-CD20 therapy (including occurrence of progressive disease (PD) during rituximab/anti-CD20 maintenance therapy, or within 6 months of completion of maintenance therapy).

6. WHO performance status of 0-2. 7. Life expectancy of ≥ 3 months. 8. Bone marrow tumour infiltration < 25% (in biopsy taken from a site not previously irradiated).

9. Measurable disease by CT or MRI: longest diameter (LDi) > 1.5 cm for nodal lesion, LDi > 1.0 cm for extra nodal lesion within 28 days prior to start of treatment.

10. ANC ≥ 1.5 x 109/L. 11. Platelet count ≥ 100 x 109/L . 12. Haemoglobin ≥ 9.0 g/dL. 13. Total bilirubin ≤1.5 x upper limit of normal (ULN) (except patients with documented Gilbert's syndrome [< 3.0 mg/dL]).

14. Liver enzymes: Aspartate transaminase (AST); Alanine transaminase (ALT) or ALP ≤ 2.5 x ULN (or ≤ 5.0 x ULN with liver involvement by primary disease).

15. Adequate renal function as demonstrated by a serum creatinine < 1.5 x ULN. 16. Women of childbearing potential must:

  1. understand that the study medication is expected to have teratogenic risk.
  2. have a negative serum beta human-chorionic gonadotropin (ß-HCG) pregnancy test at screening.
  3. commit to continued abstinence from heterosexual intercourse (excluding periodic abstinence or the withdrawal method) or begin a highly effective method of birth control with a Pearl-Index < 1%, without interruption, from 4 weeks before starting study medication, throughout study medication therapy and for 12 months after end of study medication therapy, even if she has amenorrhoea. Apart from abstinence, highly effective methods of birth control are: i. Combined (oestrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal).

ii. Progestogen-only hormonal contraception associated with inhibition of ovulation ((oral, injectable, implantable) iii. Intrauterine device (IUD). iv. Intrauterine hormone-releasing system (IUS). v. Bilateral tubal occlusion. vi. Vasectomised partner. 17. Male patients must agree to use condoms during intercourse throughout study medication therapy and the following 12 months.

18. The patient is willing and able to comply with the protocol, and agrees to return to the hospital for follow-up visits and examination.

19. The patient has been fully informed about the study and has signed the informed consent form.

20. Negative HAMA test at screening. 21. Negative Hepatitis B (negative HBsAG and anti-HBC), Hepatitis C and HIV test at screening

Exclusion Criteria:

Prior hematopoietic allogenic stem cell transplantation. Patients with a prior autologous stem cell transplanted (SCT) are excluded unless at least two years have elapsed since transplantation and the patient has been without grade ≥1 Graft vs Host Disease (GvHD) in the 8 weeks before date of consent.

3. Evidence of histological transformation from FL to diffuse large B-cell lymphoma (DLBCL) at time of screening. 4. Previous total body irradiation. 5. Prior anti-lymphoma therapy (chemotherapy, immunotherapy or other investigational agent) within 4 weeks prior to start of study treatment (corticosteroid treatment at doses of ≤ 20 mg/day, topical or inhaled corticosteroids, granulocyte colony-stimulating factor [G-CSF] or granulocyte-macrophage colony-stimulating factor [GM-CSF] are permitted up to 2 weeks prior to start of study treatment). Note: excludes pre-treatment with rituximab as part of this study.

6. Patients who are receiving any other investigational medicinal products. 7. Patients with known or suspected CNS involvement of lymphoma. 8. History of a previous treated cancer except for the following:

a. adequately treated local basal cell or squamous cell carcinoma of the skin. b. cervical carcinoma in situ. c. superficial bladder cancer. d. localised prostate cancer undergoing surveillance or surgery. e. localised breast cancer treated with surgery and radiotherapy but not including systemic chemotherapy.

f. other adequately treated Stage 1 or 2 cancer currently in CR. 9. Pregnant or breastfeeding women. 10. Exposure to another CD37 targeting drug. 11. A known hypersensitivity to rituximab, lilotomab, Betalutin or murine proteins or any excipient used in rituximab, lilotomab, or Betalutin.

