Trabectedin and Venetoclax in Treating Patients With Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma Resistant or Intolerant to a BTK Inhibitor

A Phase I/Ib Pilot Study of Combined Trabectedin and Venetoclax in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Resistant or Intolerant to a BTK Inhibitor

This phase I/Ib trial studies the best dose and side effects of trabectedin and venetoclax in treating patients with chronic lymphocytic leukemia or small lymphocytic lymphoma that is resistant or intolerant to a BTK inhibitor. Drugs used in chemotherapy, such as trabectedin and venetoclax, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.

Study Overview

• Status: Withdrawn
• Conditions: Refractory Chronic Lymphocytic Leukemia; Refractory Small Lymphocytic Lymphoma
• Intervention / Treatment: Drug: Venetoclax; Drug: Trabectedin

Detailed Description

PRIMARY OBJECTIVES:

I. To evaluate safety and tolerability, and to determine dose and schedule of trabectedin in combination with venetoclax in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) resistant or intolerant to a BTK inhibitor.

SECONDARY OBJECTIVES:

I. To determine the best response achieved by patients treated with combined trabectedin and venetoclax.

II. To determine the progression-free (PFS) and overall survival (OS) of patients treated with combined trabectedin and venetoclax.

III. To investigate the effects of trabectedin on CLL cells and on the components of the CLL microenvironment.

IV. To investigate associations between baseline characteristics (including fluorescence in situ hybridization [FISH] status, IGHV mutation status and mutations responsible for resistance to BTK inhibitors) and response to the combination of trabectedin and venetoclax.

OUTLINE: This is a dose-escalation study. Patients are assigned to 1 of 2 cohorts.

COHORT I (BTK-REFRACTORY): Patients receive venetoclax orally (PO) once daily (QD) beginning on day 1 for 5 weeks (cycle 1). Beginning in cycle 2, patients receive venetoclax PO QD and trabectedin intravenously (IV) over 3 hours on day 1. Cycles 2+ repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.

COHORT II (BTK-INTOLERANT): Patients receive trabectedin IV over 3 hours on day 1 of a 3-week cycle (cycle 1), then receive venetoclax PO QD beginning on day 1 of a 5-week cycle (cycle 2). Beginning in cycle 3, patients receive trabectedin IV over 3 hours on day 1 and venetoclax PO QD every 3 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 6 months.

• Study Type: Interventional
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • M D Anderson Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients with a diagnosis of CLL/SLL who are progressing (based on 2018 International Workshop on Chronic Lymphocytic Leukemia [iwCLL] criteria) on or intolerant to a BTK inhibitor (BTK-inhibitor-intolerant is defined as unable to maintain on a stable and continuous dose of at least ibrutinib 140 mg/day [or acalabrutinib 100 mg/day] for at least 2 weeks due to recurrent treatment-related grade 2 or higher non-hematologic toxicity by Common Terminology Criteria for Adverse Events [CTCAE] grading)
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2
• Total bilirubin =< 1.0 x upper limit of normal (ULN) or =< 3 x ULN for patients with Gilbert's disease
• Creatinine clearance > 50 mL/min (calculated according to institutional standards or using Cockcroft-Gault formula)
• Alanine aminotransferase (ALT), aspartate aminotransferase (AST) =< 2.5 x ULN
• Alkaline phosphatase (ALP) =< 2.5 x ULN
• Platelet (PLT) count >= 50,000/l, with no platelet transfusion in 2 weeks prior to registration, unless cytopenia is due to bone marrow involvement with CLL, in which case PLT count > 30,000/l, with no PLT transfusion in 2 weeks prior to registration
• Absolute neutrophil count (ANC) >= 1000/l, unless cytopenia is due to bone marrow involvement with CLL, in which case ANC > 500/l
• Creatine phosphokinase (CPK) < 2.5 x ULN
• Left ventricular ejection fraction (LVEF) assessed by multi-gated acquisition scan (MUGA) or echocardiogram within limits of normal range
• Women of childbearing potential must agree to use an effective contraception method during the study and for 60 days following the last dose of study drug. Women of non- childbearing potential are those who are postmenopausal greater than 1 year or who have had a bilateral tubal ligation or hysterectomy. Men who have partners of childbearing potential must agree to use an effective contraceptive method during the study and for 60 days following the last dose of study drug
• Free of prior malignancies for 2 years with exception of patients diagnosed with basal cell or squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast, who are eligible even if they are currently treated or have been treated and/or diagnosed in the past 2 years prior to study enrollment. If patients have another malignancy that was treated within the last 2 years, such patients may be enrolled, if the likelihood of requiring systemic therapy for this other malignancy within 2 years is less than 20%
• Patients or their legally authorized representative must provide written informed consent

