- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04462328
Acalabrutinib and Durvalumab in Primary and Secondary Central Nervous System Lymphoma
Phase I Study With Dose Expansion of Acalabrutinib and Durvalumab (MEDI 4736) in Primary and Secondary Central Nervous System Lymphoma
BTK inhibition and checkpoint blockade are promising classes of therapy for central nervous system (CNS) lymphoma and have demonstrated efficacy with acceptable toxicity. A multidrug approach may carry a higher chance of durable efficacy in this aggressive disease that carries significant morbidity and mortality. Given the poor outcomes and limited options for patients who are not candidates for high-dose methotrexate, the investigators seek to evaluate the combination in this patient population.
08/30/2022: The study was originally designed for those with primary and secondary central nervous system (CNS) lymphoma. However, the first three patients who were enrolled all had secondary CNS lymphoma and most had germinal center phenotype disease with double hit phenotypes. In these three patients, two dose limiting toxicities were seen including 1 patient with grade 4 neutropenia at the time of disease progression and one with pneumonia in the setting of disease progression and worsening of existing heart disease. The third patient came off for clinical progression within cycle 1. Given the lack of response in patients with secondary CNS lymphomas, who do not exhibit the same biology as primary CNS lymphoma patients, Amendment 3 updates the study to only include patients with primary CNS lymphomas.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Contact
- Name: Neha Mehta-Shah, M.D.
- Phone Number: 314-747-7510
- Email: mehta-n@wustl.edu
Study Locations
-
-
Missouri
-
Saint Louis, Missouri, United States, 63110
- Recruiting
- Washington University School of Medicine
-
Contact:
- Neha Mehta-Shah, M.D.
- Phone Number: 314-747-7510
- Email: mehta-n@wustl.edu
-
Principal Investigator:
- Neha Mehta-Shah, M.D.
-
Sub-Investigator:
- Nancy Bartlett, M.D.
-
Sub-Investigator:
- Mary-Kate Malecek, M.D.
-
Principal Investigator:
- Fei Wan, Ph.D.
-
Sub-Investigator:
- Maria Rosana Ponisio, M.D.
-
-
Ohio
-
Columbus, Ohio, United States, 43210
- Recruiting
- The Ohio State University Hospital
-
Contact:
- Narendranath Epperla, M.D.
- Phone Number: 800-293-5066
-
Principal Investigator:
- Narendranath Epperla, M.D.
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Histologically documented primary CNS lymphoma with either:
- Relapsed or refractory disease with at least 1 prior therapy OR
- Ineligible for high dose methotrexate based therapy as determined by the treating physician, including previously untreated patients. Examples of medical conditions that for which a patient could be considered ineligible for high dose methotrexate include renal impairment, liver disease, heart failure or having ascites or effusions.
- Patients with leptomeningeal disease only must have been previously treated with intrathecal therapy Note: Patients with secondary CNS lymphoma are excluded even if the disease is isolated to the CNS.
Patients must have evaluable disease. This includes radiographic evidence of parenchymal disease or leptomeningeal enhancement or thickening, or disease detected in the CSF.
*Patients with vitreous involvement alone are not eligible.
- ECOG performance status of 0, 1, or 2. Patients with ECOG performance status of 3 are permitted if their performance status limitations are due to lymphoma in the opinion of the treating physician.
Participants must have adequate bone marrow and organ function shown by:
- Absolute neutrophil count (ANC) ≥ 1.0 x 109/L
- Platelets ≥ 75 x 10^9/L and no platelet transfusion within the past 7 days prior to initiation of protocol treatment
- Prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) < 2 times the upper limit of normal (unless attributed to lupus anticoagulant or attributed to anticoagulant such as a direct oral anticoagulant)
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 times the upper limit of normal
- Serum bilirubin ≤ 1.5 times the upper limit of normal
- Creatinine clearance > 30 mL/min calculated by the Cockcroft-Gault formula using actual body weight
- Age ≥ 18 years of age
- Body weight >30 kg
- Participants must have a documented negative antibody to HIV
Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:
- Women <50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy).
- Women ≥50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses >1 year ago, had chemotherapy-induced menopause with last menses >1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy).
- Female subjects of childbearing potential must have a negative pregnancy test no more than 3 days prior to the start of study treatment.
- Able to understand and willing to sign an IRB approved written informed consent document. A legally authorized representative can consent on behalf of a patient who is able to understand the purpose and risk of the study but not able to provide a signature on the ICF and authorization to use PHI due to neurologic deficits (e.g. motor or language deficits)
Exclusion Criteria:
- Concurrent use of other approved or investigational antineoplastic agents (with the exception of corticosteroids)
- Participation in another clinical study with an investigational product during the 4 weeks prior to the first day of study treatment.
Prior chemotherapy or targeted small molecule therapy (or other therapy for CNS lymphoma) within 3 weeks prior to the first day of study treatment (or 5 half-lives (whichever is shorter)), or 2 weeks prior to the first day of study treatment for monoclonal antibodies
*The patient must have recovered to baseline or ≤ grade 1 from prior toxicities of therapy with the exception of alopecia. Recovery to ≤ grade 2 neuropathy is permitted
- External beam radiation therapy to the CNS within 14 days of the first day of study treatment.
- Patient requires more than 8 mg of dexamethasone daily or the equivalent for control of CNS symptoms at the time of initiation of study therapy. Patients must taper off high dose corticosteroids for the control of CNS symptoms within 14 days after starting on study therapy.
- History of intracranial hemorrhage or clinically significant stroke within 6 months prior to first day of study treatment
- Inability to swallow oral medications.