12. Has received a live-attenuated vaccine within 30 days prior to enrolment. 13. Evidence of severe or uncontrolled systemic diseases:

  1. Uncontrolled infection including evidence of ongoing systemic bacterial, fungal, or viral infection (excluding viral upper respiratory tract infections) at the time of initiation of study treatment.
  2. Pulmonary conditions e.g. unstable or uncompensated respiratory disease.
  3. Hepatic, renal, neurological, or metabolic conditions - which in the opinion of the investigator would compromise the protocol objectives.
  4. Psychiatric conditions e.g. patients unlikely to comply with the protocol, e.g. mental condition rendering the patient unable to understand the nature, scope, and possible consequences of participating in the study.
  5. History of erythema multiforme, toxic epidermal necrolysis, or Stevens-Johnson syndrome.
  6. Cardiac conditions in the previous 24 weeks (before date of consent), including

i. history of acute coronary syndromes (including unstable angina). ii. class II, III, or IV heart failure as defined by the New York Heart Association (NYHA) functional classification system.

iii. known uncontrolled arrhythmias (except sinus arrhythmia).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Part A, Arm 1: with lilotomab pre-dosing

Betalutin, 10 MBq/kg b.w. in escalated doses with lilotomab pre-dosing.

COMPLETED enrolment into this arm

Betalutin, 10 MBq/kg b.w. in escalated doses with 40 mg lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses without pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with rituximab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with 100 mg/m2 lilotomab pre-dosing
Betalutin, 20 MBq/kg b.w. in escalated doses with 60 mg/m2 lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. with 40mg lilotomab
Experimental: Part A, Arm 2: without pre-dosing

Betalutin, 15 MBq/kg b.w. in escalated doses without pre-dosing.

COMPLETED enrolment into this arm

Betalutin, 10 MBq/kg b.w. in escalated doses with 40 mg lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses without pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with rituximab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with 100 mg/m2 lilotomab pre-dosing
Betalutin, 20 MBq/kg b.w. in escalated doses with 60 mg/m2 lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. with 40mg lilotomab
Experimental: Part A, Arm 3: with rituximab pre-dosing

Betalutin, 15 MBq/kg b.w. in escalated doses with rituximab pre-dosing.

COMPLETED enrolment into this arm

Betalutin, 10 MBq/kg b.w. in escalated doses with 40 mg lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses without pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with rituximab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with 100 mg/m2 lilotomab pre-dosing
Betalutin, 20 MBq/kg b.w. in escalated doses with 60 mg/m2 lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. with 40mg lilotomab
Experimental: Part A, Arm 4: with higher dose lilotomab pre-dosing

Betalutin, 15 MBq/kg b.w. in escalated doses with a higher dose lilotomab pre-dosing regimen.

COMPLETED enrolment into this arm

Betalutin, 10 MBq/kg b.w. in escalated doses with 40 mg lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses without pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with rituximab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with 100 mg/m2 lilotomab pre-dosing
Betalutin, 20 MBq/kg b.w. in escalated doses with 60 mg/m2 lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. with 40mg lilotomab
Experimental: Part A, Arm 5: with intermediate dose lilotomab pre-dosing

Betalutin, 20 MBq/kg b.w. with an intermediate dose lilotomab pre-dosing regimen.

COMPLETED enrolment into this arm

Betalutin, 10 MBq/kg b.w. in escalated doses with 40 mg lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses without pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with rituximab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with 100 mg/m2 lilotomab pre-dosing
Betalutin, 20 MBq/kg b.w. in escalated doses with 60 mg/m2 lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. with 40mg lilotomab
Experimental: Part B and Part C

Available dosing arm - '40/15'

Completed enrolment

Betalutin, 10 MBq/kg b.w. in escalated doses with 40 mg lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses without pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with rituximab pre-dosing
Betalutin, 15 MBq/kg b.w. in escalated doses with 100 mg/m2 lilotomab pre-dosing
Betalutin, 20 MBq/kg b.w. in escalated doses with 60 mg/m2 lilotomab pre-dosing
Betalutin, 15 MBq/kg b.w. with 40mg lilotomab

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Part A, Phase I
Time Frame: 12 weeks
To define Maximum tolerated dose (MTD) of Betalutin Adverse events and abnormal laboratory values will be graded for toxicity according to CTCAE version 4.
12 weeks
Part A, Phase IIa
Time Frame: 3 months - 5 years
To explore tumour response rates in patients receiving Betalutin
3 months - 5 years
Part B, Phase IIb
Time Frame: 3 months - 5 years
Overall response rate
3 months - 5 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Collaborators

Investigators

  • Study Director: Chris Freitag, Nordic Nanovector

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 1, 2012

Primary Completion (Anticipated)

November 1, 2022

Study Completion (Anticipated)

November 1, 2022

Study Registration Dates

First Submitted

February 19, 2013

First Submitted That Met QC Criteria

February 19, 2013

First Posted (Estimate)

February 21, 2013

Study Record Updates

Last Update Posted (Actual)

September 14, 2022

Last Update Submitted That Met QC Criteria

September 9, 2022

Last Verified

September 1, 2022

More Information

Terms related to this study

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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