Exclusion Criteria:

• Radiotherapy or chemotherapy within 2 weeks prior to the first dose of the study drugs. Given the quick progression associated with resistance to BTK inhibitors, no limits will be placed to the use of BTK inhibitors for enrollment or initiation of treatment on this trial
• Uncontrolled active systemic infection (viral, bacterial, and fungal)
• Active, uncontrolled autoimmune phenomenon (autoimmune hemolytic anemia or immune thrombocytopenia) requiring steroid therapy with > 20 mg daily of prednisone or equivalent
• Significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 2 months of screening, or any class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification
• Patient is pregnant or breast-feeding
• Venetoclax-refractory CLL or prior treatment with trabectedin
• Malabsorption syndrome or other condition that precludes oral/enteral route of administration
• Patients who received the following within 7 days prior to first dose of venetoclax: moderate and strong CYP3A inhibitors and inducers, P-glycoprotein inhibitors, or narrow therapeutic index P-glycoprotein substrates AND patients who received the following within 3 days prior to first dose of venetoclax: grapefruit or grapefruit products, Seville oranges and star fruit

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cohort I (BTK-refractory); Patients receive venetoclax PO QD beginning on day 1 for 5 weeks (cycle 1). Beginning in cycle 2, patients receive venetoclax PO QD and trabectedin IV over 3 hours on day 1. Cycles 2+ repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.	Drug: Venetoclax; Given PO; Other Names: Venclexta; ABT-0199; ABT-199; ABT199; GDC-0199; RG7601; Drug: Trabectedin; Given IV; Other Names: Yondelis; Ecteinascidin; ET-743; ecteinascidin 743
Experimental: Cohort II (BTK-intolerant); Patients receive trabectedin IV over 3 hours on day 1 of a 3-week cycle (cycle 1), then receive venetoclax PO QD beginning on day 1 of a 5-week cycle (cycle 2). Beginning in cycle 3, patients receive trabectedin IV over 3 hours on day 1 and venetoclax PO QD every 3 weeks in the absence of disease progression or unacceptable toxicity.	Drug: Venetoclax; Given PO; Other Names: Venclexta; ABT-0199; ABT-199; ABT199; GDC-0199; RG7601; Drug: Trabectedin; Given IV; Other Names: Yondelis; Ecteinascidin; ET-743; ecteinascidin 743

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Dose and schedule of trabectedin in combination with venetoclax	Up to 6 months post-treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Best response	Will be assessed using the 2018 International Workshop on Chronic Lymphocytic Leukemia response criteria. Minimal residual disease will be evaluated by 4-color flow cytometry.	Up to 6 months post-treatment
Progression free survival		From treatment initiation to disease progression or death, assessed up to 6 months post-treatment
Overall survival		From treatment initiation to death due to any cause, assessed up to 6 months post-treatment
Frequency of myeloid cells and of other immune cells	Will be analyzed in the peripheral blood and bone marrow (if available).	Baseline up to 6 months post-treatment

Collaborators and Investigators

• Sponsor: M.D. Anderson Cancer Center
• Collaborators: National Cancer Institute (NCI)
• Investigators: Principal Investigator: William G Wierda, M.D. Anderson Cancer Center

Publications and helpful links

Helpful Links

• MD Anderson Cancer Center Website

Study record dates

Study Major Dates

• Study Start (Actual): June 18, 2019
• Primary Completion (Actual): March 4, 2020
• Study Completion (Estimated): March 4, 2020

Study Registration Dates

• First Submitted: March 19, 2019
• First Submitted That Met QC Criteria: March 19, 2019
• First Posted (Actual): March 21, 2019

Study Record Updates

• Last Update Posted (Actual): September 25, 2023
• Last Update Submitted That Met QC Criteria: September 21, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Disease Attributes; Leukemia, B-Cell; Chronic Disease; Lymphoma; Leukemia; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Lymphoid; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Alkylating Agents; Venetoclax; Trabectedin
• Other Study ID Numbers: 2018-0302 (Other Identifier: M D Anderson Cancer Center); P30CA016672 (U.S. NIH Grant/Contract); NCI-2019-01555 (Registry Identifier: CTRP (Clinical Trial Reporting Program))

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