- History of significant gastrointestinal disease that would limit absorption of oral medications. This could include refractory nausea, vomiting, chronic gastrointestinal disease, bariatric surgery such as gastric bypass, partial or complete bowel obstruction, or previous significant bowel resection that would preclude adequate absorption, distribution, metabolism, or excretion of study treatment.
- Active concurrent malignancy requiring active therapy.
- Prior therapy with a checkpoint inhibitor, including durvalumab.
- Prior therapy with BTK inhibitor.
- Warfarin or any other Coumadin-derivative anticoagulant or vitamin K antagonists. Patients must be off warfarin-derivative anticoagulants for at least seven days prior to starting the study drug. Use of low molecular weight heparin and novel oral anticoagulants (eg. rivaroxaban, apixaban) is permitted if required.
Concurrent use of a moderate or strong inhibitor or inducer of the P450 isoenzyme CYP3A. Participants must be off P450/CYP3A inhibitors and inducers prior to starting the study drug.
*Study therapy may be started after 5-half-lives or 7 days (whichever is shorter) have surpassed since last administration of a strong or moderate CYP3A4 inducer/inhibitors.
Use of systemic immunosuppressant therapy, including cyclosporine A, tacrolimus, sirolimus, and other such medications, or chronic administration of > 10 mg/day of prednisone or the equivalent. This does not refer to patients on corticosteroids for CNS lymphoma symptoms. Participants must be off of immunosuppressant therapy (with the exception of steroids) for at least 14 days prior to the first day of study treatment. The items listed below are exceptions to this criterion:
- Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection)
- Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent
- Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication)
- Receipt of live attenuated vaccine within 30 days prior to the first day of study treatment. Note: Patients, if enrolled, should not receive live vaccine while receiving IP and up to 30 days after the last day of study treatment.
- Suspicion of or confirmed progressive multifocal leukoencephalopathy
Active autoimmune disease (including autoimmune hemolytic anemia and immune thrombocytopenia purpura) requiring systemic treatment within the past two years (i.e. with the use of disease modifying agents, corticosteroids, or immunosuppressive drugs). The following are exceptions to this criterion:
- Patients with vitiligo or alopecia
- Patients with hypothyroidism (e.g., due to Hashimoto syndrome) stable on hormone replacement
- Any chronic skin condition that does not require systemic therapy
- Patients without active disease in the last 5 years may be included but only after consultation with the study physician
- Patients with celiac disease controlled by diet alone
- Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroids replacement therapy for adrenal or pituitary insufficiency, etc.)
- Significant medical diseases or conditions, as assessed by the investigator, that would substantially increase the risk to benefit ratio of participating in the study. This includes, but is not limited to, acute myocardial infarction in the past 6 months, unstable angina, uncontrolled diabetes mellitus, significant active infections,, severely immunocompromised state, and congestive heart failure, New York Heart Association Class III-IV.
- Known bleeding diathesis (e.g. von Willebrand's disease), hemophilia, or active bleeding.
- Known Human immunodeficiency virus (HIV) infection.
- Known active infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) as determined by serologic tests and/or PCR.
- History of invasive fungal infection, including invasive aspergillosis, or known active tuberculosis.
- Major surgery ≤ 28 days prior to starting the trial treatment (or has not recovered from the side effects of such surgery) or plans to have surgery within 2 weeks of the first dose of the study drug.
- Prior allogenic stem cell transplant (autologous stem cell transplant is NOT an exclusion).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Phase I Dose Level 1: Durvalumab + Acalabruitinib
|
Durvalumab will be administered over 60 minutes
Other Names:
Patients will take acalabrutinib orally every 12 hours (+/- 3 hours) daily.
Other Names:
|
Experimental: Phase I Dose Level 2: Durvalumab + Acalabruitinib
|
Durvalumab will be administered over 60 minutes
Other Names:
Patients will take acalabrutinib orally every 12 hours (+/- 3 hours) daily.
Other Names:
|
Experimental: Expansion Cohort: Durvalumab + Acalabrutinib
|
Durvalumab will be administered over 60 minutes
Other Names:
Patients will take acalabrutinib orally every 12 hours (+/- 3 hours) daily.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Safe and tolerable dose of regimen
Time Frame: Completion of first 12 weeks of treatment within phase I portion of study (estimated to be 14 months)
|
|
Completion of first 12 weeks of treatment within phase I portion of study (estimated to be 14 months)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall response rate (complete response (CR) + partial response (PR))
Time Frame: Through completion of treatment (estimated to be 6 months)
|
|
Through completion of treatment (estimated to be 6 months)
|
Duration of response
Time Frame: Through 2 years post treatment (estimated to be 2 years and 6 months)
|
-The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
|
Through 2 years post treatment (estimated to be 2 years and 6 months)
|
Time to response
Time Frame: Through completion of treatment (estimated to be 6 months)
|
-Time to response is measured from the start of treatment until the time measurement criteria are met for first objective tumor response (CR or PR, whichever is first recorded).
|
Through completion of treatment (estimated to be 6 months)
|
Progression-free survival (PFS)
Time Frame: Through 2 years post treatment (estimated to be 2 years and 6 months)
|
|
Through 2 years post treatment (estimated to be 2 years and 6 months)
|
Overall survival (OS)
Time Frame: Until death (estimated to be 5 years and 6 months)
|
|
Until death (estimated to be 5 years and 6 months)
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Neha Mehta-Shah, M.D., Washington University School of Medicine
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 202009139
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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